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 munic.i.p.al 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 a.s.sociated charities, of visiting nurses, pure water and milk commissions, tuberculosis camps, play-grounds a.s.sociations, 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 a.s.set 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 j.a.pan'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 ill.u.s.trating our progress, the report on "National Vitality, Its Wastes and Conservation," which was issued by the American a.s.sociation 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 a.s.sociation, and the speech of Senator Owen in the Congressional Record of March 24, 1910, as well as Federal, State, munic.i.p.al and other health reports, afford examples of what can be done.

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 Ca.n.a.l 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 a.s.sets 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 a.s.sociation and the American Public Health a.s.sociation, 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 a.s.sociations 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 bacteriology, pathology, epidemiology, and in public health, hospital, school and inst.i.tutional administrative work must be drafted into the direct and official service of the people. This need is increasingly apparent. Others are required who can present evidence of special scientific training in chemistry, engineering, statistical, sociological, charity and other work. At present, great as is the actual need, the demand on the part of the public and the remuneration offered are so small and the possibility of employment so uncertain that universities, technical schools, and other inst.i.tutions which offer special courses fail to attract students. The public seems to prefer as yet to jeopardize its most valuable a.s.set by employing untrained public health servants who develop efficiency after, instead of before, their appointment. This means a payment in life and health instead of dollars.

The average individual seems willing to pay, and pay well, for a cure when he is sick. Communities pay the cost of epidemics, and will even pay for engineering services in relation to public utilities, such as water supply and sewage disposal; but this is usually done only under the stimulus of some recent or threatened disaster. They, like the individual, want a _cure_, not a _protection_. Clinical experts, life insurance examiners, and consulting and commercial engineers, are all sure of a good livelihood because they can help the individual or community out of difficulties. Sanitarians and munic.i.p.al engineers are usually left to semi-starvation, because their function is to prevent those same difficulties, without, however, having either available public sentiment or funds to enable them to do it.

Physicians are naturally skeptical of the scientific training and possession of proper ideals on the part of those who have not been especially trained in medicine, and who may have failed to develop the "disease point of view." That they are, however, of a receptive frame of mind can be shown in many ways. The American Medical a.s.sociation has a number of standing committees, including a Council on Medical Education.

This Council, in the endeavor to raise the standard of medical teaching throughout the United States, prepared a standard schedule of minimal requirements, through the agency of ten committees, each of which consisted of ten representative men. One of these ten committees (which had to deal with hygiene, medical jurisprudence, and medical economics) contained in its membership university and college professors of chemistry, physiological chemistry, political economy, pathology, bacteriology and hygiene. There were also executive officers of State and munic.i.p.al boards of health, and representatives of the Federal Health Service; whilst among the collaborators were engineers and many university professors. Bear in mind that this was a committee of the so-called "medical trust"--the American Medical a.s.sociation.

Through oversight for which no one is responsible, this Second National Conservation Congress and the American Public Health a.s.sociation are meeting on exactly the same dates, September 5-9, we in Saint Paul and the a.s.sociation in Milwaukee--I was just able to get here from Milwaukee. This a.s.sociation consists of some physicians who are in practice, but more particularly of Federal, State, munic.i.p.al and inst.i.tutional administrative officers, as also of laboratory, statistical, engineering, and other technical workers. The membership includes representatives from all of the leading universities and medical and technical colleges. It has three sections, namely, laboratory, vital statistics, and munic.i.p.al health officer sections. You are familiar with the work of many of its officers and members. Colonel Gorgas, who was responsible for the administrative health work in Cuba, and who has made possible the building of the Panama Ca.n.a.l without undue loss of life, is a member of both a.s.sociations. The late Dr Walter Reed, who eliminated yellow fever from civilized communities, was vice-president. It is an international a.s.sociation in which Canada, Mexico, and Cuba also partic.i.p.ate, and much can be learned by attendance at these annual meetings. One of its chief benefits has been the formulation of standard methods of scientific procedure, applicable to the suppression of disease in various districts of the several countries.

We in this country are compelled to admit that our neighbors upon the north and south have much in the way of advantage which is denied to our own workers in the United States. In our sister countries, the tenure of office depends on the fitness and training of the inc.u.mbent. As a rule the compensation for public service is relatively higher, and the official organizations are better provided with an authority which is commensurate with their responsibility than is the case in our own country. Time will not permit extended discussion of these conditions, but the annual opportunity to compare notes; to tell each other of our successes, as also of our failures; and to help in the formulation of new methods and in an effort toward a higher standard of efficiency, is of untold value. This is, however, a purely voluntary organization maintained for over thirty years at the personal expense of its members in the face of public apathy. This will be realized if I ask, "How many of you knew that we have such an a.s.sociation," and "Did you know that it is now in session"?

There yet remain a few matters of which a general understanding would bring about yet greater cooperation between the doctor and the general public. The medical profession has realized for a number of years that its members must become teachers of personal hygiene to their patients and families, as also to schools and the general public. It is a new viewpoint, and involves the a.s.sumption of new responsibilities. The doctor has guarded himself against publicity except through his professional societies and journals and to his students, though ever eager to furnish details of his own discoveries and to recount his failures and his successes to those who could understand and sympathize.

This kind of publicity has been regarded, however, by the lay public as a sort of soliloquy carried on in an unknown tongue, and intended for the mystification of that same poor public.

Why there should be any failure of the medical profession, as a whole, to be understood by the general public, it is difficult to see. The general public is composed of individuals, each of whom has a feeling of trust, affection, and possibly of veneration for one or more members of the medical profession. Why then does the public, as an aggregation of individuals, allow itself to become suspicious of the medical profession, an aggregation of physicians? Why does the public abhor and obstruct the physician in his study of anatomy, dissection, and autopsy on the human body? Why is there so much suspicion of the motives and work, as well as denial of the benefits which accrue to humanity from animal experimentation, when it must be apparent to any right-thinking individual that the extension of a physician's knowledge is possible only by such means? Why must doctors from time to time be themselves forced to urge the necessity of making every hospital a teaching and research inst.i.tution? A moment's thought would convince anyone that if this be not done, and if medical knowledge be allowed to die out with this generation, there will be no skilled men available for the hospitals and patients of the future. It must also be patent to all that the patients themselves cannot possibly receive such effective care in a hospital in which medical research and teaching are not fostered. Why should the burden of maintaining a high standard of entrance to the profession and of preventing incompetent and untrained persons from a.s.suming the responsibility of physicians rest solely on the medical profession, when the object is the protection of private citizens and public health?

The physicians of the United States are now thoroughly organized. The public should rejoice in this, since it is an attempt to neutralize the narrowing effect of isolation and to foster an exchange of information which physicians offer freely to each other and publish broadcast to the world (applause). County and State a.s.sociations are affiliated with the American Medical a.s.sociation, which numbers in its membership over seventy thousand doctors. Just as the individual physician's concern is the care of his patient, so that of the organized medical profession is public health and welfare.

The medical profession is, as a rule, underpaid, but members spend their hard-earned-money and a large portion of their time in efforts to benefit humanity, individually and _en ma.s.se_. It is the people's concern to demand a broad education and a thorough scientific training of all students and pract.i.tioners of medicine, public and private. It is to their interest to see that every possible facility is afforded for teaching and that a rigid standard of teaching, examination, degree conference, and licensure is maintained. Nothing is more exasperating to the physician of high ideals, whose length and breadth of sacrifice is known to none, than to hear the sneer directed at his profession for its effort to protect the public. The time has come when the medical profession is in a position to demand that the people exercise discrimination and protect themselves.

One of the first steps toward the betterment of our public health conditions is the coordination of the existing Federal agencies in Washington, of which we are all so proud. When no logical reason can be advanced in explanation of further delay, it is very discouraging to realize that this important matter has been postponed. At the 61st Congress, various bills were introduced, including that of Senator Owen.

In support of these bills appeared those who by special training and long experience are recognized at home and abroad as the highest authorities on public health. The whole country is waiting to see what action her representatives will take to protect her most precious a.s.set.

With your permission, I should like to cite some sixteen reasons why the people of the United States should have a department of health at Washington, which were published by the Committee of One Hundred of the American a.s.sociation for the Advancement of Science:

1--To stop the spread of typhoid fever through drinking sewage-polluted water of interstate streams.

2--To enforce adequate quarantine regulations so as to keep out of the country plague and other similar pestilences.

3--To supervise interstate common carriers, in so far as without such supervision they prove a menace to the health of the traveling public.

4--To have a central organization of such dignity and importance that departments of health of States and cities will seek its cooperation and will pay heed to its advice.

5--To influence health authorities, State and munic.i.p.al, to enact reform legislation in relation to health matters.

6--To act as a clearing-house of State and local health regulations, and to codify such regulations.

7--To draw up a model scheme of sanitary legislation for the a.s.sistance of State and munic.i.p.al health officers.

8--To gather accurate data on all questions of sanitation throughout the United States.

9--To establish the chief causes of preventable disease and unnecessary ill-health.

10--To study conditions and causes of disease recurring in different parts of the United States.

11--To correlate and a.s.sist investigations carried on in many separate and unrelated biological and pathological Federal, State and private laboratories.

12--To consolidate and coordinate the many separate Government bureaus now engaged in independent health work.

13--To effect economies in the administration of these bureaus.

14--To publish and distribute, throughout the country, bulletins in relation to human health.

15--To apply our existing knowledge of hygiene to our living conditions.

16--To reduce the death-rate.

In 1912 there will meet in Washington, on the invitation of the President and Congress of the United States, the International Congress of Hygiene and Demography. This Congress meets triennially in the capitals of the world, and brings together the leaders in health conservation who are officially delegated by the governments of all civilized countries. We have many things to show them of which we can be justly proud. Our Federal, State, munic.i.p.al and other official health organizations, however, leave much to be desired: and it behooves us, in the few months still at our disposal, to prepare to show the visiting nations our methods and successes. We need many other things, but due recognition and coordination of our Federal health mechanism is the first step which, if we have taken it before the meeting of this International Congress, will best enable us to profit by the experience of the world's experts there a.s.sembled.

Nature has been prodigal in her gifts to our Nation. In no respect has she been kinder than in opportunities for health and efficiency. Her very prodigality has rendered us careless and extravagant. It is high time that Americans do as well for themselves in health protection at home as they have done for themselves and others in Cuba, the Ca.n.a.l Zone, Porto Rico, and the Philippines (applause). This demands the creation and maintenance of official organizations to amplify, extend, and ultimately replace the work of our voluntary organizations whose lack of authority prevents their complete success, and whose continuance is an admission of popular inertia and official incompetence. (Applause)

[During the foregoing, Governor Eberhart withdrew, and professor Condra took the chair.]

Professor CONDRA--Ladies and Gentlemen: In the temporary absence of Governor Eberhart I have the pleasure of introducing Mr Wallace D.

Simmons, of Saint Louis, who will address you on "Our Resources as the Basis for Business." (Applause)

Mr SIMMONS--Mr Chairman, Ladies and Gentlemen: The President of the United States in opening this Congress called upon the speakers to make definite practical suggestions. The ex-President of the United States the next day emphasized the need of further enlightenment of the people regarding Conservation. It has frequently been my privilege to cooperate with both of them, and I will endeavor to do so now by suggesting a definite plan for spreading enlightenment in a practical manner.

We of this generation have developed a distinctly new type in our American citizenship, one which has no counterpart in the history of any other people, one which has become a most potent and influential factor in our daily affairs: our modern high-cla.s.s commercial traveler. In any campaign of education, such as I am going to suggest, you can have no more efficient allies than the 600,000 commercial travelers covering this country--not the old-time drummers of questionable methods, but the gentlemen of high character who have won the confidence, the respect and friendship of the merchants and the people generally in every part of this country; and I may add, as a requisite to their success that they are resourceful.

To this development I attribute my having the honor of addressing you today regarding our resources as the basis of our business, because the organization of which I am president employs probably the largest corps of such representatives in the country, and has through them the best system of keeping accurately informed regarding all matters that affect business.

From conclusions based largely upon the observations of the commercial travelers of this country, I will endeavor to outline to you what I believe to be the relationship between our business interests and the question of natural resources; and I believe this phase of the question is most vitally important to the people in whose interest you have gathered here from every State in the Union. The primary reason for that belief--and the one on which all others hinge--is that we are a Nation in trade; a whole people engaged in business. Eighty-odd percent of our people are directly or indirectly dependent for their living on business conditions. The business interest therefore is the greatest interest, collectively, in the country.

Anything which directly affects the living of the majority of our people is not only worthy of our most earnest attention, but should be approached with due consideration. We should be especially cautious about experimenting with legislation that may interfere with the natural laws of trade. When this is more generally recognized, and the people begin to understand that their individual daily incomes are at stake, they will put a stop to using the business interests of the country as a football for politics.

Not only does there appear to me to be a direct relation between our natural resources and our business, but as I view it our resources are the foundation of our business, or as Mr Hill so aptly put it yesterday, they const.i.tute the capital on which our business is done.

In business we endeavor, by industrious and intelligent use of our capital, to produce as the fruit of our efforts an annual return without impairing the capital--without touching the principle or jeopardizing it in any manner. In private enterprises, the man who a.s.sumes the headship of a business organization in which the funds of others are invested as capital, and who then makes a show of prosperity by drawing on that capital to pay what he represents as dividends, is charged with running a "get-rich quick" scheme, and in most States is, by law, held personally liable. I commend to your consideration the consistency of applying that principle where there is involved the capital of all the people--the Nation's resources. (Applause)

If we are a people in trade and mean to continue to be, and if our resources are our capital, can there be any doubt about the wisdom of handling that capital according to the rules of good business? Can there be any doubt where we as a Nation will land if we make annual inroads upon that capital; if we, in the management of the people's business, follow methods which in private affairs bring those responsible before the bar of justice?