364 



SCIENCE 



[N. S. Vol. XLII. No. 1081 



not most, physicians, deprecated the prac- 

 tise; through the one following, in which 

 the scales began to turn in favor of pas- 

 teurization; and into the present when al- 

 most no one fully informed on the subject 

 actively opposes pasteurization. And yet, 

 even to-day, some physicians are short- 

 sighted enough to tolerate if not to recom- 

 mend the general use of raw milk, which 

 still constitutes the great bulk of the milk 

 used by infants and adults all over the 

 land. Such use of raw milk we must count 

 as long as it lasts one of our worst public 

 health failures. 



We have also failed thus far to pay 

 proper attention to our American climate, 

 which has been well described by a popular 

 writer as "polar-tropic." Placed as we 

 of the United States are on the latitude of 

 southern Europe, Persia, and the northern 

 parts of Africa and Arabia, we are exposed 

 alike to the stimulating and dangerous 

 sunburn of the south and the cold dry 

 winds driving down upon us from the con- 

 tinental area of Canada and the high 

 north. In this fact perhaps we shall some 

 day find one of the principal causes of that 

 eager, strenuous, often nervous and some- 

 times excited, condition which we may call 

 " Americanitis. " 



Another conspicuous failure is our rural 

 and industrial hygiene and sanitation. 

 "With vast regions given over to rural life, 

 and with other regions called industrial, 

 small in area but teeming with life and 

 noise, we have as yet only touched the sur- 

 face of the public health problems in- 

 volved. The same is even more true of 

 the problems of alcoholism and venereal 

 disease. Here we shall probably learn by 

 comparison with the spitting evil that it is 

 easier to overcome habit than to conquer 

 appetite, and we must be prepared for de- 

 lays and disappointments yet without giv- 

 ing up hope. 



Some streets of most American cities are 

 often disgracefully dirty and untidy. 

 Horse-dung and other dirt, dust, papers, 

 fruit skins, old hats, abandoned umbrellas, 

 discarded shoes and the like are too often 

 seen lying about our streets. Yet these same 

 streets are the principal playgrounds of 

 the poor, and ought for every reason to be 

 kept scrupulously clean. We have devised 

 excellent apparatus for heating and venti- 

 lating halls and houses in our polar win- 

 ters but have neglected the almost equally 

 important problem of cooling habitations 

 and public buildings in our tropical sum- 

 mers. We have not done all we might 

 do for the prevention of blindness, of 

 tuberculosis or of cancer. Our vital sta- 

 tistics are not yet either complete or trust- 

 worthy; our health boards are too often 

 loaded up with political refugees, political 

 doctors, and ignorant or incompetent lay- 

 men. Our health officers are frequently 

 untrained, ill-paid, or only part-time em- 

 ployees of a no-time board. 



But above all I must put our almost com- 

 plete neglect of preventive personal hy- 

 giene. From 1720 to 1886 we had little to 

 show in public health work beyond vacci- 

 nation for small-pox — the fundamental 

 procedure of preventive medicine. To this, 

 which has since expanded immensely in 

 various directions, we have added preven- 

 tive sanitation, by which I mean the puri- 

 fication of water and sewage and milk, the 

 control of mosquitoes to guard against ma- 

 laria and yellow fever, improved housing, 

 and many other fundamentals of a sanitary 

 environment. But we have not yet even be- 

 gun to demand that study and care of the 

 individual which is the most fundamental 

 of all public health problems. We have 

 paid little or no attention to the preven- 

 tion of overeating, overworking, overdrink- 

 ing, deficient exercise and deficient sleep- 

 ing, to family hygiene, and the hygiene of 



