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increasing the scope of the marine hospital service or establishing a national bureau of health having general control of such matters.
You all recall how the whole world was shocked two summers ago at the awful loss of life when the ocean steamer La Bourgogne was wrecked and 560 lives were lost in a few minutes. Those of us who lost friends on that unfortunate vessel were most severe in our condemnation of the management and discipline of the ship. Whatever may have been the excuse for her having been out of her course, many felt that the disaster was preventable; that the awful sacrifice of life was unnecessary and could have been avoided. It is such terrible catastrophes as these that make some people afraid to travel by sea, although they enter a railroad train without any thought of danger. In the aggregate, the loss of life from the latter method of traveling is probably greater than from the former, but we read of it in the papers every day, we get accustomed to it, and never stop to think of it, while the loss of life from an accident to a steamship makes us shudder. Did you ever stop to think that one-third of the deaths occurring in this country in 1890 were due to preventable diseases? Think of it, over 250,000 lives sacrificed in one year! Some of these could not have been saved. The infection may in some instances have resulted from circumstances which were uncontrollable, but it is safe to say that at least three-fourths of these deaths could have been avoided had all the knowledge of the cause, the way of spreading and the means of prevention been properly used. Is it not time that we do something in preventive medicine? If we are so ready to blame the master of a vessel for the loss of life on an ocean steamer resulting from a collision, should we not blame ourselves with indifference that is unpardonable and neglect that is criminal?
In former ages smallpox was the most dreaded contagion. More than a century ago Jenner gave vaccination to mankind and steadily since then this disease has been shorn of its horrors until the mortality from it at present is comparatively trifling. The great plague of modern civilization is tuberculosis (consumption). It is more to be dreaded now than was smallpox before the days of vaccination, as it causes relatively twice as many deaths at the present time as smallpox did then. In fact it caused more deaths in 1433 cities and towns in the United States, having a population of over 21,000,
000, in the year 1898, than all other contagious diseases put together. One death in every nine from all causes in these cities resulted from tuberculosis. If it spread rapidly and ran a short course, the people would demand that every precaution be taken to prevent its «spread, but as we see it constantly everywhere about us, it becomes so familiar that we neglect it and cease to fear it. This is the more remarkable when it is remembered that no disease is better underetood or its spread more easily prevented. It does not require isoJation like the highly contagious diseases. Simple precautions may be applied in the patient's home so that the consumptive may not endanger the lives of those about him.
When one recalls the universal fright, the confusion and anxiety to get away that prevailed among the panic-stricken people of Galveston less than three years ago when it was telegraphed to Washington that yellow fever existed here, it is difficult to understand the supreme indifference that exists among these same people not only to tuberculosis, but to sanitary measures in general. And yet tuberculosis causes more deaths ery month in New Orleans alone than occurred in the entire State of Louisiana or in Mississippi from yellow fever in 1898.
I am aware that those who preach the communicability of tuberculosis are considered by some to be extremists and fanatics, but I challenge anyone, either in the medical profession or outside of it, to prove that tuberculosis can be caused in any other way than by a specific germ, or that this germ ever arises from any other source than from some previous case of the disease.
How well do we all remember the Maine! The mere mention of her name fills us with emotion. Whoever destroyed her, the thought of it makes the blood of every American citizen boil with righteous indignation to thing 266 lives were needlesely sacrificed by the most cowardly and barbarous act of modern civilization. As a result of the inhuman destruction of life in Cuba, this country was willing to go to war with a foreign power. The results are so recent that it is unnecessary to recall them. The ar was very exceptional in the small number of our men killed by bullets, but it was just as remarkable for the large number of deaths from dis
In the civil war the number dying from disease was twice the number killed in battle and dying from wounds. That was at a ime when the causes, the ways of spreading and the means of preventing camp diseases were unknown. In the Spanish-American war the number of deaths from diseases was more than five times the number resulting from bullets. The greatest disgrace is that over 2000 of these did not occur in an active campaign, but in the training camps at home, where the sanitary conditions could have been and should have been controlled. Most of these deaths were due to diseases that are well understood and entirely preventable. The fault was not with the medical department of the regular army, but the primary cause of this enormous mortality was the method of making appointments to responsible positions purely for political reasons and not because of fitness for the position.
Contrast with this the conditions in the Philippine, where, notwithstanding the climate and inability to control sanitary conditions in an active campaign, the mortality from disease for the year 1899 did not exceed the number killed and dying from wounds. Or, contrast the condition of the British army in South Africa, where, up to March 1, 1900, the number of deaths from disease was less than one-half of those killed in battle and less than one-eighth of those wounded.
Without offering any apologies for the mismanagement of our army in the summer of 1898, let me call your attention to the high mortality from typhoid fever constantly occurring among us at home. There probably occur annually in the United States from 25,000 to 30,000 death from typhoid fever, probably representing nearly 200,000 cases of this disease. In Philadelphia alone, with a little over 1,000,000 population, there were 7985 cases of typhoid fever in 1899. An English writer has said: “For every case of typhoid fever somebody ought to be hung.” Would it not be well for the good people and “yellow journals” who strained so hard at this comparative gnat in the form of mortality rate in our army two summers ago, to concern themselves more about swallowing a camel in the shape of the inexcusably high mortality rate from typioid fever at home? It is difficult to understand how a people that felt so indignant at the loss of life on the Maine will tolerate such loss of life from causes that can be prevented. The fault is ours; the way is clear; the certain means of prevention is at hand; it only needs to be supplied.
The achievements of modern sanitary science are numerous and istriking. The great reduction of mortality resulting from a pure water supply and from a good sewerage system has been experienced by so many cities and towns throughout the country that every one is familiar with it, and these two matters have become corner stones in the foundation of public sanitation.
As a result of cleanliness enforced by Americans, the mortality of Santiago de Cuba for 1899 was but 30 per cent. of the average annual mortality rate for the three years preceding, notwithstanding an inadequate water supply and the absence of a sewerage system. The mortality of Havana for 1899 was but 44 per cent. of the average for the three years before that time, even without a sewerage system.
However, it is not only in cities that have been so indescribably filthy as these were under Spanish control that great improvements have been made. In New York City, where sanitary matters have always received due attention, there has been a reduction of 25 per cent. in the death rate from 1887 to 1897, without any single great public improvement, such as a purer water supply or better sewerage system. This improvement has resulted chiefly from the thorough and scientific methods used in the recognition, notification and isolation of contagious diseases and the disinfection after their occurrence. Other cities have adopted her methods with the same benefits. This movement has extended so rapidly that at present New York, Boston, Chicago and Philadelphia have medical inspectors of schools to prevent the spread of contagious diseases through the public schools.
Does anyone think the people are not in favor of sanitary improvements? The popular vote in Pittsburg for a pure water supply; the vote in Philadelphia to provide means for purifying the water, and the vote of the property holders in New Orleans for a public sewerage system all indicate that the people are in favor of such improvements, even though they are expensive. It is indeed a sad thing to see the metropolis of the South only taking such action because the recurrence of epidemics affects her commerce. Human Jife can not be valued in terms of dollars and cents. But it is a still sadder thing to see other cities, like Galveston, equally bad off from a sanitary standpoint, failing to profit by her unfortunate experience.
I hope that each one of you graduating in medicine today will .consider it a duty you owe to the State that has given you a free education to lend your best efforts to the cause of public medicine, to the prevention of disease.
As physicians you should keep out of politics, but if the important position of health officer or of membership of a board of health should come to you, do not shirk the responsibility merely because the duties of the position may not have been properly performed in the past. You are fitted for such work, and we want capable, strong and fearless men for such positions, and not mere figureheads, who know nothing of sanitation, and often care even less.
But it is not only as public sanitarians that opportunities are opened to you. Every physician can do much in his private practice toward the prevention of disease. Dr. Holmes once humorously said: “Physicians desire for their patients great longevity, with frequent illness.” It is entirely unnecessary to attempt to refute these suggestions before this audience. The question is, however, often asked, Why should a physician, who makes his living by treating the sick, use his knowledge of hygiene in the prevention of disease? Even from a purely business standpoint it is to his advantage to do so.
The time is past when intelligent people are satisfied to have the physician call, prescribe his medicine and then leave. They want to know something of the nature and the cause of the disease, the way in which it was most probably contracted, and, if preventable, the means of preventing its spread. If the physician does not give this information he may soon find himself supplanted by some one else who will.
But there is a higher moral reason why every true physician will practice preventive medicine on all occasions, whether it is of any pecuniary benefit to him or not. It is the duty of the physician to save life, to lessen and prevent suffering whenever and wherever he can, and if any one of you have no higher motive in the practice of medicine than the money to be gained you had better give it up right now.
If the public water supply is polluted, you should tell your patients