Such figures as I have given, showing saving and prolongation of life during the last fifty years, are apt, if left uncorrected, to create a complacent warmth tending to public health inertia. It may conduce further to this folding of the hands when I state that Simon in his first report to the Local Government Board expressed the opinion that the half million deaths a year approximately which occurred in 1871 in England and Wales were a third (125,000) more numerous than they would be if existing knowledge of the chief causes of disease were reasonably well applied throughout the country; and further that had the mortality experience during 1911-15 held good for 1871, the deaths in that year would have been reduced by 200,000 instead of by 125,000, the ideal then aimed at by Simon. But with increased knowledge we know that a larger proportion of diseases are preventable than was formerly supposed. It will be easy within the next ten years to reduce the death-rate by one-third of its present amount, given systematic and adequate action on the part of Public Health Authorities and an effective educational propaganda among the general public. More important still, an even larger proportion of mankind’s total illness can be avoided, and life on a higher plane of health secured, as well as life prolonged to its normal limit. The work carried out during the last ten years, sanitary, medical and hygienic, in improving the prospects of healthy child-bearing and of normal infancy and childhood constitute the most important advance toward national physiological life on a higher plane which has hitherto been made. Preventive medicine can never be satisfied until it has approached Isaiah’s ideal (Isaiah, LXV, 20), “There shall be no more thence an infant of days, nor an old man that hath not filled his days; for the child shall die a hundred years old.” FOOTNOTES: [1] An address prepared for the celebration of the fiftieth anniversary of the Massachusetts Board of Health, September, 1919. [2] The administrative side of the subject is sketched in the next chapter. [3] Reprint of Reports, Vol. I, p. 448. [4] There is still no evidence to show that in the production of the excessive diarrhœa which prevails in insanitary districts, specific contamination of the filth accumulations is necessary. CHAPTER II THE HISTORICAL DEVELOPMENT OF PUBLIC HEALTH POLICY IN ENGLAND[5] The subject is too large to be treated adequately in the course of an evening’s address; and to bring it within manageable compass it is necessary for me to select my material rigidly and, as far as I can, to present this material in such a manner as will bring into relief its salient and most instructive features. The evolution of public health in England proceeded by experimental steps, some mistaken and then retraced, others mistaken and not retraced, but steps oftenest in the direction of a complete service, which is the goal of our work.