ECONOMIC ASPECT OF 
 LENGTHENING HUMAN LIFE 
 
 BY 
 
 Prof. IRVING FISHER 
 
 of Yale University 
 President of the Committee of One Hundred on National Health 
 
 Address delivered before 
 
 ASSOCIATION OF LIFE INSURANCE PRESENTS 
 
 New York, February 5, 1909 V/
 
 SAN DtEGO' I 

 
 ECONOMIC ASPECT OF LENGTHENING HUMAN LIFE. 
 
 BY PROFESSOR IRVING FISHER OF YALE UNIVERSITY, 
 President of the Committee of One Hundred on National Health. 
 
 Concerted action by life insurance companies to lengthen human 
 life would mark, I believe, one of the greatest steps, if not the great- 
 est step, ever yet taken toward the improvement of human longevity. 
 The nearest analogy is perhaps to be found in the work of fire 
 insurance companies in reducing the number of fires. But it is a 
 general truth that the best success of any movement is found only 
 when, in a sense, it reaches the commercial stage in other words, 
 when it is made to pay in some tangible way. Philanthropy is keen 
 to lead the way to reform, but becomes a broken reed if depended 
 upon for its support continuously or on a large scale. 
 
 The insurance men whom I have consulted as to whether it 
 would pay to engage in the saving of lives have been unanimously 
 affirmative in their answers. So obvious does this seem that the 
 question arises, why have insurance companies never attempted it 
 before ? There seem to be three explanations : 
 
 First, the continuance, until recently, of the tradition that 
 human mortality follows a nearly invariable law, and a law which 
 can not be appreciably affected by any act of man. 
 
 Second, after it became known to experts that human life is 
 greatly extensible through public and private hygiene, this knowl- 
 edge was possessed by so few, that the general public, and even the 
 rank and file of the medical profession, remained of the contrary 
 belief, and the inertia of their conservative opinion prevailed. 
 
 Third, it seemed too large a task for any one company to pro- 
 long life for the whole country, and there seemed no way to pro- 
 long the lives of its own policy-holders alone, so long as unsanitary 
 conditions prevailed throughout the communities in which these 
 policy-holders lived, while finally there seemed no way of bringing 1 
 the various life insurance interests to agree on concerted action. 
 
 It seems now, however, that the time has arrived when all three 
 of these objections can be removed. I assume that before this- 
 audience there is no need of presenting evidence or arguments to
 
 prove that human life may be lengthened by hygienic measures, and 
 shall therefore merely run over very briefly the most salient and 
 general facts, as introductory to the formulation of a practical plan 
 of action. 
 
 It has long been known that there is no iron law of mortality, 
 but that mortality depends on the hygienic state of the community. 
 Baines, in a recent paper in the Journal of the Royal Statistical 
 Society, has calculated that the average duration of life in India 
 is only twenty-three years for males and twenty-four years for 
 females, or less than half the life span in the advanced countries of 
 Europe. The estimates of Finkelnburg show that in Europe human 
 life has probably doubled in the last 350 years. More recent and 
 more reliable figures show that life is lengthening to-day more 
 rapidly than ever. If we take life tables for different periods for 
 England, France, Prussia, Denmark, Sweden, and Massachusetts, 
 we find that human life lengthened during the Seventeenth and 
 Eighteenth Centuries at the rate of four years per century; that 
 during the first three-quarters of the Nineteenth Century it 
 lengthened at the rate of about nine years per century; that at 
 present it is lengthening in Europe generally at the rate of seventeen 
 years per century, and in Prussia (which is perhaps the home of 
 preventive medicine) at the rate of 27 years per century. For this 
 country the rate can only be judged from the statistics for Massa- 
 chusetts, which show that life is lengthening by about fourteen 
 years per century, or approximately half of the Prussian rate. 
 These rates may not continue in the future, but the opinion of 
 our best authorities on longevity, such as Ray Lankester and Metch- 
 nikoff, is that there is still great room for improvement especially 
 after middle life. Hitherto almost all the improvement has 
 applied to ages before fifty and only the most recent figures show 
 any tendency toward improvement beyond that age. It is significant 
 that backward India in spite of the enormous room for improve- 
 ment shows during twenty years no rate of improvement whatever. 
 
 The statistics of insured lives show that the insured poor, as 
 represented by the Industrial Companies, have a mortality from 
 fifty to eighty per cent, higher than the insured rich or well-to-do, 
 as represented in the ordinary insurance companies. The unsani- 
 tary districts of Glasgow and Paris show a mortality more than 
 double that of the sanitary districts, while cities in general show a 
 much higher mortality than the open country. A fall of the death 
 rate always promptly follows sanitation. Colonel Gorgas cut the
 
 death rate in Havana in two, bringing it down to between 20 
 and 24 per 1000. The New York death rate responded at once to 
 Colonel Waring's clean streets, and that of Rochester to Dr. Goler's 
 milk crusade. And now it is announced that the death rate of 
 New York is 16.5, the lowest on record a result, in all human 
 probability due to the hygienic work of Dr. Darlington, the 
 efficient health officer, Mr. Nathan Straus, the milk reformer, and 
 the public agitation for health prosecuted by the New York Times, 
 the Journal, and other media, allied with the health work of the 
 Committee of One Hundred on National Health, the Tuberculosis 
 Association and Committees, and other organizations. 
 
 These and other facts and the mass of detailed figures which 
 they represent show conclusively that human life is long or short 
 precisely according to the hygienic conditions under which it is 
 lived ; that human life can be prolonged as these hygienic conditions 
 are improved, and that there is still enormous room for improve- 
 ment. Farr, twenty years ago, in his masterly work on Vital 
 Statistics, stated that any community could attain an average dura- 
 tion of life equal to that in the so-called "healthy districts" of 
 England where the average duration of life was then fifty-one years. 
 To bring all England up to this level would at that time mean a 
 lengthening of life by one-fifth, or twenty per cent. 
 
 A report which I have recently prepared for the Conservation 
 Commission, based on data contributed from acknowledged Ameri- 
 can authorities, shows that human life in America could, by the 
 adoption of hygienic reforms already known and entirely practic- 
 able, be lengthened by over one-third that is, over fifteen years. 
 This calculation has been made very conservatively and is prob- 
 ably several years inside the truth. The statistics and estimates on 
 which it is based have been taken from published sources, as well 
 as contributed by some score of American authorities medical, 
 actuarial, and hygienic. 
 
 A safe minimum estimate was made- of the degree of pre- 
 ventability of the deaths from each of the ninety principal causes 
 of death in the United States. For instance, for typhoid fever, 
 experience in Lawrence, Massachusetts, has shown that the intro- 
 duction of a public water filter reduced the typhoid mortality by 
 eighty per cent. In Munich the cleaning of cesspools and other 
 hygienic measures reduced the mortality from typhoid by ninety- 
 seven per cent. On the basis of these and other facts, it was con- 
 servatively estimated that eighty-five per cent, of the deaths now
 
 occurring from typhoid fever in the United States could be easily 
 prevented. Professor Sedgwick recently announced the truth of 
 Hazen's theorem that for each life saved from typhoid, two or 
 three lives are saved from other diseases. This cumulative effect, 
 however, was not taken into account in the calculations, nor was 
 account taken of the constant advance being made in preventive 
 medicine. 
 
 For these and other reasons, the calculated estimate of the 
 improvability of human life is regarded as ultra-conservative. 
 Tuberculosis is known to be preventable. In my table, it is entered 
 as only seventy-five per cent, preventable; pneumonia as forty-five 
 per cent, preventable; typhoid as eighty-five per cent.; diphtheria, 
 seventy per cent. These conservative figures are among the highest 
 allowed. Many diseases, such as cancer, are recorded in the table 
 as zero per cent, preventable, although the best expert opinion 
 would allow some degree of preventability, if prevention begins 
 early enough in life. 
 
 On the basis of these ratios of preventability, or rather post- 
 ponability of death, has been computed the possible extension of 
 the average human life <by saving lives now lost by preventable di- 
 seases. The calculation is made on the assumption that those thus 
 saved from death enjoy as their new lease of life only the expecta- 
 tion of life now belonging to their respective ages. This assump- 
 tion is very conservative, for it means that lives once saved shall 
 receive no further benefits from improved mortality, but shall die 
 off at the old rates of mortality. 
 
 Even on these safe premises of partial postponability of deaths, 
 we find that about two years of the possible lengthening of human 
 life would be due to the elimination of preventable tuberculosis; 
 .6 of a year to the elimination of preventable typhoid; .5 to the 
 elimination of preventable diphtheria; .9 to the elimination of pre- 
 ventable accidents. It is estimated that at least eight years could 
 be added to human life merely by securing reasonably pure air, 
 water and milk. 
 
 A grouping by ages will bring home these figures to life insur- 
 ance companies. It was estimated that for diseases of infants under 
 one year of age, such as broncho-pneumonia, diarrhoea and enteritis, 
 at least half of the deaths were preventable that is, postponable. 
 For diseases of childhood such as meningitis, diphtheria and scarlet 
 fever, the same is true ; for diseases of middle life, such as typhoid 
 fever, tuberculosis, pneumonia and accidents, over one-third are
 
 postponable; and for diseases of late life, such as Bright's disease, 
 heart disease and apoplexy, at least one-fourth of the deaths are 
 postponable. 
 
 These ratios may seem high at first glance, but only because 
 no one has previously attempted to assemble all ratios of prevent- 
 ability. Each investigator has seen clearly the preventability within 
 his own special sphere, but assumed that outside that sphere the 
 preventability was less. One specialist knows that tuberculosis is, 
 for the most part, preventable ; another, typhoid ; a third, diphtheria ; 
 a fourth, infantile diarrhoea. And yet each clings to the idea that 
 disease in general is unpreventable. Some of the very experts of 
 the Yale Medical School and State and Federal health officers who 
 contributed the individual estimates and these experts include 
 eighteen of the best and safest authorities in the United States 
 have been surprised to find how large in the aggregate the resultant 
 preventability is. It shows that over a third of all deaths which 
 now occur could be prevented that is to say, deferred. Every 
 precaution has been taken to make these figures so safely within 
 the truth as to avoid the possibility of any reasonable criticism. 
 I will add that those who contributed the statistics, estimates, and 
 expert guesses on which these aggregates are based were especially 
 urged to be conservative. The eighteen estimators included Drs. 
 Flint, Blumer, Swain and Osborne of the Yale Medical School; 
 Dr. Wilbur, Chief of Vital Statistics of the United States ; Health 
 Officers Townsend of Connecticut, Baker of Michigan, Wright of 
 New Haven, Woodward of Washington, Chapin of Providence, etc. 
 These gentlemen made their estimates independently, but they 
 agreed remarkably well. This would indicate that they were cor- 
 rect. These gentlemen are not given to exaggeration, but even if 
 their estimates are three times too great, the preventable deaths still 
 exceed ten per cent. 
 
 By working out the ratios of preventability for each of the prin- 
 cipal causes of death, it is possible to construct an ideal survivor- 
 ship table which may then be compared with existing survivorship 
 tables. Actuaries' tables show that a reduction of one-third in 
 mortality would enable the premium to be reduced by over fifteen 
 per cent. Even if only a third of this possible reduction were 
 obtained, or five per cent., the insured in the United States would 
 be saved many millions annually. Of course whatever saving is pos- 
 sible could not be secured without effort or cost. Not all of it 
 could be obtained at once, and some of it could be obtained whether
 
 insurance companies took a hand or not. But by so doing they can 
 greatly accelerate the improvement. While it would be manifestly 
 impossible to estimate exactly what returns could be made on the 
 investment, it is clear that even if the most meagre returns could 
 be secured, the gain would pay. 
 
 It can scarcely be imagined that the companies would lose 
 anything. I understand that $200,000 a year is about two cents per 
 $1,000 of insurance carried. It would be strange if $200,000 
 could not be expended in such a manner as to secure a saving of 
 a postage stamp a year on each $1,000 policy! As one of your 
 actuaries, Mr. Messenger, has shown, $200,000 is only one-eighth of 
 one per cent, of present annual death claims. 
 
 The chance of failure is further reduced when we remember 
 that the effect in reducing mortality is progressive or cumulative, 
 while no cumulative effect is needed to return the money invested. 
 
 The conclusion seems safe that here is a rich unexploited field 
 for saving money. And the beauty of it is that these gains bring 
 with them gains far more precious to the nation than dollars 
 immeasurable gains of longevity, vitality, efficiency, and happiness. 
 Life insurance is not philanthropy, but it is a beneficent business. 
 Though at first glance it might seem that to prevent the pollution 
 of streams, to improve the milk supply, to obtain pure foods, and 
 freedom from accident is no part of the business of life insurance, 
 yet it is easy enough to see the very vital connection. By far the 
 larger part of the cost of the insurance business is not management 
 nor agents' fees but cost of mortality. It is the right, if in fact it 
 is not the duty, of any business to reduce its cost. To pare down 
 salaries might not save the policy-holder one per cent, of his 
 premium, but to reduce mortality cost might save him many per 
 cent. 
 
 Another point may be emphasized. The mere announcement 
 that insurance companies intended to improve health conditions 
 would have an effect in improving those conditions. This effect 
 would be felt in two ways: First, it would convince millions of 
 the ignorant and indifferent that the public health movement must 
 have substantial merit to be an object of interest by life insurance 
 companies. People are easily led by those whose opinions they 
 respect. In spite of the great progress of the health movement, 
 there are still vast hordes of our people who know nothing of it. 
 Knowledge of its merits is largely confined to scientific and medical 
 men, who constitute only a small fraction of the population. The
 
 actuaries and medical boards and other insurance officials constitute 
 a still smaller class. Yet these classes can easily sway the whole. 
 The second way in which the mere announcement of your purpose 
 to labor for health would have immediate effect is in spurring 
 numerous officials and firms to reform. Every health officer, every 
 food manufacturer, every milk dealer in the United States that 
 heard of the intention of the insurance companies to improve health 
 conditions would become ambitious to make a good showing. 
 Local pride in every community would result in efforts to 
 keep abreast of the best records and avoid the reputation for being 
 an unhealthful place to live in. Insurance companies sometimes 
 charge, I believe, higher rates for policies involving tropical resi- 
 dence, but in the United States are not allowed to make local dis- 
 crimination. There is, therefore, all the more reason why they 
 might properly endeavor to lower the mortality in say Mississippi 
 if the mortality is high there in order that they might be enabled 
 to do business there. 
 
 In the history of fire insurance, the mutual companies first 
 made the effort to reduce fire risks. When the importance of ex- 
 ercising the function of preventing fires, as well as indemnifying 
 against fires, once entered into the plans of stock companies, they 
 soon overtook, if they did not outrun, the mutual companies in the 
 success of their efforts. It is estimated that the risk from fire in 
 certain particular classes has been reduced, through the fire insur- 
 ance companies, some seventy per cent. In New England seventy 
 years ago the rate on cotton and woolen mills averaged three or 
 four dollars per hundred. To-day these mills are being insured 
 at a total cost per annum of seven cents per hundred. In some cases 
 the cost has been reduced to i/ioo of the former amount. This 
 enormous decrease has been accomplished by slight expenditures. 
 In some factories the cost of improvements have been more than 
 paid for in the saving of premiums for fire insurance in one year. 
 The stock companies were forced by the competition of the mutual 
 companies to take up preventive measures. They now employ fire 
 insurance engineers to maintain a laboratory in Chicago which is 
 well equipped for the purpose of studying fire-resisting materials, 
 fire-resisting devices, new apparatus and fire prevention in general. 
 Many fire insurance men believe that this laboratory is their best 
 investment. No reduction in rate is guaranteed until fire fighting 
 devices are approved by the laboratory. Now that the stock com- 
 panies have gone into this work of fire prevention systematically,
 
 8 
 
 they are regaining the ground that they had lost by allowing the 
 mutuals to get ahead of them? 
 
 In employers' liability insurance, the idea of prevention has 
 made great headway. Here the companies are all stock companies, 
 but they have learned that their function is not simply to distribute 
 losses, but to lessen them as well. So also accident companies have 
 aided in passing laws which tend to prevent accidents to life and 
 limb. Here they have reached the very threshold of public health. 
 It is manifest destiny that if insurance companies now aid in legis- 
 lation to save the arms and legs of workmen, they will soon aid 
 in legislation to save lives also. In fact, protection from accidental 
 injury, is also protection from accidental death; and if you strive 
 to reduce the deaths from accident, why not reduce the deaths from 
 other causes? If casualty companies work for improved safety, 
 why should not life companies work for improved sanitation and 
 improved hygiene in general? In fact, the Industrial Department 
 of the Metropolitan Company has just announced that if prevention 
 of tuberculosis and reduction of the death rate will give cheaper 
 insurance, the Company hopes to co-operate with existing agencies 
 for the eradication of this and other diseases, and to place at their 
 disposal its machinery and the statistical material which it has 
 gathered since its organization. 
 
 According to the plans which I have in mind, the money 
 to be invested in life-saving would be largely in the edu- 
 cation of the public and especially policy-holders in health 
 matters, and co-operation in every legitimate way to improve 
 the public health offices and service in the municipalities, 
 states and the Federal Government. In this latter way, 
 the result of the expenditure of money by the insurance com- 
 panies would be to induce the Government to spend much larger 
 sums, and the money invested by the insurance companies would 
 be multiplied in efficiency several fold. If, for instance, by the 
 expenditure of $200,000 a year the public throughout the country 
 could be made to appreciate the importance of clean streets, pure 
 water supply, etc., sufficiently to result in municipal expenditure by 
 the cities of the United States for public health of an additional 
 $20,000,000 which would otherwise not have been made, every 
 dollar invested would be multiplied a hundred fold. In other words, 
 the insured lives would not have to carry the entire load, but could 
 induce the tax-payer to do his share. Our public health laws and 
 administration leave vast room for improvement. As Dr. Welch
 
 has said neglect of public health is a disgrace to the nation. Some 
 states have no boards of health. Few have good ones. A minority 
 have accurate registration of deaths and not one has accurate 
 registration of births. We therefore lack even the first step to- 
 ward efficient national health protection good vital statistics. 
 
 Just as fire insurance companies endeavor to secure in munici- 
 palities adequate fire protection, so life insurance companies might 
 properly endeavor to secure adequate municipal health protection, 
 and they might likewise bring their influence to bear in securing the 
 passage of model health laws by our states in respect to slaughter 
 houses, pure food and other health reforms. The present great and 
 needless waste of human life, brings its heavy financial weight 
 largely on insurance companies. The Prudential Company pays out 
 annually $800,000 for death claims on account of tuberculosis 
 alone, a disease which is known to be preventable. 
 
 As to a practical plan for participation by the life insurance 
 companies in the health movement, two methods suggest themselves. 
 The first is for the life insurance companies, in combination, to 
 establish their own machinery for disbursing funds intended to 
 improve the public health. The second is to contribute to one or 
 more organizations already existing for this purpose. I shall speak 
 in favor of the second, and in particular of the advantages to be 
 obtained by using the Committee of One Hundred on National 
 Health, of which I am president, as the agent for this distribution. 
 I will say at the outset, however, that I think our Committee would 
 be willing, if need be, to stand aside in favor of any plan which 
 the insurance companies should prefer. We have been interested 
 in this work from a philanthropic point of view only, and have 
 borne its burden because no other organization was doing the work. 
 It has been a tax on our time and purses, and we should, if the 
 same work could be done by others without this tax, be only too 
 ready to hand it over. We believe, however, that there would 
 be a distinct advantage to the insurance companies in utilizing 
 our agency, instead of creating a new one. Since the work is 
 largely one of educating and convincing public opinion, it seems 
 an advantage that the movement should have a scientific as well 
 as a commercial flavor. Our Committee was appointed by the 
 American Association for the Advancement of Science, and con- 
 sists, for the most part, of men of national reputation. Our Vice- 
 Presidents are:
 
 10 
 
 Rev. Lyman Abbott, New York. 
 Miss Jane Addams, Chicago. 
 Mr. Felix Adler, New York. 
 Pres. James B. Angell, Ann Arbor. 
 Hon. Joseph H. Choate, New York. 
 President Charles W. Eliot, Cambridge. 
 Archbishop Ireland, St. Paul. 
 Hon. Ben. B. Lindsey, Denver. 
 Mr. John Mitchell, New York. 
 Dr. Wm. H. Welch, Baltimore. 
 
 Again, there is a great advantage in having the movement 
 popular and under the auspices of a popular league. Our Com- 
 mittee has organized the American Health League; the membership 
 of which is at present 23,000. It appears that this league will have 
 a more independent existence and its members feel a greater esprit 
 de corps if conducted under its present leadership than if given 
 over entirely to a commercial organization. 
 
 Again, I am told that there would be difficulties in getting 
 agreements between various competing life insurance interests so 
 as to form a central committee in which all would have confidence 
 as working for a common benefit and not for one particular company 
 or companies to the exclusion of others. No such difficulty would 
 apply to our organization, which is and would naturally remain 
 impartial so far as the interests of special companies are concerned. 
 Saving life belongs to agencies which do nothing else. There are, 
 of course, other organizations working for public health aside from 
 the Committee of One Hundred, but these other organizations work 
 for special health reforms and largely for relief from the effects 
 of disease, rather than for prevention. It would seem, therefore, 
 that the Committee of One Hundred is the logical agency for doing 
 the proposed work, and in this opinion I am confirmed by the in- 
 surance men whom I have thus far consulted. 
 
 As to the method of contribution by the insurance companies, 
 several plans are open. The most feasible and just seems to me to 
 be a plan by which the life insurance companies shall deposit with 
 the treasurer of the Committee of One Hundred, which is the 
 Title Guarantee & Trust Company of New York City, a fund to 
 be set aside as a special fund, and the disbursements from it to 
 be made only as authorized by a committee appointed for this pur- 
 pose by the Association of Life Insurance Presidents. This in-
 
 II 
 
 surance committee might be called an advisory and auditing com- 
 mittee, whose purpose would be merely to see that the funds were 
 properly and wisely expended. They would not need to have the 
 responsibility of forming plans for their expenditure, but would 
 have the power to prevent any expenditure deemed improper or in- 
 advisable. 
 
 The work, to yield results, should be done on a national scale 
 ten times the scale which our Committee has yet reached. Yet this 
 would be a trifling item of cost equal to two cents a year for 
 each $1,000 of insurance. The policy-holder is not likely to object 
 to paying one postage stamp a year, especially when this will be 
 largely used to induce the governments to contribute larger sums 
 and when as a consequence he is likely to enjoy the two-fold benefit 
 of a longer life and a lessened premium. 
 
 It would be entirely agreeable to the Committee of One 
 Hundred to put a number of representatives of life insurance com- 
 panies on the Committee of One Hundred itself and if desired on 
 the executive committee, which has the responsibility of doing the 
 actual work. 
 
 As to the methpds of expending the proposed fund to be created 
 by the insurance companies, details can be submitted to the com- 
 mittee appointed to consider them. This would include the enlarge- 
 ment of our magazine, the pressing of health bills before 
 Congress and the legislatures of the several states, the publication 
 and distribution of leaflets of information in continuation of the 
 series of twenty-six which we have already published, a campaign 
 of newspaper publicity and education, especially through plate 
 matter prepared and given to 10,000 country newspapers. It would 
 also include efforts to enlarge the American Health League so that 
 it may fulfill two functions : First, create an interest in a large num- 
 ber of people in healthful individual living, and, second, create and 
 formulate public opinion which shall secure public health legislation. 
 
 The extraordinary success of our movement thus far is the best 
 guarantee that its success may be greatly increased. The move- 
 ment has swept along with an increasing momentum, which has 
 repeatedly called forth, from those at first skeptical, expressions of 
 delight and amazement. The alliance with life insurance com- 
 panies would tend to the speedy completion of the first task set 
 before us the creation of a powerful national organization of 
 public health at Washington. From the first we have felt that if 
 a Bureau of Health Information could be established at Washington
 
 12 
 
 which should have as its function the distribution of millions of 
 small pamphlets on health that is, teaching the people how to live 
 long and avoid the dangers which shorten life and cause morbidity , 
 this federal publicity would arouse a public sentiment which would 
 sweep all opposition before it. Such a sentiment when aroused 
 would work to the greater harmony of all social classes. For in- 
 stance, much ill-advised legislation hampering business to the detri- 
 ment of both capital and labor would give way to direct legislation 
 beneficial to labor by eliminating preventable mortality and invalidity 
 which now cause the heaviest burdens to the poor. 
 
 The fraternal societies have already undertaken this campaign. 
 We have contributed our matter to their journals, and they have 
 addressed our meetings. Fraternal insurance companies have also 
 in several instances established sanatoria, and have attempted in 
 other ways to lengthen lives and decrease death claims. 
 
 In order that you may better know what kind of work our 
 organization has been doing and plans to do, I will rehearse briefly 
 the main features. After two years we have now representatives 
 in sixteen hundred towns and cities in the United States. We hope 
 ultimately to organize local committees in all of these towns similar 
 to a few already organized, the last being in Portland, Oregon. 
 Through these committees we have brought pressure to bear on all 
 political parties. With 23,000 members, we have friends in 
 almost every important town in the nation. The mem- 
 bers are taken from among the influential men in the community. 
 Some 700,000 pamphlets and letters have gone out from the execu- 
 tive office, presided over by our able executive secretary, Professor 
 J. P. Norton. The cost of this and other work has been $28,000, 
 and has largely been contributed in small amounts by people in 
 moderate circumstances. This shows the diffusion of interest. 
 Over a year ago we planned to spend $250,000 during 1908, but 
 the panic closed up the larger pocketbooks, and we had to be content 
 with such smaller contributions as we could get. 
 
 At the outset we gained the support of the great men in the 
 nation. Ex-President Cleveland favored the movement, and Presi- 
 dent Roosevelt wrote to me a letter, a part of which I quote: 
 
 "Our national health is physically our greatest national 
 asset. To prevent any possible deterioration of the American 
 stock should be a national ambition. We cannot too strongly 
 insist on the necessity of proper ideals for the family, for 
 simple living, and for those habits and tastes which produce
 
 13 
 
 vigor and make men capable of strenuous service to their 
 country. The preservation of national vigor should be a 
 matter of patriotism . . . Federal activity in these mat- 
 ters has already developed greatly, until it now includes 
 quarantine, meat inspection, pure food administration and 
 federal investigation of the conditions of child labor. It is 
 my own hope that these important activities may be still 
 further developed." 
 
 Later, in his Provincetown speech, President Roosevelt said : 
 
 "I also hope that there will be legislation increasing the 
 power of the National Government to deal with certain mat- 
 ters concerning the health of our people everywhere; the 
 Federal authorities, for instance, should join with all the 
 State authorities in warring against the dreadful scourge of 
 tuberculosis. I hope to see the National Government abreast 
 of the foremost State Governments." 
 
 In his message to Congress a year ago, he emphasized the im- 
 portance of our campaign in these words: 
 
 "There is a constantly growing interest in this country in 
 the question of the public health. At last the public mind is 
 awake to the fact that many diseases, notably tuberculosis, 
 are natural scourges. The work of the state and city boards 
 of health should be supplemented by a constantly increasing 
 interest on the part of the National Government. The Con- 
 gress has already provided a bureau of public health and has 
 provided for a hygienic laboratory. There are other valu- 
 able laws relating to the public health connected with the 
 various departments. This whole branch of the Govern- 
 ment should be strengthened and aided in every way." 
 
 By the appointment of a Conservation Commission, the oppor- 
 tunity was given to us to present the measure of the wastes of 
 human life in comparison with the wastes in the forests, the soil, 
 the waters and the land. Co-operating with fifty medical men and 
 technical experts, I prepared the report for President Roosevelt 
 which has already been mentioned. 
 
 In the meantime, the campaign for political planks proceeded. 
 In two months, three national platforms were framed which con- 
 tained planks in approbation of our program, and, so far as I know, 
 for the first time in history political parties took note of public 
 health as worthy of consideration. The Republican national plat- 
 form at Chicago contained this plank:
 
 14 
 
 "We commend the efforts designed to secure greater 
 efficiency in national public health agencies, and favor such 
 legislation as will effect this purpose." 
 
 The Democratic national platform adopted at Denver stated : 
 
 "We advocate the organization of all existing national 
 public health agencies into a national bureau of public health, 
 with such power over sanitary conditions connected with 
 factories, mines, tenements, child labor, and other such sub- 
 jects as are properly within the jurisdiction of the Federal 
 Government and do not interfere with the power of the 
 States controlling public health agencies." 
 
 The Independence League party adopted an even broader plank 
 in favor of a National Department of Health, and Mr. Arthur 
 Brisbane has warmly supported in the Hearst journals the move- 
 ment to protect public health. 
 
 In the meantime, both candidates for President had written 
 warm letters of endorsement. I quote briefly from Mr. William 
 J. Bryan: 
 
 "Congress should appropriate sufficient money to carry 
 on investigations into diseases national in their scope." 
 
 Mr. Taft in his letter said: 
 
 "The American Health League is certainly to be con- 
 gratulated on its rapid progress in numbers and recognition. 
 It is through such an enlistment of public interest that Con- 
 gress may be expected to enact the legislation necessary to 
 enlarge the activities of the Federal Government in respect 
 to public health. 
 
 "I hope to live to see the time when the increased 
 efficiency in the public health service Federal, State and 
 Municipal will show itself in a greatly reduced death rate. 
 The Federal Government can give a powerful impulse to this 
 end by creating a model public health service and making 
 our national capital a model sanitary city. 
 
 "With most cordial wishes for the success of your 
 movement . . . ." 
 
 In President Taft's letter of acceptance, he said: 
 
 "I have long been of opinion that the various agencies 
 of the national government established for the preservation 
 of the national health, scattered through several departments, 
 should be rendered more efficient by uniting them in a bureau 
 of the government under a competent head, and that I 
 understand to be, in effect, the recommendation of both 
 parties."
 
 15 
 
 With the convening of Congress in December, 1908, President 
 Roosevelt made the program of the Committee of One Hundred 
 his administration policy. He authorized the announcement of this 
 policy before a conference last October in Washington, called 
 by the Committee of One Hundred at which were represented the 
 American Medical Association, the Government and State health 
 bureaus and the other leading health organizations of the United 
 States. Again, in his December message, President Roosevelt 
 said: 
 
 "It is highly advisable that there should be intelligent 
 action on the part of the nation on the question of pre- 
 serving the health of the country. . . . The dangers 
 to public health from food adulteration and from any other 
 sources, such as the menace to the physical, mental, and 
 moral development of children from child labor, should be 
 met and overcome. There are numerous diseases which are 
 now known to be preventable, which are, nevertheless, not 
 prevented. The recent International Congress on Tubercu- 
 losis has made us painfully aware of the inadequacy of 
 American public health legislation. This nation cannot 
 afford to lag behind in the world-wide battle now being 
 waged by all civilized people with the microscopic foes of 
 mankind, nor ought we longer to ignore the reproach that 
 this Government takes more pains to protect the lives of hogs 
 and cattle than of human beings. The first legislative step to 
 be taken is that for the concentration of the proper bureaus 
 into one of the existing departments. I therefore urgently 
 recommend the passage of a bill which shall authorize a re- 
 distribution of the bureaus which shall best accomplish this 
 end." 
 
 We have received letters from one-third of the Congressmen 
 in favor of such legislation. The bill is in the hands of a sub- 
 committee of the House at the present time. Among those who 
 have actively aided this movement in Washington are President 
 Roosevelt, President-Elect Taft, Mr. Gifford Pinchot, Hon. Charles 
 D. Walcott, Secretary of the Smithsonian Institution, Hon. James R. 
 Garfield, Hon. George Shiras, III, Dr. Kober, Dr. Wiley, and Dr. 
 Wyman of the Public Health and Marine Hospital Service, in whose 
 hands our bill now rests. These men are, I understand, hopeful 
 of accomplishing legislation at this session. 
 
 The State Governments are equally interested. Through our 
 representatives in Ohio, a resolution endorsing our movement was
 
 It 
 
 passed in that State. Our health planks were adopted in the State 
 Republican platforms of Ohio and Delaware, and we have had the 
 cordial endorsement of the governors of some twenty states, in- 
 cluding such widely separated states as Massachusetts, Pennsylvania, 
 Alabama, Mississippi, Michigan, New Mexico, South Dakota, 
 Oregon and Washington. Among these governors I will quote 
 only two, one being the nearest to, and the other the farthest 
 from our executive office. In his letter, Governor Woodruff of 
 Connecticut said, "I am glad of this opportunity to endorse the 
 work of the Committee of One Hundred on National Health . . . 
 I consider the question of public health the most important one which 
 our country has before it." Governor Freer of Hawaii wrote, "The 
 people of Hawaii . . . are in a position to realize with peculiar force 
 not only the great importance of the subject of health, but also the 
 importance of the co-operation between national, state and terri- 
 torial governments in this matter. ... I wish the Committee 
 of One Hundred every success." 
 
 In the peroration of President Roosevelt's famous speech be- 
 fore the Conference on the Conservation of Natural Resources, at 
 the first meeting of the Conservation Commission at Washington, 
 he said : 
 
 "Finally, let us remember that the conservation of our 
 natural resources, though the gravest problem of to-day, is 
 yet but part of another and greater problem to which this 
 nation is not yet awake, but to which it will awake in time 
 and with which it must hereafter grapple if it is to live the 
 problem of national efficiency." 
 
 In the Conservation Report now issued, after summarizing the 
 wastes of material wealth, the Commission has gone on record with 
 these words, which were written in the main by the eloquent Gov- 
 ernor Blanchard of Louisiana : 
 
 "Since the greatest of our national assets is the health 
 and vigor of the American people, our efficiency must depend 
 on national vitality even more than on the resources of the 
 minerals, lands, forests and waters. The average length of 
 human life in different countries varies from less than 25 
 to more than 50 years. This span of life is increasing 
 wherever sanitary sciences and preventive medicine are ap- 
 plied. It may be greatly extended. Our annual mortality 
 from tuberculosis is about 150,000. Stopping three- fourths 
 of the loss of life from this cause and from typhoid and
 
 I? 
 
 other prevalent diseases would increase our average length 
 t of life fifteen years. There are constantly about 3,000,000 
 
 persons seriously ill in the United States of whom 500,000 
 are consumptives. More than half this illness is preventable. 
 If we count the value of each life lost at only $1,700, and 
 reckon the average earning lost by illness at $700 a year for 
 grown men, we find that the economic gain from mitigation 
 of preventable disease in the United States would exceed 
 $1,500,000,000 a year. This gain, or the lengthening and 
 strengthening of life which it measures, can be had through 
 medical investigation and practice, school and factory hygiene, 
 restriction of labor by women and children, the education of 
 the people in both public and private hygiene, and through 
 improving the efficiency of our health service, municipal, 
 state and national." 
 
 This, in brief, is the record of what has been accomplished in 
 two years with nothing except plans to start with. Much more 
 remains to be accomplished. The complete solution of the public 
 health problem requires the combination of three factors: First, 
 the activity of expert enthusiasts; second, the force of public 
 opinion; third, money with which to pay the bills. The 
 Committee of One Hundred has had the first and second 
 that is, the workers and public opinion. The proposed alliance 
 between policy-holders, your companies and our Committee will 
 bring the third also, the sinews of war. 
 
 It should be emphasized that mere money can do little alone 
 in such a country as ours. We must have expert leaders and public 
 following. These, as organized by the Committee of One Hun- 
 dred, are at your service. Our membership includes expert 
 workers in the 
 
 American Association for the Advancement of Science 
 American Medical Association 
 American Public Health Association 
 Federal, State and City Boards and Bureaus of Health 
 National Association for the Study and Prevention of Tuber- 
 culosis 
 
 Rockefeller Institute 
 
 American Society of Sanitary and Moral Prophylaxis 
 National Child Labor Committee 
 
 Presidents and Professors in the principal universities 
 As to public confidence, we have besides the endorsements of 
 these associations and the backing of political leaders and party
 
 i8 
 
 platforms the co-operation of about twenty other important 
 organizations, including the Associated Fraternities of America and 
 the United Mine Workers of America. Such a degree of public 
 confidence is an asset worth having. Public confidence is valuable 
 not only in securing public health legislation, but especially 
 so in effecting any change in personal hygiene, the habits of 
 living in a community. If, for instance, the people are to sleep 
 with more fresh air in their bedrooms, they can be led to do so 
 only by the weight of medical authority. No faddist movement will 
 secure rapid reforms, and this is one reason why reforms so often 
 fail. To be rapidly successful, reforms must spread from the 
 top and not from the bottom. Western civilization has made rapid 
 progress in Japan because the reform started with the Mikado. 
 In China it failed because the Empress and Court opposed. The 
 secret of the success of the Committee of One Hundred has been 
 the approval of the leaders political, medical, philanthropic and 
 social. With the momentum already gained, we need only financial 
 backing to achieve greater results in reducing mortality than hitherto 
 achieved in the world. It is primarily a question of judicious pub- 
 licity under auspices which weigh in the public esteem. It is easier, 
 as everyone who has observed public movements knows, to accom- 
 plish a large reform with such publicity than a small one. Chicago 
 could not clean its slaughter houses, but when the whole nation 
 became awake to slaughter house conditions, they were immediately 
 reformed, in part at least. Since the agitation for the national 
 pure food law, similar pure food laws have been passed in the states 
 where before it was impossible to secure their enactment. Since 
 the recent International Congress on Tuberculosis in Washington, 
 the spread of the anti-tuberculosis movement throughout the 
 country has been many times more rapid and enthusiastic than ever 
 before. There never was a time more favorable for securing 
 tangible results in improving public health than at present, and 
 though these results must be achieved largely through legislation, 
 the legislation cannot be secured except through a public agitation 
 such as the Committee of One Hundred is now engaged in on a 
 small scale.
 
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