Over 150,000 Americans are destroyed annually by tuberculosis. We know how to prevent it, but our taxpayers object to the expense and leave the battle almost wholly to charity.

Nearly a million afflicted people are spreading the poison of tuberculosis to the well, with virtually no official restraint or supervision because of the expense Over 25,000 Americans are still sacrificed annually to the preventable filth disease-typhoid fever. About 300,000 suffer from it and are more or less impaired by it.

Other germ diseases are wasting more lives than typhoid and tuberculosis combined. We are warring against them, but compared to the lives still being Jost our efforts are feeble and only partially effective.

Over 90,000 Americans are killed annually by accidents and various forms of violence. Our efforts to prevent the steady increase of this waste have failed. The annual economic loss due to preventable disease and death is conservatively estimated at $1,500,000,000, and our fire loss at about $250,000,000.

To prevent fire waste our cities spend through the public service approximately $1.65 per capita, and to prevent life waste, 33 cents per capita.

It is estimated that 1,500,000 of our people are constantly suffering from preventable disease, and that during the next ten years American lives equaling the population of the Pacific Coast and Rocky Mountain States (about 6,000,000) will be needlessly destroyed if the present estimated mortality from preventable and postponable disease continues.

These are the conditions we are asking our people to correct. Is there anything unreasonable in the request?

The money loss is stupendous, but if this does not impress our people, surely they should be stirred to action when they reflect upon the immeasurable sum of sorrow, suffering, poverty, immorality, crime and the hereditary degeneracy which results from this wholesale wrecking and destruction of human life from preventable cause.

RACE SUICIDE.

We are not only reducing the fertility of our race and also shortening the span of life, but we are permitting at least 650,000 lives to be destroyed annually which we could save by the application of simple and well-known precautions.

This is the real race suicide problem.

If we would save these lives, they together with their natural offspring would solve the problem of maintaining an adequate surplus of births over deaths. What we need is not necessarily larger families, but more families. A larger number of small families is surely preferable to a smaller number of large families.

THE DOLLAR AND THE DEATH RATE.

The primary duty of conserving our human assets resting with the State, it is obvious that the State must lead in the national movement. It is, therefore, the first duty of every individual and of every unofficial

organization interested in this efficiency and life-saving campaign to rally to the support of the public health service.

We must not only teach the individual how to guard his life against preventable disease and accident, we must educate our communities to the need of an effective public health service to enforce sanitary regulations and otherwise guard the health and lives of their members.

But it takes money to carry on a great educational movement, and it takes money to conduct the public health service.

The war against preventable disease and death is therefore in the final analysis, a struggle between the dollar and the death rate.

So far the dollar is ahead. The body politic seems still to prefer a high death rate to a slight and temporary increase in the tax rate. "How much," says the American taxpayer, "will it cost to reduce this annoying death rate to the lowest possible limit?"

"About $1.50 per capita at first, much less later on,' answers the health officer, "and you will gain immeasurably by the increase in the wealth and happiness of the community."

"Very well," says the taxpayer, "here is 25 cents; we will save two bits' worth of these lives. The rest will have to die. We have much more important places for our money; we must improve the streets and roads, beautify our cities with much needed parks and public structures. We must improve our harbors and rivers, build canals, and encourage commerce generally. Besides, we are absolutely obliged to use about two and a half billion dollars this year for automobiles, jewelry, candy, alcoholic drinks, tobacco, diamonds and other similar urgent needs of life. What is the loss of a few hundred thousand lives compared to these vital necessities?"

And so the health officer plods along with his two-bit appropriation and naturally runs a two-bit health service. His own fitness and efficiency may be 100 per cent., but the effectiveness of his department only 15 per cent. because of the 25-cent limit.

TRIFLING WITH A SOLEMN DUTY.

National Government. Of all the money provided by the people for the expenses of the National Government only about 1.3 per cent. is used for the conservation of health and life.

Our national health corps has an international reputation for efficiency and achievement. Although the service is undermanned and its personnel underpaid, the patriotism and high sense of duty of these able and energetic men have spurred them to the performance of the very highest service to their country and to humanity. They have not only jeopardized their lives, but numbers of them have sacrificed health and life in the performance of duty.

Through their discoveries in the science of prevention, they have

been the means of saving thousands of lives, not only for one year but for all years to come. They have won the admiration of the American people and deserve their most hearty support.

And yet, when it is proposed to co-ordinate the various public health activities of the Government in order to increase the efficiency and usefulness of this splendid body of men, the interest of our countrymen in this service seems to end with admiration. For notwithstanding our confidence and appreciation we have permitted a small but active body of people who are more concerned in treating disease than in preventing it to block the consummation of this thoroughly sensible and businesslike consolidation of the various bureaus under one responsible head.

We have many educational agencies at work throughout the country which are directly or indirectly arousing public interest in health conservation, but this experience emphasizes the need for a permanent central organization to stimulate interested people to back up their judg ment with action, and no organization is better fitted to render this invaluable service than this National Conservation Congress.

At the last session of this Congress Dr. Harvey Wiley told you something about the dangers of impure food, drink and drugs, and what was being done to guard the public against them. Your individual interest was excited. How long did it continue? Were any of you inspired to give actual support and assistance in the enforcement of the pure food laws or to any other official public healh activity? To be interested and to agree is not enough-again, we must act, individually as well as collectively, and stimulate others to act.

States. The same lack of practical support of the public life-saving service exists in most of the States. The appropriations for the public. health work of our State departments can only be characterized as trifling. The exception is Pennsylvania, which is paving the way for a fully adequate health service, as was explained to you at the third session of this Congress in the able paper of Mr. A. B. Farquhar.

The appropriation for the Pennsylvania State Health Department is about 48 cents per capita. Arkansas makes none at all, the State of New York spends about 1.7 cents; Massachusetts, 4.2; Florida, 10; Indiana, 1.8; Kansas, 2.7; Virginia, 1,9, and so on.

Municipalities.-We have many cities with active and efficient health officers, but there is not a city in this country with an adequately equipped and financed health department. Not one of them has sufficient financial support to successfully perform its task, which must be measured by the preventable sick and death list in each community. And we must not confine this list to contagious affections. It must include an educational campaign against all preventable diseases.

The duty of the State to teach our people, through the health departments, how to avoid preventable disease of all kinds that they may live

healthful and productive lives, is just as imperative as is the duty of teaching them, through our schools, how to avoid illiteracy and how to live intelligent and useful lives.

While health appropriations have increased over former years, all of our cities place the value of property far above that of human life in applying measures to prevent waste. Here are a few examples:

In 1911, fifty of our important American cities, with an annual preventable death list of 117,724 people (which means an economic loss of at least $200,000,000) spent through their public service to prevent life waste, an average of 30 cents per capita, and through their fire departments to prevent fire waste, $1.63 per capita.

Here are a few examples: Providence, R. I., spent for health conservation, 11 cents; for fire prevention, $1.99 per capita; Portland, Ore., health, 13 cents; fire, $1.91; Minneapolis, health, 14 cents; fire, $1.67; Louisville, health, 12 cents; fire, $1.36.

In 1910, 184 American cities could spare but two per cent. of their total public appropriations for the public health service. The average for all expenses was $16.54 per capita. Of this but 33 cents was for the public health. Seventy-one of these 184 cities spent less than 15 cents per capita for the public health, and among these are such cities as Quincy, Ill., 2 cents; Lansing, Mich., 5 cents; Rockford, Ill., 6 cents; Scranton, Pa., 7 cents; Bridgeport, Conn., 9 cents; Portland, Ore., 10 cents; Harrisburg, Pa., 12 cents; Jersey City, N. J., 13 cents; Springfield, Ill., 14 cents.

There are many of our largest cities that are well below the average of 33 cents per capita. Among them: Toledo, 15 cents; St. Paul, 17 cents; Minneapolis, 18 cents; Indianapolis, 20 cents; Kansas City, Mo., 20 cents; Milwaukee, 20 cents; Cincinnati, 21 cents; Chicago, 22 cents; St. Louis, Mo., 26 cents; Buffalo, 27 cents; San Francisco, 28 cents.

The natural result of this sort of economy is that the health laws we have are not properly enforced.

How can we benefit from the pure food laws, for example, while we refuse to provide the means of enforcing them?

The great city of New York has an ably administered health de partment, but it has only thirty inspectors to supervise over 27,000 food dispensing establishments. The request of the health officer for an inspection force of 209 men has been steadily ignored for years.

How do you suppose the meat ordinances of Philadelphia are enforced where the people allow the health department but seven inspectors to watch over 8,000 meat shops and slaughter houses?

How can the eight pure food inspectors in Kansas be expected to enforce the pure food laws in the drug and grocery stores, the meat shops, bakeries, etc., in 800 towns? These inspections must be made frequently to be of any value.

These are not exceptions, they are examples.

Could anything be more absurd from a business point of view than this record of "economy" in providing for the public life-saving service!

HOW SOME COMMUNITIES SAVE MONEY.

Some prosperous American communities hold human life so cheaply that they maintain no public health service at all. Others and there are many of them-have a mere skeleton service. The citizens imagine that if they appoint a health board consisting of doctors, all will be well with them. The suggestion that the board be provided with money to carry on its functions would be regarded as wanton extravagance.

There are scores of cities and towns which select a doctor to head the health department and expect him to earn his living by practicing his profession among the very people over whom he is supposed to exercise police authority in enforcing sanitary and other health regulations.

There are cities of from 5,000 to 100,000 population that hire a doctor on the "part time" plan as chief health officer, and pay him a trifling salary. Whether he is a competent sanitarian or in any way skilled in the prevention of disease is a matter of little concern to them. The fact that they are saving a few dollars in his salary fills them with joy and indifference as to the consequences to the community.

I know of a thriving, wealthy young city in the South of 130,000 population with a substantial preventable death rate which saves as much as $800 annually in this way.

I know of a prosperous New England city of 40,000 population with but three people in its health department-two of them are "part time" employes. It is a six cents per capita department and 50 per cent. of the annual deaths in that city are of children under five years of age.

In theory, we must all stand ready to serve the State when called upon, even at personal loss. But does it not seem the height of absudity to expect a competent professional man to leave his practice to take charge of these under-manned and under-financed health departments at the small salaries which our States and cities offer them? If he does his duty, he is sure to make enemies during his term of service, and if he is an able man he will certainly lose money by leaving his practice.

Surely we offer our health officers every inducement to follow the line of least resistance.

A SAMPLE GROUP OF CITIES.

An investigation was recently made of forty-four Illinois cities averaging in population about 16,000; fifteen of them had over 20,000 population, and three had over 50,000.

The average salaries paid the chief health officer amounted to the magnificent sum of $300 annually.