CHAPTER 1

"To Push Back the Shadowupon the Dial of Time"

The Astonishing New Facts of Life and Death

At the end of 1921, New York City hosted an extraordinaryevent. Mayor John F. Hylan declared November 13–19 "HealthWeek." Two floors of New York's premier exhibition hall, the Grand CentralPalace (right next to Grand Central Terminal), were given over to what wasbilled as "the largest health exposition ever attempted." Thousands attendedthe exposition. To help draw in crowds, organizers offered a "Health Clown"and "Health Characters." There was a Harbor of Child Health, where the ChildHealth Family resided. "Happy," a member of that family, appeared as a sailor.Baseball great Babe Ruth and heavyweight boxing champion Jack Dempseywere on hand to sign autographs (though it's hard to see how either could haveserved as a model for healthy living, even in those days). Visitors had a chanceto gawk at "fat men and women" who for the past three weeks had participatedin a weight-loss competition. The winner of the "perfect baby contest" was announced(William Yarnias, eighteen months old). And of course no healthexposition would be complete without a finalist in the quest for the perfectwoman's foot—to demonstrate, as the reporter for the New York Times put it,"that the world is as romantic as in the days of Cinderella and the Prince." Thehonor went to Miss Elizabeth Doyle, nurse.

The United States Public Health Bureau and other New York City departmentsparticipated, as did social service, charity, and business organizations.There was a plan to set up educational displays and activities throughout thecity: "diet squads," blood pressure machines, and nutritional demonstrations,including animals. Proceeds from ticket sales were to be used to fund publichealth organizations and activities at the local, national, and international levels.

But none of this was the big news. "Health Week" was actually just themiddle segment of an entire "Health Fortnight." It had been preceded by aninternational conference, called the "Health Institute," and it was followed bythe Fiftieth Annual Meeting of the American Public Health Association. Thebig news came at that meeting.

The APHA had been founded in New York City in 1872. It was the first publichealth organization in America, at a time when the very concept of "publichealth," with its emphasis on sanitation, preventive medicine, and collectiveresponsibility, was a novelty. In November of 1921, at the Hotel Astor, the associationwas celebrating its fiftieth anniversary. The Jubilee meeting broughttogether some of the most distinguished figures in the field. On the programwere dozens of speeches, including some with such deadening titles as "Sanitationof Bath-Houses at Public Bathing Beaches," "Proper Size of Sand for RapidSand Filters," and "The Prevention and Cure of Rickets by Sunlight." But twocaught the attention of the press. Dr. Mazÿck P. Ravenel gave the PresidentialAddress, titled "The American Public Health Association, Past, Present, Future."Like other top officials of the association, the president was partly interestedin boosting the achievements of his organization—and why not? This was acelebration, after all. But he also used the occasion to give a capsule history ofmedicine over the previous half-century, speaking above all of Louis Pasteurand Robert Koch. Each achievement he listed—the discovery of a pathogenicmicroorganism (staphylococcus, streptococcus, pneumococcus, the Asiaticcholera spirillum, the tuberculosis and diphtheria bacilli)—represented a victory,imminent or current, over an illness that had threatened populations forcenturies.

One passage in his speech was particularly striking. Telling his audienceabout the journals the APHA had published during its fifty-year history, Dr.Ravenel was moved to say this:

In comparing the earlier volumes with those of to-day, one is struck by the factthat the most important topics discussed in the early years are scarcely evermentioned now. The first volume, published in 1873, is given up largely to yellowfever and cholera. One finds it hard to believe that cholera was at that timewidespread in the United States, and that it existed in more than two hundredtowns and cities of the Mississippi Valley.

The other presentation that found its way into the newspapers was the keynotespeech at the opening banquet. Dr. Stephen Smith was a founder of theassociation, and on the evening of November 16, 1921, his topic was "A HalfCentury of Public Health." While Ravenel and others celebrated the concreteachievements of medicine and public health over the previous, extraordinaryhalf-century, Smith looked at the larger ramifications. Let's say you believedthat European and American medicine had practically obliterated the ravagesof infectious disease. What did that mean for you? It's a simple question, andDr. Smith had a simple answer: a longer life—a much longer life.

Smith spoke specifically of the drop in the death rate, making an astonishingobservation. "The steady fall of the death-rate," he said, "until it has nearlyreached the...