WITH 
Compliments of tine Aittlioi'- 
SICKNESS A FACTOR OF POLITICAL ECONOMY. 
COST OF SICKNESS TO THE INDIVIDUAL 
AND THE STATE. 
Annual Address 
DELIVERED BEFORE THE 
CONNECTICUT MEDICAL SOCIETY, 
AT 
HARTFORD, MAY 23, 1889, 
BY 
George ID. Porter, m.d., 
Bridgeport, Conn. PRESIDENT’S ADDRESS. 
Gentlemen of the Connecticut Medical Society and Deleyates oj 
Sister Societies: 
In accordance with due and ancient custom, established by 
our professional ancestors, and by their successors honored in 
the observance, we are again assembled to share the fruition of 
the year’s experience in the practice of medicine. 
To the Ninety-eighth Annual Convention of the Connecticut 
Medical Society I give you cordial greeting; to the consideration 
of the topics announced in its programme I welcome you ; to a 
personal participation in the discussions I invite you. 
To the present membership is transmitted the responsibility 
of perpetuating the prosperity of our Society, made eminent by 
the achievements in surgery and medicine of many of its 
distinguished leaders, adorned with the charms of tradition and 
enriched with the wisdom of professional experience. The desire 
for mutual benefit and improvement cherished by its founders, 
who for many years attempted in vain the organization as orig- 
inally proposed, finally established a Society for the purpose of 
“ rendering the Practice of Physic more Safe and Serviceable to 
the Patient, and at the same time yield more Satisfaction and 
Honour to the Profession.” 
This honorable ambition of the charter members of the Society 
has been its guide through the nearly completed century of its 
existence. 
The perusal of the record of its proceedings reveals that with 
varying conditions of public opinion arose many expressions of 
dissensions, of opposition and of protest, but that a sturdy loy- 
alty, “ which runs through all and doetli all unite,” to the 
principles of the Society, equally the principles of the profession, 
has ever encouraged its members to labor for the increase of 
medical knowledge, and for the general welfare. Progress in 
this direction has resulted from efforts made within the Society 
with scant assistance from without. 2 
president’s address. 
Its experience has been the same as that common to many 
similar attempts by medical men to secure the public health of 
communities. Their benevolent aspirations have often been dis- 
couraged by feeble support, abashed by a disdainful apathy or 
extinguished by unreasoning denunciation. 
The opposition to medical interference with the spread of 
disease, upon the part of an ignorant public, when the attention 
of the practitioner is so imperatively demanded by the individual 
sufferer, is a curious historical fact. Its universality attests that 
it is an inherent mental quality. Not to recur to tradition, pos- 
sibly colored by the glamour of an interested exaggeration, 
illustrative instances present themselves in our own time. Dur- 
ing the recent cholera epidemic in Spain and in Italy, the popu- 
lace refused to avail themselves of the sanitary and prophylactic 
measures proposed by medical authority, and were so violent in 
personal abuse that physicians required, in their daily attendance 
upon the sick, the constant protection of police and military 
power. During the epidemic of cholera in St. Petersburg, 
within two days in June, 1831, “One German physician was 
killed, two narrowly escaped the same fate and six others were 
severely beaten; ” * a gruesome fate and a hard experience to 
reward our brethren who were enacting for suffering strangers, 
in a strange land and among strange people, the Christian 
devotion of the good Samaritan. 
Is this blind spirit of un-reason and fanaticism the avatismal 
strain of our fetich-worshipping progenitors, when law and 
religion and medicine emanated from the banks of 
“ The still glassy lake that sleeps 
Beneath Aricia’s trees— 
Those trees jn whose dim shadow 
The ghostly priest doth reign, 
The priest who slew the slayer, 
Who shall himself be slain” f 
or is it the intuitive protest against trust in human efforts, when 
mankind, despairing of self-protection, believes that diseases and 
epidemics are the tangible evidences of the anger of an offended 
and all-powerful God? Such a supposition, however, is not 
sufficient; for the opposition, active or latent, to the assistance of 
* McClellan’s Report on Cholera, p. 552. t Macaulay’s Lake Regillus, v. 10. president’s address. 
3 
medical progress largely pervades the ranks of the educated. 
The same action of the profession has been ascribed to the most 
criminal motives, at various times, for diametrically opposite 
reasons. The clever Lady Montague, when she introduced from 
Constantinople into England, the process of inoculation of 
smallpox to secure subsequent protection from the disease, airily 
wrote upon the first day of April, 1717 : “I am patriot enough 
to take pains to bring this useful invention into fashion in Eng- 
land ; and I should not fail to write to some of our doctors very 
particularly about it, if I knew any of them that I thought had 
virtue enough to destroy such a considerable branch of their 
revenue, for the good of mankind. But that distemper is too 
beneficial to them not to expose to all their resentment the hardy 
knight that should undertake to put an end to it.” 
The other day, April, 1889, the law-makers of the State of 
New York were informed by an expert, so-called, that vaccina- 
tion was no protection against small pox, and if not told in so 
many words, were left to infer that the doctor vaccinated, not to 
protect the patient, but to collect his fee. Such opposing 
reasons nullify each other. 
To explain the mental grounds of this widespread undercur- 
rent of popular opposition to medical efforts for the public 
benefit, attempted by a profession that in official utterances and 
in personal self-sacrifices substantiates its claim to probably pre- 
vent and certainly to combat diseases, may wisely engage the study 
and the pen of the psychological student. An honest review of 
the history of plagues and epidemics testifies that, faithful 
among the faithless, medical men have fearlessly exposed them- 
selves to every personal danger, enduring privation, suffering, 
and death itself, if thereby they might minister to the afflicted 
and find out some way of escape for the rest of mankind. 
The history of our Society, illustrating at its organization the 
condition of the profession in New England after the close of 
the Revolutionary War, and in its different decades the progress 
of medical knowledge throughout the State, recounting the 
changes in its general relations, and its chartered rights as 
affected by Legislative enactments, is instructive and encour- 
aging. But a review of this history and a comparison of the 
Medical and Surgical theories and beliefs of the eighteenth 4 
president’s address. 
and nineteenth centuries will be more appropriate when the com- 
pletion of its five score years shall have been accomplished. 
The most important event in the medical world during the 
past year, was the Congress assembled in Paris in July, 1888, 
for the study of Tuberculosis. Its list of members included the 
names of many representative men in General and Veterinary 
Medicine throughout the world. Its time was occupied by the 
reading of papers upon, and the discussion of questions relating 
to the contagiousness of consumption from infected persons and 
animals, and the transmission and development of the bacilli of 
tuberculosis during the process of the digestion of the meat and 
milk of diseased cattle. 
The statements of personal observation and experience, as 
well as the reports of committees for experimental investigation; 
the design of essays, and the purport of discussions developed 
an almost universal consensus of belief in the possibility and 
probability of its contagiousness. 
In some cases cited, so direct was the exposure to the disease 
and its subsequent development; in others so eliminated were 
foreign sources of contamination, so exactly did experimental 
provings coincide with apriori reasoning and recorded histories, 
that individual opinions supported and endorsed the radical con- 
clusions of the meeting; conclusions, which may seem to many 
unacquainted with the startling illustrations and deductions 
from individual cases and classified statistics, presented during 
the discussions, to have been at least hastily, and perhaps rashly, 
formulated as the deliberate expression of the belief of the 
medical profession. 
The most remarkable event in our National life during the 
past year, was the centennial celebration of the Inauguration of 
the first President of the Republic. The permanent value of 
so general an observance of the event is its educating influence 
upon the National character. The study of the resemblances 
and contrasts of the two historic events, separated by the inter- 
val of a hundred years; of the condition of the Nation, then 
essaying the original and unexpected problems of an experiment- 
al Republic—problems still further complicated by the jealousies, 
claims and opposing interests of the several States, and of the 
Nation, now cemented by common interests and accepted laws, president’s address. 
5 
purified from the reproach of harboring “the sum of all villainies,” 
fused into a homogeneous people in the furnace of internecine 
warfare, enriched with population and material wealth far 
beyond even the hope of its founders—a realization of these 
great contrasts should arouse a loyalty to the spirit of personal 
liberty, combined with civic duties which made possible the suc- 
cess of the Republic, and impress every thoughtful person with 
the burden of personal responsibility, not alone to preserve our 
heritage unimpaired, but also to transmit it, strengthened by 
the best efforts of his generation. 
It seems appropriate to invite your attention to the considera- 
tion of a subject which is now under investigation by European 
Physicians and Statesmen, and in the near future will in America 
demand and command National action. 
As physicians we are concerned in its study, most familiar 
with its effects, conversant with its immediate statistics, and best 
prepared by education and experience to obstruct its devel- 
opment ; as members of the commonwealth we are liable per- 
sonally and familywise; we are sure socially to suffer from the 
multiform evils of its results. 
SICKNESS A .FACTOR OF POLITICAL ECONOMY. THE COST OF SICKNESS 
TO THE INDIVIDUAL AND TO THE STATE. 
An extended research has not disclosed any tabulated statistics 
nor any previous paper upon this particular topic, except a brief 
paper upon the cost of scarlet fever, diphtheria and typhoid 
fever, in Albion, Michigan, by Dr. B. A. Brown; a reference to 
the cost to the city, in a paper upon an epidemic of yellow fever 
in Memphis, by Professor Brewer; a few sentences by Dr. 
Billings at the conclusion of his report upon the vital statistics 
of the tenth census, and an Inaugural Address before the College 
of State Medicine of London, England, in 1887, by Dr. R. 
Brudenell Carter, who writes that his address is not yet 
published. 
At the beginning of this inquiry, its extent was not anticipated. 
It is a labor demanding many co-workers. An investigation of 
consumption upon somewhat similar lines undertaken by many 
physicians in England, was not completed for a number of years. 
With no claim to exhaustively present the case, enough statistics 
will be furnished to exhibit its importance, and to prove that by 6 
president’s address. 
accomplishing the decrease, or even preventing the increase of 
sickness, public men would practically demonstrate their States- 
manship. 
Writers upon Political Economy hold ♦that the fundamental 
purpose of National organization determines the unit of value. 
In the earlier civilizations of Asia Minor, and Southern Europe, 
when military aggrandizement established, enlarged, supported 
or destroyed the State, the military capacity of the commander, 
and the fighting efficiency of the army were the most important 
considerations, and the soldier was the unit. The ambition of 
governments encouraged the development of the warrior, and to 
this end overrode the claims of property, the comfort of the 
individual, the ties of family and relationship, and the sentiments 
of humanity. 
“ For Roman in Rome’s quarrel spared neither lands, nor gold, 
Nor limb, nor life, nor son, nor wife in the brave days of old.” 
On the rocks of classic Greece, joining his puny cry to the 
much resounding waves of the Egean, the Spartan infant asserted 
his right to live, and share in the glories of the heroes of Ther- 
mopylae. 
In medieval Europe, as increasing numbers became more de- 
pendant upon the products of agriculture, as indeed in all 
agricultural communities, the amount of fertile land and the 
number of slaves became the standards of value, and it was no 
longer the Soldier, who had then become largely the Soldier of 
Fortune, and the defender of the longest purse. 
“ ‘ Soldiers! those German gentlemen are bought 
For four pounds, eight and seven pence per man, 
By England’s King; a bargain as is thought. 
Are we worth more f Let’s prove it now we can; 
For we must beat them, boys, ere set of sun, 
Or Mary Stark’s a widow.’ It was done.” * 
Centres of population still enlarging in a multiple ratio in- 
creased their actual and artificial wants, which developed systems 
of agriculture, manufacture and transportation dependant upon 
labor, which in turn became in proportion to the extent that 
it was independent, one of the principal units of value. 
* “Connecticut,” by Fitz-Green Halleck. president’s address. 
7 
“Labor,” writes Adam Smith in his Wealth of Nations, “is 
the real measure of the exchangeable value of all commodities. 
Labor alone, therefore, never varying in its own value, is alone 
the ultimate and real standard by which the real value of all 
commodities can at all times and places be estimated and com- 
pared. It is their real price, money is their nominal price only.” 
This was the conclusion logically deduced from the philosophic 
teachings of Smith, Malthus, Ricardo, James Mills and Harriet 
Martineau. Hence arose the “ System of natural liberty,” 
founded on the right of the individual to an unimpeded sphere 
for the exercise of his economic activity—individualistic rights 
rather than Socialistic duties. 
As capital, the accumulated wealth of labor; machinery, the 
Briarean cross of invention and material, and skilled and un- 
skilled labor became factors in the problem, the commercial 
standard of value was shifted to the precious metals, and as 
these also were subject to the law of a supply and demand, the 
world wide standard has been restricted to gold. 
In contra distinction to the above theories the modern school 
of Political Economy holds that the wealth of Nations does not 
consist of military power, or material possessions alone, but 
resides in the intellectual and physical ability of its people to 
develop the agricultural and mineral resources of its territory, 
to institute systems of education, manufacture and transporta- 
tion, to secure the largest individual liberty consistent with the 
rights of the community and personal duties to the State—to 
contribute materially and morally to the welfare of the race. 
Nor is this strictly a modern theory. Antonio Serra, “ regarded 
by some as the Creator of modern political economy,” in 1613, 
when confined for attempting to liberate Naples from the Spanish 
yoke, and to establish a Republican government, inculcated 
“ the importance towards the acquisition of wealth, not alone of 
favorable external conditions, but of energetic character and 
industrious habits in a population, as well as of a stable govern- 
ment, and a good administration of the laws.” 
The historic school in the writings of Adolf Wagner, “ recognizes 
the State as not merely an institution for the maintenance of 
order, but as the organ of the Nation for all ends which cannot 
be adequately effected by voluntary individual effort. Whenever 8 
president’s address. 
social aims can be attained only, or most advantageously through 
its action, that action is justified. The cases in which it can 
properly interfere must be determined separately on their own 
merits, and in relation to the stage of the National development. 
It ought certainly to promote intellectual and aesthetic culture. 
It ought to enforce provisions for public health, and regula- 
tions for the proper conduct of production and transport. It 
ought to protect the weaker members of society, especially 
women, children, the aged and the destitute. It ought to secure 
the laborer against the worse consequences of personal injury 
not due to his own negligence.” * “ The abolition of the impolitic 
and discredited system of European Governments, by bringing 
to the surface the evils arising from unlimited competition irre- 
sistibly demonstrated the necessity of public action according to 
new and more enlightened methods.” * 
Political Economy, thus considered, does not hold a right of 
eminent domain, with independent laws and powers, subjecting 
all questions to the inexorable law of supply and demand, nor 
is it susceptible of precise and differential description, but it is 
only a single department—a most important one to be sure—in 
the wide realm of Sociology, and is subject to the direct and 
indirect influences of climate, country, environment, religion, 
customs and the energies of communities and individuals, result- 
ing fi*oni the varying desires, ambitions, loves, hates and necessi- 
ties of mankind. 
In the United States, the River and Harbor Bills, the Post 
Office Department, the Interstate Commerce Law, bear witness 
that some of the claims of the modern school of Political Econ- 
omy are recognized and accepted, but it is not within the compass 
of my subject to consider the intercurrent relations between the 
Government and the pursuits of its people, only as they involve 
the duty of the authorities to provide for the public health, cir- 
cumscribing contagions, preventing epidemics, discovering and 
destroying the causes of disease. So reasonable, so natural, so 
axiomatic a claim upon “ a Government of the people, by the 
people, for the people,” might seem a work of supererogation, 
did we not remember that, only within recent years have modern 
Governments accepted this responsibility, that State Legislatures 
*Encyc. Brittannic.—Art., “Labor.” president’s address. 
9 
have rarely been enthusiastic in developing this probable means 
for great good results, and that the political wisdom of the 
entire country, deliberating in Washington, has purposely starved 
into dissolution the National Board of Health by ignoring its 
record of usefulness, and neglecting to make the required appro- 
priation for its support. 
An ideal monarchy has ample resources of husbandry and 
manufacture, of mines and commerce, of convenient inter com- 
munication, of means of offence and defence, of sturdy, religious 
and contented people, of just and wise administration. An ideal 
republic must have all of these resources, and in addition must 
so educate its citizens that they may be prepared to perform 
those public duties of the State, which under other forms of 
government are intrusted to members of the nobility and privi- 
leged classes, who, by education, inheritance and association, have 
had exceptional preparation. Considering, then, that the devel- 
opment of our agricultural and mineral possessions ; the appli- 
cation of science and invention to manufacture; the prosecution 
of business and vast railway enterprises ; the conservation of 
religion and education ; the support of the State ; the political 
administration of its domestic and foreign affairs, depend upon 
“ the common peopleespecially contemplating the origin and 
fundamental theory of our Government, the conclusion is logical, 
that no other nation is as directly dependent upon the character, 
ability and strength of its citizens as our own. The unit of 
value in the Republic is the individual citizen, whose best type 
is found in him who, by personal endeavor and by public effort, 
has obtained the liberal education described by Milton: “ I call, 
therefore, a complete and generous education that which fits a 
man to perform justly, skilfully and magnanimously all the 
offices, both private and public, of peace and war.” 
To how great an extent does the health of the people under 
any form of government contribute to the development of its 
resources ; to what extent does sickness not only not contribute 
to, but often hinder and frequently prevent such development! 
A nation is established and waxes great only by the combined 
activities of a healthy people ; its decadence dates from their 
effeminacy. 
How jealous is the experienced commander of the health of 10 
president’s address. 
liis troops; with what care does the medical officer inspect the 
anatomy and investigate the physical history of the recruit, in 
search of all present personal defects, and probable cause of future 
impairment,—for well do they both know that upon the possession 
of a “ sound mind in a sound body ” may depend success, not 
only in the immediate shock of opposing armies, but in the 
grand tactics of campaigns, involving the prolonged exposure of 
forced marches, with inadequate provisions and scanty clothing, 
when the stamina of hardy veterans may compel a bloodless 
victory. No holiday troops, but only soldiers inured to personal 
privation, and toughened by exposure to rain and snow, during 
marches and in unprotected camps, could have completed that 
famous march around Richmond, when under skies that ceased 
not by day nor night from raining, through mud, where experi- 
enced commanders humanely protested that troops could not 
move, the Army of the Potomac waded for eight days, and for 
more than one hundred miles from Petersburg to Appomatox, 
and without a general engagement, virtually ended the rebellion 
and conquered a peace by strategic methods, made possible only 
by the robust health of the boys in blue. 
In all times people have realized that the warning of the 
prophet Samuel voiced the experience of mankind, that military 
power would demand and take the best material. 
In affairs of State, of jurisprudence, of medicine, of theology, 
how necessary to investigation, judgment and decision, is an 
intelligence which is not impaired nor distorted by physical 
ailments. Says Voltaire: “ The fate of a nation has often 
depended upon the good or bad digestion of a Prime Minister.” 
Business prosperity, struggling between the upper and nether 
millstones of the tyranny of capital and the tyranny of labor, 
financial ventures, exhausting body and mind with unceasing 
anxiety, often depend for success upon health and physical 
endurance. 
The necessity of good health to accomplish the work of the 
farmer, the mechanic, the miner and the laborer, may be realized 
when we read that “ it has been calculated that a fair day’s 
work equals 300 foot tons (i. e., lifted one foot), a hard day’s 
labor 450 foot tons, and the maximum day’s labor has been fixed 
at 600 foot tons. president’s address. 
11 
“It must be borne in mind that when the amount of work 
required exceeds the average amount of it, which the human 
system is capable of sustaining, the strain upon the nervous and 
muscular systems, and especially upon the heart, increases in a 
geometrical ratio.” * 
That “public health is public wealth,” is an unquestioned 
adage, but it conveys slight significance of the importance of its 
possession. The car, the steamboat, the telegraph, the postal 
service, are public conveniences, and in their daily employment are 
used without a thought of how necessary they are in modern 
civilization, but when obstructed by design, by accident, by storm, 
the failure to perform their part in our daily life demonstrates 
their importance. No less marked is the contrast between the 
state of health and of sickness in the individual, and in the 
community. Prevented by sickness, the customary duties de- 
pendent upon the active brain, the busy hand, the intelligent 
strength cease. The laborer becomes a burden. The supporter 
becomes a dependant. The wage-earner becomes a surplus 
destroyer. As the value of perfect machinery is better appre- 
ciated when improved, and as health is more highly valued when 
absent, since “ blessings brighten as they take their flight,” the 
cost of sickness to the person and to the public will be the most 
tangible, striking and workable data by which to appraise the 
value of health. 
Physicians comprehend so correctly what may be called the 
sympathetic aspects of sickness, the relations sustained by the 
ties of friendship, of kindred, of affection—the effects upon the 
constitution of the sufferer, upon the health of attendants, upon 
the inheritance of children, and the far reaching consequential 
damages of sickness, that to them only incidental reference is 
required. But sickness is not often considered in its monetary 
aspect alone, although it is frequently characterized as an expen- 
sive experience. 
The precise cost of sickness to the individual cannot be 
definitely determined, because the conditions of life are so 
various. The recent sickness of the beautiful American actress, 
Miss Anderson, in its immediate expense and prospective loss, is 
estimated to have involved a loss to herself and to her business 
*Dr. Joseph Jones, Ninth International Med. Congress, Yol. IV., p. 301. 12 
president’s address. 
manager of more than $50,000. For medical attendance upon 
his daughter, a generous father last April was reported to 
have rewarded her physician with a fee of $75,000. A praise- 
worthy precedent. The sickness of business and professional 
men often involves the miscarriage of enterprises and pre- 
vention of personal efforts, which immediately and prospec- 
tively occasion a monetary loss far in excess of the large direct 
expense of professional and other attendance. These exceptional 
cases are referred to, that they may be considered in determining 
an average. 
In the first Annual Report of the Commissioner of Labor in 
1886, made to the Secretary of the Interior, Commissioner 
Wright states (p. 142) that “ a casual examination of these sum- 
maries ” (Table of rate of daily wages in selected occupations 
throughout the United States,) “will show that any attempt to 
prove an American rate of wages must necessarily result in 
failure. There is no such thing as an American rate of wages.” 
But for our purpose a determination of the precise amount is 
not required. An approximate average of the wages paid to 
skilled and unskilled labor is over $1.50 a day. When the 
laborer is sick, his medical attendance, medicines and food are 
estimated at $1.00 a day. But that we may under-, rather than 
over-estimate, we will claim that it costs the laborer daily, in loss 
of wages and necessary expenses for his own sickness $2.00, for 
the sickness of his wife or child, $1.00. The total population of 
the United States in 1880, was over fifty millions (50,155,783). 
Upon June 1st, 1880, an attempt was made to compile the num- 
ber sick and disabled that day, omitting those under the age of 
fifteen years, lunatics, the blind, deaf and dumb. “ This is the 
first experiment of this kind which has been made in this country, 
but similar attempts have been made in the censuses of Ireland 
and the Australian Colonies.” It was only partially successful. 
In a total population of 13,998,301, there were reported 178,246 
sick persons, with the exceptions above referred to. There were, 
probably, many not reported. The proportionate number of sick, 
had the full census been taken, would have been in round numbers 
637,500 or 12.75 per thousand. There was no enumeration 
of the sick under the age of 15 years: a low estimate of sickness 
among children is one quarter of the total sick. Therefore it is president’s address. 
13 
probable that upon June 1st, 1880, there were sick 637,500 men 
and women, and 159,375 children. From the above premises the 
cost to the individual, assuming that June 1st was an average 
day, and deducting one dollar a day for sixty-five days when the 
man might not have work, would be more than $392,000,000. 
When the wage-earner is sick his earnings stop. The support 
of himself and of those dependent upon him must be defrayed out 
of his accumulation, or be supplied by the State. The cost to the 
individual is intentionally restricted to the loss of wages and per- 
sonal expense, that it might be separate from the cost to the State. 
To the sufferer his personal loss and sickness seem all impor- 
tant ; to the community they may be thought worthy of sympathy 
and assistance, yet subordinate to the general welfare. Human- 
ity tenders relief, but self protection demands the isolation of 
scarlet fever and diphtheria, the inclosure of small pox in pest 
houses, the quarantine of yellow fever in sanitary camps. In 
fashionable hotels and on shipboard the victim of contagious 
disease is regarded almost as >_a malefactor, although in this 
“ piping time of peace ” he is not subjected to the treatment expe- 
rienced by Jonah. 
Compared with the public interests, small and insignificant are 
those of the individual, who passes away and is soon forgotten, 
and whose place is taken by another, but freighted with grander 
possibilities, and wider responsibilities sails on our Ship of 
State. 
“ Sail on, O Union, strong and great! 
Humanity with all its fears, 
With all the hopes of future years, 
Is hanging breathless on thy fate!” 
The relative importance of the sickness of the individual, and 
the general sickness of the community, is best appreciated by 
considering the effects of a contagious epidemic. As increasing 
sickness proclaims the pestilence, an ill-defined dread asserts 
itself; public entertainments are unattended, educational institu- 
tions closed, public and private business is unperformed—fear 
engenders suspicion, suspicion enmity, enmity violence a panic 
is inaugurated, communication is impeded or prohibited, food 
and other supplies are lessened, the duties incumbent upon 
family relations and common to the race are repudiated;—fam- 14 
president's address. 
ine, rapine and “the shot-gun policy ” add their horrors; civiliza- 
tion returns to barbarism; humanity becomes inhuman. 
Cholera and yellow fever portray but feebly the terrible exper- 
iences of those pestilences, which so pitilessly destroyed mankind 
until the beginning of the 19tli century, when their violence was 
abated by medical ingenuity and wisdom and sanitary precau- 
tions. The history of a single disease will illustrate. 
Small pox was not known by the early Greeks and Romans, 
was first recognized A. D., 569, the year of the birth of Mahom- 
met, when an Abyssinian army threatening Mecca unexpectedly 
raised the siege, probably because of the dreadful mortality 
caused by an epidemic of this disease. Bruce during his search 
for the sources of the Nile, found a manuscript of the war con- 
firming the Arabian account. A tradition of the East assigns 
the origin of the disease to the camel. 
A disease so fatal as to cause a death rate of 95% of all 
attacked ; so infectious from person and clothing, seizing, with 
few exceptions, all who for the first time come within its influence, 
and in some cases re-attacking for the second, third and even 
more times, largely evolves its own history. 
At its first entry into a community, all being unprotected, its 
ravages were general. In countries with dense populations and 
constant commercial intercourse, there would only occasionally 
be extensive epidemics among the adult population, but among 
the young the sickle of death would reap continual harvests. 
Dinsdale, who inoculated the Empress Catherine, puts the 
annual deaths from small pox in the Russian Empire, at two 
millions. In France and Sweden, one-tenth of all the deaths 
were caused by small pox; in England, not in epidemic years, a 
fourteenth. It has been estimated that in Europe, previous to 
the year 1800, there died of this disease alone, more than twenty- 
five millions of people. 
Clark testifies that the small pox mortality of China is incal- 
culable. 
In communities isolated bv geographical, political or commer- 
cial barriers, after an epidemic, there might be comparative 
immunity, until the contagion was again imported. 
“ In 1734, Greenland suffered its first epidemic, when nearly 
two-tliirds of its population were swept away.” president’s address. 
15 
In Iceland the disease had been early known, but upon its 
eighteenth visitation is said to have destroyed 18,000 persons, 
out of a population of about 50,000. Of this epidemic, Crantz 
narrates this terrible detail: “ In one island they found only one 
girl with the small pox upon her and her three little brothers ; 
the father having first* buried all the people in the place, laid 
himself and smallest sick child in a grave, raised with stones, 
and ordered the girl to cover him.” 
Holwell. describing its ravages in Bengal, says: “ Every seventh 
year it is epidemic in March, April and May. The disease is of 
the most malignant kind, from which few, either native or 
European, escape * * * many dying upon the first, second or 
third day of the irruption.” 
On this side of the Atlantic, it has been known since 1518, when 
it concurred with fire and famine and warfare to complete the 
destruction of St. Domingo, and soon after in Mexico, smiting 
down three and a half millions of its population. 
Prescott describes this terrible epidemic as “sweeping over 
the land as fire over the prairies, smiting down prince and 
peasant * * leaving its path strewn with the dead bodies of the 
natives, who perished in heaps like cattle stricken with murrain.” 
“ In Brazil in 1563, it extirpated whole races of men ; in the 
single province of Quito, it destroyed upwards of one hundred 
thousand Indians.” 
In the United States, Catlin, in his “ Letters on the Manners, 
Customs and Condition of the North American Indians,” thus 
vigorously notes the effects of this disease: “ Thirty millions of 
white men are now scuffling for the goods and luxuries of life, 
over the bones and ashes of red men; six millions of whom 
have fallen victims to small pox, and the remainder to the sword, 
the bayonet, or whiskey.” 
In 1837, near the forts on the Missouri, this disease raged 
among the Mandans, the Crows, the Black Feet, the Bicaries 
and the Assinniboines. 
The Assinniboines, nine thousand in number, were nearly exter- 
minated. 
The Ricaries were reduced from four to two thousand. The 
Mandans, a once powerful tribe, reduced by many previous 
disasters to fifteen hundred souls, were exterminated, save a 
remnant of thirty persons. 16 
president’s address. 
Thus has history recorded these sad stories, revelations of 
unutterable misery. For more than a thousand years this “pest- 
ilence which walketh in darkness, this destruction which wastetli 
at noon-day,” was the unwelcomed guest of our ancestors. A 
temporary respite was purchased only by an increase of future 
victories. Its coming was almost as certain as death, its frequent 
companion. Its sign manual was stamped upon the features of 
many races. There was no protection, save personal idiosyncracy, 
or a previous attack, and the latter sometimes failed. In Europe, 
at the beginning of the 18tli Century, this was the bitter experi- 
ence : 
I. For every five persons thus secured against the disease, at 
the price of much past suffering, one, at least, must have died. 
II. One-fourth of mankind were thus destroyed, or maimed, 
or disfigured for life. 
III. No rank protected. In the family of William III., of 
this disease died his father and mother and Mary, his wife ; his 
uncle, the Duke of Gloucester, his cousins, the oldest son and 
the youngest daughter of James II., and he had himself suf- 
fered from it most severely, barely surviving with a constitu- 
tion damaged for life. 
A single case of small pox now terrorizes a community, and 
properly demands the attention of the authorities. Imagine 
that condition of affairs when it was not very unusual for 
every fifth person to have the disease. The cloud of this terror 
was never so dark as just previous to A. D., 1717, for English 
intelligence began to realize its certain and fatal influence. 
“ Just then, as through one cloudless chink of a black, stormy 
sky, shines forth the dewy Morning Star,” the rays of another 
Star of Promise illumined the East. 
During the Middle Ages, a protection against small pox was 
secretly employed among the Chinese, and the Brahmins had 
long known its value. It was practised in Persia, Armenia, 
Georgia, and among the peoples dwelling upon the eastern shores 
of the Mediterranean. In 1714-16, communications by medical 
men regarding the practice of inoculation in Constantinople and 
Smyrna, were published in London. 
In 1715, in the Highlands of Scotland, by rubbing with the 
small pox virus, the kindly pock was given. [ Simon.] RRESIDENt’s ADDRESS. 
17 
Public curiosity was effectually awakened, however, by a letter 
dated Adrianople, April 1st, 1717, O. S., written by Lady Mary 
Wortley Montague, and confidence in the foreign preventive was 
established by her patriotic action of almost publicly inoculat- 
ing her son, in England, four years later, and by the critical 
experiment of inoculating two children of the Royal Family, 
in 1722, after a preliminary trial upon seven condemned crim- 
inals. 
But inoculation did not entirely protect. Kennerdy states 
“ the second infection is rarely or never in the same manner, or 
the same fullness of malignity,” and is commonly called bastard or 
hog-pox, modern varioloid. 
Objectors were plenty. Massey, an English divine, in a ser- 
mon against inoculation, 1722, says: “Let the atheist, and the 
scoffer, the heathen and the unbeliever inoculate and be inocu- 
lated.” He held that natural small pox was a useful check on 
the increase of vice and immorality. In France, Monsieur 
Hecquet objected, because it came from Turkey, and had been 
well received in a Protestant country. 
Another objection was its danger. During the first eight 
years of its practice in England, out of eight hundred and forty- 
five inoculations, seventeen died. The results were proportion- 
ately about the same in Boston, Massachusetts. Still another 
objection was the expense which was so considerable, that only 
a small proportion of the whole population would, or could be 
inoculated. 
At the close of the eighteenth century, statistics showed that, 
for the thirty years immediately preceding the introduction of 
inoculation, of a thousand deaths, seventy-five were caused by 
small pox;-—for the last thirty years, of a thousand deaths, small 
pox caused ninety-five. 
Expense and partial protection, and a definite ratio of deaths 
would not have stopped the practice of inoculation, but the fatal 
objection was this: that every case was one of small pox itself, 
consequently, a constant source of infection to the unprotected. 
The means of relief increased the general danger. “ Medicine 
was baffled and helpless.” No hope of escape but, “ for after- 
time,—for millions of our race—the continual raging of that 
pitiless plague.” The dawn of promise, bright with belief of 18 
president’s address. 
protection, by contrast made more gloomy the shadow of the 
pestilence. Again, 
“ The dreary day grew drearier 
Toward night descending.” 
In the w-est of England, near Bristol, a village doctor’s 
apprentice heard the tradition among the dairy folks of Glouces- 
tershire, that cow pox protected from small pox. “ The thought 
was never after absent from his mind.” For thirty years he 
studied, investigated and experimented. In 1798, he published 
his “Inquiry into the Causes and Effects of Variola Yaccinfe,” 
“ a master piece of medical induction,” claiming: 
I. Tr admissibility of vaccine virus through human bodies 
without impairment, 
II. Establishing thereby a constant supply. 
III. Safety of operation, without infecting others. 
TV. Protection from small pox. 
This introduces Edward Jenner, the investigating physician, 
who, of all the children of men, has done most to relieve man- 
kind of misery. 
The distinguished surgeon of St. Thomas’ Hospital, Dr. Cline, 
and Dr. Woodville, of the Small Pox Hospital, examined and 
endorsed the claims. Thousands were vaccinated, were then 
exposed in every way to the contamination of small pox, and 
experienced no evil results. England believed finally in the 
matchless discovery and has legislated accordingly. In 1807, 
the Report of the Royal College of Physicians was made to the 
Crown and was adopted in the House of Commons, after “ such 
a debate as is seldom given to matters of concord, when the 
foremost members of the House honored themselves by honoring 
the great benefactor of mankind.” “ From this period dates 
the almost universal vaccination of children among the educated 
classes of England.” 
In 1841, inoculation was made illegal. In 1853, statistics 
showed an alarming increase of deaths from small pox in the 
first quinquennial of life, and determined the Act of that year 
which required parents to have their children vaccinated before 
they were six months old, imposing a fine of (20) twenty 
shillings; a single fine closed the case. 
In 1867, another law compelled vaccination within the first PRESIDENT S ADDRESS. 
19 
three months of life; disobedience to the law was punished by 
repeated lines or imprisonment. 
To Jenner, in recognition of the indebtedness of his country- 
men, Parliament gave £30,000. 
By the protection which resulted from the investigations of 
Dr. Jenner, the disease is robbed of nearly all danger. So cer- 
tain is its prevention, that a death from small pox is generally 
criminal; if the victim be a child, the natural guardians deserve 
condemnation for contributory negligence ; if an adult, the Board 
of Health, if they have the power to enforce vaccination, if not, 
the community, should be pilloried at the bar of public opinion 
and be made to realize that they are morally guilty of an 
unnecessary death.* 
Upon no investment, or other business venture are so dispro- 
portionate chances of failure taken as in the intelligent care of 
the public health—the sum total of individual health—mainly 
because the public opinion of the past has rested content in the 
belief that sickness is a matter of chance rather than of cause ; 
or, if of cause, that it selects its victims from those predisposed 
by unfortunate inheritance or exposed by personal irregularities 
or vices, and whether with, or without, cause, sickness concerns 
the individual and not the community, unless it be epidemic. 
Since it has been realized that the community is something 
more than a collection of individual, independent units—that it 
is composed of interdependent parts, and that the welfare of 
each person is necessary for the common good, Boards of Health 
have been established, have received a qualified recognition and 
a paltry financial support. 
But the popular question still remains, “ Does it pay % ” The 
nation is a commercial one. Its resources and their develop- 
ment, its complex population, and its rapidly constructed 
systems of intercommunication, have evolved the commercial 
spirit. To scold because of the absence of “ sweetness and 
light,” which are claimed for a class developed by educational 
and polite environment, is narrow and illogical. But to attempt 
to foster the growth of a broader and more enlightened liumani- 
* References to small pox in this address are from the English Blue Book, 
containing Report of Commission appointed by Parliament, to Investigate 
Small Pox. 20 
president’s address. 
tarianism by tlie employment of the activity, the ability, and 
the enterprise of that commercial spirit, is a judicious and feas- 
ible undertaking. 
The public condemns a theory as a matter of opinion, but 
accepts a balance sheet as a matter of fact. Congress makes 
generous appropriations for commissioners to investigate the 
cause, and to attempt the prevention of the diseases of American 
cattle and of “ the great American hog ” ; one of its members 
introduces a bill to offer a prize for the discovery of the cause 
and the cure of yellow fever ; in the former case employing the 
method of an intelligent profession, in the latter that of an 
enterprising quack. To educate public opinion by a demonstra- 
tion of provable statistics, not only that scientific investigation 
only possible by the support of the State, concerns the general 
and personal physical welfare, but that the monetary cost of 
sickness to the nation is greater than the value of all the cattle 
and hogs in the country, and that much of this results from 
preventable diseases, will speedily awaken such a sense of 
responsibility that some action will be taken, which will be 
creditable to the national reputation, will reasonably result in 
the prevention of much personal suffering, and secure large addi- 
tions to the public prosperity. 
In the Report of the Vital Statistics of the Tenth Census it is 
stated : “ From the results of data derived from mutual benefit 
societies in England it has been usual to estimate that for every 
case of death in a community there are two persons constantly 
sick; that is to say, that there is an average of two years’ sick- 
ness to each death, or that, if the annual death rate is 18 per 
1,000, the average number constantly sick is about 36 per 1,000 
of living population, and this seems to be borne out by the pro- 
portion of those taken on sick report in the army. Thus, for the 
five years, 1878-82 inclusive, the proportion constantly on sick 
report per 1,000 of mean strength in the United States Army 
was, for the white troops 43.9 and for the colored troops 41.6, or 
for the whole an annual mean of 43.7 per 1,000 of mean 
strength,”—(other tables, etc). 
Considering that troops, although carefully selected upon 
enlistment, are peculiarly exposed, we will take the smaller per- 
centage, that among the general population. president’s address. 
21 
It is a reasonable estimate that, including all varieties of sick- 
ness, every sick person must be supported and attended by at 
least one well person, and that the daily loss to the productive 
capacity of the country, directly and indirectly, is one dollar for 
each individual. By the records of the Tenth Census, in 1880 
there died 756,893 persons ; this would give a constant sickness 
of 1,513,786 individuals, a much larger number than in the 
previous estimate from the number reported sick upon June 1, 
1880; * but it must be remembered that in that enumeration, 
from its very character, many would naturally be overlooked, and 
there were intentionally omitted those under fifteen years of age, 
the blind, the deaf, and the insane. 
Accepting these premises, the conclusion would show that for 
the year 1880, with a population of a little over fifty millions, 
the loss to the productive wealth of the United States, from 
sickness, was over $1,100,000,000, which added to the personal 
loss of $390,000,000, would give a grand total of nearly 
$1,500,000,000. In the British Medical Journal, October 22, 
1887, a sanitary authority asserts : “ It is not only in France 
that sickness, with the enforced rest and expense which it 
entails, causes a loss of 708,000,000 francs every year. If pre- 
ventable diseases in England were charged in like manner, with 
waste of time and money, and other evils which they involve, we 
fear that a similar number of pounds sterling instead of francs 
would not represent the loss to the community.” 
By the tenth census in the United States there were reported 
twelve millions of milch cows, twenty-six millions of other cattle 
and forty-seven millions of hogs. Various diseases, prominently 
tuberculosis and pleuro-pneumonia among cattle, and hog cholera, 
were causing so great depreciation of immediate value and 
threatening even greater prospective loss, that in 1887 Congress 
appropriated $500,000 for the purposes of investigating the 
causes and limiting the spread of these diseases; for the same 
purpose the State of New York appropriated $105,000; Virginia, 
$75,000, and New Jersey, $12,000. The circumstances Avar- 
ranted the expenditure. Dr. Salmon, Chief of the Bureau of 
Animal Industry, reports: “ The disease (tuberculosis) is no 
greater here than in other countries, but its widespread preva- 
* See page 12. 22 
president’s address. 
lence is certain. I have encountered it from the Atlantic Ocean 
to the Rocky Mountains. Instances where this disease is intro- 
duced and spread through whole herds are now so frequent that 
every veterinarian I am acquainted with, who has a cattle prac- 
tice, is thoroughly convinced, not only that the malady is con- 
tagious, but that it is easily transmitted. This brings up the 
question as to the identity of human and animal tuberculosis 
and I unhesitatingly answer it in the affirmative.” Dr. J. S. 
Billings, a recognized authority, states: “ I venture to assert 
that the monetary loss to the cattle interests of this country 
from tuberculosis is greater than from all the other cattle 
diseases put together.”* Dr. Crundall writes: “ I have no hesi- 
tation in saying that fully thirty per cent, of the grade cattle in 
the counties of Seneca and Ontario, N. Y., are affected with 
tuberculosis. ”f 
The cattle business of this country involves many millions of 
dollars—the entire valuation of all stock in 1880 was over 
$1,500,000,000. Private interests cannot be trusted to make the 
necessary sacrifices of destroying stock as long as the‘public is 
willing to drink the milk and eat the meat of tubercular cattle; 
therefore, in the wise exercise of its authority, according to 
the principles of modern political economy, the Government 
condemns private infected herds and appropriates the public 
money to recompense this loss of the owners. If we estimate 
the value of the cattle as half of the valuation of the entire stock 
of domestic animals, their average value is about twenty dollars. 
What is the average value of the citizen? According to Mr. 
Chadwick, President of the Sanitary Association of England, 
every human being is worth (to the State) “ seven hundred and 
ninety-five dollars.” They are worth more in this country. 
Within a month a Miss Allen, who had lost the use of her jaw, 
as she claims because a surgeon of a steamboat company had 
given her mercury instead of quinine, sued for $22,000 and a 
jury mulcted the company in $11,000 damages. Within the 
same time a verdict against the Boston & Albany Railroad has 
been given for the second time, in the case of a seven-year-old 
boy, whose leg was so severely crushed by the falling of a lamp- 
* Journal Comparative Medicine and Surgery: Yol. VII, No. 1, p. 85. 
f Ibid., p. 86. president’s address. 
23 
post that amputation was necessary, to the amount of $28,500. 
It is recognized that a person, seriously injured through no 
contributory negligence, can recover larger damages if he sur- 
vives, than his heirs can recover if he be killed outright. 
For a death thus accidentally caused the maximum sum 
allowed by the courts in some of the States is $5,000. In a 
community where “ one man is as good as another,” this 
appraisement of the Statute Law must be accepted as the valua- 
tion of the individual. 
In 1880 there were reported 91,270 deaths from consumption, 
which was the largest number of deaths from any single disease, 
and the mean age of death was the thirty-seventh year, when a 
healthy person is at about the maximum of mental and physical 
vigor ; therefore, if the loss by consumption in people is estim- 
ated, as the loss in cattle by the same disease would be, it 
amounted in that single year to more than $450,000,000, and 
for the total deaths more than $3,784,000,000. 
Accepting these estimates of value, the total cost to the Unit- 
ed States of sickness among the people, and the loss by death, 
including loss and expense to the individual, and loss to the 
State in productive and personal value as citizens, amount annu- 
ally to more than $5,274,000,000. 
A decrease of one per cent, in the death rate would reduce the 
number of deaths, upon the basis of the census of 1880, by 
7,568, and effect a saving of total cost to the individual and to 
the State of nearly $50,000,000 of money. 
That sanitation reduces the death rate, official statistics prove: 
most remarkably however in limited localities. Note a single 
instance: Memphis, Tennessee, afflicted by the yellow fever epi- 
demics of 1878 and 1879, “ was in a sorry plight; its population 
greatly diminished and impoverished, its business had fled to 
other places, its debt heavy, and the interest more than due, the 
treasury empty, the city practically bankrupt.” It was such a 
menace to the prosperity of the surrounding country that “ in 
one instance at least the heartless suggestion was offered that the 
flames be made to consume what the pestilence had spared.” 
The city resigned its charter, and most rigorous sanitation was 
adopted. In 1887 it had become “in some respects a model 
city, the largest inland cotton market in the world,” and its for- 24 
president’s address. 
mer “ normal death rate of 35 per 1,000 had been reduced to 9 
per 1,000 of the white, and 20 per 1,000 of the colored resident 
population.” * 
That a large reduction may be made in total number of deaths 
in the United States is the belief of the Commissioner of the 
Census, who reports : “ Nearly one hundred thousand deaths 
occurred during the census year * * * which were, in a sense, 
unnecessary and preventable.” 
These enormous totals may seem exaggerations, but in reality 
they are undervaluations. They are based upon the number of 
deaths reported in the Tenth Census. The deaths so reported 
are never more than the actual number, but are often less. 
The number of deaths returned by the census enumerators, 
when compared with the returns of the State Board of Health, 
were, in Massachusetts, outside of Boston, 26.63%' below the 
actual number, and in New Jersey 36.50%. In other States the 
enumeration was probably equally inaccurate; the number of 
deaths returned throughout the whole country was at least 25% 
below the actual number, f 
No mention has been made of the vast sums expended for 
sick and wounded pensioners, for whose benefit since the war 
have been appropriated over $1,100,000,000. 
These estimates are for tangible loss; who can estimate the 
indirect loss to the Nation from the impaired work of the disabled, 
from* the enfeebled intellectual and bodily capacity, from the 
inherited tendency to vicious habits of thought and living ? 
The laws of nature are inexorable—disobedience creates the 
penalty—the mortgage upon functional or organic overdrafts are 
inevitably foreclosed. Through inherited feebleness and personal 
physiological ignorance and crimes, the present generation does 
not live out half its days. Nations, as individuals, too ignorant, 
or too careless to secure the health and to strengthen the char- 
acter of their people, fail in their natural duty, and, no longer in 
harmony with their environment, yield place to such new evolu- 
tion as the times may demand. 
Medicine, as an art, treats single cases of sickness or injury— 
as a science, institutes inquisitions regarding the causes of disease 
* Report Conn. Roai-d of Health, 1887, pp. 158-160. 
f Census 1880, Vital Statistics, Vol. I, p. xix. president’s address. 
25 
and their prevention. The busy practitioner is occupied with 
the immediate care of individual patients. The medical scientist 
studies the historical progress of medicine, critically analyzes 
theories, experiments and experiences;—investigates the origin, 
development and dissemination of the material causes of the 
“ ills that flesh is heir to —contrasts the influences of varying 
social conditions, examines predisposing susceptibilities produced 
by inheritence and habits of life, and solicits nature to reveal the 
occult mysteries of telluric and atmospheric environment, and 
to explain “ the sweet influences of pleiades.” 
The art and science are component parts, intimately related, 
of a single system. Their acquisitions enrich the common 
armamentary. But for the successful prosecution of their com- 
plemental labors, so different are the intellectual powers and the 
mental processes required, that they are rarely combined in the 
same individual, or, if combined, the exhausting labors demanded 
for success in one department, leave a wearied body and mind, 
and scant time for the other. 
Medical men in America are mainly dependent for support 
upon their own exertions, and with few exceptions rarely accu- 
mulate from professional work more than a comfortable living; 
their scientific work is at personal expense. 
Abroad, the money necessary for investigation, upon an extended 
scale, is appropriated by the Government. Hence it has naturally 
resulted that prominent surgeons and physicians in America 
have acquired high rank in the profession, but the great discov- 
eries during the last fifteen years—revolutionizing the theories 
of medicine—have originated in the laboratories of the Continent. 
There Pandora’s box has been again opened and hope, the sole 
remnant of the gifts of the Gods, has revealed the hidden cause 
of the evils that had before escaped. The microscope, like the 
prayer of the prophet, made plain invisible hosts, and invites to 
an investigation, which must close only when the prevention of dis- 
ease is as sure as the cause. The necessary empiricism of the 
past may now be engrafted with the exact knowledge of the 
future. 
The key of the situation is even now within the ken of the 
profession, but the mysteries attending the preparation of the 
nidus appropriate for the development of the various bacilli are 26 
president’s address. 
problems, not for the experience of the practitioner, but for the 
investigation of the scientist; not for the bedside of the patient, 
but for the laboratory of the bacteriologist. To some authorita- 
tive central Bureau, with the best scientific abilities, and ample 
financial resources, must also be referred the study of the 
unexplained distribution, throughout the United States, of 
diphtheria, cancer, consumption and other diseases, which, upon 
the illuminated charts of the census seem to have boundaries as 
definite as those of the States. 
Will not a reasoning people, claiming as “ unalienable rights,” 
life, liberty, and the pursuit of happiness, if convinced that life 
and the pursuit of happiness are curtailed by preventable disease, 
demand protection ? If assured by so eminent an authority as 
Dr. Austin Flint, that “ even a person, with an inherited tendency 
to consumption, would never develop the disease, if he could be 
absolutely protected against infection with the tubercle bacillus,” 
will they not eagerly provide every means to discover the origin, 
the development, the poisonous activities of these powerful 
agents of evil, and to accomplish their destruction 1 If assured 
by their official reports, that annually one hundred thousand 
citizens die of preventable diseases, will there not arise so violent 
a protest, that prevention shall be enforced by the National 
laws ? Alas! we must answer, “ No.” For a decade, hundreds of 
thousands of unwilling victims have been annually sacrificed to 
the juggernauts of indifference and ignorance 
A father’s devotion, a mother’s love, a son’s respect, and a 
daughter’s affection, a patriot’s loyalty, a humanitarian’s sympa- 
thy, and a philanthropist’s solicitude, either singly or combined, 
have never demanded governmental investigation. Even self- 
protection is lulled into neglect, if the danger be postponed. 
They have been “ tried in the balances and found wanting.” 
Fortunately for the welfare of the Nation, we may yet invoke 
the master spirit that commands the age. Financial considera- 
tions outlast and outweigh personal sentiments, when a continent 
is the field of action. The sensitiveness of capital has no rival 
in its demand for protection. The Government, and the far 
reaching business enterprises of the country have a more tangible 
interest in the health of the people, scattered throughout the 
length and breadth of the land, than individuals are likely to president’s address. 
27 
have, and also receive more direct returns from the improvement 
of the public welfare. To lower the death rate, thereby favor- 
ably altering the computations of life insurance tables, would 
redound to the advantage of all. An enormous decrease in sick- 
ness, and fewer deaths, increasing the general productive and 
receptive capacity, would assist in largely developing the National 
resources. The prevention of consumption—not included in the 
census of 1880, if the bacillus can be destroyed, as it may now 
be, among the preventable diseases—would prevent an annual 
loss of over $450,000,000. 
Who shall arouse a public sentiment which may attempt these 
beneficent reforms ? Nathan said unto David, “ Thou art the 
man.” The Republic, conferring personal liberty to the citizen, 
demands a personal service; and granting unrestricted oppor- 
tunities for self-improvement, imposes the gravest responsibil- 
ities. 
Says Professor Sumner: “ Every honest citizen of a free 
State owes it to himself, to the community, and especially to 
those who are at once weak and wronged, to go to their assistance 
and to help redress their wrongs. Whenever a law or social 
arrangement acts so as to injure anyone, and that one the 
humblest, then there is a duty on those who are stronger, 
or who know better, to demand, and fight for redress and cor- 
rection.” 
Not many years ago a tramp received from the benevolent in 
Bridgeport money and food to relieve his complaints of sickness, 
but when suspected of small pox, doors were shut in his face. 
For many hours he plodded the streets, his brain racked with 
dolorous pain, his body feverish with sore sickness; women 
drove him from their homes; men fled from his presence. 
“ Oh, it was pitiful, 
In a whole city full 
Friends he had none.” 
As I watched by his dying bed I wished that every opponent 
of vaccination could have been with me. He was a man, when 
in health, like the rest of us, but then moaning with pain or in 
harmless delirium reverting to the home of his childhoodwith 
face whose early softness had been hallowed by the, holy tears of 
a mother’s affection, or dimpled with delight at a mother’s joy, 28 
president’s address. 
now so changed that none might know his family, or lineage, or 
nation, or race, or even his manhood itself. 
Without act of a brother’s sympathy or a father’s pity; with- 
out the tender touch of a sister’s hand, without a word of love 
from a mother’s heart, he died. 
“ No reckoning made, but sent to his account 
With all his imperfections on his head.” 
That death was unnecessary—the disease was preventable. 
If by his own fault he died 
“It was a grievous fault; 
And grievously hath the dead man answer’d it.” 
If by the folly of his parents, then did they doom him to a 
painful, dreadful death; if by the negligence of the State, then 
was it “ a blunder which is worse than a crime.” 
Small pox, from a preventable, has become a prevented dis- 
ease ; until all preventable diseases receive a similar quietus let 
us cry aloud.