In making a health programme as in making a boat, a garden, or a baseball team, the first step is to look about and see what material there is to work with. A baseball team will fail miserably unless the captain places each man where he can play best. Gardening is profitless when the gardener does not know the habits of plants and the possibilities of different kinds of soil. So in planning a health programme we must study our materials and use each where it will fit best. The materials of first importance to a health programme in civilized countries are men; for men working together can control water sources, drainage, and ventilation, or else move away to surroundings better suited to healthful living. Therefore the first concern of the leader in a health crusade is the human kind he has to work for and work with.

Seven kinds of man are to be found in every community, seven different points of view with regard to health administration. Each individual, likewise, may have seven attitudes toward health laws, seven reasons for demanding health protection. These seven points of view, seven stages of development, are clearly marked in the evolution of sanitary administration throughout the civilized world. With few exceptions, it is possible, by examining ourselves, our friends, and our communities, to see where one motive begins and leaves off, giving way to or mixing with one or more other motives. A friend once asked me if I could keep this number seven from growing to eight or nine. Perhaps not. Perhaps there are more kinds of people, more health motives, more stages in health progress; but I am sure of these seven, and certain that they have been of great help to me in planning health crusades for the state of New Jersey and for New York City. The number seven was not reached hit-or-miss fashion, nor was it chosen for its biblical prestige. On the contrary, it came as the result of studying health administration in twoscore British and American cities, and of reading scores of books on sanitary evolution.

Seven catchwords make it easy to remember the characteristics and the source of every motive, every kind of person, and every stage in the evolution of sanitary standards. These seven catchwords are: Instinct, Display, Commerce, Anti-nuisance, Anti-slum, Pro-slum, Rights. By the use of these catchwords any teacher, parent, public official, educator, or social worker should be able to size up the situation, the needs, and the opportunity of the individuals or the communities for whom a health crusade is planned.

Instinct was the first health officer and made the first health laws. Instinct warns us against unusual and offensive odors, sights, and noises, just as it causes us to seek that which is agreeable. Primitive man in common with other animals learned by sad experience to avoid certain herbs as poisons; to bury or to move away from the dead; to shun discolored drinking water. During the roaming period sun and air and water acted as scavengers. When tribes settled down in one spot for long periods, habits that had hitherto been inoffensive and safe became noticeably injurious and unpleasant. Heads of tribes gave orders prohibiting such habits and restricting disagreeable acts and objects to certain portions of the camp. Instinct places outhouses on our farms and then gradually removes them farther and farther from dwellings. In many school yards, more particularly in country districts and small towns, outhouses are a crying offense against animal instinct. In visiting slum districts in Irish and Scotch cities, and in London, Paris, Berlin, and New York, I never found conditions so offensive to crude animal instinct as those I knew when a boy in Minnesota school yards, or those I have since seen in a Boy Republic. But the evil is not corrected because it is not made anybody's business to execute instinct's mandates. In the Boy Republic the leaders were waiting for the children themselves to revolt, as does primitive man.

Table I

Typhoid a Rural Disease[1]

 Average Per Cent of Rural PopulationAverage Typhoid Fever Death Rate per 100,000
Five states in which the urban population was more than 60% of the total3025
Six states in which the urban population was between 40% and 60%4942
Seven states in which the urban population was between 30% and 40%6738
Eight states in which the urban population was between 20% and 30%7546
Twelve states in which the urban population was between 10% and 20%8762
Twelve states in which the urban population was between 0 and 10%9567

[1] Prepared by Dr. John S. Fulton, secretary of the state board of health, Maryland, and quoted by Dr. George C. Whipple in Typhoid Fever.