President White—We will put things through on the ten-minute plan this morning, so as to give every one a chance who has a place on the program. Today we have reports from the committees, and elect our officers. We can then get ready for another Congress, for we are all going into the field, we are going to work for Conservation, and the whole country is going to take it up. We will give them the text, and the press will take it up, the politicians will take it up, and we will each be a committee of one to go forth through the country and make this Conservation idea a potent force that will change and correct legislation for the benefit of all the people. (Applause.)
Mr. A. B. Farquhar, who was to speak this morning, spoke yesterday, and therefore his address, for which a great many expected to be present, will be printed and you will have an opportunity to read it. Every one should subscribe for as many copies of the Proceedings as he can afford, for distribution among friends. It is without doubt going to prove to be the greatest book on conservation of human life that has ever been written. These papers are scholarly, and they are true, and the truth will prevail if we can only get people to read and to think. We want to give you all an opportunity to subscribe for this publication, which will be published as soon as possible, and will only cost one dollar, and those who pay this dollar will be entitled to membership in this organization next year, so that if your Mayor, or your Governor, or your civic body does not reappoint you, you are sure of membership next year, because you have paid in your dollar and subscribed for the book.
Dr. Livingston Farrand, of New York, will now speak to us on “The Problem of Tuberculosis.”
Address, “The Problem of Tuberculosis”
Dr. Farrand—Mr. President, Ladies and Gentlemen: The problem of tuberculosis in the United States is simple in its outlines. Stated in their lowest terms, the figures which describe it are sufficiently impressive and appalling. Increasing experience and added knowledge serve only to confirm earlier estimates and to emphasize the seriousness of the situation which confronts us. The vital statistics of our country are notoriously faulty and incomplete, but the lesson they teach must arrest the attention of every thinking citizen.
According to the census of 1910, treating the non-registration area on the same basis as that from which mortality reports were recorded, there were 150,000 deaths from tuberculosis in that year. This is, of course, an under statement by many thousands. Rigidly conservative estimates agree that the mortality from tuberculosis in this country is at least 200,000 each year and very probably considerably more. Let us for the moment, however, deal with the demonstrable facts and not enter the field of estimate.
The real problem is not the number of deaths from tuberculosis, but the number of living cases of the disease. In calculating this different methods have been employed. For many years, the ratio of three living cases to each death was used as an index of the situation in any community. It was quickly realized by those familiar with the situation that this proportion was far too low, but with our almost total lack of registration, figures to demonstrate the discrepancy were not available. With the improvement in recording the facts of disease in certain typical centers of population, it became certain, however, that a ratio of five to one was not only conservative but below the truth.
More recently records of great value have been obtained which confirm the convictions of experts and allow still sharper definition of the problem.
It has remained for the city of Cleveland to work out during the past two years a system of tuberculosis registration and administration which is undoubtedly the most complete in the country for a community of its size and complexity. Without going into details of method, notification, and registration have been brought to such a point in Cleveland that of all the deaths from tuberculosis now occurring approximately ninety per cent. have been previously recorded and under observation by the Department of Health, before death is reported. This is an achievement for a city of its population of extraordinary significance. There are in round numbers something over 700 deaths a year from pulmonary tuberculosis in that city of 600,000 inhabitants. There are in register and under observation at this time approximately 4,600 cases of tuberculosis. Allowing for the ten per cent. in the mortality not reported before the death, it is obvious that the number of living cases is over seven times the number of deaths and with slight allowance for the very large number of active cases in any community which have not yet come to diagnosis, we can demonstrate in that city a ratio of eight living cases for each death.
It is singularly fortunate that this demonstration has taken place in a community of sufficient size to include the problems in some degree of all our larger cities and to be regarded as reasonably typical of the situation throughout the country. It has also been shown that except for certain centers, where the problem of congestion is extraordinarily prominent, the rural situation in the United States does not differ appreciably from that obtaining in all cities and towns so far as the presence of tuberculosis is concerned. I have no hesitation, therefore, in asserting that we must from this time on raise our figures and use a ratio of at least eight to one in calculating the prevalence of tuberculosis on a basis of the recorded deaths from that disease.