Frank Albert Fetter.

Source book in economics, selected and ed. for the use of college classes online

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Nevertheless, death rates, if compared under similar condi-
tions, furnish a fairly good index of vitality. They vary in
different places and at different times.

§ 2. Mortality in various regions. — In the registration area
of the United States the death rate is 16.5 per 1,000 ; in France
it is 20 ; in India 42. In different States of the United States
it varies from 14 in Michigan to 18 in New York.

§ 3. TJrdan and rural mortality. — The death rate is higher
in the city than in the country, and the larger the city the
higher the death rate. In European countries among the
cities with the highest death rate are Dublin (40) and Mos-
cow (37) ; among the lowest, Frankfort on the Main (16) and
The Hague (16).

§ 4. Race and condition. — The colored death rate greatly
exceeds tlie white. The death rate among the poor exceeds


that among the rich, beiuy in Glasgow and l*aris over twice
as great.

§ 5. Mortality historicallij. — Death rates have been decreas-
ing during several centuries. In London, where now the death
rate is only 15, it was during the seventeenth and eighteenth
centuries 40 to 50, and during 1680 to 1728, a period of
pests, it rose as high as 80. Similar reduction has also been
experienced in this country. In Ilabana the death rate after
the American occupation fell from over 50 to about 20.

§ 6. Adult and infant mortality. — The greatest reduction
has been effected among children, although the death rate is
still undoubtedly high. Statistics show that during the last
thirty years the death rate up to 50 years of age has de-
creased, but that beyond 50 it has remained almost stationary.

§ 7. Particular diseases. — The mortality from certain spe-
cial diseases has greatly decreased. The tuberculosis death
rate is now in England only one-third of what it was seventy
years ago. The death rate from pneumonia now equals that
of tuberculosis. Typhoid fever is decreasing. In Munich
during 1856 the mortality was 291 per 100,000 of population.
The city at that time contained many cesspools. After these
were filled up the typhoid rate fell to 10 per 100,000 in 1887,
making a reduction of 97 per cent. In Lawrence, Mass., after
the public water was filtered in 1893 the typhoid-fever rate
fell from 105 to 22. Doctor Kober has shown that death rates
from typhoid fever are greatest in cities in which the rivers'
waters are polluted, the average for these cities being 62, as
compared with 18 for cities using unpolluted Avater of im-
pounded and conserved streams. Doctor Rosenau concludes
that any community having clean water and uninfected milk
supply may be free from typhoid.

Smallpox has greatly decreased since vaccination has been
employed. In Prussia the death rate per 100,000 from small-
pox between 1846 and 1870 was 24. In 1874 vaccination was
made compulsory, and the death rate for the years 1875-76 fell
to 1.5. Similar figures can be given for other places. The


present outcry against vaccination is based on misinformation
and on the general reasoning that it is unnatural to introduce a
poison into the blood. Statistics show clearly that vaccination
decreases smallpox and lengthens life. Even though it were
shown that the virus is injurious, it would be the lesser of two

Yellow fever in Philadelphia in 1793 caused the death of
one-tenth of the city's population within six and one-half
weeks. In 1900 it was found that a species of mosquito trans-
mits this disease. The result of this applied knowledge is
that the disease has practically disappeared in America.

Part II. — Breadth of life versus invalidity.


§ 1. Loss of time. — Life is shortened by death and nar-
rowed by invalidity. The ideal life, with respect to health,
would be free from illness and disability of every kind. To
approximate such an ideal is the aim of hygiene. It is usually
true that the healthier a life the longer it will last. Hum-
boldt maintained that he had lived four working lives by re-
taining a working power double the average for double the
average number of years. According to Farr, for every death
there is an average severe sickness of two years, or for each
death per year there are two persons sick throughout the year.
This would mean in the United States that, as there are about
1,500,000 annual deaths, there will always be about 3,000,000
persons on the sick list, which is equivalent to about thirteen
days per capita.

§ 2. Particidar diseases. — There are constantly ill in the
United States of tuberculosis about 500,000 persons, of
whom about one-half are totally incapacitated, while the re-
mainder are half incapacitated. The causes of various dis-
eases are closely interwoven. Professor Sedgwick tells us that
"Hazen's theorem" shows for every death from typhoid fever


avoided by the purification of a polluted water supply two or
three deaths are avoided from other causes. Hook-worm dis-
ease in the South is a chief cause of incapacitation, especially
among the poor whites. For this reason the hook worm has
been nicknamed the "germ of laziness." It is believed that a
sufferer from hook-worm disease is incapacitated from one-
fourth to one-half of the time.

. . . The social diseases, which certainly are preventable, are
one of the gravest of the menaces to national efficiency.

American railways in 1907-8 killed nearly 11,800 and in-
jured nearly 111,000 persons. The deaths and disablements
from accidents in industry, although less carefully recorded,
also represent a great and needless impairment of efficiency.


§ 1. Importance of minor ailments. — Minor ailments are
far more common than most persons realize. They are chiefly
functional disorders, such as of the stomach, heart, nerves,
liver, kidney, etc. These deserve more attention than they
have hitherto received, because they are the gateway to more
serious troubles. For instance, those who neglect colds, or
what seem to be colds, will be far more likely to become victims
of tuberculosis or pneumonia. No statistics of the prevalence
of minor ailments exist. Physicians, whose experience gives
them good opportunity to judge, place the time lost annually
for each person from minor ailments at three or more days a

§ 2. Preventahility of minor ailments. — Practically all
minor ailments can be avoided by proper hygiene, public and
private. Neurasthenia, so common in America, is one of the
most serious and insidious introductions to grave disorders,
and is usually due to needless worry or failure to have ade-
(luate recreation.



§ 1. Strength, endurance, and fatigue. — Strength is meas-
ured by the force a muscle can exert once; endurance by the
number of times it can repeat an exertion requiring a specified
part of the strength. Fatigue is a chemical effect, due to
"fatigue poisons." Far greater differences exist between
different persons in respect to endurance than in respect to
strength. Some "well" people become tired by a short walk,
while others withstand hours of walking, running, or climbing.

§ 2. Alcohol and fatigue. — The "Committee of Fifty"
found that alcohol gives no persistent increase of muscular
power. It is well understood by all who control large bodies
of men engaged in physical labor that alcohol and effective
work are incompatible. Rivers, writing on the influence of
alcohol on fatigue, found that when workmen were provided
with a moderate amount of wine it resulted in a considerable
diminution of their capacity for work.

§ 3. Tohacco and fatigue. — Athletes recognize that smoking
interferes with one's "wind" or "staying power." " In-
haling" tobacco smoke brings carbon-monoxide directly into
the blood stream. It is found that smoking increases blood
pressure, which fact possibly partly explains the reduction in

§ 4. Diet and fatigue. — When excessive amounts of the
protein element in food (exemplified in white of egg or the
lean part of meat) are taken, they putrefy in the large in-
testine, producing "auto-intoxication." For this and other
reasons, there is a present tendency among physiologists to
advise a reduction in the use of such foods from the amounts
customary in many countries, and especially in the United
States. Auto-intoxication induces fatigue. The comparison
of those using high protein and of those using low protein
shows in general, although with some exceptions, that the for-
mer have less endurance than the latter. Whether the latter
are vegetarian or not does not seem to matter. Experiments


show that thorough mastication leads instinctively to a reduc-
tion in protein.

§ 5. Excrlion and fatigue. — Oxygen, whether taken natur-
ally or artificially, increases the capacity for exertion. A
judicious amount of exercise is perhaps the chief factor in
producing the highest state of muscular efficiency. Physical
training, comprising exercise and other hygienic measures,
will probably make the capacity to withstand great exertion
three or four times that possessed by most persons.

§ 6. The working day. — The present working day, from a
physiological standpoint, is too long, and keeps the majority
of men and women in a continual state of overfatigue. It
starts a vicious circle, leading to the craving of means for
deadening fatigue, thus inducing drunkenness and other ex-
cesses. Experiments in reducing the working day show a
great improvement in the physical efficiency of laborers, and
in many cases results in even increasing their output suffi-
c'ieutl}^ to compensate the employer for the shorter day.
Several examples of such a result exist, but the real justifica-
tion for a shorter work day is found in the interest of the
race, not the employer. One company, which keeps its
factory going night and day, found, on changing from two
shifts of twelve hours each to three shifts of eight hours each,
that the efficiency of the men gradually increased, and the
days lost per man by illness fell from seven and one-half to
live and one-half per year. Public safety requires, in order
to avoid railway collisions and other accidents, the prevention
of long hours, lack of sleep, and undue fatigue in workmen.

§ 7. The importance of preventing undue fatigue. — The
economic waste from undue fatigue is probably much greater
than the waste from serious illness. This is because the
number of fatigued persons is great enough to more than out-
weigh the fact that the incapacitation from fatigue is rela-
tively small. Moreover, the relatively slight impairment of
efficiency due to overfatigue leads to greater impairment from
serious illness. A typical succession of events is, first, fatigue,


then "colds," then tuberculosis, then death. The prevention
of undue fatigue means the arrest at the start of this ac-
celerating chain of calamities.

[Part III, comprising about two-fifths of the Report, deals with the
conserving of life by various methods, through improving the hereditary
vitality (the ideal of the new science of eugenics), and through hygiene,
public, semipublic and personal.]

Part IV. — Results of conserving life.


§ 1. Life is lengthening. — So far as we can judge from sta-
tistics of the average duration of life, it has been on the in-
crease for three hundred and fifty years, and is now increasing
more rapidly than ever before. During the seventeenth and
eighteenth centuries the increase was at the rate of about
four years per century ; during the first three-quarters of the
nineteenth century the rate was about nine years. At pres-
ent in Massachusetts life is lengthening at the rate of about
fourteen years per century; in Europe about seventeen; and
in Prussia, the land of medical discovery and its application,
twenty-seven. In India, where medical progress is practically
unknown, the life span is short (twenty-five) and remains

§ 2. Tahle showing further practicable prolongation. — It is
possible to estimate the effect on the length of life of the par-
tial elimination of various diseases. Using the statistics, ex-
perience, and estimate of 18 physicians as to the preventability
of each of the list of 90 causes of death, we find that the
length of life could easily be increased from forty-five to
sixty, an increase of one-third, or fifteen years. This would
result in a permanent reduction in death rate of about 25 per
cent. The principal reductions would be from infantile
diarrhea and enteritis, over 60 per cent.- of which could be
prevented, with the result of an addition to the average length


of life of 2.32 years. Bronelio-pneumoiiia, also an infant dis-
ease, could be prevented to the extent of 50 per cent., whereby
life would be lengthened by 0.60 year. Meningitis, which is
usually fatal at the age of two, could be prevented by at least
70 per cent., and this prevention would lengthen the average
life by 0.60 year. Eighty-five per cent, of the mortality by ty-
phoid fever is unnecessary, and if avoided would lengthen life
at least 0.65 year. It would be feasible to prevent at least 75
per cent, of cases of tuberculosis of the lungs, and thereby to
lengthen life by about two years. If the deaths from violence
w^ere reduced only 35 per cent., human life would be increased
by 0.86 year. The prevention of 45 per cent, of cases of pneu-
monia would lengthen life by 0.94 year. These seven dis-
eases alone could easily be reduced by these amounts so as to
lengthen life by eight years. This could be done simply
through insistence by the public on pure milk, pure water,
pure air, and reasonable protection from accidents.

§ 3. Effect of prolongation at different ages. [Discussion
of a diagram representing the life table of Massachusetts for
1893-1897.] It shows that about thirteen or more years could
easily be added to the average duration of life. The diagram
also shows the extent to which the additional life would fall in
different ages. The per cent, of life which would fall to the
ages between llYz a^id 60, taken as the working period, would
remain the same, namely, about 55 per cent.

§ 4. Fifteen years a minimum estimate. — The estimate of
fifteen years is a minimum because, first, it takes no account
of future medical discoveries, such as a method of curing or
l)reventing cancer and of postponing old age, as would Metch-
nikoff; second, it takes little account of the cumulative in-
fluence of hygiene. The full benefit of hygiene cannot be felt
until it is practised throughout life, and not at the approach
of specific danger. Most so-called "causes" of death are
merely the last straws which break the camel 's back. When a
pure water supply prevents deaths from typhoid fever, it pre-
vents two or three times as many deaths from other causes.


Third, it takes no account of the racial effects of new health
ideals leading, in a general way, as they must, to healthier

§ 5. Need of lengthening human life. — With increase of
knowledge the period of education or preparation for life
must constantly increase. This fact creates a need for a
longer life, with the later periods of life increased in propor-
tion. The result of such a prolongation will be not the keep-
ing alive of invalids, but the creation of a population contain-
ing a large number of vigorous old men. Metchnikoff says,
* ' The old man will no longer be subject to loss of memory or to
intellectual weakness; he will be able to apply his great ex-
perience to the most complicated and most delicate parts of the
social life."

§ 6. The normal lifetime. — It is usually recognized that hu-
man life is abnormally short, but no exact determination has
ever been made of what constitutes a normal lifetime.
Flourens maintains that a mammal lives five times the length
of its growing period, which would mean, since the growing
period for man does not cease until about 30, a normal human
lifetime of one hundred and fifty years. Another method of
estimating normal life is to reckon the length of normal life
as the time when old age now sets in, 83 years. But clearly,
if Metchnikoff is right in thinking that old age itself is ab-
normal, the normal lifetime must exceed 83. Many remark-
able cases of longevity are on record, but most cases of reputed
centenarians are not authenticated. Drakenburg's record was
authentic, and he lived to be 146. Mrs. Wood, of Portland,
Ore., recently died at 120. To what extent these exceptional
cases could be made common cannot, as yet, be known,


§ 1. Money appraisal of preventaMe wastes. — Doctor Farr
has estimated the net economic value of an English agricul-
tural laborer at various times of life by discounting his chance


of future earnings after subtracting tlie cost of niaintenaneo.
On the basis of this table we may construct a rough estimate
of the worth of an average American life at various ages,
assuming that only three-fourths of those of working age are
actually earners of money or housekeepers. It gradually rises
from a value of $90 in the first year to $4,200 at the age of
30, and then declines until it becomes negative for the higher
ages. This estimate assumes $700 per year as the average
earnings in middle life. This is largely conjecture, but is re-
garded as a very safe estimate. Applying this table to the
existing population at various ages in the United States, we
find that the average value of a person now living in the
United States is $2,900, and the average value of the lives
now saeriticed by preventable deaths is $1,700. The latter is
smaller than the former because the age of the dying is
greater than the age of the living. Applying the $2,900 to
the population of eighty-five and a half millions, we find that
our population may be valued as assets at more than $250,000-
000,000; and since the number of preventable deaths is
estimated at 630,000, the annual waste from preventable
deaths is 630,000 tnnes $1,700 or about $1,000,000,000. This
represents the annual preventable loss of potential earnings.

We saw in Chapter III that there are always 3,000,000
persons in the United States on the sick list, of whom about
1,000,000 are in the working period of life and about three-
quarters are actually workers and must lose at least $700,
which makes the aggregate loss from illness more than $500,
000,000. Adding to this another $500,000,000 as the expense
of medicines, medical attendance, special foods, etc., we find
the total cost of illness to be about $1,000,000,000 per year,
of which it is assumed that at least one-half is preventable.
Adding the preventable loss from death, $1,000,000,000, to
the preventable loss from illness, $500,000,000, we find one and
a half billions as the very lowest at which we can estimate the
preventable loss from disease and death in this country. The
true figures from the statistics available may well amount to


several times this figure, but when statistics are based partially
on conjecture, they need to be stated with special caution.

§ 2. The cost of conservation. — In Huddersfield the annual
deaths of infants for ten years had been 310. By systematic
education of mothers, the number in 1907 was reduced to 212.
The cost of saving these 98 lives was about $2,000 or about
$20 each. General Leonard Wood declared that the dis-
covery of the means of preventing yellow fever saves annually
more lives than were lost in the Cuban war. The hook-worm
disease in the South impairs the earning power of its work-
men by 25 or 50 per cent. To restore this earning power costs,
by curing this disease, on an average, less than $1 for each
case. These and other examples show that the return on in-
vestments in health are often several thousand per cent, per
annum. Probably no such unexploited opportunity for rich
returns exists in any other field of investment. An actuary
suggests that if insurance companies should combine to con-
tribute $200,000 a year for the purpose of improving the pub-
lic health, the cost would be one-eighth of 1 per cent, of the
premiums, and it would be reasonable to expect a decrease in
death claims of much more than 1 per cent. Even this 1 per
cent, would make a profit of more than seven times the ex-


§ 1. Disease, poverty, and crime. — Money estimates of
waste of life are necessarily imperfect and sometimes mis-
leading. The real wastes can only be expressed in terms of
human misery. Poverty and disease are twin evils and each
plays into the hands of the other. From each springs vice and
crime. Again, whatever diminishes poverty tends to improve
health, and vice versa.

§ 2. Conservation of natural resources. — The conservation
of our natural resources — land, raw materials, forests, and
water — will provide the food, clothing, shelter, and other


means of maintaining liealthy lil'e, while the conservation of
health likewise tends in many ways to conserve and increase
wealth. The more vigorous and long lived the race, the better
utilization it will make of its natural resources. This will be
true for two reasons in particular: First, the greater inven-
tiveness or resourcefulness of vigorous minds in vigorous
bodies. Civilization consists chiefly in invention and the most
progressive nations are those whose rate of invention is most
rapid. Second, the greater foresight and solicitude for the
future. As it is usually the normal healthy man who pro-
vides life insurance for his family, so it will be the normal
healthy nation which will take due care of its resources for the
benefit of generations yet unborn.


§ 1. Enumeration of principal measures. — Federal, State
and municipal boards of health should be better appreciated
and supported. Their powers of investigation, administra-
tion, and disseminating information should be enlarged.
School hygiene should be practised, and personal hygiene more
emphasized. The multiplication of degenerates should be
made impossible.


[Extract from the Yearbook of the Department of Agriculture, 1910,
pp. 194-200. Paper by George K. Holmes, Chief of Division of Pro-
duction and Distribution, Bureau of Statistics.]

Various investigations. The subject of the wage rates of
farm labor was first systematically investigated in this
country by the Bureau of Statistics of the Department of
Agriculture in 1866. The investigation was repeated with
variations every few years until the latest one in 1909. The
results of nineteen investigations are of record, covering the
period of forty-four years, beginning with the abnormal con-
ditions at the close of the Civil War and passing through the
two severe industrial depressions of 1873-1877 and 1893-
1897, and the less severe depressions of 1884-86, 1903-4, and

From the beginning of this period to about 1897 agricultural
overproduction was frequent. Immense areas of new public
land came into cultivation, and farmers were painfully in debt,
and often the prices of products were unprofitable, if not posi-
tively below the cost of production. Since 1897, and more es-
pecially since 1902, the financial condition of farmers has
much improved. All of the conditions mentioned may be re-
lated to the wages of farm labor, and, in fact, apparently have

In the statement of wage rates, contained in this article,
all original rates during the currency period 1866-1878 have
been converted to gold. Some of the investigations were made
in the spring with no explanation whether the published rates
represented the current year or the preceding year; indeed,
some of the wage rates, as, for instance, the rates of day labor



in harvest, must ueeessarily have belonged to the preeeding
year. In another case two investigations Avere made, but the
published results were combined. These statements account
for the use oi" a double year in several instances.

Wage rates of men per month. The average wage rate of
$15.50 was paid for the labor of men on farms per month, in

Online LibraryFrank Albert FetterSource book in economics, selected and ed. for the use of college classes → online text (page 14 of 30)