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effort for the better protection of life and health, but the precise character of the action which it is desirable to begin with is a matter concerning which there are, not very different opinions, but slightly different impressions. Under these circumstances, the first question propounded by the Chairman of this Section on Public Health in the American Medical Association, is a very proper one, as tending to render more definite, and therefore more effective, the general belief that Government should act. The question presupposes a belief that some action should be taken, and asks what shall be its character and what the object.
The character of an organization may and should be indicated by its name. I propose a “Public Health Commission” for the United States-the U.S. Public Health Commission. And this Commission should be a permanent Commission of Inquiry.
In undertaking any new project, the prevailing and dominant idea should be the accumulation of knowledge concerning that undertaking. This principle seems to be so evidently correct that I will not argue it, but only illustrate it by referring to the fact that it is acted upon by all who first learn before practising a trade, an art, or a profession, and by all who keep up with their business. As, in this case, we should continue to learn, the Commission should be permanent. Now it is granted that the medical profession is already in possession of a large amount of knowledge on the subject of Public Health, and that if this knowledge could be immediately acted upon, it would result in the prevention of thousands of deaths in these United States, in every year, and that millions of dollars in money might be saved annually to the people of this nation through the prevention of sickness and deaths. If this result could be obtained, as we firmly believe it could, through such action as might be inaugurated and maintained by the leading sanitarians of this country if they were legally constituted a National Board of Health, who will undertake to say that this should not be attempted immediately?
But it may be said that this knowledge cannot be immediately acted upon. The Government of these United States is vested in Congress, and Congress is composed not of physicians or sanitarians, but of representatives of all classes of the people, except, perhaps, sanitarians. Whatever action is taken must be by Congress, either directly or indirectly through its appointed agents, or through some of the executive officers now provided. On first thought, it may appear to some persons that all that can be done
in the way of preventing disease and death by the employment of our present sanitary knowledge is already provided for, through the local boards of health which now exist in almost every large city. But though adequate quarantine may keep cholera from entering New York City from the sea, yet, under present circumstances, cholera may begin at New Orleans and be allowed to visit Memphis, Louisville, Cincinnati, and one city after another, until it may even enter New York City or Boston from the rear. In some parts of the United States, yellow fever is promptly dealt with, and its spread prevented; but we have lately seen that in certain other parts it is allowed to go from one city and State to another, and sweep off hundreds of our citizens. Only a few of the States have State Boards of Health, and in the event of any great and wide-spread epidemic this whole country is almost entirely unprotected. Except the imperfectly planned local boards of health, there is absolutely no legal provision for even the slightest governmental protection. There are railroad trains which on every day pass through several States. No State laws are adequate to the protection of the people from the spread of contagious and infectious diseases. A railroad train may scatter smallpox from one side of the country to the other and throughout its whole length and breadth; and there appears to be no national provision for the prevention of this.
It is easy to mention other important facts which prove that all is not done that can be done in the way of carrying into practical effect the great mass of sanitary knowledge now possessed by the sanitarians of this country. It may be said that the men who now constitute our National Congress have not yet that thorough knowledge of sanitary science which will warrant them in employing such measures for the prevention of disease and death as the people themselves or local boards of health and local quarantine authorities are incapable of originating or unable to employ.
But it is fair to assume that our members of Congress have sufficient general intelligence and knowledge of what is being done by the numerous and active American Associations, which have for their object the advancement of the various sciences which bear upon the well-being of society, to understand fully that this knowl. edge only awaits their asking. For the past few years the Transac- . tions of the Medical, Public Health, and Social Science Associations of this country and of foreign countries have contained abundant evidence from our best thinkers in these special fields, that "the
people die from lack of knowledge” of the facts and principles of public hygiene, and from want of the practical application of those principles of sanitary science which are so familiar to the members of this Association. Not only members of Congress and leading men have had opportunity to learn this, but the masses of the people have for some time been eager to hear and read on this subject. As evidence of this, it may be mentioned that one of the leading newspapers of this country—the New York Times---gave over a page of each day to the publication of the proceedings of the American Public Health Association, which met in Philadel. phia in November last. In closing one editorial on the subject, that paper said:
"We know of no reading likely to prove of such vital interest at the present time, as the valuable series of papers wbich we have taken pains to reproduce so fully from the proceedings at Philadelphia. They are a reflex of the experience of physicians and sanitary engineers of national reputation, and if we cannot go to the length of Mr. Disraeli, in stating that sanitary reform is the great question for the statesmanship of our day, we may at least safely insist that it is time the public were more fully educated in its requirements."
If we admit (as many will not) that Congress has not yet sufficient knowledge of such subjects to make it for the best interests of this country that it provide a National System of Quarantine and organize a National Board of Health with power to enforce its convictions, it seems to me that no right-minded sane person living in this enlightened day will undertake to say that Congress should not take immediate steps for continuously obtaining such knowledge as will enable it to do all that men and governments are capable of doing in the way of preventing unnecessary sickness and deaths among the people who really constitute this govern. ment.
Surely it needs no argument to prove that the very highest function of a government is the protection of the lives of its people ; for the highest interest of each individual citizen is in his own life, and in the life of those dear to him. No question of finance, of taxation, of class monopolies, of civil rights, or even of personal liberty, can for a moment compare with the question of life, or even with the question of health, for without health there can be no great degree of happiness. I conclude then that "the character of a National Health Coun
cil" should be such as would be indicated by the name, which I suggest should be" The United States Public Health Commission.” The object of this commission should be to gather, from all possible sources, information bearing upon the subject of the life and health of the people, and to devise plans for the better protection of the lives and health of the people of these United States ; and to report annually, and when called upon to Congress, such facts, statistics, and recommendations as, after thorough study and due deliberation, the commission may deem important to be placed before the people or their representatives in Congress, to the end that such action be taken as that, of the many thousands of deaths which now occur in the United States in every year from preventable causes, some may be prevented, that some part of the unnecessary suffering and pain through the thousands of cases of preventable disease which now occur may be avoided, and that millions of dollars in money, now used through such causes, may be saved to the people, who also through lessened disabilities would be capable of contributing, to the general wealth of the country, millions of dollars annually in addition to those directly saved through lessening sickness and deaths.
It seems to be generally admitted by statisticians that in the United States, the birth-rate is decreasing. If we are to maintain ourselves as do other nations, we must make up for this by lessening the death-rate. The life of this and of every nation depends upon the life and vigor of the individual citizens of which it is constituted. As for the individual man, one of the primary laws of nature is self-preservation, so also one of the first duties of the State is the protection of the lives and health of the people.
When this government was founded, this principle was as clearly recognized as it could be at that time, before sanitary science bad reached its present advanced position, where it can declare, positively, that thousands of deaths can and ought to be prevented, that man is his brother's keeper, that sickness and death cannot afflict any number of our citizens without seriously affecting all classes of our people, that the people need protection from unintentional even more than from intentional destruction of life. At that time, man was believed to be in the greatest danger from his fellow men, and the declaration was that this government was inaugurated for the purpose of securing to its citizens, “life, liberty, and the pursuit of happiness.”
Now we know that more deaths result from preventable causes
than from murder and from war; and the application of that same principle which was first declared to be the chief function of the government, would, in a great degree, prevent the enormous waste of human life which individual citizens are now powerless to avoid or prevent. We ought to profit by the teachings of the wisest of our race, but in this matter of public health, the most ignorant and degraded can so engender disease that all, from the lowest to the highest, shall be swept down by the epidemic, and either perish outright or remain to drag out a miserable existence.
We want such a change in governmental methods, or rather in the objects of governmental action, that this most important of all functions of government, the principle of which has really been recognized from the Declaration of Independence, shall receive the attention which its importance demands. I do not now ask that any new organization shall undertake the government of the people in this particular; I would not relieve Congress of that responsibility. I have not even asked that in the selection of men to represent us in Congress, more thought should be given to the subject of the preservation of our lives, although I think the people might better elect sanitarians than some whom they do elect. But I do insist that we have a right to demand, and to expect, that Congress shall do as much for the public health as it has already done for the public education. There is a Bureau of Education. We have a right to demand for this matter of life, which is of interest to the whole people, at least as much as has been done for a class of people, the Agriculturists, who have their · Department of Agriculture.” In my opinion nothing short of a “Public Health Commission,” composed of the leading sanitarians of this country, will satisfy the demands of the people at this time.
· As knowledge should be the basis of all human power and government, I would have this Commission charged with the duty of collecting information concerning the public health. I would have the chief executive officer of that Board keep a central office at Washington. Inasmuch as the leading sanitarians probably best know who among them is best qualified to be their executive officer, I would have that officer chosen by the Commission, either from their own number or otherwise as they should determine. It should be the duty of that officer to compile the statistical and other information which the Commission should collect. He should haye charge of the correspondence, should receive weekly reports of mortality from all the principal cities in the Union, and should