Most of the great questions of health in its widest sense, of health as a public concern, resolve themselves into resisting the entrance of this or that species of bacterial germs into the body. The essential distinction between Mother Earth, that bringeth forth flowers and fruits, and grass for our herds, and dirt or filth, the especial opprobrium of the hygienist, is that the latter carries germs of bacteria. Cleanness, in the hygienic sense, is freedom from pathogenic germs; and when the doctors tell us that the marked improvement in health conditions recently observable in Germany and Switzerland, and pre-eminently in Sweden, is due to their exceptional attention to cleanliness, they use the term with particular reference to the provoking causes of preventable sickness. Not only is the death rate from the acute diseases in those lands rapidly falling off, but diseases of the chronic class are beginning to yield to the inculcation of better habits among the people.
We are by no means without instances in this country, of death rates reduced by preventive methods, as shown for young children in our largest cities after the introduction of pasteurized milk. Deaths have been thus spared for that peculiarly helpless class of sufferers, to the extent of fully 50 per cent. in some districts—in large measure through the well-directed activity of one public-spirited New York merchant. But we have much to do in other lines, and we have only begun to free ourselves of the typhoid fever incubus. As late as fourteen years ago there were 11,000 cases of that infection in the camp at Chattanooga, with 800 deaths. In the entire Spanish war the deaths of our soldiers from diseases, it was calculated, were thirteen times as many as from wounds in battle—the diseases mostly, like the Chattanooga typhoid, of the preventable kinds.
Loss of life by preventable accidents, on railways, in factories and mines, is too closely associated with that by diseases to be here omitted, though entitled to much fuller treatment than we can here afford. The deathroll from this cause is still disgracefully large in this country, far surpassing any country of Europe; but there are signs already of diminution. For instance, one steel factory, reporting 43 accidental deaths among 6,000 employes in 1906, showed only 12 fatalities in a payroll of 7,000 in 1909, safeguards having been introduced in the meantime. This instance is very good, so far as it goes, but we need to make much more progress in the same direction.
What we want is systematic effort, by some powerful consolidated agency, to promote the conservation of human life. We have no need to find fault with any of the organizations now engaged in furthering that end, several of which are doing good work. We may gratefully acknowledge the aid of the various medical societies, “regular” and “irregular”—though we take the liberty of wishing that they might fight the common enemy a little more and each other a little less. We may also welcome the assistance of the life insurance companies, notably the Equitable and the Metropolitan, whose managers clearly realize how their interests are involved. Whatever lengthens the average term of human life is a factor operating to increase their dividends and to reduce the cost of insurance to their policyholders. It is worth while to note, at this point, that the majority of life insurance officers are strong advocates of the formation of a national bureau or department of health.
Still more do we owe to the activities of State and municipal boards of health, which do more good because they have more power. Where properly supported they have done a great work, at obstructing the spread of epidemics by quarantines and other methods of isolation, at curing pollution of water supply, at instituting improved sewer systems, at bettering the general food supply by inspection of markets. You have just heard a condensed account of the activities of one of our best State health departments, that of Pennsylvania. You will infer from what that department has done in seven years what might be done by a national bureau or department, with powers and field of operation extending over the entire country.
The movement for a bureau or department of health, national in its scope, has been most actively advanced in Washington by Hon. Robert L. Owen, Senator from Oklahoma. His bills call for a department, and he gives strong reasons for the view that such an organization would, while that of a bureau would not, suffice for the national governmental activities in behalf of the public health. President Taft strongly urges a “Bureau of Public Health,” and plainly intimates a preference for the bureau plan. The “Committee of One Hundred on National Health,” formed by the Association for Advancement of Science, in 1906, with Prof. Irving Fisher as its president, originally contemplated a department whose head should be a member of the President’s cabinet, but it has in its recent publications adopted the alternative phrase “bureau or department,” which course is here followed, because there is manifestly nothing to gain by keeping up a contest on the point. The memorial prepared by the committee of one hundred proposes for a national department of health certain functions, as follows:
1. Administration—Including the national quarantine work, and whatever regulation of interstate commerce might affect human health, such as meat inspection and enforcing the food and drug act.
2. Co-operation—The work of assisting State, county and city health agencies, after some such fashion as the National Department of Agriculture co-operates with State agricultural colleges and institutions.
3. Research and Investigation—The work of obtaining needed scientific information concerning the cause and prevention of diseases that now shorten or impair human life; this would include a study of accidents, of poisonous manufacturing trades, of hygienic conditions in schools, etc., just as yellow fever was studied in Cuba, as the hookworm is now to be studied under private endowment, as the work of the Pasteur Institute was conducted under French government support.
4. Education—The work of supplying to the country scientifically established data on matters pertaining to health, such work as is done by the “publication division” in most of our governmental departments; thus rendering available for practical use the work of research and investigation. The countries in which is found the most rapid reduction of the death rate are just those (Sweden for example) in which the spread of a knowledge of hygiene is widest.