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4, and Vienna, 4 per 100,000. Thus, evidently in such cities as Cincinnati, Berlin and London, death from typhoid fever is no longer a terror.

Measles, which is supposed to be almost a harmless disease, causes a large number of deaths, the death rate for 1910 being 12.3 per 100,000 population, or a total of 12,300 for the estimated population. In some cities the number of deaths by measles was almost as high as that by typhoid fever, notably in Pittsburgh, Pa., 33.1; Providence, R. I., 31.9; Kansas City, Mo., 28.4; Lowell, Mass., 28.1; Albany, N. Y., 23.9; Columbus, O., 23.6; Buffalo, N. Y., 22.1, and Richmond, Va., 21.1 per 100,000. Scarlet fever is not so deadly a disease as measles, since the fatalities per 100,000 for 1910 was 11.6. Death rates from this disease were high in the following cities of 100,000 population or over: Buffalo, N. Y., 53.6; Lowell, Mass., 41.2; St. Paul, Minn., 30.2; St. Louis, Mo., 27.1; Kansas City, Mo., 23.2; Milwaukee, Wis., 22.3; Pittsburgh, Pa., 22.2; Rochester, N. Y., 21.4, and New York, N. Y., 20 per 100,000.

Whooping cough produced as many deaths as measles and scarlet fever, the death rate for 1910 being 11.4 per 100,000 population. Diphtheria and croup produced a death rate of 21.4 per 100,000 population, or a total of 21,400 for the estimated population.

Influenza, or "la grippe," caused a death rate of 14.4 per 100,000 population for 1910. This disease is less prevalent than for the preceding ten years. The above data are sufficient to show the principal causes of death, old age, unfortunately, being so small a factor as to be almost negligible in the compilation.

It might be interesting to extend these vital statistics to a greater length, but a sufficient number of data have been given to establish some of the fundamental principles which should guide physicians and the sanitarians of the future in their work.

THE MEANS OF AVOIDING AVOIDABLE DEATH.

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 wish 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 statisties 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 diarrhoea, 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.

Based on this are the great factors of prevention, namely, quarantine and segregation, which are practically one and the same. It stands to reason that an infected center should be removed or so isolated as to be no longer dangerous. For the same reason the infected center should not be allowed to enter a new community. Based upon this principle our systems of quarantine and segregation should be greatly strengthened. It is not a question of the wishes of the individual in this case; if it were, no ship would be detained and quarantined, and few people would go to a smallpox hospital or tuberculosis sanitarium. The principle of the welfare of the race as superior to the interests of the individual is dominant in these particulars. Tennyson, who foresaw many of the great truths of science, has beautifully presented this principle in his well-known stanza:

"Are God and nature then at strife,

That nature sends such fearful dreams?
So careful of the type she seems,

So careless of the single life."

In the protection of the public health it will become as much the duty of each State and Nation to provide sanitary detention camps for infectious diseases and rigidly enforce residence therein, as it is to watch the border and establish strict quarantine.

IMMUNITY.

It is evident, however, that it will take a long course of education and almost revolution in the sentiment of the people, to establish a system of segregation and quarantine as rigid and as perfect as that which is outlined. What then is the next best resort? I answer immunization. If we cannot keep the infectious organism from contact with the human body, we should endeavor to make the body immune from its ravages. There are two methods which might be adopted: the one which could be most generally practiced is that of good nutrition, proper housing, fresh air, pure water and pure foods. The child that sleeps in the open and eats an abundance of pure, wholesome foods and takes a proper amount

of exercise, will escape most of the diseases of infancy and grow into manhood with a body immune to almost every infectious germ. I need not go into detail in regard to the actual mechanism of immunity to prove the fact that a well-nourished body, sustained by blood of high nutritious power and bearing its untold millions of organisms, armed cap-a-pie to destroy intruders, is a sufficient illustration of immunity. The physiologists will describe to you the nature of the phagocytosthe opsins, and the hormones by means of which this immunity is secured.

For the above reason the campaign for pure and wholesome food lies at the very foundation of the protection of the public health. It is a mistaken idea that a food is not to be condemned unless it produces diseases. A food is to be condemned which is in any way so debased as to undermine nutrition and impoverish the blood, and thus open the door of the body to the invitation of every germ that may be coming along the road. Thus the addition to foods of bodies which in themselves are not poisonous or harmful, but which debase the product and make it less palatable or less nutritious, is a crime of the same magnitude as that of adding to the foods poisonous and deleterious ingredients or of suffering it to fall into advanced stages of decomposition.

What a sorry spectacle, in the light of these facts, was presented at the Fifteenth International Congress of Hygiene and Demography at Washington last week, when Professor Long, member of the Remsen Board, which has validated the use of some of these poisons, attempted to justify the addition of an active drug to the food supply of the nation! Such an act was so foreign to the purposes of the Congress as to constitute an unpardonable anachronism. Dr. Long was one of the most enthusiastic protagonists of benzoate of soda in the Federal Court in Indianapolis when those who secured the appointment of the Referee Board in defiance of law sought to force the people of Indiana to eat their adulterated products. The people ask for bread and Dr. Long and hist assistants give them a stone in the form of the moribund benzoate.

Of a similar pernicious and mercenary character was the paper presented by Professor Sedgewick, of Boston, in which he urged the use of infected oysters and diseased meats as human foods. Professor Sedgewick was one of the principal witnesses in the celebrated egg case in New Jersey, where he testified that eggs so decomposed as to produce death when injected into guinea pigs were wholly fit for human food if sufficiently disguised in taste and smell by baking! Oysters, according to Sedgewick, should be classified into good, to be eaten raw by the rich, and bad, to be cooked and eaten by the poor. Meats of diseased animals should also be eaten by the poor, unless so badly diseased as to be physically seen to be unsound.

This is the doctrine of modern hygiene according to its prophets Long and Sedgewick. I cannot subscribe to these doctrines. There is

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