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.