When we have improved our soil and replanted our forests and learned the most economical methods of mining our great deposits of coal, iron, and other minerals; when we have made the waters do our work and carry our freight and water our waste places; when we have learned to care for our birds and our fishes, and taken measures to stop the ravages of insects; when we have preserved our natural beauties and increased them by planting trees, shrubs, and flowers, and filling unsightly corners; there still remains to be considered the greatest subject of all,—the people who are to enjoy this wonderful inheritance. If they were to be weak and sick, suffering from all kinds of diseases, dying in great numbers, all these things would count for little. But men and women, as they are learning how to conserve their natural resources, are thinking far more than ever before of health and how to keep it. It is necessary to think of these things, for as people crowd into cities, where they live a life different from that which nature intended, sickness and the death-rate increase greatly.

Health, by which we mean the possession of a strong, well body, free from pain, should bring with it great power to work and to think and to benefit the world; and should also bring great happiness and enjoyment to the person who possesses it, for though sick people may be happy, and well people unhappy, yet it is a general rule that to be strong and well is the first great step toward being happy.

The question, "Is life worth living?" was once happily answered, "It depends upon the liver;" and it is true in both senses, for not only does happiness depend on what one gets out of life, but on good digestion. It is only the person who feels well who really enjoys life.

The person who can get up each morning able to do a day's work or have a day's enjoyment, is the one on whom we must depend for the world's work and invention. We seldom find a strong, vigorous mind in a weak body.

On the other hand, the invalid is the idle member of the family or the community. He can not find pleasure for himself nor do anything to help others, and not only that, but he must be cared for by others, thus taking the labor of the sick person himself and of his nurse. It is coming to be seen that this is a great waste of time, of money, of work, and of happiness, and people are determining that if these wastes can be stopped, it is well worth all the time and thought and money necessary to bring about the change.

People everywhere are thinking about health, and because of this, Christian Science, the Emmanuel Movement and the various sects which practise faith or mental healing have sprung up.

Hospitals and health officers are doing much for the public health. Doctors themselves are changing their ideas and are teaching us not only how to cure but how to prevent disease.

Doctors are also seeking not only to prevent disease but to find new ways of treating it. They are discarding drugs in as many cases as possible, frequently using serums in which cultures from the disease itself are used for its cure.

Health means more ability to work, more means of learning, of accomplishing great things, more pleasures in every day that is lived; and so it is as important to preserve health, in order to enjoy life, as it is to prevent death. We can realize how few persons have perfect health by noting the common salutation "How do you do?" or "How are you?"

Serious sickness is such as renders a person entirely unable to work. Benefit societies have found that the average number of days of sickness per year from each person under seventy years of age is ten, of which at least two are spent in bed.

About a million and a half people die each year in the United States, and it is estimated that twice that number, or three million persons, are constantly unable even to care for themselves. The effect of this is felt on the patient himself, in suffering, in loss of time in which he is unable to earn money, and in the amount spent for doctors, medicine, and nursing. It is felt on the family, in which the household machinery is thrown out while the wife and mother nurses the sick members of the family, or is herself too ill to work, or when the father's income stops on account of sickness.

The entire community suffers from the constant idleness of three million persons, as well as from the deaths which withdraw a still larger number of persons from actual work for a period of two to five days during the time of death and burial of the bodies of members of the family.

Then there is all the long train of small ailments, which do not make us seriously ill, often do not even keep us from work, but which do take away from the pleasure and enjoyment of life, which render work a burden instead of a delight, and lessen our ability to work by many degrees.

Not only this, but they all have within them the possibility of developing into serious diseases. Such lesser troubles are colds, headache, catarrh, dyspepsia, nervousness, neuralgia, sore throat, skin eruptions, rheumatism, toothache, earache, affections of the eyes, lameness, sprains, bruises, cuts, and burns.

Civilization has brought us great blessings but it has also brought with it many dangers to health. Professor Irving Fisher of Yale says:

"The invention of houses has made it possible for mankind to spread all over the globe but it is responsible for tuberculosis or consumption. The invention of cooking has widened the variety of man's diet but has led to the decay of his teeth. The invention of the alphabet and printing has produced eye strain with all its attendant evils. The invention of chairs has led to spinal curvature, etc., etc. Yet it would be foolish even if it were possible to attempt to return to nature in the sense of abolishing civilization.

"The cure for eye strain is not in disregarding the invention of reading, but in introducing the invention of glasses. The cure for tuberculosis is not in the destruction of houses but in ventilation. It is a little knowledge that is dangerous. Civilization can, with fuller knowledge, bring its own cure, and make the 'kingdom of man' far larger than the 'nature' people can ever dream of."

Until within the last few years, sickness and death were regarded from a religious standpoint. All sickness was to be borne with patience and resignation because all our sufferings were sent by an all-wise Providence. But since science has clearly proved that typhoid fever is usually caused by an impure water supply, and that boiling the water would prevent the suffering, expense and possible death; that the dreaded yellow fever can be banished from communities that destroy the eggs of certain mosquitoes; and many other facts in regard to health have been learned, a great change has come over the popular belief. It is seen that, to a great extent, man holds his own fate and is responsible for his own suffering, and people are eager to learn more about their own bodies, how to cure them and how to keep them well.

This knowledge has already done much to prolong life. The average length of life in India, where no attempt is made to check disease, is twenty-five years. In England the length of life has doubled in a few generations. In Sweden, where the people live a sanitary life, the average is over fifty years, in this country, forty-five years.

Insurance companies and benefit societies keep close watch of their members and they report that a person ten years old may now count on living to be sixty years of age. That is the average age, whereas a hundred years ago the average expectation of life at that age was only fifty-three years.

And this is true in spite of the fact that people have been crowding into cities, that they are living on richer foods, taking less exercise in the open air, living in houses which shut out the fresh air, and doing dozens of other things that have tended to lower rather than to raise the average.

We can scarcely realize the possibilities of life if, with all the present scientific knowledge of disease and health, we could have a generation of people living according to nature's laws.

Life can be not only lengthened but strengthened. There are many instances of frail, feeble children who have developed into exceptionally strong men and women. One of the most noted is Von Humboldt, the great scientist, who as a child was very weak physically, and, he himself says, was mentally below the average, but who lived to the age of ninety, and developed one of the greatest minds of his century.

Doctor Horace Fletcher, noted for his theories in regard to eating, was rejected at the age of forty-six for life insurance but so strengthened his constitution by careful living that by the time he was fifty he not only obtained his life insurance but celebrated his birthday by riding one hundred and ninety miles on his bicycle.

If we could imagine a person who all his life had lived in a locality where the air was pure; in a house where fresh air entered day and night, and which was heated to a uniform temperature; whose food had always consisted of the most pure and nutritious material prepared in the most wholesome way, eaten slowly and in proper quantity; if bathing, sleep, rest, exercise, brain work and pleasure had each its due proportion; if he could be always guarded from contagion and accidents, we can imagine that such a person would be free from disease and that death might be long deferred. Of course, death can not be prevented, only postponed, but disease can be prevented, and so we can increase the chances of postponing death. Doctors tell us that under ideal conditions there would be only one cause of death—old age.

There is no question that under such conditions life could be prolonged far beyond what is now usually considered its span. One hundred years or more might easily, we imagine, become the average of life, instead of the great exception.

We can hope for these things in the future though it will take several generations at least to bring them all about, but we need not wait so long for some of the best results. There are many things that can be done at once to prolong life and prevent illness. Since we know that many diseases are preventable and we know the suffering and sorrow, as well as expense, that come from sickness and premature death, we should all eagerly unite in doing all that we can to stop these ravages.

There are two agencies that will help to bring this about: individual or private means, and general or public means. Both are absolutely necessary if we are to be successful in stamping out disease. Professor Fisher says: "Personal hygiene means the strengthening of our defenses against disease. Public hygiene seeks to destroy the germs before they reach our bodily defenses."

In the first place, in order to learn what we may do to lengthen the span of life we must learn something of the nature of disease. Doctors tell us that diseases are of two classes. The first are hereditary, or inherited; those which pass from parents to their children and often run through an entire family. It is more often the tendency to disease that is inherited, rather than the disease itself, and so even these inherited diseases may often be prevented by careful living.

Diseases which may be inherited include rheumatism, gout, scrofula, diabetes, cancer and insanity. This class of diseases is the most difficult to prevent and to cure. For some of them no cure has been found.

The other class comprises the diseases of environment, or personal surroundings,—that is, our manner of living both as regards our private life and our relations to other people. These diseases are largely preventable and it is with them that most of the work of prevention is to be carried on.

A disease is considered preventable if, by using the best known means of treatment, it might be prevented or cured, so that either the disease or the death usually resulting from it would be avoided.

Of course, not all deaths from a given disease could be prevented even with the best known means. Infant diseases constitute one class which is considered most hopeful of betterment through a pure milk supply and better hygiene; and yet many authorities believe that not more than half the deaths could be prevented owing to the large part played by weather conditions, feeble constitutions, and other unchangeable conditions.

Preventable diseases may be divided into six classes:

(1) Diseases caused by lack of proper hygiene.

(2) Diseases caused by bad habits.

(3) Contagious diseases.

(4) Diseases caused by insects.

(5) Accidents, wounds, or operations and their resulting diseases.

(6) Diseases remedied by slight means.

We will treat each of these in turn.

(1) By proper hygiene is meant the proper treatment of the body as to breathing, eating, drinking, sleeping, bathing and rest. This treatment includes plenty of fresh air, both day and night, keeping outdoors as much as possible, and in well-aired houses the rest of the time. Vigorous but not violent exercise, brisk walking, regular physical exercise, such as is practised in gymnasiums, will go far toward keeping the body in good condition.

The question of fresh air in the home is one of the most important points to be considered. The bedrooms, the living-rooms, and the kitchen should have the air changed constantly, not once or twice a day. In order to prevent drafts, and that the house may not be kept at too low a temperature in winter, a board, eight to twelve inches in height, may be placed across the bottom of a window that is raised.

Many diseases, not only of the throat and lungs, but of the other organs, may be prevented by the constant introduction of fresh air into our rooms day and night.

Tuberculosis causes more deaths than any other single disease in America, and the sickness and disability continue longer than with most diseases. It is extremely contagious, being a germ disease, and not an inherited one, as was formerly supposed. It increased very rapidly for a few years but is now slightly decreasing, owing to better knowledge of its cause and cure.

Its prevention and its cure both lie largely in fresh air. Physicians say that no one who lives an open-air life with plenty of fresh air night and day will contract it. The cure which is restoring hundreds to health is to find a place where the air is pure, and live and sleep practically outdoors; to eat as much milk, raw eggs, and meat as can be digested and to observe the other rules of hygiene. Incipient cases, those in the earliest stages, may sometimes be cured while continuing at work by following the other rules as nearly as possible.

On account of the extremely contagious nature of tuberculosis, special care should be taken to prevent its spread. The sputum coughed up from the lungs is the principal carrier of the disease, and the person who, having tuberculosis, even in its earliest stages, spits in a public place, is an enemy of mankind, for he endangers the lives of hundreds of others. The only excuse for this is that he usually does it through ignorance, but the knowledge of the danger should be so impressed on all the people that no one could plead ignorance, and for a consumptive to spit on the street should be counted as much a crime morally as for a smallpox patient deliberately to expose others to the disease.

Great care should of course be taken in the home of a consumptive patient to prevent the infection from spreading through the family. Separate sleeping-rooms, thorough disinfection, and the use of paper napkins which are burned at once, to take the place of handkerchiefs, should be some of the means employed.

Pneumonia, pleurisy, bronchitis, grip, colds, and catarrh are some of the other ailments which may be largely banished by living the outdoor life. The method of treatment is medical, is different in each case, and should be decided by the family physician. The constant habit of breathing impurities, day after day and year after year, brings about a gradual change in the tissue of the lungs.

In the same way, simple food to take the place of the rich, heavy foods eaten in large quantities, will prevent many of the diseases of the stomach, liver, and kidneys, and improve the general health and strength. A diet of less meat and more eggs has been tried by football teams in training and found to give an equal amount of strength with greater endurance. A diet of milk, cereals, vegetables, nuts, and fruits, raw or simply cooked, with a small amount of animal foods, will perhaps give the best results in this climate. Food fried in fats, rich pastries and gravies are the hardest to digest, and better health will usually follow discontinuing them.

The purity of the food eaten should receive careful consideration. Artificially preserved foods are usually more or less dangerous, for although dealers urge that the poison contained in them is too small to do harm we must remember that it is not the single dose that does harm, but the many foods each containing a very small amount of poison, taken day after day.

Pure food laws, national and state, have done great good in driving adulterated and impure foods out of the markets by requiring all foods to be properly labeled.

Thorough mastication or chewing of the food is only a little less important than the character of the food itself. Rapid swallowing without chewing in childhood lays the foundation for many of the digestive diseases of later life. If food be thoroughly masticated much that would otherwise be hard to digest can be eaten without bad results. One of the best known examples of this is meat, which, while full of nourishment, sets up in the large intestine a condition known as "auto-intoxication," a species of digestive poison. If meat be eaten slowly and chewed thoroughly, this condition is almost entirely absent.

Pure drinking water is almost as necessary as pure food. We take water into the body for three principal purposes: first, it is needed to dissolve and dilute various substances and carry them from one part of the body to another; second, it forms a large part of the blood and other important fluids of the body, and is a part of many substances formed in the body; third, it serves to carry from the body the worn-out and useless tissues, the waste products of the body.

These are extremely poisonous and must be promptly disposed of to prevent sickness. This can not be done except by an ample supply of water. Few persons, especially grown persons, drink enough water. Ten glasses of pure water are needed properly to supply the body. "Insufficient water drinking is perhaps the commonest cause of the interruption of the normal life processes," says Doctor Theron C. Stearns.

But the common drinking cup in public places probably causes far more disease than the drinking itself prevents.

Particles of dead skin and disease-germs are left in the cup by each drinker. Some of the most serious diseases may be carried in this way. A cup made of heavy waterproof paper, cheap enough to be thrown away after being used once, is a recent invention that is highly recommended for use by school children and those who are obliged to drink away from home. The water in a public drinking-fountain should come out in a small steady stream so that those who have no cups may drink from the stream itself as it rises. Many school-houses are so equipped.

Sleep is a necessary part of good hygiene. It promotes health and prevents disease. It is largely in sleep that the system renews itself, that growth takes place, that waste products are thrown off, and the body repairs its wastes. No less than eight hours for grown persons and ten for children should be employed in sleep. Late hours and sleepless nights are the frequent cause of nervousness, eye strain, nervous prostration, and the beginning of brain troubles and insanity.

Bathing is also necessary to good health. The pores of the skin play a large part in carrying off the wastes of the body, through the perspiration, and if these become clogged, this poisonous material remains in the system. We have all noticed how a bath refreshes and gives tone to the entire body by opening the pores.

The skin is composed of minute scales, arranged in layers like fish scales. The tiny crevices between these form a lodging place for dirt and germs. If these remain, our own bodies are constantly exposed to their infection, if they drop off, as some are constantly doing, we may spread the contagion to others. This is strikingly illustrated by scarlet fever, smallpox, and similar diseases where these minute scales are the sole source of contagion.

Exercise is another necessity of health. Regular physical culture in a gymnasium will develop any muscle or part of the body almost at will, but if this be not possible much can be accomplished in developing the body by simple work. Gladstone found health in chopping wood, Roosevelt in a daily tennis game, and President Taft in golf. Many find it in gardening or farming. These all help to develop vigorous bodies.

Anything which brings into moderate play any set of muscles, which increases the circulation, or stimulates the secretion is beneficial. House-work, which, in its various forms, brings into use all the muscles of the body, is a wholesome exercise for women. Those who do no house-work seldom substitute for it any other active exercise, and many diseases which are caused by deposits of waste tissues that are not thrown off by the body, are the result.

Rest—recreation—pleasure—these are as necessary to health as anything else, but the American people are slow to learn the need of them. We hear much of nervous prostration as an American disease. It is due to a variety of causes,—high living, late hours, ill-ventilated rooms, and climate; but chief of all the causes is the long hours of work under strong pressure. Work done in a hurry and without rest may accomplish many things, but it invariably causes a corresponding loss of nerve force. Fatigue, by checking bodily resistance, gives rise to all kinds of poisons in the system. Every part of the body feels the ill effect of continued exhaustion.

Of the diseases caused by bad habits, it can only be said that all the evils they cause, directly and indirectly, are entirely preventable; that they are usually wrong morally, and that the suffering which results is sure.

Under this head come the effects of drinking, of the use of tobacco and drugs, and of bad personal and social habits. It is only necessary to refrain from these bad habits to prevent all the diseases that arise from them, with all their train of suffering, poverty and crime.

It is not the province of this book to deal with scientific temperance, but merely to state a few of the most serious results of the use of alcohol and other poisons. The white corpuscles of the blood have been called our "standing army," because they are natural germ-destroyers. One class of the white cells has the power of motion, and another class has the power of absorbing outside matter, such as disease-germs. One destroys the germs and the other moves them through the blood and carries them off with the waste products of the body.

The white corpuscles thus stand as the defenders of the body, ready to destroy the germs as they enter, and are, for each individual, the best of all preventives of germ diseases. The person whose blood is lacking in white cells is always liable to "catch" contagious or infectious diseases, and the one who has that element of the blood in proper proportion is best fitted to withstand disease.

Leading physicians believe that the greatest harm that comes from the use of alcohol lies in the fact that nothing else so weakens the resistance of the white corpuscles, and that therefore the person who is an habitual user of alcohol lacks the power to repel all classes of disease. English and American life insurance companies give us almost exactly the same figures, which show that of insured persons, the death rate is twenty-three per cent. higher among those who use alcohol than among total abstainers. It is probable that the proportion of persons carrying life insurance is much less among the drinking classes and that if we had complete statistics the difference would be far greater than appears in the life insurance tables.

Of time lost by sickness, directly and through other diseases caused by alcoholism, drugs and other bad habits, the percentage is very great, according to all hospital records.

The number of prominent persons who have died of "tobacco heart" indicates that the rate of those whose heart action is weakened by the use of tobacco is probably very large.

Doctor Morrow says that if we could put an end at once to diseases caused by bad habits it would result in closing at least one-half of our institutions for defective persons, and almost all of our penal institutions.

There is another long list of diseases which are contagious, that is, which one person may transmit to another. These are usually serious but their spread may be largely prevented by keeping the sick person alone, except for the necessary nurses, quarantining the house and disinfecting everything when the period of infection is past.

In this class are smallpox, diphtheria, scarlet fever, measles, mumps, chicken-pox and whooping-cough.

These latter are the so-called "childish diseases" which it was formerly considered impossible to escape, and little attempt was made to guard against them. Now they are recognized as serious, whooping-cough for its close relation to brain and spinal trouble; measles for their effect on the eyes and lungs; chicken-pox for its similarity to smallpox, and mumps for its general lowering of the tone of the system, allowing other diseases to gain a foothold.

Special serum treatment for diphtheria and vaccination for smallpox have greatly reduced the danger from these once greatly dreaded diseases.

Of preventable diseases none should receive more attention than typhoid fever, because it is a great scourge and yet it can be prevented by simple means. If we understand that typhoid is a dirt disease, that it comes only from dirt, we shall feel it a disgrace to have an epidemic of typhoid, though one of the saddest features about it is that we must suffer for the sins of others. The one who is attacked by typhoid fever may not be the one who has left dirt for the disease to breed in.

Typhoid fever germs are bred chiefly in manure piles, sewers, or cess-pools, and would not be transmitted to man directly, but there are several indirect ways in which they may be carried. Flies also breed in the same places. Their legs become covered with typhoid germs, and then they fly into houses directly on the food and cooking utensils. This is one of the most common ways in which the disease is carried, and doctors tell us that the common house-fly should be known as the "typhoid fly" so that people may know the serious danger that lurks in what was formerly considered as nothing worse than an annoying foe to clean housekeeping.

If houses are thoroughly screened, if cess-pools, manure piles and garbage are kept tightly covered, screened, or, still better, disinfected with chloride of lime, there will be no breeding-places left for flies and this will remove one of the greatest dangers.

The other danger lies in a polluted water or milk supply. Every sewer that is carried into a stream, every manure pile that drains into a water course is a menace to health.

Very frequently the farm well for watering stock is near the barn,—near the manure pile, which, as it drains, carries down millions of typhoid germs to the water-level below. The well becomes infected, the family drink from it, and soon there may be several cases of typhoid fever in the home.

Worst of all, the milk pails are rinsed at the well, and all the milk that is poured into them spreads the germs wherever the milk may be sold. In this way an epidemic may be carried to an entire town, and to persons who themselves have taken every precaution against the disease.

Drinking water should be boiled unless one is sure of the water-supply, and surface wells are never safe unless we know that they drain only from clean sources, and then the water should be analyzed frequently. Boiling absolutely destroys typhoid and other germs, and well repays the extra work it makes. One case of typhoid fever causes more work than boiling the water for years, if we consider the work only.

If you can not buy pasteurized milk, and are not sure of conditions about the dairy, your milk should be boiled, or, still better, sterilized at home by putting it in bottles or other containers, and placing in a vessel of hot water, keeping the milk for several hours about half-way to the boiling point, then cooling gradually.

All these means of prevention are troublesome and require time and work, but as the result in health for the family is sure, every housekeeper should gladly take this extra burden on herself if it be necessary. In some states and many cities, the laws governing dairies are now so strict that there is no need of doing this work in the home. This care in the dairies should be insisted on everywhere, even if it raises the price of milk, because it means the saving of many doctor and drug bills and also raises the standard of public health.

Yellow fever was formerly dreaded more than any other single disease because it was so wide-spread, so fatal, and was thought to be violently contagious, but during the Spanish-American War it was proved that it is not contagious at all, but comes only from the bite of a certain mosquito, the stegomia, which is usually found only in hot climates. It is conveyed in this way: the mosquito bites a yellow fever patient; for twelve days it is harmless, but after that time it may infect every person that it bites.

If every yellow fever patient could be screened with netting to prevent his being bitten, we could prevent the yellow fever mosquito from becoming infected. Further, if we can prevent healthy people from being bitten by fever-infected mosquitoes, they will escape the disease, and still further, if we can destroy the eggs of mosquitoes, we can entirely obviate all danger of yellow fever in a community.

The mosquito breeds only in water; by having all cisterns, rain-water barrels, and other water containers carefully covered, and by spreading the surface of pools of standing water, especially dirty water, covered with greenish scum, with a thick coating of kerosene oil, we can prevent the eggs from hatching. This has been done in many communities in Cuba and the southern part of the United States, and has resulted in completely stamping out the disease in those places.

Malaria is caused by another mosquito, called the anopheles and while malaria is seldom fatal as is yellow fever, it causes much suffering and loss of time, and strong efforts should be made to prevent it. The same measures that are used to prevent yellow fever will banish malaria from any community. They are the screening of patients to prevent spreading the disease; screening all houses closely and keeping close watch for mosquitoes in the house, and covering all ponds in the neighborhood with oil. New Jersey mosquitoes were formerly known far and wide, but such an active campaign has been waged against them, that they have been almost completely driven from the state.

The ordinary mosquito has never been found to do any harm beyond the discomfort of its bite.

Of other diseases caused by insects, an affection of the eyes called pink-eye is carried by very tiny flies, and the dreaded bubonic plague is supposed to be transferred from sick people to well ones by the bites of fleas, which in turn are brought to this country by rats.

The hook-worm which affects so many persons in the South is often called "the lazy disease" since the persons afflicted with it are not totally disabled, but are lacking in energy and vigor because the small insects take from the blood the red corpuscles which should carry the digested food all over the body. These insects can be destroyed by medicine, of which only a few cents worth is required to cure a case and make the patient fit for work and enjoyment. In Porto Rico almost 300,000 cases have been treated by the United States government in the last six years.

Another matter which should receive careful consideration is the large number of preventable accidents. Mining accidents come in a few cases from failure to provide the best appliances in the mines, but in many cases are due to carelessness or ignorance of the operators themselves. There still remain a large number of accidents which occur in the best regulated mines, and when no instance of special carelessness can be traced. For years these disasters have puzzled mining engineers, but within the last few months it has been discovered that the minute particles of coal dust in a dry mine completely fill the air, so that the air itself is ready to burn.

When a light is taken into this coal-filled atmosphere, it bursts into flame, causing a violent explosion. Sprinkling the mines, forcing a fine spray of water through the air of every part of the mines, it is thought, will prevent this class of accidents, which have furnished long lists of killed and injured each year.

Reports show that one miner is killed and several injured for every one hundred thousand tons of coal mined. The mining accidents of one year total 2,500 killed and 6,000 seriously injured.

Other industries do not cause such wholesale injuries, but there are thousands of individual accidents each year where the injury varies from mangled fingers to death.

When the cause is failure to provide suitable safeguards to machinery, or to warn employees of danger, the penalty to the employers should be made severe, so that no consideration of money will prevent them from taking precautions. More often, however, the injury is due to the carelessness of the men or to the fact that they try to run machines with which they are unfamiliar.

Manual training schools, night schools for working-men, with a short apprenticeship in the running of machinery and an explanation of the dangers, will go far to prevent this class of accidents, but the fact will still remain, that often those who are most familiar with machinery become careless and are more liable to injury than beginners.

The number of accidents that have been added to the world's list by automobiles, both to those riding and to persons who are run over by them, is great and is in a large measure due to carelessness in handling the machine or to reckless driving.

The entire number of accidents in the United States, including railway accidents, reaches the immense total of sixty thousand killed and many times that number injured. A most appalling waste of life and labor value!

Professor Ditman says, "Of 29,000,000 workers in the United States over 500,000 are yearly killed or crippled as a direct result of the occupations in which they are engaged—more than were killed and wounded throughout the whole Russo-Japanese War. More than one-half this tremendous sacrifice of life is needless."

Until the last quarter of a century there was a large addition to the death rate each year from the blood poisoning following operations and injuries making open wounds. It was not until the discovery of the germs which cause septic poisoning that deaths from these causes could be checked. The use of antiseptics, such as carbolic acid, alcohol, and various other preparations, the boiling of all surgical instruments, and the boiling or baking of all articles used in the treatment of open wounds and sores has reduced the death rate at least one-half.

The rate could be lowered much more if all sores were treated as surgical cases and carefully sterilized from the beginning. About eighty-five deaths out of every hundred from these causes might be prevented.

Every Fourth of July a great many entirely preventable deaths and minor accidents occur. The toy pistol has come to be considered almost as deadly as the larger variety. The tiny "caps" that are used in them are fired back into the hand of the person shooting them, tiny particles of powder enter the skin, burrowing into the flesh, and the skin closes over them, shutting out the air. If these particles carry with them tetanus germs, as is often the case, because these germs are found chiefly in the dirt of the street where most of this shooting is done, lock-jaw or tetanus, a severe form of blood-poisoning, results, and is usually fatal. The same results come less frequently from fire-crackers and other explosives, and in addition many accidents which injure hands, eyes, and other parts of the body, are the result of the use of the heavier explosives.

The Pasteur Treatment is saving many lives each year by treating cases of infection from "mad dogs" and other animals affected with hydrophobia.

Among the diseases which can be remedied by slight means are enlarged tonsils and adenoid growths back of the nose, both of which can be removed by a slight and almost painless operation, but which, if allowed to develop, often cause serious throat and lung troubles, deafness, and weakened minds. Slight defects of the eyes can be remedied by the wearing of glasses, but which if unchecked give rise to various nerve and spinal diseases as well as more serious eye troubles. It is believed now that most of the blindness of later life could be prevented by proper care of the eyes in early life and by prompt attention to slight defects of the eyes when they begin.

Doctor Walter Cornell, who has made a study of eye strain says, "Eye strain is the chief cause of functional diseases. It is almost the sole cause of headache, is the frequent cause of digestive diseases, of spinal curvatures, and indirectly of neurasthenia and hysteria."

Decayed teeth in children, slight in themselves, give rise to more serious troubles in later life,—ill-shaped mouths and jaws and crooked teeth result from teeth that have been drawn too early in life. Decayed teeth lead also to many stomach and digestive troubles.

Medical inspection in the schools shows a surprising number of children suffering from these minor troubles. About 80,000 children were examined, and the records show that out of every one hundred children examined sixty-six needed the services of a doctor, surgeon, or dentist, and some needed all three.

Forty out of each hundred had badly neglected teeth.

Thirty-eight had enlarged glands of the neck.

Eighteen had enlarged tonsils.

Ten had growths of the nose.

Thirty-one needed glasses.

Six needed more nourishing food.

This meant that more than 52,000 of the number needed some medical care that they would not have received at home because their parents had never noticed the need of it. Every one of them could by prompt attention, a small dentist's bill, a slight operation of the throat or nose, or the use of glasses, (almost 25,000 needed glasses) be saved great suffering or inability to work in later life.

As we learn more of disease, and especially of germ diseases, we are oppressed by the feeling that we are in constant danger, but we must bear in mind that it is the weak and unfit that are attacked, and that fitness, while partly inherited, is almost altogether a matter of proper hygiene. Keeping our bodily defenses in good condition against disease is as much a matter of necessity and good policy as keeping the defenses of a city in fighting condition in time of war.

That life may be prolonged and so strengthened that the average height, weight, and endurance will be increased, admits of no doubt. The same rule of cultivation runs through all nature. The original or natural apple was a small, sour, bitter crab. The difference between that and the finest products of western orchards, is altogether a matter of cultivation, selection, and proper treatment. In 1710 the average weight of dressed cattle did not exceed three hundred and seventy pounds. Now it is not far from one thousand pounds. An equal change could be made in the human race, but because we believe so fully in personal liberty to live our lives as we choose, little has actually been done to raise the human standard.

The care and hygiene of children is receiving universal attention, with the result of a wonderful reduction in the sickness and death of children, but as yet comparatively few grown persons apply these lessons to their own lives, and the rates for older persons remain almost unchanged.

When individuals have done all that they can, there still remains much that must be done by the city, the state, and the nation. Boards of health can do much toward controlling epidemics by placing infected households under quarantine, by compelling householders who are ignorant or careless to clean their premises and to take other precautions for the public health.

Hospitals, both public and private, have done excellent work, not only in curing disease but in gaining more definite knowledge of the nature of diseases through the study of large numbers of cases.

The cleaning of streets and the removal of garbage regularly are among the great factors in keeping a city in a sanitary condition. New Orleans and some of the cities of Cuba and Porto Rico show strikingly what may be done in that direction.

Medical inspection of schools is a new and valuable aid to health. Epidemics of childish diseases which sweep through the schools with a fearful record of illness and a lesser one of death, may often be checked entirely by the close watch of the medical inspector, who removes the first patients from the schools when the disease is in its beginning.

Public playgrounds for children in cities have an influence that it is as good for health as it is for morals, providing, as it does, fresh air and active exercise for children. Open air schools for tubercular children are being operated in several cities with excellent results in health and school work.

Many states are making an organized effort to fight tuberculosis by establishing fresh-air colonies where, with pure air, rest and plenty of the most nourishing food, patients are restored to health.

Care of epileptics and the insane by the state, with proper hygiene and treatment, accomplishes many cures.

The nation is doing excellent work in a few lines, notably the Pure Food Bureau and the Marine Hospital Corps, but perfected organization of all the forces is lacking. The Department of Agriculture has done a wonderful work in investigating and curbing insect pests that injure farm crops and trees, and in stamping out disease among live stock. Forty-six million dollars have been spent and well spent in the work in the last few years, but it is a matter of reproach that more pains are taken to save the lives of cattle and farm crops than human lives.

There should be a strong central Bureau of Health with power and money scientifically to investigate disease, to distribute information as the Department of Agriculture does to farmers, and to carry out their ideas, as do state and city boards of health.

We have dealt with only one side of the question—the suffering and sorrow; but in a work on conservation, we must consider also the money question, the loss to the nation in time and money of these great wastes of health and life.

There are no trustworthy statistics as to wages. The average yearly earnings of all persons, from day laborers to presidents, is estimated at seven hundred dollars; but as not more than three-fourths of the people are actual workers, three-fourths of this amount, or five hundred and twenty-five dollars is taken as the average wage.

From these figures the money value of a person under five years is given at ninety-five dollars; from five to ten years, at nine hundred and fifty dollars; from ten to twenty years at $2,000; from twenty to thirty at $4,000; thirty to fifty years at $4,000; fifty to eighty at $2,900 and over eighty at $700 or less. The average value of life at all ages is $2,900 and the 93,000,000 persons living in this country would be worth in earning power the vast sum of $270,000,000,000. This is probably a low estimate but is more than double all our other wealth combined.

Now let us see how much of this vital wealth is wasted. As the average death rate is at least eighteen out of each thousand, we have 1,500,000 as the number of deaths in the United States each year. Of these, forty-two per cent., or 630,000 are classed as preventable—so that a number equal to the entire population of the city of Boston die each year whose deaths are as unnecessary as is the waste of our forests by fire.

If some great plague should carry off all the people of Boston, not the people of the United States only, but of the whole world would be roused by the appalling calamity and every possible means would be employed to prevent other cities from sharing such a fate; but because these preventable deaths are not in one city, but are widely scattered, we have long remained indifferent to this terrible and needless waste.

Then there are always 3,000,000 persons ill, 1,000,000 of whom are of working age. If, as before, we count only three-fourths of them as actual workers, we find a yearly direct loss from sickness of $500,000,000 in wages. The daily cost of nursing, doctor bills, and medicine is counted at one dollar and fifty cents, which makes for the 3,000,000 sick, a yearly cost for these items of more than $1,500,000,000. What should we think if nearly all of the people of the city of New York were constantly sick, and were spending for doctors, nurses, and medicine as much money as Congress appropriates to run every department of the government!

It is estimated that sickness and death cost the United States $3,000,000,000 annually, of which at least a third, probably one-half, is preventable. Is it not well worth while, then, from a money standpoint alone, to use every effort to conserve our national health? Conservation of health and life, going hand in hand with conservation of national resources, will give us not only a better America, but better, stronger, happier, more enlightened Americans. What a new world would be opened to us if we could have a nation with no sickness or suffering! That is the ideal, and everything that we can do toward realizing that ideal is a great step in human progress.

Report on National Vitality. Committee of One Hundred. (Fisher.)

The Nature of Man. Metchnikoff.

The Prolongation of Life. Metchnikoff.

The New Hygiene. Metchnikoff.

Vital Statistics. Farr.

The Kingdom of Man. Lankester.

Cost of Tuberculosis. Fisher.

School Hygiene. Keating.

Economic Loss Through Insects That Carry Disease. Howard.

Report of Associated Fraternities on Infectious, Contagious, and Hereditary Diseases.

Conservation of Life and Health by Improved Water Supply. Kober.

Backward Children in the Public Schools. Davis.

Dangers to Mine Workers. (Mitchell.) Report Governor's Conference.

Tuberculosis in the U. S. Census Report 1908.

Industrial Accidents. Bureau of Labor Pamphlet, 1906.

Factory Sanitation and Labor Protection. Dept. of Labor, No. 44.

How Insects Affect Health in Rural Districts. Dept. of Agriculture. Bulletin 155.

Public Health and Water Pollution. Bulletin 93.