Twelve of these cities paid nothing for health protection-and this included three cities of 22,000 population and one of 30,000 population. One city of 26,000 population employed a layman as a health officer. In one of 22,000 the police matron served as "health officer" when she was not otherwise engaged. Twenty-nine of these cities made no pretense of supervising their milk supply. Only nine of them had isolation hospitals for contagious diseases. These conditions exist in a prosperous agricultural and manufacturing State and they can doubtless be found to exist in almost any State in the Union. AGENCIES THAT CAN HELP. These are unpleasant facts, but they give us an idea of the way we are performing the primary function of government-the guarding of human life against avoidable destruction. We have now briefly considered the extent of the waste of the most vital asset of the nation, and how we are conserving it, or rather how we are not conserving it. Now let us rejoice over the fact that we not only know how to reduce this waste, but that thanks to those who have aroused the life conservation sentiment in this country, a general improvement in the public health service is taking place in many States and cities. The experiment has been successful. We now know what we can do. We have the wealth and knowledge, and the machinery is organized throughout the country to rapidly correct our appalling record of life waste. Our work is to induce our people to use it. Every business and social organization should do its full share of this work. The life insurance institutions of this country have a constituency of 25,000,000 policyholders. These policyholders are directly interested in the promotion of longevity, not only from the humanitarian but from the financial viewpoint; for the lower the mortality among policyholders, the greater will be the saving and the larger the dividends to policyholders, which means a reduction in the cost of their life insurance. is estimated that about $50,000,000 is lost annually by postponable mortality among the insured. It The Equitable Life Assurance Society, with which I have the honor to be connected, is endeavoring to do its part not only in conserving the lives of its policyholders, but in stimulating community action. The Metropolitan Life Insurance Company of New York is also rendering a valuable public service in Conservation along somewhat different lines. Two or three of the small companies, and perhaps the same number of fraternal insurance societies, have also given it attention. Let us hope that the time is near at hand when the other two hundred-odd life in surance companies, and the fraternal societies as well, will also increase their usefulness to their policyholders and the public by joining in this great work. SOME SUGGESTIONS. This Congress will be asked to do and to advocate many things, for there are a multitude of independent activities connected directly or indirectly with this general subject. Among others I sincerely trust the following suggestions will be duly considered: 1. To encourage business institutions, civic, social and religious organizations which have influence over any considerable number of people to join in at least some of the many phases of the life conservation campaign. 2. To encourage the education of the individual to adopt healthful habits of life-to avoid the intemperate life, which means excess in eating, drinking. working, playing-and unhealthful indulgence in indolence as well. 3. To encourage communities to establish and maintain ample public health organizations consistent with the magnitude of the work in hand. 4. To advocate the organization of local health leagues as a stimulus to public interest and to give aid and support to the public health service. 5. To encourage the slowly growing sentiment for a rigid supervision (and isolation if necessary) of tubercular victims, which is the only way in which this devastating plague can be stamped out. 6. To advocate the employment of civic nurses in the health service, who may also act as health inspectors and aid in educational work. 7. To advocate the issuance and distribution by the States or municipalities of an official prevention manual to teach the public how to avoid preventable disease. 8. To urge every individual to go to his or her doctor for periodical health inspections to detect disease in time to arrest or cure it. 9. To urge employers of labor to give their employes these examinations free as a part of their efficiency and welfare program. 10. To encourage philanthropy, now so generously contributing for the care of the sick, to also enter the field of disease prevention which it has so far quite generally neglected. Human life is our paramount asset. Its conservation should be your paramount issue. President WHITE-The audience is certainly indebted for this great and interesting paper. It is hard to get over stubborn facts and fig ures, especially where figures are facts. A great doctor once shocked the people of the country by saying that everybody should be chloroformed when they arrived at the age of sixty. From this paper it would seem we ought at least to reach the age of sixty, the age of being chloroformed, and, better still, we had better so conduct the board of health and so support liberally the board of health in our city that people may just begin to live when they get to be sixty. I now have the pleasure of introducing Prof. Irving Fisher, of Yale University, who has given this subject many years of study and research and will now speak to you upon the "Public Health Movement." (Applause.) Prof. FISHER-The Conservation movement is a movement to prevent waste. When the Conservation Commission was appointed, four years ago, emphasis was placed on the wastes of our natural resources, but by the time the Commission made its report, it had come to the conclusion that by far the most serious as well as the most preventable wastes are the wastes of human life. A generation ago it was a common impression that the average human lifetime was fixed as by a decree of fate. When I was in college one of our reverend instructors showed us a mortality table and said with great impressiveness: "There is no law more hard and fast than the law of mortality." I believed it, and even yet many people are under this delusion. Pasteur did much to introduce a more optimistic view. He stated his belief in these immortal words, "It is within the power of man to rid himself of every parasitic disease." He staked this opinion on his own wonderful laboratory revelations as to germ life. Today we can confirm his words by absolute statistics. And now his successor, Metchnikoff, has surpassed even Pasteur in optimism. Metchnikoff is devoting himself to the question of the prolongation of human life and already gives us a vision of the time when centenarians will be regarded merely as in the prime of life and when the normal span of a century and a quarter will be a frequent occurrence. The growing consciousness that human life is not a fixed allotment, which we must accept as our doom, but a variable, which is within our power to control, has recently led to extraordinary exertions all over the world to save human life. This impulse has gained strength also from the great and almost universal decline in the birth rate. Old countries like France, and new countries like Australia, are confronted with the specter of depopulation. Consequently, as human life becomes scarce, it becomes precious-like any other commodity! These two facts, the consciousness that much mortality is preventable, or at any rate postponable and the fact that increasingly fewer babies are being born in the world, are together operating to produce a great health movement throughout the world. Nothing will stop it until the whole world is convinced of the paramount importance of this problem of human Conservation. This world-wide movement for the conservation of human life has expressed itself in many ways-in medical research; in societies for preventing tuberculosis, infant mortality, social diseases, alcoholism, and vice; in the growth of sanatoria, dispensaries, hospitals and other institutions; in an immense output of hygienic literature, not only technical books and journals, but also popular articles in the magazines and daily news papers; in the constant agitation and legislation for purer foods, milk supply, meat supply and water supply; in the movement to limit the labor of women and children and to improve factory sanitation; in the establishment of social insurance in Germany, England, Denmark and other countries; in the improvement of departments of health; in the spread of gymnastics, physical training and school hygiene; in the revival of the Olympic games and the effort to revive the old Greek ideals of physical perfection and beauty, and last, and most important, in the sudden development of the science of eugenics. In the summer of 1911 was held in Dresden a unique world's fair, devoted exclusively to health-the International Hygiene Exhibition. In this were shown the fruits of the whole movement in all lands-except, alas, our own; for to our shame it must be said that we, as yet, are among the backward nations in this movement for the conservation of human life. Our Congress was asked to appropriate $60,000 to erect a building and supply an exhibit to show what we have done for our part in this movement, but Congress thought it could not afford so large an expenditure for so small (!) an object, and the result was that from the millions of people who visited this exhibition one constantly heard the question asked: "Where is the United States?" And those few Americans who did go to visit the exhibition found that other nations had far outstripped us in this movement for national sanitation and health. Some of the achievements already attained by other nations should be recorded among the wonders of the world. One is the striking decline of the death rate in the city of London. Within two decades, London's death rate has virtually been cut in two and is now only thirteen per thousand, or less than that of most cities onefiftieth its size. Probably, however, the greatest achievement of any country is that of Sweden, where the duration of life is the longest, the mortality the least and the improvements the most general. There alone can it be said that the chances of life have been improved for all ages of life. Infancy, middle age and old age today show a lower mortality in Sweden. than in times past, while in other countries, including the United States, although we can boast of some reduction in infant mortality, the mortality after middle age is growing worse and the innate vitality of the people is, in all probability, deteriorating. The reason why Sweden of all countries has succeeded in improving the vitality of middle age and old age, while other nations have failed, is, I believe, to be found in the fact that Sweden, of all nations, has seen the problem of human hygiene as a whole instead of partially. In most other lands, and particularly in the United States, public health has been regarded almost exclusively as a matter of protection against germs; but protection against germs, while effective in defending us from plague and other epidemics of acute diseases, is almost powerless to prevent the chronic diseases of middle and late life. These maladies-Bright's disease, heart disease, nervous breakdowns are due primarily to unhygienic personal habits. Medical inspection and instruction in schools, as well as Swedish gymnastics, have aided greatly in the muscular development of the citizens of Sweden. Swedish hard bread has preserved their teeth. The Gothenburg system is gradually weaning them from alcohol. There has even been a strong movement against the use of tobacco. Other countries are tardily following in the path which Sweden has trod so successfully. The significant fact is that Sweden has not hesitated to attack the problems of personal habits. I believe we must have a revolution in the habits of living in the community if we are going really to realize the promise of Metchnikoff and others as to the prolongation of human life. Health officers in this country have not regarded it as a part of their duty either to live personally a clean, hygienic life, or to teach others to do so, or even to investigate what those conditions of well-being are which make for personal vitality. 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 |