Official proceedings of the annual meeting: 1923

PRESIDENTIAL ADDRESS-FOLKS

5

ventive efforts are not separate; they are intimately bound together. To say that
tuberculosis has been reduced is simply another way of saying that fewer children are
forming well-beaten paths from their homes to the poormaster's office; fewer families
are having their standards of education and health smashed in a long struggle against
hopeless odds; fewer widows need pensions; fewer half orphans are sent to institutions
or become wayward through lack of parental care. As tuberculosis goes down, living
standards go up; and it is one operation. Every untimely death prevented means less
waste, more income, better standards of living, more happiness, and more general wellbeing. Improvements in health and in welfare, are not separate, nor even different;
they are the same thing.
Conditions of life have improved in large cities through better housing, greater
cleanliness, more education, and better administration, until even the look of things
has changed. The slums have gone. They now exist only in fiction and in the moving
pictures. We look much more sharply for juvenile delinquency, but find less of it,
and reformatories have many vacant beds; societies for the prevention of cruelty to
children, in the earlier sense, are becoming obsolete.
These are only instances. The closer the analysis of present conditions, the
stronger becomes the impression of a notable amelioration, effecting the very texture of
human society. Standards of living have risen. Education is more general and more
practical; wages have increased; hours and conditions of work have improved; people
are happier, healthier, more useful, and live longer. Most of them don't know it, but
that does not alter the fact.
In speaking of preventive measures I am not thinking solely of efforts directed
consciously toward particular results. Extraordinary events, such as the decline in
tuberculosis, are not due wholly, possibly not largely, to the particular things done in
the anti-tuberculosis campaign, varied and inclusive as those are. I am including
broader movements, which, by conscious aim, or as incidental and unintentional
by-products, have achieved the betterment of human life in concrete ways.
The sum total of these activities, direct and indirect, has proved beyond doubt
that prevention is possible; that human affairs are manageable; that conditions of life
can be modified; that man has power by his own effort to improve (and equally to
depress) the average level of human well-being.
But prevention is not only possible, it is also practicable. It costs less than cure,
and is simpler. The cost of the funeral of one victim of typhoid would pay the bill for
chlorinating the water supply of a great city, which takes effect instantly. Shick-testing
and immunization against diphtheria are among the simplest things a doctor does; but
the treatment of a serious case of diphtheria is a heroic undertaking. Preventive
dental hygiene requires little skill, and is quick and painless; fillings and extractions
are difficult, painful, and ever dangerous. The cost of probation is a mere fraction of
the cost of institutional care; but even probation gets into action rather late, when
much damage has been done. The earlier and broader measures of recreation, health,
family preservation, and early discovery and care of mental defects, are the real prevention of delinquency.
In fact, the preventive program possesses those virtues which we have found
measurably lacking in cure and correction. Cure or correction is, as a rule, uncertain,
incomplete, temporary, expensive, and slow. Prevention, on the other hand, is relatively certain, complete, permanent, cheap, and quick.