reference only to superficial conditions, control of epidemics, cleaning of streets and similar activities, but the hygienist knows that sanitary regeneration means an attack on many existing institutions, customs, practices and methods that lie deep in the roots of the social structure.

Housing, child labor, industrial occupations, labor insurance, vital statistics, food supply, community methods and conditions are the subjects chosen for discussion. Their primary importance is apparent.

The period of twenty minutes allotted for the opening of this division makes imperative only brief suggestive statements of the essentials in their relation to public health and individual well-being.

Mr. Lawrence Veiller, in the Annals of the American Academy, says: "We have paid dear for our slums. No one has ever attempted to estimate the cost to the Nation of our bad housing conditions, because it is an impossible task. . . . . Who can say of the vast army of the unemployed how large a portion of the industrially inefficient are so because of lowered physical vitality caused by disadvantageous living conditions? Of the burden which the State is called on to bear in the support of almshouses for the dependent, hospitals for the sick, asylums for the insane, prisons and reformatories for the criminal, what portion can fairly be attributed to adverse early environment?" Describing surroundings, the author continues: "The sordidness of it all, the degrading baseness of it, unfortunately is withheld from the eyes of most of us. What it can mean to the people who have to live in the midst of it we can but faintly conceive. Let us frankly admit that these conditions result in imposing upon the great mass of our working people habits of life that are more compatible with the life of animals than with that of human beings."

Moreover, not alone in the slums do these conditions exist. In almost every city of the Union, a few blocks from the main thoroughfares, there are congested districts unspeakably bad.

With the knowledge we now have of the relation to health and sickness of air, sunlight and propagating agencies of disease incident to dirt, it is nothing short of criminal to tolerate such conditions. If physical suffering only were the result, indifference would be unpardonable, but overcrowded homes, insanitary in every respect, make for low standards or decency and morality. Vice, with its correlatives, disease and pauperism result. Often crime and insanity make the chain complete. The conditions of life in the middle ages as recorded in history seem to us barbarous in the extreme; relatively, ours really are. Then, there was no certainty as to the effect of insanitary environment; the people did not. know; we do, yet with inexplicable indifference communities not only let the worst obtain, but they permit a perpetuation of the system. Authorities stand aghast at the expense involved in the tearing away of a whole section of a city, but the cost of such a measure easily, often probably,

may become a mere item in comparison with the economic loss from an epidemic of a virulent type.

It is a hopeful sign that a few enlightened municipalities have set an example in remodeling districts, not only in the erection of comfortable homes, but further in the establishment of healthful and beautiful environments. The housing problem is one of the most difficult and complex of our day. It can be solved only by enlightened legislation supported by public opinion.

About a century and a quarter ago the factory system began to develop with intensity in England. Later, in this country, it grew by leaps and bounds. Child labor with its attendant evils was a logical result. For nine years there has been systematic effort to control the unhygienic features of the system. Some good has been accomplished, but because of the nature of the problem progress is slow. The injury to the child is plainly apparent. Long hours in poorly ventilated rooms, with constant use of the same set of muscles, stunts and dwarfs the body; equally, the mind. Toil of this nature uses up the young life; it leaves the State the burden of caring for an individual hopelessly inefficient if not worse. But of more importance is the consequential physical deterioration. If these youthful toilers grow to maturity their bodies are devitalized; if they marry their children are almost invariably low in vitality. Hygiene in its application does not imply the remedy of existing conditions alone for the individual or the present; it looks to the future. Therefore, protection of the child is a principle of paramount importance.

Child labor laws are now more humane than a few years ago; conditions in many factories have been vastly improved. But as yet we are far from an ideal stage in the regulation and supervision of this feature of industrial life.

Every argument concerning the employment of children in factories may be applied to women engaged in similar occupations. In the mills and shops where women stand all day, where they endure for hours not only unhygienic environment, but in addition mental anxiety, where the whip "employed by the week cnly" is held over them, the nervous strain as well as physical exertion saps the very foundations of vitality. Investigations made by Dr. R. Morton of New York, show the health of industrial women is proving a serious thing in the United States, and unless conditions are bettered that there will be a general breakdown of the working women of the country. Nor is this the sum total of the consequences. In the children of these women low vitality is perpetuated. Records quoted by Dr. George Reid, Health Officer of Stafford, England, give the mortality of children under one year of age as greater among those of mothers who work in factories than among home mothers. Statistics compiled by him show the death rate one hundred and forty-five per one thousand births for infants of home mothers and two hundred and

nine per one thousand births for infants of mothers who work in factories. The injury to the State is apparent.

On the question of prevention of occupational diseases, I cannot do better than quote the measures suggested by Dr. H. Linenthal, of Boston. They are: collection of accurate data about working conditions; data relative to the effect of occupation on mortality; proper medical instruction; reporting to health authorities specific industrial diseases; examination of all industrial workers; exclusion of minors and women from certain industries; sanitary laws for factories; regulation of dangerous trades by health authorities, and the carrying of an educational campaign of hygiene among employers and employes. The comprehensiveness of these measures indicates the extension of the problem. No movement of recent times is more humane and economic than the one termed industrial insurance.

The purpose is the capitalization of the workingman's energy at the time of his greatest productivity; the basic principle that every farsighted social policy is founded more on energy reserve than money reserve. The aim is to secure for the nation the greatest possible reserve of bodily and mental force and power and physical and moral health.

The problem has been attacked in various ways by different countries. Germany has been the most successful. There the workingman's insurance has attained the dimension of a gigantic social institution. Dr. Frederick Zahn of Munich, Director of the Bavarian Statistical Office, in a recent address, gave the following interesting figures: Out of 16,000,000 laborers in Germany, 14,000,000 are carrying sick insurance, and 15,700,000 invalid and old age policies.

In the past twenty-five years over one billion six hundred million dollars have been paid in benefits. In addition, prophylactic measures are provided for.

Only those familiar with the necessities for correct data in health work appreciate the immediate and imperative need for statistical information. Records of births and deaths and of supplementary details form a basis for advancement. Without such data, the sanitarian gropes in the dark. Yet no request from the health department is so lightly treated. Reform in this can be wrought slowly. Appropriations to pay registrars and enforcement through the courts are the means for the inauguration of a more perfect system."

One of the hygienic essentials in this country is education in the relative values of food products. The phenomenal growth of the urban population which has reduced the number of producers and the almost universal practice of adulteration make imperative the enforcement of stringent laws and instruction in the nutritive value of classes of foods and the economy of selection.

The campaign for a supply of clean, pure milk in many centers has

grown out of the effort to lower the infant mortality rate. It has stimulated inquiry and supervision of other food products which is encouragingly prophetic.

Hygiene in its application to personal and community life is essentially preventive. This idea is not sufficiently understood to be taken at its real value; curative measures the people commend, but possible calamity seems remote, therefore, prevention does not appeal. It is this concept of the collective mind that lies back of the extravagant parsimony universal in health appropriations. It also explains public apathy and indifference.

The most practical means for sanitary progress are two, education of all the people in the primary truths of hygiene, and the application of the science through governmental agencies. These are so closely related that they are practically inseparable, but logically may be differentiated.

Hygiene is an organized science; its principles are rational and demonstrable; its application will bring returns economic, ethical and spirtual. This must be acceptably taught to the people by methods suited to the present state of the public mind. Conviction that will lead to action is the end to be sought. Education will create a public sentiment persistent and insistent for measures promotive of public good. Concomitant. with this effort, in fact a part of it, the various units of government should be executives in the establishment of hygienic measures and the abolition of insanitary conditions. When people believe that the eradication of typhoid fever and hookworm disease is more important than high or low tariff; when they become convinced that malaria is a national disgrace and uncleanliness a relic of barbarism, there will be money and judicial decisions for the elimination of these defects.

Fortunately, these are the views of an increasingly large number of people. There is a health awakening. The principles of the science of health are every day becoming concrete in laws, and habits of thought and living. It is the conviction of the progressive minority that a Nation's first duty is to conserve and protect its citizens, to develop a community of efficient men and to minimize natural disadvantages. Further, that collective intelligence must plan for the preservation of the people and the perpetuity of the State, and in so doing must recognize public health as fundamental, both in the simple phases and in its comprehensive aspect. (Applause.)

President WHITE-The next subject to be discussed is by one who employs labor in the State of Indiana, and who is a large employer of labor. His subject is "The Duty of the Employer." I now take pleasure in introducing to you Dr. Edward A. Rumely, of Laporte, Indiana.

Dr. RUMELY-Mr. President, Ladies and Gentlemen: Four genera tions ago, there were but three millions of Americans scattered along the

Atlantic Seaboard. Back of them was a vast virgin continent, the richest the white man had ever found in the long migration upon which our race started ages ago. The American continent was rich in timber, in the soil fertility of its vast valleys and prairies, and rich beyond measure in the superabundant deposits of mineral wealth. The first settlers were few in number; they brought with them but few tools and little wealth that today we would call capital. It was the natural and proper thing for them to set to work to gain, with the least possible labor, the great natural wealth that the virgin continent treasured for them.

They killed the fur-bearing animals, felled the trees to export lumber, dug in the quickest way the mineral wealth of the land and started to grow such crops as would carry to market the greatest value from the fertility of the virgin prairies. Wheat was easily transported, and each bushel contained from twenty to thirty cents of soil value. Hence with wheat our prairies were taken under cultivation, and from the returns of the wheat crops cities and railroads and homes were paid for.

Only today, when the average yield per acre has gone down from forty to thirteen bushels are we beginning to see clearly that by this process we have been drawing heavily upon our soil capital.

While the population was small, labor was difficult to secure. Cities had to be built, roadways opened, railroads constructed, rivers bridged, and a continent brought under subjection. The process of the past four generations was possible only because our fathers economized their own labor and created, as fast as possible, the values they needed to barter off into the markets of the world for capital from the superabundant natural wealth that surrounded them.

Today, we are mining our iron, copper, lead and other metals more rapidly than any other country in the world. The pioneer farmers who worked the soils of the south with tobacco and of the east with wheat, can no longer move off to the west, when, having exhausted the fertility of our lands, they find farming no longer profitable. The hundred thousand vigorous Americans who went last year to Canada with energy, capital and American tools are a concrete evidence that we have reached the end of the course which we have been traveling.

The whole country has been startled by the warning of the farsighted men, and now the demand for conservation of our natural wealth is becoming more and more insistent. We have been made to realize that every child born brings a mouth that must be fed, a body that must be, sheltered and clothed, but no increase in natural wealth. We must still learn that every child does bring two hands which can work, and which, when highly trained and backed by scientific knowledge, can create untold values. Stated otherwise, we must care for our increasing population, not by increased exploitation of our natural stores, but by providing abundant work for skilled labor.

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