Address, “Public Health Movement”
Prof. Fisher—The Conservation movement is a movement to prevent waste. When the Conservation Commission was appointed, four years ago, emphasis was placed on the wastes of our natural resources, but by the time the Commission made its report, it had come to the conclusion that by far the most serious as well as the most preventable wastes are the wastes of human life.
A generation ago it was a common impression that the average human lifetime was fixed as by a decree of fate. When I was in college one of our reverend instructors showed us a mortality table and said with great impressiveness: “There is no law more hard and fast than the law of mortality.” I believed it, and even yet many people are under this delusion. Pasteur did much to introduce a more optimistic view. He stated his belief in these immortal words, “It is within the power of man to rid himself of every parasitic disease.” He staked this opinion on his own wonderful laboratory revelations as to germ life. Today we can confirm his words by absolute statistics. And now his successor, Metchnikoff, has surpassed even Pasteur in optimism. Metchnikoff is devoting himself to the question of the prolongation of human life and already gives us a vision of the time when centenarians will be regarded merely as in the prime of life and when the normal span of a century and a quarter will be a frequent occurrence.
The growing consciousness that human life is not a fixed allotment, which we must accept as our doom, but a variable, which is within our power to control, has recently led to extraordinary exertions all over the world to save human life. This impulse has gained strength also from the great and almost universal decline in the birth rate. Old countries like France, and new countries like Australia, are confronted with the specter of depopulation. Consequently, as human life becomes scarce, it becomes precious—like any other commodity! These two facts, the consciousness that much mortality is preventable, or at any rate postponable and the fact that increasingly fewer babies are being born in the world, are together operating to produce a great health movement throughout the world. Nothing will stop it until the whole world is convinced of the paramount importance of this problem of human Conservation.
This world-wide movement for the conservation of human life has expressed itself in many ways—in medical research; in societies for preventing tuberculosis, infant mortality, social diseases, alcoholism, and vice; in the growth of sanatoria, dispensaries, hospitals and other institutions; in an immense output of hygienic literature, not only technical books and journals, but also popular articles in the magazines and daily news papers; in the constant agitation and legislation for purer foods, milk supply, meat supply and water supply; in the movement to limit the labor of women and children and to improve factory sanitation; in the establishment of social insurance in Germany, England, Denmark and other countries; in the improvement of departments of health; in the spread of gymnastics, physical training and school hygiene; in the revival of the Olympic games and the effort to revive the old Greek ideals of physical perfection and beauty, and last, and most important, in the sudden development of the science of eugenics.
In the summer of 1911 was held in Dresden a unique world’s fair, devoted exclusively to health—the International Hygiene Exhibition. In this were shown the fruits of the whole movement in all lands—except, alas, our own; for to our shame it must be said that we, as yet, are among the backward nations in this movement for the conservation of human life. Our Congress was asked to appropriate $60,000 to erect a building and supply an exhibit to show what we have done for our part in this movement, but Congress thought it could not afford so large an expenditure for so small (!) an object, and the result was that from the millions of people who visited this exhibition one constantly heard the question asked: “Where is the United States?”
And those few Americans who did go to visit the exhibition found that other nations had far outstripped us in this movement for national sanitation and health. Some of the achievements already attained by other nations should be recorded among the wonders of the world. One is the striking decline of the death rate in the city of London. Within two decades, London’s death rate has virtually been cut in two and is now only thirteen per thousand, or less than that of most cities one-fiftieth its size.
Probably, however, the greatest achievement of any country is that of Sweden, where the duration of life is the longest, the mortality the least and the improvements the most general. There alone can it be said that the chances of life have been improved for all ages of life. Infancy, middle age and old age today show a lower mortality in Sweden than in times past, while in other countries, including the United States, although we can boast of some reduction in infant mortality, the mortality after middle age is growing worse and the innate vitality of the people is, in all probability, deteriorating. The reason why Sweden of all countries has succeeded in improving the vitality of middle age and old age, while other nations have failed, is, I believe, to be found in the fact that Sweden, of all nations, has seen the problem of human hygiene as a whole instead of partially. In most other lands, and particularly in the United States, public health has been regarded almost exclusively as a matter of protection against germs; but protection against germs, while effective in defending us from plague and other epidemics of acute diseases, is almost powerless to prevent the chronic diseases of middle and late life. These maladies—Bright’s disease, heart disease, nervous breakdowns—are due primarily to unhygienic personal habits. Medical inspection and instruction in schools, as well as Swedish gymnastics, have aided greatly in the muscular development of the citizens of Sweden. Swedish hard bread has preserved their teeth. The Gothenburg system is gradually weaning them from alcohol. There has even been a strong movement against the use of tobacco. Other countries are tardily following in the path which Sweden has trod so successfully.
The significant fact is that Sweden has not hesitated to attack the problems of personal habits. I believe we must have a revolution in the habits of living in the community if we are going really to realize the promise of Metchnikoff and others as to the prolongation of human life. Health officers in this country have not regarded it as a part of their duty either to live personally a clean, hygienic life, or to teach others to do so, or even to investigate what those conditions of well-being are which make for personal vitality.
I can remember, thirteen years ago, talking with a doctor in Colorado as to the habits of living of his patients. I said to him, “You tell me that tuberculosis is a house disease, and that the reason it exists is because people do not open their windows. Why, then, do you not tell your patients they must open their windows, or sleep out of doors?” He said, “I wouldn’t dare to do that; I would lose my practice. They would think I was a crank and meddling in their personal affairs.” Today that battle has been largely won. Today, not only in Colorado and California, and in the places where there is perpetual sunshine, sleeping out of doors is common and not confined to invalids, but indulged in by the community generally. Even in New England and throughout the country you will find sleeping balconies going up all over. The change has even affected in some degree the architecture of the country, and while as yet only a minority of the people sleep out of doors, yet I believe it is true that the majority of the people in the United States have far more air in their sleeping and living rooms today than ten years ago. The fact which the doctor in Colorado did not dare tell his patients thirteen years ago, has in some way been told to the people of the United States.
But there are many other things that need to be told, after we are sure that they are true. When we have, through our National, State or municipal officers made thorough investigation and have been able to discover the actual truth as regards eating and drinking, hours of work, recreation and play—all those facts that go into what may be called personal habits, then we may gradually overturn existing unhygienic habits of living. John Burns attributes a large part of the great reduction in London mortality to the improved personal habits of working men, particularly in regard to alcohol. In this country, Dr. Evans, both as health officer of Chicago and later as health editor of a Chicago newspaper, has shown how public instruction in personal habits can be made effective, and it will be largely through affecting personal habits that the life insurance companies will improve the longevity of their policy holders.
Scientific men today have reached substantial agreement that alcohol is a poison. When everybody understands this, the days of alcohol as a beverage will be numbered. Sweden in the thirties was called drunken Sweden, but today the antialcohol movement there has converted Sweden into one of the soberest of countries.
But the use of tobacco, tea and coffee ought also to be investigated, so that we may know how far they are deleterious, and to spread this knowledge among the people.
Fashions are in their essence changeable and the time will come when the world will not be built on fashion but on reason. Japan has made more rapid progress in civilization than any other nation, because the late Mikado resolved and publicly stated that the institutions of Japan must not be tied by tradition but must be based on reason. When we have replaced tradition by reason, we shall have gotten a solid basis for civilization, and this must apply to ancient customs and habits of every kind. I am firmly convinced that we are looking at only one-half of this public health movement as long as we confine ourselves to the acute or infectious diseases. We shall not get more than half the results obtainable until we realize that there must be a revolution in the personal habits of the people.
Yet the United States, in spite of its shortcomings, has some special triumphs to record. We have, through hygiene under Colonel Gorgas, made it possible to dig the Panama Canal. We have virtually abolished yellow fever on our shores and in Cuba. We have nearly eliminated hook worm disease in Porto Rico and are gradually doing the same in the Southern States. We have found a cure for spinal meningitis. We have, in New York, made an object lesson in the last year of reducing the summer death rate of infants in a striking manner. We have, by individual milk stations in Boston and other cities and in individual sanatoria, dispensaries and other institutions, demonstrated that the death rate from specific diseases can often be cut in two.
Yet we have depended altogether too much on private initiative. In New York the summer death rate of infants was reduced chiefly through the work of the milk committee and individuals like Nathan Straus. The elimination of hook worm disease and the discovery of the cure of spinal meningitis came through the gifts of Mr. Rockefeller. It is well that individuals should apply themselves to these problems and without such personal interest they could never be solved. Nevertheless, progress will be many times as rapid when the problems for the nation are managed in a national way. There are three great agencies to which we must look for the saving of human life in the future and it has been the object of the Committee of One Hundred on National Health, of which I am President, to help stir these three agencies into activity in this country. They are the public press, the insurance companies and the Government.
To a limited extent, all of these agencies have increased their health activities in recent years. A few years ago, popular articles on public health were seldom seen because the public and the press thought the subject of disease uninteresting and repulsive. Today, on the other hand, one can scarcely pick up a popular magazine without finding not only one but several articles dealing with questions of public health; and it has been found possible not only to make these articles interesting, but, by emphasizing the positive, or health side, instead of the negative, or disease side, to render them attractive and beautiful. And yet, as Dr. Wiley has said, the newspapers in spite of all the good they are doing with their right hands are, with their left hands, in their advertising columns trying to undo that good by advertising the fraudulent part of the “healing” profession who are trying to line their own pockets at the expense of the lives of the public.
The second great agency from which I believe we may expect wonderful results in the future is life insurance. As our committee pointed out to the Association of Life Insurance Presidents several years ago, life insurance companies can save money by preventing deaths just as fire insurance companies have saved money by preventing fires, and steam boiler insurance companies have saved money by preventing explosions. Since this suggestion was made, a number of progressive life insurance companies have tried the experiment. The Metropolitan and the Equitable have established departments of human conservation and a number of other and smaller companies have undertaken similar enterprises. The Postal Life Insurance Company has recently published the statistical results of their experience, worked out in a most careful manner, and have demonstrated absolutely that it pays life insurance companies to save human life. This being the case, we may expect life insurance companies in the future to become active in life conservation. Already there are probably fifteen million policy holders in the United States insured in companies which are trying to do something for their health—through medical examinations, instruction in hygiene, utilization of visiting nurses, participation in civic health movements and otherwise. To save human life merely to save money is sordid enough, but it is well to harness commercial motives, when possible, in the service of humanity.
The third, and most important, agency is the government. State and National health offices are becoming yearly stronger and more efficient; and yet much remains to be done, particularly by the National Government. We need a National Department of Health or a Department of Labor which shall include in its operations the conservation of human life. We have already passed the phosphorus match bill to prevent one of the worst industrial diseases—phossy jaw. We have passed effective legislation in regard to interstate commerce in prostitution. We have established a Children’s Bureau and a Bureau of Mines to prevent industrial accidents in mining. We have enacted suitable legislation in regard to cocaine and habit-forming drugs. We have a Pure Food Law and laws for the inspection of meats. Yet, as Dr. Wiley, Mrs. Crane and others who have watched the operation of these laws at close range well know, they need to be executed with a stronger hand.
The truth is that as yet we have only made a feeble beginning in public health work, especially in this country. We need first of all to do what Sweden has done for a hundred and fifty years—namely, to keep proper vital statistics. Vital statistics are the bookkeeping of health, and we cannot economize health any more successfully than we can economize money unless we keep books. At present only a little over half of the population of the United States has statistics of its deaths, while the statistics of the births are as yet nowhere sufficiently accurate to be called real statistics.
Our National Statistician, Dr. Wilbur, illustrates by a story how much better we keep our commercial books than our books of vital statistics. In a Western State a girl was entitled to a fortune when she became twenty-one. Reaching, as she supposed, her twenty-first birthday, she laid claim to the fortune. Much to her surprise, her father said, “But you are only nineteen;” and then the two tried to look up the records. They had no family Bible, they had no public record office to go to, and they were at sea as to how to discover exactly the date when she was born. However it suddenly occurred to her father, who was a farmer, that the very day his daughter was born a calf was born on his farm and the birth of the calf had been recorded. In that way he established the date of the birth of his daughter.
In view of the great slack of our vital statistics, therefore, we cannot measure even the death rate, much less the number of preventable deaths in the United States. All that we can do is to study carefully the registration area and on this basis to work out certain minimum figures.
Four years ago, as a member of President Roosevelt’s Conservation Commission, I endeavored to do this and to report on the condition of our “National Vitality.” I found, after getting together all the statistics available and taking account of the degree of preventability of different diseases as estimated by experts that, out of some 1,500,000 deaths annually in the United States, at least 630,000 are preventable. Of these preventable deaths, the greater number are from seven causes. These seven causes include three great diseases of infancy, then typhoid fever, which usually makes its attack in the twenties, then tuberculosis, accidents in industry, and pneumonia which come in the thirties.
Now 630,000 unnecessary deaths per year mean over 1,700 unnecessary deaths per day or more than the lives lost on the Titanic disaster. The nation cannot continue indifferent to hygiene as it gradually dawns on the public that for lack of hygiene we suffer a Titanic disaster every day of the year. The popular imagination was deeply stirred by the image of 1,600 helpless human beings suddenly engulfed in mid-ocean. That was a vivid dramatic picture which the blindest of men could see and understand. It led to immediate official action on both sides of the Atlantic to safeguard human life at sea. Yet on land we lose three hundred and sixty-five times as many lives as this every year and never stop to add it up. They are scattered and diffused throughout the land—a Wilbur Wright lost from typhoid, a handful of miners in an explosion, some railway employes in an accident, some victims of lead poisoning, a little army of infants, here a few and there a few. Yet these deaths are just as real and mean an infinitely more serious loss than were the deaths from the Titanic disaster. Moreover, they could be as easily prevented.
And concomitant with this unnecessarily great death rate, there is, of course, a colossal aggregate of needless sickness. We have no real statistics, but by analogy with English statistics we may assume that, on the average, for every death per annum there are two persons sick during the year. This makes about three million people constantly lying on sick beds in the United States, of which, on the most conservative estimate, at least half do not need to have been there.
If, now, on the basis of these figures, we try to compute how much human life is needlessly shortened in the United States, we find that it is shortened at least fifteen years. Again, if we translate these preventable losses into commercial terms, we find that, even by the most conservative reckoning, this country is losing over $1,500,000,000 worth of wealth producing power every year.
What does this mean? To us individually, it means that we are losing a large part of our rightful life not only by death itself which cuts off many years we might have lived, but also from diseases and disabilities which are not fatal but cripple the power to work and mar the joy of living. I believe I am far within the facts when I venture the opinion that the average man or woman in the United States is not doing half of the work nor having half of the joy of work of which the human being is capable.
With all this room for improvement before our eyes, it is not surprising that the zeal of the health movement is growing fast. Each success serves as justification for further effort.
One of the most encouraging symptoms of progress is the great attention which is being paid to public health in the present political campaign. All three of the party platforms included planks in behalf of public health. The Democratic and Progressive platforms were particularly explicit and emphatic and all the candidates have emphasized health in speeches and in their record in public life. The Democratic campaign managers are carrying out plans to make progressive health legislation prominent in the campaign.
These and other indications augur well for better legislation, more energetic enforcement of the law and, above all, a more appreciative public sentiment as to the transcendent importance of the conservation of human life. It is now reported that the Hon. Dr. Roche, Secretary of State in Canada, is in strong sympathy with the proposal there for the establishment of a Federal Department of Health and the Republic of China is reported to have already established such a department.
From all these indications of actual activity as well as from the logic of the situation we are justified in predicting that an age of human conservation is at hand. Men and women are waking to their responsibility to the race. Eugenics will be a watchword of the future. To squander our natural resources is ignoble indeed, but far worse is it to squander our vital resources. The most sacred obligation of each generation is to bequeath its life capital unimpaired to the generation which comes after. Scourges like typhoid and tuberculosis must be swept off the face of the earth. Habit-forming drugs, including alcohol (and even tobacco, especially for young boys) must be recognized in their true light as means of depleting the vitality of nations. Prostitution and the white slave traffic must be condemned anew as robbers of the race. Industries which kill and maim, poison or infect their workers, which deform and stunt little children, which incapacitate women for normal motherhood, which through overlong hours of toil close each successive day’s work with progressive exhaustion, must be controlled. Machinery was made for man, not man for machinery. Immigration which drains European public institutions of their criminal, insane, feeble-minded and other defectives and delinquents and sets these creatures loose in America to breed with and contaminate our population, must be regulated. Marriage laws and customs must be adjusted so as to discourage or forbid the procreation by the unfit. All these and other hygienic and eugenic reforms will be realized as fast as public sentiment becomes educated to the solemn responsibilities and higher valuations of human life.
The noblest task, therefore, which I can conceive for any man is to aid in erecting true ideals of perfect manhood and womanhood. Our ideals, though improving, are not yet worthy to be compared with those of Japan or Sweden and the ideals even of these countries have not yet reached the level of those of ancient Greece still imaged for us in imperishable marble. With superior knowledge our health ideals should excel those of any other age. These ideals should not stop with the mere negation of disease, degeneracy, delinquency and dependency. They should be positive and progressive. They should include muscular development, a sound mind in a sound body, integrity of moral fiber, a sense of the splendor of the perfect human body as a temple of the human soul, a sense of the enjoyment of all life’s proper functions. As William James said, simply to breathe or move our muscles should be a delight. The thoroughly healthy person is full of joy and optimism. He rejoiceth like a strong man to run a race. Said Emerson, “Give me health and a day and I will make the pomp of emperors ridiculous.” Our health ideals should be nothing short of an abiding sense of the sweetness and beauty, the nobility and holiness, of human life.