COLUMBIA LIBRARIES OFFSjTE HEALTH SCIENCES STANDARD HX64076601 R A445 C73 Work of the Committe RECAP ^^^fs c^^ College of ^f)?gician£! anb ^urgeong Hibrarp Digitized by the Internet Archive in 2010 with funding from Open Knowledge Commons http://www.archive.org/details/workofcommitteeoOOcomm WORK OF THE COMMITTEE OF ONE HUNDRED ON NATIONAL HEALTH BY WM. JAY SCHIEFFELIN, Ph.D. Chairman of the Executive Committee of Committee of One Hundred on National Health, New York Publication No. 628 American Academy of Political and Social Science Reprinted from The Annals, March, 191 1 Price, m cents WORK OF THE COMMITTEE OF ONE HUNDRED ON NATIONAL HEALTH By Wm. Jay Schieffelin, Ph.D.j Qiairman of the Executive Committee of the Committee of One Hundred on National Health. Professor J. P. Norton, of Yale, in a paper read in June, 1906, before the Economic Section of the American Association for the Advancement of Science, showed that the country is suffering great economic losses from preventable sickness and premature deaths. He advocated the creation of a National Department of Health, which should spread throughout the country a knowledge of effective ways of stamping out disease, as the Department of Agri- culture has done in the case of cattle. As a result of this paper, a committee of one hundred on national health was appointed to study its subject, and to put into effect the best methods for securing its object. The committee elected Professor Irving Fisher, of Yale, president. It was later voted by the association that the com- mittee,^ instead of merely representing its economic section, should ^The present make-up of the Committee Is as follows : President — Professor Irving Fisher. Vice-Presidents — Ex-President James B. Angell, Ann Arbor ; Ex-President Charles W. Eliot, Cambridge ; Rev. Lyman Abbott, New York ; Miss Jane Addams, Chicago ; Mr. Felix Adler, New York ; Hon. Joseph H. Choate, New York ; Arch- bishop Ireland, St. Paul ; Hon. Ben B. Lindsey, Denver ; Mr. John Mitchell, New York; Dr. William H. Welch, Baltimore. Executive Officers- — Chairman Executive Committee, Wm. .Jay Schieffelin, Ph.D. ; Secretary, Edward T. Devine, Ph.D., LL.D. ; Treasurer, Title Guarantee and Trust Company, 176 Broadway, New York City. Committee of One Hundred — Dr. A. C. Abbott, Philadelphia, Pa. ; Rev. Lyman Abbott, New York City ; Samuel Hopkins Adams, New York City ; Mlas Jane Addams, Chicago, 111. ; Felix Adler, New York City ; William H. Allen, Ph.D., New York City ; Ex-Presldent .Tames B. Angell, Ann Arbor, Mich. ; Dr. Hermann Biggs, New York City ; Dr. Frank BHlings, Chicago, 111. ; Miss Mabel T. Boardman, Wash- ington, D. C. ; Edward Bok, Philadelphia, Pa. ; Mrs. Ballington Booth, Montclalr, N. J. ; C. Loring Brace, New York City ; Bishop C. H. Brent, Manila, P. I. ; Dr. Joseph D. Bryant, Nfw York City ; Luther Burbank, Santa Rosa, Cal. ; Andrew Carnegie, New York City ; Prof. James McKeen Cattell, New York City ; Prof. R. H. Chittenden, New Haven, Conn. ; Hon. Joseph H. Choate, New York City ; Dr. Thomas D. Coleman, Augusta, Ga. ; Prof. John R. Commons, Madison, Wis. ; Dr. Thomas Darlington, New York City : Edward T. Devine, Ph.D., LL.D., New York City ; Mrs. INTelvil Dewey. Lake Placid. N. Y. ; Dr. A. H. Doty, New York City ; Thomas A. Edison, Orange, N. J. ; Ex-President, Charles W. Elliot, Cambridge. C321) 78 The Annals of the American Academy represent the whole association, and that the scope of its work should not be confined to advocating a National Department of Health, but should include the prosecution of all suitable work for securing improved national health. The committee adopted the policy of not attempting much direct work for improving health conditions, but rather of inducing other agencies, already existing and equipped, to do the work. It has aimed especially to enlist the services of three great agencies, the press, the insurance companies, and the government. At the outset the committee was confronted with the fact that very little information exists concerning the health of the nation as a whole. Actual facts as to deaths are available in only half of the population. Of the remainder we do not even know how many deaths occur. Before the nation can intelligently do its part of the work of disease prevention, the national aspect of diseases, Mass. ; Rev. W. G. Eliot, Jr., Portland, Ore. ; Dr. Livingston Parrand, New York City ; Hon. Cliarles J. Fauliiner, Washington, D. C. ; Dr. Henry B. Favill, Chicago, 111. ; Dr. George J. Fisher, New York City ; Prof. Irving Fisher, New Haven, Conn. ; Horace Fletcher, New Yor^ City ; Austen G. Fox, New York City ; Lee K. Frankel. Ph.D., New York City ; Dr. John S. Fulton, Washington, D. C. ; President H. A. Garfield, Williamstown, Mass. ; William R. George, Freeville, N. Y. ; Prof. Franklin H. Giddings, New York City ; B. R. L. Gould, New York City ; Rev. Percy S. Grant, New York City ; Dr. Luther H. Gulick, New York City ; President A. T. Hadley, New Haven, Conn. ; Norman Hapgood, New York City ; Miss Hazard, Peace Dale, R. I. ; Prof. C. R. Henderson, Chicago, 111. ; Mrs. John B. Henderson, Washington, D. C. ; Calvin W. Hendrick, Baltimore, Md. ; Byron W. Holt, New York City; Prof. L. Emmett Holt, New York City ; Dr. J. N. Hurty, Indianapolis, Ind. ; Rt Rev. John Ireland, St. Paul, Minn. ; Prof. M. B. Jaffa, Berkeley, Cal. ; Prof. Jeremiah W. Jenks, Ithaca, N. Y. ; Dr. P. M. Jones, San Francisco, Cal. ; President David Starr Jordan, Stanford University, California ; Prof. Edwin O. Jordan, Chicago, 111. ; Arthur P. Kellogg, New York City ; Dr. J. II. Kellogg, Battle Creek, Mich. ; Dr. S. A. Knopf, New York City ; Dr. George M. Kober, Washington, D. C. ; Dr. George F. Kunz, New York City ; Prof. James Law, Ithaca, N. Y. ; Samuel McCune Lindsay, New York City ; Hon. Ben B. Liudsey, Denver, Col. ; Dr. Jaques Loeh, Berkeley, Cal. ; Hon. John D. Long, Boston, Mass. ; S. S. McClure, New York City ; Dr. J. N. McCormack, Bowling Green, Ky. ; Hiram J. Messenger, Hartford, Conn. ; John Mitchell, New York City ; Hugh Moore, New York City ; Dr. Prince A. Morrow, Now York City ; Dr. Richard C. Newton, Montclair, N. J ; Prof. M. V. O'Shea, Madison, Wis.; Walter H. Page, Garden City, L. I.; Henry Plnpps, New York City ; Dr. C. O. Probst, Columbus, Ohio : Dr. Charles A. L. Reed, Cincinnati, Ohio ; Mrs. Ellen H. Richards, Boston, Mass. ; Dr. R. A. Sargent, Cambridge, Mass. ; William Jay Schieffelin, Ph.D., New York City ; Prof. Henry R. Seager, New York City ; ITon. George Shiras, III, Washington, D. C. ; Dr. George H. Simmons, Chicago, 111. ; President William F. Slocum, Colorado Springs, Col. ; Dr. Charles D. Smith, Portland, Me. ; Dr. Z. T. Sowers, Washington, D. C. ; James Snrunt, Wiln^ington, N. C. ; Melville E. Stone, New York City ; Nathan Straus, New York City ; .T. E. Sullivan, Now York City ; ; William H. Tolman, New York City; Dr. Henry P. Walcott. Boston, Mass.; Dr. WilHam H. Welch, Balti- more, Md. ; Prof. F. F. Wesbrook. Minneapolis, Minn. ; Talcott Williams, Philadel- phia, Pa. ; President, Robert S. Woodward, Washington, D. C. (322) IVork of the Committee of One Hundred 79 as they spread over state bovindaries, must be known. The lack of such knowledge has been an added incentive to the Committee of One Hundred to ask for a health department to gather national health information. Referring to a map which the government made at a great expense to show where the best beet crops might, be expected, Dr. Wiley, chief of the bureau of chemistry, has commented on the dearth of national maps on more vital subjects. He says : Our government needs maps of vital conditions throughout the country. We would have a map of the United States showing where the cancer belt is, where the greatest tuberculosis area is, where the typhoid area lies, what is the area containing men and women of the finest physiques. Such information would be of illimitable value to the nation in any intelligent attempt at the reduction of disease, and would save millions of dollars to the nation now lost by unnecessary sickness and unnecessary premature death. Meanwhile the committee has availed itself of such material as exists on national health conditions, and has endeavored to place this material in the hands of as many people as possible. The object of the committee was two-fold: First, to give ground for a popular demand for a National Health Department; second, to set the people thinking on health subjects. As Dr. Wiley further says: If we have never had a Department of Health, Congress is not at fault ; it is the fault of the people of the United States. They are perfectly apathetic about their own health. They go about their work day after day, and then when a break in health comes, they submit to all its consequences with a kind of feeling that the disaster is inevitable. An American Health League was started by the committee. The membership in the league soon numbered 25,000. To these people and to the press literature was sent on the prevention of sickness and the need of national action. In all the committee has issued over two-score publications, among them "National Vitality," the report by Professor Irving Fisher, president of the Committee of One Hundred, as a member of President Roosevelt's Conserva- tion Commission. This report, which was commended by eminent scientists, showed that out of the entire population 1,500,000 die annually, and of this number nearly half (over 620,000) die many years before they should ; that proper precautions would save those C323) 8o The Annals of the American Academy years of life. It also showed that there are constantly 3,000,000 sickbeds in the country, and that if hygienic knowledge now avail- able were used, at least one-half of these people might be among the well, instead of among the sick. But besides the knowledge which already exists in regard to the nature of diseases. Professor Fisher brings out in his report that much more knowledge is needed to explain the causes of many diseases. For obtaining such informa- tion and for spreading it among the people, a National Health Department would be effective. This conservation report on "National Vitality," was printed in several large editions by the United States Senate, at the sug- gestion of Senator Robert L. Owen, who has actively championed the National Department of Health movement. Copies of the report were spread throughout the country, and have furnished a large part of the committee's educational campaign. A magazine called "American Health," was published by the committee in the beginning of its work. After a few issues of this magazine, however, the committee succeeded in enlisting the direct co-operation of "McClure's Magazine," "World's Work," "The Survey," "The Dietetic and Hygienic Gazette," and "Good Health." When this was accomplished, the committee's own magazine was discontinued. Many other magazines have directly co-operated in the committee's work. Since the results for which the committee is working are a matter of vital consequence to life insurance companies from a business standpoint, it was apparent to the committee from the beginning that such companies could be a powerful aid in accom- plishing those results. At a meeting of the Association of Life Insurance Presidents, in February, 1909, Professor Irving Fisher read a paper on "The Economic Aspect of Lengthening Human Life." A "Human Life Extension Committee" was then appointed. Since this meeting, the life insurance companies have entered more actively into the health campaign. Health educational departments have been established in many of the companies, medical examina- tions have been increased, sanatoria have been built, and definite steps have been taken to aid in obtaining national action in behalf of health. The life insurance companies, therefore, are to-day among the most powerful agencies for the betterment of health in this country. In a recent paper on the subject, Professor Fisher (324) Work of the Committee of One Hundred 8i reviewed the progress which the insurance companies have made in health work. He said: At present the movement has only j ust begun ; although it has, 1 believe, gone far enough to demonstrate its wisdom. The Metropolitan has established a consumptive sanatorium in the face of inuch opposition and in spite of an adverse decision at first by the Insurance Commissioners of Nev(f York State as to their right to do so; it has engaged visiting nurses to co-operate with visiting nurses' associations in certain cities to care for its bed-ridden policyholders; it has established a health magazine to distribute health lit- erature among its policyholders — which magazine is made available to 15,- 000,000 readers, or one-sixth of the population in the United States; and it has endorsed in several v;ays and on several occasions the movement for a National Department of Health. The Provident Life Assurance Company has established a health bureau which performs two functions, one of issuing bulletins of health information among its policyholders, the other, of granting to those who choose, free medical examinations. At first these free examinations were to occur every two years, but the results were immediately found to be so satisfactory in holding off the Grim Reaper, who was creeping upon his victims unawares, that the interval for periodical examinations has been reduced to one year. The New York Life Insurance Company has taken a hand in the effort to improve and purify the milk supply of New York City. Mr. Robert L. Cox, counsel for the Association of Life Insurance Presi- dents, states that "practically all of the companies represented in the Associa- tion of Life Insurance Presidents are giving their moral support to the move- ment for the prolongation of human life. In addition, many of them are doing practical educative work. Measured by number of policies in force, the association companies cover seventy-eight per cent of the field of American companies, having 21,700,000 policies out of a total of about 28,000,000. The association companies engaging in individual work along health betterment lines have seventy-three per cent of the total number of policies in force, or 20,500,000. There is another group of companies in the association which goes beyond the body of policyholders in its health promotion activities. They advise impaired applicants for insurance as to their physical condition and make suggestions to aid them. There are four companies in this group. Two of them, in the East, have a total of 86,000 policies. Another is a flourishing Middle West company that has about 150,000 policies. The fourth is a young and conservative Southern company with 7,200 policies. One of the Connecticut companies has published suggestions as to health reform in its magazines to agents. Two other companies — one of Massachu- setts and the other of California — are considering active work in the future. The fraternal societies have entered the camoaign. Their journal, the "Western Review" now has a department especially devoted to the public health. Fraternal insurance companies have also in several instances estab- C325) 82 TJie Annals of the American Academy lished sanatoria, and have attempted in other ways to lengthen lives and decrease death claims. The accident companies have, I understand, for some time, aided in getting state laws passed to prevent accidents to life and limb. Finally, health insurance, one of the youngest forms of insurance, has made a beginning in the field of prevention. The Loyal Protective Insurance Company has, within the last few months, established a health bureau to issue bulletins and conduct a sort of correspondence school of health information. Considering the fact that few, if any, of the existing insurance companies have been engaged in health insurance for more than fourteen years, their present entrance into the field of prevention is unusually prompt. Personally I believe that in health and accident insurance — and especially in health insur- ance — there are gigantic possibilities of profit. I use the term profit rather than philanthropy in recognition of the fact that insurance companies as such have no business to undertake philanthropic work except when it is profitable. In the end the money gains made by the insurance companies by reducing mortality and invalidity will be shared by the public in reduced premiums. In the matter of enlisting government aid, the committee has been active in several states. It has aided health legislation, notably the law in Connecticut for the "Sterilization of Degenerates." The committee has also laid the foundations for national health legislation. In the beginning of its work, ex-President Cleveland sent a letter of endorsement. Then came the endorsements of Presidents Roosevelt and Taft, and of j\Ir. Bryan. Both political parties put national planks in their platforms. IMany noted men endorsed the movement and worked in its behalf. The governors of most of the states expressed themselves as favoring the estab- lishment of a National Health Bureau or Department. National societies favored the movement, and passed resolutions endorsing it. The Grange endorsed it. The United Mine Workers and other labor organizations endorsed it. Educational institutions, boards of health, civic associations, women's clubs — all heartily endorsed the committee's work. Boards of trade throughout the country took up the movement, recognizing that health plays an important^ part in the prosperity of a community. The countrv can now be said, therefore, to be awake to the need of national action for the suppression of disease. The Honorable George Shiras, III, a member of the committee, made an exhaustive study of the question of constitutionality of a National Health Department, and reported favorably on it. The first national bills of importance that came under the (326) Work of the Coinuiittec of One Hundred 83 consideration of cne committee were Senate bills 6101 and 6102 and their equivalents in the House. These bills aimed to increase the salaries of officers in the Public Health and Marine Hospital Service, and to enlarge the scope of their work. The merits of the bills were given thorough investigation by the executive and the legislative sub-committees of the Committee of One Hundred. After due deliberation, the committee decided to withhold approval (except as to the increase in salaries), and submitted to the Presi- dent its own plan for increasing the efficiency of the federal health service. Instead of enlarging the scope of the present Public Health and Marine Hospital Service, which might result in duplication of work already being done in other bureaus of the government, the committee recommended that all the federal health agencies be concentrated into one department, instead of being scattered, as they are now, in various departments. The President then appointed a "Commission on the Organi- zation of the Scientific Work of the Government." This commis- sion consisted of Charles Walcott, chairman (director of the Smith- sonian Institute), James R. Garfield, W. L. Capps, William Crozier and Gifford Pinchot. They confirmed the recommendations of the committee, stating that "there exists a lack of co-ordination and effectiveness [among the bureaus doing public health work] that can only be overcome by administrative supervision in one department." In the fall of 1909 President Taft took up the subject of co-ordinating the existing federal health agencies, after having repeatedly favored the idea in his public utterances. He had various plans suggested for the improvement of the federal health service. These were submitted to the Committee of One Hundred, and expert opinions were obtained from outside sources. None of these plans, however, satisfied the President or the committee. New health bills were introduced in Congress, until, during the session of 1910, there were no less than six public health bills to which the Committee of One Hundred gave consideration. One bill, introduced by Congressman Simons, aimed "to further protect the public health," imposing additional duties on the Public Health and Marine Hospital Service. Another bill, introduced by him, aimed to "establish a Department of Public Health," this depart- ment to be supervised by a director-general of public health appointed by the President, all divisions of the government work relating to (327) 84 The Annals of the American Academy public health, except those in the War and Navy departments, to be combined in one department. Congressman Hanna introduced another bill "to establish a Department of Public Health." This provided for a secretary of health, who should have a seat in the Cabinet. Congressman Mann introduced the bill "providing for a public health service." This was the plan to change the name of the Public Health and Marine Hospital Service and to enlarge its scope. He also introduced another bill to establish a bureau of health within the Department of Commerce and Labor "to per- form the functions now exercised by the Public Health and Marine Hospital Service and the division of foods and drugs of the bureau of chemistry." Senator Owen introduced a bill to establish a Depart- ment of Public Health under the head of a secretary who should be a member of the President's Cabinet. After giving due con- sideration to all of the bills, and to the subject of the advisability of drafting a bill of its own, the Committee of One Hundred decided to endorse the principle of the Owen bill, although not com- mitting itself to its details. The national health movement has been powerfully supported by many members of the House and the Senate. Upon taking a poll of Congress, the committee found that there exists predominating sentiment in favor of increasing the efficiency of the federal work concerned with conserving the human-life assets of the country. One problem before the committee was the question of estab- lishing a Department of Health instead of a bureau. The original aim of the committee was a department, but President Roosevelt was unwilling to enlarge the Cabinet by adding a Secretary of Health. In order to obtain the President's help, the committee withdrew its advocacy of a department, and asked for only a new bureau of health, to be placed wathin one of the present departments. This change was adopted, not because anything less than a depart- ment is needed to carry on properly the work of conserving the lives of 91,000,000 people, but as a step in the right direction. W^en President Taft came into office, it was found that he was less opposed to enlarging the Cabinet. Upon the appearance of the Owen bill for a Department of Health, the committee decided to endorse the principle of the bill. In regard to this question of a department versus a bureau, Senator Owen says: (328) Work of the Committee of One Hundred 85 We have had bureaus affecting the public health for one hundred years. They are scattered in eight departments. They have been disconnected and without co-ordination. They have even been jealous of each other, the one nullifying and hampering the work of another. They have been without a responsible head because of this subdivision and because the chief of the most important of these bureaus, the Surgeon-General of the Public Health and Marine Hospital Service, can not express an opinion or give information until he has consulted the Secretary of the Treasury — a system that is abso- lutely ridiculous. The Secretary of the Treasury was not selected as a Cabinet officer because of his knowledge of the public health, but because he was an expert on finance. At present our Cabinet expert on finance directs government activities in controlling bubonic plague, and the board of trade and a few commerciahzed physicians of San Francisco would be more important in his eyes in all human probability than the chief of one of his subordinate bureaus ; at all events this was true as to "a previous Secretary. Senator Owen cites an instance when local commercial interests went over the head of the chief of a health bureau, as a consequence of which public health had to suffer. Upon the appearance of Senator Owen's bill, and after the stirring speech which he made on this subject in the Senate, a new faction appeared. This sprang up suddenly, apparently with plenty, of money at its command, and put in the newspapers paid advertisements, which contained misleading statements designed to convince readers that the Owen bill proposed to establish a department of healing, that only doctors of one school of medicine would be allowed to practice, and that the "medical freedom" of those of all other schools would be restricted. As there is no part in the plan for a National Department of Health, which seems to justify such a perverted view of the national health movement, the Committee of One Hundred has endeavored to look into the source of the opposition. The committee has found that it is aimed at the American Medical Association, which happens to be one of the many endorsers of the Department of Health idea. The American Medical Association has maintained a department for investigating the ingredients of certain patent medicines, making public the facts regarding the misrepresentations made in their behalf and the harm- ful results from using those that contained injurious drugs. Such a proceeding on the part of the American Medical Association has not only antagonized the patent medicine interests, but has antago- nized those doctors who have been in the habit of prescribing such (329) 86 The Annals of the American Academy medicines for their patients. The cry of these people for "medical freedom" has been caught up by a number of unsuspecting people, however. Some of the Christian Scientists, for instance, are said to be enlisted. Ignoring the fact that the real issue is whether or not the government shall take steps to prevent the needless sick- ness from which this country is now suffering, these people appar- ently accept the present amount of sickness as inevitable, and center their attention on who shall get the business of treating it. Presi- dent Taft referred to these misrepresentations in his message to Congress in December, 1910. He said: In m}' message of last year I recommended the creation of a bureau of health, in which should be embraced all those government agencies outside of the War and Navy departments which are now directed toward the pre- servation of public health or exercise functions germane to that subject. I renew this recommendation. I greatly regret that the agitation in favor of this bureau has aroused a counter agitation against its creation, on the ground that the establishment of such a bureau is to be in the interest of a particular school of medicine. It seems to me that this assumption is wholly unwar- ranted, and that those responsible for the government can be trusted to secure in the personnel of the bureau the appointment of representatives of all recognized schools of medicine, and in the management of the bureau entire freedom from narrow prejudice in this regard. Meanwhile the country is interested in the facts regarding achievements in the prevention of sickness that have been made in different parts of the United States, and in Panama and the depen- dencies, by the adoption of sanitary measures. Congressman Mann has now introduced in the House a bill to change the name of the Public Health and Marine Hospital Service to the Public Health Service, and to enlarge its scope. The committee has decided to oppose this bill, as being an avoidance of the demand for a consolidation of the health activities of the gov- ernment. The committee is continuing its endeavors to unite /he powers of the nation against the enemies of health, confident ;jf the support of all who are guided by reason and humanity. 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