LIFE AND DEATH.

Press, Volume LXV, Issue 19610, 4 May 1929, Page 8

LIFE AND DEATH.

THE "ANNE MACKENZIE" ORATION. (By Dr. J. H. L. Cuinpston.) (Ob March 20th, in the Albert Hall, Canberra, the inaugural "Anne MacKenzie" Oration, established with a gift of £IOOO by William Colin MacKenzie, Director of the Institute of Anatomy, in memory of his mother, three of whose sons were graduates of the Medical School of the Melbourne University, was delivered by Dr. J. H. L. Cumpston. M.D., D.P.H., C.M.G., Commonwealth Director-General of Health. The Oration has been established to advance the cause of Preventive Medicine, and "Life and Death" was the subject chosen by Dr. Cumpston for the inaugural address.)

"We must count man's life as beginning at his birth," says Dr. Cumpston, "for man is the heir of all the ages and does not actually begin life at any point. The lowest forms of life consist ol" organisms which divide the subdivide through many generations in a few days; and so an individual, in a literal and absolute sense, is merely one phase in a cyclical evolution of a continuous life unit. He belongs to, and is part of, his ancestors, as he is part of his descendants. He may inherit actual disease, but this is, in fact, less important than the quality of vitality which he receives from his parents. This quality of vitality is not measurable, nor is there any exact evidence concerning it. But there are certain indications. "In one State in which it is compulsory to register the births of children born dead it is found that approximately one per cent, of all infants born are "born dead. We know also that nearly three per cent, of the children born each year in Australia die within the first week. From what do these children die? Some die from injuries received at birth, but these are few by comparison. Of the most of them it is true that they are unable to live. Even greater than the number of those that die is the number of those who show a low order of vitality. One of the great problems now being studied is how to increase the quality of vitality. "But allowing for this minority of wilted seedlings, there remain the great throng with a full inheritance of joyous health. It is estimated by reliable authorities that approximately 80 per cent of all infants are born free from obvious disease. Further, it may also be said that, notwithstanding fluctuations in the economic conditions of the people, periodic reversion on a national scale to vices and abnormal habits, there remains the invincible impulse of nature, or of species persistence, or whatever the biological factor, to produce at birth an infant in normal' health. From the evidence available, it may be assumed that in Australia the percentage of infants with an endowment of full vitality is somewhat higher than the estimate of SO per cent, for European countries."

One Great Failure. Dr. Cumpston went on to say that we could congratulate ourselves that the tuberculosis of infancy and the characteristic rickets of European countries are unknown. Our food, our sunlight and our free air have done this. But there is one great failure in our efforts to save life which is causing concern to all. It is estimated that for every 200 confinements one mother dies in childbirth. The amount of injury to organs and permanent ill-health cannot be estimated, but it is very considerable. On the other hand, the vigorous exercise, the plentiful food, and the sheer joy of living through the year in this country are laying firmly the foundations upon which man builds his expectation of longer life. Figures are never accurate, but as indicators it may be said that of 1000 infants born 26 do not survive the first week, and 71 cannot see the first anniversary of their birth. By the twenty-fifth year 137 are dead, and 192 are spared the knowledge which comes at the fortieth year that the top of the hill has been reached. Between 40 and 60, 174 die; between 60 and 80, 448 more pass, leaving the small remnant of 186 who continue -with diminishing vigour to resist the increasingly seductive approaches of Father Time. These figures are for males; at each age more women have survived, so that the average female life is longer. During the last 35 years the expectation of life at birth in Australia has been increased by 12 years for males and 12J years for females. In 1885 each male had his average chance with the rest of the community of reaching the age of 47 years. Now the male expectation of life at the time of birth is 59 years; at the age of 15 it is 51 years; and at the age of 65 it is almost twelve years. One cardinal principle should be borne in mird; inherited qualities determine longevity as they do the death of the new-born infant who dies before life has begun, but what the qualities are which make a vital inheritance no-one can say. Eunning throughout life, however, there is a heavy loss both of function and of life from physical injuries. In 1927 a total of 4370 persons lost their lives in Australia through external violence. This number formed one in thirteen of the total deaths, and was fifth in order of magnitude amongst the causes of death, those of large magnitude being cancer, diseases of the heart, congenital debility and sensility. The seriousness of this cause of death lies in the'place of its incidence, which is particularly upon the lower ages. Amongst males 26 per cent, of the total deaths between five and fourteen are due to accident; 39 per cent, of the total deaths between 15 and 24; and 25 per cent, between 25 and 44. Amongst females the proportion is not so high, but is still considerable. These figures are for deaths only; figures are not available for disabilities resulting from accidents. The use of mechanical aids in every function of life, the almost exclusive use of power for all purposes, even in domestic routine, involves, special and serious risks of injury and death. Many mechanical devices have been and are being adopted to control these dangers, but universal experience shows that man requires to be protected against himself rather than against the machinery. Man, discontinuing the use of his muscles, has not yet learned to use his wits. As this applies in the industrial world, so does it have very full significance in daily life in respect of transportation and traffic risks. The amount of disability and death from physical injuries due to external violence is already so considerable that this matter calls for immediate public attention.

An Unexplored Region. It is in connexion with the food taken by man and the narcotics used by him that there is a great, an almost unexplored, region in which preventive medicine can become active with prospects of adding very materially to the health of every individual. In infancy the food given without trained direction is almost invariably unsuitable; it is usually excessive in quantity and deficient in essential ingredients. At best, wo know very little of the suitability of the food consumed by our children, and there is urgent need to acquire knowledge In that respect. We are also ignorant of the extent to

which dietetic errors assist the degeneration .of later life. This is a field of knowledge of great richness as yet untilled. The use of narcotics is a controversial subject. There are certain products of alcoholic fermentation; there are the cerebral stimulo-sedatives, such as opium or haschish; and there are the minor nerve stimulants, such as tobacco, tea and coffee. Whether these are deleterious to the individual and socially detrimental to the nation cannot be said with any accuracy. For certain individuals any of these may either continually or occasionally be harmful. Man and nls Parasites. Man is not only an individual, but he is portion of the human race, and is portion also of the whole kingdom of life. Throughout life he is being attacked by parasites of all kinds. All living organisms are so attacked. This endless warfare to the death is an inseparable portion of Xature% scheme. The position of man in relation to his parasites is complex and only imperfectly understood. It is known that some diseases, ordinarily chronic, may become acute, and some ordinarily acute may beeome chronic, and some ordinarily benign may become devastatingly virulent.

The pulmonary tuberculosis of recent years in Australia assumes a chronic form and appears to have a lower degree of virulence. Our parents knew it as a more active and more rapidly fatal disease than we know it to-day. It may be that the bacilli have become less virulent, or that by natural selection the people are, on the whole, composed of more resistant stock, or even that the efforts of the public health worker have been in some degree successful. And yet occasional eases oceur in which the old type of tuberculosis is seen. The behaviour of certain diseases, ordinarily benign, which beeome tragically active is a puzzle. The appearance of measles, to the white man an unremarkable incident, may be followed by an epidemic of appalling virulence in a community which has for a generation or more not been exposed to infection, especially amongst coloured natives. This is simply accepted as a case of a natural susceptibility uncorrected by any acquired immunity. But such explanation will not apply to the occasional blasts of mortal influenza which seem to smite the world from without as if the gods had decided that the human race must be severely chastened. What causes these cycles of activity? As yet, no man can say; but the existence of these cyclical variations is very disturbing. The fact is that the relations between man and his parasites are little understood. The nature, form, occasion cir quantity of the changes in the infecting organisms are not even yet identified, while the nature, mechanism or quantity of the immunity possessed or developed by man has not yet been determined. It is, however, clear that, just as there are laws for the growth, development, decline and death of man as an individual, so there are as exact and as comprehensive a series of laws for man as a community. The community is a definite unit with its own laws, the nature of which is only now being dimly perceived. Sometimes we feel inclined to say with Montaigne—"Why will not Nature please, once for all, to lay open her bosom to us, and plainly discover to us the means and conduct of her movements, and prepare our eyes to see them?"

In Australia we have a status of national health which is the envy of older countries. We are a young, healthy, * virile people, with a heritage and a prospect of happiness given to no other nation. Our constant concern, should be to preserve this state of national health. Each gain costs infinitely patient labour and requires sustained enthusiasm. Typhus and typhoid fevers have almost ceased to exist in civilised countries; smallpox is entirely controlled, and other successes can be marked to our credit; but these have been attained by infinite patience and slow progress over nearly a century. The greatest responsibility that can rest to-day upon a leader in public health is to say clearly once again that progress must be slow, that we may lift veil after veil in our progressive peeps into the unknown, but there will be veil upon veil behind. We have come almost to forget how much is unknown.