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training and paramount interest lay in the field of public health. While it is apparent that the initial oversight has been in part repaired it remains to be seen what progress will result from the Second National Conservation Congress, in relation to this, the people's most important natural asset. The inclusion in the program of a paper entitled “Life and Health as National Assets” must not be taken as evidence that there is any doubt as to the real and assessable value of life and health. Rather are we called upon at this time to realize that they constitute National or public resources furnished by nature and are not to be regarded as strictly personal or private possessions. The individual life has its economic and commercial value to the community and the Nation by virtue of the contribution it may be expected to make to society. This view may perhaps be novel to some. Our ideas concerning the conservation of other natural resources however, have undergone such rapid evolution in the recent past that we may easily orient ourselves to the viewpoint exhibited by the officers of this Congress, that the individual in matters of health, as of other resources, must respect the rights of other individuals and of his municipality, State, and Government. The health aspect of Conservation, which is its most inportant aspect, cannot and will not be neglected, although it has not been the first to which the attention of the Nation has been directed. Nor can we dissociate health conservation from the other aspects of the movement, even if we would. The history of man's progress in the knowledge of the natural sciences bears out this statement. Even though we ourselves have broken faith with nature, we are able today to make her fulfil her promises in forestry, agriculture, and other economic matters by the application of our knowledge of those very sciences which may be said to owe their birth to man's search for perpetual life and youth. One can easily imagine that the medieval conservation commission comprised two sections, one on health and the other on minerals. In the former, which undoubtedly was basic and dominated all other considerations, the papers presented dealt with “elixir vitae" and the “touchstone” whilst in the latter the chief interest was displayed in the “transmutation of metals.” At this stage the studies of health and of the control of man's so-called material assets were carried on hand in hand; and, if we are logical, they always will be. In any event, man's health depends on the success of his efforts to adapt his environment to his needs, more than it does on the adaptation of himself to his environment. Health interests are fused with social and economic development, but should undoubtedly dominate rather than be dominated by them. Our lack of interest in matters of health is more apparent than real. It is characteristic of many of us that where our most vital interests are involved, we betray the least public concern. In nothing is this better exemplified than in matters of personal and public health, except it be perhaps in matters of religious belief and practice. Nor should we deem it strange that a similar attitude of mind obtains in matters of health and religion. In medieval times the priest and the physician were one. At the present day, aboriginal tribes combine religion and health, and to too great an extent, perhaps, do our civilized nations fail to discriminate between the two. Particularly is this exhibited in man's cowardly attempt to shift his responsibility for disease and death upon Providence. One of the greatest causes of lethargy in the conservation of personal and public health is the failure on the part of many to differentiate clearly and sharply between disease and death. The former is really a manifestation of life and vital force, and is capable of modification, prevention, or cure by human agency, since man has shown himself quite able to solve nature's other secrets for the benefit of his comfort or convenience. We conserve health by the application of the same sciences which enable us to conserve our other better recognized but less material natural resources. Disease yields to man's mastery; death remains man's mystery. Even death, however, may be postponed, and Professor Irving Fisher has estimated that over 600,000 deaths occur each year in our country which could be postponed by the systematic application of the scientific knowledge already available. For those who think more easily in terms of dollars and cents, he has estimated this appalling annual National loss at over one billion dollars which can and should be prevented. We must not be lulled into any sense of well-being by such statistics. There is no royal road to such a goal. Our very success in the eradication of one disease or unsanitary condition may lead to undue optimism in regard to other problems, which later may be found to be dependent on altogether different causes and to require very different methods of prevention or cure. Failure to realize the complexities of modern social activity and economic development, in their relation to health, and, at the same time, to recognize the immense number of variable factors and agencies which are involved in health-protective measures, cannot but lead to disappointment. The individual whose enthusiasm is too easily aroused by the discovery of some hitherto unknown cause of disease, or some new method or theory of cure or prevention, is a source of danger to the commonwealth. The faddist, whether in the matter of such things as food, clothing, fresh air, baths, exercise or other therapeutic agents, as well as the individual who thinks that he has discovered the one cause of all diseases, is to be feared. Our chief difficulty lies in coordinating the various forces and agencies which are essential to success in the eradication of sickness. There is no blanket method of preventing all diseases. Quarantine and fumigation are now found to have but a limited application.
protection against smallpox, cannot be applied to such diseases as malaria, yellow fever, and diphtheria. The use of antitoxin, which prevents annually many thousands of deaths from diphtheria, does not help us in many other diseases. Our knowledge of mosquito-borne disease, which has reorganized life in Cuba, Panama and the Philippines, is not of much practical use in our northern States. As there is no single cause, so there can be no single method either of cure or prevention. These considerations should not discourage us. They show us, however, the need of further study, and the imperative demand for employing the services of trained physicians, biologists, chemists, engineers, statisticians, sociologists, educationists, and other experts and of coordinating all their efforts. We must steer a middle course, avoiding on the one hand the Scylla upon which those run who become discouraged in the face of what they believe to be the unknowable, and, on the other hand, the Charybdis of that fateful tendency to minimize the actual complexities of the present day health problem. Fatalist and faddist are equally dangerous. It is fair to count upon the same progress in the adaptation of physical, chemical, biological, social and other sciences to the diagnosis, cure and prevention of disease as in their application to man's comfort, convenience and economic development. It is clear that the efforts of all the various workers in the different fields must be coordinated; yet the difficulties of coordination are at once apparent. The forces and agencies may be roughly divided into international, National, State, county, municipal and institutional, as well as individual. Each one of these is capable of still further subdivision into two classes, one of which is official or governmental and the other is voluntary. Improvement in public health requires cooperation and coordination of all these. Successful public health administration consists largely in making individuals do what they do not wish to do—or that of which they do not appreciate the necessity—for the good of themselves and others. This brings us naturally to the consideration of another National weakness. We encounter some of the same difficulties in public health work that we neet in the exercise of our other public functions. Rampant individualism is of even greater danger in matters of health conservation than in other affairs of public concern, largely on account of the fact that health is too often regarded as a purely personal rather than a most important public asset. The individualist objects to authority in matters of health control. Consequently he resents dictation as to his personal action, and fails to recognize the need for special training in health administration as in other branches of public service. Public service of many kinds, and particularly that which relates to the conservation of health in our country, is all too often relegated to voluntary agencies, while in other countries it devolves upon official and governmental agencies. This volitional duty is nobly discharged. The main function of the volunteer should be, however, to afford to the general public object lessons of what is needed and of how progress can be made. In this he rarely fails, although he labors under tremendous difficulty imposed by lack of authority. Funds which are furnished from private sources are frequently insufficient to permit of the employment of experts of the highest order. Public apathy, on the one hand, and the development of an abnormal interest on the part of voluntary workers on the other, frequently lead to their continuance in service long after they have ceased to be useful, with the result either that the public delays the establishment of an official organization, or, if such an organization be established, there is a conflict between the official and voluntary forces. If municipal health departments, hospital services, police departments, water, school, poor and park boards, and other official servants and representatives of the people were supported by the people and were quick to see and to seize their opportunities, there would be less need of associated charities, of visiting nurses, pure water and milk commissions, tuberculosis camps, play-grounds associations, and other such voluntary organizations. Is it not humiliating that public lethargy made it necessary for Mr Rockefeller to provide funds for the investigation and eradication of hookworm disease? In Germany, the Government, through its public health service and universities, provides for medical and other research so that Nation has become a leader of the world in scientific health protection and scientific economic development. Having seen some of the difficulties which stand in the way of satisfactory conservation of the public health, we might perhaps ask ourselves what proof of the possibility of conserving this asset is available. If, at this day and time, the American public is unconvinced of the need and possibility of conserving public health, it is undeserving of the respect of other nations, or even of self-respect. The daily and weekly press, our magazines, and governmental and other publications, have overflowed with information. Our attention has been particularly called to the possibility of preserving the health of men in the field by Japan's experience in the recent war with Russia. Our life insurance companies have been quick to see the practical possibilities of prolonging the lives of their insured and of thus increasing the earnings of their stockholders. As illustrating our progress, the report on “National Vitality, Its Wastes and Conservation,” which was issued by the American Association for the Advancement of Science, is a masterpiece; it was prepared and presented by Professor Irving Fisher, of Yale University. The publications of the various committees of the American Medical Association, and the speech of Senator Owen in the Congressional Record of March 24, 1910, as well as Federal, State, municipal and
Those who may be skeptical in regard to the ability of our people to compete with older nations in the prevention of disease, should note what has actually been done by Americans under the greatest of difficulties. In Cuba, our Nation overturned the existing order of affairs, and scientific discoveries, made and applied to sanitation by Americans, afforded a lesson to the world. There has been no greater factor in winning the world-wide confidence of other nations than the production of the existing sanitary state of affairs in the Canal Zone by our own citizens. Our work in Cuba, Panama, and the Philippines has served to bring about hygienic conditions in supposedly pestilential regions which are vastly superior to those which obtain at home. What Americans have done for others they have failed to do for themselves, owing largely to the lack of provision of adequate official and governmental agencies and to the failure to coordinate those which exist. Two Americans in Porto Rico showed the possibility of stamping out hookworm disease. The brains were furnished by the United States, and the money by the Island. We have the brains at home, but we refuse to pay the bills. It is manifest that a full and complete discussion of life and health as National assets is impossible within the limits of a single paper. No attempt need be made to present a complete basis either of comparison or differentiation of health conservation from the other aspects of the National movement. It must be clear to all that in the conservation of lands, minerals, waters, and forests, effort is made to prevent the individual from taking that which belongs to the public. In the conservation of public health, our effort must be directed to preventing the individual from giving to the public something which neither he nor it desires. This is particularly true of infectious diseases. There are many other phases of public health than those which relate to infectious disease, but they cannot be discussed at this time. I have the honor to be a Delegate to this Congress from both the American Medical .\ssociation and the American Public Health Association, which represent factors in the conservation of human life and health concerning which the public needs more information than it possesses; and with your permission, I shall briefly mention a few important matters: In the past, individual physicians and local medical associations and societies have brought a scattering fire to bear upon the inactivity and ignorance of the general public in matters which pertain to public health. The public fails to believe in the urgency of health needs. when presented by individuals or groups of physicians, because of its inability to appreciate the motive which leads the physician to urge the establishment of machinery and the special education of officials as also the provision of funds to carry on work which to the casual observer would mean a diminution of the individual physician's work and income. Physicians who have qualified by postgraduate training in bacteriologv. Dathology, epidemiology, and in public health, hospital