The question which is now presented for discussion at this Congress is, How can avoidable death be successfully avoided? I have not included in the discussion of this question the deaths by accident, which are lamentably all too frequent in this country. The motor car, the aeroplane, the railway, and the steamboat, still continue their deadly work in increasing violence as our population grows denser. It is easy to understand how the State could do much toward preventing these unfortunate accidents. No doubt concerted action on the part of the States will soon be perfected to prevent so many of the horrible catastrophes, whose descriptions form the principal reading matter, after murder and suicide, in the morning journals. And this leads us to say that murder as a means of ending human life is more prevalent in this country than in any other country of the world, and in consideration of the features which relate to the conservation of man the prevention of murder should receive particular attention.
A study of the above data reviewed in connection with the known etiology of disease, shows clearly where the work of the conservation of man, especially by the prevention of disease, should begin and on what line it should be prosecuted. To this end it is sufficient to call attention to the fact that diseases are naturally divided into two classes: those which are communicated and those which are produced by the conditions of the personal environment. Physicians are pretty well agreed at the present time that disease is rarely inherited, therefore, most of the causes which produce death are those which come from without, or those which are developed from within by improper habits of life. But one may inherit deficient vitality and thus fall an easy victim to an infectious disease. The point for us to consider most particularly in this connection, is to what extent we can prevent these diseases, that is, those which are contracted from without.
EDUCATION OF FUNDAMENTAL IMPORTANCE.
It would be well to classify the efforts which we are making for the prevention of disease in some systematic order. I will begin, therefore, with the one which is the most important of all, and that is education.
In order to secure proper protection for the citizen, he must be made to understand that he needs it. Further than this, it must be made plain that the protection of the individual from communicable disease is not by any means wholly within his own power. Unless the State acts, the individual in many cases is powerless; hence education beginning in the family, continued in the public school, and illustrated in practical adult life, is the most important feature of prophylaxis. Into the details of education I cannot go, but one thing I do with to insist upon, namely, that the child should be taught early, frequently and constantly, that most of the disease he has to fear are like enemies in the dark. I need not refer again by detail to the statistics of mortality, but simply would say that if the diseases which produce some of the most deadly inroads into humanity, such as tuberculosis, measles, whooping cough, scarlet fever, diphtheria, croup and typhoid fever, are solely communicated to the individual from without, they are the diseases which the State must help the individual to avoid. On the other hand, organic diseases of the heart, nephritis and Bright’s disease, are apparently more of a personal character, due either to inherited weak qualities or to errors of diet or faults of metabolism. These are diseases which we should be taught to avoid by strict attention to personal hygiene. They are not, so far as known, communicable, and therefore the State can do little, aside from educational work, towards their prevention. Another disease which may be partly communicated and partly the result of improper nutrition, is enteritis, and especially infantile diarrhœa, diseases which by proper education might be almost wholly avoided.
DISEASES OF UNKNOWN GENESIS.
There remain two great causes of human death, namely, cancer and pneumonia, which are still practically beyond control, because of our ignorance of their etiology or our powerlessness to prevent their progress. These diseases are considered communicable, that is, they are induced by specific infection, but the methods and the exact nature of the infecting germs are still subjects of investigation. It is true that we are told of the organism which produces pneumonia, and it is said to be constantly in the mouth of even healthy people, and we read almost monthly of the discovery of the real cause of cancer, but in spite of all this, these diseases remain as a rule unknown in character and are gigantic and terrible enemies which we have to fight in the dark. To one point attention should be called in regard to the increase in such diseases as those of the kidneys and the heart, that are essentially diseases of old age, just as tuberculosis and typhoid fever are diseases of early life. In proportion as we save people from tuberculosis and typhoid fever, just in that proportion will we save men and women who subsequently become victims of old age diseases. Therefore the increase in the number of deaths due to these causes may be an index to the increasing longevity of the people, instead of the opposite.
It is of course a question, which unfortunately we are unable to decide for ourselves, as to whether we should be saved from tuberculosis and typhoid fever for the express purpose of being killed by cancer, kidney lesions and diseases of the heart. Upon the whole I think, however, that terrible as these diseases are, especially cancer, most people would rather die of cancer at 70 than to succumb to tuberculosis at 30. But in the great problem of the conservation of human life we must not lose sight of the fact that many experienced and competent investigators are devoting their whole time to revealing the secret of these dread diseases, which still baffle the skill of the physician. We may hope in the near future that at least pneumonia and cancer may be put upon the same footing as typhoid and tuberculosis, that their actual genesis will be disclosed, and thus the road made clear toward their prevention. It is along these lines that education must go, because we cannot develop a public sentiment for the protection of life and health except by the desire of the people to live and be well, and the education of the youth and the adult is the best method of securing that result. When the people are educated, then we can successfully introduce the other methods of saving human life.
PREVENTION OF COMMUNICABLE DISEASES.
It is a self-evident fact, granting a disease to be of communicable origin by a specific germ, that the disease may be prevented if its victim be protected from infection. In other words, such diseases as tuberculosis, typhoid fever and others of the same character, which are undoubtedly communicated from individual to individual, could be wholly exterminated if the opportunities for communication were destroyed. We may assume, therefore, that all specific diseases due to a specific organism are capable of elimination by the simple exclusion of the organism.