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reform in these three years prevented about 600,000 cases of sickness. And who were the chief of the reformers? You physicians. The millions, nay hundreds of millions, thus saved in the last fifty years in this city alone would enrich even the most avaricious of nations.
I need not tell an audience of doctors what has been done in diphtheria, but I may well refer to its results so that you may in turn remind others. It has been done in our day; and it has been done not as a result simply of constant and fruitless trials of various supposed means of cure; it is not simply the work of a shrewd doctor carefully observing symptoms and noting the effect of remedies: but it has been done by exact laboratory work by quiet men who have been working far away from the sick-room with not a single human patient under their care, men who are not practitioners of medicine, but pathologists and bacteriologists, experimenting on rabbits, guinea-pigs, and mice instead of on men and women, and especially dear little children; and thus working unobserved, unheralded, unseen, they have given to the human race a boon second almost to that of Jenner.
As was shown by the report of the Pædiatric Society not long ago, the mortality of diphtheria has fallen from 40 to 8.8 per cent. In the laryngeal cases, before the introduction of the serum treatment, the mortality was 73 per cent. and the recoveries 27 per cent. Since that time precisely the reverse has been the case; the mortality is now 27 per cent. and the recovery rate 73 per cent.!
And yet there are actually people who reject vaccination and try to prove that the serum treatment of diphtheria is of no use!
In the little town of Plymouth, Pennsylvania, a town of 8000 people, a few years ago on its outskirts occurred one case of typhoid fever, in winter, with snow on the ground. All the dejecta of that patient were thrown out upon the snow. When the warm springtime came and the rain fell, it washed
the poison from this patient into the reservoir which supplied the town of Plymouth with water. As a result, 1200 cases of typhoid developed-nearly one-sixth of the entire population-and the town was almost desolated. We have had a somewhat similar experience in another Pennsylvania town, at Butler, when the water-supply was contaminated; and you have seen in this State some of the flower of your young men cut off at Ithaca for the same reason. And all of this was preventable!
When the medical profession has shown you what can be done in the way of preventing typhoid fever, I ask you whether it is not of enormous commercial value to the public, to say not one word of its philanthropic value, in the saving of so many valuable lives?
In 1892, an epidemic of cholera broke out in the town of Hamburg; 18,000 people were smitten down with the disease and 7614 died. Lower down on the river Elbe, where the sewage of Hamburg was added to the other impurities of the river, in Altona, a town continuous with Hamburg, there were but 516 cases. Why? Because Altona had a thoroughly efficient filtration plant and Hamburg had not; yet the researches of the medical profession had shown that proper filtration of the water-supply filtered out all the germs of cholera. Which would have been the cheapest plan-to spend a few millions of dollars on a good filtration plant, or to smite its commerce with a blight for months, at a cost many fold that of the filtration plant? You note that I say nothing of human lives and human woes. The grim satire is completed when I add in addition to the immense cost to its commerce Hamburg had to build the filtration plant after all. I need not refer to any other than this one instance of a single disease to establish the value of the work done chiefly by the researches of the medical profession. The engineer, the architect, other professions, the public-spirited citizens who are in control of municipal affairs, deserve large credit, all of them; but,
after all, you gentlemen and your confrères in the medical profession are the backbone of this humanitarian progress.
Malaria was formerly thought to be the result of the decomposition of vegetable matter, and that it originated in low-lying swampy land. In Italy alone to-day more than half a million acres of land are entirely waste and desolate because of this dread, disabling disease. On the Adriatic Railway it cost the company one million francs per annum to take care of their sick, due to malaria; but now, thanks to the investigations of medical men, we know perfectly well that if you shut out the mosquito you shut out malaria as well as yellow fever. The warning will be heeded by this country when we dig the Panama Canal. Then, I have no doubt, you will see a splendid object lesson in sanitation, which will carry conviction to us all of the money value of medical research in the saving to the country, to you and to me, of millions of dollars and of thousands of lives.
Of tuberculosis I need scarcely speak, for we all, alas, know its ravages in our homes and hearts. We are on the verge of an equally beneficent improvement in its treatment. In Germany the cure of even ten per cent. of its victims, it is estimated, on a moderate money value of the daily labor of those who recover, will add two millions of dollars annually to the resources of the State. Are not such money results a generous percentage of income from a moderate endowment? And human lives and human happiness cannot be reckoned in dollars and cents.
In military hygiene and sanitation the money return is equally promising. In the British fleet in the West Indies in 1726-I am stealing from a recent address of one of your New York doctors, you see-out of a force of 4750, 4000 died as a result of bad sanitation. On the West African cost the mortality was 69 per cent. During our own Civil War 20 per cent. of the armies were sick. But in spite of all the outcry that there was,-partly just and
partly unjust, during the Spanish-American War, the sick percentage was 3 instead of 20 per cent. and the mortality was 2 per cent. Even in distant and as I suppose some would call it-barbarous Manila the mortality was but of 1 per cent. But you may say these were soldiers and sailors wasting the country's substance and not adding to it; to which I reply that for every soldier or sailor who died an artisan or a farmer had to be taken from productive labor to fill his place; every soldier or sailor saved meant that another productive unit was saved to his family and to the State, and a family which threatened to become a charge upon the community was saved from expensive pauperism.
In fact, at the present day we have changed the aspect with which we look at medicine. Doctors thus far have been, and always will be to some extent, for the care of the sick; but to-day the medical profession is for the care of the well-to prevent sickness instead of curing it. I glory in it that ours is the only profession on the face of God's earth, I believe, that is trying to destroy itself.
As I am a surgeon, I have purposely preferred to take my examples from medicine, hygiene, and sanitation, rather than from surgery. But I cannot refrain in passing from calling to your minds also a few of the triumphs of surgery. The dreamless sleep of ether cannot be estimated in current coin of the realm, but what would you offer for its blessed relief were it just beyond your reach? But antiseptic surgery has a definite money value, when the mortality of compound fractures-one of the most frequent accidents, especially among our laboring population-which formerly swept into the grave sixty out of every one hundred of its victims and so often left their families destitute, is now shown to be less than five per cent.; when legs and arms formerly cut off to save life are now saved and their owners restored to the ranks of the breadwinners; when rupture which killed so
many and disabled so many more is now cured with almost no mortality; when diseased conditions wholly beyond the skill of our fathers are now remedied and their victims returned to active life. Translate these facts into figures and tell me then the money value of surgery alone to the American people! One Jenner, one Koch, one Lister, is worth a fabulous sum to the world.*
I should also refer to the commercial value of all the medical work done in animal diseases, such as trichina, which touches man as well as animals, hog cholera, chicken cholera, rinderpest, and all the other local diseases that affect our cattle. Our failure to control and eradicate hoof and mouth disease in cattle cost a single steamship line lately, in its trade to Great Britain alone, $5000 a day profit-and they say "money talks." The researches and improvements introduced by our profession have reduced the losses to the community by millions of dollars every year, because of the prevention of those diseases. But when a man does not lose his cattle, when the loss is only prevented, he is apt scarcely to appreciate what has been done for him negatively.
I think one of the most remarkable things we have observed in our day has been that experimental railway near Berlin, where on an electrical trolley line they have driven the cars up to speed of 130 miles an hour. Dr. Pritchett has given a most interesting account of it in a recent article in "McClure's Magazine." It seems that the idea began in a Stu
* As though to reinforce what I have here stated, the newspapers on April 11th called attention to the fact that Dr. Daniel Lewis, the Health Commissioner of the State of New York, in his Annual Report to the Governor said:
"If the monetary value of a human life is assumed to be $5000, the deaths from only five of the preventable diseases during 1903 in this State represents a loss of $94,960,000. These figures seem appalling and yet millions upon millions can properly be added to this sum, in loss of wages, expense of the care of the sick, and many other expenses incidental to the management of these epidemic and infectious diseases."