26 



SCIENCE 



[N. S. Vol. LI. No. 1306 



can be saved with the least expenditure of 

 effort. From this standpoint there are two 

 aspects of the public health program which 

 tend, and rightly tend, to overshadow all the 

 rest, the campaigns against infant mortality 

 and tuberculosis. These are the two lines of 

 endeavor which promise the largest results in 

 actual life saving; and in both these fields of 

 effort the part played by sanitation and 

 bacteriology in the narrow sense is a relatively 

 small one. We can reduce infant mortality 

 by the pasteurization of milk, by the elimina- 

 tion of flies, and by protecting the baby from 

 contact with infected persons; but these are 

 after all incidents in a broad program which 

 involves the education of the mother in the 

 whole technique of infant care, feeding, cloth- 

 ing, airing and bathing. What we are really 

 aiming at is a reform in personal hygiene. 



The campaign against tuberculosis offers 

 another illustration of the same general prin- 

 ciple. We can do something by providing a 

 sanitary environment in which the worker is 

 protected against vitiated air and harmful in- 

 dustrial dusts. We can do something by con- 

 trol of the careless consumptive and the con- 

 sequent reduction of the menace of specific in- 

 fection. Our main weapon against tuberculo- 

 sis is, however, again, the weapon of personal 

 hygiene. The principal machinery upon which 

 we rely is designed to detect the early case 

 and to impose upon the individual in the 

 home or in the sanatorium a regimen of daily 

 living that will make it possible for his own 

 tissues to wage a winning fight against the 

 invading microorganisms. Once more the 

 problem is primarily a problem in the personal 

 conduct of the individual life, and we see 

 the teacher of personal hygiene emerging as 

 a supremely important factor in the present- 

 day compaign for public health. 



According to the Director of the Census the 

 five principal causes of death in the Registra- 

 tion Area of the United States for 1916, with 

 the number of deaths caused by each were as 

 follows : 



Heart diseases 114,000 



Tuberculosis 101,000 



Pneumonia 98,000 



Bright 's disease 75,000 



Cancer 58,000 



Of these five causes of death there are two, 

 pneumonia and tuberculosis, in which the sani- 

 tation of living and work places, the isolation 

 of the infected individual, and in the case of 

 pneumonia, the use of sera and vaccines do 

 play an important part. Even with tdbercu- 

 losis and pneumonia, however, education in 

 personal hygiene fills a large place in the mod- 

 ern preventive campaign. Heart disease and 

 nephritis may of course often be the end re- 

 sults of bacterial infections, but the immediate 

 problem of their control is not to be sought 

 along conventional sanitary and bacteriolog- 

 ical lines. In the past they have indeed been 

 considered as beyond the range of control 

 measures of any kind. With these diseases too 

 it seems clear, however, that education in per- 

 sonal hygiene offers large possibilities of effec- 

 tive results. If the weakness of the heart or 

 arteries be known in time the adoption of 

 proper rules for daily living can at least post- 

 pone the fatal result, if it can not effect or- 

 ganic cure. 



It is for these reasons that the public health 

 campaign of the present day has become pre- 

 eminently an educational campaign. There are 

 those who maintain that because the public 

 health authority alone possesses the power to 

 enforce regulations with the strong arm of the 

 law such authorities should confine themselves 

 to the exercise of police power, leaving educa- 

 tional activities to develop under the hands of 

 private agencies. The actual amount of life- 

 saving that can be accomplished by purely re- 

 strictive methods is, however, small, and such 

 exercise of police power as may be necessary 

 can only gain in effectiveness if it forms an 

 integral part of a general campaign of leader- 

 ship in hygienic living. 



We have now added to the function of the 

 sanitarian and the bacteriologist that of a 

 new figure in the public health campaign, the 

 teacher of personal hygiene; but we can not 

 stop here if we are prepared to follow the 

 courageous public health official in his determi- 

 nation to adopt whatever machinery may prove 



