at 8,000,000 the number of living Americans who must sooner or later die of tuberculosis. Again, the National Service Department in England found that, out of 2,500,000 men, between the ages of 18 and 42, only 900,000 were physically fit for active military service - 36 per cent. Finally, the Health Insurance Statistics, for England, show that the 10 million insured persons lose, by disease, each year more than 80 million working days, the equivalent of over 250,000 working years. Think what these figures mean. The taxpayer has to contribute to the expenses of the treatment and maintenance of this army of the disabled, and the other workers are devoting their efforts to make good the wastage. It can be shown conclusively, with the present day expert knowledge, that the vast majority of this loss is avoidable by ordinary care; but every expert will admit that people must be educated since only through popular understanding will such care come to be exercised.

Now it is of course not primarily in the interests either of employers or labour that the League of Red Cross Societies has planned its proposed campaign, but in the interest of the happiness and well-being of the people at large, whether rich or poor. Is it not clear, however, that this is a matter in which all our interests are identical? Manufacturers in many parts of the world, realising that it is their interest to do so, have themselves inaugurated schemes for promoting the well-being of their employees. It seems to the League, however, that, in order to be widespread and effective, any measures aimed at the betterment of health, happiness and efficiency, must be based upon universal understanding. The people themselves must consciously cooperate; they cannot cooperate without the requisite knowledge, and the attainment of that knowledge necessitates instruction: the organisation of that instruction is the first plank in the platform of the League of Red Cross Societies.

In this connection I would like to read to you an extract from the November number. of "The Lancet ", r ferring to a paper by Dr. C.-E. A. Winslow, former Director of the League's Department of Health, which was published in the June issue of the Bulletin of the League of Red Cross Societies :

"To ensure the voluntary cooperation of the individual citizen, without which Government and municipal health authorities can effect little, an educational campaign is imperatively demanded, although the wide diversity of conditions in the different countries makes adherence to any rigid plan undesirable and, indeed, impossible."

For the prosecution of this purpose, a world-wide organisation is essential. Each country must create its own mechanism, adapted to its own peculiar circumstances; but for all nations certain main principles are applicable. The interest must be widely distributed, and the consciousness of the public must be generally awakened. National Red Cross Societies, based on a wide popular membership, seem to be the ideal means for preaching the gospel of public hygiene, and in the words of the pamphlet of which I have spoken "the League looks forward to the building up in every country of a strong national Red Cross Society, based on enlightened public opinion, with a wide popular membership, pledged to the idea of a world-wide health crusade. and to a continuous campaign against human suffering.

Dr. René Sand will explain to you the general scheme of procedure by which, if the Council of the League agrees with it, we propose that this advance should

be made along the road to popular knowledge and understanding of our health needs and to the means of avoiding sickness, inefficiency, and bodily misery and deterioration; but before I sit down, I would like to add this. I have said that we pin our faith first and all the time upon popular health instruction. But popular health instruction is far more difficult of assimilation by those who are grown up than by the young. The League is therefore making a very special effort to induce national Red Cross Societies to adopt, and to adapt to their needs, the Junior Red Cross organisation which originated in America and which has already made such surprising progress in several countries so widely different as, for example, England and Czecho-Slovakia. It is relatively easy to teach the principles of personal hygiene and to stimulate a consciousness of the needs of the human body among youngsters; and it is confidently believed that this organisation of the Junior Red Cross will, more rapidly than anything else, effect a revolution in the world's outlook upon the problem of preventible disease and avoidable misery.

As Dr. Sand will explain to you in greater detail, the League, after various experiments, proposes to concentrate its specialised activities and energies upon four main subjects, since these seem to be matters of universal interest namely: tuberculosis (with which 90% of humanity in civilised countries.is more or less tainted), child welfare, public health nursing, and Junior Red Cross. All of these are to be dealt with through methodical popular health instruction, which last is, consequently, made the basis of the activities which we propose to urge universally upon all national Red Cross Societies. I will now ask Dr. Sand to address you.

Ν

SPEECH BY Dr. RENE SAND.

IN to of the public health campaign undertaken the

of Red Cross Societies, I am dealing with a problem closely connected with your deliberations. You are concentrating your efforts on the improvement of the conditions of industrial life, because you know that all social and industrial advance is dependent on the health and physical capacity of the nation. Notwithstanding, however, the progress which has already been achieved, the ravages resulting from avoidable diseases are still infinitely greater than is generally realised.

In order, first of all, to discount the effects of labour, of industrial life, and of excess, I will quote statistics referring to children between the ages of 7-14 in England where, for the last fourteen years, a really excellent system of school medical inspection has been in force; of seven million children of school-going age, one million are seriously handicapped in their growth and education by physical and mental defects, a second million are totally deprived of education as a result of disease or disablement: so one child out of every three is doomed to ignorance, suffering and invalidity.

Next, that you may realise the appalling toll levied on human life, let me take a small group of people during the first 40 years of existence. Ten young women are about to become mothers: of these only eight will produce a living child. Twenty years later two of these children will be dead. In

another twenty years, only five of the group will be left, of whom two are healthy, the remaining three being more or less incapacitated.

In other words, there is over 50 per cent wastage of human life. This, mark you, not during the period of unrest following on the war, but in peace time, in time of full prosperity, in the best-educated, best-organised States of Western Europe.

Is this a process of natural selection, which, by pitilessly sacrificing the unfit, safeguards the strength of the race? This is true only to a certain extent: articifial feeding, errors of diet and infectious diseases attack, maim or destroy the strong as well as the weak. Or are these terrible conditions due to lack of scientific knowledge, or are the methods recommended by science so complicated and so onerous that their practical application is wellnigh impossible? By no means. Take as example infantile opthalmia, responsible for so vast a number of cases of blindness. In England every year 6,500 children are attacked by the disease. The experience of 50 years has, however, shown that the infection is easily counteracted by a few drops of nitrate of silver or even of lemon juice. A simple enough measure, but, alas, too often neglected.

We are here faced with a paradox. Where it is a case of ordinary problems of hygiene, education, or every-day life, the application of scientific discovery is terribly slow. Science forges for the presentation and welfare of humanity weapons of which the latter appears loth to take advantage. As a matter of fact, scientists themselves are generally too absorbed by the search for fresh discoveries to trouble to put the old into general practice. Whilst paying tribute to their enthusiasm, to which we are indebted for the admirable preventive and curative methods of to-day, it is to be regretted that the fields already conquered should be so neglected. Supposing, which God forbid, that all scientific investigation were to cease, it would be possible, by fully applying the knowledge already acquired, to decrease by half the ravages of infant mortality, of tuberculosis, of venereal disease and of many other complaints.

What in fact does each disablement and each death actually represent ? Apart from all sentiment, they represent a machine idle in the workshop, an idle shift in the mine, an imperfectly ploughed field: they represent the unproductive labour of an unskilled substitute: they entail sick pay doctors' and chemists' bills a family first impoverished, then rapidly falling into dire distress and misery, both in their turn generators of disease.

It is important to emphasise that these evils are for the most part avoidable. Take the case of the Norton Company, Worcester, Massachusetts, which, by organising a really competent medical service, has reduced the number of days of sick leave by three-quarters: or that of the Goodrich Company, Akron, Ohio, which has achieved a reduction of four-fifths. It is estimated that in America the net loss through sickness to employers and workpeople amounts to several billion dollars each year.

This wastage of human lives, of money, and of productive power is due to two main causes: the inadequacy of our hygienic equipment, and the unhygienic habits of the people.

The Office International d'Hygiène, the Health Section of the League of Nations, and the International Labour Office, are endeavouring to remedy the former. The League of Red Cross Societies, with the object of educating the public in matters of hygiene, has grouped together practically all national Red Cross Societies.

Each of these organisations has a clearly defined mission: the Office International d'Hygiène in Paris and the Health Section of the League of Nations conduct investigations, collect and publish data from all parts of the world and submit to the various Governments recommendations or conventions. The International Labour Office and its Industrial Health Service does the same with regard to its own special field.

The League of Red Cross Societies deals more especially with the education of the public, an activity which, although perhaps less apparent, is none the less essential.

Indeed, the most perfect organisation, the most admirable legislation, is powerless without the support and approval of enlightened and consenting public opinion. General health education is essential for three reasons:

Firstly, even if it is true that hygiene gives better returns than any other security, in health, in productivity, and in happiness - it is equally true that it necessitates the investment of a big capital; and no government, no municipality, no employer or trade union would risk important sums in the cause of hygiene, unless the public, the shareholders and the workpeople realise the importance of the investment.

Secondly, even when the necessary measures have been adopted, they will remain a dead letter without the sanction of public opinion, which alone can make them truly effective. What is the use of shower-baths, of which no one avail themselves, or of safety appliances which are not brought into use?

Finally, hygiene demands the active cooperation of the people concerned. It is not enough to create Garden Cities, Model Factories and Dispensaries; the working men, even more than any other class, must be trained to brush their teeth daily, to wash their hands frequently, to sleep with open windows, and to take exercise in the open air. Supposing each person to have a knowledge of even the elementary principles of cleanliness, the world would be transfigured and men would gaze at each other in amazement, astonished at their new-born dignity.

The most important point in connection with the health campaign is the awakening and development of the hygienic conscience of nations.

How may this be achieved? The League of Red Cross Societies, after wide and varied experiments, after collecting and exhaustively studying a mass of material, has recognised the essential value of three different methods.

Firstly, the work of the Health Visitor. The Health Visitor is attached to the infant dispensary, to the anti-tuberculosis dispensary, to the health department, to hospitals, consultation rooms, to the medical service of factories, and of mutual benefit societies: she visits the sick in their homes, ensures the adoption of measures for preventing the spread of infection, traces out latent or neglected cases of disease, insists on cleanliness in the home and on the admittance of fresh air and of sunshine, in short on the adoption of habits of hygiene. She may be termed the "Hygiene Teacher of the Masses", and is the veritable pivot of the health campaign.

Formerly mothers brought their babies to the Infant Dispensary, a system far inferior to the ministration of the Health Visitor in the home. The Health Visitor shows the mother which window to open, selects the most suitable spot for the cradle to stand: shows her how to wash and dress her baby, and teaches her how to prepare food. Before the advent of the Health Visitor, the tuberculosis patient attending hospital received, it is true, treatment and supplies,

but who taught him the necessary measures for preventing the spread of infection in his family? Who gave instructions as to diet? Who encouraged him to persevere in his tedious treatment?

The introduction of the Health Visitor may be considered equivalent to bringing the resources of the hospital to the patient's bedside; to placing at the the disposal of each family the services of an expert in hygiene. The Public Health Visitor is even more important in the country than in the town, where doctors are more numerous and help more easily obtained: hygiene in the country exists only through her.

The Health Visitor requires long and careful training and only a few countries possess schools created specially for this purpose. Two years ago the League therefore organised special training courses in London, in which thirty young women, sent by twenty-seven nationalRed Cross Societies, have received training in the career of public health nursing. On returning to their respective countries they have spread and developed a movement which should end in the creation of a vast “health army", the only kind of army in regard to which there will be no outcry for its demobilisation.

Secondly, the League advocates the education of the public, perseveringly and skilfully carried out. Pamphlets, posters, the press, lectures, films, exhibitions, mobile units with specially equipped automobiles, or trains-no method has been left untried. Devotion and good-will are not however enough: the art of attracting and convincing the public demands a knowledge of psychology, of pedagogy, of science, and of methods of advertisement. The League has examined these problems exhaustively, investigating mistakes, discovering needs and comparing the results of the various methods. It tries to find out how to interest the public, how mothers may be taught, the sick enlightened and vocations discovered. Hygienic education should then not only be a general principle, it is an essential element in securing child welfare, in the fight against tuberculosis, in the recruiting of nurses, and in attaining a measure of industrial and rural hygiene.

Owing to its moral authority, to its democratic organisation and methods of recruiting, to the number of its adherents, which are reckoned by millions, the Red Cross is the organisation best qualified to undertake this universal health campaign.

Ladies and gentlemen, representatives of the trade-unions, will you here allow me to speak to you quite frankly, to tell you exactly what is in my mind? Your organisations aim at the increased welfare of the workers, and, for this reason, I think they should come to the support of the Red Cross. In co-operation with the representatives of the Governments and of the employers, you are vitally interested in the study of industrial hygiene, for the success of which you have our heartiest good wishes. Let us, however, suppose your task to be accomplished, and that all trades are conducted under faultlessly hygienic conditions: would not your victory be seriously compromised if the worker during the sixteen hours spent outside the factory frittered away his health, which represents the most valuable asset of yourselves and your country?

In addition to the training of Public Health Visitors and the health education of the public, there is yet a third method, destined perhaps to bring about a veritable revolution. Adult man does not easily change his habits: the child on the contrary is still plastic. The truth of this principle inspired the creators