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THE PRESIDENT'S ADDRESS.
BY HOSMER A. JOHNSON, M. D., LL. D.,
MR. CHAIRMAN, Gentlemen OF THE BROOKLYN COMMITTEE :—I cannot in adequate words express the thanks of myself and my fellowmembers for the generous hospitality with which we have been received in your city, and for the very kind words which have been spoken to us this evening in the way of welcome. Our acts and our proceedings must testify the interest which we feel in the cause for which you have done so much in the way of providing for the transaction of our business, and in bringing together such an audience here interested in sanitary matters, and for giving us such an opportunity to do, as well and wisely as we can, the work which we have in hand. GENTLEMEN OF THE ASSOCIATION, LADIES AND GENTLEMEN:Article second of the Constitution of the Association declares "That it shall be the purpose of this Association to advance sanitary science, and promote organizations and measures for the practical application of Public Hygiene." This organization was not intended to be, nor has it ever been considered to be, a purely medical organization, but a public organization, in which not only the profession of medicine, but members of other professions, or persons devoted to other occupations, may find a place to work for better health and longer life.
In the furtherance of this object, it has seemed wise that there should be at its annual meetings not only papers upon purely scientific subjects, but that also, in the form of essays and public addresses, an effort should be made to secure the interest of those of our citizens who have no official or professional relations to this work. In other words, an effort should be made to interest the public in the great object or purpose of preventing sickness and prolonging life. To do this we must demonstrate the truth of the maxim of one of our greatest philosophers, that "Public health is public wealth." I shall not therefore offer an apology to the gentlemen of the Association, who devote themselves more exclusively to purely scientific matters, for addressing myself, not so much to the scientist or to the professional sanitarian, as to the people, to the public, who by their presence here to-night give evidence of sympathy and interest in our work, or, rather, their work, and to whom, after all, we must look for means to carry out such measures as science shall demonstrate to be for our race most beneficent. It is proper, therefore, that we should meet you, that we should con
sult with you, and have your advice and sympathy in whatever we may decide upon as finally best adapted to accomplish this great and desirable end.
Through the ages but little has been done to prolong life and mitigate distress. We know now that much can be done, much that is not done, for the accomplishment of these results. The world has, in action, never utilized its fullest capacity for work; in achievement, it has never reached its power to do. This is true along all the lines of social and public activity. It is no more true in preventive medicine than in other departments of public endeavor. One of the greatest difficulties in the way of accomplishing more in sanitation has been, and, I fear, always will be, this, that we do not fully and certainly know all of the causes of our suffering, the agencies of our destruction; and consequently the great public are skeptical, as well they may be, in view of the past history of our civilization, as to the measures proposed for relief, for the prolonging of life. We know, however, that some progress has been made-we do not know exactly how much.
Of the beginnings of this desirable kind of knowledge we know but little. It is certain, however, that the cradle of our literature upon this subject was the old Ægean sea and its islands, the names of many of which are embalmed in song or story of ancient Greece. On a high promontory of one of these, in the dim twilight of antiquity, a temple had been erected to Esculapius. A few miles back, at the base of a line of low hills, there gushed from the rock a stream of warm, life-giving water. Its properties were such as to invigorate and strengthen the wearied and exhausted, and especially to restore to the blood the qualities in which it is usually deficient in malarious countries. In a word, they were chalybeate. Rich in iron, they met most fully the needs of the dwellers along the shores of the islands and the continent and the crowded cities of Greece. To this temple and fountain the sick from many lands had come, and there had been abundant opportunity to test the healing qualities of the waters. Those who had received benefit had hung upon the walls or had inscribed on tablets, which were placed around the temple, brief histories of their diseases, and the results of their offerings to god and goddess. Here, in the fifth century before our era, a young student from a neighboring city, descendant of a long line of priest physicians, established his home. He was a lover of nature, and we may presume that he had been attracted in part by the beauty of the island, with its ridges of low mountains or, rather, hills, which skirted the southern border, and which gave birth to cool streams of delicious water, destined to give fertility to the northern slopes, the land of the grape, the home of the most generous of wines. The scholar had lingered, not so much for the beauty of the landscape, however, or for the delicacy of the fruits, as for the interest which he felt in the curative properties of the fountain itself. While he believed in the gods, he was, nevertheless, a close observer of nature. Here in the temple had already been established a school of medicine. The facts were the inscriptions just alluded to,
placed upon the walls, left by those who had been cured by their visit to the temple and the grove, and in answer to their prayers to the divinities of health and medicine. The young truth-seeker approached reverently the altar, but looked at the phenomena occurring under these influences as, nevertheless, the product of something in the world of matter. Time passed swiftly and happily in the pursuit of a more reasonable understanding of disease and its cause, and a more accurate knowledge of the instrumentalities by which it is modified.
His fame began to spread through the islands and to the shores of Asia and Europe. Numbers came to consult him. His advice was sought in times of pestilence, and he had come to be regarded as one of the wise men of his age. Whether myth or history, we know not certainly, but the story is, that while he was patiently pursuing his studies, and questioning nature, a messenger from the chief city of Greece landed upon the island. The angry gods, so the stranger said, had stricken, in their wrath, the whole population. The peasant and the prince fell alike beneath the arrows of the destroyer. The chief ruler, in his great distress, had sent for the master. His favorite son had already fallen, and he himself had been accused by the people as the author of the scourge. He therefore prayed the learned man to visit the suffering city, and advise what should be done to save, if possible, the remnant of the plague-stricken inhabitants.
In answer to the summons, the physician immediately prepared to leave his pupils, for he had already many such, and enter, as his followers have since so often done, the field of death. He gave a few simple instructions to those best fitted to carry on his work, and at once embarked. On reaching his destination, he found the city in a condition which the graphic pen of her chief historian has made to us so fearfully realistic. His first act was to note carefully the soil and drainage of the parts most severely afflicted. He also investigated the water sources. He studied the climatic conditions, and especially did he carefully note the occupations and habits of the inhabitants. He observed that filth everywhere abounded. While there was great magnificence in the architecture, and the palaces of the rich were in the most wonderful condition of adornment, there was beneath all this opulence of display a reeking hotbed of foul matter giving off the most disagreeable and offensive odors. Under his advice, there was an effort made to purify, so far as possible, the atmosphere. The city was besieged by an enemy, and the thickly crowded metropolis did not present a promising field for sanitary work. In the meantime, the great ruler, broken with his many cares and ill requited labors, was himself prostrated. The end was soon reached, and the greatest of the Athenians, Pericles, was among the immortals. Hippocrates returned to Cos, there to ponder upon the lesson which had been opened before him in the plague of Athens, and to write his book on "Airs, Waters, and Places"—the oldest treatise of which we have any knowledge on hygiene or public health. We find stated in it, with almost the definiteness of modern sanitary science, the great importance
of pure water, as well as some of the diseases which are likely to result from the presence of filth. From the time of the father of medicine to the sixteenth century, we have but very little progress in the work of saving life. The older doctrines as to the cause of disease, whether among pagan or Christian peoples, were not encouraging to efforts in this direction. It has therefore come to pass, that measures looking to the prevention of disease by the use of scientific methods are modern.
The maxims of Hippocrates, the ceremonial of the Hebrew law as to bathing, and the establishment of quarantines are almost the only exceptions. For the most part, suffering has been regarded as an infliction of the gods, or, among Hebrews and Christians, as a dispensation of Divine Providence.
The accounts we have of the pestilence of Egypt and the plague of Athens in the earlier centuries, and the visitations of Florence, London, and other cities in modern times, illustrate this tendency of the human mind, in the midst of its sorrow, to turn to the supernatural. Sacrifices among the pagans, fasts and discourses upon the terrible judgments of God among Israelites and Christians, have been regarded as among the most efficient means for the arrest of the scourge. The profession of medicine in olden times could do but little in the way of educating people in better methods, and in leading them to the use of more efficient measures for the maintenance of public health.
So long as life and its disorders were made to depend upon the unknowable, but little encouragement could be found, in fact, for an effort to prolong the one or to prevent the other. Even the materialists were content with phenomena, and wearily warred with existing conditions. Slowly, with the revolving centuries, better notions of the conditions of life have been reached. A better understanding and observation of sanitary laws have been brought about. Gradual changes in the modes of living and larger means of comfort on the part of the people have been accomplished. With all these improvements, something has been done towards increasing the length of life. We have, as a race, made some progress, and, by surviving, we have demonstrated our fitness to survive. We do not know accurately the death-rate in the earlier centuries, but we do know that famine and pestilence carried away its hecatombs. As we come to more recent times we reach some approximation, at least, to accuracy. In the seventeenth century, and for some hundreds of years before, the population of England and north-western Europe had remained, if not stationary, with, at least, only a very slow growth. The cities, it is true, increased in population, but this increase could only be appreciated by comparing periods separated by many years. The agricultural districts very slowly became occupied. Life was short, and its product small. After the revival of learning, the great awakening of the sixteenth century, however, life became more valuable, and it was worth while to make a greater effort to save it. In the diaries of individuals and in the writings of medical men we find some informa