Little difficulty has been encountered in procuring the necessary legislation for local and county institutional provision. We have now reached the point where the possibility of mandatory State legislation is being considered with care and some favor. In this connection one should note the recent passage by the Legislature of the State of New Jersey of a law which undoubtedly represents the most advanced legislation in the United States and probably in the world. Without going into details, the law in question provides for the establishment of special tuberculosis hospitals in all the counties of the State, for the payment by the State of a certain sum ($3.00 per week per patient) toward the maintenance of such hospitals, for the compulsory segregation in such hospitals of dangerous and incorrigible cases of the disease, and for the general supervision of these provisions by the State Board of Health, though the primary responsibility is placed upon the local health officer. This legislation is of the highest interest, not only in its promise of results, but as an enactment into law of principles formulated as necessary by expert experience even though in advance of public appreciation.
Reaching into every field of social activity as this campaign must do, it is inevitable that new phases of importance should successively make their appearance and demand attention. I should say that perhaps the most striking is the essential importance of the child in the tuberculosis problem. With improved methods of diagnosis and wider facilities for examination, there has been shown a prevalence of tuberculosis in children of school age that is most alarming. It is a conservative statement that there are today in the public schools of the United States 100,000 children who will die of tuberculosis before they reach the age of eighteen if the present rate of mortality be continued. A very recent estimate presented by the United States Bureau of Education states that at least 15,000,000 children now in attendance in the schools of the United States are in need of a physician’s attention, and that of this number 1,000,000 have or have had tuberculosis. It has become clear that if our educational campaign in the interest of preventive medicine and public health is to achieve success, the attention must be concentrated upon the coming generation rather than upon those who have already passed their years of plasticity.
We see, then, on every hand the tendency to attack the problem in the schools, and this not only by the establishment of provision for open air teaching and the improvement of the undernourished and the predisposed, but upon insistence of regular and intelligent instruction as to the prevention of disease.
Such in its general outlines is the plan by which we are working. With such a situation and with such a campaign what then is the outlook? I have little sympathy with the enthusiasm which deals in specific predictions or which assigns a date for the practical achievement of theoretical possibilities. It is perhaps inevitable that an impatient public should demand results before definite results can be forthcoming. There is, on the other hand, a corresponding obligation for conservatism in expression when indicating probable or even possible results. A drop in the mortality curve of a slowly developing and slowly progressive disease such as tuberculosis, is not a matter of months but a matter of years. It is unjustifiable to expect results from the specific campaign against tuberculosis in an observable diminution of mortality for some years to come. I believe, however, that we have reached a point where our equipment is such as adequately to test our basis of operations and to warrant an optimism as to the future if our reasoning and method be correct.
Believing as we do, that the soundness of the procedure is certain, it would seem reasonable to expect a response in the mortality tables within five years, and that ten years should afford indisputable proof.
There is, of course, no doubt that tuberculosis is diminishing and has been diminishing for a generation. This decrease is not to be assigned to the specific warfare against the disease, but is doubtless correlated with other factors. It is uncertain whether we are to assign as its cause the general improvement in public hygiene or whether there may be perhaps an acquisition of immunity gradually extending through the civilized world. In my own judgment this decrease in the prevalence of tuberculosis is associated with the improvement in hygienic conditions which has been so marked during the last fifty years. I believe we are justified in expecting an acceleration in this diminution as a result of the specific measures now being adopted not only here but in Europe. While we cannot interpret them with confidence, there are already appearing certain figures of possible significance. It should not be forgotten that the first result of all concentrated activity and interest is a greater accuracy in mortality and morbidity statistics, and that an actual decrease in tuberculosis might appear in official reports as an apparent increase in the disease.
Taking all these factors into account and viewing the situation candidly and with all the precautions possible, I do not hesitate to assert that optimism as to the future is justified, and that the end of the present decade will witness the beginning of another drop in the mortality curve comparable to that which was seen in the closing years of the last century. (Applause.)
President White—Dr. W. C. Mendenhall, of the United States Geological Survey, at Washington, was expected to be here this morning to speak upon the subject of “Water as a Natural Resource.” He is unable to be present, and Mr. Jacob P. Dunn, Secretary of the Indiana Historical Society, will now have ten minutes to discuss “The Conservation of Navigable Streams.”
Address, “The Conservation of Navigable Streams”
(For Mr. Dunn’s paper see Supplementary Proceedings.)