classes into real altruistic citizens of the communities of the state that make up its whole-its active cells, as it were. We had best spend most of our time with them, and in the end do our best work through them.

Another classification will perhaps be made of dullards and mediocrities, of yokels and dim-wits, so many of whom are too ignorant to do right, and, in doing wrong, are not bright enough not to get caught. They are also a very hopeful class who, notwithstanding the fact that they become the easy prey of the demagogue and the charlatan and furnish most promising material for mobs and the Ku Klux Klan, yet under wise direction, may become as docile and useful as the average twelve-year-old into whose class mentally they mostly belong. Another classification, no doubt-though not so important potentially either for good or evil, and therefore neither so hopeful nor so dangerous-are those types called feebleminded or insane, badly diseased mentally or physically. They will be then, as now-if we continue to allow them to multiplyeasily caught, easily recognized, even by the casual layman, without the assistance, in most cases, of psychiatrists or psychologists. They will, of course, have to be isolated from society in institutions more like hospitals than like prisons. But the great duty of the state in that future time to these unfortunate children will be to exercise the supremest of all humanities in seeing that they are spared the pains and penalties, the tragedies, the sin, and crime of being born. And it may be also a duty of the state, through this institution of the future, not only to find new methods for the care and disposition of this class, but, in a measure, for their first cousins, the classes so near akin to them. Thus more and more the race stream may gradually be clarified by the absence of their presence.

The time and theme unite to tempt one to prolong these pleasantries of prophecy, but I must yield no further. I shall merely add one final bit from my own dreams in that vision I see of a great building, fashioned by artists from stone and marble, that shall some day grace our civic center here in Denver. I think it might be called the Children's Building-not as carrying any reflection on the child, but as indicating the adoration of all the state's wise men for this child, that is the state, in the most important time of life of any state: the beginnings and development of its childhood and its youth. Here we shall have gathered together all the director-generals of these agencies of the state which now contribute to this child's welfare. It shall at once be the symbol and the directing place of the state's superparenthood, and so, above its portals, I would inscribe that sentiment given us by Sir Rabindranath Tagore: "I love my child -not because he is good, but because he is my child.”

III. HEALTH

THE RELATION OF SOCIAL WORKER TO
HEALTH AGENCY

IS THERE A CONFLICT BETWEEN SOCIAL WELFARE
AND PUBLIC HEALTH?

(ABSTRACT)

Mazyck Ravenel, M.D., Professor of Preventive Medicine,
University of Missouri, Columbia

The outstanding feature of the results of modern public health work is the increase in the expectation of life. A closer examination reveals the fact that this saving of life takes place largely during the first five years and that there is little evidence of any improvement in the later periods. Indeed, the earliest life tables show that if an individual reached the age of sixty, his expectation was better than it is at the present time. In almost every country the death-rate for 1,000 inhabitants for the age period 1 to 5 has been cut in half, while in some it is only one-third of what it was about the end of the last century. The infant mortality rate, which twenty-five years ago, even in certain cities in the United States, ran to more than 400 for every 1000 live births, has shown a tremendous reduction in every country from which reports are received. The saving of life is then a matter of saving those infants who a short time ago would have died.

Few will question the statement that man, as a race, has obtained his personal position by selection, or what has been spoken of as survival of the fittest. Some of the outstanding nations of past ages have practiced the exposure of infants, which led to the survival of only the hardiest. Studies in various classes of life, from royalty down, have shown that there is a relation between the longevity of the parent and the mortality of children under five years; in other words, parents who possess the vigor to live long beget children who have vigor enough to survive the dangers of infancy and childhood. Natural selection tends to eliminate stocks of defective vitality.

Longevity is also inherited, as shown in the studies of the Hyde family by Bell. Comparing the two groups into which this family could be divided on the basis of longevity, Group I, in which both parents lived to eighty or over, had twenty years added to their lives through their inheritance as compared with the second group. In saving the lives of those who are weak and short-lived through heredity, it is possible that we are reducing the longevity of the race as a whole.

Infant mortality is selective. Civilization and preventive medicine have to a great extent nullified natural selection in this respect. An enormous number of infants who would certainly have died formerly now survive the dangers of early life. The great majority of these come from the classes too poor or too ignorant to care for themselves properly. Some of these may spring from good stock mentally and physically, but many do not. Are we not endangering the future of the race by prolonging the lives of such infants? On the other hand, the death of infants is an economic waste affecting both the weak and the strong, good as well as bad stocks, though not with equal force. The outcome is an economic waste.

Natural selection shows a marked tendency to eliminate stocks which show a predisposition to certain diseases, in some of which the heredity factor is evident, like Huntington's chorea and hemophilia. The same is true of mental defectives. Even under good conditions the death-rate of infants born in asylums is much greater than the average for the ordinary population. In New York City the mortality among feebleminded is double that of other children, and in the lowest grades is four times as great as among the feebleminded. The attempts which are made to overcome natural selection are dysgenic. Galton says that "man is far more weakly through congenital imperfection than any other species of animal, wild or domestic." Nature had little regard for the individual, but was careful of the species. Cresson said: "Everything for the species; everything by the individual; nothing for the individual." We have reversed this for man, and are careful of the individual at the expense of the species.

There is good evidence to show that there are between one and a half and two million people who need institutional care in the United States, at least 50 per cent of whom owe their defects to heredity. Approximately 45,000 of these defectives are being cared for in institutions. Approximately 900,000 dependents, criminals, juvenile delinquents, etc., were in public and private institutions in January, 1925, and 78,000 paupers were in almshouses. In view of the close relationship between criminality and dependency and mental ability it seems evident that the preservation of the lives of the forbears of these people was dysgenic. It is said by the National Committee for Mental Hygiene that there are at present 600,000 mentally defective children in the country in need of special classes. The training of such children unquestionably makes good citizens of a low grade of many of them, but also tends to place them in a position in which they can marry and beget their kind.

The history of the Kallikak and the Jukes families is too well known to require repetition. The infant mortality rate, which is high among such people, is very much lessened by public health work. In the absence of laws preventing the marriage and intermarriage of such persons, and the inability to enforce such laws as exist, our efforts are again dysgenic.

In every country there is a marked decrease in the birth-rate of children

among the higher classes, considering both mental and financial ability, while the poorer classes show practically no tendency in this direction, and those of low-grade mentality are producing the largest families of all. The children of these lower and poorer classes are being preserved by our public health efforts to grow up and reproduce their kind. Both heredity and environment tend to keep the offspring of such people in the class in which they were born.

Every day brings the news of some new philanthropy which tends in one way or another to preserve the lives of those who otherwise would die young. The League of Nations has extended the teaching of modern medicine to all of the world. A modern medical school has been opened in China, already greatly overpopulated. The two lines of endeavor which show the most immediate results are the lessening of maternal mortality and infant mortality, both of which have a sentimental appeal, but tend to add to the dysgenic effects which have already been spoken of.

The inevitable effect of all of our public health work is to increase longevity, increase population, and to hasten the day when the pressure of population on subsistence will reach the breaking point. Overpopulation means low standards of living, discontent, lack of progress, and eventually war, since food is the primal necessity of all living things. Man presents himself to us as an animal, from the biological standpoint, and for this man there must be one form of consideration and treatment. Man also presents himself to us as a social animal, and for this man there must be another form of consideration and another treatment. Biological facts are not governed by sentiment and are for the most part brutal. Sociological facts are greatly influenced by sentiment, and are largely humanitarian. The two points of view are not entirely at variance one with the other. Since the time of Christ the humanitarian side has been ascendant, at least potentially. It was realized with the work of Chadwick, and made splendidly efficient by Pasteur. The task before us now is to coordinate the two points of view. At present, inferiority is at a premium. The world is filled with schools and homes for the feebleminded and subnormal, with hospitals and clinics, almshouses, colonies, and correctional institutions. Far be it from me to advise the abandonment of these unfortunates, but it is wisdom as well as charity to see that the production of such people is checked. The fact remains that public moneys are now spent largely on incompetents and derelicts rather than for the encouragement of the ambitious and industrious.

The conclusion seems inevitable that our public health work, as carried out at the present time, stresses many factors which are directly opposed to social welfare. The debt we owe to infant weaklings whose lives have been saved and who have become world-movers is freely acknowledged. We do not know enough to select or to nip unpromising buds. Those unpromising buds who have become world figures are so few in number, as far as the records show, that they are easy to pick out. Does their influence overbalance the evil done by the thousands of unpromising buds who do not develop?

THE HEALTH AGENT IN SOCIAL WORK

Sherman C. Kingsley, Executive Secretary, Welfare Federation,

Philadelphia

During my student days at Harvard I had an experience which made a profound impression upon my mind and which has influenced my thinking and action ever since. In company with a classmate I called on Oliver Wendell Holmes. It was late in the afternoon of one of the clearest, coldest February days that a real New England winter can afford. Unbidden and without appointment, and with feeling that must have been kindred to those of book agents, doorbell-ringing street urchins, or the distributors of tracts, we called at the doctor's Beacon Street home.

We had previously availed ourselves of conference privileges with college preachers and lecturers such as Washington Gladden, Lyman Abbott, Dr. Rainsford, Bishop Potter, Henry Drummond, Edward Everett Hale, and others. I was trying to get direct and tangible information as well as background concerning what seemed to be a dawning field of social work-Did it hold a place actually or potentially in the galaxy of professions? Davis was contemplating entering the ministry. We both wanted the doctor's diagnosis, his philosophy, and his advice. Our problem was real to us—almost poignant-for we had to make decisions as to life work, and without influence, acquaintance, or money to find occupation.

The doctor welcomed us to his hospitable study with a cordiality that seemed to ascribe the highest possible rating to human motives. His invitation to remove our wraps was accompanied by instant and active participation in the process, and was followed by his beckoning us to friendly chairs which he had placed before his open fire. With a pair of tongs that looked as though they knew how to assist, he poked and replenished the flickering embers, evidently anxious to help a quick reaction from numb fingers and frosty cheeks and ears acquired in our walk through the biting wind which was even then surging against the doctor's windows.

His keen, penetrating eyes and the expression of his face assured us, as he settled in a chair in chummy relation to ours, that he had not been overlooking our minds while he was making us creaturely comfortable. He seemed to understand better than we did ourselves, and was ahead of us from the start. The problems of people, especially young men, and still more especially strangers who had sought him out, seemed to appeal to the doctor, both from the point of view of the physician, the philosopher, and the social diagnostician. We had nearly two hours of the most brilliant flashes of wit and wisdom, of epigram, of the mastery of words as carriers of ideas, that I have ever heard.

Before I quote what was to me the meat and climax of this memorable interview, I want to recall a few things which Dr. Holmes said on the matter of religion and the ministry as a profession. I repeat them because I feel that they