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 IRVING FISHER 
 MISCELLANEOUS WRITINGS 
 1907-1917 
 
 The effect of diet on endurance.., 1907. 
 
 A graphic method In practical dietetics. 1907. 
 
 Insurance companies and the public health. . .1910 • 
 
 The life extension institute... 1914. 
 
 National vitality. •. 1910. 
 
 The need for health insurance. 1917. 
 
 The public health movement. 1912. 
 
 The "ratio" chart for plotting statistics. 1917. 
 
 Sale of intoxicating liquors... 1912. 
 
« ■ « » 
 
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 ^:!^'J^ '^ PUBLIC 
 
 fe * » » '*'^^ ' ' HEALTH 
 
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 REPRINTED FROM THE TRANSACTIONS OF THE 
 '^ CONNECTICUT ACADEMY OF ARTS AND SCIENCES 
 
 lNroKi(>K\Ti-i) A. D. 1799 
 
 VOLUME XIII. PP. 1-46 
 
 MAY, 1907 
 
 Publications of Yale University 
 
 
 /f^7'/f/; 
 
 / 
 
 THE EFFECT OF DIET ON ENDURANCE 
 
 BASED ON AN EXPERIMENT, IN THOROUGH MASTICATION, 
 
 WITH NINE HEALTHY STUDENTS 
 
 AT YALE UNIVERSITY, JANUARY TO JUNE, 1906 
 
 IRVINgIfISHER, Ph.D. 
 
 Professor of Political Economy at Yale University 
 
 NEW HAVEN. CONNECTICUT 
 
 1907 
 
 THE TUTTLE, MOREHOUSE & TAYLOR PRESS 
 
I. — The Effect of Dikt on Endurance, Based on an Experi- 
 ment Avnii XiNK IIeai/fhy Students at Yale University. 
 
 January-June, 190G. 
 
 Introduction. 
 
 There appears to be very little literature on the subject of endur- 
 ance. Since the epoch-making work of Mosso, much has been written 
 on fatigue, and niau}^ varieties of ergographs have been constructed 
 to record muscular fatigue ; but no systematic study of endurance 
 as such aj)j)ears to have been made. Even the concept of endurance, 
 as related to strength and fatigue, has been lacking. No corre- 
 lations have been worked out between endurance and the factors 
 upon which it di'pends, except that it has been a matter of common 
 experience that endurance increases with exercise. In respect to 
 diet, opinions as to its relation to endurance, so far as the writer knows, 
 have rested on no better foundation than the personal impressions of 
 adherents of special dietary systems, such as those of Salisbury, 
 Dewey, Haig, Kellogg, and Fletcher. In Professor Chittenden's 
 painstaking studv on "Physiological Economy in Nutrition" he has 
 shown that one result of a gradual and systematic reduction in proteid, 
 from the amount ordinarily consumed, has been an increase in strength, 
 but no data were obtained in resj^ect to endurance. 
 
 The present experiment had a somewhat accidental origin. I was 
 engaged in collecting statistics of labor-power in relation to various 
 factors, among them especially diet. The data were collected because 
 of their economic bearings and without any intention at first of mak- 
 ing independent experiments. But some of my students, whom I had 
 engaged to make computations and diagrams, became interested in 
 the material with which they thus came in contact, and expressed a 
 strong desire to try dietetic experiments upon themselves. Not 
 being a physiologist, I asked Professor Chittenden if he could not 
 take charge of these experiments for them. It so happened that on 
 account of other similar work he was unable to do so, but suofsfested 
 that I should conduct them myself. I have done so with consider- 
 able hesitation, not being e([uipped for )»hysiologic studies. I have 
 therefore restricted ni}-^ attention to the simpler practical aspects of 
 the problem, although some of the technical points have been inves- 
 
 Tran's. CoxNN. Acad., Vol. XIII. 1 May, 1907. 
 
 M5203507 
 

 '* ■••• t ! •• • 
 
 
 Fisher — The Effect of Diet on Midurance. 
 
 tigated through the very kind cooperation of able colleagues. My 
 thanks are especially due to Professor Chittenden and his co-workers, 
 Professor Mendel and Dr. Underhill, for the aid rendered by the 
 Sheffield Scientific School Laboratory in determining the nitrogen 
 excreted, and for much helpful advice and criticism. I wish also to 
 express my obligations to Dr. J. P. C. Foster for his services as 
 medical adviser to the students ; to Dr. W. G. Anderson, Director 
 of the Yale Gymnasium, and his corps of assistants, through whom 
 the endurance tests were conducted ; to Professor Rettger for fecal 
 tests ; and to the subjects of the experiment themseh es, Messrs, 
 Bauer, Edwards, Lagerquist, Lawton, Mitke, Parmelee, Reeds, Taylor, 
 and Weyman, whose patient submission to the painful tests of endur- 
 ance was little short of heroic. 
 
 In January, 1906, the students above mentioned organized them- 
 selves into an eating club. The experiment began with an endurance 
 test on January 14, and consisted of two main parts, each of which 
 lasted about ten weeks. 
 
 The object of the first half of the experiment was to test the claims 
 which have been made by Mr. Horace Fletcher, as to the effects upon 
 endurance of thorough mastication combined with implicit obedience 
 to appetite. Our conclusion in brief is that Mr. Fletcher's claims, so 
 far as they relate to endurance, are justified. 
 
 Mr. Fletcher's method may be briefly ' expressed in two rules. 
 
 1. Mastication. Thorough mastication of all food up to the 
 point of involuntary swallowing, with the attention directed, how- 
 ever, not on the mechanical act of chewing, but on the tasting and 
 enjoyment of the food ; liquid foods to be sipped and tasted, not 
 drunk down like water. There should be no artificial holdins^ of food 
 in the mouth beyond the time of natural swallowing, even if, as is to 
 be expected at the start, that swallowing is premature. It is not 
 intended to " count the chews," or hold the food forcibly in the front 
 of the mouth, or allow the tongue muscles to become fatigued by any 
 unnatural effort or position, or in any other way to make eating a 
 bore. On the contrary, every such effort distracts one from 
 the natux'al enjoyment of food. Pawlow has shown that without 
 such attention and enjoyment of the taste of food, the secretion of 
 
 1 The reader who desires to pursue the subject is referred, as to mastication 
 and instinctive eating, to Higgins, Humaniculture, Stokes, N. Y., 1906; as to 
 proteid, to Chittenden, Physiological Economy in Nutrition, Stokes, 1904 ; and 
 as to the general subject, to Horace Fletcher, The A. B.-Z. of our oivn Nutri- 
 tion, Stokes, 1903. 
 
Fisher — The Efi'ect of Diet on Endurance. 3 
 
 gastric juice is lessened. The [)uiiit of iiivoliiutaiy swallowing is 
 thus a variable point, gradually coming later and later as the practice 
 of thorough mastication proceeds, until the result is reached that the 
 food remains in \\\v mouth without effort and becomes practically taste- 
 less. Thus the food, so to speak, swallows itself, and the person eats 
 without thought either of swallowing or of not swallowing it ; swal- 
 lowing is put into the same category of physiological functions as 
 breathing, which ordinarily is involuntary. 
 
 •2. Folloioinff instinct. Never to eat when not hungr}', even if a 
 meal (or more than one, for that matter) is skipped. And when a 
 meal is taken, not to be guided b}^ the quantity of food offered, or 
 by past habit, or by au}^ theories as to the amount of food needed. 
 The natural taste or appetite is alone consulted, and the subject 
 selects, from the food available, onlj' those kinds and amounts which 
 are actually craved by the appetite. After practice, the appetite 
 gradually becomes more definite and discriminating in its indica- 
 tions. 
 
 These two rules — thorough mastication and implicit obedience 
 to appetite — were alone employed during the ten weeks which con- 
 stituted the first half of the experiment. 
 
 Shortly after the beginning of the second half of the experiment, 
 there was an interim of six days at Easter recess, during which the 
 few men who remained in New Haven took advantage of the tempo- 
 rary absence of the cook to try the possibilities of living without one 
 entirely. During this brief period use was made not only of raw foods, 
 such as fruits, nuts and milk, but also of foods which could be pur- 
 chased already cooked, such as the flaked breakfast foods. But all 
 the food was cold, and several of the men found it cheerless and 
 unsatisfactory. Judging from their feelings, they Avere losing in 
 weight and vigor. This part of the experiment was too brief, how- 
 ever, to justify any reliable conclusiun as to the virtues of a raw, or 
 rather a cookless, diet. 
 
 The second half of the experiment lasted about nine weeks. The 
 same two rules which were employed during the first half were 
 continued during the second, but a third rule was added. This was 
 the use of suggestion, as follows : 
 
 3. When instinct is in doubt, tise reason. — This rule consists of 
 acquiring and applying a little knowledge of foods and food elements. 
 For this purpose, in the present experiment two lists of food were 
 given. One was arranged in a tentative order of intrinsic merit, 
 beginning with fruits and ending Avith alcohol, and the other in 
 
4 Fisher — The Effect of Diet on Endurance. 
 
 the order of the proportion of proteid. The men were then asked, 
 when and only when the appetite was entirely vnlllng, to choose the 
 better and purer foods and the low proteid foods in preference to 
 those high in proteid. In this way the men gradually shifted their 
 diet upward in the two lists, and thereby jjursued a little faster the 
 same direction in which they had already been found to be uncon- 
 sciously moving under the influence of thorough mastication and 
 implicit obedience to appetite. 
 
 It would too greatly lengthen this report if any attempt were made 
 to repeat in detail all the specific advice given to the experimenters 
 under Rule 3. What has been said covers in a general waj^ all the 
 points except the advice (subject always to the consent of appetite) 
 to eat light and quickly digested suppers in order to go to bed on an 
 empty stomach. 
 
 Careful record of the amounts of food eaten and the constituents 
 of proteids, fats and carbohydrates was kept for each man each day, 
 certain days being omitted if for any reason the record was incom- 
 plete, as when, for instance, the men wei'e out of town or took their 
 meals away from the club.' To avoid weighing at the table, the 
 food was all weighed in the kitchen and served in "standard portions" 
 of 100 calories each, or simple fractions or multiples thereof, and the 
 men merely recorded the number of portions eaten. The proportions 
 of proteids, fats and carbohydrates were found by means of the 
 writer's "Mechanical Diet Indicator."'^ Atwater and Bryant's 
 tables were used as a basis for calculation. For the first few weeks 
 the figures were probably subject to some errors, and in all cases 
 more or less guessing had to be practiced with reference to the 
 amount of lean and fat of meats ; but the influence of any errors on 
 the results must necessarily be small, because meat supplied, at 
 the highest, only a small fraction of the total calories. It is believed 
 that the results are in general correct to two significant figures. 
 
 For the first two weeks of the first half of the experiment, the men 
 ate in their ordinary way. During the following eight weeks they 
 masticated more thoroughly and followed the leadings of taste more 
 carefully. Most persons, while nominally following taste, are largely 
 
 ^ The number of days eacli week on wliich the record of diet was kept was sel- 
 dom under six. 
 
 -For a description of this instrument, seethe writer's "A New Method of 
 Indicating Food Values," American Journal of Physiology, April, 1906. For a 
 description of its practical uses see "A Graphic Method in Practical Dietetics," 
 Jour, of the Amer. Med. Assoc, Apr. 20, 1907. 
 
lusher — The Effect of Diet o/t Emlurance. 5 
 
 controlled in their sflection of foods bv many other circninstances, — 
 as, conventionality, or the desire to eat what others eat and the unwil- 
 lingness to appear "different"; politeness, the desire to ))lease one's 
 host and hostess \f()0(l notions, the opinion that certain foods and cer- 
 tain amounts of food are " wholesome " even if not palatable and that 
 certain foods should be avoided as injurious even if delicious to the 
 taste ; narrowness of choice, as at a boardini^ house table, which 
 often su|)plies what is not wanted and withholds what is ; and 
 habit, by which the particular kinds and amounts of foods which 
 have become customary through the previous causes— conventionality, 
 politeness, food notions, and narrowness of choice — are repeated day 
 after day without thought. The subjects of the present study were 
 given a wide range of choice, the menu including fruits, nuts, cereals, 
 puddings and pastry, vegetables, milk, meats, etc. Meat if desired 
 was available three times a day. 
 
 The object of the experiment was to find what effects on diet and 
 endurance would follow from a strict obedience to the taste-instinct, 
 when this instinct was given a longer chance to act by prolonged 
 mastication and attentive tasting. Each man was therefore encour- 
 aged to choose his own food out of the menu for the day. Nothing 
 was set before him until it was ordered, and even after a food was 
 ordered it was not eaten if taste did not so dictate. The men were 
 specially warned, during the first half of the experiment, against any 
 conscious effort to decrease their food, proteid, or meat ; and while it 
 is possible that subconscious suggestion played a part, so far as could 
 be observed they were freer from its influence than any ordinary 
 experimenter who might take up the same experiment after reading 
 Mr. Fletcher's or Professor Chittenden's books. 
 
 That this conclusion as to the relative absence of subconscious sug- 
 gestion is correct was evidenced by the ex])eriences both before and 
 after this part of the experiment. For a month })rior to its actual 
 beginning (Jan. 14), the experiment had been fully decided upon, 
 and its plan and scope understood by the men. Plad subconscious 
 suggestion played an important role, it would probably have shown 
 itself in a reduction of proteid during this month ; but determinations 
 of the grams of nitrogen daily excreted in the urine, taken at the 
 beginning and end of this month, indicated no substantial change, as 
 the following table shows. (M. does not appear in this table, owing 
 to the absence of any specimen for December.) 
 
6 lusher — The Effect of Diet on Endurance. 
 
 TABLE I. 
 
 B E Lq Lw P R T W Average 
 
 Middle Dec. 11.3 11.1 13.8 12.3 11.3 13.9 14.2 15.9 13 
 
 Middle Jan. 10.4 12.7 14.3 14.3 11.1 14.8 12.2 13.4 13.1 
 
 On the other hand, during the second lialf of the experiment (Mar. 
 28-June 1), Avhen the force of suggestion was consciously introduced, 
 the reduction of flesh and proteid went on rapidly, as is seen m 
 Table II. The facts, therefore, seem to show that the men followed 
 directions closely, avoiding largely the influence of subconscious sug- 
 gestion and following that of conscious suggestion in exact accord- 
 ance with the directions given them. 
 
 Changes in Diet. 
 
 During the first two weeks of the first period when no change of 
 habits was undertaken, the food showed little tendency to change in 
 amount or in kinds. On the other hand, for the remaining eight 
 weeks, during which thorough mastication and instinctive eating- 
 were practiced, there was a distinct though gradual tendency toward 
 reduction in the amount of food, in the quantity of proteid, in the 
 quantity of flesh foods, and in the quantity of liquids of all kinds — 
 water, tea, coffee, cocoa, and even soups. Exact figures were kept 
 for calories, proteid and flesh foods. These showed that the total 
 caloi'ies gradually fell about 10^, the proteids, 15<fo, and the flesh 
 foods, 40,^, 
 
 In the second period, during which the force of suggestion to 
 reduce proteid and flesh foods was added, the same effects were 
 noted in a still greater degree. During this period the calories 
 dropped nearlj^ 20^, the proteid over 25;^, and the flesh foods about 
 'lOfo. Comparing the diet at the close of the entire five months of 
 the experiment with the diet at its beginning, it was found that the 
 total calories had fallen about 25^, the proteid about 40^, and the 
 flesh foods over 80;^, or to about one-sixth of their original amount. 
 A part of the reduction, at least of the calories, is probably due to 
 the change in season, as the experiment began in cold weather and 
 closed in hot weathei". 
 
 These results are shown in the following table : 
 
J'^sher — 77ie Ejf'ect of Diet on Endurance. 
 
 
 
 
 TABLE II. 
 
 
 
 AVERAGE DIETETIC RECORDS OF ENTIRE CLUB 
 
 
 
 
 
 Average 
 
 Calories 
 
 Daily 
 
 
 
 
 no. of 
 
 of proteid 
 
 "portions" 
 
 
 
 Average 
 
 "portions" 
 
 per lb. of 
 
 of flesh 
 
 Week 
 
 
 weight 
 
 daily 
 
 body wt. ' 
 
 foods 
 
 fJan. 17-23 
 
 
 149.8 
 
 28.3 
 
 2.7 
 
 2.4 
 
 ! 24-30 
 
 
 
 30.3 
 
 2.6 
 
 2.1 
 
 
 31-Feb. 
 
 6 
 
 
 27.8 
 
 2.5 
 
 1.6 ■ 
 
 
 Feb. 7-13 
 
 
 
 27.0 
 
 2.4 
 
 1.2 
 
 1st 
 
 14-20 
 
 
 
 25.8 
 
 2.1 
 
 .9 
 
 'eriod '' 
 
 21-27 
 
 
 
 26.4 
 
 2.2 
 
 1.1 
 
 
 28-Mar. 
 
 6 
 
 
 25.3 
 
 2.2 
 
 1.2 
 
 \ 
 
 Mar. 7-13 
 
 
 
 24.6 
 
 2.1 
 
 1.3 
 
 
 14-20 
 
 
 
 25.9 
 
 2.2 
 
 1.1 
 
 
 21-27 
 
 
 148 
 
 26.7 
 
 2.2 
 
 1.4 
 
 
 ^ 28-Apr. 
 
 3 
 
 
 26.7 
 
 2.1 
 
 .8 
 
 
 Apr. 4-10 
 
 
 
 25.7 
 
 1.9 
 
 .5 
 
 
 11-17'^ 
 
 
 
 27.3 
 
 1.7 
 
 .4 
 
 
 20-20 3 
 
 
 
 26.1 
 
 1.7 
 
 .1 
 
 2iul 
 
 27-Mav 
 
 3 
 
 
 25.5 
 
 1.9 
 
 .5 
 
 eriod ' 
 
 Mav 4-10 
 
 
 
 25.7 
 
 1.9 
 
 .4 
 
 
 ' 11-17 
 
 
 
 26.2 
 
 1.9 
 
 .4 
 
 
 18-24 
 
 
 
 24.9 
 
 1.7 
 
 .4 
 
 
 25-31 
 
 
 
 22.2 
 
 1.4 
 
 .4 
 
 
 , June 
 
 
 144 
 
 
 
 
 Remembering that a "portion " is 100 calories, avg see that, during 
 the first four weeks, the men consumed an average of from 2760 to 
 3030 calories per day, of which 120 to 240 were in the flesh foods, 
 such as meats, poultry, fish and shell-fish, and that 2.4 to 2.7 calories 
 of proteid Mere ingested for each pound of bod}'- weight. Trans- 
 lating Professor Chittenden's figures for the physiological require- 
 ment of ingested proteid, we find" it to be from 1.3 to 1.7 calories per 
 ]>ound of body-weight. Thus the men were at this time consuming 
 nearly double the Chittenden allowance. Durinof the last four weeks 
 of the experiment all these magnitudes were lower. The per capita 
 calories ranged from 2220 to 2620, of which only 40 were in flesh 
 foods, and the proteid had fallen to 1.4 to 1.9 calories per pound of 
 body-weight, which corresponds closely to the Chittenden standard. 
 
 Table II was constructed from the following thi-ee tables giving 
 separate data for the individual experimenters. 
 
 ' This column is calculated throughout on the basis of the body-weights on 
 Jan. 14. 
 
 -Except E., M. and P. 
 
 'Except E. The last two days of the Easter recess, Apr. 18, 19, are omitted 
 in tables 11. III. IV, V. 
 
Fisher — I'he Effect of Diet on Endurance. 
 
 TABLE III. 
 DAILY QUANTITIES OF FOOD 
 
 (in "portions" of 100 calories each). 
 
 
 Week 
 
 B 
 
 E 
 
 Lq 
 
 Lw 
 
 M 
 
 P 
 
 E 
 
 T 
 
 W 
 
 Averag 
 
 
 Jan. 
 
 19-23 
 
 35.4 
 
 26.1 
 
 33.4 
 
 33.6 
 
 23.9 
 
 27.0 
 
 32.0 
 
 36.1 
 
 29.4 
 
 28.3 
 
 
 
 24-30 
 
 27.9 
 
 39.1 
 
 34.3 
 
 33.6 
 
 36.8 
 
 26.3 
 
 84.5 
 
 37.3 
 
 33.9 
 
 30.3 
 
 
 
 31-Feb. 6 
 
 26.3 
 
 36.4 
 
 35.0 
 
 39.8 
 
 24.4 
 
 33.8 
 
 30.9 
 
 30.8 
 
 33.0 
 
 27.8 
 
 1st 
 Period " 
 
 Feb. 
 
 7-13 
 
 25.7 
 
 27.8 
 
 35.7 
 
 31.3 
 
 23.0 
 
 83.3 
 
 38.0 
 
 33.8 
 
 31.6 
 
 27.6 
 
 
 14-20 
 
 24.0 
 
 33.4 
 
 24.0 
 
 36.1 
 
 31.6 
 
 30.3 
 
 35.1 
 
 39.2 
 
 29.4 
 
 25.8 
 
 
 21-27 
 
 23.0 
 
 30.9 
 
 23.4 
 
 38.3 
 
 34.5 
 
 18.3 
 
 26.7 
 
 30.3 
 
 32.2 
 
 26.4 
 
 
 
 28-Mar. 6 
 
 23.3 
 
 35.7 
 
 23.6 
 
 27.4 
 
 24.1 
 
 18.0 
 
 25.4 
 
 29.1 
 
 30.8 
 
 35.3 
 
 
 Mar. 
 
 7-13 
 
 23.2 
 
 33.0 
 
 24.5 
 
 27.4 
 
 26.4 
 
 19.3 
 
 23.5 
 
 23.7 
 
 30.1 
 
 34.6 
 
 
 
 14-30 
 
 21.9 
 
 21.6 
 
 24.5 
 
 29.1 
 
 30.2 
 
 30.8 
 
 25.0 
 
 30.8 
 
 28.9 
 
 35.9 
 
 
 
 21-37 
 
 21.1 
 
 34.3 
 
 25.2 
 
 31.6 
 
 25.9 
 
 21.2 
 
 26.5 
 
 34.4 
 
 80.4 
 
 36.7 
 
 
 r 
 
 28-Apr. 3 
 
 33.6 
 
 36.3 
 
 26.2 
 
 27.5 
 
 25.2 
 
 23.0 
 
 26.1 
 
 33.5 
 
 30.2 
 
 36.7 
 
 
 Apr. 
 
 4-10 
 
 34.2 
 
 24.2 
 
 24.6 
 
 27.7 
 
 23.5 
 
 22.5 
 
 26.2 
 
 30.5 
 
 28.7 
 
 25.7 
 
 
 
 11-17 
 
 24.0 
 
 
 36.0 
 
 24.9 
 
 
 
 29.0 
 
 30.4 
 
 29.8 
 
 27.31 
 
 2nd 
 
 
 20-36 
 
 26.5 
 
 
 24.1 
 
 24.5 
 
 23"6 
 
 2:13' 
 
 35.5 
 
 32.0 
 
 29.4 
 
 26.1 ^ 
 
 
 37-May 3 
 
 25.5 
 
 22.6" 
 
 25.4 
 
 24.8 
 
 34.1 
 
 24.4 
 
 33.9 
 
 29.0 
 
 29.8 
 
 35.5 
 
 jreriOQ 
 
 May 
 
 4-10 
 
 23.0 
 
 25.5 
 
 26.5 
 
 24.4 
 
 37.1 
 
 23.1 
 
 26.0 
 
 28.7 
 
 26.7 
 
 35.7 
 
 
 
 11-17 
 
 21.8 
 
 19.3 
 
 26.5 
 
 27.6 
 
 34.5 
 
 23.8 
 
 37.6 
 
 30.3 
 
 34.2 
 
 36.3 
 
 
 
 18-24 
 
 32.7 
 
 19.1 
 
 33.7 
 
 27.8 
 
 19.5 
 
 25.4 
 
 34.6 
 
 26.5 
 
 35.2 
 
 34.9 
 
 
 ^ 
 
 35-31 
 
 19.3 
 
 17.2 
 
 33.6 
 
 27.1 
 
 17.8 
 
 21.9 
 
 34.3 
 
 20.3 
 
 28.6 
 
 22.2 
 
 From this table we see that there were wide differences between 
 the men in regard to the change in the quantity of food. During 
 the first period the men who reduced their calories conspicuously 
 were B., P. and R., the very men, as Table IX will show, who lost 
 weight during this period. 
 
 During the second period, reductions were noticeable in E., Lw., M. 
 and T. These, together with B. and P., were the men who lost 
 weight during the second period. We see here a distinct correlation 
 between quantity of food and loss of body-weight. 
 
 TABLE IV. 
 PROTEID (in calories) PER LB. OF BODY-WEIGHT 
 
 (Body-weiglit as taken Jan. 14, 1906) 
 
 Week 
 f Jan. 17-23 
 
 . 1st , 
 Period ' 
 
 Feb. 
 
 Mar. 
 
 24-30 
 31-Feb. 6 
 
 7-13 
 14-20 
 21-27 
 28-Mar. 8 
 
 7-13 
 14-20 
 21-27 
 
 B E Lq Lw M 
 
 2.6 
 
 2.5 
 2.2 
 2.1 
 3.0 
 1.8 
 1.8 
 1.9 
 1.9 
 1.6 
 
 2.9 
 
 2.8 
 3.1 
 3.9 
 3.1 
 3.3 
 3.0 
 3.5 
 3.3 
 3.6 
 
 1.8 
 2.2 
 2.4 
 2.2 
 1.8 
 1.9 
 1.8 
 2.0 
 1.9 
 2.0 
 
 2.8 
 2.8 
 2.9 
 2.6 
 2.0 
 2.3 
 2.3 
 3.3 
 2.5 
 2.7 
 
 3.6 
 
 3.7 
 3.5 
 2.0 
 1.9 
 2.0 
 2.4 
 2.5 
 2.7 
 2.4 
 
 2.8 
 2.5 
 2.0 
 2.1 
 1.7 
 1,5 
 1.5 
 1.7 
 1.7 
 1.7 
 
 R 
 
 2.5 
 2.5 
 2.8 
 2.0 
 
 1.8 
 1.9 
 1.8 
 1.7 
 1.9 
 1.9 
 
 3.3 
 3.0 
 
 3.7 
 2.9 
 3.7 
 3.8 
 3.6 
 3.1 
 3.8 
 ':> 7 
 
 W 
 
 3.7 
 3.8 
 3.6 
 2.6 
 2.2 
 2.4 
 2.4 
 2.6 
 2.4 
 
 9, 9, 
 
 Average 
 
 2.7 
 2.6 
 2.5 
 2.4 
 2.1 
 2.2 
 3.3 
 2.1 
 2.2 
 2.3 
 
 Not including E., M. and P. 
 
 " " E. 
 
Fisher — The J^ffect of Dkt on JEndurance. 
 
 TABLE lY—Coniinued. 
 
 PROTEID (in calories) PER LB. OF BODY-WEIGHT 
 
 (Body-weight as taken Jan. 14. 1006) 
 
 Week 
 
 B 
 
 E 
 
 Lq 
 
 L\v 
 
 M 
 
 1' 
 
 R 
 
 T 
 
 W 
 
 Average 
 
 ■^Mar. 28- Apr. :3 
 
 1.8 
 
 2.6 
 
 2.0 
 
 2.2 
 
 .■V . .W 
 
 l.!» 
 
 1.8 
 
 2.7 
 
 O 
 
 2.1 
 
 Apr. 4-10 
 
 1.5 
 
 2.!) 
 
 1.7 
 
 2.0 
 
 1.7 
 
 1.5 
 
 1.8 
 
 2.4 
 
 1.8 
 
 1.9 
 
 11-17 
 
 1.3 
 
 
 1.8 
 
 1.7 
 
 
 
 1.7 
 
 1.9 
 
 1.9 
 
 1. 1 
 
 20-'2(! 
 
 1.8 
 
 
 1.6 
 
 1.6 
 
 1.7 
 
 1.5 
 
 1.5 
 
 2.3 
 
 1.6 
 
 J . t 
 
 27-Mav;3 
 
 1.7 
 
 2.5 
 
 1.7 
 
 1.7 
 
 2.0 
 
 1.7 
 
 1.6 
 
 2.3 
 
 1.8 
 
 1.9 
 
 Mav 4-10 
 
 1.6 
 
 3.0 
 
 1.9 
 
 1.9 
 
 2.2 
 
 1.4 
 
 1.8 
 
 2.1 
 
 1.5 
 
 1.9 
 
 11-17 
 
 1.6 
 
 1.9 
 
 1,7 
 
 1.9 
 
 1.9 
 
 1.6 
 
 1.9 
 
 2.1 
 
 2.0 
 
 1.9 
 
 18-24 
 
 1.5 
 
 1.8 
 
 1.4 
 
 1.7 
 
 1.8 
 
 1.6 
 
 1.6 
 
 1.7 
 
 2.1 
 
 1 . I 
 
 2n(l 
 Periud 
 
 25-31 1.1 1.3 1.5 1.6 1.6 1.3 1.7 1.4 1.5 1.4 
 
 We observe from Table IV that the men who reduced their proteid 
 the most during the first period were B., P., R., T. and W. Of these 
 the first three only lost weight appreciably, and this was partly ascrib- 
 able, as we have seen, to reduction in their calories. Careful 
 examination of the figures would seem to show, however, that there is 
 some correlation between reduction of proteid and loss of weight. 
 
 During the second period there was a decided reduction of proteid 
 in all cases except that of R., who had already brought his proteid 
 down considerabl}" in the first period. E. reduced his proteid, but not 
 until the last three weelis, when he seemed to try to make up for lost 
 time. E., in fact, was the only man in. the club, except possibly M. 
 who (through mere inadvertence) did not follow out the rules of the 
 experiment systematically. It need scarcely be said that this is not 
 stated as censure ; for the very fact.of the moderation of E.'s and M.'s 
 mastication added to the value of the final comparisons. Even E.'s 
 sudden reduction in proteid at the end was not maintained two weeks 
 afterward, as was shown by the excretion of nitrogen in June, 
 given in Table VI, 
 
 It will be observed that the proteid at the end of the experiment 
 was reduced to a fairly uniform level for all the men. Moreover, the 
 proteid at the end corresj)onds closely with the results of Professor 
 Chittenden's experiments. This is especially significant in view of 
 the fact that this level was I'eached unconsciously — for only one of 
 the men, Lq., who used the mechanical diet indicator for the entire 
 club, knew regularly the exact character of each man's food propor- 
 tions — and without an^^ food prescription as was employed in the 
 ex[)eriments of Professor Chittenden. This means that there is a 
 simple way of reducing proteid to the level of " physio logical econ- 
 
10 FlsJier—TJie Effect of Diet on Endurance. 
 
 omy," open to the ordinary man, v/ithout the necessity of special 
 knowledge of foods and without the necessity of weighing and measur- 
 ing food, either by the subject himself or by others. 
 
 Aside from the changes in proteid, the proportions of food elements 
 did not vary greatly, the percentages of fat and carbohydrate in the 
 total fuel value remaining very nearly constant. At the close of the 
 experiment it was found that for all of the men the proteid in propor- 
 tion to the total fuel value was very nearly 10^, having been reduced 
 from about 14^. This reduction in the percentage of proteid was 
 almost entirel}^ offset by the increase in the percentage of fat, which 
 rose from about 30^ to about 33^ on the average. The percentage 
 of carbohydrate thus remained almost constant. Individual varia- 
 tions were much less than might have been expected. The proteid 
 at the close of the experiment among the diiferent subjects deviated 
 very little from lO'/o ; the proportion of fat varied from 28 to 36^j 
 and the carbohydrate from 51 to 62^. 
 
 The results of the experiment may throw some light on the 
 problem of the proper amount of food and food constituents for 
 healthy men eating in a natural manner. For the five men, Lq., Lw.> 
 M., R. and W., whose weights showed least tendency to fall and 
 whose average weight at the close of the experiment was 151.4, we 
 find the average total calories were 2G20, of which 10.7^ was proteid, 
 83^ fat, and 56.3^^ carbohydrate. The number of calories agrees 
 closely with the estimates (for sedentary persons) of Atwater and 
 Benedict by means of the calorimeter. 
 
 TABLE V. 
 
 QUANTITIES OF FLESH FOODS CONSUMED (meat, fish, 
 
 shell-fish; poultry) 
 
 (In "portions" of 100 calories each). 
 
 1st 
 Period ^ 
 
 Week 
 
 B 
 
 E 
 
 Lq 
 
 Lw 
 
 M 
 
 P 
 
 R 
 
 T 
 
 W Average 
 
 f Jan. 17-23 
 
 2.7 
 
 2.4 
 
 1.5 
 
 2.6 
 
 2.4 
 
 2.6 
 
 2.3 
 
 2.9 
 
 2.1 
 
 2.4 
 
 24-30 
 
 2.2 
 
 2.2 
 
 1.7 
 
 2.0 
 
 1.8 
 
 2.2 
 
 2.1 
 
 2.1 
 
 2.2 
 
 2.1 
 
 31-Feb. 6 
 
 1.3 
 
 1.9 
 
 1.2 
 
 2.1 
 
 1.6 
 
 1.3 
 
 2.1 
 
 1.9 
 
 1.4 
 
 1.6 
 
 Feb. 7-13 
 
 1.3 
 
 1.6 
 
 .9 
 
 1.7 
 
 .6 
 
 1.2 
 
 1.5 
 
 1.8 
 
 1.2 
 
 1.2 
 
 14-20 
 
 .9 
 
 2.3 
 
 .2 
 
 1.1 
 
 rr 
 
 .9 
 
 .9 
 
 1.6 
 
 .5 
 
 .9 
 
 21-27 
 
 1.2 
 
 2.0 
 
 .2 
 
 1.6 
 
 .6 
 
 
 1.6 
 
 2.1 
 
 .6 
 
 1.1 
 
 28-Mar. 6 
 
 .8 
 
 2.1 
 
 !3 
 
 1.5 
 
 1.1 
 
 1.1 
 
 1.6 
 
 1.5 
 
 .8 
 
 1.2 
 
 Mar. 7-13 
 
 I*' 
 . i 
 
 1.6 
 
 .1 
 
 2.4 
 
 1.0 
 
 1.2 
 
 1.9 
 
 1.6 
 
 .9 
 
 1.3 
 
 14-20 
 
 1.0 
 
 1.7 
 
 .03 
 
 1.9 
 
 .9 
 
 
 1.8 
 
 1.5 
 
 .7 
 
 1.1 
 
 21-27 
 
 1.0 
 
 2.5 
 
 .0 
 
 2.5 
 
 1.7 
 
 .7- 
 
 1.2 
 
 2.5 
 
 .6 
 
 1.4 
 
Fisher — 7'he Ejf'ect of Diet on Endurance. 11 
 
 TABLE Y— Continued. 
 QUANTITIES OF FLESH FOODS CONSUMED (meat, fish, 
 
 shell-fish, poultrj-) 
 (In "portions" of 100 calories each). 
 
 
 Week 
 
 B 
 
 E 
 
 L,i 
 
 Lw 
 
 M 
 
 P 
 
 R 
 
 T 
 
 W 
 
 Aver 
 
 Mar. 
 
 28-Apr. :l 
 
 .9 
 
 1.7 
 
 .0 
 
 1.7 
 
 .6 
 
 .8 
 
 1.1 
 
 .s 
 
 .1 
 
 .8 
 
 Apr. 
 
 4-10 
 
 .4 
 
 1.1 
 
 .0 
 
 1.0 
 
 1.0 
 
 .1 
 
 
 .8 
 
 .0 
 
 .5 
 
 
 11-17 
 
 .1 
 
 
 .0 
 
 .9 
 
 
 
 .8 
 
 . 1 
 
 .0 
 
 .4 
 
 
 20-26 
 
 .0 
 
 
 .0 
 
 .1 
 
 "i 
 
 "o 
 
 .2 
 
 .4 
 
 .0 
 
 .1 
 
 
 2r-Mav :} 
 
 .16 
 
 L2 
 
 .0 
 
 .6 
 
 .8 
 
 .2 
 
 .9 
 
 .5 
 
 .0 
 
 .5 
 
 May 
 
 4-10 ■ 
 
 .0 
 
 .9 
 
 .0 
 
 .8 
 
 .8 
 
 .0 
 
 .5 
 
 ,6 
 
 .0 
 
 .4 
 
 
 11-17 
 
 .0 
 
 1.2 
 
 .0 
 
 . I 
 
 .8 
 
 .0 
 
 .4 
 
 .3 
 
 .0 
 
 .4 
 
 
 18-24 
 
 .0 
 
 i.;{ 
 
 .0 
 
 .■) 
 
 .i) 
 
 .0 
 
 .8 
 
 .2 
 
 .0 
 
 .4 
 
 2ucl 
 Period 
 
 25-31 .0 1.0 .0 1.0 .9 .0 .8 .4 .0 .4 
 
 Table V shows that during the first period all except E. and Lw. 
 reduced their consumption of fiesh foods considerably. It is note- 
 worthy, as Tables XI-XIII will show, that these two were the men 
 whose improvements in endurance were probably among the least 
 during this period. 
 
 During the second period Lq., W., P. and B. virtually abandoned 
 fiesh foods entirely, the " portions " consumed daily averaging nearer 
 zero than .1. These men improved greatly in endurance also. On 
 the other hand, E., Lw., M. and R. reduced their flesh foods the 
 least, and their ranking in respect to increased endurance was in 
 general relatively low. 
 
 Excretions, Body- Weight, Strength. 
 
 The following table of nitrogen excreted in the urine is interesting 
 in connection with the preceding table. It will be seen that the 
 reduction in nitrogen daily excreted corresponds in general to the 
 reduction in proteid consumed. 
 
 
 
 TABLE 
 
 VI. 
 
 
 
 
 
 GRAMS 
 
 , OF 
 
 NITROGEN EXCRETED DAILY. • 
 
 
 
 B 
 
 E 
 
 Lq Lw 
 
 M 
 
 P 
 
 R 
 
 T 
 
 W 
 
 Mid.Ue Jan. 10.4 
 
 12.7 
 
 14.3 14.3 
 
 8.7 = 
 
 11.1 
 
 14.8 
 
 12.2 
 
 15.4 
 
 First April 6.6 
 
 14.7 
 
 9.2 11.1 
 
 
 6.3 
 
 11.0 
 
 12.4 
 
 9.0 
 
 Middle June 6.:J 
 
 13.1 
 
 8.4 
 
 13". 7 
 
 6.1 
 
 \ 
 
 8.8 
 
 9.4 
 
 N. in middle"! 
 
 
 
 
 
 
 
 
 June per ! q,... 
 kilog. of ; -^''^ 
 
 .22 
 
 .12 ... 
 
 .21 
 
 .09 
 
 — 
 
 .12 
 
 .13 
 
 body-weight J 
 
 
 
 
 
 
 
 
 ' Each figure is obtained by averaging 2 or 3 consecutive days' specimens. 
 2 Jan. 23 and Feb. 10. 
 
12 Fisher— The Effect of Diet on Endurance. 
 
 This table shows that all the men excepting E. and M, greatly 
 reduced their nitrogen excretion dnring the experiment, and that at 
 the close (with the two exceptions noted) the men were on about the 
 same nitrogen level as the subjects of Professor Chittenden's exper- 
 iment, namely, near one-tenth of a gram of nitrogen per kilogram of 
 body- weight. 
 
 Through the kindness of Professor Benedict of Wesleyan Univer- 
 sity, nitrogen analyses were made in December, 1906, six months 
 after the close of the experiment, to discover to what extent the men 
 had adhered to their newly acquired diet after the eating club in 
 which it had been practiced was disbanded. The results were B. 
 11.0, Lq. 10.5, Lw. 7.9, M. 9.9, P. 6.8, R. 11.5, T. 11.9, W. 8.9. These ■ 
 show that half of the men had reverted to some extent toward their 
 original diets. The men stale that the reason for this reversion was 
 the difficulty in selecting food differing greatly in kind and amount 
 from that customarilv served at their boarding houses. 
 
 The following table shows that the volume of urine dailv excreted 
 was greatly reduced during the experiment : 
 
 TABLE VII. 
 VOLUME OF URINE DAILY EXGEETED (in cubic centimeters) 
 
 B E* Lq Lw M P R T W 
 
 Middle Jan. 1425 1160 1180 l;;91 817^ 706 1387 1792 1177 
 First April 630 985 900 1252 ..._ 629 1025 930 797 
 Middle June 802 1120 822 785 480 696 970 
 
 From this table we see a striking reduction in the volume of urine 
 excreted, with the same two notable exceptions, E. and M. These 
 two, who reduced their excretions lea§t, were the men who Avere the 
 least assiduous in observing the rules of the experiment. 
 
 A careful examination of the feces was made hj Professor L. F. 
 Rettger of the Sheffield Scientific School. A summary of his report 
 follows. In it was included a comparative statement for three sets 
 of specimens of two days each, taken in January, March and June, 
 referred to below as series I, II and III. These included data as to 
 the color, odor, quantity, consistency, approximate determination of 
 the number and predominant kinds of bacteria, putrefactive and 
 fermentative properties, and a true microscopic bacterial examination. 
 In brief, to quote from Dr. Rettger's report and letter : 
 
 ' Jan. 23 and Feb. 10. 
 
Fisher — T/ie Ejf'ect of l)ht on Endurance. 13 
 
 " The odor was very slii^^ht in almost every specimen in the last 
 series, a marked difference between tliese and series I and II, 
 ](articularly I. Tlie average weight is less than in both series I and 
 
 II (av. wt, of series 1= 137.3 grams; of II = 1G4.8 grams, and 
 
 III = 120.4 grams). 
 
 "The Hgures indicate considerable different' in the putrefactive and 
 fermentative properties of the three series, and the decrease is progi-es- 
 sive. In series I the amount of proteid dissolved was mucli larger 
 than in II and III. . . The specimens [of series III] were more 
 solid generally than in both })revious scries. I was unable to note 
 any apj»reciabk' difference in the microscopic a])pearance of the last 
 series as compared with the previous, except that in specimen B of 
 the last series a large number of moulds were present. This has little 
 significance, however." 
 
 TABLE Till. FECAL TESTS ' 
 Putrefactive Deuree Fermentative Propertt 
 
 
 Mid. 
 
 End 
 
 Mid. 
 
 Mid. 
 
 End 
 
 Mid. 
 
 
 Jan. 
 
 March 
 
 June 
 
 Jail. 
 
 March 
 
 June 
 
 B 
 
 f 
 
 i 
 
 8.'? 
 
 + + 
 
 + 
 
 + 
 
 E 
 
 ^0% 
 
 35^ 
 
 1Q% 
 
 + + 
 
 + 
 
 + 
 
 M 
 
 2% 
 
 10% 
 
 \5% 
 
 + 
 
 + 
 
 + 
 
 Lq 
 
 00,'j; 
 
 « 
 
 50<^ 
 
 + + 
 
 + 
 
 + 
 
 Lw 
 
 2o% 
 
 15^ 
 
 + 
 
 + + 
 
 + 
 
 + 
 
 P 
 
 20t; 
 
 1 
 
 « 
 
 + 
 
 — 
 
 — 
 
 R 
 
 m% 
 
 2Q% ' 
 
 t 
 
 + + 
 
 + 
 
 t 
 
 T 
 
 20ri 
 
 ? 
 
 0% 
 
 ? 
 
 + 
 
 + 
 
 W 
 
 30$^ 
 
 10^ 
 
 0% 
 
 + + 
 
 + 
 
 + 
 
 We here observe that the degree of putrefaction in the last two 
 tests was usually considerably less than its magnitude in the first 
 test. The least change in the feces occurred in the cases of Lq., M. 
 and E., and the greatest changes in P., T. and W. Here again we 
 find some correspondence between the assiduity of the men and the 
 observed phj^siological changes ; for E. and M. were the least and P. 
 and W. the most careful among the experimenters. 
 
 A critic has raised the question whether the improvement in the 
 feces indicates lessened absorption of poi.sons, and whether, if the 
 feces were longer retained, the imj^rovement in their character might 
 not be in consequence of the abstraction from them and absorption 
 
 ' In the table, " + " signifies the presence and *' — " the absence of fermenta- 
 tive property ; " + + " represents a high degree of fermentative property ; " ?" 
 signifies that the putrefactive degree was doubtful, if not absent. 
 
 fNo specimen. 
 
14 Fisher — The Effect of Diet on JEn durance. 
 
 into the system of a larger amount of poisons. The length of time of 
 retention of the feces was not measured in any way. So far as can be 
 guessed from the impressions of the men, it was not lengthened, cer- 
 tainly not greatly, as in the case of Mr. Fletcher. ' As to the sig- 
 nificance of the improvement in feces, Dr. Rettger writes : 
 
 " The subject of intestinal putrefaction is one of which very little 
 is as yet known. A retention of feces may have the tendency of 
 lowering the amount of putrefactive products. This is due, I believe, 
 to two things : first, an absorption of such products as indol and 
 mercaptan ; and second, an unusual amount of antagonistic action 
 exerted on the evil-producing (])utrefactive) bacteria by the ordinary 
 and presumably helpful bacteria. Recent work seems strongly to 
 emphasize the latter point. . . There is nothing to show that a 
 small degree of retention would make a very "great difference. 
 
 " The absence of appreciable amounts of jjutrefactive bodies from 
 feces under the ordinar}^ conditions of peristalsis does, beyond a 
 doubt, indicate a lessened jjroduction of the products (toxines) ; the 
 system must be the better off on account of this . . . the inter- 
 pretation of the facts must be dealt with rather cautiously." 
 
 The following table shows the body-weights of the men (after 
 deducting weight of clothing). 
 
 TABLE IX. 
 BODY-WEIGHTS IN POUNDS (without clothing) 
 
 B E Lq Lw M P R T W Average 
 
 Jan. 14 148 127 147 153 141 144 179 156 153 149.8 
 
 Mar. 28 144 128 147 154 142 136 176 155 151 148 
 
 June 16 138 122 146 149 138 131 175 148 149 144 
 
 We see that during the first period, the weights, except of P., 
 remained practically stationary, but that in the second period all of 
 the men lost somewhat in weight, though the loss was trifling in most 
 cases. The only substantial losses during the two periods combined 
 were : P. 13 lbs., B, 10 lbs., and T. 8 lbs. Of these it may be said 
 that B. was distinctly over his normal weight at the start. 
 
 The distinct correlation between the loss of weight and the reduction 
 in food, and to some extent in proteid, has already been noted. P.'s 
 loss is ascribable largely to overstudy. The general slight reduction 
 in weight of the entire club is probably explained in the same way, 
 for all the men, with possibly two exceptions, distinctly overstrained 
 
 ' See The A. B.-Z. of our own Nutrition. 
 
Fisher — 7Vie Effect of Diet on Endurance. 
 
 15 
 
 ill their college work. Besides the iiittuence of overwork, there was 
 also present the iiirtiience of the season, — at least if the connnon 
 impression is correct that persons usually lose weij^ht with the 
 approach of warm weather. 
 
 Gymnasium tests were made at the beginning', middle and end of 
 the experiment. These tests were of two kinds, — tests of strength 
 and tests of endurance. The times of the tests were widely separated, 
 partly because those of endurance were too exhausting to be often 
 repeated, and partly because it was desired to avoid the influence of 
 '' j)ractice " ; for not only does practice increase strength and en- 
 durance, but it also gives the users of the strength-registering 
 apparatus a facility or "knack" in manipulating it which produces 
 a false appearance of improvement. 
 
 The dates of the three tests wei'e January 14, a week after the end 
 of the Christmas vacation ; March 28, just before the Easter recess ; 
 and June 10, ' just before the summer vacation. 
 
 Tests of strength, taken at the beginning, middle and end of the 
 \experiment, show the following effects : 
 
 Date 
 
 ( Jau. 14 
 
 R. Grip - ilch. 28 
 
 ( Jim. 16 
 
 ( Jan. 14 
 
 L. Grip - Mch. 28 
 
 ( Jnu. 16 
 
 ( Jan. 14 
 
 Back Lift - Mch. 28 
 
 ( Jun 
 
 16 
 
 Leg Lift 
 
 Total 
 
 ( Jan. 14 
 
 - Mch. 28 
 ( Jun. 16 
 
 ( Jan. 14 
 
 - Mch. 28 
 ( Jun. 16 
 
 TABLE X. 
 STRENGTH TESTS (in lbs.) 
 
 BE Lq Lw M 
 
 100 185 95 98 145 
 
 93 180 110 100 112 
 91 130 110 92 105 
 
 94 115 83 112 107 
 82 115 110 100 105 
 75 115 97 105 105 
 
 275 400 280 310 375 
 
 260 440 375 380 275 
 
 280 300 290 250 330 
 
 520 600 370 400 460 
 
 515 600 455 450 410 
 
 400 545 440 445 400 
 
 989 1250 827 050 1087 
 
 950 1285 1050 1030 902 
 
 846 1090 937 892 940 
 
 P 
 
 95 
 102 
 103 
 
 R T W Average 
 
 132 120 125 116 
 
 127 130 117 113 
 
 125 121 115 110 
 
 82 131 95 127 105 
 
 70 115 106 111 102 
 
 70 125 98 110 100 
 
 250 360 370 365 835 
 
 275 390 400 400 355 
 
 265 345 330 364 306 
 
 820 820 545 635 519 
 
 415 865 570 650 548 
 
 300 610 520 650 479 
 
 747 1443 1180 1252 1075 
 
 862 1497 1206 1278 1118 
 
 788 1205 ]()<)!» 1239 995 
 
 In this table we see that during the first period there was a slight 
 increase in strength (from an average "total" strength of 1076 to 
 1118), and during the second period a slight fall to 995, which is 
 about 12^ from the mid-yeai''s 1118, and about 8^ from the original 
 
 ' But May 31 for E., Lw. , R. and W. , on account of earlier examinations than 
 the others, necessity to leave town, etc. 
 
16 Fisher — The Effect of Diet on Endurance. 
 
 1076. Thus the strength of the men remained nearl}^ stationary 
 throughout the experiment. The greatest losses were those of B., E. 
 and R., whose records fell respectively from 989 to 846, 1250 to 
 1090, and 1443 to 1205. 
 
 The loss of strength, like the loss of weight, seems most jjrobably 
 explainable by the overstudy of the men. This cause was certainly act- 
 ively at work, and would apply in the case of all of the club with possi- 
 bly two exceptions. Overstudy applied conspicuously to B. and R., 
 both of whom not onlj^ overworked during the entire period of the 
 experiment, but had, just before coming to the last test, been through 
 the most exhausting and sleep-robbing week of all. There seems, 
 therefore, little reason to ascribe any part of the slight losses of 
 strength to the dietetic experiment itself. 
 
 This opinion is confirmed by two facts : One is that the man who 
 w'as least affected dietetically by the experiment was E., one of 
 the three largest losers of strength, while the men who were most 
 affected dietetically were P. and W., neither of whom lost strength 
 perceptibly, in spite of P.'s severe overwork and loss of Aveight. The 
 other fact is that in Professor Chittenden's experiment, which dietet- 
 ically was very similar, the subjects, who were soldiers and athletes 
 and not subject to pressure of work of any kind, showed large gains 
 in strength. F'rom these two facts we may infer that, so far as the 
 diet is concerned, the effect would be to increase rather than to 
 decrease strength. 
 
 Changes in Physical Endurance. 
 
 It is fortunate that the strength of the men remained so nearly 
 stationary ; for it demonstrates the more clearly that the increase 
 in endurance which will be shown below was an increase in endur- 
 ance per se, and not in any degree due to an increase in strength. 
 Strength and endurance are entirely distinct and should be separately 
 measured. The strength of a muscle is measured by the utmost force 
 which it can exert o?ice ; its endurance, by the number of times it 
 can repeat a given exertion well loithin its strength. 
 
 After much consideration and consultation it was decided not to 
 place reliance on the ordinary ergographs as a means of measuring 
 endurance.' Instead, seven simple gymnastic tests of physical endur- 
 
 ^ The reasons, in brief, were (1) iDecanse these ergographs are adapted to testing 
 only a few unimportant, and for the most part unused, muscles ; (3) because, in 
 operating these devices, the subjects do not simulate real work, since the mtis- 
 
Fisher — 21ie Jijfect of Diet on, Endurance. IT 
 
 anee were employed, and one of mental endurance. The seven phys- 
 ical tests were : 
 
 (1) Rising on the toes as many times as possil)le. 
 
 [•2) Deep knee-bending, or squatting as far as possible and rising to 
 
 the standing posture, repeating as often as possible. 
 {.;) ^Vhile lying on the back, raising tlic legs from the floor to a 
 
 vertical position and lowering them again, repeating to the 
 
 point of ])hysical exhaustion. 
 (4) Raising a 5-lb. dumb-bell (with the triceps) in each hand from 
 
 the shoulder up to the highest point above the head, repeating 
 
 to the point of physical exhaustion, 
 (o) Holding the arms from the sides horizontally for as long a time 
 
 as possible. 
 
 (6) Raising a dumb-bell (with the bicei^s) in one hand from a position 
 
 in which the arm hangs down, up to the shoulder and lower- 
 ing it again, repeating the motion to the point of physical 
 exhaustion. This test was taken with four successive dumb- 
 bells of decreasing weight, viz., 50, 25, 10 and 5 lbs. respectively. 
 
 (7) Running on the gvmnasium track at a speed to suit the subject, 
 
 to as great a distance as possible. 
 
 The mental test consisted of adding specified columns of figures 
 as rapidly as possible, the object being to find out whether the 
 rapidity of performing such Avork tended to improve during the 
 experiment. 
 
 From the Avisdom born of experience it may be stated that the 
 physical tests were too numerous and too severe. But after they 
 
 eles are placed in an awkward and unnatural position in which " no purchase " 
 is felt ; (3) because experience has shown that subjects waste their efPort by 
 expending it not only while raising but while lowering the weight, and that this 
 waste during the period of relaxation varies gi-eatly with different subjects ; (4) 
 because a fixed weight is used instead of a weight proijortionate to the different 
 strengths of the various siibjects. One might as well attempt to test the walk- 
 ing powers of a woman weighing 100 lbs., as compared with those of a man weigh- 
 ing 200 lbs., by compelling the woman to carry a 100-lb. weight so that she 
 might walk with the same weight as the man. Some of these objections have 
 been met in special instruments, such as that of Prof. W. S. Hall of Northwest- 
 ern University. 
 
 After the experiment was half over, and too late to make use of it, the writer 
 devised an ergograph which, it is believed, meets all of the above objections. 
 He was led to do so by the fact that the tests employed w^ere so frightfully 
 exhausting to the men. A description of the new ergograjih will be piiblished 
 later. It is to be employed in further tests. 
 
 Trans. Conx. Acad., Vol. XIII. 2 May, 1907. 
 
18 Fisher — The Effect of Diet on Endurance. 
 
 were once adopted in January, it was necessary in subsequent tests 
 to adhere to them, so far at least as always to begin with the same 
 test and follow the same sequence of tests as far as the series was 
 repeated. It is clear that one's ability to succeed in an individual 
 test would depend greatly on what and how many tests had immedi- 
 ately preceded ; consequently the o\\\j modifications in the January 
 tests which could legitimately be adopted in JMarch consisted in omit- 
 ting all tests after the first two or three. These first two or three, 
 being taken under the same conditions as before, reflected correctly 
 an}^ change in endurance so far as those particular tests were con- 
 cerned. 
 
 At the final series of tests in June, no omissions from the January 
 program were made ; to save time, however, the last two parts of 
 test 6, together with test 7 (which came at the end for all the men), 
 w^ere repeated only up to the point at which they had been carried in 
 January, although the men were able in June to carry them much 
 further, and in many cases did so of their own accord. One man, for 
 instance (W.), who in the run in January was glad to stop at 10 
 laps, went on in June to 34, running at the same speed until near 
 the end ; and this was done after having more than doubled his 
 former records in almost all of the other tests. The unlooked-for 
 increase in endurance made the June tests much more time-consuming: 
 than the tests in January and March. Had the men in June taken 
 test 7, and the two last parts of test 6 up to the same fatigue limit 
 as in January, some of them would have had to remain in the gym- 
 nasium (supperless) until bed time. One of the men, who in January 
 in the last two parts of test 6 raised the 10-lb. dumb-bells 318 times 
 and the 5-lb. dumb-bells 1,863 times, without doubt could have raised 
 them in June double and probably treble these numbers, but to have 
 done so would have consumed of itself an hour and a half of extra 
 time. 
 
 In view, therefore, of the only partial repetition of test 7 and the 
 last two parts of test 6, these records are omitted from Table XI. 
 The first part of test 6 (lifting the 50-lb. dumb-bell) is also omitted, 
 being given separately below. 
 
 The following table (XI) shows the results of the three sets of tests 
 in January, March and June. ' This table will repay careful study. 
 
 •^ The order in which tlie tests were taken was not the same for all of the nine 
 men, owing to the lack of a sufficient number of gymnasium assistants in taking 
 the tests. But care was taken that each man should himself i^reserve the same 
 order in all three series of tests. Thus, for the March series he took the first two 
 
Fisher — 77t<j E^'ect of Diet on Endurance. 1!) 
 
 From it we see tliat witli one exception (K.) all of the men had im- 
 proved in the 3Iart'h and June tests as compared witli the .lanuary 
 tests, and the eight men who did improve showed iini»rovement in 
 every test, exee|)t L(]., Lw. and T., who sliowed slight falling off in 
 iiulividnal cases. 
 
 As inspection will show, some of the increases are remarkable. 
 The recorded increases in the 60 odd cases were, Avith a few excep- 
 tions noted below, all true increases and not due to increased effort 
 to break a previous record. In anticipation of such possible effect 
 of ambition, the men were urged in the Januar}'^ tests to the utmost 
 limit the}' could or would stand. The origiijal intention had been to 
 work each muscle tested until it was plij^sically unable to repeat the 
 motion, but this was not usually found'practicable, except in tests 3, 4 
 and 6, and in some cases 2. In the other tests the Avill gave out before 
 the muscles. The ]\[arch and June tests were so managed that when 
 a man had surpassed his January record he was not allowed to pro- 
 ceed beyond the degree of fatigue which he had reached in the first 
 test. Tliis was usually not a difficult matter, as the fatigue in 
 January had been excessive and the men had no desire to suffer 
 again the painful after-effects. Hence, with the exceptions to be 
 noted, the March and June records not only exceeded those of Jan- 
 uary, but were accomplished with much less fatigue. The actual 
 improvement was therefore greater than the recorded impi'ovement. 
 
 oi' three tests which he had taken in January. This explains why, in the March 
 series, the tests as shown in the tables are not the same for all the men. The 
 order of the January and Jnne tests for the different men is given below. The 
 tests which were taken in March are in italics. 
 
 B 
 
 / 
 
 2 
 
 3 
 
 4 
 
 o 
 
 E 
 
 1 
 
 2 
 
 3 
 
 4 
 
 
 
 Lq 
 
 1 
 
 J 
 
 4 
 
 3 
 
 5 
 
 Lw 
 
 1 
 
 2 
 
 3 
 
 4 
 
 5 
 
 M 
 
 1 
 
 5 
 
 2 
 
 3 
 
 4 
 
 P 
 
 3 
 
 1 
 
 5 
 
 2 
 
 4 
 
 R 
 
 1 
 
 
 3 
 
 4 
 
 5 
 
 T 
 
 1 
 
 o 
 
 3 
 
 4 
 
 5 
 
 W 
 
 3 
 
 J 
 
 1 
 
 2 
 
 4 
 
20 Fisher — The Effect of Diet on Endurance. 
 
 TABLE XI. 
 TESTS OF PHYSICAL ENDURANCE. 
 
 B E Lq Lw M P R T W 
 
 ( Rising Jan. 300 1007 333 ' 69' 127 1483 702 900 1263 
 
 (1)- on Mar. 400'^ 1265^ 2620^ 65 1 400' .... . 831 ^ 1500-* .... 
 
 \ Toes June 500- 1061' 3000 ^ 85 ^ 1500 ^ 1800^ 1263 ^ 1800 ^ 3350 ^ 
 
 ( Deep Jan. 82 142 70 48 132 208 374 129 404 
 (2)- Knee Mar. ... ... 191' 47" ... 
 
 ( Bending June 200^ 81'' 202^ 58' 155^ 2302 453' 250^ 508* 
 
 ( T- Jan. 25« 526 93 22« 30" 27e 50^ 23" 30« 
 
 (3)^' T, .? Mar. ._. ._. ... 33" ... 34« ... ... 40^ 
 
 ( raising j^^^^g 335 3g6 206 356 316 376 103" 19'^ 53 
 
 ( 5-lb. Jan. 75 « 138 « 78« 38« 51 « 44'' 100 ^ 83 6 i85« 
 (4) ■^' Dumb-bell Mar. ... ... 1066 ... ... ... 
 
 ( (triceps) June 1276 59 « 806 51 6 756 56 6 io46 1016 501 e 
 
 MS MS M S M S MS MS MS MS MS 
 
 f Holding Jan. 5- 1-33 4- 7 3-37 3-30 5-39 2- 5 3-22 11- 
 
 (~'i)\ Arms Mar 5-49 15-35 
 
 [^Horizontal June 9-36 6 2-56' 3-50' 3-0' 6-0 10-1 = 3-16' 3-24' 23-45' 
 
 ,« J Ti ~'YY ,, Jan. 506 186 166 66 20 6 116 10 « 256 545 
 
 f (bice 3s) ^"'^*^ 1056 106 oge 336 30 6 29 « 27 ^ 75 ^ 108 ^ 
 
 6 ' 
 
 Criticism of JRecoi'ds of Physical Endurance. 
 
 That the fatigue after the March and June tests was in general 
 much less than after the January test was made evident by three 
 substantial proofs. The first was the feelings of the men themselves 
 as recorded in the foot-notes to Table XL After the March and J une 
 tests, every man of the eight who showed improvement felt " not 
 tired," or " less tired than in January test," which is the same as 
 saying -'not exhausted"; or else he had gone " to limit" as in Jan- 
 uary, which means that the muscle itself refused to continue work. 
 The last was usually true of the "leg-raising," "raising o-lb. dumb- 
 bell (triceps)" and "raising 25-lb. dumb-bell (biceps)". The only tests 
 in which thei-e was the possibility of being mistaken as to the degree 
 of fatigue were the "rising on toes" and "holding arms horizontal." 
 In the former fatigue comes so slowly, and in the latter the pain is 
 so intense that they prove to be tests of will power or "grit " quite as 
 
 ^ Cramped. 
 
 ^ Not as tired as in January test. 
 
 ^ Not to limit. 
 
 * Not nearly as tired as in January test. 
 
 5 Not tired. 
 
 6 To limit of muscle's eapacity. 
 
 ' About same fatigue as in January, 
 
Fisher — T/ie Ffeet of Diet on Endurance. 21 
 
 much as of muscle power. lu tliese cases the men had some difficulty 
 in remembering- the original degree of fatigue. But tiie increases 
 were so great and the men were so positive as to their feelings that 
 there remains little room to doubt the substantial correctness of the 
 results. In a few other individual cases, as of Lw. and L<j., whose 
 records in test 1 were sometimes stopped by cramps, there is some 
 room for doubt as to the correctness of the recorded improvement. 
 
 The second proof that the fatigue of the men in the June tests was 
 less than that in the January tests was found in the fact that the 
 stiffness and soreness which followed in June were markedly less 
 than in January and of much shorter duration. This Avas true of all 
 the eight men who showed improvement, except R. 
 
 The third proof of less fatigue in June than in January for the 
 eight men is that in June the men finished the ordeal of the endurance 
 tests with more strength left than in January, although, as we saw 
 from Table X, they began the two tests with slightly less strength. 
 The fact that they had more strength left after the June test is made 
 evident by the first part of test 6, given below, which in each case 
 came after the endurance tests were nearly or quite finished. This 
 consisted in lifting a 50-lb. dumb-bell. The weight being so great, 
 this was practically a test of strength rather than of endurance. 
 Now all of the eight men who showed improvement in the endurance 
 tests of Table XI, showed improvement in this strength test also, as 
 the following table shows: 
 
 I 
 
 TABLE XII. 
 LIFTING O'v biceps) 50-lb. DUMB-BELL. ^ 
 
 
 B 
 
 E 
 
 Lq 
 
 Lw 
 
 M 
 
 P 
 
 R 
 
 T 
 
 W 
 
 Jan. 
 
 03 
 
 13 
 
 13 
 
 03 
 
 13 
 
 03 
 
 43 
 
 23 
 
 133 
 
 June 
 
 13 
 
 03 
 
 53 
 
 83 
 
 133 
 
 13 
 
 103 
 
 12 2 
 
 26 3 
 
 But, as we have seen in Table X, the strength tests taken before 
 the endurance tests showed a slight falling off in June as compared 
 with .Januaiy for all but one (Lq.) of these eight men. In other words, 
 m June the men began their endurance tests weaker than in Jan- 
 uaiy, but finished them stronger. The larger residuum of strength 
 
 ^ This part of test 6, being one of strength rather than of endurance, was not 
 inchided in the endurance Table XI. Had it been included it would have 
 increased even more the percentage of improvement shown, for it shows an 
 average increase from 2.4 to 8.4, or 250$«. 
 
 2 Not to limit. 
 
 3 To limit of muscle's capacity. 
 
22 Fisher — The Effect of Diet on Endurance. 
 
 left after the June tests as compared with the January tests indicates 
 that the June tests, in spite of being far more severe, fatigued the 
 men less. 
 
 The 50-lb. dumb-bell test resolved the last doubts in ray own mind 
 whether, for some of the men, the recorded results might not exag- 
 gerate the true improvement. The two men of whose records I 
 should have felt a little doubt were B. and R. Both of them came 
 to the June test after prolonged mental exertion, and their exhaustion 
 at the end was far more evident than that of any of the others. That it 
 was great is clear from their own statements given below, though 
 only R. reported himself as having been about as stiff and sore after 
 the June as after the January tests. But both B. and R., whereas 
 they had less strength (Table X) before the June endurance tests 
 than before the January tests, had more strength left (Table XII) 
 after the June tests than after the January tests. At the close of 
 the January tests they were so exhausted that B. could not raise 
 the 50-lb. dumb-bell at all and R. could raise it onl3- 4 times. Had 
 their exhaustion after the June tests been as great, it seems certain 
 that B. would still have been unable to raise it, and R. would have 
 been unable to raise it more than 4 times ; but as it was, B. raised 
 it once and R. 10 times. 
 
 The value of such a positive proof that the June tests were more 
 easily endured than those of January was not perceived until the 
 figures were analyzed. Had it occurred to me in time, all the strength 
 tests 1»aken before the endurance tests would have been repeated after 
 them. It is true that the strength tests at the beginning were not 
 of the same muscles as those (the biceps) used in the strength test by 
 dumb-bells at the end, but, as Table X shoAvs, the strengths of different 
 muscles for the most part vary in unison with each other.' 
 
 It is significant that the only man whose strength, as shown by the 
 above table, was less at the close of the June experiment than at the 
 close of the January experiment was E., who was also the onl}^ man 
 whose endurance showed any reduction. The facts, therefore, in his 
 case are not discordant with those already stated ; for, as has been 
 stated, E.was the least assiduous in following the experiment. This was 
 
 'Out of the 108 comparisons of strength (i. e., comparisons for each of nine 
 men in each of four tests for Januax\y vs. March, March vs. June, and January 
 vs. June), only 20 are discordant with the general trend as shown by the totals. 
 Thus, for B. the general trend between March and June as shown by the total 
 was downward, and this downward trend is found in all but one of his four tests 
 the discordant case being the "back lift." 
 
.Fisher — lite Ejf'eet of Diet on Endurance. 23 
 
 often ivmarked, both to liiiii and to me, by the other members of the 
 elub, and it was suogested more than once that I should "nudge" 
 Iiiin, But, as I had been desiring a "control," or a subject in which 
 all the conditions except mastication were the same as for the other 
 men, I decided to sav nothing. The result was instructive, for E.'s 
 ease stood out as exceptional in almost all respects. Ilis reduction 
 in (piantity of food (Table III), except for a sjjurt at the end, "was 
 less than of most of the men ; his reduction in proteid (Table IV), 
 with the same exception, was the least of all ; his reduction in 
 (|Uantity of tlesh foods (Table Y) was the least of all ; his nitrogen in 
 •lune (Tal)le VI) was one of the highest ; his reduction in volume of 
 urine (Table VII) was one of the lowest two ; his improvement 
 in the fecal tests (Table VIII) was third to lowest ; his loss of 
 strength (Table X) was second greatest ; and as to endurance, he 
 was the only one who failed to show^ improvement. 
 
 There was only one other man, M., who was thought, though in a 
 smaller degree, to masticate less carefulh'^ than the experiment called 
 for ; and for him we find corresponding peculiarities, though in a 
 smaller degree. Thus, his reduction in total daily food (Talkie III) 
 Avas less than of most of the men ; his reduction in proteid (Table 
 TV) was less than the average reduction ; his reduction in flesh 
 foods (Table V) was the third smallest ; his June nitrogen was the 
 highest (Table VI) ; his reduction in quantity of urine (Table VIl) 
 was one of the lowest two ; his improvement in fecal test (Table VIII) 
 was second to lowest ; his loss of strength (Table X) was the third 
 greatest (or fourth, if measured in percentage) ; and his increase in 
 endurance, though great, was (except in test 1, which is subject to 
 some doubt) less than the average. 
 
 The shortcomings of these two men, E. and M., as to mastication 
 were not intentional, but due to carelessness and force of habit, as 
 well as, in the case of M., to the fact that he waited on table and felt 
 naturally more pressed for time. Their experience is valuable in 
 showinflf that, in a general wav, the changes in diet and endurance 
 Avere proportionate to the thoroughness of mastication and the follow- 
 ing of natural a})petite. 
 
 The men kept diaries in which are recorded their sufferings after 
 the various tests. These show a decided lessening in stiffness and sore- 
 ness in the later tests, though in the June tests the men had generally 
 done double the amount of Avork that thev had done in January. It 
 Avould have been a physical impossibility to do as much in January 
 as Avas easily apcomplished in .Tune in tests 3, 4 and G ; and granted 
 
24 Fisher — The Effect of Diet on Endurance. 
 
 that it had been even possible in January to goad the men to do as 
 much in tests 1, 2 and 5 as they did without urging in June, they 
 must certainly have been ill. 
 
 The following are statements from the men themselves : 
 
 Personal Tmp7'essions at end of Experiment. 
 
 (B) I was very sore [after the June test, Saturday, June 16, 1906] ' 
 However, 1 think the soreness was not so severe or lasting as it was 
 after the January test. The muscles of my right arm were swollen 
 considerably and I was unable to straighten it for two or three 
 days. But the swelling was not so severe as it was after the 
 earlier test and the arm Avas much more usable. The muscles of the 
 thighs were the sorest ; they were nearly worn out. Daring Sunday, 
 Monday and Tuesday after the test I had difficulty in walking ; and 
 going down stairs was quite a difficult and severe undertaking. 
 Wednesday morning the soreness had not left, though it had de- 
 creased considerably. I took a considerable tramp that day, and by 
 night I could scarcely feel the soreness at all. By Thursday I had 
 practically regained my normal endurance ; walked six or seven 
 miles that day. The calf-muscles too were quite sore, but much less 
 so than after the January test. Thei'e was another particular dis- 
 tinction. After the earlier test the calf-muscles were hard and 
 knotted for several days ; but this time, while they wei"e sore, they 
 were almost normally soft. Saturday evening when I Avent to bed 
 they were quite hard, but Sundaj^ morning they were normal and 
 practically remained so. . . . 
 
 I have no doubt that in my case there was great increase in 
 endurance, though I think that I lost in amount of energy that I 
 could exert at any given moment. This loss is due perhaps to two 
 things ; (1) I took, on the whole, less exercise than during the time 
 preceding the January test ; (2) I had been working quite hard for 
 three months steadih', while the January test followed a three weeks' 
 vacation during which I did little or nothing. As to increase of 
 endurance there can be no doubt. For example, in the deep knee- 
 bending, I began to get tired at 50 and had no idea of going above 
 100. When I reached this I set my goal at 125, then 150, 160, and 
 was able to reach 200 before I was exhausted. In January, after I 
 was tired I was not able to go on very, long before I became com- 
 pletely exhausted. This shows increased endurance. I had the 
 same experience in the other hard physical tests. In case of the run, 
 I was sure I could not go more than three laps after my first lap ; 
 
Fisher — 21ie EjfWt of Diet on Endurance. lb 
 
 but I made 1 1 <>r 1 1' mid could have Sfone several more. Coiisideriiisr 
 evervthino", 1 liave no doul)t iliat I was :il>U' to liaim- on inucli lontrer, 
 after I began to get tired, tlian in January. 
 
 I am at a loss to ascribe the increased endurance to an^-thing else 
 than to the diet. My way of living otherwise continued about the 
 same after the Januar}^ test as it was before. . . . Personally I 
 am convinced that the increased endurance mnst be due to diet and 
 manner of eating ; all other factors that I can think of are unfavor- 
 able rather than favorable to more endurance. I am convinced to 
 the extent that I shall certainly continue " FletcheriziuG: " and usinof 
 a low-proteid diet. 
 
 (E) All effects of [June] test disappeared entii-ely within four 
 days. [Effects of Januar}^ test lasted six days.] 
 
 (Lq) The stiffness and soreness had entireh^ disappeared in four 
 days. It was not nearh' so severe as the test in January. After I 
 was through in Januar}' I could hardly go down the stairs of the 
 Gymnasium, and three days after the test going up and down stairs 
 was accompanied with a great deal of pain, ... I was stupid 
 mentally for a Avliole week the first time, but in the last test I passed 
 that stage in a couple of days. . . . Had it not been for the late 
 hours and long stretches of work, I should have been able to make a 
 better comparison with conditions in January, though as it was 
 results show improvement. 
 
 I cannot say as to the help mentally I have derived, for I have, 
 always gone to my limit and I would be unwilling to make any posi- 
 tive statement. As for the i>hysi«al, I know there is an improve- 
 ment there, for my stomach, which was never so very strong, has 
 been greatly helped. 
 
 (Lw) There was no stiffness or soreness felt in the triceps or the 
 stomach muscles as the result of the last tests. The thig^h muscles 
 were a little stiff on the second day only — about such stiffness as one 
 might expect from a long Avalk. The calves of my legs began to 
 stiffen on Friday [June 15, 1906, the day after the test] and continued 
 to do so on Saturday, after which the stiffening began to lessen, and was 
 scarcely felt on ^Monday. The biceps of my right arm gave me the 
 most trouble. These were sore on Friday A. M. and continued to 
 increase in soreness till Sunday evening, feeling worst, however, 
 Sunday A. ]M. When I arose Monday A. Vi. all the soreness and 
 stiffness had disappeared. A peculiarity about the latter Avhicli im- 
 pressed me was the fact that although my arm was very sore it did 
 not seem to be very stiff. After the tests in January I could not 
 
26 Fisher — The Effect of Diet on Eadaranoe. 
 
 straighten my arm, but I could after the last tests in spite of the 
 extreme soreness. I had entirely recovered by Monday from the 
 tests. At no time after the tests did I feel any pain in proceeding 
 up and down stairs, and if I remember rightly I couldn't say the same 
 in January; neither did I feel particularly uncomfortable at any time. 
 After the half-mile run and the lifting tests which I took later, I felt 
 no soreness or stiffness afterward. . . . 
 
 I think the credit must be given to the diet experiment. I have 
 worked harder from January to June than ever before, and have taken 
 less exercise. As my mental work was so different from that previous, 
 I cannot form an estimate of any increase or decrease in efficienc}", 
 but as I have said before, I alwavs rested ud more quicklv. Durinof 
 the spring I have not felt that " all gone feeling " which usually has 
 appeared in the past. The diet which we have had has relieved me 
 of the sour stomach after meals, and I have felt better and worked 
 harder on less exercise than ever before. . . . After a moderate 
 amount of exercise, I have felt no such stiffness as used to come. 
 
 (M) The stiffness and soreness Avere entirely worn off in two 
 davs. I did not feel it nearly as much as I did last .January. In fact, 
 I did not exert myself to the utmost this last time because I had sev- 
 eral examinations to take a day or two later. 
 
 My general impression is that the experiment was an all around 
 benefit to me. I fully believe that during the tests, thej' reflected 
 the true state of the case in showing my efficiency in June compared 
 with that in January. I believe that there was a decided improve- 
 ment in efficienc}'^ and could ascribe it partly to my exercise and the 
 other part to the new manner of eating. I believe, however, that my 
 exercise played a \evj small part because I think what I gained in 
 exercise I lost in sickness [mumps]. 
 
 My exercise this year was practically the same as years preceding. 
 After April 1st I had very little exercise, on account of the mumps. 
 This left me in a weak condition over a month. I had lots of work 
 to make up and studied harder from April to June than 3L\\y other 
 period of my course. M}^ exercise was neglected these three months 
 and I studied almost constantly every day and until 12 at night. 
 
 My experience has shown me that I was at my best in mind and 
 body when I ate meat four times a week. I have tried both more and 
 less and found the above to be the medium. I also found that I could 
 do more when I had the largest meal at noon. The greatest benefit 
 of the experiment to me personally is that last year I broke down in 
 the spring term and this spring I kept up my work and health in a 
 much better condition. 
 
Fisher — Th( J'Jft'ect of Diet ott Eiidur<mce. 27 
 
 (P) T wi'nt into tlie second tost witli some trepidation, knowing 
 tliat 1 had lost eoiisi(leral)le weight the preceding ten weeks. 
 Physically, I cannot say that I felt stronger before the second test 
 than before the first ; nor did I feel weaker. As tlie test developed, 
 however, I soon saw that njy endnrance, both mental and ]thysical, 
 had increased. 
 
 Generally speaking, the soreness was less extensive, less trying or 
 acute, and (I think) shorter-lived than in January. ... It seems 
 to me, as 1 tinishe<l the test much fresher than in January, a clear 
 gain in efficiency is proven. The test seemed certainly to make a 
 true re})ort. 
 
 I can ascribe sain in endurance to nothinf'" l)ut the diet and thor- 
 ough mastication. Every other factor in the situation was against 
 this gain — exercise, of which I took certainly no more than usual 
 and in the latter weeks much less ; work, of which I had had a long, 
 hard pull as against the three weeks' rest preceding the Januarj'" 
 test ; sleep, iiuich decreased for most of May and June. You stated 
 last December that you wished every factor to be in favor of the 
 first test and against the second. This condition has been true in 
 high degree for my case. . . Whatever the efficacy of the two 
 tests in proving the superiority of low proteid and thorough masti- 
 cation for the other members of the club, I feel convinced that they 
 prove that superioritj' with considerable force in my own case. 
 
 I have tried meat and chicken a number of times in the last two 
 weeks, partly from curiosity and partly from necessity. But in every 
 case anticipation has been pleasanter than realization, and my low- 
 jiroteid tendencies bid fair to remain for some time to come. I may 
 say that I had no opinion on the diet question when the experiment 
 started, but am now a hearty low-proteid exponent. 
 
 I went into the test with considerable foreboding as to my endur- 
 ance showing ; for I have worked now without a break for twenty- 
 two weeks at hard mental labor, the last two weeks being especialh'' 
 confining and involving large losses of sleep and exercise. I may 
 say that I have been unusually well for six or eight weeks, and 
 bowels have been running with greater ease and constancy than for 
 several years, . . The endurance-tests, showini; a arood inci'ease 
 in every test, consequently came as a complete surprise ; and my 
 self-confidence, largely absent at the start, returned in increasing 
 measure as the test went on. . . 
 
 Thursday, June 21 [5 days after test]. Played golf this morning 
 and afternoon (9 holes each time) with perfect ease, no difficulty 
 
28 Fisher — The Effect of Diet on Endurance. 
 
 Avith walking or driving the ball. Soreness wholly gone at present 
 writing, no touch of it noticeable anywhere. 
 
 . (R) The outcome of the last endurance test was about the same 
 as the one held January 14, 1906. I was fearfully sore for about one 
 week, reaching the climax at the middle of the week. 
 
 (T) Throughout the test I passed from one event to another 
 with much shorter periods between than I did in January. With the 
 exception of l^'ing on my back and raising ray feet, I at no time ap- 
 proached as near exhaustion as I did in January. In January, in rising 
 on my toes and in the deep knee-bending, I continued till I fell to 
 the floor. I was not exhausted at the close [of the June test], but 
 marked papers for 2-| hours before going to bed. Sunday I scarcely 
 felt any the worse, though my muscles felt a little queer when I poked 
 my finger into them. Monday my leg muscles were a little stiff 
 after a period of rest, but not painful in the least. My right shoulder 
 was a trifle lame, due wholly I think to hitting it once in a while in 
 the last test with the 10 and 5-lb. Aveights. My right arm at the 
 elbow was decidedly lame and would not admit of being completely 
 straightened, though it was undoubtedly better than in January. 
 By Tuesday all the other stiffness had practically left me except the 
 right elbow, which was, however, better. By Thursday I was unable 
 to detect any soreness whatever in any part. 
 
 (W) May 31. After the test I felt fairly tired and ready to quit 
 — however, not nearly so exhausted as before in January. Could 
 walk down stairs with more confidence and could raise my supper to 
 my mouth much more easily than after the first test. . . . The 
 results certainly far surpassed any expectation I had, especially as 
 in the morning I did not feel quite as spry and active as usual, due 
 to a little unusual over-exertion the previous day. 
 
 June 1. Sore in thighs and biceps, also felt my abdominal muscles. 
 
 June 2. Expected to be much worse on this the second day, as in 
 January, but not so. About same as yesterday. Later in the day 
 could run up-stairs two steps at a time as I could yesterday— a thing 
 undreamed of in January for .over a week after the test. 
 
 June 3. Felt pretty well today, much improved over yesterday, 
 still felt my thighs in walking down hill or down stairs, but not 
 nearly as bad as yesterday. 
 
 June 4. Feel my thighs only very little, other muscles not felt at 
 all. Rode a bicycle 5^ miles ; did not feel it. 
 
 June 5. Seem to be all well, haven't noticed a soreness all day. 
 
Fisher — The Efect of Diet on Endurance. 29 
 
 The followiiic: table oxprosses tlic ]i(i-cciitago of iiii]ir(n('incnt in 
 tlic records ot" Table XI. 
 
 TABLE XIII. 
 IMPROVEMENT IX PHYSICAL ENDURANCE IN PERCENTAGES. 
 
 
 
 B 
 
 E 
 
 Lq 
 
 Lw 
 
 M 
 
 P 
 
 R 
 
 T 
 
 W 
 
 ... (Jan. 
 ^^' (Jan. 
 
 -Mar. 
 -Jiine 
 
 33 + 
 
 66 + 
 
 26 ± 
 
 5± 
 
 686- 
 
 800- 
 
 -5± 
 23 ± 
 
 215 ± 
 
 1081 ± 
 
 li + 
 
 18 + 
 
 79 + 
 
 66 + 
 
 100 + 
 
 16.5 + 
 
 ^~> i Jan. 
 
 -Mar. 
 -June 
 
 144 + 
 
 -43 ± 
 
 172 ± 
 188 + 
 
 -2± 
 
 21 ± 
 
 "17 + 
 
 '10 + 
 
 '21 ± 
 
 '94 + 
 
 '26 + 
 
 ,.^ \ Jau. 
 (•^' "<Jau. 
 
 -Mar. 
 -June 
 
 '■62 
 
 -ir 
 
 122- 
 
 59 
 
 "3 
 
 26 
 37 
 
 106 
 
 -17 
 
 33 
 
 77 
 
 ^^' (Jan. 
 
 -Mar. 
 -June 
 
 "69 
 
 -57 
 
 36 
 2 
 
 '34 
 
 '47 
 
 '27 
 
 "4 
 
 '22 
 
 170 
 
 - ' (Jan. 
 
 -Mar. 
 -June 
 
 "9C'- 
 
 '8S>± 
 
 -7± 
 
 -17 ± 
 
 66 ± 
 
 74 ± 
 
 "77 + 
 
 "56± 
 
 ""i± 
 
 42 ± 
 115± 
 
 (6) ■{ Jan. 
 
 -June 
 
 110 
 
 -44 
 
 62 
 
 450 
 
 50 
 
 163 
 
 170 
 
 200 
 
 100 + 
 
 ^' • / Jan. 
 
 -Mar. 
 -June 
 
 38 + 
 
 85 ± 
 
 26 ± 
 
 -13± 
 
 208 ± 
 194± 
 
 14± 
 95 + 
 
 140 ± 
 
 212 ± 
 
 26 
 56 + 
 
 18 + 
 73 ± 
 
 66 + 
 66 ± 
 
 37 ± 
 109 ± 
 
 In the preceding table most of tlie figures are succeeded by a "4-", 
 which signifies that the true improvement was greater than the 
 figures indicate. Thus, the first entry in Table XIII, " 33 + ", means 
 that B.'s improvement between January and March in test (1) 
 (rising on toes) was 9nore than 33^, Similarly, "686-" for Lq. in 
 same test means that improvement was less than 686^5^. Again, 
 "•215+ "for M.'s same test signifies that his improvement in this 
 test may have been greater or less than 215^. Finally, when any 
 figure is not followed by a sign, as for instance, B.'s (3) (leg raising), 
 the meaning is that the figure given is, humanly speaking, correct. 
 This accuracy applies onl}^ to those tests in which the muscles were 
 worked till they were physicalh' unable to repeat the movement. 
 The reasons for the various suffixes may be found by studying the 
 foot-notes of Table XI.' 
 
 ^ For instance the " + " after 33 for B.'s (1) is explained by the fact (as indi- 
 cated in the foot-note to Table XI) that after his March test he was not as fatigued 
 as after his January test, although he had improved upon his January record 
 by 33^. The only cases in which the explanation of the suffi.xes will not be 
 foiind from the foot-notes to Table XI are the following: E.'s (1), 26 ±, in 
 which case the "— " is inserted owing to the fact that E. had come to the March 
 test after the refreshment of a nap ; and M.'s (1), 1081 ±, in which case the " — " 
 is inserted owing to the fact that this high figure is inconsistent with the other 
 resiilts of the test, it being thought that M. may have been mistaken in his 
 
30 Fisher — The Effect of Diet on Endurance. 
 
 The table shows enormous differences in the figures even of the 
 same man for the same period. Thus, the June improvement of 
 W. reads 165 + , 26 + , 77, 170, 115 ±, 100 + . Such wide differences 
 between the improvements in different tests seem puzzling at first, 
 but they are explained, partly if not wholly, by two reasons. The 
 first is the obvious one that many of the figures are not exact records, 
 but understatements, and naturally their margin within the truth 
 will vary widely. Thus, the records for deep knee-bending (2) for 
 W. i>how merely that the improvement is over 26^ ; the true figure 
 may well be 100^, which would be more consistent with the other 
 figures. But the deep knee-bending test had been found in January 
 very painful and inconvenient in its after-effects, and there was there- 
 fore less inclination in the June tests to approach closely to the limit 
 in this particular test. 
 
 The other reason is that in some tests a larger fraction of the total 
 strength of the muscle tested was called into play than in others. 
 Thus, "leg raising" requires a very large fraction of the strength of 
 the abdominal muscles, Avhile "rising on toes" requires only a small 
 fraction of the strength of the calf muscles. This may explain why, 
 in general, the improvement in the test of the calf muscles seemed 
 so much greater than in that of the abdominal muscles. This expla- 
 nation is, however, purely hypothetical. It would be interesting to 
 find out experimentally how much an improvement in the endurance 
 of a muscle shows itself when it is exerted in different degrees, say to 
 75^, 50^ and 25^ of its strength-capacity.' 
 
 Bearing in mind these two possible reasons for the variations in the 
 figures, and also the fact that there must have been more or less actual 
 differences in the improvement of different muscles, we need not be 
 surprised at the disparities which the table shows. 
 
 If we omit the cases in which the records are at all doubtful (with 
 sufiix ±) or exaggerated (suftix — -), we have left the following table 
 for the eight men who showed improvement : 
 
 remembrance of his January test. The " — " has been inserted whenever there 
 was the slightest ground of any kind for thinking the figures might be overstate- 
 ments. With these figures weeded out, the remaining ones certainly understate 
 the actual improvement. 
 
 ' The original object of using the graded dumb-bells, 50-lb., 35-lb., 10-lb., 
 and 5-lb. , for testing the biceps, was to throw light on this problem ; but for 
 reasons previously stated, these tests were not fully carried out. 
 
Msher — 'J^he Efect of Diet o)i Eiiduranve. 31 
 
 TABLli XIV. 
 
 PERCENTAGE OK IMPROVEMENT (exact or uiidfistated) 
 OF ElOHT MEN. 
 
 
 
 B 
 
 Lci 
 
 Lw 
 
 M 
 
 P 
 
 R 
 
 T 
 
 W 
 
 a) 
 
 Jan. -Mar. 
 
 Jan. -June 
 
 33 + 
 
 6(i + 
 
 ... 
 
 ... 
 
 ::: 
 
 '21 + 
 
 18 + 
 7i» + 
 
 66 + 
 
 100 + 
 
 16.5 
 
 (2) 
 
 ( Jan. -Mar. 
 \ Jan. -June 
 
 144 + 
 
 188 + 
 
 ... 
 
 "17 + 
 
 'io + 
 
 ::: 
 
 "94 + 
 
 '26 
 
 (a) 
 
 i Jan. -Mar. 
 i J an, -June 
 
 ":« 
 
 ... 
 
 .10 
 5!» 
 
 
 
 26 
 37 
 
 106 
 
 -17 
 
 33 
 
 1 1 
 
 (4) 
 
 ( Jan. -Mar. 
 ( Jan. -J line 
 
 "ti9 
 
 36 
 
 "34 
 
 '47 
 
 '27 
 
 "4 
 
 22 
 
 170 
 
 (•^) 
 
 Jan. -Mar. 
 Jan. -June 
 
 ... 
 
 ... 
 
 --- 
 
 ... 
 
 77 + 
 
 ... 
 
 ... 
 
 ... 
 
 (6) 
 
 -[ Jan. -June 
 
 110 
 
 (52 
 
 4.50 
 
 .50 
 
 163 
 
 170 
 
 200 
 
 100 
 
 Av. 
 
 < Jan. -Mar. 
 \ Jan. -June 
 
 :5:} + 
 
 84 + 
 
 :5G 
 
 84 + 
 
 .50 
 181 
 
 "29 + 
 
 26 
 56 + 
 
 18 + 
 89 + 
 
 66 + 
 80 + 
 
 33 
 107 
 
 The figures of Table XIV show an undoubted increase in endur- 
 ance, both for the first lialf and more especially for the Avhole 
 period of the experiment. 
 
 But, for an accurate j^resentation, we may cainy our criticism one 
 stage further. The figures given hitherto represent a conglomerate 
 sort of endurance, made up of endurance of different muscles su})ject 
 to different degrees of strain. As pointed out before, the calf mus- 
 cles were called upon for onl}' a small fraction of their strength - 
 capacity, whereas the abdominal muscles were called upon for a very 
 large fraction. Moreover, the fraction must have varied somewhat 
 in different tests, according to the variation in strength and weight. 
 An ideal test would be one in which the same fraction of strength 
 Avas used. ' 
 
 Fortunately, such an exact test is afforded by the 2o-lb. dumb- 
 bell. Tt followed immediately after the 50-lb. dumb-bell had been 
 raised until the biceps was unable to repeat the motion. At the 
 moment the .50-lb. test ended, the 25-lb. test began. At this moment 
 the strength of the biceps was just at or barely below the fifty lbs. 
 required to raise the heavier dumb-bell. In other words, in raising the 
 25-lb. dumb-bell the muscle needed just fifty j^^r cent, of its strength 
 at the time the test began. The use of the 25-lb. dumb-bell grad- 
 ualh' reduced this strength from 50 to 25 lbs. The test was there- 
 
 ^ It is on this principle that the new ergograph, before referred to, is con- 
 structed. 
 
32 Fishei — The Effect of Diet on Endurance. 
 
 fore perfectly uniform for all the men ; it showed how many con- 
 tractions were necessary in each case to bring down the strength of 
 the biceps from 50 to 25 ; it showed how much the muscle could 
 endure before being robbed, by fatigue, of half its strength. Thus at 
 the beginning the strength is 50 lbs. ; after the first contraction it is, 
 say, 49 ; after the second, 48, etc. But the contractions continue until 
 the strength sinks below 25 lbs. The loss of strength maybe said to 
 measure fatigue. The sloioness of this loss may be said to measure 
 endurance and is well indicated by the number of contractions 
 necessary to tire a muscle from a strength of 50 lbs. to a strength of 
 25 lbs. 
 
 Four exceptions, however, need to be noted. Three men, B., Lw. 
 and P., were unable in January to raise the 50-lb. dumb-bell at all 
 (see Table XII). Consequently their January test with the 25-lb. 
 dumb-bell did not begin at 50^ of the strength, but at a higher frac- 
 tion. This explains their high apparent improvement. Thus, Lw. is 
 credited with an improvement of 450^*, because in January he could 
 raise the 25-lb. dumb-bell only 6 times, and in June, 33 times. 
 But the 33 contractions in June began at just 50fo of the strength of 
 the muscle, owing to its previous exhaustion to the 50-lb. level by 
 the 50-lb. dumb-bell, whereas the six contractions in January began 
 at a higher level ; for at that time the biceps could not raise the 
 50-lb. dumb-bell at all. Its strength was at that time less than 50 
 lbs., say 40 lbs., in which case the lifting of the 25-lb. dumb-bell 
 required not 50,^ but 62-^^ of its strength. To compare a 50^ test of 
 June with a 62^^ test in Januaiy gives a record of improvement 
 which is not one of pure endurance, but which includes the element 
 of increased strength. This is " endurance " in the crude sense in 
 which we may say a man has more endurance for carrying trunks 
 than a boy ; but for a comparison of pure endurance, the boy should 
 be given smaller trunks to handle than the man. 
 
 The fourth case is E., to whom the reverse reasoning applies. In 
 June when he I'eached test 6, he was unable to raise the 50-lb. dumb- 
 bell at all, though in January he had raised it once. Hence, while 
 the 25-lb. dumb-bell was a 50^ test in January, it was a more 
 severe one in June, and the -44^ which records his falling off does 
 not represent a pure loss in endurance, but partly also a loss of 
 strength. To reckon pure endurance we need to bring -44 up toward 
 zero. 
 
 Making the four omissions just mentioned, we may use the remain- 
 ing records from the last line of Table XIII, as a barometer of pure 
 endurance. 
 
Fisher — The Efect of Diet on Endurance. 33 
 
 * 
 
 We theroforc' liave tlirco iiu'tluxls of estiiiKiting tlie increase of 
 endurance V)et\veen January aiul June. These may be put together 
 in the following table : 
 
 TABLE XV. 
 
 PERCENTAGE OF INCREASE OF ENDURANCE, JANUARY TO JUNE. 
 
 BY THREE METHODS. 
 
 B E Lq Lw M P R T W 
 
 Avera-e ) ^- _^.^ ^,^ t,-^ 2^o^ 56+ 70^ 06 ± 109 ± 
 
 tests ) 
 
 Omittine: ) 
 
 (lonbtfnl - 84+ --- 84+ 181 20+ 56+ 80+ 80+ 107 + 
 
 cases " + '' ) 
 
 • ' Pure " ) 
 emliirance - --- --- 62 ... 50 ... 170 200 100 + 
 
 of biceps ) 
 
 The first line of this table tells us the average of the recorded im- 
 ])rovement in endurance shovvai for each man. But as each such aver- 
 age is made up from the figures of Table XIII, some of which, as 
 indicated in that table, ai'e possibly too high, some doubt necessarily 
 attaches to it, though practically the only real cases of doubt are 
 Lq. and M. The a\^erage of these averages is 101^ for the entire 
 club, and is probably within the truth ; for most of the individual 
 figures which go to make up this result are understatements, not 
 overstatements. 
 
 The second line shows the average improvement in tests in which 
 there is no doubt that the figure is at least not too high, though it 
 may be too low. The average of these is 89^, and is therefore cer- 
 tainly too low an estimate of the average improvement for the eight 
 men who improved at all. 
 
 The third line shows the increase of ^:>?^;'e endurance (that is, en- 
 durance considered apart from strength) for the five men for whom 
 the figures were available. The average of these is 116^. 
 
 We are quite safe in saying therefore that the average improvement 
 of the eight men who improved was 90^. As to the degree of retro- 
 gression of E., it is difficult to say, though it is believed that the fig- 
 ures exaggerate it. This is certainly true of the 2.5-lb, dumb-bell test, 
 for reasons given. My own impression, and E.'s also, is that he actually 
 gained in endurance from the dietetic experiment, but that his gain 
 was not enough to offset the loss occasioned by (1) the hard term's 
 work, which, as in the case of the other men, was a decided handicap, 
 and (2) the omission of his customary exercises, which must have 
 
 Trans. Conn. Acad., Vol. XIII. 3 May, 1907. 
 
34 Fisher — The Effect of Diet on Endurance. 
 
 * 
 
 been a greater handicap in his case than in any other of tlie men ; 
 for he had been accustomed for six j'ears to heavy gymnasium train- 
 ing, but during the year of the experiment this training was given 
 up, largely because of the difficulty in finding time for it. If this 
 interpretation is correct, we may liken the experiment to nine men try- 
 ing to swim against a current. The eight who exerted themselves 
 the most succeeded in forging ahead ; the one who tried the least 
 drifted backward, though the effect of the swimming (dieting) was to 
 propel him forward. Whether or not E. was actually propelled for- 
 Avard by diet must remain a matter of conjecture or inference ; but 
 that the other eight men gained is an established fact. 
 
 Changes in Mental Endurance. 
 
 The mental test consisted in adding a specified number of figures. 
 The followinof tables show the time durintj Avhich the addition was 
 performed and the number of errors committed : 
 
 TABLE XVI. 
 
 TIME OF PEEFORMING A UNIFORM AMOUNT OF ADDITION. 
 
 BELqLwM P RTW Average 
 
 MSMS MSMSMS MS MSMSMSMS 
 
 Time ( Jau. 14 5 40 4 49 6 15 4 54 6 46 3 17 6 6 41 4 6 5 29 
 
 of - Mar. 28 5 16 4 27 4 35 4 15 5 47 2 43 6 32 7 18 4 34 5 3 
 
 adding ( ' June 16 4 50 5 9 4 40 4 23 5 50 2 58 7 3 6 5 4 7 5 
 
 This shows that during the first period seven had improved and 
 two had fallen oif, and on an average there had been a decrease from 
 5m. 29s. to 5m. 3s., an average improvement of 26s. W. showed an 
 increase in time of adding, although he Avould naturall}^ have been 
 expected to improve on account of having taken up clerical work 
 involving adding. 
 
 During the second period there was an average improvement of 
 only 3s. ; three retrogressed 1 5s. to 42s., three retrogressed 3s. to 8s., 
 and three improved 26s. to VSs. The fact that the men held their 
 own in the June adding test is probably indicative of actual improve- 
 ment, for they were fatigued mentally by examinations, etc., on the 
 day when they entered the June test. During the entire experiment 
 there was an average impi'ovement of 29s. ; seven had improved and 
 two had retrogressed (Is. and 20s.) 
 
 'E., Lw., R. and "W. taken on May 31. 
 
Fisher — The Effect of Diet on Endurance. 35 
 
 The followiiin- table sliows that the iiuuiher of errors coiiiinitted 
 was remarkably constant for most of the men and for the averaije : 
 
 TABLE XVII. 
 NUMBER OF ERRORS OF ADDITION. 
 
 B E Lq L\v M P R T W Average 
 
 10 8 1-2 4 
 
 -V lujir. -;o lb O 8 4 
 
 ( June 16 8 13 Tt 4 
 
 (Jan. 14 10 8 12 4 112 11 4.4 
 
 Errors \ Mar. 28 16 5 8 4 ;'. :! -J 1 4.6 
 
 16 2 4.5 
 
 The adding test was too short to be of great value. In future 
 tests a larger number of figures will be employed, and a different 
 method. After the specified amount of adding has been done, it 
 will be at once rei)eated«on another equivalent set of examples. The 
 excess of time required for the second set over that required for the 
 first may be called the " fatigue time," and this fatigue time, taken 
 as a percentage of the total time of adding, may be \ised as a criterion 
 of endurance — the less it is, the greater the endurance, and vice 
 versa. This plan was developed too late to be put into operation at 
 the beginning of the experiment. It was, however, employed in the 
 March and June tests, and confirmed the conclusion reached above, 
 that there was little difference between the mental endurance in 
 ^larch and June. Five of the men showed a less "fatigue time " in 
 June than in March, and four a greater. 
 
 The foUoAving statements of the men themselves Avill show that 
 tlieir feelings as to working power were in harmony with the conclu- 
 sion that it had improved : 
 
 Subjective Jmjyressions as to Mental Working Power. 
 
 13. (March) " Xot decreased at any rate, seems to have increased." 
 (June) I did more work during the latter part of year than I 
 ever did before in an equal period of time. But, I had the 
 work to do and compelled myself to do it. However, I was 
 mentally tired at the close of the year, particularly so at the 
 time of the test, for it came after the siege of exams for Avhich 
 I did my own work besides a couple of days of hard tutoring. 
 This much, at any rate, is positive : There was no decrease 
 of mental power resulting from the experiment. I was no 
 more tired al the close of last year than I was at the close of 
 the year before. After a week's rest I felt quite normal and 
 then did considerable mental work all summer. 
 
36 Fisher — The Effect of Diet on Endurance. 
 
 E. (March) " Working power improved. Can concentrate atten- 
 tion for a longer time." 
 (June) " I accomplished a greater amount of mental work than 
 in previous years during the corresponding period of the col- 
 lege year, I do not think that my feeling of fitness for it 
 was any greater, however, and I cannot say that my experi- 
 ence of fatigue after the work was any less. I learned to eat 
 slower than had been my custom during previous years. 
 Though not subject to indigestion, I experienced less stomach 
 disorders during the period of the experiment." 
 
 Lq. (March) " I have put in more long hours during this term 
 than any previous term, consequently have had a good deal 
 less sleep. I do not know that I can work any better, except 
 that I can work a longer period at one* time without feeling so 
 tired from it." 
 (June) " Of course a great deal of the extra work was outside 
 work which was an extra tax. I, however, did a great deal 
 more work on papers that I prepared than I ever had before. 
 . . . Although I spent longer hours than before I did not 
 feel the effect of the work so much as before." 
 
 Lw. (March) " Have been working harder during the past four 
 months and have taken less exercise than at any other equal 
 period during past 2|^ years. The character of the work has 
 been so different that I am unable to say whether there is any 
 increase in working power, but I find that I rest up very 
 quickly after becoming tired (mentally), 
 
 " When March tests were taken I did not feel as ' fit' for test 
 on that particular day as at time of January tests. Had been 
 working hard and had been under nervous strain, which un- 
 doubtedly affected the tests." 
 (June) " I have worked harder from January to June than ever 
 before, and have taken less exercise. As my mental woi*k Avas 
 so different from that previous, I cannot form an estimate of 
 any increase or decrease in efiiciency, but as I have said 
 before, I always rested up more quickly." 
 
 M. (March) '' I think on the whole a slight improvement." 
 (June) "Do not notice any change." 
 
 P. (March) " I have never worked so steadil}^, or with so little 
 necessity to exercise the will to work, as in the central six 
 weeks of the test. The work I was doinsr was chieflv research 
 in the Library, poring for three or four hours at a time over 
 old records — not labor of the most interesting kind." 
 
Ji^is/ier — yVte Efi'ect of Diet on Enchtrance. 37 
 
 (June) ^[y work lioiii Miiii-h to .lune was of a moiv confining 
 sort than ever before in tlie s[)ring. From Marcli to tlie Easter 
 recess I was occupied with lil)rary research ; from Easter on I 
 was engaovd on an essay aii<l tlu' marking of some 2G0 Social 
 Conditions tlieses. On these hist I spent considerably more 
 tiincand eti'ort than in tlie pri'ceding year. Thus my work 
 was liarder and more tinu'-tilling th;>n usual. I had much less 
 out-door exercise than in previous s])rings, and missed that 
 relaxation from effort which all j)rior springtimes have bred. 
 Vet there Avas no feeling of overwork, or even of work as a 
 burden, till the first of June. From then on I did feel tired, 
 and examination time found me with a mind very difficult to 
 kiep in harness. Undoubtedly I had over-pushed myself, but 
 did not realize it till June. . . 
 
 K. (March) Felt an increase in efficiency. 
 
 (June) My power for mental work Avas greater between the 
 March and June tests than between the January and March 
 tests and the latter was greater than before the experiment 
 began in January. I can state Avithout hesitation that my 
 mental working power increased in consequence of " Fletclier- 
 izing." 
 
 'r. (March) Felt that he had at least held his OAvn, but " surprised 
 to find that every one of my tests (physical) had improved." 
 For the first test came after the rest and recreation of the 
 winter holidays when he " was in splendid condition. Since 
 then I have had to work extremely hard Avith little regular 
 exercise and rarely in bed before about midnight." Surprised 
 also that the mental test shoAA^ed no improvement, probably 
 because " the confusion around me Avas considerably greater 
 than in the first test." Can do his ordinary mental Avork 
 faster than before, though not sure that he can Avork longer. 
 (June) " I consider I did more work last year during the period 
 of the experiment than an}' other year. During the Avhole 
 nine months of the college year I was practically Avorking up 
 to my limit of endurance. I did not grow sleepy as early 
 evenings as previous years and my attention Avas not as easily 
 distracted from my work as previous years. 
 
 "The lack of imi)rovement in the second mental test may 
 have been due largeh' to the fact that I was mentally fagged 
 out after the examinations and Avas feeling the need of my 
 holidavs." 
 
38 Fisher — The Effect of Diet on Endurance. 
 
 W. (March) No definite impression either of gain or loss. 
 
 (June) ' " On the whole I felt quite as workish as ever I did in 
 the spring months and did not feel the hot days as much of 
 a drag as usual." 
 
 As to illness, in the course of the experiment there were the usual 
 winter colds, though appai'ently these were less common than before. 
 One man had grip for a few days, another the mumps, and several had 
 constipation. In general, the men expressed themselves as better 
 than usual and in some cases they were very enthusiastic. None of 
 the ailments suffered by the men were ascribable to the test itself, 
 unless it be a case of what appeared to be slight rheumatic sensations 
 of T., who had always been a heavy meat-eater, and who during the 
 experiment introduced at first much acid fruit. That the acid in 
 conjunction with the high proteid might occasion such symptoms is 
 at least consistent with some of the numerous theories of rheuma- 
 tism. On avoiding ver^^ acid fruits he soon lost all these symptoms. 
 
 The following extract from the diary of B. is, I think, typical of 
 the facts in this respect to general health : " Have now, March 23, 
 slight sore throat. In regard to colds, I have been troubled less 
 this year than at any time for years ; but this fact may be due to 
 great change in climate, Nebraska to Connecticut. Have usually had 
 colds more or less ail winter ; therefore my freedom has been indeed 
 remarkable. From September last till the beginning of the experi- 
 ment I experienced frequent attacks of indigestion, 'heart-burn.' 
 Have been almost free from that, though two or three times I had the 
 same experience after eating bananas." 
 
 Summary. 
 
 The phenomena observed during the experiment may be summar- 
 ized as a slight reduction of total food consumed, a large reduction 
 of the proteid element, especially for flesh foods, a lessened excretion 
 of nitrogen, a reduction in the odor, putrefaction, fermentation 
 and quantity of t\\k feces, a slight loss of weight, a slight loss of 
 Strength, an enormous increase of physical endurance, a slight 
 increase in mental quickness. These phenomena A'aried somewhat 
 with different individuals, the variations corresponding in general to 
 the varying degree in which the men adhered to the rules of the 
 experiment. 
 
 That we are correct in ascribing the results, especially in endur- 
 ance, to dietetic causes alone, cannot reasonably be doubted when it is 
 considered that no other factors of known significance were allowed 
 
Fisher — llie J\fect of Diet on Endurance. 39 
 
 to aid ill tliis rosiilt. On the contrary, so far as the operation of 
 other fac!tors was couceriietl, these must have worked against rather 
 than for the results achieved. Exercise was in no case indulged in 
 to a greater extent than hail previously been the custom, and in most 
 cases it was less. Tlie men were warned not to take up exei'cise, 
 except so far as they had l)een accustomed to before tlie experiment 
 began, and if they varied their exercise at all. to U'sseii rather than 
 increase it. They were very conscientious on this ))oint, as on others, 
 — so much so that some of them at first gave up exercising until they 
 began to feel "logy." This over-zeal was corrected ; but in no case 
 have I reason to think that the exercise taken was more, or more S3'^s- 
 tematic, than previously. M. was probably the most s^'stematic in 
 taking exercise. His statement on this point, as previously given, 
 the reader may care to review. 
 
 The men did not practice on the endurance tests between times. 
 This was expressly forbidden, and the men were too trustworthy to 
 admit of a doubt on this point. The tests themselves, needless to 
 say, were too far apart to have given any chance for repetition to 
 give " knack," and were too severe to count as beneficial exercise. 
 
 Nor were the men more reofular in their hours of retiring or other 
 habits. On the contrary', they were rather more reckless in burning 
 the midnight oil. It developed that, with their increased freedom 
 fi'om fatigue, they indulged more freely than ever their propensity 
 to work in the lines of their respective ambitions. At first they felt 
 justified in doing this, as it accorded with their instructions not to 
 remove any handicaps to their chance of improving their endurance, 
 but to increase rather than decrease such handicaps. But this liberty 
 l)ecame license, and 1 was forced to remonstrate with the men for 
 their late hours arid overstudy, which tended to rob them of their 
 surplus endurance almost as fast as it accrued. Long before the 
 experiment was finished the men had given every appearance of 
 improved working power, but I was not at all sure that they would 
 have any of it left to show in the final test, because of their tendency 
 to use it up in work. Had the extent of their working proclivities 
 been realized in advance, it is doubtful if the experiment would have 
 been undertaken at all. It should be stated that all except M. were 
 graduate students, and almost all of them, in addition to their uni- 
 versity work, were earning their own way. 
 
 The advance of warm weather must have tended, had not their 
 diet counteracted it, to tire the men, if, at least, Ave may trust com- 
 mon impressions as to " spring lassitude." 
 
40 Fisher — The Effect of Diet on Endurance. 
 
 Again, the conditions immediately preceding the March and June 
 tests, as compared witli those preceding the January test, were such 
 as to give the advantage to the January test. The latter came soon 
 after the Christmas holida3's, when the men, as they themselves 
 stated, felt refreshed and at their best, whereas the March test came 
 just before the Easter recess, after a hard term's work, and the June 
 tests came after a like period of hard work, — in some cases, as of B. 
 and R., immediately after exhausting examinations. 
 
 Finally, the tests themselves were serious drains on vitality. Each 
 required a period of from several days to two weeks for recuperation, 
 and each robbed the men temporarily of several pounds of weight. 
 The cookless diet experiment for six days also cost something to 
 those who took part in it. 
 
 In addition to the tests mentioned in this report was one on Jan- 
 uary 23 of leg-raising, deep knee-bending and arm-stretching, taken 
 after a night from which two hours of sleep were purposely cut off. 
 After consideration, it was decided not to repeat this test as being 
 top fatiguing. It therefore has been omitted from this report ; but 
 it added one more burden for the men. 
 
 When, therefore, we observe the known handicaps, — the over-study, 
 the strain of the tests, the advance of warm weather, the fact that 
 the first test came after rest and the other tests after work, and 
 when we are unable to find any other cause than diet — such as exer- 
 cise, regularity of bed-tirne or other habits — we are forced to 
 conclude that the only causes which produced the endurance were 
 dietetic. 
 
 Possibly some persons may be disposed to find a convenient escape 
 from this conclusion b}^ ascribing the improvement to suggestion. 
 Under this theory, the men improved because they expected to. It 
 is quite true that there may be more force in autosuggestion than 
 most of us realize. But, fortunately, for the present case we scarcely 
 need to argue the point ; for as a matter of fact it was not true that 
 all of the men expected to improve. This was certainly not true 
 before the March test. In fact, the men were about equally divided 
 in their predictions as to the outcome, and used to have animated 
 discussions. Yet, both the confident and the skeptic faction im- 
 proved in endurance in the March test ; and so far as I am acquainted 
 Avith their prognostications and have noted their improvement, there 
 was little if any correlation between those prognostications and their 
 improvement. 
 
 It is of course still possible that some unobserved element has crept 
 
Fisher — The Ff'ect of Diet on Endurance. -tl 
 
 into the case, to which, and not to the diet, the imi)rovement in 
 endurance was due ; hut in view of all the facts recited, this is 
 extremely Improbable. What slight doubt remains should be resolved 
 by further studies. I earnestly hope that other and more careful 
 studies may be made by more competent investigators than I. 
 
 We conclude that the improvement in endurance was exclusively 
 due to dietetic causes. The only dietetic causes at work were(l)' 
 thorough mastication, (2) implicit obedience to ai)petite, (3) (during 
 the second half of the experiment) when appetite did not clearly 
 determine the choice, the voluntary selection of the non-flesh and 
 low-proteid foods, and (4) an ample variety of good foods, well 
 cooked. 
 
 So far as cooking is concerned, this cause, as has been said, entered 
 unintentionally. But there is no evidence that it was a prime factor 
 in the experiment, while there is some evidence to the contrary. 
 Thus, E., who especially remarked the culinary virtues of the cook 
 and who missed her services more than any one else during the brief 
 period of her absence, was the one member of the club who failed to 
 im|)rove in endurance. 
 
 If we allow ourselves to speculate as to the changes in the charac- 
 ter of diet which were produced hx thorough mastication, we may 
 <lraw an inference from the fact that the carnivorous animals are fast- 
 eaters, Avhereas the grain-eating animals are slow-eaters. It would 
 seem, therefore, when man changes his habits from fast eating to 
 slow eating he naturallv chancres his food from the food of a fast- 
 eating to that of a slow-eating animal. The question, therefore, 
 which is the natural food for man, may possibly be associated with 
 the (juestion, which of the tAvo methods of eating is natural to man. 
 Was the slow eating of the nine men an artificial and unnatural |)rac- 
 tice, as would be indicated from the fact that the majority of men 
 eat far faster '? Or, are the ordinary habits of man in respect to the 
 manner of fast eating themselves unnatural ? I have not attempted 
 to gather the facts necessary to solve this problem, but it certainly 
 constitutes an interesting one for the physiologist and anthropologist. 
 The few facts upon which I have chanced to fall Avould seem to 
 indicate that man is naturally a slow eater, and that the hurry-habit 
 to which most of us are prone is a consequence of the artificial high- 
 pressure to which modern civilization has subjected us. Certain it is 
 that the conditions which give rise to quick-lunch counters and to the 
 short stops of trains for refreshments, were produced, not in order to 
 meet any natural propensity to eat fast, but on the contrary, in the 
 
42 Fisher — The Effect of Diet on Endurance. 
 
 interest of the more rapid transaction of business, with which meal- 
 times are regarded as an interference. 
 
 We may therefore at least conclude that whatever the speed, of 
 eating which is natural to the human animal, his actual speed under 
 civilized conditions is greater than natural. It is noteworthj^ also 
 that children are very deliberate in eating their cookies. It is only 
 after they are reproved for keeping their elders waiting that they 
 begin to imitate the latter and bolt their food. Dr. Higgins * and 
 Dr. Hasse ° have pointed out also some physiological considerations, 
 based on the anatomy of the human throat compared with the 
 throats of the carnivores and of " poltophagic" animals, which would 
 indicate that man, to a large extent at least, is naturally a slow-eating 
 animal. Dr. Henrj^ Campbell ^ has also given some evidence, based 
 on a study of the primitive tribes, to show that chewing is more 
 thorough among uncivilized races, and that the hurry habit to which 
 we are accustomed is largely promoted by the use of prepared and 
 ' mushy " foods, — which, in fact, apj^ear to have been devised ex- 
 pressly for the purpose of being quickly swallowed. 
 
 The evidence, however, on the natural food-habits of man is as yet 
 very meager, and it is only provisionally that we may consider the 
 thorough mastication advocated by Mr. Fletcher as " natural." With 
 this reservation we may say that the expei'iment here described may 
 be called an experiment in natural eating, or an effort to restore a 
 blunted or lost food-instinct, so that it may serve as a safe guide to 
 the proper quantities and kinds of foods. If it be asked in what 
 way this natural eating tended to improve endurance, whether it was 
 because of the. finer sub-division of food through mastication ; the 
 increased " insalivation " ; the increased flow of " appetite juice " ; 
 the better adaptation of foods to the particular needs of the individual 
 and the moment ; the lessened quantity of food ; the lessened proteid ; 
 or the lessened amount of flesh foods, no satisfactory answer can be 
 given, although, as the previous discussion shoAvs, there is more or 
 less evidence on some of these points. There are certainlj^ some very 
 fascinating problems for the physiologist to solve in regard to fatigue 
 as related to diet. Are the "fatigue poisons" due, for instance, 
 chiefly to the combustion of proteid in excess of the physiological 
 
 ' See Humanicultiu-e, N. Y. Stokes, 1904. 
 
 2 See Archiv fur Anatomie (Waldeyer's) 1905, p. 321. 
 
 * ''Observations on Mastication," London Lancet, Jiily 11, 18, 25 and Aug. 8, 
 1903. Reprinted in Horace Fletcher's The A. B.-Z. of Our Own Nutrition, 
 Stokes, 1903. See pp. 126-135. 
 
Fisher — IVw Ejfect of Diet on Endurance. 43 
 
 needs, as the theory of CMiittenden would ex])laiii them ? Or, are they 
 largely due to the inucstiou of these poisons with Hesli foods, as tlie 
 vet^etarians and Dr. llaig liave maintained ? Or, do both exphiua- 
 tions liave a share ? 
 
 The results of the experiment demonstrated so great an increase 
 of endurance as to seem at first incredible. It certainly was a sur- 
 prise, both to the nuMi and to nu'. But statistics which I have been 
 eollecting during the last two years have prepared me to find great 
 differences and changes in endurance. The s])ecial result of the 
 present exjieriment is to show that diet is an important factor in 
 producing such alterations. The fact that endurance, even among 
 l>ersons free from disease, is one of the most variable of human fac- 
 ulties — far more variable than strength, for instance — is evident to' 
 any one who has made even a superficial examination. Some persons 
 are tired bv climbing a flight of stairs, whereas the Swiss guides, 
 throughout the summer season, da}' after day spend the entire time 
 in climbing the Matterhorn and other peaks ; some persons are 
 '•winded" ])y running a l)lock for a street car, whereas a Chinese 
 coolie will run for hours on end ; in mental work, some persons are 
 unable to apply themselves more than an hour at a time, whereas 
 others, like Humboldt, can work almost continuous!}' through eight- 
 een hours of the da}'. Among statistics gathered independently of 
 the present experiment, I have found measurable differences between 
 persons far greater than the change of endurance of the eight students 
 which we have seen.' Among some 50 tests of different pei'sons 
 holding their arms horizontally, many were found whose arms actually 
 dropped against their will inside of ten minutes, whereas several were 
 able to hold them up over an houi*, and one man held them 3 hours 
 and 20 minutes, or a round 200 minutes, and then dropped them 
 voluntarily. Similarly with deep knee-bending, some persons were 
 found physically unable to rise again from the stooping posture after 
 accomplishing less than 500 bendings, whereas several succeeded in 
 stooping 1,000 times, and in one case, 2,400. Again, in leg-raising, 
 the legs positively refused to rise to the vertical in some cases before 
 40 times were reached, Avhereas in two cases this motion was per. 
 formed 1,000 times or over. On the new ergograph previously 
 referred to, among the 1(3 j)reliminary tests there was a range in 
 endurance between different persons from 18 to 145 and in the same 
 person at different times from 29 to 110. 
 
 ' For an account of some of these statistics see " The influence of flesh-eating on 
 endurance." Yale Medical Journal, March, IflOT. 
 
44 Fisher — The Effect of Diet on JEndurance. 
 
 It is, to say the least, remarkable that hitherto so little effort has 
 been directed toward discovering the factors which explain such 
 differences in endurance. That exercise is one of the most and per- 
 haps the most important factor has alone been recognized. A 
 correspondent assures me that by means of moderate re^i^/ar exercise 
 he succeeded in increasing his endurance between 100 and 200^ in 
 three weeks as measured by leg-raising and " dipping. " The 
 influence of diet has always been regarded as small or negligible, and 
 the opinion has been almost universal, until recently, that a diet rich 
 ^n proteid promotes endurance. Even among those whose researches 
 have led them to the opposite conclusion, there is very little concep- 
 tion of the extent to which diet is correlated with endurance. Such 
 a person, a medical friend of the writer, stated, when the present 
 experiment was planned, that he did not think the dietetic factor strong 
 enough compared with others to produce any marked effect. We 
 have all heard, of course, of the enthusiastic reports of vegetarians 
 as to their increased endurance, but these we have discounted as 
 exaggerations. The result of the present experiment, however, 
 would seem to indicate that one's improvement in endurance is usuall}^ 
 not less, but greater, than he himself is aware of. Probably it is 
 also true that we may lose a large fraction of our working power 
 before we are distinctly conscious of the fact. 
 
 While the results of the present experiment lean toward " vegeta- 
 rianism," they are only incidentally related to that propaganda. 
 Meat was by no means excluded ; on the contrary, the subjects were 
 urged to eat it if their appetite distinctly preferred it to other foods. 
 
 The sudden and complete exclusion of meat is not always desir- 
 able, unless more skill and knowledge in food matters are employed 
 than most persons possess. On the contrarj^, disaster has repeatedly, 
 overtaken many who have made this attempt. Pawlow has shown 
 that meat is one of the most and perhaps the most "peptogenic" 
 of foods. Whether the stimulus it gives to the stomach is natural, or 
 in the nature of an improper goad or whip, certain it is that stomachs 
 which are accustomed to this daily whip have failed, for a time at 
 least, to act when it was withdrawn. 
 
 Nor is it necessary that meat should be permanently abjured, even 
 when it ceases to become a daily necessity. The safer course, at least? 
 is to indulge the craving whenever one is " meat hungry," even if, as 
 in mau}^ case-^, this be not oftener than once in several months. The 
 rule of selection employed in the experiment was merely to give the 
 benefit of the doubt to the non-flesh food ; but even a slight preference 
 for flesh foods was to be followed. 
 
FisJier — The Eff-ect of Diet on Endurance. 45 
 
 lender flesh foods are iiieliuk'd all meat- and " stock-" sou[)S. It 
 has been shown that althoiiij^h these extracts of meat contain a large 
 amount of nitrogen, it is not in the form of proteid which can be 
 utilized, but only of waste nitrogen which must be excreted. Ap- 
 parently the sole virtue of sucli soups is that they supply the '' pepto- 
 genic'" stimulus above referred to. 
 
 The experiment will be seen to harmonize with and supplement the 
 experiment of Professor Chittenden, on which it was founded ; but 
 the objects of the two experiments were quite different. Professor 
 Chittenden's was aimed to ascertain the pliysiological requirements 
 as to proteid, and did not touch upon the question of endurance. 
 Moreover, Professor Chittenden, in order the better to measure the 
 proteid and nitrogen, artificially reduced the quantities ingested, 
 whereas in the })resent experiment, test was made of Mr. Fletcher's 
 claim, that thorough mastication leads naturally to the adoption of 
 the physiological amount of proteid. This we found to be true, espe- 
 cially after the introduction, at the middle of the test, of the susrsres- 
 tion that when appetite was in doubt, the lower proteid foods should 
 be selected. But the tendency Avas quite marked during the first 
 period also, and might have been expected to lead to the same results 
 without the introduction of even the suggestion of voluntary choice, 
 had the experiment been long enough. This was the experience of 
 others, notably Mr. Fletcher himself, whose case, in fact, first called 
 Professor Chittenden's attention to the possible virtues of low 
 proteid. 
 
 The practical value of the experiment consists in the fact that any 
 layman can apply it, with or without a knowledge of food values, 
 though with more advantage if he possesses than if he lacks such 
 knowledge. 
 
 If the dietetic rules of the present experiment are followed, no self- 
 denial as to foods is required. It is, however, absolutely necessary 
 that there should be self-control enough to break up the habit of 
 hurried eating to wdiich modern civilization has brought us, habitu- 
 ating us, as it does, to eat against time. 
 
 Experience indicates that appetite does not lead to a diet fixed in 
 amount or constituents, but moves in undulating waves or cycles. 
 The men who took part in the experiment were encouraged, after 
 any of the symptoms which seemed to be associated with high pro- 
 teid (such as heaviness, sleepiness, stiffness or soreness after exer- 
 cise, or catching cold), to cut down on their proteid and substitute 
 fat to restrain the gastric juice. This advice was intended to make 
 
46 Fisher — The Effect of Diet on Endurance. 
 
 application of the theories of Foliii' that we usually cany a reservoir 
 of proteid, enough to supply our needs for body-building for a fort- 
 night. If this reserv^oir is exhausted, proteid starvation occurs and 
 the body feeds on itself ; if it is filled too far it overflows and causes 
 the evils of excessive proteid. If this theory is correct, the art of 
 eating may consist largely in maintaining a golden mean such that 
 the proteid reservoir is neither empty nor overflowing, or at any rate, 
 not overflowing much. Many persons fear to reduce their proteid to 
 the Chittenden minimum for fear of i^roteid starvation.; but the 
 experience of those who have tried it would seem to show that this 
 fear is groundless, provided no violence is done to natural appetite. 
 This may be trusted, so it would appear, to raise a warning in the 
 form of " nitrogen hunger " before the danger point is reached. 
 
 '"A Theory of Protein Metabolism."' American Journal of Physiology, March, 
 1905. 
 
2_ 
 
 A GRAPHIC METHOD IN PRACTICAL 
 
 DIETETICS 
 
 llMl N (i F r STIEE, Pji.I). 
 
 rri)t"('sPoi' of I'olltical Economy, Yalo Univorslty, and Secretary of 
 the Xew Haven County Antituberculosis Association 
 
 NEW HAVEX^ CONN". 
 
 Reprinteil from The Journal of the American Medical Association 
 Api-il 20, 1907, Vol. XLVin, pp. 1H16-1324 
 
 Copyright, 1011 
 
 A.MKRir.W MKDlCAri ASSOCIATION' 
 
 FivK IlrNur.rn axd Tniiny-FivE Dkarboex Avenue 
 CHICAGO 
 
 PRiri:. in Cents 
 
I 
 
A GRArillC ^lETHOD IX PILVCTICAL 
 DIETETICS 
 
 IRVING FISHER, I'li.!). 
 
 Professor of Political Kconomy, Yale University, and Secretary of 
 the New Haven loanty Antitubi rculosis Association 
 
 NEW llAVKN, COXN. 
 
 Professor IMeiidel, in an address on dietetics before an 
 audience of Boston physicians, asked the very pertinent 
 question : "\\ hy do physicians take so much care in 
 measuring their dosages of drugs, which are adminis- 
 tered only occasionally, and so little care in measuring 
 their food presciiptions, which are to be followed daily?" 
 In prescribing diugs, a physician wou'd be regarded 
 as ciiminally negligent if he simply told his patients 
 to take ''a little'' strychnia, but to be sure "not to 
 take too much ;" or to take a "Vig dose" of calomel. 
 Yet in prescribing diet, physicians often give just such 
 advice. 
 
 Doubtless in the scheme of Nature man was not 
 expected to measure his food. He was provided with 
 healthy, normal instincts instead. But, as often happens 
 in diseased conditions, the food instinct has sometimes 
 become perverted and cannot be trusted. The con- 
 sumptive lequires, or at any rate is believed by most 
 physicians to require, more food than his appetite calls 
 for, and the victim of kidney diseases less. To reestab- 
 lish the instinctive guides to food selection should 
 doubfess be the ultimate aim of the physician; but. to 
 that end, a quantitative determination of the food 
 actually used, and a quantitative regulation thereof, may 
 be advantageously employed. As yet. however, neither 
 the quantity of food nor the piopoitions of its constit- 
 uents have been often prescribed with precision. 
 
 AM-.at Dr. Bui ton-Fanning says of prescribing food 
 for the consumptive applies to food prescriptions in 
 geneial, that the whole art of such prescriptions is 
 
3 
 
 summed i;p in the word acfuraey.^ Until recently 
 accuracT was impossible. But to-da}', by the aid of 
 elaborate tables of food values constrncted by Atwater 
 and Bryant in America, and of mineral salts by Koenig 
 in Germany, and, if great accuracy is required, of coeffi- 
 cients of digestibility, it has become possible to make a 
 true measurement of diet prescriptions. 
 
 As to mineral salts, we know at least in which foods 
 they are severally to be found. For instance, if a 
 patient needs iron, he may, instead of taking the prep- 
 arations of the druggist, have added to his list of foods 
 one or more of the following: lentils, asparagus, lettuce. 
 
 C 
 
 10 20 30 40 50 60 70 80 90 100 
 Figuri' 1 
 
 peas, figs, strawberries, spinach, beans, potatoes, prunes 
 or apples, the order of which is that of the amount of 
 iron contained in proportion to total food value. 
 
 Again, if calcium is needed, instead of limewater 
 there may be administered milk, figs, cabbage or lentils. 
 ]f sulphur is needed, the patient may be given potatoes, 
 peas, beans, asparagus or cabbage; if phosphorus, beans, 
 peas, rice, milk; if silicon, lettuce, cabbage, strawber- 
 ries, rice, potatoes, barley or cucumbers ; if magnesium, 
 peas, beans, cocoanuts, barley and rice ; if chlorin. 
 cocoanuts, milk, lentils, asparagus, cabbage; if sodium, 
 
 1. For a statement of the groat divergences of sanatoria from 
 tliis ideal, see "Statistics of "Diet in Consumptive Sanatoria." 
 Fisher. Tran. Second Annual Meeting, Nat. Assoc, for Study and 
 rrevention of Tuberculosis, New Yorj;, 10(»7 : also in Am. .Tour, of 
 the Med. Sci., October, 1906. 
 
lontiliJ, fi,<2;s. asj)arnii:us ; if pota?pinin. l)cans. lentils, 
 peas, eoeoamits. jiotatoes. Or if simply mineral salts in 
 general are re<piireil, tliev are found in lai-_>:e (piantities 
 in jnoportion to food value, amonj; lentils, ]icas. beans, 
 eocoanuts, ]^otatoes, milk. rice. figs, apples, barley, 
 eal)ba<ie and ebestnuts. 
 
 There are data also wbi.-.li (lesei'ibe the amount and 
 kinds of acids in foods, their ])e])togenic (pialities, their 
 etfects on ]ieristalsis. etc. 
 
 rUsK and Ctrtalsi 
 
 Oatmial QcliJ Sb 
 
 rwur /Graham jf, _'^ ^ 
 [Sraniard gradr SJ 
 
 ^ra<j,tii 37 ." 
 
 yili"-t drnd /3 - - 
 
 C«rn FttHfs 97 . • ^ 
 
 Hommij 4 2 y 
 
 ,>« r^ 
 
 
 r- I ^ M ' " » 
 
 Figure 2 
 
 THE BASIS OF CO:\rPUTATION" 
 
 But the ordinar}^ problems of dietetics are concerned 
 not so much with these minor constituents and proper- 
 ties of foods as with the amount and proportions of 
 proteids, fats and carbohydrates. 
 
 Two methods have hitherto been used for computing 
 ])roportions of proteids, fats and carl)ohydrates. One 
 consists in using the tables of percentages by weight of 
 ]iroteids, fats and carbohydrates ; the other, Dr. J. H. 
 Kellogg's, in using a table which gives the number of 
 calories in the form of proteids. fats and carl)ohydrates 
 per ounce of each kind of food. These may be described, 
 
respectivel.y, as the method of weioht per cent, and the 
 method of calories per onnce. The method here sug- 
 gested is different from either, and may he called the 
 method of calories per cent. It takes as its starting 
 point not a nnit of weight, but a unit of food value, 
 called a "^standard portion" of each kind of food. A 
 "standard portion" is defined as that amount of food 
 which contains 100 calories. A table is constructed 
 which gives the weight in a "standard portion" of each 
 particular kind of food, and out of the 100 calories con- 
 
 suls and Fruits. 
 
 Olatfriii/len nj 
 Bananei} J f ' \ 
 
 riunn in - — ~ _, ^ '"^ ' '' \ 1 ' . 
 
 
 I a o o 
 
 
 
 
 <0 5> 
 
 Fig'urc 3 
 
 tained therein the number of calories in the form of 
 proteids, fats and carbohydrates. The three methods 
 were discussed and the last-named explained in detail in 
 another paper.- We shall, therefore, pass over this part 
 of our subject very briefly in the present paper and 
 devote our main attention to the practical application. 
 In order to carry out this inethod, foods should l)e 
 served at the table in "standard portions" or simple 
 multiples thereof. The amount of milk served, instead 
 
 2. Fishei- : "A New Method for Indicating Food Values," Amcr. 
 Jour, of Physiol., April 1, 1906. 
 
(if Ihmiil; a wliole iiiinilici- of (Hiiirt's, sIkhiM lie ( Inr a\rr- 
 a^o milk) t.!' ^^ml•l';^ — tlio amount that coiitaiiis KM) 
 calorirs. This •'stamhird portion"" constitutrs ahoiit two- 
 thirds ot' an ordinal \' <ihiss of milk. Of the liH) t'alorios 
 which it contains. l!t will hi' in the form of protcid. 52 
 in fal. and "i".' in carhnlivdratcs. In other words, of the 
 lood valiii' of milk. !!• per ccni. is ju'dtcid. ')'i per cent. 
 fat. and 2!) ])er tent, ^■arl)o!lydl■ates. 
 
 ()nc advantao:^ of tliis mctliod is apparent at once, 
 it enahles us to make a ii'iie eonipaiison heiweeii (lif- 
 
 ts. 
 
 Ce/fr^ /? - — ^ 
 I-''"" en„3 ^)\ 
 {^9 fianr t^^ , 
 
 Purnftf'n^ If ~. " ^ 
 Oni ens(f,nhi 
 
 CortTigfTfrr> \ — - 
 
 
 
 Figui-o 4 
 
 ferent foods as to the relative amounts of ])roteid. fat 
 and carholiydrate. The other nietliods are misleadinir in 
 this regard. For instance, though it is well recognized 
 that milk is a higher ])roteid food than ])eean nuts, yet 
 if we compare milk and the pecans on the l)asis of the 
 method of "weight per cent.."' we shall lind tliat the 
 ])ecans ap|)ear three times as 7'ich in proteid. milk con- 
 taining 3.3 per cent, and pecans fl i)er cent. But if we 
 compare them oti the hasis of "calories per cent.." we 
 find that, while milk contains 19 calories of proteid out 
 of each 100 of total calories, pecans contain only 6. milk 
 
6 
 
 showing three times as much proteid as pecans. The 
 paradox that pecans are higher in proteid per ounce but 
 lower in proteid per 100 calories is due to the fact that 
 pecans are a much more concentrated food than milk: 
 whereas 100 calories of milk weigh 4.9 ounces, 100 
 calories of pecans weigh only half an ounce. The weight 
 of a '"standard portion" of anv food. i. e., of that 
 amount which contains 100 calories, is a measure of the 
 
 The most concentrated of all 
 P 
 
 PuddiTK^s.Pits Paslriti, Sorttts. 
 
 degree of concentration 
 
 Hone^ I OS ■ 
 Afdpssn Cane 12 • 
 Tapioca -?Si"- \\ 
 Tapioco Applet 32 - ■'. 
 hunt Marmalade 22 ■■ . 
 Oronulattdiuqar /3fc- . 
 Maple su^jr I'Z — p 
 
 I 
 ' \ 
 
 «M \ 
 
 v. , 
 
 i £ C cS 5- |.~* <^ 
 
 •< ^ 5>, Os; * V ts 
 
 
 S <:» >a 
 
 ^ <^ t:^ 
 
 
 Figure o 
 
 foods is probably olive oil, which contains 100 calories 
 in a little over one-third of an ounce (0.38 oz.). "Water- 
 melon represents a food at the opposite extreme, of 
 which over \y=> pounds are required to yield the 100 
 calories. In order that the '"'calories per cent."" method 
 may be easily put in practice, it is necessary to have a 
 table giving the weight constituting a ""standard por- 
 tion"" (i. e.. the amount yielding 100 calories) and the 
 calories of proteid. fat and carbohydrate in this portion. 
 
At tlio close of tlio present nrlicle such a laltk-.is ^iveii. 
 eonipiited chietly frDiii tlie tables of AtwatiT and lii-vanl 
 and, for made dishes. I'lnm those of l)r. K<•^o(r«.^ 'UK- 
 chief advantatje of tins method of expressing' food'vahies 
 is that it lends itself readily to <,Maphic representation. 
 'J'lie dillieulty in the ])ia(tieal use of most tables of food 
 values is that they cannot he visualized. 
 
 THE (iUAI'IIK METHOD 
 
 Different foods contain the tliree food elements, pro- 
 teids, fats and carbohydrates, in different pi'opoi-tions. 
 The tripartite constitution of any jiaiticular food is rep- 
 
 VthltftrEqf, ty. 
 
 Dairy Products . f ijc^s atvA 
 Mtat Subst'vl ute.5. 
 
 4 
 
 ^1- V 
 
 Glutrn Cru// 7 3- 
 
 ^H\mmrd NilK » 4 - 
 Bulttrmilli 9 7 ' 
 
 
 CtHitnitd N,lk I Ob 
 
 figure t; 
 
 resented in the present method by the position of a 
 point in the triangle^ CPF (Fig. 1). The method of 
 locating the point on the triangle is analogous to that of 
 locating a city on a maj) by latitude and longitude; the 
 per cent, of proteid* in the food is represented, like lati- 
 tude, by the height of the point above the base line CF 
 (the total height, CP, being taken as 100 per cent.). 
 'J'he percentage of fat is represented, like longitude, by 
 the distance of the point horizontally from the vertical 
 
 ?,. YoT ronvfnifncf. the triantrlo is drawn with one angle, C, 
 a right angle and the two sides about it e(|iial. 
 
 4. I emi>loy the term pioteid, alllioiigh in the tables the figures 
 represent "protein" (i. e., 014 times nitrogen), the usuai malteshift 
 for proteid. 
 
8 
 
 line CP- (the total horizontal breadth, CF, being taken 
 as 100 per cent.). Thus, the point 0, representing 
 milk, is located at a height above CF ("latitude") 19 
 per cent, of the total height of the triangle, which sig- 
 nifies that 19 per cent, of the food value of- milk is pro- 
 teid ; and at a distance to the right of CP ("longi- 
 tude") 52 per cent, of the total breadth of the triangle, 
 which signifies that 52 per cent, of the food value of 
 
 Soups , Salctds anA.Rellslies 
 
 Cemtmme se"/" ^»- — 
 
 Cram Chcndfr dSf ~ ' 
 ffmato Catiufi b 
 
 
 ■^ •» tM ^ 
 
 1 
 
 1- 
 
 ■5 ^ ? ^ 
 
 ^ •? S ^ 
 
 ^ ^ 1 ^ 
 
 > 
 
 «r 
 
 "0 i ^ "^ 
 
 o 
 
 J 
 
 liii 
 
 1 
 
 
 Figure 
 
 7 
 
 a i. "» ^ 
 
 c o * V 
 
 i V ! » 
 
 o 5 5 * 
 
 milk is fat. Foods liigh in ])roteid will be represented 
 by points high up in the triangle. AVhite of egg. of 
 which tlie food value is all proteid, will be represented 
 at the ]joint P, representing 100 per cent. P is, there- 
 fore, called the "proteid corner" of the triangle. Foods 
 rich in fats, as nuts, cream, butter, are represented by 
 ]ioints far to the right. Pure fats, like olive oil, are 
 located at F at the extreme right, representing 100 per 
 cent, of fat. F is, therefore, called the "fat corner." 
 
T1)0 jxiiiit ri'[)rc'Scnliii^U" a Uhh\ is i-oiiipli'li'ly located liv 
 means of the ]icn-('iitauo of jnofcid and fat; no attiMitioii 
 need l)e paid to the eai-lidh vdrate. If, lidwexci'. it is 
 desired to find the eailtoliydrate, its ])ereentago is lead- 
 ily deterniined. l)ein<i- what is left (d' I dd calrn'ies not 
 alreadv aceonnted for hv proleid and lai. Tliii-. a 
 "standard portion" of eotta.ui' ehet'se. heiuL:' ^<i per eeiii. 
 pioteid and S jier cent, fat, will have left Ki pei' eeiii. n>' 
 oarhohydiate. If one desires a aiaphic I'epi'eseiiial ion. 
 it is fiHind in the distance of the poiid <) from the tldid 
 side of the trianLile. FP (ilie total distance of thi< side 
 
 Classe.5 of Foods. 
 
 Jam \ 
 
 • flartTialatUil — _ 
 
 Figure N 
 
 fi'om the opposite corner l)einii' taken as 100 |)or cent.). 
 Foods like l)read. cereals and frnits. which aio mostly 
 carbohydrate, will thns be represented hy points far 
 away from the side FP. Foods snch as snoar, of which 
 the food value is wholly carlxiliydrate. ■will he repre- 
 sented at the i-eiiiotot ])oint (V representing ino per 
 cent, carbohydrate, which i<. therefore, called the "car- 
 holiydrate corner." 
 
 Any food is thus lepresi'ntcd on the "food map" hy a 
 jioint tlie relative distances of which from the three 
 sides of the trianiile represent the proteid, fat and car- 
 
10 
 
 bolivdrate.^ On this food may. fatty foods are repre- 
 sented by points near the fat corner. F, starchy and 
 saccharine foods by points near the carbohydrate corner, 
 C, and proteid foods by points near the proteid corner. 
 P. A food devoid of proteid is evidently located on the 
 base line C; a food devoid of fat, on the side CP, 
 and a food devoid of carbohydrate on PP. The chief 
 classes are represented in the accompanying diagrams, 
 flesh foods and cereals being shown in Figure 2, nuts 
 and fruits in Figure 3. vegetables in Figure 4, pud- 
 dings, pies, pastries and sweets in Figure 5, dairy prod- 
 ucts, eggs and meat substitutes in Figure 6, and soups, 
 
 Butter 
 
 10 20 30 40 50 60 70 80 90 100 f 
 
 Figure 9 
 
 salads and relishes in Figure T. In each case the posi- 
 tion of the point relatively to the sides of the triangle 
 represents the proportions of the proteids, fats and car- 
 
 5. It has been shown elsewhere (Amer. Jour, of Physiol., April, 
 1006. pp. 422-4) that this method of visunlizins the composition of 
 any food carries another method with it. If from the point O 
 (Fig. 1), the position of which in the triangle indicates the food 
 composition (of milk for instance), we draw straight lines to the 
 three corners of the triangle, thus resolving the triangle into three 
 constituent triangles, it may be shown that if we call the total 
 area of the triangle 100 to represent a "standard portion" (100 
 calories I of the food, then the three partial triangles will exactly 
 represent the constituents for proteid. fat and carbohydrate. The 
 triangle representing proteid is COF, i. e., the trianale whose alti- 
 tude to O represents proteid in the first method. Similarly. COP 
 represents fat. and POF carbohydrate. For the graphic represen- 
 tation of particular foods by this method of triangles, see the 
 article alread.v cited. In the jiresent article onl.v the method of 
 lines or. as we may call it, the "latitude and longitude" method will 
 be employed. 
 
11 
 
 Ixihydi all's, and l\\v miiiilR'r oppij-silo each nana' ii'jiro- 
 seiits the wei,alit (in ouni-os) of a "standard portion." 
 'I'his iiH'thod of r('])ivscntin<r food values reveals some 
 strikinij J'aots — for instance, the great variations in the 
 jiroportioii of proteid in diiferent vegetahles. A'egetables 
 are eonunonly suiijioscd to be low in ])roteid. This is 
 true of some vegetables, such as beets, artichokes and 
 sweet potatoes; hut others are high in pi-otcid such a< 
 asparagus, cabbage, cauliflower, celerv, cueunihers, egg- 
 jilant, radishes, s]iinach, squash and tomatoes." Among 
 fruits also we find some instances of luoderatelv higli 
 j)roteid, such as strawberries and UhukberriL's, oranges 
 
 10 20 30 40 50 60 70 80 90 100 
 
 Figure 10 
 
 and -natermelon. These foods are as high in jiroteid, 
 in proportion to total food value, as most uiits and 
 cereals. Un the other hand, dried fruits, whii-h are 
 sometimes mentioned as containing a higher percentage 
 of proteid than other fruits, are as a matter of fact 
 ofter much lower. Thus, dates contain but 2 per cent., 
 prunes and raisins 3 per cent., figs 5 per cent. 
 
 (>. Ii should bo stilted, however, that all (\stimates of i)roteid 
 ari'. strictly speaking, "protein," i. e.. tjV^ times the contained nitro- 
 gen. In some cases proteid and protein are not identical, but the 
 former is less than the latter, owing to the fact that some of the 
 nitrogen is not in i)roteid. but in a waste or useless form. This is 
 true of almost all the proteid of meat soup*, which have, therefore, 
 practically no food value except a ijeptogenic fiin'. As to vegetables, 
 in default of <'xa<'t data, no cDrrcctinn t'loin iirntcln id i)roteid is 
 here .attempted. 
 

 It "is evident that in most cases foods of the same 
 class show a famih' resemblance. Meats and other flesh 
 foods, with the exception of shellfish, are represented bv 
 points on FP, he'ing devoid of carbohydrates. Cereals 
 are represented l)y points near the carbohydrate corner, 
 C; nuts, with the exception of chestnuts, are located 
 near the fat corner. F ; fruits, with the exception of 
 olives, near the carbohydrate corner, C ; veoerables show 
 a laroe rano-p within the trianole. In Fioure 8 the 
 range of each of these classes is approximately shown. 
 
 The foods eaten at a meal may thus be indicated l)y 
 points on the "food map."' Opposite each point should 
 l)e written the amount eaten, measured in "standard 
 
 100 
 90 
 
 80 
 70 
 
 €0 
 50 
 40 
 
 30 
 
 5 
 
 \ 
 
 
 
 \ 
 
 
 
 
 \ 
 
 • 
 
 
 
 
 \ 
 
 
 
 
 
 
 \ 
 
 
 
 
 
 
 
 \ 
 
 
 
 
 
 
 
 
 \ 
 
 
 20 
 
 
 
 
 
 
 
 
 \ 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 t'- 
 
 
 
 
 
 
 \ 
 
 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 
 
 
 
 
 
 ^ 10 20 30 40 50 60 .70 80 90 100 
 
 Fignrc 11 
 
 ]30itions."" This array of points presents a picture of 
 what foods and how much of each have been eaten, and 
 shows at a glance their characteristics. But to use this 
 properly we need to coml^ine these points into one point, 
 their center of gravity, \\hich represents the entire meal. 
 Thi< may l)e done in various ways. 
 
 DEMOXSTRATTXG C'OMBIXATIOXS 
 
 The combination of two foods equal in calories is rep- 
 resented by a point midway between them. Thus, to 
 combine one "portion"" of bread and one "portion" of 
 l)utter (Fig. 9) draw a straight line between their 
 points, and at the middle of it mark a cross and label it 
 "2 :" this point will represent two "portions"" of bread 
 and butter. 
 
13 
 
 It' tlio calorics of the two foo(]s arc iiiUM|ual. tlic point 
 represent iiiii' tlu' coiiiljination will Ix- pi'opoilioiiatcly 
 nearci' the point with llu' lar,i;'cr nuniltcr. Thus, if one 
 jjortion of hreacl is eoint)ine(l with one-half portion of 
 l)uttei', the hread-and-hutter ]toint will not he midway 
 hctwecn the points I'oi- hread and for hutti'r. hut will lie 
 twice as near the hi-cad point as' ihc i)utlcr point. Its 
 aj)pro\iniate ]iosition may he found with lireat i-apidity 
 hv the eve witliout makino- exa^t measurements. 
 
 Fiuure 1 li 
 
 When three foods are coml)ined. the point re])resent- 
 in.ii the comhination is, in like manner, the ''center of 
 gravity" of the three, and may he found Ijy first ohtain- 
 ing the center of gravity of two, and then ohtaining the 
 center of gravity of the point thus ohtained, and the 
 third. Thus if, as in Figure !<•. we have three points 
 representing, lespectively. 3. I and o calories of three 
 separate foods, shown hy the aitmlicd nuuihers 3, 4 and 
 5, the point representing the comhination may he found 
 hy joining the points laheled 3 and 4. and finding their 
 center of gravity, 7, situated nearer the point 4 than 
 
14 
 
 point 3, and dividing the line between them in the ratio 
 of 3 to 4. The first two points, 3 and 4, may be consid- 
 ered as concentrated at 7 with their combined weight, 7. 
 We then find the center of gravity of this new point 7 
 and the remaining point, 5. ■ The center of gravity of 
 this point 7 and point 5 will be a point, 12, on the 
 straight line between them, situated nearer the 7 than 
 the 5, and dividing the distance between in the ratio of 
 5 to 7. At point 12 the whole combination of 12 por- 
 tions may be considered to be concentrated. It is evi- 
 dent that we could find the center of gravity of the same 
 three points by combining them in a different order, but 
 the result would be the same. 
 
 Figure 13 
 
 It is also evident that more than three points may be 
 combined on the same principles by combining them by 
 twos and threes and then combining the coml)inations. 
 
 When all the points are combined into one point, that 
 point will represent the entire meal. If the final point 
 thus found is labeled "22," and is located 20 per cent, 
 up and 30 per cent, to the right, this shows that in all 
 twenty-two "portions" (2,200 calories) have been con- 
 sumed, of which 20 per cent. (440 calories) are juoteid. 
 30 per cent. (660 calories) are fat, and the l)alance. 50 
 per cent. (1,100 calories), are carbohydrate. 
 
 The ration here exemplified contains too much pro- 
 teid. If we accept Professor Chittenden's^ results as to 
 
 7. See his "Plivsiological Economy in Nutrition. 
 (Stolics), 1904. 
 
 New York 
 
15 
 
 ]irntci(l i-L'(iiiiieiiu'nts. a \vt'll-l>iiliiiic('(l daily latioii foi- 
 tlu' avi'vajio ])c'rs<)ii will he i-i'pi-csciilcd l»y a piMiit lyiiiL;' 
 within the "normal i(X'tan«ilo," as shown in I'iuurc 11. 
 '\'h\< shows that jn'oteid shonM he near 10 ])er cent. 
 
 All fcods niav ho classihod aecordin<; to thoir location 
 rehitivoly to this rwtaimlc Tluis, all foods located 
 above tiie lectaitulc ■aw hiLih-jU'dteid t'oi)ds; all helow, 
 low-pioteid foods; all within, iini'iiial-piotcid foods. 
 Lo(>kini:- at the "food niaiT" we see aiiion*^' Ihe hiiih-pro- 
 teid foods, heiiinninu' with the lowest, irrahani hrcad. 
 
 Figure 14 
 
 macaroni, tomatoes, whole-wheat hi'ead. pine nuts, 
 beans. l)ntterniilk, cheese and meats. Among the low- 
 proteid foods. ])eginninu- wit1i the highest, are most 
 fruits (except laspherries and stra wherries), cieam, 
 pecans, olives, butter, olive oil, sugar. Among the foods 
 normal in proteid are most breads, wheat flakes, corn 
 flakes, strawberries, raspberries, chestnuts and most 
 other nuts (except pine nuts and pe<'ans). In the same 
 way we may classify foods as to their richness in fat or 
 carbohvdrate; but there is a larger range allowable for 
 
16 
 
 these elements than for proteid. High-proteid foods 
 tend to make the ration high in proteid, and will do so 
 unless balanced by ]ow-])roteid foods. Most ])ersonp 
 consume nuuh more proteid than that in the Chitten- 
 den standard. This excess may l:)e avoided either Ijy 
 omitting foods high in proteid or Ijy using them very 
 sparingly. 
 
 Since the resultant point, representing the ration, is 
 the center of gravity of the points representing its con- 
 stituents, it is evident that it can be obtained by 
 
 Figure 15 
 
 mechanical as well as hy geoiuetrical methods. For this 
 purpose a meclianical diet indicator has been devised, as 
 shown in Figures 12, 13, 14, 15. 
 
 The essential feature of this apparatus is a card on 
 which is drawn the right-angled triangle with which we 
 have already become familiar. Points on this card may 
 be located to represent the various foods emploved. 
 These points may be easily found from tables given at 
 the end of this article. Points representing the most 
 common foods may be already jjrinted on it. At iwints 
 representing foods eaten, pins with heavy heads are 
 
ir 
 
 tlu'ust thruu^h llu' (aidhoiird ( Ki,ii'. T-i). tlic wciiilit of 
 viu-h n'jin'-i'iitiiiL;- (^m- 'Vtiuidard jiDrtioii." Similar pins. 
 I»ut DiU'-liair and (Ui('-(iuart('r as licavv. arc alsn pi'ovidcd 
 to roj)iesont liall' and (juaiicr ""iiortions.'" \\ Iumi these 
 ])ins are placed, the total ration wliicli lias \)vr\\ con- 
 sunied is easily found, simply hy counting the "por- 
 tions"" thus represented. For instam-e. ii' tliere ari' lo 
 |)ins re|)reseiitin,ii' ''standard portions" and Id pins rep- 
 resenting half "portions" (and, therefore, five full "por- 
 tions"), the total ration is 20 '"portions,"" or •^.i»(»() 
 calories. In ordci' to [ind the percentages of pi'oteid. 
 fat and earhohydrate in this ration, it is oidy necessary 
 to ohtain the center of gravity of all the pins. For this 
 jiurpose the card is placed in a hasket (Fig. 115) and 
 suspended on a standard (Fig. 11) so that the center of 
 gravity of the pins may assume a ]K)sition vertically 
 under the ])oint of support. The position of this center 
 of gravity is easily indicated on the card hy means of a 
 vertical pi'icker (F'ig. 1-")). whirh may he piTs>('(l on the 
 card. Thus, almost instantaneously, the center of grav- 
 ity is found. The total time consumed in placing the 
 ]Mns. adjusting the card and hasket. and finding the 
 center of gravity, is fouml to he, foi- accuiate woi'k. 
 ahout five minutes.'' 
 
 The mechanism in which the cardhoard triangle is 
 held is so arranged that when the cardhoard is hori- 
 zontal the center of gravity falls at a point indicating 
 normal food pro]wrtions. If the center of gravity is at 
 some other ]ioint. the cardhoard will tip, showing that 
 till- ration is not "halanced." If the proteid vertex tips 
 down, it indicates an excess of proteid; if the fat ver- 
 tex, excess of fat; if the carljohydrate vertex, excess of 
 carl)ohydrate. 
 
 It is now evident that, hy means of the mechanism 
 and the rectangles marked on the card, it is a simple 
 matter to discover whether a particular diet conforms to 
 any given standard. It is equally simple to correct dis- 
 crejiancies thus found, and. if need he, the corrections 
 may be made in advance and the balanced ration pre- 
 
 8. The weisrtit of tlio cardboard and tho basljet containing it is 
 oliminatcd liy the construction of tlic I)asliet. Its center of gi-avity 
 (wtien containing tlie cardboard irithoiit pins) exactly coincides 
 witli tlie point of supi)ort. Ilente. when the baslcet witli the card 
 (but irilhoiit pins) is placed on the point of siii)|)ort. it tends 
 neither to swing (which wocld imply stable e(|(iililirinm) , nor to 
 be top-heavy (which would inipl.\ unstable eiiuijilirium > . but is in 
 "neutral" e(iuilibriuiii. and will ri'main at any angb' at whicli il is 
 plac<'d. 
 
18 
 
 scribed. A trial ration may ])e ]uit on the card, and if 
 it fails to balance, the pins may be rearranged and bal- 
 anced with far greater rapidity than the corresponding 
 operations conld be carried out by arithmetical compu- 
 tations. 
 
 One advantage, however, of the foregoing methods is 
 that, whether the object is merely to record what is 
 consumed or actually to prescribe, the patient need not 
 be annoyed by having scales at table. All weighing 
 mav be ■ done in the kitchen and the food served in 
 "standard portions" or in known multiples or fractions 
 of such portions. It is only necessary that the patient", 
 or some one else, shall report exactly what part of the 
 various portions served has been consumed. The patient 
 need not -even know the food values of the portions 
 served to him, and thus the introspection and trepida- 
 tion, which often defeat the very aim of diet prescrip- 
 tion for the sick, may be avoided. For well persons who 
 desire to keep a record of their dietary, the method here 
 given . has the advantage that when it is once made 
 familiar it can be employed without any apparatus. One 
 soon becomes able to recognize the quantities of the 
 ordinary foods which contain 100 calories, and to hold 
 in memory the position on the triangle where these foods 
 are indicated. A little reflection will then enable him to 
 judge how many "standard portions" he has consumed 
 at a meal, and also whether their center of gravity falls 
 within the normal rectangle. If he has a good locative 
 imagination, he can rely entirely on his ment-al image 
 of 'the triangle. Any one who has once pictured the 
 foods on the "food map" is not likely to forget their 
 several locations. He will know that a meal in which 
 soup, fish, meat, certain high-proteid vegetables, eggs, 
 cheese, milk and ice cream predominate, must be too 
 high in proteid ; for all these foods are located above the 
 "normal rectangle." Moreover, he will be able, after a 
 little practice, to estimate roughly the calorific value of 
 his food. A "portion" of 100 calories may be ascribed 
 to each lamb chop, or its equivalent in other meat, each 
 (large) egg, each two-thirds of a glass of milk, each 
 ordinary potato, large slice of bread, large banana, ordi- 
 nary pat or square of butter, shredded wheat biscuit or 
 its equivalent in other cereal, eight almonds, half dozen 
 English walnuts, one and one-half lumps of sugar, etc. 
 
■oZs 
 s a 
 
 TOO 
 
 a £■■3 -^ 5 • _ e 
 
 D Zi Cs 2^5 = -, 
 
 is:?: 
 
 liiliiil?? 
 
 
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 io o o o g o 
 
 
 
 
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 TTT; T =!■=. 
 
 S r-o o-o 
 
 
 Si- 
 
 £■3 = 
 
 ctt ;; 
 
 
 
 
 
 .5--^.'S.|S I 
 
 £.°-S,i--- 
 
 
 - S5: 5:-: 
 
 53 
 
 SSSa 
 
 ?3 = 
 
 9 g 
 
 
 ^^0^-?-g><OCOHHCC[:>;^Hr: pOOZ:v.wc 
 
 i'-.a; 
 
 2 = : ?-S: ; 2: : 
 
 iSS SSSSS3£ 
 
 ssisisi^issSsSss^sSilaiiS 
 
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 Ora-.tO »-4& U •»■ a M 93 U M S 
 
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 £gSffiS^S£SS223::5;3d;JSgSg^S3w2S^ 
 
 sssssssyss^ssss^sssssssgs 
 
 •^ 1 w w M o ?: ?; H 
 52 = = = = 5'15 
 
 III 
 
 
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 I52S- : ;=.33?3fa 5-= = -"_?■- 
 
 q: «?^ 
 
 
 ■;i; %\ 
 
 
 ?-5.; 
 
 3:5"r~:s'^^i?'7:^> '£-'j» '^■'vZO^'£XT- 
 
 ^-:-3-3"3t-:'rTT3-3i;rt:'T^" 
 
 Si-??'^!?~T7T--2'^"r-'^ "£;,-"*"-"-->>> 
 
 0;?2.2.eS 
 
 
 DBS Sig 
 
 ^ -3 3 -■ 1^ t -:; * 
 
 ■ ^-■'£r2.^5,^P S i*3S = %.. 
 
 
 5 - 2 ^ ^ 
 
 
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 B -5 3 
 
 ^^■av 
 
 rt3'3 c'tf err tf : 
 : = S-a = = /;». 
 
 '-z.'£ a=.c.^ c; 
 
 ■ 2^* O 
 
 c-s; 
 
 > T « ■ 
 
 ' O : : : 
 
 H : : : 
 
 w : : : 
 75 
 
 s: ; ; is 
 
 ills 
 
 E? ; fi 
 
 ^ 2,3 : s 
 
 iS-n.: " 
 
 llfi 
 
 
 = H 
 
 - 
 
 -/.-• — 
 
 H 
 
 cc CHr r> 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 : 23, 
 
 < 
 : 
 
 1^^ 
 
 : = = 
 
 
 
 
 
 
 
 
 
 ^2J2Z.^: 
 
 ■ K 
 
 
 ^1! 
 
 
 
 
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 iillifsSs 
 
 5i S«!8SS3SSE8S«SSaS5;3S8S 
 
 sssK csisafiss i3sassass!s^s-S3agK:issB gg 
 
 3SSSS=S5k 
 
 'i'i'f/z"'z—^-S''-e-i.''-£yii 
 
 3^''c'°-''.^s.*a8ag 
 
 SSSSSiSESSiSSSSS 
 
 S!ES18£S8S-iia28S8iPii 
 
 'tSS 21-, s'.g^g'^ 
 
 3:!!S£2'££S£.iSS:3£gS££3i£$£;«S£SsSf 
 
11) 
 
 To illiist I'atc till' iiictlidil li\ jirMct ic;il cxiiiiiiilcs. let u-: 
 suppose that I'or a paiticular patient the prcscripl ion is 
 I'or '^.01)0 calories a day ot foods so conihini'd that tlio 
 food proportions will lie icpreseiited liy a point within 
 the ritjht hall' of the roetannle. To earrv out this pre- 
 scription the ])atient looks at the '"t'ood map " and linds 
 no foods on it wliieli themselves fall within the ]ire- 
 seribod area. He observes, liowcver, that bread and but- 
 ter are located on opjiosite sides of this area, and his eye 
 shows liim that a combination of the two in equal ])arts 
 (by calories, not by weight) will very nearly fall within 
 it. though slightly too low. Corn flakes and cream eom- 
 l)ine within the set limits; milk and dates (a fnxorite 
 oriental combination) fall near the mark; poached eggs 
 on toast (with the whites left out) will also come near 
 the proper spot, though slightly loo high; any cereal 
 foods or fruits (which lie at the left), combined with 
 foods which lie at the right, as egs: yolk, nuts or cream, 
 butter, olives or olive oil will combine nearly right, pro- 
 vided the right-hand foods predominate. Choosing such 
 of these combinations as are most relished, the patient 
 eats his meal. Afterward he. his- physician or nurse, 
 indicates on the triangle l)y iiencil marks each food 
 which has been eaten, or. if he has a mechanical diet 
 indicator, by the weighted pins. The- center of gravity 
 will then show exactly where his meal is located on the 
 "food map,-'' and the total nuinber of "portions"" "will 
 show how much he has eaten. The cause of any deviation 
 from the prescription will be very apparent. It may be 
 that the point is too high, indicating excessive proteid. 
 and this may be due to too much milk, eggs or meat ; or 
 too much cereal food may have displaced the point to 
 the left. These errors may be rectified at the next meal. 
 At the end of the day. from_ the cards used in the three 
 meals, he selects the three centers of gravity and trans- 
 fers them to a fourth card, from which, in the same 
 way, the total calories and center of gravity for the 
 three are found ; this represents the total day's ration. 
 Or, again, a patient may at first be given carte 
 blanche in his food, merely reporting the "portions" 
 eaten. Each dish being served in "portions," this will 
 require little trouble. In fact, a nurse may do it all by 
 noting what is put on a tray and wluit is left after the 
 meal. On the basis of the returns, the physician or 
 imrse can tell exactly how mu-.h and what proportions 
 
20 
 
 tlie patient is eating, and his besetting dietetic sins Avill 
 be evident. Tlie ]:»]iysic'ian will be enabled thereby to 
 guide him intelligently, suggesting, for instance, that 
 he reduce his ration to two-thirds of what he has been 
 accustomed to. or reduce meat, eggs, etc., or take more 
 cream and l)utter. etc. It goes without saying that any 
 change in diet, unless it be a change in amount only, 
 should be gradual." Thus, if a person has been accus- 
 tomed to excessive proteid, his stomach has probably 
 become adjusted to this condition and secretes a large 
 amount of gastric juice. AVhen the reduction of proteid 
 is sudden, the gastric juice will not at first decrease in 
 proportion, and a large part of this secretion will there- 
 fore remain unused. This uncombined acid interferes 
 with the digestion of starch and the person feels a "sour 
 stomach." A gradual reduction of proteid, on the other 
 hand. Avill avoid .this difficulty. The reduction may be 
 more rapid (for the hyperacid) if the proportion of fat 
 is increased, as fat tends to restrain the gastric secre- 
 tion. 
 
 In the winter of 3 900 the mechanical diet indicator 
 was employed for five months in an experiment with 
 nine Yale students. Xo diet \Aas prescribed, and the 
 indicator was used only to record the diet which the 
 men themselves chose. It was found that by follow- 
 ing Mr. Fletcher's rules of thorough mastication and 
 obedience to appetite, the men gradually and natuially 
 reduced their proteid. • The extraordinary efFects on 
 their working power are described elsewhere.^" To what 
 extent such "natural eating'' can help in ])athologic 
 cases has not yet been shown, although some ])hysicians 
 are reported to have found it a very valuable aid in their 
 practice. Certainly it could scarcely fail to lie more 
 serviceable than the unintelligent and reckless diet ])re- 
 scriptions so often made. 
 
 AY.hether or not diet prescriptions are given, the 
 actual diet employed by patients should receive study. 
 Tills study is made easy by means of the grayihic and 
 mechanical methods.^^ These methods may be used 
 
 9. Hutchison. Robort : Oonoi-al ronsidorations on the Thera- 
 peutic I'ses of Diet. I'ractitionei'. April. 190(!. p. 470. 
 
 10. For a short abstract see Science, Xov. Iti. lOOfi. A full 
 report will appear in the Transactions of the Connecticut Academj- 
 of Arts and Sciences. 
 
 11. There is no patent on this device: anyone is free to make and 
 use it. The Battle Creek Sanitarium has had experience in con- 
 structing the apparatus. .\ rej^ular instrument maker may take up 
 its manufacture later if conditions warrant. 
 
21 
 
 witli advantage in ilio kitrlion by lionscwivos desirons 
 of snjijilyinc: balanced meals, and may be of special serv- 
 ice in in?titiiti(ms wbere it is ini]iortnnt to provide coni- 
 ])lete and \vell-])ro])()rtioned nourislnnent at a niinimnni 
 of cost. On the meclianieal diet indicator llic weiirlitcil 
 pins may be placed to indicate any proposed iiica!. nnd 
 tbis meal, by a slifjht adjnstment of tlie weiglits, may bo 
 balanced as exactly as desired. 
 
 The accompanying table of foods is classified under 
 several heads : 
 
 Cookod meats. Uncooked meats. 
 
 Vegetables. Dairy products. 
 
 Fruits. Nuts. 
 
 Sweets and pickles. Cereals. 
 
 Cakes, pastry, nuddinss and desserts. 
 Miscellaneous. 
 
 APPENDIX 
 
 The preceding table gives the data for the ordinary foods, in 
 a form most readily used for the grapliic or the meclianieal 
 metliod. Tlie figures for carbohydrate are included, although, 
 as has been shown, they do not need to be used in practical 
 application, the location of each food on the "food map" being 
 completely determined by its "latitude" and "longitiule," i. e., 
 the proportion of the fuel value in proteid and fat respectively. 
 The foods, so far as possible, are prepared foods such as are 
 served on the table, but unfortunately, the main sources of 
 information being Bulletin Xo. 2S of the Department of Agri- 
 culture, for food materials, it has not been possible to include 
 all prepared dishes desired. Moreover, recipes vary so tliat it 
 would be impracticable to supply data for such dishes wliieh 
 could be used with advantage or certainty. It is easily pos- 
 sible, however, for any one who uses the table to add to it the 
 necessary data for any made dish of known recipe. All that is 
 necessary is to translate the weights of the various ingredients 
 into a number of "standard portions," and then to locate these 
 ingredients on the "food map" and find their center of gravity. 
 This will indicate the position of the composite food. The 
 weight of a "standard portion" of this food is found by divid- 
 ing the aggregate weight of all the ingredients used by the 
 number of "portions" in them, as above ascertained. 
 
 Tlius, to locate sponge cake, when the recipe is 3 eggs, 1 
 "cup" (4 oz.) sugar, and 1 "cup" (4 oz.) flour; the eggs, if 
 of ordinary size, weigh 4^/4 oz. and constitute, as the table 
 shows, 2 "portions"; the sugar, weighing 4 oz., constitutes 
 4.65 "portions" and the flour, weighing 4 oz., 4.2 "portions." 
 This gives a total weight of 12 14 oz., and 11 as the total num- 
 ber of "portions." Dividing the former by the latter, we have 
 1.1 oz. as the weight of a "portion" of sponge cake. The 
 position on tlie "fdcxl map" of sponge cake is now found by 
 
32 
 
 putting the pins at the points on the map as indicated by the 
 table for sugar, eggs and flour. These weights, representing 
 respectively 4.65, 2, and 4.2 "portions," the center of gravity 
 shows the position of sponge cake, which is about 11 per cent, 
 of proteid and about 12 per cent, of fat. This result does not 
 agree exactly with sponge cake as given in the table, owing to 
 the difference in recipe, that in the table probably including 
 shortening. 
 
 Unless great precision is required, a suffi<'ient approximation 
 may be obtained in general by omitting fractional portions : 
 thus, we may call the egg 2 "portions," the sugar 5, and the 
 flour 4. The resulting center of gravity may be found roughly 
 by the eye, without even the aid of the diet indicator. It is 
 surprising how close such a rough approximation will usually 
 be found to the true value, as tlie influence of the errors in the 
 particular ingredients, on the combined result, is small, and 
 the various errors usually tend to offset each other. 
 
 (Should the reader desire to add other items to the table, 
 either of food materials or foodstuffs, he may do so by using 
 the sources from which the table is constructed. Thus, if he 
 will obtain from the Department of Agriculture Bulletin No. 
 28, "Chemical Composition of American Food Materials," he 
 may translate the figures there given into the form to be 
 entered in the table as follows : The weight in ounces of a 
 "standard portion" is found by dividing 1,600 by the number 
 of calories per pound given in the table. The calories per cent, 
 of proteid is found by multiplying the figure in the Bulletin 
 table giving the weight per cent, of proteid, by 1,860 and 
 dividing the result by the figure giving the number of calories 
 per pound. The same calculation and the same factor, 1,860, 
 apply to carbohydrate. For fat tlie same calculation applies, 
 but with the substitution of the factor 4,220 in place of 1,860. 
 The three results may be verified by adding the resulting fig- 
 ures for proteid, fat and carbohydrate, the sum of which should 
 be 100 per cent. To weigh foods, letter scales will usually 
 suffice, the food being weighed in dishes and the weight of tlie 
 dishes subtracted. 
 
Not to be released until 
 September 20, 1910 
 
 INSURANCE COMPANIES AND THE PUBLIC HEALTH 
 
 AN ADDRESS BY 
 
 PROF. IRVING FISHER 
 
 I 
 
 Of Yale University, New Haven, Conn. 
 
 Read Before the Twenty-third Convention of 
 
 The International Association 
 Accident Underwriters 
 
 5RETT0N WOODS, N. H., SEPTEMBER 20, 21, 22 & 23, 1910 
 
Insurance Companies and the Public Health. 
 
 In the history of all forms of insurance Ave iind that at first 
 i conception of insurance is restricted to the one function of trad- 
 T in risks, i. e., selling for a price (called the premium) the chance 
 receiving an indemnity (called the insurance). Later a second 
 iction is almost invariahly added, that of reducing the risks. Such 
 the natural and inevitahle order of development. At first we 
 ist take the risks just as we find them. But sooner or later we 
 cover that risks are more or less i)reventa})le and sooner or later 
 befalls that those insurance companies prosper most which prac- 
 3 prevention as well as indemnification. The addition of the pre- 
 iting function at first aroused antagonism as all new ideas do. 
 it it is bound to win wherever prevention is found to ])ay--which 
 probably everywhere that insurance applies. First one far-sighted 
 npany sees profits in prevention and then competition compels 
 liers to follow its example or withdraw entirely from the race. 
 
 It would seem that marine insurance has stimulated to safe 
 p construction as much as any one factor in the history of ship- 
 Iding. 
 
 In the history of fire insurance, the mutual companies first 
 de the effort to reduce fire risks. When the importance of ex- 
 ising the function of preventing fires, as well as indemnifying 
 linst fires, once entered into the plans of stock companies, they 
 n overtook, if they did not outrun, the mutual companies. It is 
 imated that the risk from fire in certain particular classes has been 
 uced, through the fire insurance companies, some seventy ])er 
 t. In New England seventy years ago the rate on cotton and 
 3len mills averaged three or four dollars per himdred. Today 
 se mills are being insured at a total cost per annum of seven 
 ts per hundred. In some cases the cost has been reduced to 1-100 
 the former amount. This enormous decrease has been accom- 
 {hed by slight expenditures. In some factories the cost of im- 
 •vements has been more than paid for in the saving of ])remiums 
 fire insurance in one year. The stock companies were forced by 
 comj)etition of the mutual com])anies to take up ])reventive 
 isures. They now employ fire insurance engineers to maintain 
 
 I 
 
 i 
 
laboratory in Cliica<>'o wliich is well equipped for the purpose of 
 tudying fire-resisting materials, fire-resistinL>- deviees, and new a])- 
 aratus and fire prevention in general. Many fire insurance men 
 elieve that this laboratory is their best investment. No reduction 
 1 rate is guaranteed until fire figliting devices are a|)])roved by the 
 iboratory. 
 
 I understand that in steam boiler insurance, under the leader- 
 lip of one man, the companies assuming these risks gradually dis- 
 jvered tliat it ])aid to put back nearly half of their premiums into 
 le work of insj^ection of boilers witii a view of preventing ex- 
 losions. 
 
 In emi)loyers' liability insurance, the idea of prevention has 
 lade great headway. Here the companies are all stock companies, 
 it they have learned that their function is not simply to distribute 
 sses, but to lessen them as well. 
 
 The sanie idea of prevention doubtless plays an important i)art 
 most other forms of insurance, such as live stock insurance, cyclone 
 isurance, burglary insurance, plate glass insiu'ance, fidelity in- 
 irance. 
 
 Finally the movement toward ])revention is now taking pos- 
 !Ssion of Hiose forms of insiu'ance most vitally connected with 
 liman life, — accident insurance, health insurance and life in- 
 ; ranee. 
 
 n 
 
 On February 5th, 1909, I had the honor of addressing the As- 
 
 ciation of Life Insurance Presidents in New York Citv on the 
 
 conomic Aspect of I^engthening Human Life. As a member of 
 
 resident Roosevelt's Conservation Commission I had just com- 
 
 eted a report on our National Vitality, Its Wastes and Conserva- 
 
 )n, and as President of the Committee of One Hundred on Na- 
 
 t)nal Health I was then, as I am now, actively engaged in an 
 
 )rt to secure a National De})artment or Bureau of Health. In 
 
 \ address I suggested that the life insurance companies could, 
 
 i)titably to themselves, and especially to the country, co-operate 
 
 the health movement now spreading over the whole world. The 
 
 association appointed a Committee on Human Life Extension, of 
 
 lich ^Ir. Ide, President of the Home Life, is chairman. This com- 
 
 ;ttee has held several meetings in New York and AVashington. 
 
 It is a profound satisfaction to have had even a minor part in 
 augurating the movement to introduce prevention into life in- 
 rance, for I am fully persuaded tluit, sooner or later, life, accident 
 
and liealtli insurance companies will assume their rightful place i 
 among the most ])owerful engines for human safety, health and ; 
 l()iij>cvitv the world has ever seen. 
 
 But, tliough many have mistakenly thought and said so, I can- \ 
 not lay claim to heing the first to suggest the particij)ation of life j 
 insurance companies in the health movement. Mr. Iliram J. Mes- j 
 ^enger, actuary of the Travelers' Insurance Company, Dr. Burn- ' 
 side Foster, Prof. .J. Pease Norton, and I helieve many others, had : 
 reached the same idea independently. The industrial department ; 
 3f the ^Metropolitan Life Insurance Company, under the guidance ! 
 Df ]NIr. Lee K. Frankel, had already laid ])lans to reduce its mortality, i 
 
 xVt present the movement has only just begun; although it has, | 
 [ believe, gone far enough to demonstrate its wisdom. The Metro- ' 
 )olitan has established a consumptive sanatorium for its employees 
 n the face of much opposition and in spite of an adverse decision at | 
 irst by the Insurance Commissioners of New^ York State as to their | 
 •ight to do so; it has engaged visiting nurses to co-operate w^ith visit- 1 
 ng nurses' associations in certain cities to care for its bed-ridden ' 
 policyholders; it has established a health magazine to distribute 
 lealth literature among its policyholders, — v/hich magazine is made 
 .vailable to 15,000,000 readers, or one-sixth of the population in the ' 
 Jnited States; and it has endorsed in several wavs and on several ! 
 ■ccasions the movement for a National Department of Health. ! 
 
 The Provident Life Assurance Company has established a health > 
 •ureau which performs two functions, one of issuing bulletins of ! 
 ealth information among its policyholders, the other, of granting : 
 3 those who choose, free medical examinations. At first these free i 
 xaminations were to occur everv two years, but the results were im- ' 
 lediately found to be so satisfactory in holding off the Grim \ 
 leaper, who was creeping upon his victims unawares, that the in- 
 n'val for periodical examinations has been reduced to one year. 
 
 I The New York Life Insurance Company has taken a hand in 
 le effort to improve and purify the milk supply of New York City. 
 ]Mr. Robert L. Cox, counsel for the Association of Life Insur- 
 ace Presidents, states that "practically all of the companies repre- 
 tmted in the Association of Life Insurance Presidents are o-ivins* 
 leir moral support to the movement for the prolongation of human 
 fe. In addition, many of them are doing practical educative work, 
 feasured by number of ]:K)licies in force, the Association companies 
 )ver 78 per cent, of the field of American companies, having 21,- 
 
700,000 policies out of a total of about 28,000,000. The Associa- 
 tion coni})anie.s cnoagiufr in individual work alon<j' health betterment 
 lines have T-J per cent, ol' tlie total number of pobcies in force, or 
 20,.)()0.()00;' 
 
 'There is another group of e()m])anies in the iVssoeiation which 
 goes beyond the body of policyholders in its health promotion 
 activities. They advise impaired applicants for insurance as to their 
 physical condition and make suggestions to aid them. There are 
 four com])anies in this group. Two of them, in the Kast, have a 
 total of 80,000 policies. Another is a flourishing ^Middle West com- 
 pany that has about 150,000 policies. The fourth is a young and 
 conservative Southern company with 7,200 ])olicies." 
 
 "One of the Connecticut companies has published suggestions as 
 to health reform in its magazines to agents. Two other comjjanies 
 — one of jNIassachusetts and the other of California— are consider- 
 ing active work in the future." 
 
 i The fraternal societies have entered the campaign. Their 
 sjournal, the Western Review, now has a department especially de- 
 i^^oted to the public health. Fraternal insurance companies have also 
 in several instances established sanatoria, and have attempted in other 
 ivays to lengthen lives and decrease death claims. 
 I The accident companies have, I understand, for some time, aided 
 n getting State laws passed to prevent accidents to life and limb. 
 
 Finally, health insurance, one of the yoimgest forms of insur- 
 ince, has made a beginning in the field of prevention. The Loyal 
 'rotective Insurance Company has, within the last few months, es- 
 ablished a health bureau to issue bulletins and conduct a sort of 
 orrespondence school of health information. Considering the fact 
 hat few, if any, of the existing insurance companies have been en- 
 *aged in health insurance for more than fourteen years, their pres- 
 nt entrance into the field of prevention is unusually prompt. Per- 
 Dnallv I believe that in health and accident insiu'ance, — and es- 
 ecially in health insurance — there are gigantic possibilities of profit, 
 use the term profit rather than philanthroj)y in recognition of the 
 let that insurance companies as such have no business to undertake 
 hilanthropic w^ork except when it is profitable. In the end the 
 loney gains made by the insurance companies by reducing mortality 
 id invalidity will be shared by the public in reduced premiums. 
 
 5 
 
My object in this paper is two-fold, (1) to show that the un- 
 exploited possibihties of improved safety and health constitute a 
 veritable bonanza for insurance companies, and (2) to show sonu 
 ways in which the insurance companies may begin in the work of ex- 
 ploiting- this bonanza. 
 
 First, then, What room for im})rovement is there in the matter 
 of American accidents and ill health? For answer I beg to refer you 
 to mv report on National VitaHtv to President Roosevelt on behalf 
 of his National Conservation Commission. Such reference will save|| 
 you the trouble of listening to an elaborate statistical argument. In 
 the re])ort referred to it is shown that human life in America could,] 
 by the adoj)tion of hygienic reforms already known and entirely 
 practicable, be lengthened over one-third — that is, over fifteen years. 
 This calculation has been made very conservatively and is j^robably 
 several years inside the truth. The statistics and estiniates on which 
 it is based have been taken from published sources, as well as con- 
 tributed by some score of American authorities — medical, actuarial 
 and hvgienic. It is estimated that at least eio-ht years could be added 
 to human life merely by securing reasonably pure air, water and 
 milk. 
 
 Now it is well known that mortality and invalidity are very in- 
 timately related. Farr attempted to establish a ratio betw^een them. 
 He calculated that for every death each year there Avas an average of 
 two persons sick throughout the year. But whether or not we can 
 establish a fixed ratio betw^een deaths and invalidity no one wull gain- 
 say that they are sufficiently connected to enable us to reason from 
 one to the other. In the absence of good invalidity statistics, mor- 
 tality may therefore be accepted as a rough barometer of invalidity; 
 and longevity as a rough barometer of vitality and health. We may 
 therefore conclude that the possibility of adding fifteen years to hu- 
 man life carnes with it the possibility of adding greatly to human 
 health. If the ratio of disease to death be a fixed one, such exten- 
 sion of human life would reduce invalidity in the same ratio as it 
 would reduce mortality, — which would be, ultimately, about 25 per 
 cent. 
 
 There is reason to suspect that the reduction in invalidity would 
 be even more than the reduction in mortality. This may be reason- 
 ably inferred from one's general study of the prevention of disease 
 and in particular from the fact that mortality is only preventable up 
 to a certain point — for every one must die some time — whereas dis- 
 ease may perhaps in the millennium be abolished entireh\ Pasteur 
 
said: "It is within the power of man to rid himself of every parasiti 
 disease." And if in the (hstant future disease shall be so much mor 
 preventable than deatli, it is ])robab]y more ])reventable at ever 
 stage of progress. AVe feel reasonably safe, tlierefore, in statin, 
 that every success attending' our efforts to reduce mortality will b 
 attended by at least equal success in reducing invalidity. 
 
 We now know that the death rate is not the fixed and fatalisti 
 thing it was once su])posed to be, but that on the contrary it varie 
 according to many known conditions. 
 
 The estimates of Finkelburg show that in Europe human lif 
 has doubled in the last 350 years. More recent and more reliable fig 
 ures show tliat life is lengthening today more rapidly than ever 
 If we take life tables for different periods for EfUgland, France 
 Prussia, Denmark, Sweden, and ^Massachusetts, w^e find that humai 
 life lengthened during the seventeenth and eighteenth centuries a 
 the rate of four years per century; that during the first three 
 quarters of the nineteenth century it lengthened at the rate of abou1 
 nine years per century; that at present it is lengthening in Europt 
 generally at the rate of 17 years per century, and in Prussia (which i; 
 perhaps the home of preventive medicine) at the rate of 27 year;- 
 per century. For this country the rate can only be judged froiT 
 the statistics for JNIassachusetts, which show that life is lengtheninc 
 by about fourteen years per century, or approximately half of tht 
 Prussian rate. These rates may not continue in the future, but the 
 opinion of our best authorities on longevity, such as Ray Lankastei 
 and INIetchnikoff, is that there is still great room for imj^rovement, 
 especially after middle life. Hitherto almost all the improvement 
 has been applied to ages before fifty and only the most recent fig-|i 
 ures show^ any tendency toward improvement beyond that age. 
 
 Recent figures for England show improved mortality at every 
 age of life, and in a September magazine Mr. Lee Frankel tells us 
 that recent statistics for the JNIetropolitan Life Insurance Conqiany, 
 covering forty-eight million years at risk and over three-quar- 
 ters of a million death claims, show the following improvement: The 
 death rate of policyholders 20 years of age declined in eleven years 
 from 10.5 per thousand to 7.6; that of ])()licyholders 80 years old from 
 15.7 to 11.8; of those 40 years old from 19.3 to 14.9. These and other 
 statistics and facts remove entirely the old objection that improved 
 mortality is only to be expected of infants or of those below the ages 
 of policyholders. This improvement is ascribed by Dr. Frankel to 
 
1 
 
 ( 
 
 a 
 
the general movement throughout the United States during the last 
 decade for hetter tenements, milk, water, etc. 
 
 It is significant that backward India — in spite of the enormous 
 room for improvement — shows during twenty years no rate of im- 
 provement whatever. Ijife there remains only half the Km'opean 
 span. This is because hygiene is so little practiced. 
 
 A fall of the death rate always promptly follows sanitation. 
 Colonel Gorgas cut the death rate in Havana in two, bringing it 
 down to between 20 and 24 per 1,000. The New York death rate 
 responded at once to Colonel Waring's clean streets. And recently 
 it is announced that the death rate of New York is 16.5, the lowest 
 )n record — a result, in all human probability, due to the hygienic work 
 if the health officer, the milk reformers and the public agitation for 
 lealth. 
 
 Contrast the death rates from yellow fever at Panama during 
 ■.he efforts of the French to dig the canal and during the American 
 vork under the sanitary regulations of Colonel Gorgas! 
 
 All evidence points clearly to the value of preventive measures 
 n the conflict with disease. The fall in tuberculosis mortality is di- 
 rectly due to the growing use of hospitals, which have tended to iso- 
 ate consumptives, and to a use of outdoor life; typhoid fever has 
 irtually disappeared when water and milk supplies have been made 
 mre, the open privy abolished, and flies and other carriers of the 
 pecific cause of the disease have been provided against ; smallpox has 
 fiven a^\ay before vaccination ; yellow fever is fast disappearing now 
 hat the agent of transmission is known; while many of the less 
 erious diseases are losing their power, purely owing to preventive 
 leasures. 
 
 As to the preventability of accidents in the United States, it is 
 nly necessary to contrast their frequency here and in Europe. The 
 ailroad accidents in this country are not only more numerous than 
 1 Europe but many times more numerous, the exact ratio depend- 
 ig on the country and on the method of measuring. 
 
 The Commissioner of Labor of INIinnesota has stated that in his 
 pinion at least half of all industrial accidents are preventable. 
 >ther authorities have ex])ressed similar opinions. There is now 
 ^ery reason to hope that, with the recent establishment of a bureau 
 P mines, the accidents in mining will within a few years show a sub- 
 antial decrease. 
 
 8 
 
!S 
 
 
 t 
 
In my report of Xational Vitality I have collected the estimates 
 )f a large number of authorities as to the degree of preventability 
 )f 00 causes of death. 
 
 On the basis of these figures, tlie total imnibcr of needless, or 
 •ather premature, deaths in the United States is estimated at 
 130,000. 
 
 If we accept Farr's conclusion that corresponding to each death 
 here was an average sickness of two years, there are probably con- 
 tantly ill in the United States about 3,000,000 persons, of whom 
 00,000 are consum.ptives. The best authorities agree that at least 
 alf this illness is needless. We have, then, abundant evidence that 
 here is a vast amount of unapplied scientific knowledge capable, 
 dien applied, of greatly reducing the mimber of victims of disease 
 nd death. This knowledge has come suddenly, most of it within a 
 eneration, since the epoch-making work of Pasteur, IJster, Koch, 
 ''on Behring, ]Metchnikoff, Chittenden and many others. The mod- 
 rn laboratory is manufacturing knowledge faster than it is being 
 pplied. jNIoreover, the rate of increase in hygienic knowledge will 
 oubtless increase rather than decrease in the future. This is the 
 tuation of which insurance companies can now take advantage. 
 
 Since life and health insurance companies have to deal with dis- 
 bility and deaths as questions of dollars and cents, I may add a few 
 ords as to the financial side of the question. 
 
 Dr. Farr has estimated the net economic value of an English 
 ^ricultural laborer at various times of life by discounting his chance 
 ' future earnings after subtracting the cost of maintenance. On the 
 isis of tables in my report on National Vitality, it is estimated that 
 le average value of the lives now sacrificed by preventable deaths is 
 ; least $1,700. Since the number of preventable deaths is estimated 
 ; 630,000, the annual waste from preventable deaths is 630,000 times 
 1,700, or about $1,000,000,000. This represents the annual pre- 
 ;ntable loss of potential earnings. 
 
 We saw that there are always 3,000,000,000 persons in the 
 nited States on the sick list, of whom about 1,000,000 are in the 
 Drking period of life and about three-quarters are actually workers 
 id must lose at least $700, which makes the aggregate loss from 
 ness more than $500,000,000. Adding to this another $500,000,- 
 »0 as the expense of medicines, medical attendance, special foods, 
 2., we find the total cost of illness to be about $1,000,000,000 per 
 ar, of which it is assumed that at least one-half is preventable. Add- 
 
iiig the preventable loss from death, }j>l,00(),()0(),()()(), to tlie preventable 
 loss from illness, $5(){),()()(),()0(), we find one and a half billions as the 
 very lowest at which we can estimate the preventable loss from dis- 
 ease and death in this country. The true fio'ures may well amount to 
 
 a. C* • 
 
 several times this fi<>ure, but when statistics are l)ased ])artially on 
 2()n jecture, they need to be stated with especial caution. 
 
 The cost of conservation is often trifiiniJ' in com])arison with 
 the saving attained. For instance, the hook-worm disease in the South 
 impairs the earning power of its workmen by 25 or .30 per cent. To 
 restore this earning power costs, by curing this disease, on an aver- 
 ige, less than $1 for each case. Other examples show that the return 
 Du investments in health are often several thousand per cent, per 
 mnum. Probably no such unexj^loited opportunity for rich returns 
 exists in any other field of investment. Mr. Messenger, the actuary, 
 mggests that if insurance companies should combine to contribute 
 ^200,000 a year for the purpose of improving the ])ublic health, the 
 lost would be one-eighth of 1 per cent, of the premiums, and it would 
 )e reasonable to expect a decrease in death claims of nuich more tluui 
 1 per cent. Even this 1 per cent, would make a j^rofit of more than 
 leven times the expense. 
 
 Actuaries' tables show that a reduction of one-third in mortality 
 'vould enable the premium to be reduced by over fifteen per cent. 
 
 Dr. Frankel, in the article already referred to, states that 
 
 jihrough the lessening in mortality which has already been going on 
 
 jvithout special effort on the part of insurance companies, the policy- 
 
 liolders of his com])any have received back from the com])any over 
 
 Imd above their policy contracts the tidy sum of $23,00(),0()0. Cer- 
 
 ainly it stands to reason that intelligent and esjDccially concerted 
 
 iction by insurance com])anies should bear fruit worth many times 
 
 he cost. In the case of health insin*ance the saving would be still 
 
 p-eater for the reason that the rate of interest does not enter as so dis- 
 
 urbing a factor. The insurance men whom I have consulted as to 
 
 vhether it would pay to engage in the saving of lives have been 
 
 jinaniuKmsly affirmative in their answers. 
 
 The c(mclusion seems safe that here is a rich unex])loited field 
 or saving money. And the beauty of it is that these gains bring with 
 hem gains far more precious to the nation than dollars — immeasur- 
 ible gains of longevity, vitality, efficiency, and hap])ines«. Jjife, 
 jiealth and accident insurance is not ])hilanthropy but it is a beneficent 
 jiusiness. Though at first glance it might seem that to prevent the 
 ►ollution of streams, to improve the milk su])ply, to obtain pure foods, 
 .nd freedom from accident is no part of tlie business of :ns\n'ance, yet 
 
 11) 
 
it is oasv enoiinli to sec the vei'v vital fonnectioii. I5\ I'jir I he larger 
 part of the cost of the insurance business is not uianagcinent Jior 
 agent's fees, but the cost of niortabty and invahdity. It is the right, 
 if in fact, it is not the dutv, of any l)usiness to reduce its cost. To -jare 
 iown sahiries might not save the policvhohler one per cent, of his 
 preniiiiin. I)ut to reduce inortah'ty cost might save him many i)er ^'cnt. 
 
 W'liat, tiien, can accident and healtli insui-ance com))anies do to- 
 ward the reduction of accidents and illness :* They can follow the 
 example of the xMetro])olitan, the New York Life, the Provident J.ife, 
 the Loyal, and other C!)mj)ames, which have already blazed the way, 
 md they can set their experts to study the ])rol)lem with reference 
 ;o devising still other methods. Their work of prevention like that of 
 ire ])revention can l)e classified under two lieads, — the \^'ork rf pre- 
 tention among their own policyholders in ])articular and the coorpera- 
 ;i()n with public health agencies toward ])revention i!i general. '■'Mre 
 [nsurance Companies not only compel or induce their policyholders 
 :o take certain precautions against tire, but they act on the co)nmunity 
 is a whole and stimulate it to provide a pro})er fire department, proper 
 niilding laws, etc. In the same way the life insurance com])an!es are 
 low advocating that the Government take up the organization and 
 !o-ordination of public health service. 
 
 By arousing the Government of the United States, of the .States 
 md of municipalities to greater activity, the insurance companies 
 rvould reap a large share of the benefit without incurring all tiie cost, 
 [n other words, the insured lives would not have Lo carrv the entire 
 cad. but could induce the taxpayer to do his share. 
 
 To ])e specific, the Insurance Companies may act '\u the following 
 vays : 
 
 1st. By examination and correspondence they may give specific 
 nformation or advice to individual policyholders. 
 
 2nd. They may diffuse existing knowledge of hygiene — es])eci- 
 illy of personal hygiene — among their policyholders. 
 
 .-Jrd. Bv investigation, thev mav discover the ultimate conditions 
 'or optimum vitality and safety. AVith 'the exce])tion of the investi- 
 gations of ^Nletchnikoff, very little scientific work is now being done as 
 o the factors of longevity. 
 
 4th. By resolutions and by personal representation, they may aid 
 n the passage of laws and regulations for ])ublic liealth and safety, 
 n city, state and nation, and in general cooperate with and give stim- 
 ilus to all existing agencies for im])roving human vitality. 
 
 11 
 
Were tlicrc time. I slioiild like to l>() into (i( lails in rct'creiice t;) 
 each of these four sijo-oestions. 1 will, however, confine myself to 
 three s})ecitic sugo-estions to this association as an association. The 
 first is that it a])i)oint a committee consisting of those fittest to con- 
 struct a woi'kahle and detailed scheme for the use of the companies 
 constitntin<>- the association. The second is that the association shall 
 by resolution put itself on record as fuv()rinf>' the establishment of a 
 National Department of Health: and third that it authorize the aj)- 
 pointment of one or more re])resentatives to attend tlie future Con- 
 oressional hearings on Public Health bills. 
 
 This is a commercial country and Congress is influenced by the 
 wishes and argunients of commercial organizations. As an offset to 
 the commercial interest opposed to a Department of Health — the 
 food adulterators and ])romoters of pro])rietary medicines— the sup- 
 port of Life Accident and Health Insurance Companies has 
 been and will be a strong influence. 
 
 President Taft and Ex-President Roosevelt have favored a Bu- 
 reau of Health and both have reaffirmed this advocacy within a month. 
 The medical profession, the Public Health Association, and associa- 
 tions of State and Territorial Boards of Health, scientific, ])hilan- 
 thropic, labor, and grange organizations, and the recent Conservation 
 Congress have advocated the project. It is one of the burning ques- 
 tions of the day and made especiall}^ so by the opposition from the 
 quacks and the quack interests. I trust that this association will join 
 with other insiu'ance organizations in the effort to secure a Depart- 
 ment of Health worthv of the Xation. 
 
 12 
 
Obe^^eTExknsionlfnstilute 
 
 BY 
 
 PROF. IRVING FISHER 
 
 of Yale University 
 
 xMARCH 9, 1914 
 
M 
 
 .i-: 
 
THE LIFE EXTENSION INSTITUTE 
 
 BY 
 
 PROF. IRVING FISHER 
 
 of Yale University, (delivered at tke Annual Banquet 
 of trie Insurance Institute of Hartford, Conn. 
 
 MARCH 9. 1914 
 
THE LIFE EXTENSION INSTITUTE 
 
 II Y 
 
 PROF. IRVING FISHER 
 
 of Yale University, delivered at the Annunl Banquet 
 
 MARCH 9. 1914 
 
 In the history of insurance we find that at first the concep- 
 tion of insurance is restricted to the function of tradin^^ in risks, 
 i. e., selHng for a price (called the premium) the chance of 
 receivinfi^ an indemnity (called the insurance). Later a second 
 function is almost invariably added, that of reducing the risks. 
 Such is the natural and inevitable order of development. 
 
 The plan of reducing risks through prevention has for many 
 years been followed by the various types of insurance companies 
 such as marine, fire, steam-boiler, cyclone, burglary, plate-glass, 
 accident, etc. When applied to life insurance companies the 
 reduction of risks by prevention means the prevention of disease 
 and death among polic}^ holders. The problem for life insurance 
 companies was therefore (1) whether life could be prolonged; 
 (2) whether its prolongation would cost the insurance companies 
 less than it would return. 
 
 As to the first problem, it was once believed that human 
 mortality followed an inexorable law. We now know, however, 
 that the death rate is not the fixed and fatalistic thing it was 
 once supposed to be, but that on the contrary it varies according 
 to many known conditions. The estimates of Finkelburg show 
 that in Europe human life has doubled in the last 350 years. 
 More recent and more reliable figures show that life is lengthen- 
 ing today more rapidly than ever. If we take life tables for 
 different periods for England and France, Prussia, Denmark, 
 Sweden, and Massachusetts, we find that human life lengthened 
 during the seventeenth and eighteenth centuries at the rate of 
 four years per century; that during the first three-quarters 
 of the nineteenth century it lengthened at the rate of about nine 
 years per century; that at present it is lengthening in Europe 
 generally at the rate of seventeen years per century and in Prussia 
 (which is perhaps the home of preventive medicine) at the rate 
 of twenty-seven years per century. For this country the rate can 
 only be judged from the statistics for Massachusetts, which show 
 that life is lengthening by about fourteen years per century, 
 or approximately half of the Prussian rate. 
 
 There is no reason why our lives should not be as long as 
 those of our Swedish and Danish brethern across the sea, just 
 as there is no need that the length of life in India should be, as 
 
it is, only half that of Europe and America. It may be Utopian 
 to expect that a hundred years from now human life in Germany 
 will actually be twenty-seven years longer than it is today, but 
 the fact is that such prolongation will occur unless the present 
 rate of progress be slackened. 
 
 In my report on "National Vitality" for the Conservation 
 Commission I tried to compute the effects on human longevity 
 of preventing each preventable disease, not on the assumption 
 of total preventability, but on the assumption of partial prevent- 
 ability, the degree being conservatively estimated for me by 
 the best medical experts available. The prolongation of life 
 which, at the very lowest, is certainly attainable, has been 
 worked out from each of ninety causes of death. The total was 
 found to be about fifteen years. Undoubtedly this is a low 
 minimum. In selected groups such as apply in life insurance 
 the possible prolongation would be far greater. 
 
 The second problem of the insurance companies is whether 
 or not the prolongation of human life will mean a net gain. By 
 far the larger part of the cost of the insurance business is not 
 management, nor agent's fees, but the cost of mortality and 
 invalidity. It is the right, if in fact, it is not the duty, of any 
 business to reduce its cost. To pare down salaries might not 
 save the policy holder 1% of his premium, but to reduce mor- 
 tality cost might save him many per cent. A dollar saved from 
 reduced mortality will buy a policy holder as much as a dollar 
 returned to him from any other source. If it is wise, just and 
 sound business practice to spend money to guard against 
 impaired lives being insured, it follows that it must be wise, 
 just and sound business practice to spend a reasonable sum 
 annually to keep the policy holder unimpaired as long as pos- 
 sible after he is insured, and for the very same purpose, namely — 
 to prevent a needlessly high mortality average. 
 
 The cost of life conservation where it has been practiced 
 outside of life insurance is often trifling in comparison with the 
 saving attained. For instance, the hook-worm disease in the 
 South impairs the earning power of its workmen by 25% or 50%. 
 To restore this earning power costs, by curing this disease, on an 
 average, less than $1 for each case. The investment of the SI 
 or less is returned to the worker about every working day of his 
 life. Other examples show that the return on investments 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. 
 
 The late Mr. Messenger, suggested that if insurance com- 
 panies should combine to contribute S200,000 a year for the 
 purpose of improving the pubhc health the cost would be one- 
 eighth of 1% of the premiums, and it would be reasonable to 
 expect a decrease in death claims of much more than 1%. Even 
 
this 1% would make a jirofit of more tlian seven times the 
 expense. 
 
 In every life insurance company there is a group of policy 
 holders varying from 3% to 5% of the total, who will accept 
 free medical examinations annually and suggestions as to disease 
 prevention, if the company chooses to supply this life saving 
 service. It is obvious, expecially in view of the favorable mental 
 attitude of these people, that to bring them under health exami- 
 nations and suggestions will result in lowering the mortality rate 
 in that group. 
 
 Nor is it difficult to understand why the cost of this service 
 is readily recovered when we consider how very few lives it is 
 necessary to prolong in order to cover the expense even in a 
 large group. For instance, at a flat rate of $3.00 each the medical 
 examination of a group of 5,000 people annually would cost 
 S15,000. With the average policy at $2,000 the cost of this 
 service would be saved in interest alone, if each life were extended 
 an average of eleven days. That this is far within the limits of 
 reasonable probability is apparent when we note that the entire 
 cost would be thus covered by the prolongation of but 30 lives 
 out of the entire 5,000 examined in varying ratios, e. g., one Hfe 
 being prolonged twenty years ; two, fifteen years; four, ten years; 
 six, five years; seven, three years; and ten, one year. This refers 
 to the one item of interest. The premium saved on these 30 lives 
 would amount to more than $5,000. 
 
 Bright's disease and other kidney affections alone cost 
 90,000 lives annually. At least 70% of these lives could be saved 
 or prolonged if these insidious diseases could be detected in their 
 incipiency. And it is a matter of common knowledge that 
 health examinations would readily detect their presence in time 
 to arrest or cure them. Health examinations would prolong 
 enough lives menaced by kidney diseases alone to pay the cost 
 several times over of the periodical health examinations by 
 insurance companies, and the same may be said of heart disease, 
 arterial degeneration and other chronic maladies that can be 
 detected in their early stages by blood pressure tests and other 
 diagnostic methods. In one of the older companies 43% of the 
 deaths were due to these diseases (of the heart, etc.) and 42% 
 of the applications rejected are charged to evidences of these 
 same maladies. The same ratio doubtless holds good in all 
 excepting the younger companies. 
 
 The conclusion seems safe that there is a rich unexploited 
 field for saving money. And the beauty of it is that these gains 
 bring with them gains far more precious to the nation than 
 dollars — immeasurable gains of longevity, vitality, efficiency 
 and happiness. The life insurance company that endeavors 
 to reduce sickness and to prolong life renders the very highest 
 form of human service, and wins the warm approval and support 
 of its poHcy holders and of the pubHc. 
 
6 
 
 The life insurance companies have at last begun to move in 
 this direction. In a short time the movement promises to be 
 general. This will, I believe, mark one of the greatest steps, if 
 not the greatest step, ever taken toward the improvement of 
 human longevity. 
 
 As far back as 1905 the Loyal League, a fraternal company, 
 opened a sanatorium for policy holders who should contract 
 tuberculosis. The Modern Woodmen opened a similar sanato- 
 rium in 1908. Other fraternal companies have done the same. 
 The Metropolitan was the first old line insurance company to 
 enter this field of welfare work, having established a welfare 
 department under Dr. Lee K. Frankel in 1909. In the same year 
 the Provident Savings, later merged into the Postal, opened a 
 health bureau. This was the first to undertake the work of 
 medical re-examinations of policy holders, a work which will 
 now be continued for this company as for others by the newly- 
 formed Life Extension Institute. The Metropolitan established 
 a sanatorium in 1911, and a District Nurse Service about the 
 same time. The Equitable has had a conservation department 
 for four years under a conservation commissioner, Mr. E. E. 
 Rittenhouse. The Association of Life Insurance Presidents has, 
 since 1909, had a committee on health which has sought in 
 particular to secure the enactment of better state laws governing 
 vital statistics. 
 
 The Life Extension Institute is specially organized and 
 equipped to supply an effective life-saving service to life insur- 
 ance companies at a cost much lower than they could possibly 
 operate such a comprehensive service themselves. Briefly, this 
 service consists of health examinations arranged by the Institute 
 to detect disease in its early stages, when it can be checked or 
 cured, and of an educational program to increase physical 
 efficiency by promoting healthful living and protection against 
 disease. It will deal solely with prevention. Treatment will be 
 left to the family physician. The specific plan regarding life 
 insurance companies will be the forming of contracts with such 
 companies to offer examinations to certain groups of their policy 
 holders at regular intervals. 
 
 The Directors of the new Institute are: Ex-President Taft, 
 who, since his experience with tropical hygiene in the Philippines 
 and Panama, has been an enthusiast on the possibilities of modern 
 scientific hygiene; Harold A. Ley, the originator of the plan; 
 Prof. Irving Fisher; Frank A. VanderHp, President of the 
 National City Bank of New York; E. R. L. Gould, originator of 
 the Model Homes Association; Francis R. Cooley, of Hartford; 
 and Henry H. Bowman, banker, of Springfield, Mass. Dr. 
 Eugene L. Fisk, the well known writer and worker in hygiene, is 
 Medical Director. The Hygiene Reference Board, which will 
 direct the hygienic policy of the company, contains many emi- 
 nent names, such as Colonel Wm. C. Gorgas, Surgeon General, 
 
U. S. A.; Dr. Rupert Blue, Surs^con General. U. S. P. II. S.; 
 Dr. Harvey W. Wiley, Director, Hureau of Foods, Sanitation 
 and Health, "Good Housekeeping Magazine"; William J. Harris, 
 Director of Census, Washington; Dr. George Blumer, Dean, 
 Yale Medical School; Dr. David L. Edsall, Professor, Clinical 
 Surgery, Western Reserve University; Dr. J. H. Kellogg, 
 Superintendent, Battle Creek Sanitarium: Dr. Victor C. Vaughn, 
 President of the American Medical Association; Dr. Russell H. 
 Chittenden, Professor of Physiological Chemistry; Director, 
 Sheffield Scientific School, Yale University; Dr. William H. 
 Welch, Professor of Pathology, Johns Hopkins University, and 
 President, Maryland State Board of Health; Miss Mabel T. 
 Boardman, Chaimian, American Red Cross National Relief 
 Board; Dr. WicklifTe Rose, Director, Rockefeller Sanitary 
 Commission, etc.; Hon. Walter H. Page, Ambassador to Eng- 
 land; Dr. Alexander Graham Bell, of the Board of Scientific 
 Directors, Eugenics Record Office. 
 
 No single company or group of companies could secure for 
 this purpose the service of such a group of philanthropic, busi- 
 ness and scientific men as have volunteered to serve on the 
 Hygiene Reference Board and as Directors of the Institute. 
 This board is already actively at work on its literature and 
 policy. 
 
 The advantage of the Life Extension Institute over single 
 companies lies in the fact that in serving a number of companies, 
 the Institute is able to relieve each of the burden of administra- 
 tion and much of the cost thereof. As an expert salaried stafT is 
 developed in the larger centers, it will be possible to reduce the 
 cost of the service and a further reduction can be effected by the 
 avoidance of duplicate examinations among those insured with 
 a number of companies having contracts with the Institute. 
 Evidently it would be a saving to life insurance companies if 
 examinations of appHcants had been made through one organi- 
 zation. It may be too late now to change the present plan of 
 separate examinations, but this economy can certainly be 
 efTected with health examinations by adopting the combined 
 service plan at the start. The companies do not need to fonn a 
 central bureau. It exists ready to their hand. 
 
 We have already made contracts with a few life insurance 
 companies and commercial organizations to examine policy 
 holders and employees and have approached some organizations 
 in Hartford. It is expected that several of the Hartford com- 
 panies will enter into contract with the Life Extension Institute, 
 but in most cases the matter has not yet progressed to the point 
 where a definite statement can be made. The Connecticut 
 General, however, has definitely promised a contract with the 
 Life Extension Institute to examine all policy holders of over 
 five years' standing. 
 
8 
 
 The Life Extension service of the Institute, beside that 
 offered to policy holders in companies contracting with it, 
 includes provision for health examinations for individuals 
 applying directly, for schools, for members of clubs and similar 
 organizations, for employees of business enterprises. That is, 
 the Institute stands ready to contract with any individuals, or 
 groups of individuals to furnish periodic examinations, supple- 
 mented by regular health bulletins. To put it briefly — the 
 Institute will offer the general public a practical life saving 
 service. 
 
 The Institute is primarily a philanthropic organization. In 
 order that its service to humanity may be continuous and its 
 existence perpetuated without the aid of charitable contributions 
 the Institute has been organized as a self-sustaining philanthropy. 
 The charges of the Institute are put at the lowest possible point. 
 Two-thirds of any profits above a small rate of interest will be 
 applied to public use in life extension work in preventive fields 
 that a life insurance company itself cannot enter. With the 
 exception of the active administration officers the gentlemen on 
 the Board of Directors and the Hygiene Reference Board donate 
 their services to the Institute as a contribution to human wel- 
 fare. One special province of the Institute will be to study and 
 promote personal hygiene as distinct from public hygiene. Today, 
 especially in America, personal hygiene is neglected on all sides. 
 In fact, in the United States, it is nobody's business. The duty 
 of making a systematic and scientific study of personal hygiene 
 falls neither to government officers, private institutions, or 
 individuals. 
 
 Another most important function from the viewpoint of 
 public service which the Life Extension Institute will perform 
 is in more promptly introducing new advances in hygiene. It 
 will be able to crystalize the best opinion in one authoritative 
 statement that will reach every physician in the country and 
 which every physician in the country will respect from the 
 character of the men sending it forth. 
 
5' 
 
 NGRESS I SENATE 
 
 f D(kl;.mi:.nt 
 ^d Session f ox:.i.-.^YXi. < j^t^^_.j|,, 
 
 NATIONAL VITALITY 
 
 ITS AVASTES AND CONSERVATION 
 
 By 
 IRVING FISHER 
 
 Extract from Report of the National Conservaiion Commission 
 
 (Senate Document No. 676, Vol. Ill, Sixtieth 
 
 Congress, second session) 
 
 
 PRESENTED BY MR. OWEN 
 
 March 8, ISHO. — Ordered to be printed, with illustration 
 
 WASHINGTON 
 
 GOVERNMENT PRINTING OFFICE 
 
 1910 
 
NATIONAL VITALITY, ITS WASTES AND CONSERVATION. 
 
 By Ievinq Fisheb, 
 Professor of Political Economy, Yale University. 
 
 ACKNOWLEDGMENTS. 
 
 The materials upon which this report is principally based were 
 collected during the last ten years. They are far from complete, and 
 I had expected to make use of them at my leisure for a series of 
 special articles, but the opportunity which suddenly presented itself 
 of utilizing them in the construction of this report was one which 
 could not be resisted, despite the fact that the time available was 
 only three months. In the endeavor to make the best use of this 
 time I have been compelled in some cases to rely on secondary 
 sources of information. The number of such cases has been greatly 
 reduced, however, through the kindness of colleagues, friends, and 
 correspondents who were appealed to for suggestions, criticisms, and 
 supplementary material. I am greatly indebted to Prof. Lafayette 
 B. Mendel, of the Sheffield Scientific School of Yale University, for 
 helpful comments and detailed criticism of the whole report, and 
 especially of those parts relative to the physiology of nutrition; to 
 Prof. Yandell Henderson, for many helpful suggestions; to Prof. 
 Henry W. Farnam, for suggestions regarding the topics of industrial 
 conditions; to Prof. M. V. O'Shea, of the University of Wisconsin, 
 for carefully revising the major part of the section on school hygiene; 
 to Dr. Charles Wardell Stiles, Chief of the Division of Zoology, 
 Hygienic Laboratory, United States Public Health and Marine- 
 Hospital Service, for information on the extent and burden of the 
 hook-worm disease; to Surg. Gen. Robert M. O'Reilly, of the United 
 States Army, for statistics of army hygiene; to Dr. Prince A. Mor- 
 row, of New York City, and to Prof. C. R. Henderson, of the Uni- 
 versity of Chicago, for carefully prepared notes in regard to " the 
 social evil." 
 
 I am indebted to Dr. Herbert E. Smith, dean of the Yale Medical 
 School, for general criticism; and to his colleagues. Profs. Joseph M. 
 Flint, George Blumer, H. L. Swain, and Oliver T. Osborne, for 
 criticism and aid, both general and special. 
 
 Among the many others who have rendered very valuable assist- 
 ance I would especially mention Dr. J. H. Townsend, secretary Con- 
 necticut state board of health; Dr. Cressy L. Wilbur, Chief of 
 Division of Vital Statistics, Bureau of the Census; Col. W. C. 
 Gorgas, chief sanitary officer. Isthmian Canal Commission ; Dr. J. N. 
 Hurty, secretary of the state board of health of Indiana ; Dr. Charles 
 V. Chapin, city health officer. Providence, R. I. ; Dr. George H. Sim 
 mons, of Chicago, secretary of the American Medical Association;, 
 Dr. J. N. McCormack, lecturer of the American Medical Association;] 
 Dr. William J. Mayo, formerly president of the American Medical' 
 Association; Dr. Henry P. Walcott, president Massachusetts state 
 «20 
 
 I 
 
riSHEE.] NATIONAL VITALITY. 621 
 
 )onrd of health; Prof. F. F. Wesbrook, dean of the Medical School 
 )f the University of Minnesota; Dr. Henry B. Baker, ex-secretary 
 Vlichigan state board of health; Dr. "William C. AVoodward, health 
 )fficer of the District of Columbia; Dr. (ieorge M. Kober, dean of 
 Georgetown Medical College; Dr. Norman E. Ditman, of Columbia 
 ■Jniversity; Dr. J. H. Kellogg, superintendent of the Battle Creek 
 Sanitarium, and his assistants, Dr. J, T. Case and Dr. W. H. Riley; 
 Dr. Ixichard C. Newton, of Montclair, N. J.; Dr. Luther H. Gulick, 
 )f New York City; Dr. W. G. Anderson, director Yale gymnasium; 
 3r. Charles H. Castle, of Cincinnati, Ohio; Dr. J. P. C. Foster, of 
 >Iew Haven ; Prof. Russell H. Chittenden, director of the Sheffield 
 Scientific School of Yale University; Leo F. Rettger, assistant pro- 
 cessor of hygiene, Yale University; Dr. George M. Gould, of Ithaca, 
 ^. Y. ; Dr. Helen C. Putnam, of Providence, R. I.; F. B. Sanborn, 
 if Cambridge, JNLass. ; Hiram J. Messenger, actuary of the Travelers 
 insurance Company, Hartford; Mrs. Ellen H. Richards, of the 
 klassachusetts Institute of Technology; Mrs. Frank P. Kinnicutt, of 
 •^ew York City; and William H. Tolman, of the Museum of Safety 
 ,nd Sanitation, New York City. 
 
 To the help received from these persons will be due in large measure 
 whatever of value this report may have. I could not, single-handed, 
 lave done justice to even a portion of the subject. Except for a few 
 tatistical monographs and papers cited in it, I have contributed 
 ittle original material. It has been my task to interpret material 
 irought together from many sources. Despite all the aid received, I 
 m aware that the report abounds in sins of omission. Great pains 
 save been taken to avoid those of commission. Doubtful material 
 las been eliminated so far as possible, and where exact ligures were 
 mobtainable, every eifort has been made to see that the statements 
 aade should be cautious and conservative. 
 
 For aid in the difficult work of incorporating into the manuscript 
 he numerous suggestions received, I am indebted to Profs. J. Pease 
 Wton, William B. Bailey, Fred R. Fairchild, and Dr. L. W. Zart- 
 aan, of the economic department of Yale University; and to Dr. 
 L M. Scarborough, of the Yale Medical School, and Dr. F. B. 
 jtandish, of New Haven. For criticisms on the form of presenta- 
 ion, I am indebted to Mr. Edwin Bjorkman, of New York City; 
 Mr. ]\Iichael Williams, of Oak Bluffs, Mass. ; and to Mr. Herbert 
 L. Smith, of the U. S. Forest Service. 
 
 I wish to thank the Interstate Commerce Commission and Prof, 
 lenry C. Adams, the statistician of the commission, for temporarily 
 'etailing Mr. Julius H. Parmelee, a member of the Statistical Division 
 f the Interstate Commerce Commission, to the work of compiling the 
 laterial gathered from various sources. Mr. Parmelee has brought to 
 is work an unusual equipment. His studies have been not only in 
 tatistics, but also in hygiene. Added to his knowledge he has en- 
 husiasm for the subjects covered and a keen appreciation of their 
 nportance. The aid which he has rendered has been much more 
 urn that of mere calculator and compiler. His ability, thoughtful- 
 ess, and self-sacrificing devotion have resulted in painstaking work 
 f a high order, without which the report could not have been written 
 1 the allotted time. 
 
 Irving Fisher. 
 Yale University, November, 1908, 
 
I 
 
 SUGGESTIONS FOR READERS. 
 
 In crder that this report may be read and used as widely as pos< 
 sible, it has been arranged with reference to five classes of readers: 
 
 1. The " Contents by sections," the index, and the page headingji 
 will facilitate the use of the report for reference purposes. 
 
 2. The " Abstract " is chiefly intended for those who have no time 
 to read more. 
 
 3. The " Summary " is a somewhat fuller resume. 
 
 4. The " Summary" is also designed to enable those who so desin 
 to read some parts of the report more fully than others. To this end 
 the " Summary " is arranged to correspond to the main report, chap- 
 ter by chapter and section by section. The reader who, after reading 
 any particular part of the " Siunmary," wishes to read the corre-' 
 sponding part of the main report has only to turn to the chapter oi 
 section having the same number. j 
 
 5. Those who read the entire report will probably prefer to read 
 the "Summary" or "Abstract" last. 
 
 t>22 
 
ABSTKACT. 
 
 The prolilem of conserving natural rosonrees is only one part of the larpor 
 proltleui (if ('(lusi'rv iii^: national ellicieney. The other jiart relates to the vitality 
 )f onr iiopulation. The two jiarts are closely interwoven. Protection against 
 iilning aeciilents, forest tires. Hoods, or pollution of streams prevents not only 
 OBS of proi)erty, but loss of life. The prevention of disease, on the other hand, 
 ncreasos economic productivity. 
 
 So far as we can compare vital and physical assets as measured by earning 
 30wer. the vital assets are three to five times the physical. The facts show 
 :hat there is as great room for imiirovement in our vital resources as in our 
 ands. waters, minerals, and forests. This improvement is possible In respect 
 )Oth to the length of life and to freedom from disease during life. 
 
 Contrary to common impression, there is no iron law of mortality. Recent 
 statistics for India show that the average duration of life there is less than 
 :wenty-five years. In Sweden it is over fifty years, in Massachusetts forty-five 
 rears. The length of life is increasing wherever sanitary science and prevent- 
 ive medicine are applied. In India it is stationary. In Europe it has doubled 
 n three and a half centuries. The rate of increase during the seventeenth and 
 jighteenth centuries was about four years per century, during the first half of 
 he nineteenth century about nine years per century, during the latter half of 
 he nineteenth century about seventeen years per century, and in Germany, 
 vhere medical and sanitary science has reached the highest development, about 
 :weuty-seven years per century. The only comparative statistics available in 
 :his country are for Massachusetts, w^here life is lengthening at the rate of 
 ibout fourteen years per century, or half the rate in Germany. 
 
 There is no need, however, of waiting a century for this increase. It could 
 >e obtained within a generation. Thx-ee-fourths of tuberculosis, from which 
 50,000 Americans die annually, could be avoided. Eighteen experts in various 
 liseasos, as well as vital statisticians, liave contributed data on the ratio of 
 )reventability of the ninety different causes of death into which mortality 
 nay be classified. From these data it is found that fifteen years at least could 
 >e at once added to the average human lifetime by applying the science of 
 )reventing disease. More than half of this additional life would come from the 
 )revention of tuberculosis, typhoid, and five other diseases, the prevention of 
 vhich could be accomplished by purer air, water, and milk. In Lawrence, 
 dass., after the installation of a pure-water supply, the death rate from typhoid 
 vas reduced by 80 per cent. For every death thus saved from typhoid, two 
 If three deaths are saved from other diseases. 
 
 Judging from the English statistics of illness, we must conclude that at all 
 Imes in the United States about 3,000,000 persons are seriously ill, of whom 
 ibout 500,000 are consumptives. Fully half of this illness is preventable. 
 
 If we appraise each life lost at only $1,700 and each year's average earnings 
 or adults at only $700, the economic gain to be obtained from preventing pre- 
 'entable disease, measured in dollars, exceeds one and a half billions. This 
 ;ain, or the lengthening and strengthening of life which it measures, can be 
 ecured through medical investigation and practice, school and factory hygiene, 
 estriction of labor of women and children, the education of the public in both 
 uihlic and private hygiene, and through improving the etBciency of our munic- 
 l»al, state, and national health service. Our National Government has now 
 everal bureaus exercising health functions, which only need to be concentrated 
 mder one department to become coordinated parts of a greater health service 
 ^Forthy of the nation. 
 
 623 
 
SUMMARY. 
 Summary of Part I. — Lensjtii of life versus mortality. 
 
 SUMMARY OF CHAPTER 1 — THE LENGTH OF LIFE. 
 
 Section 1. In different places. — President Roosevelt has pointed out that th( 
 problem of conserviug our natural re'sources is part of another and greater prob 
 lem — that of national efficiency. This depends not only on physical environuieni 
 but on social environment, and most of all on human vitality. Modern hygiene 
 is the reaction against the old fatalistic creed that deaths inevitably occur at : 
 constant rate. The new motto is that of Pasteur: "It is within the power o 
 man to rid himself of every parasitic disease." 
 
 It was once believed that human mortality followed an " inexorable law.'. 
 Facts, however, show that mortality varies in different places and is decreasing 
 as hygiene comes into use. The length of life in Sweden and Denmark is ove: 
 fifty years; in the United States and England about forty-five; in India less thai 
 twenty-five. 
 
 Sec. 2. At different times. — In Europe, according to one authority, the lengtl 
 of life has increased in three hundred and fifty years from less than twenty ti 
 about forty years; in England, in less than half a century, it has increased abou 
 five years'; in Prussia, in the last quarter of a century, over six years; h 
 America it has also increased, although good life tables are lacking exceptinj 
 for insurance experience. The tables for Massachusetts for 1893-1897 show ai 
 average duration of life in that State of forty-five years, as compared with fortj 
 in 1855, and thirty-five, an estimate of 1789, based, however, on doubtful returns 
 
 SUMMARY OF CHAPTER II — THE MORTALITY RATE. 
 
 Section 1. — Relation of longevity to mortality.— Ks duration of life increases 
 the death rate decreases. A death rate is the ratio of the number of deaths ii 
 a year to the population. Under normal conditions where the population i; 
 " stationary " — that is, neither incx-easing nor decreasing nor subject to immigra 
 tion or emigration — the death rate and the duration of life are " reciprocals.' 
 In such a i)opulation, if the death rate is 20 per 1,000, the duration of life will b. 
 1,000^20=50 years. 
 
 This relation, however, is disturbed in most countries to-day, and especially ii 
 America, by immigration and emigration and by the birth rate being in exces 
 of the death rate. Nevertheless, death rates, if compared under similar condi 
 tions, furnish a fairly good index of vitality. They vary in different places an< 
 at different times. 
 
 Sec 2. Mortality in various regions. — In the registration area of the Unitec 
 States the death rate is 16.5 per 1,000; in France it is 20; in India 42. In dif 
 ferent States of the United States it varies from 14 in Michigan to 18 in Nev. 
 York. 
 
 Sec. 3. Vrtan and rural mortality. — The death rate is higher in the city thai 
 In the country, and the larger the city the higher the death rate. In Europeai 
 countries among the cities with the highest death rate are Dublin (40) am 
 Moscow (37) ; among the lowest, Frankfort on the Main (16) and Th' 
 Hague (16). 
 
 Sec. 4. Race and condition. — The colored death rate greatly exceeds the white 
 The death rate among the poor exceeds that among the rich, being in Glasgov 
 and Paris over twice as great. 
 
 Sec 5. Mortality historically. — Death rates have been decreasing during sev 
 eral centuries. In London, where now the death rate is only 15, it was durin; 
 the seventeenth and eighteenth centuries 40 to 50. and during 1680 to 1728, f 
 period of pests, it rose as high as 80. Similar reduction has also been experi 
 enced in this country. In Habana the death rate after the American occupa 
 tion fell from over 50 to about 20. 
 
 624 
 
risHEE.] NATIONAL VITALITY. 625 
 
 Sec. 6. Adult and infant mortality. — The greatest reduction has been effected 
 among eliildroii, although thr donth rate is still undoubtedly high. Statistics 
 show that during tht> last thirty years the doath rate up to 50 years of age has 
 decreased, but that beyond DO it has remained almost stationary. 
 
 Sec. 7. Particular diseases. — The mortality from certain special 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 
 1850 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 1SS7, making a reduction of 97 per cent. In Lawrence. Mass., 
 after the public water was filtered in 1S93 the ty])ho id-fever rate fell from 105 
 to 22. Doctor Kober has shown that death rates from typhoid fever are great- 
 est in cities in which the rivers' waters are polluted, the average for these 
 cities being 62, as compared with IS for cities using unpolluted water of 
 Impounded and conserved streams. Doctor Rosenau concludes that any com- 
 muuity having clean water and uninfected milk supply may be free from 
 typhoid. 
 
 Smallpox has greatly decreased since vaccination has been employed. !■ 
 Prussia the death rate per 100,000 from smallpox 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 place.s. The present 
 outcry against vaccination is based on misinformation and on the general rea- 
 soning 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 evils. 
 
 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 transmits this disease. The result of this applied knowl- 
 edge is that the disease has practically disappeared in America. 
 
 Summary of Past II. — Breadth of life versus invalidity. 
 
 SUMMARY OF CHAPTER III — PREVALENCE OF SERIOUS ILLNESS. 
 
 Section 1. Loss of time. — Life is shortened by death and narrowed by inva- 
 lidity. The ideal life, with respect to health, would be free from illness and dis- 
 ability 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. Humboldt main- 
 
 ' tained that he had lived four working lives by retaining a working power double 
 the average for double the average number of years. According to Farr, for 
 
 I 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. 
 
 Sec. 2. Particular diseases. — There are constantly ill in the United States of 
 tuberculosis about 500,000 persons, of whom about one-half are totally incapac- 
 itated, while the remainder are half incapacitated. The causes of various 
 diseases 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 disease 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 number of syphilitics in the United States has been estimated at 2,000,000, 
 
 I though from the nature of the case this figure is chiefly conjecture. The social 
 diseases, syphilis and gonorrhea, are responsible for the existence of a large 
 proportion of defectives of various kinds which fill our institutions. Among the 
 
 I troops in the Philippines the venereal morbidity, during the year 1904, was 297 
 per 1,000, largely exceeding the morbidity from malarial fevers and diarrhea, as 
 22 out of every 1,000 soldiers were constantly ineffective from venereal disease — 
 four times as many as from any other disease. The statistics outside of army 
 and navy service are impracticable, but there is some reason to believe that they 
 might show an even larger morbidity. The social diseases, which certainly art 
 preventable, are one of the gravest of the menaces to national efficiency. 
 
626 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 American railways In 1907-8 killed nearly 11,800 and injured 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. 
 
 SUMMABY OF CHAPTEB IV — PREVALENCE OF MINOR AILMENTS. 
 
 Section 1. Importance of minor ailments. — Minor ailments are far more com- 
 mon 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 experi- 
 ence gives them good opportunity to judge, place the time lost annually for each 
 person from minor ailments at three or more days a year. i 
 
 Sec. 2. PreveniahiUty 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 adequate 
 recreation. 
 
 SUMMARY OF CHAPTEB V — PREVALENCE OF UNDUE FATIGUE. 
 
 Section 1. Strength, endurance, and fatigue. — Strength is measured 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 differ- 
 ent persons in respect to endurance than in respect to strength. Some " well " 
 people become tired by a short walk, while others withstand hours of walk- 
 ing, running, or climbing. 
 
 Sec. 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. 
 
 Sec. 3. Tobacco and fatigue. — Athletes recognize that smoking interferes 
 with one's " wind " or " staying power." " Inhaling " tobacco smoke brings 
 carbon-monoxide directly into the blood stream. It is found that smoking in- 
 creases blood pressure, which fact possibly partly explains the reduction in 
 endurance. 
 
 Sec. 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 intestine, 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 coun- 
 tries, and especially in the United States. Auto-intoxication induces fatigue. 
 The endurance of those using high protein and of those using low protein shows 
 in general, although with some exceptions, that the former 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 
 reduction in protein. 
 
 Sec. 5. Exertion and fatigue. — Oxygen, whether taken naturally or artificially, 
 increases the capacity for exertion. A judicious amount of exercise is per- 
 haps the chief factor in producing the highest state of muscular efficiency. 
 Physical training, comprising exercise and other hygienic measures, will prob- 
 ably make the capacity to withstand great exertion three or four times that 
 possessed by most persons. 
 
 Sec. 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 con- 
 tinual state of overfatigue. It starts a vicious circle, leading to the craving 
 of means for deadening fatigue, thus inducing drunkenness and other excesses. 
 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 sufficiently to compensate the employer for the shorter day. Several 
 
FISHER.] NATIONAL VITALITY. 627 
 
 examples of such a result exist, but the real justification for a shorter work day 
 l8 found in the interest of the race, not tlio eu]])loyer. One coniiKiny, 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, th.it tlie efliciency of the 
 men gi-adually increased, and the days lost per man by illness fell from seven 
 and one-half to five 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. 
 
 Sec. 7. The impuriance of preventing undue fatigue. — The economic waste 
 from undue fatigue is probably much greater than the waste from serious ill- 
 ness. This is because the number of fatigued persons is great enough to more 
 than outweigh the fact that the incapacitation from fatigue is relatively small. 
 Moreover, the relatively slight impairment of elliciency due to overfatigue leads 
 to greater impairment from serious illness. A typical succession of events is, 
 first, fatigue, then " colds," then tuberculosis, then death. Tlie prevention of 
 undue fatigue means the arrest at the start of this accelerating chain of 
 calamities. 
 
 SuMMAEY OF Pabt III. — Methods of conserving life. 
 
 SUMMARY OF CHAPTEB VI — CONSEKVATION THROUGH HEREDITY. 
 
 Section 1. Heredity and environment. — A wise and farsighted economy will 
 lead the nation to conserve its vital i-esources by every possible method. These 
 resources depend on two primary conditions, heredity and hygiene, or conditions 
 preceding birth and conditions during life. In other words, vitality is partly 
 inherited and partly acquired. A sound physical and mental inheritance is a 
 greater asset than the inheritance of extraneous advantages like wealth. Even 
 in the Old World a degenerate nobility in the end receives less respect than a 
 virile middle class. The effort to improve vitality reaches its highest point in a 
 nation when its health ideals affect marriage. 
 
 Sec. 2. Eugenics. — Galton, Pearson, and others are attempting to found the 
 new science of " eugenics," by which is not meant any scheme of general govern- 
 mental interference with marriage, but the gradual establishment in public 
 opinion of fundamental standards. Just as to-day the marriage of brother and 
 sister is unthinkable, Galton suggests that the time may come when aiarriage 
 which obviously promotes degeneration will be equally tabooed. The result 
 would be, not to make marriage more artificial, but less. Health, beauty, and 
 vitality are much more natural objects of youthful admiration than titles or 
 wealth, which now exercise, for the most part, a baneful infiuence on marriage. 
 To lessen the esteem for those false attractions and increase that for natural 
 attractions will tend not only to increase the number of healthy marriages, but 
 to give greater importance to natural and normal love. The effect will bo felt 
 both in bringing about a larger proportion of marriages among the healthy and 
 a smaller proportion among the unhealthy. It will also lead to a partial segre- 
 gation by which the healthy will to a large extent marry among themselves, and 
 thus leave the unhealthy either unmarried or compelled to make alliances in 
 their own class. The result will be, in the struggle for race supremacy, that 
 the healthy, thus separated off from the relatively unfit, will have a distinct 
 advantage both in the number of offspring and in their vitality. 
 
 Sec. 3. Eugenics and laic. — The only government influences which have been 
 seriously suggested by eugenists are two : First, the offering of prizes or 
 bounties to couples who conform to certain standards, in the same way as the 
 French Government has encouraged the increase of its population by offering 
 Inducements to couples of the poorer class who raise seven or more children ; 
 second, to prevent marriage alliances among criminals, paupers, and the feeble- 
 minded. Some laws on these subjects already exist in Connecticut, Michigan, 
 and especially Indiana, where there is a prohibition of marriage of all persons 
 suffering from transmissible diseases. It is also now provided in Indiana that 
 confirmed criminals, imbeciles, and rapists, when it is deemed advisable by 
 experts, shall be unsexed. What such laws might accomplish may be judged 
 from the history of two criminal families, the " Jukes " and the " Tribe of 
 Ishmael." Out of 3,200 descendants from the founder of the "Jukes" through 
 seventy-five years, 310 were professional paupers, who spent in all two thousand 
 three hundred years in poorhouses, 50 were prostitutes, 7 murderers, 60 habitual 
 thieves, and 130 common criminals. The loss of potential usefulness, cost of 
 
628 EEPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 prosecutions, expense of maintenance of Jails, etc., Dugdale estimated to be 
 $1,300,000 In serenty-fiTe years, or over $1,000 for each member of tbe family. 
 All these unfortunate results could have been avoided had the original criminals 
 In this family been sterilized under a law like that of Indiana. 
 
 We have the more agreeable record of excellent human qualities inherited 
 through successive generations in the Darwin, Hohenzollern, and other families. 
 
 SUMMAET OF CHAPTER VII — CONSERVATION THROUGH PUBLIC HYGIENE. 
 
 Section 1. Municipal hygiene. — The benefits of improved heredity can be en- 
 joyed only by future generations. But we of the present day may conserve our 
 vital resources through hygiene, practiced in one or all of three ways — public, 
 semipublic, and personal hygiene. The first refers to governmental regulation 
 of health, the second to the professional or institutional care of health, and the 
 third to the private life of the individual and the family. Every city now has 
 its health board, yet few citizens realize that the protection rendered by these 
 boards is more important than the protection by the police or fire departments. 
 Much as is done by these boards, there is enormous room for improvement, both 
 in making regulations and in enforcing them by the aid of a more enlightened 
 public opinion. The abatements of the nuisance and menace from spitting and 
 from vitiation by smoke are cases in point. Pure air is one of the primary 
 necessaries of life, but only a small fraction of our countrymen actually enjoy 
 this boon. To this end proper drainage and garbage removal and clean streets 
 are needed. The transmission of disease by insects, flies, and vermin needs to 
 be checked. A constant cause of mortality, among infants especially, is an im- 
 pure milk supply. The same danger exists in other dairy products, cream, 
 butter, cheese, and ice cream. In Washington, owing apparently to the enact- 
 ment of a law in 1895 regulating the sale of milk, the death rate from diarrhea 
 and inflammation of the bowels among children under 2 years of age was re- 
 duced from 160 or 170 to 135, then 109, 104, and in 1906 to 97. Similar reports 
 come from many other cities in this country and abroad. 
 
 Sec. 2. State hygiene. — The regulation of the labor of women and children 
 is usually a state matter. It has been suggested by Doctor Stiles that every 
 woman should be allowed once a month to leave a factory without being asked 
 questions or losing wages. The employment of mothers before and after child- 
 birth should be prohibited, as it is now in a number of European countries. 
 This single reform would help greatly to conserve the vitality of the next 
 generation. Child labor in the South is in many cases the lesser of two evils, 
 the other being exposure to the hook-worm disease on polluted farms. In 
 these cases, the abolition of child labor should be preceded by the abolition of 
 hook-worm disease. Hours of labor have been steadily decreasing, and should 
 be decreased further. Accidents are unnecessarily frequent on our American 
 railroads, as well as in industrial establishments. Statistics do not exist for 
 the latter. Special trades have special dangers. Among such trades are those 
 using lead and other dangerous poisonous chemicals, as well as the dust- 
 producing trades which tend to pulmonary troubles. The dark room tenements 
 are a common means in our large cities of depleting national vitality. 
 
 Sec. 3. Federal hygiene. — This includes quarantine, the inspection of im- 
 migrants and exclusion of those with infectious diseases, administration of 
 government hospitals, of pure-food laws and meat inspection, and cooperation 
 with state boards of health in fighting yellow fever, bubonic plague, etc. 
 Federal power needs extension, however. Our interstate railroads should be 
 improved in respect to the sanitation of sleeping cars, smoking cars, etc. 
 
 The movement to secure a more intelligent national organization of health 
 Is now being pushed by the President, President-Elect, and Members of Con- 
 gress, and has found expression in the recent platforms of both political parties. 
 What is needed is that the Federal Government should make the national 
 capital a model of sanitation, should provide for more investigation in health 
 matters and the dissemination of information on the prevention of tuberculosis, 
 etc., should cooperate further with state and municipal authorities, and should 
 check the pollution of interstate streams and prevent the transmission of dis- 
 ease-bearing meats or other food from one State to another. Lastly, It should 
 secure, through whatever constitutional means exist, some method of collecting 
 statistical information as to our national mortality and morbidity. Our short- 
 comings in this respect are now a national disgrace. There is no accurate 
 record of births in any part of the United States, and that of deaths includes 
 less than half our population. As a statistician has said of one of the States, 
 
risHKH-l NATIONAL VTTALrTT. 629 
 
 " It buries Its dead people with no mere ceremony than It bnrles Its dead dof!;s." 
 Obviously, no Intelligent control of epidemics and other diseases can be made 
 unless the facts in regard to those diseases arc known; in other words, unless 
 there exist mortality and morbidity statistics of real value. 
 
 BUMMABT OF CHAPTER \^1I — CONSERVATION THROUGH 8EMIPTJBLI0 HYGIENEL 
 
 Section 1. Medical research and instruction. — Semipublic hygiene comprises 
 that relating to institutions and the medical profession. The hygiene of the future 
 must depend more on discoveries in preventive medicine than on any other 
 single factor, and institutions such as the Tastour Institute, the Rockefeller 
 and the Carnegie institutes, and the research laboratories of the Government 
 and universities offer the most promising means of increasing this most useful 
 and iirnetieal of all linnuin knowledj^e. The knowledge is dispensed through 
 medical schools in the training of physicians. These schools are imijroving so 
 as to introduce more of hygiene and preventive medicine. We are still far, 
 however, from having facilities for training public health oflicers, or giving 
 them such a degree as D. P. H. (diploma of public health), as is given in 
 England. 
 
 Sec. 2. The medical profession. — Antiseptic surgery has in the last century 
 been the greatest triumph of the medical profession, and has given it a greater 
 prestige than ever before. It has greatly reduced the mortality from opera- 
 tions, and is illustrated by the figures in army operations. The mortality of the 
 wounded in the Crimean war among English troops was 15 per cent. The 
 mortality in the Transvaal war, 1000-1901, was less than 6 per cent. 
 
 In the practice of medicine, the tendency is progressively to give up the use 
 of violent drugs and to depend more on hygiene. Through the modern fight 
 against tuberculosis, physicians have come to prescribe fresh air in their prac- 
 tice generally. They are now turning in like manner to exploit the resources 
 of diet, exercise, bathing, and mental hygiene. 
 
 There is danger that these new fields will be preempted by quacks. Many 
 quacks to-day, far from using patent medicines, oppose the use of any drugs 
 whatever. In order that modern hygiene shall be applied by trained physicians, 
 it is necessary that they provide more facilities in this direction. The leaders 
 of the profession are making every effort to raise all members of their profes- 
 sion to their own high standard. This standard not only aims to prevent mal- 
 practice and unethical operations, but to set an example to the people in public 
 service and in personal hygienic living. 
 
 Sec 3. Institutional hygiene. — Hospitals have done much to prevent disease 
 by segregating infectious cases. Institutions for the deaf and blind and other 
 defectives have led to a better utilization of their powers. Institutional care of 
 the insane has done much, too, but can do more. Mental hygiene as a whole needs 
 to be more carefully studied and taught in all its relations — heredity, alcohol, 
 syphilis, and environment. 
 
 The modern sanitarium has become a useful institution for prevention of 
 serious illness, as distinct from the hospital, of which the function has been to 
 cure. Department stores, hotels, and other commercial institutions are install 
 ing ventilating and other hygienic apparatus. The churches are also taking 
 part in the health movement, especially the Emmanuel Church in Boston. 
 
 Sec 4. School hygiene. — The hygiene of school children is especially impor- 
 tant because of its application to human life in its early stages. There is a 
 world-wide movement, led by Switzerland and some other countries of Europe, 
 to obtain and apply knowledge of how to educate the mind without weakening 
 the body. As it is, school children are especially exposed to contagious dis- 
 eases, which under present conditions often sweep through a whole school be- 
 fore the local health board even hears of it. Quite as serious, if not more so, is 
 the protecting of school children from imperfect seating, lighting, ventilation, 
 and sanitation. 
 
 Backward children, with defects of eye, ear, nose, or throat, are numerous, 
 but experiments have shown that the majority could be improved both in intel- 
 lect and in morals. 
 
 In respect to school hygiene, it is not so much lack of knowledge as lack of 
 application of knowledge which is at fault. In order to find and then correct 
 defects of eyes, ears, teeth, etc., and properly apply our knowledge, medical 
 Inspection is necessary. Such inspections as have been made disclose an 
 natonishing amount of ill health, the percentage of morbidity being from 20 to 
 60 per ceat. The committee on physical welfare of school children in New 
 
630 EEPOET OF NATIONAL CONSERVATION COMMISSION. 
 
 York found that 66 per cent needed medical or surgical attention or better 
 nourisbment; 40 per cent needed dental care; 38 per cent had enlarged glands 
 of the neck ; 31 per cent had defective hearing ; 18 per cent had enlarged tonsils. 
 
 Eye strain is a particular evil of civilization, and makes its first appearance 
 In school when the scholar tries to accommodate the eye to the short range 
 which reading requires, but for which the eye mechanism is not well adapted 
 by nature. The evil effects of eye strain are not confined to that organ, but ex- 
 tend to the whole nervous system, and indirectly to the whole organism. 
 Doctor Gould, who has made a special study of this subject, goes so far as to 
 maintain that " eye strain is the chief source of the functional diseases of our 
 citizens." 
 
 At present medical inspection Is the exception rather than the rule. Only 70 
 cities in the United States outside of Massachusetts, and 32 cities and 321 
 towns in Massachusetts, have systems more or less complete. New York em 
 ploys 150 physicians, who visit each public school once a day to examine chil- 
 dren set aside for that purpose by the teacher. In Providence a fresh-air 
 school for children suffering from tuberculosis has been established. The cost 
 of the school per capita is about 50 per cent more than the ordinary schools, 
 but the results justify the expenditure. 
 
 Our scholars are being seriously injured by nervous overstrain. Probably 
 this is not because too much work is being required, but because the perform- 
 ance of this work is not accomplished economically. Some experiments seem 
 to indicate that children could accomplish as much intellectually with far less 
 dissipation of nervous energy if they were in the schoolroom about half of the 
 time now spent there. High pressure and long hours are bad economy in 
 schools as in factories. 
 
 Playgrounds conserve child vitality and are far superior to formal gymnastics. 
 They provide physical training which accords with child instincts, and keep the 
 child out of mischief and often out of jail. Here, as elsewhere, the suppression 
 by civilized and urban life of the instinct for play and amusement is re- 
 sponsible for much of what we call " crime " and " depravity." In school children 
 should not only be surrounded by hygienic environment, but should be taught 
 the value of hygiene. The suggestion of an annual " health day " or " health 
 week " may prove a fruitful one for this purpose. 
 
 Sec. 5. Voluntary and business organizations. — Societies to prevent the spread 
 of tuberculosis, social diseases, insanity, etc., or to advocate labor or health 
 legislation (state and national), are now numerous and active. It is being 
 found that philanthropy and profit are not always antagonistic. Labor organi- 
 zations are connecting the health movement with the eight-hour movement. 
 Farsighted employers are providing social secretaries to watch over the health, 
 comfort, and happiness of their employees, and are often eager for practical 
 suggestions in these matters. 
 
 Coi-porations that have installed apparatus for ventilation and sanitation, 
 even sometimes for the benefit of their machinery rather than their employees, 
 have in known instances gotten back the cost in lessened illness and greater 
 efficiency of work. 
 
 An interesting experiment near Paris was that of a mill employing 44 men 
 and 75 women and children. Largely through the services, instruction, and 
 suggestions of a medical officer there was not a single death in three years. 
 
 The temperance reform has to-day a powerful impulse in the demands by 
 employers for more efficient labor and by the public for greater safety in 
 travel. Locomotive engineers, conductors, and ship captains who drink can not 
 get employment. 
 
 Life-insurance companies may possibly in the future realize their opportunity 
 to make financial gains by participation in the health movement. 
 
 Finally, one of the greatest potential agencies for bringing about health re- 
 form is the public press. It is already interested and active in the movement, 
 although the good it does is often undone by inserting quack advertising. This 
 not only does direct harm, but often ties the hands of the editor, preventing 
 him from expressing any disapproval of nostrums, however injurious or 
 immoral. 
 
 SUMMABY OF CHAPTER IX CONSEEVATION THROUGH PERSONAL HYGIENE. 
 
 Section 1. Its importance. — Personal hygiene i.. not only of direct importance 
 to the individual, but furnishes the public opinion from which, and from which 
 alone, sound public and semipublic hygiene can spring. Public hygiene will be 
 
»I8H«.] NATIONAL, VITALITY. 631 
 
 Ineflfectlve unless supported by personal hygiene. The milk nnd water sTip]ily of 
 a city may be ideal as supplitHl at a dwelling;, but may be carelessly contami- 
 nated there. Observation shows that many of the world's most vital men and 
 women have practiced hygiene and often thereby turned weak constitutions 
 Into strong ones. Cornaro, the Venetian nobleman, about to die at 37, adopted 
 the " temperate life," taking especial care not to overeat.. He lived to be nearly, 
 or quite, 100. 
 
 Sec. 2. Brnnvficn of personal hygiene. — Personal hygiene comprises hygiene 
 of environment (air, soil, dwellings, clothing), hygiene of nutrition, and hygiene 
 of activity. The ideal conditions of health require purity in air, purity and 
 |)roi)er use of food, and a proper balance between mental and physical activity, 
 rest, and sleep. The present world-wide interest in personal hygiene and 
 physical education is not due to any startling discoveries, but to the rediscovery 
 of the importance of truths long insisted upon by the medical profession. 
 
 Sec. 3. The hygiene of environment. — The prime factor in environment is the 
 atmosphere. Originally man was doubtless an outdoor animal. Civilization has 
 brought him an indoor environment, and with it tuberculosis. Experiments In 
 hospitals have shown that the agitation of the air by dry sweeping greatly 
 increases bacteria. Air in a confined room may be contaminated by chemicals 
 contained in wall paper, plaster, or mortar. The one place In which the indi- 
 vidual has most control over his air supply is the bedroom. The fashion now of 
 sleeping with wide-open windows, or even out-of-doors, is certain to improve 
 American vitality. The windows of living and work rooms also may be open 
 even in winter if a window board is used to deflect the air upward and prevent 
 a cold stratum forming on the floor. The outdoor life or the abundant use of 
 fresh air is an almost certain preventive of colds. This fact was commented 
 upon by Franklin over a century ago, and has been rediscovered many times 
 since, especially in the experience of army troops. The evils of bad air are not 
 confined to its chemical content. A room is sometimes " close " simply because 
 it is hot or overmoist or devoid of any air current. 
 
 The effect of air on the skin and of radiation of heat from the body is im- 
 portant. Consequently, a proper use of air involves a proper use of clothing, 
 which needs to be both porous and light. 
 
 Closely connected with air hygiene is the hygiene of light. "Where sun and 
 air enter seldom the physician enters often." The lighting of dwellings and 
 schoolrooms is especially important with reference to the eyes. This is true also 
 of even the color and texture of the printed page we read. Probably one-fourth 
 of all educated people in America suffer from disturbances due more or less to 
 eye strain and its numerous indirect effects. 
 
 Sec. 4. The hygiene of nutrition. — ^The scientific study of diet has only just 
 begun, and few authoritative results can yet be stated. That diet has a dis- 
 tinct relation to endurance has been rendered probable by many investigations, 
 which seem to show in particular that avoidance of overeating, and especially 
 of excess in protein, and thorough mastication are wholesome rules. In the 
 choice of foods the individual must be given a wide latitude. His own instinct, 
 restored and educated by avoiding food-bolting which blunts it, will probably 
 be a truer guide than the wisest of physiologists. Diseased foods, such as 
 oysters polluted with sewage, may transmit typhoid and other maladies. 
 
 Sec. i. Drug habits. — Poisons, whether taken into the body or produced 
 within, are injurious. The commonest form of intoxication is alcoholic. Its 
 evils are becoming more apparent than ever before. As Metchnikoff says, it 
 lowers the resistance of the white corpuscles, which are the natural defenders 
 of the body. It predisposes to tuberculosis and numerous other diseases. 
 The findings of the " Committee of Fifty " for the investigation of the liquor 
 problem are important evidence of the evils of the use of alcohol, and these 
 have not received the attention which they deserve. Absinthe in France is 
 being recognized now as a distinct menace to the nation, and in Germany 
 there is a tendency toward a lessened use of alcohol in all its forms. But the 
 movement against the abuse of alcohol has reached its highest point in 
 America. 
 
 The evils of tobacco are less and are less appreciated. Its stunting effects 
 on the growing child are especially harmful. 
 
 Sec 6. Activity hygiene. — It is an encouraging sign of the times that baths 
 are coming more into vogue, both through the private bath tub for the wealthy 
 and the public baths for the poor. During the last generation the importance 
 of exercise has come to be acknowledged, due largely to the growth of modern 
 athletics. The athletic ideal of the Greeks was, however, higher than that 
 
632 EEPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 which now prevails in this country. Overexertion, physical and mental, Is one 
 of the chief American faults. The danger signal of fatigue is seldom observed, 
 and the instinct for recreation and amusement is often stifled. 
 
 Sec. 7. Sex hygiene. — Undue reticence on this subject is responsible for the 
 general ignorance as to the extent to which the abuse of the sex relation is in- 
 juring this and every nation, physically, mentally, and morally. Syphilis 
 poisons the blood and affects all parts of the body. It makes the individual a 
 " bad risk " for life insurauce companies for several years, and is likely to be 
 transmitted to others through a kiss or through the use of a common towel, 
 while the danger of transmitting from husband to wife, or vice versa, continues 
 for many years. Syphilis is one of the few really hereditary diseases, and the 
 saddest of all facts connected with it is that the guilty parent may escape and 
 the innocent children suffer. Gonorrhoea, while usually cured without ap- 
 parent impairment of health, destroys fertility, and for years after it has ap- 
 parently ceased may be rearoused. It is responsible for a large number of 
 the cases of infantile blindness and for a larger percentage of many of the 
 serious troubles of women. The social diseases, while seldom assigned as a 
 cause of death, are known to predispose to other diseases and greatly to 
 shorten life. 
 
 Sec. 8. Personal hygiene in general. — The cumulative effect of hygiene, or of 
 lack of hygiene, needs emphasis. Breathing, eating, working, and sleeping are 
 matters of daily habit. If they are wrong, the evil, however slight, being re- 
 peated every day for many years, produces cumulative effects more subtle, but 
 often more powerful, than the effects of sudden infection or accident. 
 
 SUMMARY OF CHAPTER X ARE HYGIENIC MEASURES EUGENIC? 
 
 Section 1. The p7-olongation of toenlc lives. — The question has been raised 
 whether reduction in infant and child mortality will not weaken rather than 
 strengthen the race by interfering with natural selection and favoring the sur- 
 vival of the unfit. It is pointed out that the mortality at later ages of life has 
 not decreased, as has that in the earlier ages. There is probably, however, a 
 sufficient explanation of this in the fact that the improvement in hygienic living 
 has not as yet affected adults as much as children. Parents are quick to apply 
 for the benefit of their children new methods of preventing disease, such as 
 sferilizing milk, but do not take the same precautions for themselves. The 
 hurry and stress of modern life has in fact tended to produce in some respects 
 more unhygienic habits among adults than prevailed under the simpler condi- 
 tions of a generation ago. 
 
 Sec. 2. Children's diseases impair both fit and unfit. — It must be borne in mind 
 also that the same children's diseases and other causes which tend to kill the 
 unfit child also tend to injure the proper development of the fit. Consequently 
 a lessening of children's diseases will have the effect of not only prolonging 
 weak lives, but also of prolonging and developing the strong. Statistics, so far 
 as available, appear to show that where infant mortality is the highest, mor- 
 tality at all ages is high. 
 
 Sec 3. Fitness is relative to environment. — What is sometimes called degen- 
 eration does not deserve that name. A lessening of physical strength, for 
 instance, can not be called degeneration if conditions under civilization do not 
 require the same physical strength as our barbarian ancestors needed. It is 
 adaptation to existing conditions which measures fitness. 
 
 Whatever danger of degeneration there may be from the care of the insane 
 and defective classes can be avoided if the health ideals of the nation are strong 
 and broad enough to meet the situation, for with these high health ideals will 
 come a demand which will prevent the perpetuation of the unfit and through 
 the mere force of public opinion lead in general to healthier marriages. 
 
 Summary of Part IV. — Results of conserving life. 
 
 SUMMARY OF CHAPTER XI — PROLONGATION OF LIFE. 
 
 Section 1. Life is lengthening. — So far as we can judge from statistics of the 
 average duration of life, it has been on the increase for three hundred and fifty 
 years, and is now increasing more rapidly than ever before. During the seven- 
 teenth 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 present in Massachusetts life is lengthening at the 
 
nsHER] NATIONAL VITALITY. 633 
 
 rate of about fourteen years per century; in Europe abont f?eventpen ; and in 
 Prussia, the land of medical discovery and its application, twenty-seven. In 
 India, ^bere medical progress is practically unknown, the life span is short 
 (twenty-five) and remains stationary. 
 
 Sec. 2. Table shoxcing further practicable prolongation. — It is possible to 
 estimate the effect on the length of life of the partial elimination of various 
 diseases. Using the statistics, experience, and estimate of IS 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 infan- 
 tile 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. Broncho- 
 pneumonia, also an infant disease, 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 death by typhoid fever is unnecessary, and if avoided would lengthen 
 life at least 0.G5 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 were reduced only 35 per cent, human life would be 
 Increased by O.SG year. The prevention of 45 per cent of cases of pneumonia 
 would lengthen life by 0.94 year. These seven diseases 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. 
 
 Sec. 3. Diagram showing effect of prolongation at different ages. — If we take 
 the diagram representing the life table of Massachusetts for 1893-1 S97, we may 
 use it as the basis for constructing an ideal curve to show the effect of preven- 
 tion if applied according to the ratios of prevention given in the preceding 
 table. The results agree substantially with those found in the table and show 
 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 
 17* and 60, taken as the working period, would remain the same, namely, about 
 55 per cent. 
 
 Sec. 4. Fifteen years a safe minimum estimate of prolongation possible. — 
 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 preventing cancer 
 and of postponing old age, as would Metchnikoff ; second, it takes little account 
 of the cumulative influence of hygiene. The full benefit of hygiene can not be 
 felt until it is practiced 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 prevents 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 marriages. 
 
 Sec. 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 pro- 
 portion. The result of such a prolongation will be not the keeping alive of 
 Invalids, but the creation of a population containing 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 
 experience to the most complicated and most delicate parts of the social life." 
 
 Sec. 6. The normal lifetime. — It is usually recognized that human 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 abnormal, 
 the normal lifetime must exceed S3. Many remarkable 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 
 
634 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 Portland, Oreg., recently died at 120. To what extent these exceptional case' 
 could be made common can not, as yet, be known. 
 
 BUMMABY OF CHAPTER XII — THE MONEY VAXTTE OF INCEEASED VITALITY. 
 
 Section 3. Money appraisal of preventable wastes. — Doctor Farr has est 
 mated the net economic value of an English agricultural laborer at various tlmt 
 of life by discounting his chance of future earnings after subtracting the co; 
 of maintenance. On the basis of this table we may construct a rough estimal 
 of the worth of an average American life at various ages, assuming that on! 
 three-fourths of those of working age are actually earners of money or housi 
 keepers. It gradually rises from a value of $90 in the first year to $4,200 c 
 the age of 30, and then declines until it becomes negative for the higher age 
 This estimate assumes $700 per year as the average earnings in middle lif 
 This is largely conjecture, but is regarded as a very safe estimate. ApplyinJ 
 this table to the existing population at various ages in the United States, w 
 find that the average value of a person now living in the United States : 
 $2,900, and the average value of the lives now sacrifled by preventable deatl 
 is $1,700. The latter is smaller than the former because the age of the dyiu 
 is greater than the age of the living. Applying the $2,900 to the population c 
 eighty-five and a half millions, we find that our population may be valued ai 
 assets at more than $250,000,000,000 ; and since the number of preventab 
 deaths is estimated at 030,000, the annual waste from preventable deaths ; 
 630,000 times $1,700. or about $1,000,000,000. This represents the annual pr. 
 ventable loss of potential earnings. 
 
 We saw in Chapter III that there are always 3,000,000 persons in the Unite 
 States on the sick list, of whom about 1,000.000 are in the working period ( 
 life and about three-quarters ai'e actually workers and must lose at least $70i 
 which makes the aggregate loss from illness more than $500,000,000. Addin 
 to this another $500,000,000 as the expense of medicines, medical attendanc 
 special foods, etc., we find the total cost of illness to be about $1.000,000,0C 
 per year, of which it is assumed that at least one-half is preventable. Addin: 
 the preventable loss from death, $1,000,000,000, to the preventable loss froi 
 illness, $500,000,000, we find one and a half billions as the very lowest at whic 
 we can estimate the preventable loss from disease and death in this countr; 
 The true figures from the statistics available may well amount to several timf 
 this figure, but when statistics are based partially on conjecture, they need t 
 be stated with special caution. 
 
 Sec. 2. The cost of cons orv at inn. — In Huddersfield the annual deaths of ii 
 fants for ten years had been 310. By systematic education of mothers, tli 
 number in 1907 was reduced to 212. The cost of saving these 98 lives \vi 
 about $2,000, or about $20 each. Gen. Leonard Wood declared that the discovei 
 of the means of preventing yellow fever saves annually more lives than wei 
 lost in the Cuban war. The hook-worm disease in the South impairs tt 
 earning power of its workmen by 25 or 50 per cent. To restore this earnin 
 power costs, by curing this disease, on an average, less than $1 for each casi 
 These and other examples show that the return on investments in health ar 
 often several thousand per cent per annum. Probably no such unexploited o] 
 portunlty for rich returns exists in any other field of investment. An actuar 
 suggests that if insurance companies should combine to contribute $200,000 
 year for the purT)Ose of improving the public health, the cost would be om 
 eighth of 1 per cent of the premiums, and it would be reasonable to expect 
 decrease in death claims of much more than 1 per cent. Even this 1 per cet 
 would make a profit of more than seven times the expense. 
 
 SUMMARY OF CHAPTER XIII — THE GENERAL VALTJB OF INCREASED VITALITY. 
 
 Section 1. — Disease, poverty, and crime. — Money estimates of waste of lii 
 are necessarily imperfect and sometimes misleading. The real wastes can onl 
 be expressed in terms of human misery. Poverty and disease are twin evi^ 
 and each plays into the hands of the other. From each springs vice and crim< 
 Again, whatever diminishes poverty tends to improve health, and vice versa. 
 
 Sec. 2. Conservation of naliiral resources. — The conservation of our naturf 
 resources — land, raw materials, forests, and water — will provide the fooi 
 clothing, shelter, and other means of maintaining healthy life, while the coi 
 servation of health likewise tends in many ways to conserve and increae 
 
risHEB.l NATIONAL VITALITY. Go 5 
 
 wealth. The more vigorous and long-lived the race, the better iitillzntlon It will 
 
 make of its natural resources. This will be true for two reasons in particular: 
 
 First, the greater inventiveness or resouroofulnoss of vij;orous uiltuls in viKnrous 
 
 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 
 
 Iprovides life insurance for his family, so It will be the normal healthy nation 
 
 Iwhch will take due care of its resources for the benefit of gencrutious yet 
 
 i unborn. 
 
 I SUMMABT or CHAPTER IIV THINGS WHICH NEED TO BE DONE. 
 
 ( Section 1. Ku itineration of principal measures. — Federal, stale, and munlclr'al 
 ^boards of health should be better appreciated and supported. Their powers of 
 hnvostigation. administration, and disseminating information should bo en- 
 ilarged. School hygiene should be practiced, and personal hygiene more empha- 
 I sized. The multiplication of degenerates should be made Impossible. 
 
 S. Doc. 419. 61-2 2 
 
INTRODTJCTIOTT. 
 
 At the conclusion of his Wliite House address on the " Conservo 
 tion of Natural Besources," President Roosevelt said : 
 
 Finally, let us remember that the conservation of our natural resources 
 though the gravest problem of to-day, is yet but part of another and greatei 
 problem to which this nation is not yet awake, but to which it will awake in 
 time, and with which it must hereafter grapple if it is to live — the problem ol 
 national efficiency. 
 
 The conditions on which national efficiency depend may be classi- 
 fied under three heads: Those relating to physical environment, 
 those relating to social environment, and those relating to human 
 nature. Under the first head comes the problem of the conservation oi 
 land, forests, minerals, and water. The second comprises social ques- 
 tions, whether political, economic, or religious. The third covers 
 the study of the characteristics of man himself — physical, mental, and 
 moral. 
 
 This report falls under the third head, concerning as it does vital- 
 ity, the measure of life itself, and the basis of all human qualities' 
 The object is to review briefly the condition of American vitality, 
 contrasted with the vitality of other nations; to show the extent to 
 which it may be increased; and to point out the value of such an 
 increase in years of life, enjoyment of life, and economic earnings. 
 
 The world is gradually awakening to the fact of its own improvabil- 
 ity. Political economy is no longer the " dismal science," teaching 
 that starvation wages are inevitable from the Malthusian growth 
 of population, but is now seriously and hopefully grappling with 
 the problem of abolition of poverty. In like manner hygiene, the 
 3^oungest of the biological studies, has repudiated the outworn doc- 
 trine that mortality is fatality, and must exact a regular and in- 
 evitable sacrifice at its present rate year after year. Instead of this 
 fatalistic creed we now have the assurance of Pasteur that " It is 
 within the power of man to rid himself of every parasitic disease,'' 
 as well as the optimistic writings of Metchnikoff and others. 
 
 Many evidences of a world-wide awakening to the importance of 
 improving human vitality can be given. Among them are the recent 
 English parliamentary report of the interdepartmental committee 
 on physical degeneration (prompted by the fact that the English 
 army recruits were decreasing in stature) ; in America, the many 
 societies and congresses to prevent and control tuberculosis, insanity, 
 alcoholism, social diseases' and vice, and infant mortality; the growth 
 of preventive sanatoria, dispensaries, and similar institutions: the 
 establishment of numerous journals of preventive medicine, both 
 technical and popular; the increased attention to the subject of 
 health in the public press; the spread of athletics and the physical 
 training movement; the growth of the custom among city people to 
 636 
 
FisHEr] NATIONAL VITALITY. 637 
 
 orpanize country clubs, and the increasinfj popularity of golf and 
 similar recreations: the constant acritation and U^fjfislation in refer- 
 ence to child labor, slaughterhouses, impure foods, milk supply, and 
 water contamination: the increased vigilance of iiealth boards; the 
 growth of sick-benefit associations and insurance among working 
 men; the efforts toward improving tiie sanitary surroundings and 
 houi-s of labor of workmen, and especially of women and children, 
 and, finally, the movement to secure a national organization of health 
 at "Washington. 
 
 A number of universities are supporting special investigations in 
 physiology, hygiene, and preventive medicine. Some schools also 
 have placed the allied subjects of domestic science and dietetics on 
 their curricula, while physical education is receiving constantly in- 
 creasing attention. Within a generation every important college, 
 school, and branch of the Young Men's Christian Association has 
 ome to have a gymnasium and classes in gymnastics. Research insti- 
 tutions are being established, such as the Rockefeller Institute for 
 Medical Research, the fund established by Mrs. Sage to study dis- 
 eases of old age, and the Memorial Institute for Infectious Diseases. 
 The home-economics movement is rapidly growing and seems destined 
 X) improve greatly the management of xVmerican homes. 
 
 The practice of medicine, which for ages has been known as the 
 'healing art," is undergoing a gradual but radical revolution. The 
 jhange is based on the conviction that an ounce of prevention is 
 svorth a pound of cure. As teachers and writers on hygiene, as 
 :rainers for athletes, as advisers for the welfare departments of large 
 ndustrial plants, and in many other directions, physicians are find- 
 ng fields for practicing preventive medicine. There is a still higher 
 jtage of medical science than that of fighting or preventing disease 
 n the individual — the stage which has been called " biological engi- 
 leering,-' i. e., the study of the conditions under which the individual 
 nay reach his highest efficiency. In the development of this science 
 physicians are turning from private practice to public service and 
 ire acting as health officers in federal, state, and city governments, 
 IS heads of sanatoria and as medical inspectors of schools, factories, 
 nines, and shops. Even the family physician is in some cases being 
 itsked by his patients to keep them well instead of curing them after 
 hey have fallen sick. 
 
 Finally, we have also the suggestion by Sir Francis Galton of the 
 lew science of eugenics, which seeks to study the hereditary condi- 
 ions of human vitality. He has established a research fellowship 
 »n the subject at the University of London. Already Karl Pearson 
 .nd others have made valuable contributions to the study of human 
 legeneration, the effect of tuberculosis on the race, the comparative 
 
 K umber of offspring of various classes, and the extent to which 
 lating is " assortative," so that like marries like. 
 With all these facts in view it requires no great prophetic vision 
 iO see that among the rising generation there will be a great move- 
 aent to conserve human life and health. The power and success of 
 his movement will depend upon the realization of its stupendous 
 mportance. A chief object of this report is, in a conservative and 
 autious manner, to help make this importance clear. 
 
Part I.— THE LENGTH OF LIFE VERSUS MORTALITY. 
 
 Chapter I. — The length of life. 
 
 Section 1. — In different places. 
 
 By those who have never considered the problem, death and disease] 
 are accepted as a matter of course. In individual cases it is recog- 
 nized that a death or an illness might have been prevented, but thei 
 idea that the death rate could be changed in any appreciable degree, 
 or controlled, is quite foreign to the mind of the average man. 
 Charles Babbage wrote: " There are few things less subject to fluctua- 
 tion than the average duration of life of a multitude of individuals." 
 
 If this statement were correct, we should find the average duration 
 of life* and the death rate substantially the same in different places 
 and at different times. The facts do not conform to this view. 
 Modem life tables show that the average length of life in the leadingf 
 countries of the world varies remarkably, as the following figures 
 will illustrate.' 
 
 Modem duration of life. 
 
 Country. 
 
 ilulcs. 
 
 50.9 
 
 50.2 
 
 45.7 
 
 44.1 
 
 44.1 
 
 42.8 
 
 41.0 
 
 23.0 
 
 Females. 
 
 Sweden, 1891-1900 
 
 Denmark, 1895-1900 
 
 France, 1898-1903 
 
 England and Wales, 1891-1900 
 
 United States (Massachusetts, 1893-1897) « 
 
 Italy, 1899-1902 
 
 Prussia. 1891-1900 
 
 India, 1901* 
 
 53.6 
 ,53. 2 
 49.1 
 47.7 
 46.6 
 43.1 
 44.5 
 24.0 
 
 • Samuel W. Abbott, M. D. : " Vital Statistics of Massachusetts for 1897," Thirtieth 
 Annual Report of the State Board of Health of Massachusetts, 1898. 
 
 * Statistiques Generale de la France: Statistiques Internationales, etc., 1907, p. 566. 
 See also J. A. Balnes, " The Peradventures of an Indian Life Table," .Tournal Royal Sta- 
 tistical Society, 1908, Vol. LXXI, part 2, p. 310, where the average duration of life for 
 males is given as 23.6. 
 
 When we consider that the average duration of life in India is 
 scarcely more than one-half that of France and less than one-half 
 
 "Charles Babbage: A Comparative View of the Various Institutions for the 
 Assurance of Lives, p. 15. London, 1S26. 
 
 * By average duration of life or the life span is meant the average length of 
 life among a large number of persons born taken at random. It is not the same 
 as the average age at death in a community during a year, since that com- 
 munity may contain an abnormally large proportion of infants, or of any other 
 " age group." 
 
 " Some of the figures, especially those for India, rest on imperfect data, but 
 they are believed to be sufficiently accurate for general comparison. 
 
 638 
 
MSHXR-l NATIONAL VITALITY. 639 
 
 that of Sweden, we must conclude that the length of human life is 
 dependent on definite conditions and can be increased or diminished 
 by a modification of those conditions. 
 
 Section 2. — At different times. 
 
 Striking corroboration of this conclusion is found as soon as we 
 compare the average duration of life at different periods of time. 
 The earliest attempt to discover a hiw of human mortality appears to 
 be that of UljMan, a Roman pretorian prefect, about 220 A. 1). The 
 meaning of his table is somewhat doubtful, but it is assumed to refer 
 to " expectation of life," which for ages up to 20 is given as thirty 
 years." 
 
 This estimate is so crude and vague as to be of little value for 
 comparative purposes. Professor Finkelnburg, of Bonn, estimates 
 that^ 
 
 The average length of human life In the sixteenth century was only between 
 eighteen and twenty years, and that at the close of the eighteenth century it 
 was a little over thirty years, while to-day it is between thirty-eight and forty 
 years.* 
 
 In Geneva the records go back over three centuries showing the fol- 
 lowing life span : * 
 
 I6th century 21.2 
 
 !.7th century 25.7 
 
 18tb century 33.6 
 
 1801-1SS3 39.7 
 
 Here we see an increase in the span of life of 100 per cent in three 
 or four centuries. The last few decades, moreover, tell a striking story 
 of increase. It is one of the boasts of the nineteenth century that the 
 splendid medical and scientific advances of that period have aided in 
 a distinct lengthening of life. 
 
 In 1693 the British Government borrowed money by selling an- 
 nuities, and in 1790, a century later, it did the same thing. ^Vliile 
 the first venture proved satisfactory, the second caused a great loss to 
 the Government, owing to the improvement in longevity which had 
 taken place, and which was estimated, for the annuitant class, at 
 20 years.'' 
 
 If we compare Ogle's English life tables for 1871-1881 with those 
 of Farr for 1838-1854, we find an increase in life span of 1.4 years 
 for males and 2.8 for females.* 
 
 I " See Irving Fisher: Mortality Statistics of the United States Census, Publica- 
 tions of the American Economic Association, Mouograijh on Federal Census, 
 ISIt'J, p. 157. Taken from Assurance Magazine, VI, p. 31-1; note. 
 
 ^ George M. Kober, M. D. : " Conservation of Life and Health by Improved 
 Water Supply," publications of conference on the conservation of natural re- 
 sources, 190S, p. 23. Washington, D. C, privately published. From Finkein- 
 burg'8 " Organisation der oCCentl. Gesundheitsphlage in der Kulturstaaten " in 
 Handbuch der Hygiene, 1893. 
 
 ^ From Mnllot in "Annales d' Hygiene," XVII, 1G9 ; quoted by Dr. Edward 
 Jarvis, " Political Economy of Health," in Fifth Annual Report, Mass. Board of 
 Health, 1874. 
 
 <* See Dr. Southward Smith, Transactions P.ritish Social Science Association, 
 1857, p. 498, quoted by Dr. Edward Jarvis. ibid. 
 
 ' R. Mayo-Smith; Statistics and Sociology, p. 178. New i'ork (Macmillan), 
 
 , 16U0. 
 
640 REPORT OP NATIONAL CONSERVATION COMMTSSTON. 
 
 A still greater improvement has been effected since Ogle's figures J 
 of 1871-1881 : 
 
 Lifetime in England and Wales: 
 
 Males — 
 
 1838-1854 39. 9 
 
 1891-1900 44. 1 
 
 Females — 
 
 1838-1854 41. 8 
 
 1891-1900 47. 8 
 
 Similar improvements are observable in other countries. 
 
 Lifetime in France: 
 
 Males — 
 
 1817-1831 38. 3 
 
 1898-1903 45. 7 
 
 Females — 
 
 1817-1831 40. 8 
 
 1898-1903 49. 1 
 
 Lifetime in Prussia : 
 
 Males — 
 
 1867-1877 35. 3 
 
 1891-1900 41. 1 
 
 Females — 
 
 1867-1877 37. 9 
 
 1891-1900 44. 6 
 
 Lifetime in Denmark : 
 
 Males — 
 
 1835-1844 42. 6 
 
 1895-1900 50. 2 
 
 Females — 
 
 1835-1844 44. 7 
 
 1895-1900 53. 2 
 
 Lifetime in Sweden : 
 
 Males — 
 
 1816-1840 39. 5 
 
 1891-1900 50. S 
 
 Females — 
 
 1816-1840 -. 43. S 
 
 1891-1900 53. € 
 
 It is difficult to obtain American life tables that go far enough back 
 into history to display increases in the life span similar to those jusi 
 presented; yet comparisons of Abbott's Massachusetts life tables foi 
 1893-1897 with Elliott's Massachusetts tables for 1855 and WiggleS' 
 worth's Massachusetts and New Hampshire life tables of a centurj 
 ago give us a progressive increase from 35 in 1789 " to 40 in 1855 ' 
 and 45 in 1893-1897.'' Unfortunately no tables exist for the Unitec 
 States as a whole from which similar comparisons might be made 
 Good and reliable vital statistics are among our most crying needs 
 Meech's life tables, based on the census figures of 1830, 1840, 1850 
 and 1860, showed a life span for the whole country of 42.'* 
 
 "E. Wigglesworth : "Table showing the probability of the duration, tin 
 decrement and the expectation of life in the States of Massachusetts and Ne\< 
 Hampshire, formed from 62 bills of mortality on the files of the Americar 
 Academy of Arts and Sciences in the year 1789." Memoir of the Americai 
 Academy of Arts and Sciences, Vol. II, p. 133. 
 
 ^ Proceedings American Association for the Advancement of Science, 1857 
 pp. 61 and 69. 
 
 "Abbott, loc. cit. 
 
 <* Levi W. Meech : System and Tables of Life Insurance, ed. of 1886, p^ 
 255-259. The figures for life span at different periods given in this paragrapl 
 have been secured by averaging the figures for males and females. 
 
iisHBB.] NATION ALi VITALITY. 641 
 
 The census of 1880 gave some 70 sets of life tables for different 
 registration States and cities. The expectation of life for white 
 males was given for Massachusetts as 44, New Jersey 40, District of 
 Columbia 41, and New York City 33, but in constructing the tables 
 "the census was too prodigal as to quantity and somewhat careless as 
 to quality. It is difficult to separate the wheat from the chaff. The 
 table sliould have been accompanied by a running criticism. The 
 general defect was that no attempt was made to correct the deficiencies 
 in the returns for infants."" The census for 1890 gives only a few 
 life tables, and that for 1900 none. 
 
 In striking contrast to these recent increases of the life span in 
 progressive countries is the table for backward India, which showed 
 no advance in twenty years." 
 
 Lifetime in ludia : 
 Males — 
 
 1881 23.7 
 
 1901 23.6 
 
 Chapter II. — The mortality rate. 
 Section 1. — Relation of longevity and mortality. 
 
 The average duration of life and the death rate*^ are two comple- 
 mentary magnitudes. An increase in the life span means a decrease 
 in the death rate, and vice versa ; in fact, in a " stationary " popula- 
 tion (a population in which the annual number of deaths equals the 
 annual number of births, and without emigration or immigration), 
 it will be true that the average duration of life and the death rate 
 are mathematically the " reciprocals " of each other.*^ Thus, if the 
 death rate is 20 deaths per annum for each 1,000 of population (i. e., 
 twenty one-thousandths per annum), the average duration of life 
 «rould be J^5§°- = 50 years. 
 
 If this reciprocal relation between duration of life and mortality 
 held true in every poiDulation, it would be easy to translate death 
 rates into average duration of life, and conversely; but unfortunately 
 such a simple calculation is impracticable under conditions existing 
 in America, and even in most countries of Europe. With the ex- 
 1 1 ption of France, few countries have even approximately an equality 
 I iween deaths and births and an absence of emigration and im- 
 migration. In America, where the deaths are exceeded by the births, 
 and where there is a large immigration of j^oung men and women in 
 t!ie prime of life, the death rate is smaller than it would be if our 
 population were " stationary." The annual death rate in the United 
 
 " Fisher : Mortality Statistics of the United States Census, American Eco- 
 nomic Association Monograph on the Federal Census, 1899, p. 160. 
 
 '^Baines: "The Peradventures of :in Indian Life Table," Journal of the 
 Royal Statistical Society, 1908, Vol. LXXL, pt. 2, p. 310. 
 
 '"A death rato is the ratio of the numljor of deaths during a year to the popu- 
 lation, taken at some point in the year, usually the middle. 
 
 '^ For a short explanation of this reciprocal relation, which is more fully 
 explained in works on actuarial science, see I^isher : Mortality Statistics of the 
 United States Census, pp. 149-150. It is interesting to see the grjiphic tn- 
 torpretation of this reciprocal relation by means of the diagram in Chapter 
 XI of this Report. 
 
642 KEPOET OF NATIONAL CONSERVATION COMMISSION. 
 
 States is probably about 18 per thousand" of population. The 
 reciprocal of this would be l,000-f-18, or 55 years, which is altogether 
 too high an estimate for the average length or life in the United, 
 States. 
 
 It is possible to " correct " the death rate for " age distribution " sol 
 that its reciprocal will be the true average duration of life, but the 
 calculation is a difficult and tedious one. We are forced, therefore, 
 to get along in most cases with the " crude death rate," or the quo- 
 tient of the number of deaths in a year divided by the population. 
 This figure is much easier to obtain than a corrected death rate or its 
 reciprocal, the average duration of life. 
 
 Our data for death rates are far more voluminous than our data 
 for the average duration of life. Although theoretically death rates 
 are not an unerring indication of longevity, they furnish in practice 
 very valuable information. In a general way death rates may be 
 compared with each other, especially in the same community. For 
 instance, a decrease in the death rate in New York City from one year 
 to another is practically a certain indication of improvement in vital 
 conditions. 
 
 Section 2. — Mortality in various regions. i 
 
 Forty years ago the variations in the death rates of the different 
 sections of Europe were given by Quetelet ^ as follows : 
 
 Death rate per 1,000 population. 
 
 Northern Europe 24. 3i 
 
 Central Europe 24. 5 
 
 Southern Europe 29. 7 
 
 To-day the death rates of various countries compare with each 
 other as in the following table : 
 
 Modem death rates per 1,000 of population.^ 
 
 Denmark (3906) 13.5 
 
 Sweden (1906) 14. 4 
 
 England and Wales (1906) 15.4 
 
 United States (registration area) (1907) 16.5 
 
 Germany (1905) 19.8 
 
 France (1906) 19.9 
 
 Italy (1906) 20.8 
 
 Japan (1905) 21.9 
 
 India (males,<J 1901) 42.3. 
 
 As we found in the study of duration of life, so we find here wide' 
 variations from country to country. Italy presents a death rate 
 larger by nea^rly one-sixth than that of the United States, while 
 famine-tortured and plague-ridden India's mortality rate is twice 
 that of France and three times the rates of Denmark and of Sweden. 
 
 «W. F. Willcox: "Death Rate of the United States in 1900," publications 
 of the American Statistical Association, Vol. X, p. 155. 
 
 * Quetelet, Physique Sociale, Vol. I, p. 281. These figures refer to the ex- 
 perience of different periods between ISOl and 1831. 
 
 <' With the exception of the figures for India, this table is taken from figures 
 furnished by the Bureau of the Census. 
 
 <* Baiues, loc. cit., p. 310. 
 
risHEB.] NATIONAX, VITALITY. 643 
 
 Even the fairly homogeneous population of our registration States 
 in America shows variations in death rates." 
 
 Death rate per 1,000 population in 1900. 
 
 Michigan 13.9 
 
 Vernioiit IT. 
 
 Massachusetts 17. 7 
 
 New York 17. 9 
 
 The death rate in Michigan, at the one extreme, is thus but three- 
 ' fourths that of New York at the other extreme. This difference may 
 probably be accounted for in part by the difference in the age con- 
 stitution, as the population for Michigan contains a larger propor- 
 tion of population in young and vigorous life than does New York. 
 
 Section 3. — Urian and rural mortality. 
 
 Comparison of urban and rural death rates also gives us varia- 
 tions.^ 
 
 Death rates per 1,000 population in 1900. 
 
 Massachusetts : 
 
 Urban 17.9 
 
 Rural 17. 1 
 
 Michigan : 
 
 Urban 15.3 
 
 Rural 13. 3 
 
 New Jersey : 
 
 Urban 18. 8 
 
 Rural 15. 5 
 
 Interesting comparisons may be made of the death rates of Ameri- 
 can cities varying in size and location. The death rate per 1,000 of 
 population in 1906 was given "^ as 14.2 (probablv incorrect) in Chicago, 
 in Boston 18.9, in New York 18.6, and in Philadelphia 19.3. Cleve- 
 land, Ohio, was credited with a death rate of but 16, while Cincinnati, 
 in the same State, had 20.8. The causes of such differences are not 
 always attributable to variations in size. New Haven, for instance, 
 a larger Connecticut city than either Hartford or New London, had a 
 lower death rate in 1900 by 2.2 and 2.5, respectively, per 1,000 popu- 
 lation. The differences are accounted for partly by differences in 
 age constitution, partly — it is unfortunatel}'' true — by differences in 
 the accuracy of the collected statistics, partly by differences in size 
 and location, and partly by differences in the vigilance of the public 
 and private health authorities. 
 
 European cities show even greater variations in mortality than 
 these just given for the United States. 
 
 « Twelfth Census of the United States, Vol. Ill, p. LVIII. 
 
 i" United States Census Bulletin, No. 88, 1901. 
 
 * Seventh Annual Census Report on Mortality Statistics, 1906. 
 
644 
 
 BEPOKT OF NATIONAL CONSEEVATION COMMISSION. 
 
 Death rates of European cities per 1,000 population, 1S07: 
 
 Locality. 
 
 High. 
 
 Locality. 
 
 Low. 
 
 Dublin 
 
 39.9 
 36.9 
 31.3 
 31 
 
 Frankfort on the Main 
 
 15 
 
 Moscow 
 
 The Hague 
 
 16 2 
 
 Belfast 
 
 Berlin. . 
 
 17 
 
 St. Petersburg 
 
 Amsterdam 
 
 17.8 
 
 
 
 « One must doubt, however, the accuracy of some of these figures, especially the 
 Russian. The rates in Moscow and St. Petersburg in 1906 are reported as 25.8 and 25.5, 
 respectively, which do not comport with the rates for 1S97. 
 
 Section 4. — Race and condition. 
 
 The variations in death rates among different races are well known. 
 The black race, for example, always suffers a higher mortality than 
 the white. In Boston during the half century from 1725 to 1774 the 
 death rate per 1,000 is given as ranging from 56 to 87 for the blacks 
 and only from 30 to 41 for the whites. Thus the maximum white 
 death rate was lower than the minimum black death rate.* 
 
 In 1906 the death rate per 1,000 in all registration cities having not 
 less than 10 per cent colored inhabitants was 17.2 for whites and 28.1 
 for blacks. 
 
 These racial differences may be ascribed in part to different habits 
 and conditions of life, but probably in part also to varying racial 
 susceptibility to disease. 
 
 The relation of social status to the rate of mortality has been often 
 discussed and offers a partial explanation of racial or national varia- 
 tion of death rate. That a well-to-do class, properly fed and clothed 
 and with opportunity for leisure, will be less susceptible to disease 
 and death than a poverty-stricken class, ill-fed and overworked, has 
 been repeatedly shown by statistics. Newsholme has stated,'' for ex- 
 ample, that in Glasgow the death rate among tenants of large houses 
 is much lower than among the tenants of smaller dwellings : 
 
 One and two 
 room houses. 
 
 Three and 
 
 four room 
 
 houses. 
 
 Five rooms 
 and over. 
 
 Death rate per 1,000 occupants in 1885. 
 
 27.7 
 
 19.5 
 
 n.3 
 
 In Paris comparison has been made between two quarters known to 
 be rich, on the one hand, and, on the other, a third quarter known to 
 be poor. 
 
 Death rate per 1,000 population." 
 Rich quarters: 
 
 Elysee 13.4 
 
 Opera 16. 2 
 
 Poor quarter : 
 
 Menilmontant 31. 3 
 
 " Lemuel Shattuck, " Tlie Vital Statistics of Boston," p. xiii. Reprinted in 
 " Bills of Mortality, 1810-1849," city of Boston, 1893. 
 
 * Arthur Newsholme, "Vital Statistics," London (Swan Sonnenschein), 1899, 
 p. 163. 
 
 « E. Levasseur, " La Population Francaise," Paris, 1891, Vol. II, p. 403. 
 
riSEBK.] 
 
 NATIONAL. VITALITY. 
 
 645 
 
 In Russia a similar comparison has been made between peasants 
 who own no Lmd, those who own less than 13^ acres, those who own 
 between 13i and 40^ acres, and so on up the scale of proprietorship." 
 
 Peasant death rate per 1,000, Oovernnicnt of Voronezh, 1889-1891. 
 
 Class of household. 
 
 For 1,000. 
 
 Having no land 
 
 Having less than 13.5 acres 
 
 Havitisj 13.0 and less than 40.5 acres 
 Havinj,' 40.5 and less than (J7.5 acres 
 Having 67.5 and less than 135 acres 
 Hsving more than 135 acres 
 
 34.7 
 32.7 
 30.1 
 25.4 
 23.1 
 19.2 
 
 Occupational comparisons are often made ; and while they must be 
 handled with great care, especially because of dill'erences in age, the 
 following may be said to display roughly the variations in death 
 rate among social classes. 
 
 Death rate of males per 1,000, according to occupations, for registration States, 
 
 1900J> 
 
 Mercantile and trading 12. 1 
 
 Clerical and official 13.5 
 
 Professional 15. 3 
 
 Laboring and servant 20.2 
 
 Special industries have high death rates from special diseases. 
 Among dusty trades, for instance, tuberculosis is very common.*' 
 
 Finally, the experience of industrial life-insurance companies, 
 which deal largely with the poorer classes of society, shows a higher 
 death rate than that displayed by the experience tables of other in- 
 surance companies.'^ 
 
 Insurance mortality per 1,000. 
 
 Ag. 
 
 Ordinary 
 insurance, 
 
 English 
 experience. 
 
 Industrial 
 insurance, 
 Metropoli- 
 tan Life. 
 
 20 
 
 7.3 
 
 7.8 
 
 9.3 
 
 21.7 
 
 64.9 
 
 10.5 
 
 25 
 
 14.1 
 
 35 
 
 17.2 
 
 65 
 
 35.2 
 
 70 
 
 91.0 
 
 
 
 We find also great variations in death rates dependent on varying 
 climatic or seasonal conditions, on the prevalence or absence of certain 
 pests, on the fluctuating virulence of specific diseases, and on numer- 
 ous natural differences. Other significant factors in mortality are 
 historical events, such as wars, plagues, and ej^idemics. Hard times 
 bring increased mortality, whether due t(^ natural or politico-economic 
 causes. There remain to be mentioned also deaths by accident in all 
 its many forms. 
 
 " I. M. Rubinow, " Poverty's Death Rate," publications of the American Sta- 
 tist ical Association, December, 1905, p. 348. 
 
 & " Twelfth Census of the United States," Vol. Ill, p. cclxi. 
 
 " See Fredoi'iok L. Hoffman, " Mortality from Consumption in dusty trades," 
 Bulletin No. 79 of the U. S. Bureau of Labor. 
 
 <* Haley Fiske, "Industrial Insurance," The Charities Review, March 1S9S, p. 33. 
 
646 EEPOET OF NATIONAIi CONSEEVATIOiir COMMISSION. 
 
 Section 5 — Mortality historically. 
 
 Not only does the death rate vary greatly from place to place and 
 from one social class to another, but it changes in a most marked 
 fashion from period to period in history. The records of old cities 
 show that a decided decrease in mortality has been steadily going on. 
 In London, for example, the rate per 1,000 has fallen from 50 in 1660- 
 1679 to 15 in 1905, a decrease of 70 per cent. In the plague years,, 
 1593, 1625, 1636, and 1665, the death rates per 1,000 were 240, 310, 130, 
 and 430.« The " black death " in 1348-9 probably swept away half 
 of the population in many localities throughout Europe.' 
 
 Mortality in London.'^ 
 
 Year. 
 
 Rate per 
 1.000. 
 
 1660-1679 
 
 60 
 
 1680-1728 6 
 
 80 
 
 1729-1780 
 
 40 
 
 1905 
 
 15.1 
 
 
 
 • Kober, loc. cit., p. 25. 
 
 * These years include the period of pests. 
 
 Within a quarter century London has cut her death rate in half, 
 wliile Vienna, if we may trust the figures, has within a century re- 
 duced her rate from 60 per 1,000 of population to 23." Similarly, the 
 mortality rate in Boston has been lowered from an estimated 34 per 
 1,000 <* in 1700 to 19 to-day. 
 
 Mr. John K, Gore, actuary of the Prudential Insurance Company, 
 shows ® that the average death rates per 1,000 of population among 
 typical American cities was, for the white population, as follows: 
 
 Years. Death rate per 1,000. 
 
 1804r-1825 24. 6 
 
 182&-1850 25. 7 
 
 1851-1S63 28.3 
 
 1864-1875 — 1 25. 4 
 
 1876-1888 22. 9 
 
 1889-1901 21.0 
 
 The record even of the last thirty years displays a fall in death 
 rates that may inspire us with buoyant hope for the future. The 
 mortality rate per 1,000 has fallen in Berlin from 33 in 1875 to 16 
 in 1904; in Munich, from 41 in 1871 to 18 in 1906; and in Washing- 
 ton, from 28 in 1875 to 19 in 1907.^ 
 
 Between 1890 and 1906 New York lowered her death rate per 1,000 
 from 25.4 to 18.6, and Boston from 23.4 to 18.9. The mortality rate 
 in the whole registration area of the United States fell from 19.6 
 per 1,000 in 1890 to 16.1 in 1906, although the area in the last-named 
 year included a larger proportion of urban population. 
 
 o See Farr, Vital Statistics, Loudon, 1885, p. 131. 
 
 'See Abbot Gasquet, "The Black Death of 1348 and 1349," London (Bell), 
 1893. 
 
 "A. F. Weber, " The Growth of Cities," New York, 1899, pp. 355, 356. 
 
 * Shattuck, loc. cit., pp. xii-xiv. 
 
 « " On the Improvement in Longevity in the United States during the Nine- 
 teenth Century." 
 
 f Kober, loc. cit., p. 25. 
 
FISHIB.1 NATIONAL VITALITY. 647 
 
 We have also vital records for the city of Habana. running back 
 over a century. These show that while the death rate in 1802 was 
 given as 54.6 per 1,000, rising in cholera years even as high as 103.4 
 (1833) and in the last year of "Woyler's concentration methods as 
 high as 91, the rate during the eight years from 1899-190G ranged 
 from 20.4 to aS.G.* 
 
 These records also show the remarkable and sudden fall that may 
 lie brought about by a change in the living conditions of a community. 
 During^ the three "concentration" years of 1896, 1897, and 1898 
 tlie mortality rate per 1,000 was 51.7, 78.7, and 91, respectively. In 
 1JS99, the first complete year of American occupation, the rate 
 dropped to 33.6, and since then it has ranged between 20.4 and 24.4, 
 There can be no question that the improvement was almost wholly 
 due to the sanitary reforms introduced by Colonel Gorgas, and the 
 other United States Army surgeons under Gen. Leonard Wood. 
 
 The record of American Army sanitarians in the Panama Canal 
 Zone shows as striking results as in Cuba. The death rate in 
 Panama during 1887, when the French canal companies held occu- 
 pation, ran over 100 per 1,000. In 1906 the death rate was 49 per 
 1.000, while in 1907 it fell to less than 34. Colonel Gorgas attributes 
 the decrease in the general death rate in great part to improved sani- 
 tation, though he adds that " increased wages, better food, and better 
 clothing have no doubt played a considerable part in the general im- 
 provement of the health." * 
 
 Section 6. — Adult and infant mortality. 
 
 Mortality varies greatly with age. The improvement in the city 
 death rate of the past half century has been especially marked 
 among the young. 
 
 It is true that in countries of the same degree of civilization the 
 infant death rate is remarkably constant,*^ but this is probably ac- 
 counted for by the similarity in the methods of feeding of infants. 
 Certainly where there is a difference in conditions there will be 
 found a difference in mortality. Thus, the comparison between the 
 mortality of infants fed on cow's milk and those fed on mother's 
 milk shows that the former is five to ten times that of the latter.'* 
 
 Although the infant mortality rate is probably falling,* the de- 
 crease is not accompanied by a lowering of the mortality of later 
 life. There is an increased mortality beyond the age of 50 years. 
 In Massachusetts the death rates by age changed during thirty years 
 as follows: 
 
 " " Report of the National Sanitary Department of tho Republic of Cuba," 
 Habana, 1906, p. 78. 
 
 * Letter from Col. W. C. Gorfjas, chief sanitary ofl3cer, Canal Zone. 
 
 f^ See E. B. Phelps. "A Statistical Study of Infant Mortality," quarterly pub- 
 lication of the American Statistical Association, September, 1908. Mr. Phelps 
 Bhows the utter unreliahilify of most statistics of infants under 1 year of age, 
 especially in the United States. 
 
 '^ See Harald Westergaard. " Mortalitilt und Morbilitat," Jena, 1901, p. 364. 
 
 ® Edward E. Graham, M. D., " Journal of the American Medical Association," 
 September 26, 1908 ; also " British Medical Journal," February 1^ 1908, p. 271. 
 
648 EEPORT OF NATIONAL, CONSERVATION COMMISSION. 
 
 Death rate m Massachusetts per 1,000 of population in each age period.'^ 
 
 Age. 
 
 1865. 
 
 1895. 
 
 5-9 
 
 9.6 
 5.1 
 9.« 
 
 12.6 
 
 11.7 
 
 12 
 
 17 
 
 33 
 
 70 
 168 
 
 6 2 
 
 10-14 
 
 3.2 
 
 15-19 
 
 5 3 
 
 20-29 
 
 7.1 
 
 .30-39 
 
 9 7 
 
 40-49 
 
 13 
 
 50-59 
 
 20 
 
 60-69 
 
 39 
 
 70-79 
 
 82 
 
 80 and upward 
 
 185 
 
 
 
 » " Vital Statistics of Massachusetts," 1856-1895, p. 755. 
 
 * Here, while the death rate for all age periods under 40 has mate- 
 rially decreased, the later periods of life have suifered progressive 
 increases in mortality rate." 
 As Frederick L. Hoffman has expressed it : 
 
 There is, of course, no question whatever that the American death rate, using 
 the term in a very comprehensive sense, has substantially declined within the 
 last fifty years, but it is equally evident that this decline has been at the younger 
 ages, and not during the period of life which, economically, is of the gi'eatest 
 value. There is no doubt that the mortality of adult ages is still decidedly 
 excessive. 
 
 The same tendency, viewed from the standpoint of the exjoectation 
 of life,* is disclosed in the study of two Massachusetts life tables, 
 compiled nearly a century apart — one, Wigglesworth's life tables for 
 Massachusetts and New Hampshire in 1789, though not very accurate ; 
 the other, Abbott's Massachusetts life tables for 1893-1897. 
 
 Expectation of life in Massachusetts. 
 
 Age. 
 
 1789. 
 
 1897. 
 
 Age. 
 
 1789. 
 
 1897. 
 
 
 
 35.5 
 43.2 
 34.2 
 26 
 
 45.4 
 50 
 42 
 28.2 
 
 60. . . . 
 
 15.4 
 5.9 
 3.7 
 
 15 1 
 
 10 
 
 80 
 
 6 1 
 
 20 
 
 90 . 
 
 3 i 
 
 40 
 
 
 
 
 
 These figures indicate that the expectation of life at the earlier 
 ages is much greater than a century ago, but that for the age of 60 
 and upward it has remained practically stationary. 
 
 "At first sight it would seem that this increased mortality in later ages could 
 be explained away as due to the larger number of persons who are saved from 
 earlier death and tend to produce a higher mortality at the older ages. I speak 
 of this because very intelligent persons have drawn this conclusion. But it is 
 obviously fallacious, since the figures do not indicate the number of deaths in 
 different periods, but the death rates in dift'erent periods of life per 1,000 at each 
 period. There are, to be sure, as a consequence of saving lives in the past, 
 more old men now living than otherwise there would be, and there will be more 
 deaths, but the figures show that these old deaths 'have increased faster than 
 the number of old men. This fact raises the suspicion, therefore, that the 
 lives which have been saved by the hygiene of a generation ago are weak lives, 
 Whether this is a tenable hypothesis or not will be discussed in Chapter X. 
 
 * " Expectation of life " at any given age is the mean after-lifetime of per- 
 sons who reach that age. Thus 100 persons have an expectation of life of 50 
 at the age of 10, if the total life to be lived by those 100 persons before death 
 1« five thousand years. 
 
wisma 1 
 
 NATIONAL VITALITY. 
 
 649 
 
 English life tables " for three decades ending 1900 display the same 
 tendency. 
 
 English life tables — Expectation of life. 
 
 MALES. 
 
 Age. 
 
 1871-18S0. 
 
 1881-1890. 
 
 1891-1900. 
 
 
 
 41.4 
 
 39.4 
 
 13.1 
 
 4.8 
 
 43.7 
 
 40.3 
 
 12.9 
 
 4.5 
 
 44.1 
 
 20 
 
 41 
 
 60 
 
 12.0 
 
 80 
 
 4.0 
 
 
 
 FEMALES. 
 
 
 
 44.6 
 
 41.7 
 
 14.2 
 
 5.2 
 
 47.2 
 
 42.4 
 
 14.1 
 
 6 
 
 47.8 
 
 20 
 
 43.4 
 
 60 
 
 14.1 
 
 80 
 
 5.1 
 
 
 
 These tables show that there is improvement at the younger ages 
 for the period 1891-1900 over the period 1871-1880. For ages over 
 60 there has been a retrogression. It is observable, however, that 
 between the periods 1881-1890 and 1891-1900 the figures for 60 years 
 have remained stationary, and for 80 have slightly improved. 
 
 In other words, a baby to-day has in prospect a much longer 
 average lifetime than did the baby of two generations ago; but a 
 man or woman 60 years old has in prospect an average after lifetime 
 no greater than formerly. 
 
 The proximate cause of this contrast would seem to lie in the fact 
 that the mortality from many of the diseases of later life has been 
 and is on the increase. The death rates from diabetes, heart disease, 
 and Bright's disease have all doubled in thirty years.' 
 
 Cancer is probably on the increase," and " to-day one in every 21 
 men who have reached the age of 35 and one in every 12 women who 
 have reached 35 eventually die of that disease." "^ 
 
 In addition, there may be mentioned other diseases, arteriosclerosis, 
 nephritis, apoplexy, paresis, disorders of the liver, and all manner of 
 degeneration, all of them maladies of adult life, and all of them 
 apparently tending to increase. 
 
 Section 7. — Particular diseases. 
 
 We turn now to the ravages made by particular diseases in the 
 modern world. The death rate in the United States from tuber- 
 culosis of all forms equals the combined death rate from small- 
 pox, typhoid fever, diphtheria, cancer, diabetes, appendicitis, and 
 
 meningitis. 
 
 " " Supplement to Sixty-fifth Annual Report Register-General of England and 
 Wales," pt. 1, 1907, p. XLVIII-LI. 
 
 ^ Xorman E. Dilman, M. D., " Education and its Economic Value in the Field 
 of Preventive Medicine," Columbia University Quarterly, Supplement to June, 
 1908, p. 38. 
 
 ■ cElie Metchnikoff, "The Nature of Man," English translation, New York 
 (Putnam), 1903, pp. 213, 214; see also "United States Census mortality statis- 
 tics, 1906," p. 29. 
 
 ' Ditman, loc. cit, p. 38. 
 
650 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 The death rate from tuberculosis of all kinds in the registration 
 area was 183.6 per 100,000 in 1907." The rate is high among negroes.* 
 Large as these figures are, they represent a considerable decrease 
 since 1900." Tuberculosis is a preventable disease. 
 
 On a par with tuberculosis in the number of its victims in this, 
 country stands pneumonia. 
 
 The mortality statistics of the last census show that in the registra- 
 tion area of the United States pneumonia is responsible for 11 per 
 cent of all deaths. Pneumonia is now known to be a communicable 
 disease, the germ of which is very widely distributed; but there is 
 great need for sj^ecial researches into the modes of spreading this 
 formidable disease. In the meantime the best protection is to " keep 
 in condition." While the germ of pneumonia is the exciting cause of 
 the disease, predisposing causes are acute or chronic alcoholism, ex- 
 posure to cold, extreme exhaustion, and debility of any kind. 
 
 Typhoid fever is in some places yielding to preventive measures in 
 a most striking manner. The fall in the death rate from typhoid in 
 the registration area from 4G.3 per 100,000 of population in 1890 to 
 33.9 in 1900,'* and to 32.1 in 1906,* may be safely ascribed to improve- 
 ments in the water and milk supplies of our cities. The surprising 
 reduction of the typhoid-fever death rate in individual cities, result- 
 ing from definite improvements in the water supply, gives direct con- 
 firmation of this statement. 
 
 The typhoid mortality in Munich during 1856 was 291 per 100,000 
 of population. The city at that time contained numerous cesspools, 
 and the water supply was largely obtained from wells and pumps. 
 From 1856 to 1887 there was great activity in the filling up of cess- 
 pools, the abandonment of pumps and wells, and the installation of 
 modern sewers. A pure water supply was also secured, the water 
 being brought from a distance. The typhoid-fever death rate fell in 
 1887 to 10 per 100,000 of population — a reduction of 97 per cent.' 
 
 In Hamburg the typhoid mortalitv for 1880-1892 ranged from 24 to 
 88, averaging 39.7 per 100.000. In May, 1893, a filtration plant was . 
 opened, and the rate fell in that same year to 18. For the five years 
 following it averaged only 7.2, showing a reduction of over 80 per 
 cent.^ 
 
 The introduction of a water filter in the town of Lawrence, Mass., 
 in 1893 was followed by a reduction in deaths caused by typhoid . 
 from 105 in 1892 to 22 in 1896, one-fifth the previous figure. Filter- 
 
 " For a careful statistical study of tuberculosis see "Tuberculosis iu tlie 
 United States," United States Census, issued for the International Congress on 
 Tuberculosis, 190S. See also " Bulstrode's Report in Tliirty-flfth Annual Report 
 of (Euglisli) Local Government Board, 1905-6," and Arthur Newsholme, M. D., 
 " Prevention of Tuberculosis," 1908. 
 
 ^ For the prevalence of tuberculosis in the negro, see F. L. Hoffman's valuable 
 monograph, " The American Negro," publications of the American Economic 
 Association, August, 1S96. 
 
 " This decrease is shown by the exact figures (not estimated) in the registra- 
 tion area. 
 
 <* Twelfth Census of the United States, Vol. Ill, p. cxliv. 
 
 « Mortality Statistics, U. S. Census Office, 1906, p. 30. 
 
 f Ditman, loc. cit. p. 17. 
 
 s A. C. Abbott, IM. D., " The Hygiene of Transmissible Diseases," Philadelphia, 
 Saunders, 1899, pp. 88-89. 
 
"«HEE.] NATIONAL VITALITY. 651 
 
 ing the city water in several other American cities has shown abrupt 
 ieclines in the typhoid death rate almost as remarkable." 
 
 Another method of pointing out the importance of a pure water 
 supply is to compare the mortality rates from typhoid fover of cities 
 bhat secure water from various sources of supply, as the following 
 ;able shows : " 
 
 Death rate from typhoid fever per 100,000 of population, 1902-1906. 
 
 4 cities using ground water from large wells 18.1 
 
 v8 cities using impounded and conserved rivers or streams 18. 5 
 
 8 cities using water from small lakes 19.3 
 
 7 cities using water from Great Lakes 32.8 
 
 5 cities using surface and underground water 45.7 
 
 .9 cities using polluted river water 61. 1 
 
 Thus far our studies indicate that typhoid fever will cease to be a " prob- 
 em " in any community having clean water and an uninfected milk supply, and 
 ji which cases of the disease are treated as dangerous and conta&ious." « 
 
 Unfortunately such communities are too rare at present. 
 
 Perhaps the most common and neglected source of danger of in- 
 fection from typhoid is the ordinary house fly or, as Dr. L. O. How- 
 ird, chief of U. S. Bureau of Entomology, would have us call it, 
 ,he " typhoid fly." 
 
 Smallpox, another disease that yields readily to preventive meas- 
 ires, has decreased greatly in virulence and mortality since the 
 ntroduction of vaccination. In Prussia, for example, the death 
 *ate from smallpox per 100,000 population was 24.4 in the period 
 Tom 1846-1870. In 1874 vaccination, which up to that time had 
 )een onlv intermittently utilized, was made compulsory, and the 
 ieath rate per 100,000 fell at once to 1.5 for the years 1875-1886.'' 
 
 Other European States, however, have been more lax than Ger- 
 nany. In 1886 the death rate from smallpox in Switzerland was 
 ifty-fourfold that of Germany; in Belgium, forty-eightfold; in 
 iustria, eighty-onefold, and in Hungary, six hundred and sevenfold." 
 
 Babbage '" states that " it has been shown by M. Duvillard that the 
 ntroduction of vaccination has increased the mean duration of human 
 ife about three years and a half." Before Jenner's utilization of 
 vaccination to guard against smallpox that disease was causing one- 
 ^nth" of all deaths of the human race, just as does tuberculosis 
 o-day, while " nearly twice as many were permanently disfigured by 
 ts ravages. In England 300 per 100,000 population died annually 
 Tom it. It is computed that during the eighteenth century 50,000,000 
 )eople died of smallpox in Europe." '' 
 
 <* 8ee Kuber, loc. cit., pp. IS, lU. 
 *Kober, loc. cit, p. 15. 
 
 • M. J. Rosenau, L. L. Lumsden, and Jos. H. Kastle, " The origin and prev- 
 lence of typhoid fever in the District of Columbia," Hygienic Laboratory 
 iulletin No. 44, 190S, p. 9. 
 
 ^ Ditman, loc. cit., p. 8. 
 
 ^ Floyd M. Crandall, "A century of vaccination," American Medicine, De- 
 ember 7, 1901. 
 ' Loc. cit, p. 8. " 
 
 " Crandall, loc. cit, p. 6. 
 
 * Ditman, loc. cit, pp. 6, 52-3. 
 
 S. Doc. 419, Gl-2 3 
 
652 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 Boston was visited twelve times by smallpox epidemics in tlie cen- 
 tury and a half ending 1800." 
 
 Yet where vaccination has been made compulsory, or where it is 
 generally resorted to, smallpox has virtually disappeared. The last 
 census reported but 3,500 deaths from smallpox in the United States 
 in 1900. Even as long ago as 1826 Denmark was enforcing the prac- 
 tice of vaccination so vigorously that not a single case had appeared 
 for eleven years.'' Habana, during the eight years prior to the Amer- 
 ican intervention, reported 3,132 deaths from smallpox. In 1899 
 the year following the American entry, there were four deaths, and 
 three more during the next seven years — a virtual uprooting of the; 
 disease.*' 
 
 The present outcry against vaccination is based on a misunder- 
 standing, and is one of many evidences of the imperative necessity 
 of the diffusion of correct knowledge among the people on matters 
 of hygiene and preventive medicine. Whether vaccination should be 
 made compulsory is a fair question, but that it is efficacious is not 
 open to question. The argument that because some unvaccinated 
 persons escape during an epidemic all would escape is too absurd 
 to deserve serious consideration."* 
 
 Yellow fever first appeared in serious form at Philadelphia inl 
 1793, when one-tenth of that city's population died of it in the space 
 of six and a half weeks. Since 1793 the United States has had 500,- 
 000 cases, resulting, it is estimated, in about 100,000 deaths. In 
 1900 it was discovered that a species of mosquito is responsible for 
 the transmission of this fever, and in consequence of this knowledge 
 and its application the disease is now practically banished from thi^ 
 country.* 
 
 The marked decrease in the death rate from yellow fever in Ha- 
 bana since the American intervention in 1898 is shown in the fol- 
 lowing table. The deaths from yellow fever numbered 4,420 in the 
 eight years from 1891 to 1898, while in the eight years from 189J 
 to 1906 they numbered but 465. 
 
 » Shattuck, loc. cit, p. xiv. 
 
 ' Crandall. op. cit. 
 
 " Report of National Sanitary Department of the Republic of Cuba, Habana 
 1906, p. 79. 
 
 <* For the most scientific statistical studies of vaccination see W. R. Mac 
 donnell, Biometrika, Vol. I, 1902, p. 375, and Vol. II, 1903, p. 135. J. Brown, 
 lee, Biometrika, Vol. IV, 1905-6, p. 313. F. M. Turner, Biometrika, Vol. IV 
 p. 483. Karl Pearson, Biometrika, Vol. IV, and Philosophical Transactions o1 
 the Royal Society of London, Series A, Vol. 195, p. 43. Humphreys, Journal oJ 
 the Royal Statistical Society, 1897, p. 503. For the best of antivaccination lit! 
 erature see Alfred Russell Wallace, " The Vaccination Delusion," and MilneS 
 Journal Royal Statistical Society, 1897, p. 5-52 (Comment by G. U. Yale, p. 608); 
 For both sides see Report of the Royal Commission on Vaccination, 1897. 
 
 * Ditman, loc. cit, pp. 11-12. 
 
yiBHXB.] 
 
 NATIONAL. VITALITY. 
 
 658 
 
 Yellow-fever death rate in Haharva, 1870-1906. 
 [Rate per 100,000 population."] 
 
 Before American Intervention. 
 
 
 .vrter American Int 
 
 erventlon. 
 
 
 1S70. 
 
 
 300 5 
 
 1898.... 
 
 1899.... 
 1900.... 
 1901 
 
 
 
 67 8 
 
 1880... 
 1890. . . 
 1895... 
 
 
 .. 32'1.5 
 
 .. 15;!. (i 
 
 . 27.5. S 
 
 . 6;i<j.5 
 
 .. 428 
 
 ... 42.5 
 
 ... 124.0 
 
 6.9 
 
 1896... 
 
 1902 
 
 
 
 
 
 1887... 
 
 1903.... 
 1904.... 
 1906.... 
 1906. . . . 
 
 
 
 ... 
 ... 
 . . . 8. 
 ... 4.3 
 
 "Report of the National Sanitary Department of the Republic of Cuba, 1906, p. 79. 
 
 These results have been due partly to the elimination of the 
 contagion-carrying mosquito and partly to the general improvement 
 of the city's sanitary appointments. 
 
 A similar contrast might be drawn between the death rates from 
 yellow fever at Panama during the efforts of the French to dig the 
 canal and during the American work under the sanitary regulations 
 of Colonel Gorgas. If the same thoroughgoing measures used in 
 Habana and at Panama were employed among our own people, the 
 resultant blessings would be almost equally striking. 
 
 The impressive figures just presented, showing the fall in mortality 
 from so many of the most dangerous diseases, point clearly to the 
 value of preventive measures in the conflict with disease. The fall 
 in tuberculosis mortality is directly due to the growing use of hospi- 
 tals, which have tended to isolate '* consumptives, and to a use of our 
 recently acquired knowledge of the efficacy of fresh air and the out- 
 door life; typhoid fever has virtually disappeared when water and 
 milk supplies have been made pure, the open privy abolished, and 
 flies and other carriers of the specific cause of the disease have been 
 provided against ; smallpox has given way before vaccination ; yellow 
 lever is fast disappearing now that the agent of transmission is 
 known ; while many of the less serious diseases are losing their power, 
 purely owing to preventive methods. 
 
 Some diseases, once the scourges of humanity, have practically 
 disappeared from the civilized world. 
 
 Scurvy up to the latter half of the eighteenth century decimated 
 the armies and fleets of Europe and afterwards proved a menace to 
 the civilized population. During Anson's famous expedition about 
 the year 1750, 600 out of 900 died, chiefly from scurvy. The use of 
 lime juice and fresh vegetables has practically eradicated the disease,^ 
 
 " Cholera was wont to visit the cities of the Atlantic coast in the 
 past about every ten years, and it was a standing menace to the world 
 every summer. It was not uncommon for the disease to decimate 
 whole towns and cities. Since the discovery of its cause, however, it 
 has been robbed of its terrors, and the children of to-day will prob- 
 ably never know of it except by name." 
 
 Malaria has been on the decrease ever since the discovery that the 
 malarial organism is transported by a species of mosquito. Even the 
 
 <» See Arthur Newsholme, " Tlie phthisic death rate," Journal of Hygiene, 
 July, 1906. 
 
 ' Ditman, loc. cit, 14-15. 
 
654 
 
 EEPOET OF NATIONAL CONSERVATION COMMISSION. 
 
 five years ending 1906 show a progressive decline in the death rate 
 from malarial fever in tlie registration area. The figures are 5.4, 4.3, 
 4.2, 3.9, and 3.5 deaths per 100,000 of population, for the five years in 
 question. In themselves, the figures are so small as to show the virtual 
 disappearance of the disease, at least from the Northern States. It 
 is still very common in the Southern States. Its evil is by no means 
 to be measured by the deaths it causes. It produces chronic disability 
 and predisposes to other diseases." 
 
 Finally, the furnishing of pure milk to the infant population of the 
 cities is eliminating year by year the infant scourges — diarrheal dis- 
 eases and related maladies. 
 
 There are of course diseases which show no sign as yet of decreas- 
 ing. The census volume, "Mortality Statistics of 1906" (p. 29) 
 gives only one important disease (diabetes) as actually on the increase 
 within the registration area, but several which are given as having 
 " fluctuating rates," such as cancer, heart disease, and Bright's disease, 
 seem still to have an upward trend. 
 
 It is known that malaria is preventable. Why, then, is it not pre- 
 vented in the South? Probably for two reasons. First, the facts are 
 not generally known, owing to lack of vital statistics in the Southern 
 States. Second, owing largely to this ignorance no adequate effort 
 has yet been made. A.s an example of what can be done we have the i 
 cleaning of Habana by Colonel Gorgas. The following table, sup- 
 plied by him, shows the deaths from malaria from 1899 to 1907 : 
 
 Year. 
 
 Number 
 
 of 
 deaths. 
 
 Year. 
 
 Number 
 
 of 
 deaths. 
 
 1899 
 
 909 
 
 325 
 
 151 
 
 77 
 
 61 
 
 1904 
 
 44 
 
 ]900 
 
 1905 
 
 32 
 
 1901 
 
 1906 
 
 26 
 
 1902 
 
 1907 
 
 o23 
 
 1903 
 
 
 
 
 
 » Annual Report of the Sanitary Department for the City of Habana for the year 1907. 
 
 " The first year quoted, 1899, the malarial deaths were excessive, 
 owing to the crowding into the city of the ' reconcentrados ' and the 
 starvation and misery thereby involved. 
 
 The next year, 1900, was about the normal rate. The next year, 
 1901, begins to show the effect of the antimalarial work done in con- 
 nection with the yellow-fever work; 1901 was the first year of mos- 
 quito work in Habana. The last year, 1907, shows only 23 deaths 
 from malaria. This means practically the extinction of malaria in 
 Habana. The item of 23 deaths in 1907 from malaria would probably 
 be covered by the malarial cases coming in from the rural districts 
 and by mistakes in diagnosis." 
 
 The preventability of accidents is beginning to be appreciated. It 
 is now proposed by Mr. W. H. Tolman to establish in New York a 
 museum of safety and sanitation to demonstrate this fact. Mr. 
 Frederick L. Hoffman, statistician of the Prudential Insurance Com- 
 pany, estimates the number of deaths among male workers alone in 
 1908 as between 30,000 and 35,000." 
 
 <» See " Report to the Conservation Commission " of L. O. Howard. " Eco- 
 nomic loss to the people of the United States through insects that carry disease." 
 <> " Industrial accidents," Bulletin of the Bureau of Labor, 1908. 
 
Part II.— THE BREADTH OF LIFE VERSUS INVALIDITY. 
 
 Chapter III. — Prevalence of serious illness. 
 Section 1 — Loss of time. 
 
 Length of life is but one indication of vitality. Everyone recog- 
 nizes that the life of a valetudinarian or an invalid, however long, is 
 but a narrow stream. "We may therefore conceive, besides the dimen- 
 sion of length, another dimension of life which may be called its 
 " breadth." By the breadth of life we mean its healthiness. Just 
 as length of life is limited by and opposed to mortality or death, so 
 breadth of life is limited by and opposed to invalidity or illness. 
 
 An ideally healthy life, free throughout from ailment and dis- 
 ability, is rarely if ever found. But it is the aim of hygiene to ap- 
 proximate such an ideal. Some persons imagine that length of life 
 can be jiurchased only at the expense of breadth, and counsel the 
 deliberate shortening of one's life for the sake of living it faster. In 
 exceptional cases such a policy may be justified, but the study of 
 longevity reveals the fact that, as a rule, length and breadth of life 
 are not opposed, but that, on the contrary, the one can seldom be 
 increased without an increase of the other. Centenarians are usually 
 persons who have been exceptionally free from illness" and who 
 have performed a large amount of work. This work is usually 
 physical labor out of doors, although the few mental workers com- 
 pleting the century have also lived busy lives. 
 
 Chevreul, the distinguished French chemist who died twenty years 
 ago at the age of 103, lived a life of great activity and usefulness as 
 laboratory experimenter, as industrial chemist, as university pro- 
 fessor, and as a writer and lecturer. It was said of Alexander Von 
 Humboldt, who was 90 at the time of his death, that he had not only 
 lived twice as long as others in years, but that in work accomplished 
 he had lived twice as much per day, thus enjoying four times the 
 average lifetime. 
 
 It is shortsighted to spend more vitality each day than we earn. 
 Such a policy must not only prove suicidal sooner or later, but tends 
 to narrow one's life in every way long before the arrival of death. 
 The ordinary individual burns the candle at both ends. The result 
 is an almost universal invalidism in some degree. "VVliile statistics 
 are lacking, a wide observation seems to justify the conclusion that 
 it is difficult to find a man or woman over 40 whose health has not 
 become impaired in some manner. Few who have not studied the 
 facts realize how common illness is, although we all know it is suf- 
 ficiently common to make the question " How are you?" the ordinary 
 form of salutation. 
 
 • Metchnikoff. " The Prolongation of Life," English translation, New York, 
 (Putnam's) 1908, p. 145. 
 
 655 
 
656 BEPOBT OF NATIONAL, OONSEEVATION COMMISSION. 
 
 Serious illness is such as totally incapacitates a person from work, 
 whether or not h© is confined to his bed. The burden of serious ill- 
 ness is felt in several distinct ways. There is the annual idleness en- 
 tailed by this illness, the cost of maintaining institutions devoted to 
 the care of the sick, and the cost to the individual of medicines, medi- 
 cal service, and nursing. 
 
 The amount of invalidity or illness in a community has been esti- 
 mated by a number of different investigators, and in a number of dif-i 
 ferent ways. While the results vary somewhat, on the whole they 
 harmonize fairly well." 
 
 The most careful consideration of the various illness statistics avail- 
 able was made by FaiT. He finds that the rate of invalidity increases 
 with age, and at the later ages increases with great rapidity. The 
 material he has used has come chiefly from various friendly societies 
 in Great Britain and Scotland, and especially from the East India 
 Company. His final conclusion is probably nearly as valid to-day as 
 then. It is that corresponding to each death in a community, there 
 are a little more than two years of illness. 
 
 Another way of expressing the same fact is that for each annual 
 death, there are on the average two persons constantly sick during the 
 year. Applying this estimate to the United States,'' in which about i 
 1 ,500,000 persons die per annum, there are probably at all times about 
 3,000,000 persons seriously ill. This means an average of thirteen 
 days per annum for each inhabitant." 
 
 Returns gathered from 79 benefit societies in Scotland, aggregating 
 over 100,000 members, and based on the experience of various periods 
 between 1750 and 1821, showed that the average duration of sickness 
 for each member under seventy years of age was ten days per year, 2 
 of which were assumed to be " bedfast " days, five as days of walking 
 sickness, and three as days of permanent sickness.'* 
 
 Section 2 — Particular diseases. 
 
 It has been estimated that the number of persons in the United 
 States constantly suffering from tuberculosis reaches 500,000. Of this 
 number probably about half are totally incapacitated, while the re- 
 mainder are able to earn about half of the ordinary wages.® 
 
 " See Farr, Vital Statistics, London, 18S5, pp. 501-514. Ha raid Westergaard, 
 Mortalitat und Morbilitat, Jena, 1901, p. 683. See also a pamphlet by Hiram J. 
 Messenger, actuary of the Travelers' Insurance Company, Hartford " The Rate 
 of Sickness;" Pettenkofer, quoted by UfEelman, Handbuch der Hygiene, p. 3. 
 Edwin Chadwick, "The Health of Nations," ed. by B. W. Richardson, 2 vols. 
 (Longmans), London, 1887, Vol. I, p. 57; Mayo-Smith, " Statistics and Sociology," 
 New York, (Macmillan) 1895, p. 158; " Statistische Jahrbuch fCr das Deutschen 
 Reich, 1908," pp. 304-305. 
 
 ^ Judging from the experience of sickness insurance, there is more sickness in 
 the United States than in England. See Dr. Edward Jarvis, " Political Econ- 
 omy of Health," Fifth Report of Mass. Board of Health, 1874. Dr. Jarvis also 
 points out that estimates of illness are based on experience of provident persons 
 among whom illness is a minimum, and that the estimates of illness take no 
 account of chronic ailments or " decrepitude." 
 
 <= Farr, Vital Statistics, p. 513. 
 
 <» Edwin Chadwick, "The Health of Nations," vol. 1, pp. 56-57. 
 
 « Irving Fisher, " The Cost of Tuberculosis in the United States and Its Re- 
 duction," paper read before International Congress on Tuberculosis, Washing- 
 ton, 1908; see also Huber, "Consumption and Civilization," Philadelphia, 1906; 
 and Bardswell, " The Consumptive Workingman," London, 1906. 
 
W8HEE.] NATIONAL. VITALITY. 657 
 
 For every death from typhoid fever, there are about 8 cases of ill- 
 ness, averaging seventy-five days of incapacity. But this is not the 
 only loss. Professor Sedgwick has said, " Hazen's theorem asserts that 
 for every death from typhoid fever avoided by the purification of a 
 polluted public water supply two or three deaths are avoided from 
 other causes. Working under my direction Mr. Scott MacNutt has 
 recently been able to confirm this surprising theorem, and even to 
 establish it as conservative. We have also gone further than Hazen 
 and discovered what the other causes are from which deaths are thus 
 avoided ; and, although our results are not yet all published, I may say 
 that conspicuous among these are pneumonia, pulmonary tuberculosis, 
 bronchitis, and infant mortality." <» 
 
 The prevalence of the hook-worm disease in the South has been a 
 matter of investigation for several years by Doctor Stiles ''' of the 
 Public Health and Marine-Hospital Service. The disease is remarka- 
 ble not so much for its fatality, though that is large, as for the chronic 
 incapacity for work which it produces. For this reason the hook 
 worm has been nicknamed the " germ of laziness." The disease ex- 
 tends over the whole South, and is responsible for a large part both 
 of the sickness (the so-called "laziness") and of the poverty of the 
 " whit€ trash." 
 
 There are no satisfactory statistics as to the extent of hook-worm 
 disease; but it has been estimated that the sufferers are incapacitated 
 for labor from one-fourth to one-half of their time. Most striking is 
 the fact that the disease is easily preventable through the introduction 
 of sanitary measures as well as' curable by the proper (drug) treat- 
 ment of the present victims. It has been largely eradicated from 
 Porto Rico.'' Hook-worm disease weakens when it does not kill and 
 is known to be a precursor of tuberculosis. 
 
 Malaria is one of the diseases which are fatal relatively seldom, but 
 which shorten life by predisposing to other causes of death, and nar- 
 row life by reducing working efficiency by a large percentage. Doctor 
 I Howard states that each year there are probably 3,000,000 cases of 
 [ malaria in the United States, most of which are in the South. This 
 is practically all preventable.* 
 
 Dr. Prince A. Morrow says that the number of syphilitics in the 
 ^ United States has been estimated at 2,000,000. This disease is not 
 only in itself a danger, but it also causes a large number of diseases 
 of the circulatory and nervous systems. 
 
 Doctor Morrow says that the extermination of social diseases 
 would probably mean the elimination of at least one-half of our insti- 
 tutions for defectives. The loss of citizens to the State from the 
 sterilizing influence of gonorrhea upon the productive energy of the 
 family, and the blighting destructive effect of syphilis upon the off- 
 spring are enormous. In the opinion of very competent j udges social 
 
 oW. T. Sedgwick, "The Call to Public Health," Science, 1908, p. 198. 
 
 6 Report upon the Prevalence and Geographic Distribution of Hook-worm 
 Disease in the United States," Hygienic Laboratory, Bulletin No. 10, February, 
 1903, Washington. 
 
 c " Reports of Commission on the Suppression of Uncinariasis, 1904, 1905, 
 1906-7, 1907-8, San Juan, P. R." This commission has been succeeded by a 
 bureau, the " Anemia dispensary service." 
 
 <» See* L. O. Howard, Report to Conservation Commission, " Economic loss to 
 the people of the United States through insects that carry disease." 
 
658 KEPORT OF NATIONAL, CONSERVATION COMMISSION. 
 
 disease constitutes the most powerful of all factors in the degenera 
 tion and depopulation of the world. 
 
 Among the troops stationed in the Philippines, the venereal mor 
 bidity during the year 1904 was 297 per 1,000, largely exceeding th< 
 morbidity from malarial fevers and diarrhea; 22 out of every 1,00( 
 soldiers were constantly ineffective from venereal diseases, four times 
 as many as from any other disease. 
 
 The statistics of the Navy Department show during the same year 
 that venereal disease was chargeable with a percentage of 25.S 
 of the total number of sick days in the hospital from all causes 
 combined. In four years 949 men were discharged from the navj 
 for disability from venereal disease. The statistics of the English 
 army show that among the troops stationed in India 537 per 1,000 
 were admitted to the hospital for venereal disease. Of the troops re 
 turning home to England after completing their time of service in 
 India, 25 per cent were found to be infected with syphilis. 
 
 No statistics exist for venereal disease in civil life. It may be more 
 prevalent than in the army and navy service, since the inhibitory 
 influence of military restraint and discipline do not exist and the 
 opportunities for licentious relations are more abundant. ] 
 
 Neisser, a distinguished German authority, states that " fully 75; 
 per cent of the adult male population contract gonorrhea and 15 per 
 cent have syphilis." 
 
 AVliat syphilis and gonorrhea represent in the lowered working 
 efficiency of our population — to say nothing of the still more impor- 
 tant subject of increased mortality— -^is impossible to estimate; but it 
 would be difficult to overemphasize the grave danger to national ef- 
 ficiency from these and the other venereal diseases. And here again 
 the most strildng point is that the venereal diseases are preventable. 
 
 Alcoholism and drug addiction are maladies of frightful preva- 
 lence. They are so familiar as to be taken by many as a matter of 
 course. 
 
 Venereal diseases and inebriety, whether alcoholic or drug, fre- 
 quently lead to insanity. Statistics are not yet able to prove con- 
 clusively that insanity is increasing, though this is the opinion of the 
 best judges." 
 
 Dr. C. L. Dana, formerly president of the New York Academy of 
 Medicine, believes the increase in insanity to be real as well as ap- 
 parent. He says : " The annual increment of insane in Massachusetts, 
 according to the Massachusetts board of lunacy, is 400 in about 10,000, 
 or 4 per cent." At this ratio the annual increment for the United 
 States would be approximately 5,600. " We may say that in the last 
 twenty-five years the ratio of insane to sane has shown an apparent 
 gradual increase from 1 to 450 to 1 to 300, and this latter seems to be 
 about the ratio in those communities of North America and Europe in 
 which modern conditions of civilization prevail. This average has 
 varied but little in the last few years; the slight yearly increase prob- 
 ably will not change rapidly and probably not continue, for when the 
 increase in the insane reaches a certain point of excess society will 
 have to take notice of it and correct it." ^ There are no accurate fig- 
 
 <» For a critical examination of statistical data on insanity, see Humphreys, 
 (Noel, A.), "The alleged increase of insanity," Journal of the Royal Statisti- 
 cal Society, June, 1907. 
 
 ^ " Psychiatry in its Relation to Other Sciences," section on psychiatry at the 
 International Congress of Arts and Sciences, St Louis, September, 1904. 
 
FisnEH.l NATIPNAL VITALITY. 659 
 
 [ures of the number of insane. Mr. Sanborn estimates that the number 
 exceeds 250,000 in the United States. 
 
 j Among defective and disabled classes are to be especially mentioned 
 ithe feeble-minded, paralytic, crippled, blind, and deaf mutes. The 
 aggregate disability of these groups is greater than is commonly 
 recognized. The preventability is still less appreciated. 
 
 With reference to the losses each year from industrial accidents: 
 
 The statistical report of the Interstate Commerce Commission for 
 the year ending June 30, 1907, shows that during that year 11,800 
 persons were killed and 111,000 injured on our American railways, 
 I these figures including passengers, employees, and all other persons. 
 ;A large number of the victims were railway employees, for whose 
 safety Congress has passed a number of laws. The total number of 
 [cases of industrial accidents can not be estimated, owing to the lack 
 •of statistical information ; but Census Bulletin 83 gives the number of 
 deaths b}' accident and violence in 1900 at 57,500. 
 
 " Of 29,000,000 workers in the United States over 500,000 are yearly 
 killed or crippled as a direct result of the occupations in which they 
 ;are engaged — more than were slain and wounded throughout the 
 iwhole Russo-Japanese war. More than one-half this tremendous sac- 
 rifice of life is needless." " 
 
 Mr. Frederick L. Hoffman estimates * that the number of accidents 
 among men employed in the United States in 1906 was 208,000, of 
 which about 5,000 were fatal. These figures are exclusive of mining, 
 railway, and shipping accidents. 
 
 John Mitchell " estimates that for every 100,000 tons of coal pro- 
 duced in the United States one mine worker is killed and several 
 injured. In 1907 the figures were 2,500 coal miners killed and 6,000 
 seriously injured. 
 
 In Wisconsin from October 1, 1906, to October 1, 1907, the total 
 number of accidents reported which incapacitated the victim by at 
 least two weeks was 13,572. The accidents to employees constituted 
 53 per cent of this number.* 
 
 I Special trades have special perils for workmen. "Among diseases 
 'to which workmen are most often subject are the so-called ' inanition, 
 'scrofula, rachitis, pulmonary consumption, dropsy;' also rheumatic 
 ■.roubles, pleurisy, typhoid fever, gangrene, and the various skin dis- 
 eases. Every epidemic, be it typhoid, smallpox, scarlet fever, dysen- 
 :ery, cholera, etc., draws its greatest army of victims from this classl 
 For every death that occurs among the richer and higher classes 
 :here are many in the working class. It is the workman engaged in 
 mhealthy factories first of all who fills the hospitals and their death 
 chambers." * 
 
 It is the pollution of the air breathed by workmen, whether the 
 pollution come through poisons or through dust, that makes many 
 .rades dangerous. Among poisonous trades are the many lead-using 
 
 Ditman, loc. cit., 43. 
 
 ^ In an article contributed to the " New Encyclopedia of Social Reform," 1908. 
 
 ' Speech before the Governor's Conference on Conservation, White House, 
 May, 3 908. 
 
 <* Thirteenth biennial Report, Bureau of Labor and Industrial Statistics, Madi- 
 son, Wis., 1908. 
 
 ^ C. F. W. Doehring, " Factory Sanitation and Labor Protection," Bulletin 
 Department of Labor No. 44, January, 1903, p. 2. 
 
660 
 
 EEPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 industries, foundries, and chemical factories. Investigations of the 
 dust-producing trades have been made, showing the results on tht, 
 respiratory systems. 
 
 Hirt's statistics show that men employed in dust-producing occu-| 
 pations suffer much more frequently from pneumonia and consump- 
 tion than do those not exposed to dust. The relative frequency ol_ 
 these diseases per 100 workmen is as follows: 
 
 Cases of consumption and pneumowia per 100 workers in certain occupations. 
 
 Consump- 
 
 Pneu- 
 
 tion. 
 
 monia. 
 
 28 
 
 17. 
 
 25.2 
 
 6. 
 
 22.6 
 
 6. 
 
 20.8 
 
 7. 
 
 13.3 
 
 9. 
 
 11.1 
 
 o4. 
 
 Workers in metallic dust 
 
 Worlrers in mineral dust 
 
 Workers in mixed dust 
 
 Workers in animal dust 
 
 Workers In vegetable dust. . 
 Workers in nondusty trades. 
 
 « George M. Kober, M. D., " Industrial Hygiene," Bulletin of Bureau of Labor, Marchi 
 1908, p. 477. 
 
 Mr. Owen R. Lovejoy, secretary of the national child-labor com- 
 mittee, has condensed a table from Indiana reports " showing the high 
 injury rate suffered by children in the industries. 
 
 Injuries to children in Indiana, 1907. 
 Proportion of adults injured ( ^ P^^ J' J^ 
 
 Proportion of children injured j;^ ^^^^' f ^^r 
 
 UO per 1, OOC 
 
 The injury rate for children is shown to be three to four times as 
 great as for adults. 
 
 Chapter IV. — Prevalence of ininor ailments. 
 Section 1. — Importance of minor ailments. 
 
 The statistics of morbidity which we have given refer to forms 
 which are relatively acute; but there are many milder forms which 
 do not incapacitate the patient from work or compel him to take! 
 to his bed. The extent of these milder ills is not generally appre- 
 ciated. They are often carefully guarded secrets. The individual 
 often knows only his own physical troubles, but is unaware of the 
 fact that almost every person about him has such troubles also. Once 
 you penetrate beneath conventional acquaintance there will almost 
 invariably be found some functional impairment of heart, liver, 
 kidneys or bladder; or dyspepsia, gastritis, jaundice, gallstones, 
 constipation, diarrhea; or insomnia, neurasthenia, nervousness, neu- 
 ritis, neuralgia, sick headache; or tonsilitis, bronchitis, hay fever, 
 catarrh, grip, colds, sore throat; or rupture, hernia, phlebitis, skin 
 eruption; or rheumatism, lumbago, gout, obesity; or decayed teeth, 
 baldness, deafness, eye ailment, spinal curvature, lameness, broken 
 bones, dislocations, sprains, bruises, cuts, burns, or other " troubles." 
 
 " " Eleventh Annual Report of the Department of Inspection of Indiana, 1907," 
 Exhibit O, pp. 166-198. 
 
nsHKB.l NATIONAL VITALITY. ' 661 
 
 These so-called " minor ailments " will undoubtedly in the next few 
 years receive much more attention than now. Until recently the 
 physician has been accustomed to treat only acute diseases, but as 
 preventive medicine gradually replaces curative medicine the physi- 
 cian will be more called upon to treat minor ailments. These are 
 generally the first warnings of more serious troubles. If what seem 
 to be " mere colds " were less commonly neglected, tuberculosis would 
 more often be caught in its incipiency, and pneumonia and diphtheria 
 would often be prevented. 
 
 From the " common colds " also tonsilitis and abscess of the ear can and do 
 M)nie, purulent inflammations of the. pneumatic and venous cavities of the face 
 and skull, and meningitis and cerebral abscess — all of which destroy many 
 lives annually ; or the lives may be saved by a surgical operation after a serious 
 and prolonged illness. Tonsilitis, in turn, in addition to lighting up furious 
 inflammations in its own immediate vicinity, can be held responsible in a cer- 
 tain number of cases for serious diseases at a distance from its ov?n site. These 
 ire septic arthritis (inflammation of joints), septic peritonitis, appendicitis, 
 endocarditis (valvular disease of the heart) — severe and frequently fatal dis- 
 eases. Gastritis or gastroenteritis, sick headache, jaundice, lumbago, are not 
 usually of serious import, but sometimes are the signs that point to an under- 
 tying cause (alcoholism, overeating, chronic protein intoxication, worry — busi- 
 oess or domestic — sedentary life, etc.) which will lead later to arteriosclerosis, 
 chronic nephritis, toxic amblyopia (optic nerve blindness), cirrhosis of the liver, 
 cerebral hemorrhage or valvular disease of the heart." 
 
 If the first twinges of rheumatic pains were heeded, gout and the 
 dreaded arthritis deformans would lose most of their terrors. We 
 could then arrest a great majority of serious affections at the very 
 gateway. It can hardly be doubted that even such diseases as cancer, 
 whose causation is not yet understood, gain a foothold through low- 
 ered vital resistance, manifesting itself at the first in minor ailments 
 af some kind. 
 
 I The American neurasthenia, widespread and subtle, has its grip on 
 thousands of men and women, driving them from home and offices 
 annually to sanitaria or various health resorts, and so breaking down 
 their average vitality as to render them much more liable to serious 
 sickness and death. 
 
 This, the most widely prevalent of all nervous disorders in this 
 country, seems to be on the increase. It is very commonly found 
 among persons who take no reasonable recreation — many business 
 men, among others — and the loss of time and incapacitation for work 
 lare very great, often weeks and months at a time. 
 
 As to the extent to which minor ailments exist, no statistics are 
 available. Doctor Castle, of Cincinnati, estimates, from an experi- 
 ence of many years in the medical supervision of institution em- 
 ployees and general practice, that there is an average of at least three 
 days' time lost annually for each person in the population because of 
 such minor ailments. Similarly, Dr. J. F. Morse, of the Battle Creek 
 Sanitarium, who has had a long experience in dealing with a large 
 number of cases, estimates that the average " well man " loses on an 
 average five days a year from work on account of headaches, tooth- 
 aches, " colds," and similar minor ailments which do not come under 
 the head of any of the diseases reported. 
 
 • Letter from Dr. Chas. H. Castle. 
 
662 REPORT OF NATIONAL. CONSERVATION COMMISSION. 
 
 Section 2. — Preventahility of minor ailments. 
 
 f' 
 
 lai 
 
 I 
 
 That almost all minor ailments can be avoided is scarcely to h 
 doubted. Doctor Gulick is " inclined to believe that something lik. 
 nine-tenths of all the minor ailments that we have, and which consti 
 tute the chief source of decreasing our daily efficiency, could bi 
 removed by careful attention." " With the removal of nine-tenths o 
 our disabilities and the conservation and further development of ou 
 natural powers," he adds, " the average person can increase his effi 
 ciency 100 per cent, that is, he can be twice as effective. This doei 
 not refer to doing merely or mainly twice as much work, of course 
 but by making less mistakes, and by working at a higher degree oj 
 speed when he does work. By working under conditions so that th< 
 work does not need to be repeated, the whole total will be mucl 
 greater — I think not too much to say twice as great — as under ordi 
 nary conditions." 
 
 Minor ailments are preventable by leading a .reasonably hygienic 
 life and by revising the modern gospel of " hustle " — which lattei 
 usually means crude, imperfect, and slovenly work, whether menta 
 or manual. The j^revention of these diseases would " cost " nothing — 
 for it costs nothing to stay well. 
 
 If, again, we consider the experience of those who have made a 
 serious attempt to avoid minor ailments, their preventability becomes 
 clear. Personally, I have laiown of scores of cases in which the tend 
 ency to catch cold has been almost completely overcome. In on( 
 case a physician, who as a boy had suffered from continual colds and 
 hay fever, succeeded, through the simplification and control of his 
 diet, in attaining almost complete emancipation, which has lasted over 
 forty years. Another physician reports that for ten years, during 
 which time he has taken special means to produce complete evacua 
 tion, he has not caught a single cold. A large number of cases ob 
 served are of persons, physicians as well as laymen, who have taken 
 the outdoor cure for tuberculosis or nerrous prostration. These 
 persons not only succeeded in combating these serious troubles, but 
 in completely freeing themselves from liability to colds. Evidently,' 
 if the outdoor life had been adopted simply as a preventive of colds, 
 it would have prevented originally, as it cured subsequently, their: 
 more serious disorders. 
 
 Chapter V. — Prevalence of undue fatigue. 
 
 Section 1. — Strength, endurance, and fatigue. 
 
 When a person is free from all specific ailments, both serious and 
 minor, he usually calls himself " well." There is, however, a vast 
 difference between such a "well" man and one in ideally robust i 
 health. The difference is one of endurance or susceptibility to 
 fatigue. Many " well " men can not run a block for a street car or 
 climb more than one flight of stairs without feeling completely tired, 
 out, while another " well " man will run 25 miles or climb the IVIatter- 
 hom from pure love of sport. The Swiss guides, throughout the 
 summer season day after day, spend their entire time in climbing. 
 A Chinese cooly will run for hours at a stretch. That the world 
 regards such performances as " marvelous feats of endurance " only , 
 
nsHER.] NATIONAL VITALITY. 663 
 
 5hows how marvelously out of training the world as a whole really 
 s. In mental work some persons are unable to apply themselves more 
 ■than an hour at a time, while others, like Humboldt or Mommsen, can 
 nvork almost continuously through fifteen hours of the day. 
 i As Mosso <* and others have proved, muscular fatigue is a chemical 
 jffect, due to the circulation of " fatigue poisons " in the blood. This 
 'las been strikingly shown by experiments by Weishardt and others 
 )n dogs; when blood is transfused from an exhausted dog to a 
 ' frisky " one, the latter immediately wilts and becomes fatigued 
 ike the former, although he has not exerted himself in the least. In 
 )rder to reduce fatigue, therefore, we should keep down fatigue 
 Doisons. It is not unlikely that almost all poisons produce fatigue, 
 whether the poisons come from infections, from drugs, from impure 
 )r excessive food, from bad air, or from exertion. 
 
 It should be noted that endurance is a quality quite distinct from 
 strength,* Strength is measured by the utmost force a muscle can 
 ixert once; endurance by the number of times it can repeat an ex- 
 ertion requiring a specified fraction of available strength at the start. 
 Thus, if each one of two men is barely able to lift a dumb-bell weigh- 
 ng 100 pounds, their strengths are equal, but if one of them can raise 
 I dumb-bell weighing 50 pounds 20 times, while the other can raise it 
 times, the latter may be said to have double the endurance of the 
 brmer. Another mode of expressing the same thought is that endur- 
 mce is measured by the slowness with which strength decreases 
 hrough exertion. 
 
 Section 2. — Alcohol and fatigue. 
 
 Of all poisons in ordinary use, alcohol and tobacco are the most 
 ;ommon. That alcohol increases fatigue is now commonly recognized 
 )y athletes. "Alcohol gives no persistent increase of muscular power, 
 't is well understood by all who control large bodies of men engaged 
 n physical labor that alcohol and effective work are incompatible." " 
 
 One of the most interesting features of the cycling sport, when long 
 ,ours were the fashion a few years ago, was the fact that the wayside 
 ;eller of drinks found himself forced to supply chiefly " temperance 
 Irinks." The cyclists discovered that they could not make their " cen- 
 .ury runs " on alcoholic beverages. Two friends report that they 
 topped for refreshments and drank beer. Resuming their ride they 
 ound it hard to propel the machine, and both ima^ned some obstruc- 
 ■ion had lodged in the gears. Only after having dismounted and sat- 
 sfied themselves to the contrary did they come to the conclusion, 
 whether rightly or wrongly, that the resistance was in their own legs 
 Hid was due to the beer. 
 
 Careful experiments with alcohol in relation to fatigue have been 
 eported by Rivers,"* who shows that alcohol diminishes the capacity 
 
 "See Fatigue, English translation. New York (Putnapi), 1904, 
 
 '' See Irving Fisher: The Effect of Diet on Endurance. (Publications of Yale 
 Jniversity, Transactions of the Connecticut Academy of Arts and Sciences; 
 Jew Haven, 1906, p. 1.) 
 
 " The Liquor Problem, a summary. Report of subcommittee of committee of 
 ifty on physiological aspects of the liquor problem. New York ( lloiiiiliton- 
 lifflin), 1.905. . 
 
 *W. H. R. Rivers: "Influence of Alcohol on Fatigue, etc." London (Edward 
 irnold), 1908, pp, 89-90. 
 
 I 
 
664 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 for exertion. Experiments carried on by Professor Aschaffenburg 
 with four typesetters, all users of alcohol, showed that on days when 
 Greek wine, containing 18 per cent of alcohol, was given the men 
 there was considerable diminution of the capacity for work. On 
 the alcohol days two of the men did decidedly less work, while the 
 work of the remaining two was marked by great irregularity. 
 
 The injury from alcohol is mitigated, but not excluded, through 
 combination with sugar, malt, and other beneficial ingredients, as, 
 
 in beer. 
 
 Section 3. — Tobacco and fatigue. 
 
 As to tobacco it is a common observation that smoking interferes 
 with one's " wind " in nmning. The poisons which probably bring 
 about this result include others than nicotine. Possibly the most 
 important poison is carbon monoxide, which has a great affinity for 
 the iron in the blood." "When the smoker " inhales," this poison, 
 probably joined with others, enters directly into the blood stream. 
 
 In an experiment carried on by Doctor Lombard, " smoking was 
 found to have a very depressing effect upon the strength of the 
 voluntary muscular contractions. * * * Undoubtedly the effect 
 of tobacco to lessen the voluntary power is due to its influence upon 
 the central nervous system." ^ 
 
 It is the testimony of many users of tobacco that the habit of 
 smoking leads to nervousness and disinclination to exertion directly 
 after smoking. 
 
 Experimentation has shown that smoking increases blood pressure 
 The greater resistance to circulation offered by the blood is pre- 
 sumably due to the excitation caused by the introduction into the 
 blood stream of foreign matter from the tobacco. There is reason 
 to believe, though the fact has not been established, that endurance 
 is lessened by high blood pressure. 
 
 Section 4. — Diet and fatigue. 
 
 Poisons may also enter the system through food. Many poisons 
 come from diseased, contaminated, or adulterated foods; but they may 
 also be due to excess of food or wrong preparation of foods, and espe- 
 cially to the decomposition of protein (the principal ingredient of 
 white of egg and lean meat) in the colon. The absorption of such 
 poisons causes auto-intoxication. 
 
 It has long been known by physiologists that the putrefaction in 
 the intestines is the putrefaction of protein. But only recently have 
 they raised the question whether a reduction of the protein element ' 
 of food would be feasible and whether the resulting reduction in 
 putrefaction and auto-intoxication might not be advantageous.' I 
 These questions are still under debate, but the trend of physiological 
 opinion is increasingly in favor of protein reduction. Practically 
 this means a lessening of the consumption of lean meat and eggs. . 
 
 "'♦The toxicity of tobacco smoke," The Lancet, CLXXV, 1908, p. 104. 
 
 ' Warren P. Lombard, M. D., " Some of the influences which affect the power 
 of voluntary muscular contraction." Journal of Physiology, Vol. XIII, 1892, 
 p. 48. 
 
 * See C. A. Herter, " Bacterial Infections of the Digestive Tract," New York 
 (Macmillan), 1907. 
 
FISHER.] NATION All VTTALITT. 665 
 
 Evidence has accumulated, though it has not yet been put in proper 
 experimental form for absolute proof, that auto-intoxication is not 
 only "an exceedingly common affection, but also the chief cause of 
 undue fatigue. Most persons know the heavy feeling and disinclina- 
 tion to e^^ertion which generally accompany constipation, and, on 
 tho other hand, the relief which comes with a complete evacuation. 
 
 Leaving auto-intoxication aside, Professor Chittenden is of the 
 opinion that waste products from combustion of protein are probably 
 responsible for fatigue. Whatever the explanation. Professor Chit- 
 tenden found in his classical experiment" with a squad of soldiers, 
 that strength and endurance were increased by a reduction of the 
 protein. Thirteen soldiers were placed for six months on a diet con- 
 taining a much smaller quantity of protein food than what is pre- 
 scribed by ordinary dietary standards and containing only one-third 
 of what is demanded by common American usage. Professor Chit- 
 tenden's results are gaining recognition, but they will need to be 
 further tested before any unanimity of opinion can be reached. 
 
 Analysis of the diet of several hundred vegetarians shows that on 
 the whole they are lower in protein than the average American. 
 Comparative experiments on 17 vegetarians and 25 meat eaters in the 
 laboratory of the University of Brussels have shown Mttle differences 
 in strength between the two classes, but a marked superiority of the 
 vegetarians in point of endurance. The average superiority was 53 
 per cent. The vegetarians recuperated from fatigue more quickly 
 than the meat eaters.^ To what extent, if at all, the superiority of 
 the vegetarians was due to vegetarianism as such, and to what extent 
 to the fact that they made a more moderate use of protein, can not 
 be exactly determined, although the evidence indicates that the lower 
 protein is the essential factor. The virtues and drawbacks of vege- 
 tarianism as such have as yet received almost no scientific study." 
 Professor Chittenden is now engaged in such a study. 
 
 In another experiment, comprising 49 subjects and contrasting 
 those on high and low protein diets, it was found that the low pro- 
 tein subjects had greater endurance.'' For instance, the test of 
 "deep-knee bending" showed that whereas the high-protein subjects 
 could seldom exceed 400 or 500 times, the low-protein men could fre- 
 quently exceed 1,000, and in one case reached 2,400. 
 
 The writer has in his possession several hundred unpublished in- 
 dividual records of men on a low and high protein diet. These, on 
 the whole, seem to show a considerable superiority in endurance 
 among those using the lesser amounts of protein. But while the trend 
 of evidence seems at present to favor a reduction in protein, the ques- 
 tion is not yet settled.* There exist many conspicuous cases of high 
 
 « See Russell H. Chittenden, " Physiological Economy in Nutrition," New York 
 (Stokes), 1904, and "The Nutrition of Man," New York (Stokes), 1907. 
 
 ^ " Enquete Scientifique sur les Vegeteriens de Bruxelles," par Mile, le Dr. J. 
 loteyko and Mile. Varia Kipiani, Bruxelles (Lemartin), 1907. For EJnglish 
 abstract see " Diet and Endurance at Brussels," Science, Vol. XXVI, 1907, pp. 
 561-563, 
 
 "An exception is Caspari, " Physiologische Studien iiber Vegetarismus," 
 Bonn (Hager), 1905; see also Gautier, "Diet and Dietetics," English transla- 
 tion, London, 1906. 
 
 <* Irving Fisher, " Influence of flesh eating on endurance," Yale Medtlcal Jour- 
 nal, March, 1907. 
 
 * See, for example, Prof. F. G. Benedict's paper on " The nutritive require- 
 ments of the body," American Jourual of Physiology, Vol. XVI, 1906, pp. 
 409-437. 
 
666 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 protein and great endurance. A striking instance is that of the 
 pedestrian Weston. , 
 
 In an experiment on nine healthy students, the writer found that 
 thorough mastication seemed to cause a gradual decrease in protein. 
 The significance of the experiment lay in the improvement "in physi- 
 cal endurance of eight of the men, which increased over 90 per cent 
 in five months. The ninth man — the only one whose protein was not 
 greatly reduced — failed to improve in endurance." 
 
 Section 5. — Exertion and fatigue. 
 
 Exertion increases combustion of oxygen, and the capacity for ex- 
 ertion is intimately related to the completeness of this combustion. 
 
 Experiments in artificially administering oxygen to athletes have 
 been made in England by Hill, Flack, Pombrey, and others.^ Fol- 
 lowing these, a series of experiments in swimming recently took 
 place at Huntington, L. I. The swimmers to whom oxygen had been 
 administered surpassed their nonoxygenized competitors as well as 
 their own previous natural records. Doctor Bising, who carried on 
 the experiment, states that the effects of oxygen inhalation are useful 
 for short efforts only. At most the oxygen exercises its influence 
 for not more than three minutes. 
 
 Perhaps the most important of the common influences affecting the 
 capacity to resist fatigue is physical exertion. It is well known that 
 a man " in training " has greater endurance than one who attempts 
 exertion without previous systematic exercise or training. In general, 
 it may be said that a person in the " pink of condition " is fit not 
 only for physical but also for mental exertion. The great majority of 
 adults are far from being " in condition," suffering either from lack 
 of exercise or from too much exercise. The ordinary man errs either 
 in one direction or the other. The brain worker lives too sedentary a 
 life, while the manual worker, through fatigue caused by long hours, 
 is in a continual state of overexertion. Could these conditions be 
 remedied, endurance, as measured by capacity to withstand prolonged 
 strains, might be greatly increased. 
 
 Experiments have shown that physical endurance can be doubled 
 by dietetic causes alone, or doubled by exercise alone. By both 
 together it is not unlikely that it could be tripled or quadrupled. 
 But when it is said that the endurance, or capacity for exertion, of 
 the ordinary healthy man could be thus multiplied, it is not meant 
 that the hours of his daily work, or even his daily output of work, 
 could be increased in such a ratio. What it does mean is the removal 
 of the fatigue limit, a freer and more buoyant life, and a visible 
 increase in the quantity and quality of work per hour. 
 
 In an ideal life fatigue would seldom be experienced. But in 
 most lives, unfortunately, fatigue is a daily experience. A workman 
 who gives intelligent and systematic care to the body writes that 
 when after a long day's work the factory whistle blows at night he^j 
 unlike his fellows, feels as fresh as when he began work in the morn- 
 ing. Workmen can by such self-care mitigate some of the evils of; 
 
 « Irving Fisher, " Effects of diet on endurance," loc. clt. 
 "British Medical Journal, 1908, August 22, p. 499; also August 29, p. 578, 
 Journal of Physiology, 1908, XXXVII, 77-112. 
 
nsHEK.J NATIONAL. VITALITY. 667 
 
 " the long day." But they are amply justified, both in the interest 
 of their own and of national efficiency, in continuing their efforts 
 toward a shortening of the work day. 
 
 Section 6. — The ivorking day. 
 
 The present working day is a striking example of the failure to 
 conserve national vitality. In order to keep labor power unimpaired, 
 the working day should be physiological — i. e., it should be such as 
 would enable the average individual to completely recuperate over 
 night. Otherwise, instead of a simple daily cycle, there is a pro- 
 gressive deterioration. A reduction in the length of the work day 
 would be a chief moans of improving the vitality of workmen, as well 
 as the worth of life to them. 
 
 The fatigue of workmen is largely traceable to their long work 
 day and serves to start a vicious circle. Fatigue puts the workman 
 in an abnormal frame of mind. He seeks to deaden his fatigue by 
 alcohol, tobacco, exciting amusements, and excesses of various kinds. 
 The momentary relief which he thereby obtains is purchased at the 
 expense of an increasing susceptibility to fatigue, resulting sooner 
 or later in complete depletion of his vital energies and in the con- 
 traction of tuberculosis or other fatal disease. The decrease in the 
 length of the working day has not diminished the total output. 
 
 An instance in which the eight-hour day superseded the nine-hour 
 day with entire success is the case of the Salf ord Iron Works, of Mather 
 & Piatt, at Manchester, England, which changed to the eight-hour 
 day in 1893. As the firm's products were subject to keen competition 
 in both home and foreign markets, it was obliged to look carefully 
 after the labor cost, and its conclusion that such cost did not increase 
 in consequence of the reduction in working hours was reached after 
 extremely accurate comparisons by accountants, who of course took 
 into consideration the saving in consumables, wear and tear, fuel, etc. 
 The Bureau of Labor inquired of Messrs. Mather & Piatt if they were 
 still on the eight-hour basis, and received a reply dated May, 24, 1904, 
 in which they stated that— 
 
 our experience since the first year In which it (the eight-hour system) was tried 
 has fully borne out the conclusions then arrived at, and we are fully satisfied 
 that as regards the comparison between eight and nine hours per day the bal- 
 ance of advantages is in favor of the shorter period. <* 
 
 In 1894 the hours of labor of about 43,000 workmen in British government 
 factories and workshops were reduced to forty-eight per week. Of this number, 
 18,600 received a reduction of five and three-fourths hours a week, and 24,300 
 had their time reduced two and one-half hours a week. With no change in 
 piece rates the workmen were able to earn as much as formerly. Day workers 
 received an increased hourly rate of pay to make their earnings per week of 
 forty-eight hours equal to those per week of fifty-four hours. It was not found 
 necessary to increase the number of day workers.* 
 
 In 1899 the owners of the great Zeiss optical goods factory at Jena, 
 Germany, introduced the eight-hour day and then made careful rec- 
 ords of the results. In 1903 it was announced that although the 
 aggregate number of hours worked had decreased 15 per cent the out- 
 put per hour had increased 16.2 per cent." 
 
 « New York Labor Bulletin No. 25, June, 1905, p. 240. 
 
 * Board of Trade Labor Gazette, July, 1905, reported in New York Labor 
 Bulletin No. 28, March, 1906. 
 « New York Labor Bulletin, No. 25, June, 1905, p. 240. 
 
 S. Doc. 419, 61-2 4 
 
668 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 At Liege it was found in a sulphuric acid establishment similar to 
 a foundry " that shortening the working day from eleven hours to ten, 
 from ten to nine, and so on gradually down to seven and one-half, 
 resulted, in each case, in an increase of the output. 
 
 The Solvay Process Company, of Syracuse, installed in 1892 a 
 system of three eight-hour shifts in place of the two previous shifts 
 of eleven and thirteen hours, respectively. It was stated by the 
 assistant general manager in 1905 that the change had considerably 
 lessened the wear and tear on the men, and that they could be called 
 on to do their work at their highest state of efficiency, which had not 
 been possible on the two-shift basis. President Hazard of the com- 
 pany writes: 
 
 In general, I can say that the results of the change from a twelve-hour shift 
 to an eight-hour shift were very satisfactory and have continued to be so. 
 While the immediate result was to considerably increase the cost per unit of prod- 
 uct, the efficiency of the men gradually increased, so that at the end of about 
 one year the first increase has been overcome and the cost per unit of product 
 fell to a point even lower than had been obtained under the twelve-hour shift, 
 and further the time consumed per unit of product has since been so reduced 
 that we are today and for some time have been operating with a smaller 
 number of hours per unit of product than we had under the twelve-hour shift. 
 
 Further proof of the benefits of the change to the three-shift day 
 is furnished by the records of the Solvay Mutual Benefit Association 
 for 1891 and 1904. The days lost per man by sickness each year fell 
 from seven and one-half days in 1891 to five and one-half days in 
 1904. 
 
 It is not maintained that in all cases productivity will be as great 
 in eight hours as in nine. Cases to the contrary could also be cited. 
 The point to be insisted upon is not that it is profitable to an em- 
 ployer to make the work day shorter, for often it is not, but to show 
 that it is profitable to the nation and the race. Continual fatig-ue is 
 inimical to national vitality, and however it may affect the commer- 
 cial profits of the individual it will in the end deplete the vital 
 resources on which national efficiency depends. 
 
 In the interests of this efficiency, a longer time at noon for lunch 
 is usually necessary. The present economy of lunch time is short- 
 sighted, tends to food bolting, indigestion, a drowsy and tired after- 
 noon, and inferior work. This has been shown by actual experience.^ 
 
 The accident bulletins of the Interstate Commerce Commission 
 contain frequent records of disasters caused by the long hours of rail- 
 way employees. In a recent bulletin, No. 27, two collisions are at- 
 tributed to the mistakes of employees who have been on duty much 
 longer than the instinct of safety should allow. Collision No. 3,'' 
 which killed 2 and injured 13, was due to the mistake of a station 
 operator who had been on duty from 7 a. m. to 3.30 p. m. and who 
 had returned to duty at 8 p. m. The collision took place at 12.30 
 a. m. the next morning. 
 
 ; 
 
 o See L. G. Fremont, " Une Experience Industrielle de Reduction de la Journel 
 de Travail," Brussels, Solvay Institute, 1906. 
 
 * See especially description of a French experiment cited by Hubert Higgins 
 In Humaniculture, New York (Stokes), 1906. 
 
 "Accident Bulletin No. 27, January to March, 190S. 
 
■isHEB.l NATIONAL VITALITY. 669 
 
 Section 7. — Importance of preventing undue fatigue. 
 
 The economic waste from undue fatigue is probably much greater 
 ihan the waste from serious ilhiess. We have seen that the average 
 ierious ilhiess per capita is usually about two weeks each year. This 
 s about 4 per cent of the year. Expressed differently, about 4 per 
 ;ent of the population is constantly sick. 
 
 On the other hand, the number that suffer partial disability 
 Jirough undue fatigue certainly constitute the great majority of the 
 copulation. No observer can fail to conclude that this is true of the 
 :Vmerican working, business, and professional classes, and the latest 
 Yord among the students of school hygiene is that it is true to a 
 arge extent even among children. If therefore we assume that only 
 ')0 i^er cent of the population is suffering some impairment of its 
 )est powers through undue fatigue, we are on safe ground. The ex- 
 ent to which the power of this supposed 50 per cent of the popula- 
 ion is impaired must certainly exceed 10 per cent. When we consider 
 hat young men, supposed to be perfectly well, have the enormous 
 ■com for improvement indicated in this chapter, and when we con- 
 sider the gratifying results of experiments with a shorter work day it 
 .vill be seen that the true impairment is probably several times 10 per 
 ;ent. Yet if only 50 per cent of the population are suffering an im- 
 Dairment equal to only 10 per cent of its working powers, the result 
 s equivalent to 5 per cent of the population suffering total impair- 
 nent which is more than the 4 per cent impairment from serious 
 llness. 
 
 The relatively slight impairment of efficiency due to overfatigue 
 •eads to more serious impairment. Just as minor ailments prove to 
 lave an unsuspected importance when considered as gateways to 
 serious illness, so the inefficiency from fatigue is vested with great 
 dgnificance as the first step toward minor ailments. Obviously if 
 overfatigue could be reduced to a minimum, this reduction would 
 :arry with it the prevention of the major part of minor ailments, 
 jyhich in turn would lead to a great reduction in more serious illness, 
 md this finally would lead to a great reduction in mortality. A 
 ;ypical succession of events is first fatigue, then colds, then tubercu- 
 losis, then death. Prevention, to be effective, must begin at the 
 Deginning. 
 
 But prevention is merely the first step in increasing the breadth of 
 ife. Life is to be broadened not only negatively by diminishing those 
 iisabilities which now narrow it, but also positively by increasing the 
 jultivation of vitality. Here we leave the realm of medicine and 
 mter the realm of physical training. The first and lowest step is 
 ^mnastics. This is valuable — far more so than the ordinary seden- 
 :ary man who neglects it realizes — but it is after all a kind of medicine 
 lot altogether pleasant to take and far less valuable to him who takes 
 t than are athletic sports, which constitute the next highest stage. 
 Beyond athletic sports in turn comes mental, moral, and spiritual 
 mlture, the highest product of health cultivation. It is an encour- 
 iging sign of the times that the ecclesiastical view of the Middle Ages, 
 which associated saintliness with sickliness, has given way to modern 
 ^muscular Christianity," typified in Young Men's Christian Associ- 
 itions with their gymnastics and athletics. This is but one evidence 
 
670 REPORT OF NATIONAL. CONSERVATION COMMISSION. 
 
 of the tendency toward the " religion of healthymindedness " de- 
 scribed by Professor James. Epictetus taught that no one could be 
 the highest type of philosopher unless in exuberant health. Expres- 
 sions of Emerson's and Walt Whitman's show how much their spirit- 
 ual exaltation was bound up with health ideals. " Give me health and 
 a day," said Emerson, " and I will make the pomp of emperors ridicu- 
 lous." It is only when these health ideals take a deep hold that a 
 nation can achieve its highest state of development. Any country 
 which adopts such ideals as an integral part of its practical life 
 philosophy may be expected to reach or even excel the development 
 of the health-loving Greeks. 
 
 The means of securing both the negative prevention of invalidity 
 and the positive accumulation of vitality will form the subject of 
 Part IIL 
 
 II 
 
 t 
 
 t 
 
 1 
 i 
 
Part III.— METHODS OF CONSERVING LIFE. 
 
 Chapter VI. — Conservation through heredity. 
 Section 1. — Heredity and environment. 
 
 That the -waste of life through preventable disease and death is 
 mormons appears clearly from the facts already cited. The practical 
 problem is this : If such waste is really preventable, what are the con- 
 ditions necessary to make prevention an accomplished fact? There 
 ire two main conditions. First, a general desire for improvement; 
 second, a general knowledge of how to secure that improvement. 
 
 Once the general public recognizes the needless waste of vitality, 
 
 will not be content until that waste has been eliminated. To such 
 m awakening the American instinct of economy is in itself a power- 
 ul spur. Practical men are coming to consider it " good business " 
 ;o take some care of their own vital resources. As this view gains 
 zround, habits and fashions will adapt themselves to the change. 
 The folly of the man who loses his health in the pursuit of wealth, 
 md then for the rest of his days spends his wealth to win back health, 
 s beginning to be appreciated. 
 
 Human vitality depends upon two prianary conditions, heredity 
 md hygiene, or conditions preceding birth and conditions during life, 
 in other words, vitality is partly inherited and partly acquired. 
 
 It is well known that cultivated plants and animals have been 
 greatly changed and developed by breeding. " The original apple, 
 is offered by nature to mankind, was the small, sour, bitter crab of 
 he forest, unpleasant, indigestible, innutritions. * * * jj^ ^^^10 
 Doctor Davenant, a writer on political economy, estimated that the 
 iverage weight of dressed cattle did not exceed 370 pounds. * * * 
 !n 1846 McCullock stated that ' at present the average weight of 
 ;attle is estimated at or about 800 pounds.'"" 
 
 Human heredity is now dependent on haphazard selection. Little 
 attention is paid by those who contemplate marriage to the question 
 i how much stamina w^ill be transmitted to the next generation. The 
 tory was told of a famous dog fancier who, when asked why he paid 
 much attention to his dogs but delegated the care of his children to 
 lurses, replied: "My dogs have a pedigree." Human pedigrees, no 
 ess than canine, rest on a physical basis; yet genealogical records of 
 luman beings, while they have much to say of social position, have 
 '■ery little to say of physical capacity or intellectual ability. Those 
 vho, like Galton and Pearson, believe in a science of eugenics, hope 
 hat the day will come when pride of inheritance will include as im- 
 
 « See Dr. Edward Jarvis, Political Economy and Health, Fifth Report, Mass. 
 Joard of Health, 1874. Doctor Jarvis adds that human life is as "expansible" 
 
 i8 animal life. 
 
 671 
 
672 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 portant, if not as the chief items, physical, mental, and moral stam 
 ina. A tendency in this direction can be discerned. When the no 
 bility commanded the reverence of all classes, quite irrespective o 
 ability, commoners, however well endowed by nature, could never ob 
 tain the same respect. But to-day the English House of Commons i 
 more honored and respected than the House of Lords. 
 
 Once the importance of a physical pedigree comes to be rated a 
 its true value, a man's pride in his own inheritance will show itsel 
 in a correlative feeling of responsibility for future generations. Fo; 
 the sake of children yet unborn, men and women will set for them 
 selves physical ideals of the highest order. 
 
 SECTioisr 2. — Eugenics. 
 
 The whole question of race improvement through heredity consti 
 tutes the subject-matter of the new science of eugenics. The devotee 
 of this science are at present engaged in studying the laws of heredity 
 in all its aspects. The Mendelian doctrine of heredity, with tb 
 theories of Darwin and Weissmann, are some of the topics whicl 
 need to be studied in reference to their practical application. 
 
 Until more results have been obtained, it would be premature t< 
 make great claims for the possible future usefulness of appliec 
 eugenics. A word may be said to prevent misunderstanding as to iti 
 aims. Many have supposed that the object of eugenics was to brin^ 
 about suitable marriages by compulsion of the Government. Such ( 
 proposal would not only be absolutely impracticable, but would de 
 feat the very ends aimed at. JNIarriage, above all human choices 
 must, as a rule, be left to the individual, guided by his ideals alone 
 By the change of these ideals alone can the character of marriagei 
 be influenced. Sir Francis Galton, the founder of the science oJ 
 eugenics, expects intelligent public opinion to be the chief guide ir 
 marriage. Just as the union of brother and sister is tabooed, and 
 the marriage of even first cousins" is eyed askance — whether justly oi 
 not does not matter — so, if the aims of eugenists are carried out, ar 
 obviously unhygienic marriage will be frowned upon. It was some- 
 what in this way that the ancient Sparta raised its vitality to a high 
 point of physical excellence. 
 
 Galton has pointed out * that present restrictive rules of marriage 
 selection are endured without any sense of loss of privilege or free 
 dom. For example, members of the European nobility are, in theii 
 marriage choice, restricted almost wholly to fellow-aristocrats; yet 
 so much has this restriction become a part of their ideal and creed 
 that the narrowness of the range of choice is not usually realized. 
 
 Even granting that some marriages are studiously calculated to 
 win money or title, a much stronger or more pervasive, although 
 unconscious, influence is exerted by the ideals which young men and 
 women at marriageable age have formed of what their compan- 
 ions for life sliould be. Nothing is more certain than that if from 
 
 " In at least 20 States the marriage of first cousins is forbidden by law. An 
 excellent discussion of this subject is contained in " Consanguineous Marriages 
 in the American Population," by G. B. L. Arner, Ph. D., New York (Longmans), 
 1908. 
 
 »" Sociological Papers," London (Macmillan), 1906, Vol. II, p. 12. 
 
riSHEE.] NATIONAL, VITALITY. 673 
 
 childhood they were trained to regard vitality as the first essential in 
 an ideal man or woman, this would influence their personal fancy. 
 Health, beauty, and vitality are natural objects of admiration and 
 love. Titles, wealth, and other extraneous attractions are not. To 
 lessen the public esteem for these, and to increase the esteem for 
 natural human merit, will tend to increase not only the number of 
 healthy marriages, but the importance of the role played by normal 
 love. Jf, therefore, eugenic ideals ever hold sway, love marriages will 
 not only continue to exist, but will become more frequent. Love is a 
 primal and natural instinct, and the more natural men and women 
 are, and the more highly they esteem natural vitality, the more will 
 they be guided by mutual attraction. 
 
 If a considerable percentage of the population once shall come to 
 regard vitality as an essential endowment, the effect on mating will 
 be felt in two ways: First, a larger percentage of healthy persons 
 will marry, leaving a larger percentage of unhealthy persons single; 
 second, healthy persons will mate with each other, and unhealthy 
 persons, in so far as they marry at all, will do so among themselves. 
 Of mixed matings there will be a smaller number. Both of these 
 results will tend gradually toward the improvement of the race. 
 That the first — the increased proportion of marriages among the 
 healthy — will do so, is obvious. The second — the marriage of like 
 with like in respect to health — would, it seems probable, operate to 
 increase the number of progeny of healthy couples and decrease that 
 of the unhealthy, especially after the first generation. 
 
 Since athletics have come into vogue it is well known that the 
 athletic ideal has led to athletic mating. The tendency of the present 
 devotion to athletics must be to elevate the respect for physical 
 prowess. The high esteem entertained in Japan for physical train- 
 ing and for hygiene as a guarantee of the fighting power of the 
 country, constitutes an object lesson, if not a warning, to Americans 
 who wish their country to be the peer of the best. It would be folly, 
 of course, to expect any change in ideals so complete that there would 
 not be numerous exceptions to hygienic mating, but, once the bulk of 
 mankind are guided by a truer principle in forming marriages, the 
 effect on racial development will make itself distinctly felt within a 
 generation. As President Roosevelt has said: "The preservation 
 of national vigor should be a matter of patriotism." Some persons 
 would even make it a matter of religion. 
 
 Section 8. — Eugenics and law. 
 
 It is possible, however, that governmental interference with the 
 birth rate may in future be employed to a limited extent. Two ways 
 have been suggested : One is for the Government to give prizes or 
 bounties to couples that conform to certain specified standards in the 
 same way as the French Government has encouraged the increase of 
 population by offering inducements to couples of the poorer class 
 who raise seven or more children." 
 
 The second is to forbid alliances among criminals, paupers, and the 
 feeble-minded. These classes fall under the tutelage of the State, 
 
 « In 1889, fathers of seven children were made exempt from payment of the 
 personal property tax. This exemption was in 1890 limited to fathers who paid 
 taxes of not over 10 francs each. 
 
674 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 and thereby forfeit their right to free choice. Already Indiana," 
 Connecticut,^ Michigan,'' and other States in this country, have 
 passed laws of this sort. 
 
 Indiana extends the prohibition to all persons suffering from trans- 
 missible disease of any sort. This prohibition is called into daily 
 operation in that State. It is in the power of the Indiana state board i 
 of health to raise by degrees the standards of health demanded of 
 those who desire license to marry, a provision that aims directly at 
 the improvement of human vitality in the State. Indiana has gone i 
 even further and has recently provided <* that confirmed criminals, 
 imbeciles, idiots, and rapists, procreation by whom is deemed inad- 
 visable by experts, shall be unsexcd (or " sterilized ") by surgical 
 operation. Under this law over 800 prisoners have been sterilized to 
 date.'' 
 
 The experiments started in Indiana and other States will be inter- 
 esting to watch, and promise an improvement over the conditions 
 which have prevailed too often in the past. Professor Brewer, of 
 Yale, tells of a case in Connecticut some years ago where a feeble- 
 minded pauper woman, kept as a public ward, was admired by a 
 half-witted farmer living in an adjoining town. A selectman of 
 the town maintaining the w^oman " to get rid of her support " en- 
 couraged their marriage. His short-sightedness, even from the stand- 
 point of immediate money economy, to say nothing of racial economy, 
 became apparent when, a few years later, she and her husband and 
 three idiotic children drifted into the poorhouse of the husband's j 
 town. 
 
 That laws like the ones discussed, but of gradually increasing 
 severity, will become common in the future seems likely; and, as 
 Professor Lankester has remarked, humanity will probably submit 
 in the future to communal restriction of the right to multiply with as 
 good grace as it has given up the right to rob and to rape.^ 
 
 The effect of restrictions upon free right of marriage is discussed 
 by Doctor Hurty, secretary of the Indiana state board of health, as 
 follows : 
 
 It seems most essential and necessary that we have laws for the prevention 
 of the production of the unfit if society is to be saved from destruction. Modern 
 hygiene, under which I include in this instance all such benevolent institutions 
 as insane asylums and institutions for the feeble-minded, is extending the dura- 
 tion of life of the dependents and deficients, and it might be added that the 
 humane and hj^gienic care in the prisons is extending the duration of life of the 
 delinquents. In Indiana the life duration of the insane has been extended eight 
 years within the last two decades. This slight extension means a very con- 
 siderable burden upon the people, and if this class of deficients is unrestricted 
 we can readily see what a burden time will place upon society. The production 
 of the unfit must cease if charity and hygiene continue. Otherwise it seems 
 certain that society will be swamped. 
 
 « Indiana Laws of 1905, chap. 126, H. US, sec. 3. 
 
 ^Connecticut Statutes (revision of 1902, sec. 1354), forbid the marriage of 
 epileptics. 
 
 " Michigan forbids the marriage of epileptics. 
 
 <» Indiana Law of 1907, chap. 215, H. 364. 
 
 « Letter from Dr. J. N. Hurty. 
 
 ^ E. R. Lankester, "The Kingdom of Man," London (Constable), 1907, p, 41. 
 
 The recent report of the Royal Commission on the Care and Control of the 
 Feeble Minded recommends such restriction. 
 
jlSHBB.1 NATIONAL VITALITY. 675 
 
 While institutional treatment of the insane is right and proper 
 rom a humanitarian point of view, by bringing an increase in the 
 verage insane lifetime it adds to the public burden and enlarges the 
 igures of the living insane. Mr, Sanborn estimates the average 
 Qsane life in Massachusetts at thirteen years, of which at least three 
 ears occur, on the average, before hospital treatment is applied. 
 le adds: 
 
 I suspect we have come nearer to statistical accuracy on this question In 
 Tassachusetts than has been reached in any region of equal population any- 
 where. The world has been gradually coming round to the conclusions reached 
 y the late Dr. Pliny Earle (of Northampton) and myself, viz, that the changes 
 1 the social and sanitary conditions of all civilized countries have increased 
 ae number (proportioned to population) of new cases of insanity, while the 
 nproved treatment of patients in the meantime has made the average insane 
 fe longer than formerly, and that in spite of the well-known increase in forms, 
 ke paresis and epilepsy, which may soon end fatally. 
 
 Interesting records exist of two families of criminals, the so-called 
 Jukes " and the " Tribe of Ishmael." From the one man who 
 ounded the "Juke" family came 1,200 descendants in seventy-five 
 ears; out of these, 310 were professional pauj^ers, who spent an 
 ggregate of two thousand three hundred years in poorhouses, 50 
 jere prostitutes, 7 murderers, 60 habitual thieves, and 130 common 
 riminals. 
 
 Dugdale" has estimated that the "Juke" family was an economic 
 )ss to the State, measured in terms of potential usefulness wasted, 
 osts of prosecution, expenses of maintenance in jail, hospital, and 
 sylums, and of private loss through thefts and robberies of $1,300,000 
 1 seventy-five years, or over $1,000 for each member of the family. 
 
 Similarly, the " Tribe of Ishmael," numbering 1,692 individuals in 
 LX generations, has produced 121 known prostitutes and has bred 
 undreds of petty thieves, vagrants, and murderers. The history of 
 le tribe is a swiftly moving picture of social degeneration and gross 
 arasitism, extending from its seventeenth-century convict ancestry 
 ) the present-day horde of wandering and criminal descendants.'' 
 
 Had the original criminals in the " Juke " family and the " Tribe 
 f Ishmael " been sterilized under some law like that of Indiana, this 
 Duntry would not only have been spared a widely disseminated 
 riminal, epileptic, and immoral strain, but would have saved hun- 
 reds of thousands of dollars paid out for criminal suits and for 
 istitutional care, to say nothing of the expenses still to come from 
 le incapacity and criminality of future generations. 
 
 These cases present only one side of the case. Over against them 
 lay be set illustrious families in which great intellectual ability and 
 loral worth have been passed on through many generations. Such a 
 Qe is the Hohenzollern family. In commenting on the frequent oc- 
 irrence of persons of surpassing mental and moral attainments in 
 lis family, Woods'' says : " It is particularly suggestive of what might 
 3 done with the human race were mankind ever so inclined." A simi- 
 ;ir example from a different walk in life is afforded by the Darwin 
 ^mily, where for four generations in direct line (Erasmus, Charles, 
 
 '«R. L. Dugdale: "The Jukes," New York (Putnam), 1877. 
 
 'Oscar C. McCulIoch, "The Tribe of Ishmael," a study in social degeneration, 
 Report of Fifteenth Annual Conference of Charities and Corrections, 1888," 
 ?. 154-159. 
 
 "F. A. Woods, "Mental and Moral Heredity," New York (Holt), p. 79. 
 
676 REPORT OF NATIONAXi CONSERVATION COMMISSION. 
 
 George, Horace, and Francis) as well as in collateral lines (e. g. 
 Francis Galton) Bcientific ability of the first rank has been manifest 
 
 President Roosevelt has pointed out that " race suicide " is a sigi 
 and accompaniment of coming decay. Mere numerical increase ii 
 not the whole solution, however; there must be improvement ii 
 quality also. A race that can not hold its fiber strong and true de 
 serves to suffer extinction through race suicide. The decline of oui 
 Puritan stock, so well pictured in the genteel but worn-out Pyncheoi 
 family of Hawthorne's novel, need not alarm us if we can replace r 
 with a new influx from the West or from the vigorous stocks o; 
 Europe. 
 
 There is one problem which concerns both the numbers and thi 
 quality of future generations, which hitherto has received practicalb 
 no attention except in a partial report upon the subject in Australia 
 This problem is. What is now and will be the effect of voluntary 
 childlessness upon the size and character of the birth rate and upoi 
 morals? It would be useless, here, however, to do more than mentioi 
 this as one of the gravest problems in the world to-day. Ronald M 
 Byrnes * shows that the fecundity of Yale graduates has steadih 
 diminished from 5.7 for the graduates of 1701-1791 to 2.0 for those o 
 1867-18-86. This reduction is much greater than the reduction for th' 
 whole country, which is reported by the census to he from 5.8 in 179( 
 to 4.6 in 1900. Degenerates have large families. From a study of 15( 
 degenerate families. Doctor Tredgold " found that the average num 
 ber of children per family was 7.3, while the normal average for thi 
 country at large (England) is 4. These figures do not specify th 
 frequency of marriage among degenerates or the mortality. Unles 
 the OHe is sufficiently low and the other sufficiently high, there mus 
 follow deterioration. General reduction of the birth rate may end ii 
 depopulation. It is not unlikely that this phenomenon will be thi 
 stimulus needed to bring about practical eugenic reforms. 
 
 What eugenics might possibly accomplish is indicated by on 
 writer in the following manner : " How rapidly the race would ad 
 vance if mankind should resolve : ' The next generation must be bon 
 with healthy bodies; must be nurtured in healthy phj^sical and mora 
 environments; and must be filled with the ambition to again giv( 
 birth to a still healthier, still nobler, generation.' " <* 
 
 * The Francis Galtou Laboratory for National Eugenics. University of Lou 
 don, is soon to issue a " Treasury of Human Inheritance," containing pedigree 
 Illustrating inheritance of various types of intellectual ability, of tuberculoa 
 stocks, of epilepsy, physical depravity, etc. 
 
 ^ Yale Review, November, 1908. 
 
 " W. C. D. Whetham, " Inheritance and Sociology," the Nineteenth Centurj 
 January, 1909. 
 
 ^ Louis R. Ehrich, " Posteritism," an address delivered at the dedication ex 
 ercises of The Century Chest, Colorado Springs, Colo., 1901. For literature oi 
 eugenics, the reader is referred to the following papers and the references thereii 
 contained : " Eugenics, Its Definition, Scope, and Aims," by Francis Galtoi 
 American Journal of Sociology, Vol. X, pp. 1-6, 1904. " The Scope and Im 
 portance to the State of the Science of National Eugenics," by Karl PearsoE 
 Oxford University Press, England. " Social Darwinism," by D. Collin Weill 
 Papers and Proceedings of the American Sociological Society, Vol. I, Universit] 
 of Chicago Press. "The Human Harvest," by David Starr Jordan, Bostoi 
 (American Unitarian Association), 1907. " Eugenics," by Prof. Albert G. Kellei 
 Yale Review, August, 1908. "A First Study of the Statistics of PulmonarJ 
 Tuberculosis," by Karl Pearson, Drapers Company, Research Memoirs, Londoi 
 (Delau & Co.), 1907. 
 
FISHER.] NATION All VTTALJTT. 677 
 
 Chapter VII. — Conservation through public hygiene. 
 Section 1. — Mnnidpal hygiene. 
 
 "\Miatever improvements in heredity may sometime be achieved, the 
 benefits of their influence can be enjoyed only by future, perhaps dis- 
 tantly future, generations. We of the present generation have to take 
 our heredity as we find it. We can not follow the advice of the hu- 
 morous philosopher to begin life by selecting our grandparents; but, 
 through hygiene, we can make the most of our inherited endowment. 
 Even such a limited effort offers large — amazingly large — rewards. 
 
 Ideal conditions for health comprise a pure and disease- free atmos- 
 phere in which to live and work; pure food and a pure water supply; 
 protection from infection and accident; and a proper adjustment of 
 work, rest, and amusement. Existing conditions are not only far 
 from ideal, but also far from what might easily and speedily be 
 attained. 
 
 That the savins: power of hygiene is great is now universally recog- 
 nized; that it will be greater is the hope and belief of those most 
 competent to judge. " If hygiene were able to prolong life when it 
 was little developed, as was the case until recently, we may well be- 
 lieve that, with our greater knowledge of to-day, a much better result 
 will be obtained." " 
 
 There is every reason to believe that human beings are as amenable 
 to cultivation as other animals and plants. Professor Graves, of the 
 Yale Forest School, states that by protecting trees from infection 
 their lives may often be prolonged a century. Domestic animals are 
 equally dependent on care. Doctor McGee states that the growth of a 
 colt may be stopped by giving it alcohol. 
 
 The methods of securing improvement in health conditions may be 
 roughly classified under three groups: Public hygiene, semipublic 
 hygiene, and personal hygiene. The first group refers to activities 
 of the government; the second refers to activities of the medical 
 ■profession and institutions such as hospitals, sanatoria, schools, and 
 factories, and to voluntary associations; the third group deals with 
 the private life of the family and the individual. Each of these 
 . three groups covers phases of all three branches of hygiene, viz, 
 the hygiene of environment, nutrition, and activity.^ 
 
 In this chapter we have to deal with public or governmental 
 hygiene. This branch has been chiefly concerned with pure air and 
 pure food and with organisms producing epidemic diseases. Boards 
 of health are a recent invention, and in this country they have as yet 
 been only imperfectly developed. They can never become the power 
 they should be until, first, public opinion better realizes their use- 
 fulness and the fact that their cost to the taxpayer is saved many 
 times over by the prevention of death and disease; second, more and 
 better health legislation is enacted — national, state, and municipal ; 
 ' and, third, special training is secured for what is really a new pro- 
 
 » Metchnikoff, Prolongation of Life, p. 144. 
 
 * Since tliis report was written tliere has appeared the excellent and inspiring 
 " Civics and Health," by William H. Allen, Bureau of Municipal Research, New 
 York (Ginn), 1909. 
 
Fi 
 
 678 KEPORT OF NATIONAL. CONSERVATION COMMISSION. 
 
 fession, that of public health officer — a profession already recognized 
 in England by a special diploma. 
 
 The health officer should be supported entirely by the salary of his office and 
 should be absolutely prohibited from practicing medicine. Not only are his 
 duties incompatible with practice quite as siuch as those of judges with the 
 practice of law, but if he gives them proper attention there is no time for other 
 duties. No court, police, or fire department, or other agency of government, 
 can be more important to a people than this under the complex conditions 
 incident to the rapid growth of both rural and urban populations. It is so 
 Important that this be realized that it is worthy of serious consideration as to 
 whether it would not be better for all imperfectly equipped and supported 
 health boards in this country to resign— so that the authorities and people 
 would be brought face to face with the knowledge that they have no real pro- 
 tection except in the emergency of an epidemic — than for existing conditions to 
 continue. 
 
 Laboratories, research workers, statisticians, and other facilities for the 
 performance of a national board of health's duties should be furnished in pro- 
 portion to the power and wealth of the Government and the vast interests it 
 would protect and promote. The results of its scientific and collective investi- 
 gations should be constantly utilized in promoting health in the army and navy, 
 in protecting streams and soils from pollution, in the construction of interstate 
 waterways, in the reclamation of swamp lauds, and in other public works 
 involving health problems of supreme importance to the future of this country .<• 
 
 Public hygiene may be studied under three heads, corresponding to 
 our governmental divisions: Municipal hygiene, state hygiene, and 
 federal hygiene. 
 
 Municipal hygiene and sanitation are placed largely in the hands of 
 city boards of health, or equivalent organizations, which have power 
 to issue sanitary regulations, abate nuisances, and even to punish 
 infractions of their instructions by fine and imprisonment. Sanitary 
 legislation is a product of advanced civilization. To-day not a city 
 is without a board of health. The powers of these boards have 
 grown, till to-day they are by no means inconsiderable; yet they 
 must be given even greater authority, if our municipal sanitary con- 
 ditions are to be what they should. Public apathy and political 
 interference are such that health authorities can not enforce their 
 orders. In addition to the acquirement of greater power, city health 
 boards often need purification of motive and the banishment of 
 political bickerings and personal jealousies. 
 
 The simplest ordinances along the line of public hygiene are those 
 against spitting, which now remain so largel;^ unenforced. 
 
 The smoke nuisance is another seemingly simple form of air vitia- 
 tion that is receiving attention to-day. Sulphuric acid is apparently 
 the most injurious factor. The corrosion of stone structures suggests 
 the irritation resulting in catarrh and other respiratory mucous- 
 membrane troubles.* 
 
 The effect of the introduction of closed sewers on the reduction of 
 tuberculosis should not be overlooked. By closing sewers, impure 
 gases have been confined, thereby removing an important source of 
 air pollution. Some cities realize that pure air spells life and health 
 to its inhabitants, and that pure air is a possibility only when atmos- 
 pheric particles of soot and dirt are removed. 
 
 Regulations governing garbage removal, notification and isolation 
 of disease, and the like are as a rule enforced, and new regulations 
 are being issued constantly. Substantial progress is shown each year 
 
 « Letter from Dr. J. N. McCormack. 
 
 ' See Journal American Medical Association, September 7, 1907, p. 813. 
 
i-iSHKB.] NATIONAL VITALITY. 679 
 
 in the purification of city water supplies, in the improvement of sew- 
 age disposal, and in the bettering of drainage conditions. Streets 
 are more thoroughly cleaned and the elimination of public and private 
 nuisances continues without ceasing. 
 
 Our city streets have received greater care since Colonel Waring 
 organized his " white wings " brigade in New York City a dozen 
 years ago, thus proving the great effectiveness of clean streets in the 
 elimination of disease. The probable elimination of the horse from 
 our city life, through automobiles, tlie betterment of our trolley sys- 
 tems, and the introduction of subways (especially freight subways) 
 will go far to improve our city atmosphere. The problem of city air 
 will be half solved when our streets reach their proper state of clean- 
 liness. The gradual elimination of the horse will tend not only to 
 produce cleaner air, but also to reduce the dangers from flies. It is 
 in horse manure that the common housefly (" typhoid fly ") chiefly 
 breeds. Doctor Howard attributes the termination of typhoid in 
 certain parts of Washington to the displacement of the horse by the 
 automobile. 
 
 Only within a dozen years has the dread importance of insect car- 
 riers of disease been realized. That mosquitoes carry malarial germs ; 
 that flies are the propagators of typhoid, cholera, and other infectious 
 diseases ; that rats breed the fleas which transmit to man the dreaded 
 Asiatic plague * — all this knowledge is of recent origin.* 
 
 Well people are sometimes carriers and distribute typhoid, diph- 
 theria, etc., a fact which complicates public-health regulations. 
 
 The simple reporting of all contagious disease to the health au- 
 thorities immediately on its appearance is often the means of prevent- 
 ing an epidemic. 
 
 Smallpox epidemics are prevented both by quarantine and vacci- 
 nation. Because of the outcry against compulsory vaccination, in some 
 places the responsibility for vaccination is being thrown upon the 
 individual. This is true in Leicester, England, and in Minnesota. 
 Doctor Bracken, secretary of the Minnesota State Board of Health, 
 writes that since the quarantine has been abandoned and the indi- 
 vidual has had the option of being vaccinated or not, a larger number 
 has been vaccinated and smallpox has diminished. 
 
 We are awaking to the importance of securing for ourselves, 
 through our city health agencies, a pure milk supply. Great danger 
 is also present in cream, butter, cheese, and ice cream. More than one 
 city has inaugurated a policy of careful supervision of the milk sup- 
 ply. Montclair, N. J., has a well-considered plan in operation 
 whereby the bacterial count of each dairy is public to inquirers at 
 the board of health. This species of publicity will some day prove a 
 strong incentive to a better milk supply. Some cities have even estab- 
 lished municipal stations, where during the summer season sanitary 
 milk may be purchased at cost. Doctor Goler, of Rochester, has em- 
 phasized the fact that " We employ physicians to cure children af- 
 
 • See Rupert Blue, " The prophylaxis and eradication of plague," California 
 State Journal of Medicine, Vol. V, 1907, p. 304. 
 
 *A full treatment of the subject of insect-borne disease has been prepared 
 by Dr. L. O. Howard, Chief of the Bureau of Entomology of the Department of 
 Agriculture, for the National Conservation Commission. See also Charles Har- 
 Mngton, M. D., "Practical Hygiene," Third Edition, Philadelphia (Lea), 1905, 
 pp. 637-G60. 
 
680 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 fected by the diarrheal diseases from dirty milk, while we permit the 
 sale of dirty milk from filthy cattle." « 
 
 In Rochester, through the efforts of Doctors Goler and Roby, a few 
 municipal milk stations were established in 1897, where during July 
 and August milk in nursing bottles could be bought at a low price. 
 The reduction in the Rochester infant death rate between 1897 and ; 
 1906 is doubtless due to many other conditions than the quality of 
 milk ; but the special attention drawn to the milk supply and the con- 
 sequent education of the public, which probably boiled its milk when 
 it could not get it clean, would explain a considerable part of the 
 reduction.* 
 
 The interrelation of the purity of milk supply and infant mortality 
 is shown by the following excerpt from Doctor Woodward's annual 
 report as health officer of the District of Columbia for the year 1907: 
 
 High as is the infantile mortality even now from diarrhea and inflammation 
 of the bowels, it is far below the figures that formerly prevailed. 
 
 The only explanation for the fall in the death rate from infantile diarrhea 
 that I have been able to discover is the enactment on March 2, 1895, of the law j 
 regulating the sale of milk in this District and the establishment of dairy and ! 
 dairy-farm inspection under the provision of that law. , 
 
 The weekly report of the Cincinnati board of health for August 
 21, 1908, states: 
 
 , As far as we know, there has been but one death among the babies whose food 
 supply has been obtained from the milk stations. When it is taken into con- 
 sideration the large number of children we have supplied, this statement is 
 certainly a fitting commentary upon the value of a bacteria-free and chemically 
 pure milk. 
 
 At the recent International Congress on Tuberculosis, one delegate 
 reported an experiment in England which has not yet appeared in 
 print. In Liverpool the local government board tried the experiment 
 of using pasteurized milk. The amount of illness and death in that 
 city from children's tuberculosis is very great, yet among 1,800 chil- 
 dren who were given pasteurized milk and who were carefully 
 watched every week not a single case of tuberculosis developed, 
 which seems to prove conclusively that children's tuberculosis is en- 
 tirely preventable by the use of pure or pasteurized milk. This is 
 interesting, though at variance with former opinion regarding bovine 
 tuberculosis in children. 
 
 In this section should also be mentioned such municipal health 
 agencies as public baths, bacteriological laboratories, and the dis- 
 tribution and administration of specific antitoxin, vaccine, and free 
 medical service. Municipal inspection of local abattoirs is also im- 
 portant, inasmuch as federal inspection covers only establishments i 
 engaged in interstate business. 
 
 Most important of all is the matter of preventing pollution of the i 
 water supply of cities, a topic that will receive fuller treatment later 
 in the chapter. 
 
 « See George W. Goler, M. D., " Municipal regulation of the milk supply," 
 paper at the meeting of the American Medical Association, 1007, p. 2. For con- 
 clusions based on a study of 330 milk-borne epidemics, see George M. Ko- 
 ber, M. D., "Milk in relation to public health," S. Doc. No. 441, Government 
 Printing Office, 1902. 
 
 ^ See George W. Goler, M. D., " Origin, development, and results of municipal 
 milk work in Rochester, N. Y.," Maryland Medical Journal, June, 190G. 
 
ISHEB.] NATIONAL VITALITY. 681 
 
 The needs of municipal as of state hygiene are not so much new 
 aws as better men to enforce existing laws and an aroused public 
 pinion that will result in the appropriation of funds sufficient to 
 nable health authorities to perform their duties in an efficient man- 
 er. Larger appropriations will doubtless bring better men into the 
 'ublic-health service. 
 
 Section 2. — State hygiene. 
 
 \ State hj^giene is necessary to supplement municipal hygiene for 
 lany reasons. One is that the country often has no other sort of 
 mitation possible. Another is that the city is dependent on the 
 Duntry for its water, milk, and other supplies. Dr. W. G. Daggett, 
 f New Haven, has emphasized the fact that in origin typhoid is 
 irgely a rural disease and must be combated by controlling rural 
 rivies and other sources of infection.** A competent authority as- 
 jrts that " old country wells, so much valued by their owners, are 
 positive menace to public health. Fully 50 per cent of these are 
 nfit for use." Much of the typhoid fever brought by milk is readily 
 aceable to such wells. 
 
 In the control of the liquor traffic the State and local units should 
 Doperate.* 
 
 A state, rather than a municipal, function is the regulation of 
 oman labor and child labor. The growth of public opinion on this 
 oint has been rapid. In order to make the working hours meet 
 le physiological requirements of women, two special conditions 
 lould be attended to. One is her monthly period ; the other is child- 
 saring. The neglect of both is responsible not only for physical 
 npairment of factory women, but also for their inability to perform 
 leir functions as mothers of the race. Doctor Stiles, of the Public 
 [ealth and Marine-Hospital Service, has suggested a very sensible 
 jmedy to meet the first of these conditions, and one which has met 
 ith the approval of many factory employers. It is that each woman 
 lall have the right, once every month, to walk out of the factory 
 ithout any questions being asked, and without loss of the day's 
 ages. The matter is further simplified in factories provided with a 
 atron and a rest room. In respect to the second condition — that of 
 lildbearing — the evidence is clear and convincing. Women, on 
 jcount of their imperfectly developed muscular system and more 
 ilicate physique, are unfitted for hard work; nor should they be 
 )liged to work steadily in a sedentary position, especially at the sew- 
 ig machine, or other occupations involving the use of the lower 
 ctremities. Special protection should be extended to them during 
 le childbearing period. It is a matter of constant observation that 
 omen who have to deny themselves proper rest and care during the 
 ixt six weeks after confinement are very liable to suffer from hemor- 
 lages and chronic uterine diseases, while miscarriages and prema- 
 je births are not infrequent results of overwork.'' 
 
 •^ " The prevention of typhoid fever," Proceedings Connecticut Medical So- 
 jty, New Haven. 
 
 '' See " Regulation of the liquor traffic," Annals American Academy of Political 
 id Social Science, November, 1908. 
 
 '^ George M. Kober, M. D., " Industrial and personal hygiene," " Report of 
 )mmittee on Social Betterment of the President's Homes Commission," Wash- 
 ! Elton. 1908, pp. 67-68. 
 
682 REPORT OP NATIONAL CONSERVATION COMMISSION. 
 
 The employment of mothers shortly before and after the time of 
 childbirth is prohibited in a number of European countries. Ameri- 
 can statutes, however, are almost silent on the question." Professor 
 Jevons went so far as to advocate the enactment of legislation forbid- 
 ding the employment of mothers till their youngest children were at 
 least 3 years old. j 
 
 The beneficial effect on the mother, and especially on the child, of 
 forbidding the factory to her just before and after childbirth has 
 been proved many times. The case of M. Dollfus, a large employer 
 of women at Mulhausen, in Alsace, has been repeatedly cited. He 
 required mothers to remain away from their work for a period of 
 six weeks after childbirth, during which time he paid them full 
 wages. The decrease in infantile mortality in the first year of the^ 
 experiment was from more than 40 to less than 18 per cent.^ 
 
 The waste of vitality from unphysiological hours of work is most 
 striking in the case of children. It is hardly to be questioned that 
 children need longer hours of rest and sleep than adults, and that 
 their immature bodies are much closer to the fatigue limit. A little 
 girl in a southern mill replied to Mrs. Van Vorst's query whether she 
 were often tired, " AVhy, I'm always tired." Except in unusual cases 
 and for limited periods, child factory labor can not be defended on 
 any hygienic grounds. The period of preparation for a wholesome, 
 healthy life should be left free from the cares and evil physical in- 
 fluences of factory life. No child should run the risk of serious acci- 
 dent, deformity, dwarfing, or mental stunting through factory labor. 
 It is true that in the South child labor is often the lesser of twc 
 evils, the other being the life on a farm where, through soil pollu- 
 tion, the child contracts hook-worm disease. Here the abolition oi 
 child labor should be preceded by the abolition of hook-worm disease.' 
 
 Closely connected with the restriction of child and woman laboi 
 is factory legislation in general, dealing with hours of labor, factory 
 hygiene and sanitation, and dangers from industrial accident. 
 
 The hours of labor have for a century been on a gradual decrease 
 A hundred years ago fourteen and fifteen hours were by no means un- 
 common. The first public action regarding hours of labor was taker 
 by President Van Buren in 1840, when he set ten hours as the limii 
 of the working day in all government establisliments. Thirty year; 
 later this was lowered by Congress to eight hours. Since 1850 th< 
 fight has been waged for a shorter day, both by labor unions anc 
 individuals; and the statutes of nearly all States contain legislatioi 
 limiting the working hours of women and children in all industries 
 as well as of all workers in certain industries, especially mining, rail 
 roading, and the more dangerous manufacturing industries. Th 
 Aldrich report of 1890 ^ estimated that the American working da^^ 
 averaged eleven and four-tenths hours in 1840 and ten hours in 18O0 
 Tables based upon annual reports of the Bureau of Labor show ! 
 reduction of about 4 per cent from 1890 to 1903,« while it is th 
 
 "John Spargo, "The Bitter Cry of the Children," New York (Macmillan) 
 1906, pp. 44-45. 
 
 '' Spargo, loc. cit, pp. 50-51. 
 
 " See " Report of the Surgeon-General of the Public Health and Marint 
 Hospital Service for 1907," relating to the investigations of Doctor Stiles. 
 
 *" Report on Wholesale Prices and Wages," 1890, Vol. I, p. 178. 
 
 •T. S. Adams and Helen L. Sumner, "Labor Problems," New York (Macmi 
 Ian), 1905, pp. 51G-518. 
 
nsnBR.] NATIONAL VITALITY. 683 
 
 opinion of United States Commissioner of Labor Neill that the 
 figures for 1908 would unquestionably be lower than for 1908, as the 
 straggle for the shorter working day has been making steady prog- 
 ress each year." 
 
 The frightful losses of life and efficiency from preventable acci- 
 dents can be prevented only by state legislation.* 
 
 Our emploj-er's liability acts are very unsatisfactory, because they 
 fix no scale of compensation for injuries, but necessitate expensive 
 lawsuits to determine in each case the sum due. A president of an 
 insurance company doing a large business in employer's liability 
 insurance states that of the sums they pay employers only one-quarter 
 reaches the injured employee, who is forced to spend the other three- 
 fourths in litigation. In England the workman's compensation acts 
 have substituted a system of specific sums for which the employer is 
 liable. Not only does this result in larger indemnities reaching the 
 injured, because suits are ordinarily unnecessary, but it has the fur- 
 ther beneficial effect of reducing the number of accidents by inducing 
 employers to instal safety devices. 
 
 The regulation not only of the place of work, but also of the dwelling 
 place, has come to demand action on the part of the State as well 
 [is of the community. The growth in tenement-house legislation dur- 
 ng the past ten years has been most encouraging. Standards of 
 'sanitation for our large buildings have been raised; provision is in- 
 :;reasingly made for good light, air, water, and for protection from 
 ^ire; and the "rookeries" of old are giving way to improved tene- 
 ments. Yet New York City still contains 300,000 rooms without a 
 
 ivindow." 
 
 Section 3. — Federal hygiene. 
 
 The regulation of disease has increasingly become a national func- 
 tion. The exclusion of inmiigrants with infectious diseases is only 
 Dne instance of this; another is the work of our Public Health and 
 Alarine-Hospital Service, which not only regulates the spread of dis- 
 'ase from State to State, and regulates by quarantine the entry of 
 disease from without the country, but also assists local health boards 
 n their fights against epidemics and disease scourges. Epeciaily is 
 his true in coastal cities. The Marine-Hospital Service assistedNew 
 Orleans to eliminate yellow fever and San Francisco to rid itself 
 )f bubonic plague. In addition, this service treats 50,000 seamen 
 )f the merchant marine each year, conducts a large number of hos- 
 pitals and relief stations, examines pilots, life-saving crews and 
 •evenue-service men, and conducts a well-equipped hygienic labora- 
 ory. 
 
 Federal, state, and municipal sanitatio^^. are all concerned with the 
 lygiene of transportation. To-day almost the whole American pub- 
 ic travels, and it is therefore most important that the conveyances 
 
 » See Bulletin of the Bureau of Labor, No. 77, July, 1908, pp. 6-7 ; also, " First 
 Lnnual Report on Changes in Rates of Wages and Hours of Labor in Massachu- 
 tetts," Boston, 1908, pp. 592-3. 
 
 *The Federal Government can of course reach interstate railways. A law 
 )assed during the last session provided for a safe locomotive ash pan. Previous 
 aws provide for autonintie couplers, air brakes, etc. 
 
 " A. Jacobi, M. D., " The physicai cost of women's work," Charities, February 
 ; 1907. 
 
 S. Doc. 419, 61-2—5 
 
684 BEPOKT OF NATIONAL CONSERVATION COMMISSION. 
 
 which they occupy, whether carriage, cab, street car, or railway train, 
 shall be sanitary in respect to ventilation, cleanliness, toilet facilities, 
 spittoons, dust, smoke, sleeping-car accommodations, and the like. 
 In smoking cars, in addition to the smoke itself, the floors are usually 
 iDefouled with tobacco juice and other expectoration. The efficient 
 remedy here as elsewhere is to be found, not simply m providing 
 facilities for cleanliness, but in fostering the present public sentiment 
 against spitting and other untidy habits. A physician of experience 
 maintains the opinion that " foul air in railway trains and street 
 cars is the cause of serious poisonings called ' colds ' and ' grip,' par- 
 ticularly in those many trains where air from the smoker sweeps 
 through passenger cars." 
 
 The development of our national quarantine methods is indicated 
 in the following paragraph from Surgeon-General Wyman, of the 
 Public Health and Marine-Hospital Service: 
 
 Until 1893 there was, properly speaking, no national system of quarantine. 
 The colonies had their own quarantine regulations before the formation of the 
 Union, and from that event to 1S9.3 quarantine was left to the care of state 
 governments and by the latter to county governments or to municipalities, as 
 the case might be. There was, indeed, national legislation, but all the acts 
 of Congress up to 1893 relating to quarantine specially provided that the said 
 national measures were in aid of the state and local authorities. Whatever 
 opinions may have been held by members of the national legislature, quarantine 
 was permitted to be exercised by the States as a police function, and even in 
 the present law, which gives national supremacy, it is iirovided that assistance 
 shall be given the States or municipalities by the government authorities, the 
 supremacy of the latter being asserted only when the state or local authorities 
 fail or refuse to enforce the uniform national regulations.<* 
 
 To-day efficient inspection at our various ports of entry and at 1 
 disembarking stations abroad keeps out many cases of disease each 
 year, while the quarantine cordon thrown around ports or municipal 
 quarters affected by infectious disease is an important factor in 
 stamping out such disease. 
 
 Federal meat inspection chiefly benefits the foreigner, but the ad- 
 ministration of the pure- food laws is of value to our own people. 
 
 There are two functions of Federal Government which now are 
 very imperfectly served and which might be made of paramount 
 importance. They are the functions of research and of the dis- . 
 semination of information. A poultry raiser, or a cattleman, or a j 
 farmer can secure scientific information to guide him in his selections i 
 of fowl, or stock, or seed by applying to the Government at Washing- 
 ton, but information on how to raise children has up to this time been 
 neglected by our Government. Nothing is to-day more significant of 
 future progress than the fact that the President, the President-elect, 
 and many Congressmen are so strongly in favor of a greater federal 
 organization of health. Through the dissemination of information 
 throughout the country, tlirough enactment and administration of 
 effective regulations concerning pure food, inspection of meat, and 
 exclusion of foreign diseases, through research, statistics, and through jJ 
 better standards for state and municipal health service, a great econ- " 
 omy of national vitality can be effected. Washington, our national 
 capital, might be made by the Federal Government a model cit}^ of 
 
 « Walter Wyman, M. D., " The quarantine system of the United States," 
 The Sanitarian, November, 1897, p. 3. See also James W. Garner, " Federal 
 activity ia the interest of the public health," Yale Review, 1905-6, p. 181. 
 
FISHEB.1 NATIONAli VITALITY. 685 
 
 healthfulness, as a preliminary to its becoming a mo(lel in every 
 otlier way. 
 
 Army hygiene in time of war is most important. The lack of such 
 hygiene has shown grave consequences. In the Boer war the British 
 army in South Africa lost more men from typhoid fever than from 
 wounds received in battle." 
 
 The efficiency of Japanese hygiene manifests itself in the fact that 
 General Oku's army of 75,000 during the recent Russo-Japanese war 
 had but 187 typhoid fever cases in a seven months' active campaign. 
 
 The Japanese reduced their dysentery cases from 12,052 in the 
 Chinese war to 6,624 in the Russian war; their cholera cases from 
 7,667 to none; and their malaria cases from 41,734 to 1,257. This was 
 in spite of the fact that their army in the Russian war was three 
 times tlie size of that employed in the Chinese war.** 
 
 The crying need of better statistics is trenchantly expressed by Dr. 
 Cressy L. Wilbur, Chief of the Division of Vital Statistics of the Cen- 
 sus Bureau, whose words should be read and pondered by everyone 
 who desires to see any intelligent conservation of our vital resources: 
 
 Sound vital statistics are the indispensable basis of modern sanitation. A 
 nation that does not consider it necessary, or tliat is not able, to provide ade- 
 quate means for registering the births of its own children, or for otiicially 
 recording the deaths of its citizens, can hardly be supposed to attach sufficient 
 value to human life to enable sanitary measures for its conservation to be ade- 
 iquately carried out. 
 
 1 For the continental United States in 1907 somewhat less than one-half of the 
 ,total population (48.8 per cent) was represented in the registration area from 
 which returns of deaths were received by the Bureau of the Census. For the 
 remaining 51.2 per cent of the total population of the United States, estimated 
 at 43,774,724 persons, either very imperfect laws were in effect, giving only 
 p.irtial registration, quite worthless for statistical purposes, or else the condi- 
 tions in many States might be represented by the statement made by one of 
 tlii'ir health officers, that it buries its dead people with no more ceremony than 
 it buries its dead dogs. 
 
 As for the registration of births, a measure which is so supremely Important 
 for the knowledge of infant mortality, for the protection of infant life, and for 
 .securing the legal rights of children, not a single State in the Union nor a single 
 city of any considerable size makes positive claim that it registers as many as 
 nine births out of every ten that occur. Even the city of Washington, whose 
 law for this purpose is a direct enactment of Congress, does not arise above 
 this low limit of efficiency. The total number of births must be known before 
 one can make a computation of infant mortality which will be comparable with 
 the rates given in the vital statistics of all civilized nations except the United 
 'States. This ratio depends upon the comi)arison of deaths of infants under 1 
 year of age with total births, and, as we have no exact registration of births, 
 we can not present these important statistics. 
 
 In the consideration of the effect of such an important disease as tuberculosis 
 upon the people of the United States there is no means of knowing, within a 
 very wide margin of error, exactly how many persons die from this cause In 
 this country during any year. We have registration of deaths for about one- 
 half of the population only, and the very dissimilar conditions of life and the 
 large proportion of colored population in the unregistered half seriously inter- 
 fere with any attempts to guess at the exact number. Estimates have varied 
 from 138,000 to 200,000. The truth probably lies somewhere between them, but 
 we certainly ought to have an exact record of the facts and not be obliged to 
 depend upon mere guesswork in entering upon an important sanitary under- 
 taking, such as the prevention of tuberculosis. 
 
 <• Ditman, loc. cit, p. 17. 
 
 ''L. L. Seaman, "The Real Triumph of Japan," New York (Appleton), 1906, 
 pp. 106-7. 
 
 On the question of army diet, see Blackham : British Medical Journal, 1908, 
 August 8, p, 311. 
 
686 BEPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 We are laboring, In conjunction with the American Medical Association, the 
 American Public Health Association, and with the sanitary ofRcials of as many 
 States as we can interest, to extend the registration area as rapidly as possible. 
 Ohio has just adopted an excellent law, which takes effect next year. Not a 
 single State in the South has yet succeeded in reachiii?^ a satisfactory stand- 
 ard — not one of them in fact has even passed an adequate law. We are de- 
 pendinj; upon the volunlnry cooperation of the States. The Government has no 
 power, it would seem, to collect the statistics or to secure the proper registration 
 of births and deaths by its direct action. If all of the important interests in- 
 volved could be awakened to the importance of this matter, if Congress would 
 take a direct interest in the accomplishment of this work, we could secure fairly 
 complete registration of deaths for the United States within the next ten years.<* 
 
 Chapter VIII. — Conservation through seTnipuhlic hygiene. 
 Section 1. — Medical research and instruction. 
 
 By semipublic hygiene is meant hygiene through nongovernmental 
 institutions, inchiding inslilutions for medical research, the medical 
 profession, hospitals, sanatoria, associations, schools, and factories. 
 
 Medical discoveries have usually been made in the laboratories of 
 medical schools, universities, and research institutions. The practical 
 value of these institutions is only beginning to be appreciated. The 
 benefits ab-eady received from them are great, and the benefits to come 
 will be incomparably greater. One of the earliest medical labora- 
 tories, the Pasteur Institute of Paris, has done splendid work during 
 the past two decades in the study of harmful and beneficent bacteria. 
 Of more recent origin are the British Sanitary Institute in London, 
 the Rockefeller Institute for Medical Research, the Memorial Insti- 
 tute for Infectious Diseases at Chicago, and the Nutrition Research 
 Laboratory in Boston, under the Carnegie Institute of Washington. 
 The recent achievement of Dr. Simon Flexner in finding a serum for 
 the treatment of meningitis is but one example of what well-directed 
 research under the auspices of such institutions can accomplish. The 
 crowning achievement of science in the present century should be, 
 and probably will be, the discovery of practical methods of making 
 human life healthier, longer, and happier than heretofore. 
 
 The medical schools in this coimtry number 156. They are rapidly 
 advancing, although the great majority are still ill equipped for pro- 
 viding intending practitioners with the most recent and useful knowl- 
 edge. The future practice of medicine depends more on the character 
 and aims of the medical schools of to-day than on any other factor, 
 At the dedication of the Harvard medical buildings in 190G, President 
 Eliot laid down as the primary duties of that school the study of the 
 prevention of disease and the education of the public. The need of 
 such a school especially devoted to prevention has been fully dis- 
 cussed by Doctor Ditman.^ Several universities liave courses, or are i 
 taking steps to give courses in the fields not only of public hygiene 5 
 and preventive medicine, but also of personal hygiene and home | 
 economics. 
 
 •Letter from Dr. Cressy L. Wilbur, See also Irving Fisher, "Mortality sta- 
 tistics of the I'nited States census," publication of the American Economic, 
 Association, 189!); and R. Dudfield, "A critical examination of the methods ofi 
 recording and publishing statistical data bearing on public health," Journal of 
 the (Royal) Statistical Society, March, 1905. 
 
 * See N. E. Ditnian, M. D., " Education and its economic value in the field of 
 preventive medicine," Columbia University PresSj Vol. X, supp. to No. 3, June^ 
 1908. 
 
 i 
 
nsHEE.] NATIONAL. VITALITY. 687 
 
 One difficulty in establishing such a school is the lack of students 
 who can atl'ord tlie means or the time to attend. This was the ex- 
 perience of the George Washington University, in Washington, when 
 a course of this kind was offered. For tliis reason it is gratifying to 
 see that an effort is being made to throw open the research laboratory 
 of the Public Health and Marine-Hospital Service for the use of 
 health officers detailed from their several States and municipalities. 
 In England the degree of D. P. H. (diploma in public health) is given 
 those who meet the high standard set there for health officers. 
 
 During the last few years the American Medical Association has 
 been seeking to study, classify, and improve the medical schools in 
 the United States. A large conmiittee, of which the writer is one 
 member, has been appointed by the association to consider methods 
 of securing such improvements as are deemed necessary. It includes 
 in its scope the important but heretofore little appreciated field of 
 medical economics. 
 
 Section 2. — The medical profession. 
 
 We come next to the part played by physicians, so far as relates to 
 their " private practice.'' Their work as public health officers has 
 already been mentioned, and does not concern us here. Their Avork 
 in the home is of primary importance. It is on the physician that the 
 average man relies for protection wdien he finds himself in the dread 
 grip of disease. 
 
 Private practice comprises two main divisions, surgery and gen- 
 eral ])ractice. The first important application of the knowledge of 
 germs was to surgery. Antiseptic surgery, originated by Lord Lister, 
 has resulted in the saving of untold thousands of lives and has led 
 in turn to aseptic surger}^, which is still more effective. Not only has 
 it reduced the previous mortality from operations, but it has vastly 
 increased the number and kind of operations which can be performed 
 in cases which under the old regime would necessarily have proved 
 fat ah 
 
 Of one of the most recent advances the eminent surgeon Dr. W. J. 
 Mayo writes: 
 
 Second only to the germ theory has been the usefulness of the great discovery 
 of Rontgen and the a[)r)Iication of the X-ray to surgical diagnosis. It makes 
 certain the diagnosis in a large number of conditions which were previously 
 a matter of speculation, and enables remedial surgical measures at an early 
 date, lessening mortality and morbidity. 
 
 Another great surgical discovery is the suture of blood vessels evidenced by 
 the \v(irk of Carrel. Its i)Ossibilities are astounding. The ability to transplant 
 the kidney of one dog to another and have it continue its function, the amputa- 
 tion of a leg and its resuture, opens up the whole question of the transplantation 
 of sound for diseased organs, especially organs which are double." 
 
 In these and other surgical work a certain amount of vivisection is 
 necessary. The present outcry against vivisection is an example of a 
 defective sense of proportion. While needless cruelty should be 
 avoided, the suffering of animals through vivisection, including all 
 cases where the practice has been abused, is as nothing compared with 
 the suffering of human beings which would be caused if all vivisection 
 were abolished. 
 
 " Letter from Dr. William J. Mayo. 
 
688 EEPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 The progress of antisepsis has so reformed midwifery that puer- 
 peral fever, a former scourge of humanity, is now extremely rare. 
 In many cases the child, by being freed from gonorrheal contamina- 
 tion by the mother at birth, has been saved from blindness." 
 
 The advance of surgery is shown by the following table of mor- 
 tality of the wounded in the wars of the nineteenth century. Anti- 
 septic surgery was introduced at the time of the Franco-Prussian 
 war in 1870-1 : 
 
 Per cent 
 
 Crimean war, English troops 15.2 
 
 French troops in Italy, 1859-GO 37.4 
 
 German army, 1870-71 11.1 
 
 Spanish-American, 1S9S 6. 6 
 
 Transvaal, 1900-1901 : 5. 5 
 
 In general practice progress is also being made. The use of violent 
 drugs is fast going out of fashion. The recognition of the self-limit- 
 ing character of most of the acute diseases sounded the death knell 
 of the harsh drugging of the olden time. Laboratory experimenta- 
 tion and careful study as to the physiologic and therapeutic effects 
 of drugs have shown the necessity of subjecting everything material 
 or immaterial, intended for the relief of human ailments, to the 
 crucible of the most rigid scientific scrutiny. This sentiment has 
 grown until in the best medical circles it is properly considered a 
 reproach for a physician to use any preparation without an exact 
 knowledge of its composition and a definite conception of the results 
 expected from its administration. The number of medicines used by 
 physicians is decreasing and will, if the predictions of experts in this 
 field may be trusted, ultimately be reduced to a small fraction of the 
 present pharmacopoeia. Many medicines, like quinine and mercury, 
 will of course merit a continuance of use. Syphilis, malaria, hook- 
 worm disease, and some other diseases are best combated by drugs. 
 
 Serum therapy, although in its infancy as to most diseases, has 
 opened up a field of great promise. For example, antidiphtheritic 
 serum, the one best understood and in most common use, has reduced 
 the mortality in that disease from 50 or 60 to 12 or 11 per cent.'' Not 
 so much medicines or serums, but hygiene, will probably be the de- 
 pendence of the next generation of physicians. Possibly the term 
 " medicine " will some day be almost as inappropriate in describing 
 the treatment toward which physicians are tending as the term 
 " leech " now is in describing the phj'sician. The profession has 
 ceased to be hostile to hygienic treatment, and is slowdy but surely 
 substituting it for much of the internal treatment formerly employed. 
 The new treatment includes the use of air, light, water, food, rest, 
 massage, mechanical vibration, electricity, exercise, and suggestion, 
 under the names of aerotherapy, hydrotherapy, psychotherapy, etc. 
 These remedies have the great advantage of preventing as well as 
 curing disease. 
 
 It onl}^ remains for all medical schools and the courses of lectures 
 now gratuitously provided by the American Medical Association for 
 all county medical societies to teach these things in such a thorough 
 and practical way as will reach the whole profession and bring these 
 
 "Elie Metchnikoff, "The Nature of Man." New Yorli (Putnam), 1903, p. 210. 
 > Metchnikoff, " The Nature of Man," p. 212. 
 
nsHBB.l NATIONAL. VITALITY. 689 
 
 benefactions to the whole people. In proportion as prevention is 
 more important than cure, the rapid advance in the knowledge and 
 practice of preventive medicine will be of value. 
 
 " To hygiene belongs without a doubt the place of honor in modem 
 medicine. It is in the prevention of infectious diseases that the inter- 
 est of the medical art is now mainly centered." " The best men are 
 turning to these phj^siologic methods with enthusiasm.* They are 
 I learning to take into account the anxiety and other mental reactions 
 of the patient as to what is said in his presence." They are becoming 
 more public-spirited and cooperative,'' and alive to their responsibil- 
 ity to set patients a good example in living hygienic lives.* 
 
 The trend toward prevention is indicated in various ways — by the 
 fact, for instance, that some physicians are now employed by families, 
 schools, firms, associations, etc., for the purpose chiefly of preventing 
 rather than curing disease. Women dentists graduating from the 
 University of Michigan have made a practice of attending to chil- 
 dren's teeth at a stated amount per month. Employers are increas- 
 ingly securing the services of competent physicians to care for the 
 health and physical welfare of their employees. This is a preventive 
 measure, and has been found to be a " paying proposition " to the 
 ernployer because of the resulting enlarged efficiency of the workers. 
 
 Their modern fight against tuberculosis has led physicians to a 
 larger use of fresh air in their practice. At first many employed this 
 agent merely as a " specific for tuberculosis," but its utility in all 
 chronic ailments, such as neurasthenia, for instance, was next recog- 
 nized. Latterly, fresh air has been discovered to be of use in pneu- 
 monia and other acute diseases. It is now not unusual to find physi- 
 cians advising their patients, whether ill or w^ell, to sleep out of doors. 
 There can be no question that man was originally an outdoor animal. 
 
 The discovery of the germ origin of Asiatic cholera, tuberculosis, 
 diphtheria, typhoid fever, bubonic plague, influenza, and other dis- 
 eases, and of the part played by water, impure food, insects, rodents, 
 and other common and almost omnipresent, but hitherto unrecognized, 
 agencies as carriers of disease to man and animals, has awakened a 
 world-wide interest in these subjects which, properly fostered and 
 directed, opens up ever extending possibilities to the humanitarian, 
 the economist, the statesman, and, still more, to the people at large. 
 
 The consequence must be a great revolution in medicine in the im- 
 mediate future. The practice of medicine is destined to become a 
 much more powerful agent than ever before in the suppression and 
 prevention of disease. This result will be reached when the change 
 now going on permeates the rank and file of the profession. It would 
 be a pity if, through undue conservatism of some of its members, the 
 profession should lose some of its prestige hard won during the last 
 generation. Already the ever-present quack is pressing into the invit- 
 ing field. As the public demands " drugless treatment " and many 
 
 » Metchnikoff, "The New Hygiene," Chica.w (Keener), 190G, pp. 12-13. 
 
 6 See G. Stanley Hall, "Adolescence," New York (Appleton), 1905, vol. 1, 
 p. 238. 
 
 "See A. T. Schofleld, "Power of Mind," London (Churchill), 1902, 2d ed., 
 p. 277. 
 
 * See Osier, " Maryland Medical Journal," October, 1905, p. 420. 
 
 •See Professor Osier's address to St. Mary's Hospital, Loudon, 1907. 
 
690 EEPOET OF NATIONAL, CONSERVATION COMMISSION. 
 
 physicians fail to see and meet that demand so far as it is rational, 
 the quacks see their opj^ortunity. As a consequence, there is fast 
 developing a species or quack that not only does not use " patent 
 medicines," but condemns their use by regular physicians. Men of 
 this type base their appeals on " naturopath}^," become " food ex- 
 perts," prescribe fasting, or two meals a day or five meals a day, give 
 lessons in " deep breathing," conduct outdoor sanatoria, and employ 
 light and air baths, dry cupping, mechanical vibration, intestinal 
 lavage, water cures, electricity, osteopathic manipulations, " divine 
 healing," etc. All these methods have value under certain conditions; 
 the only objection is that when applied by the uneducated they are 
 utilized to poor advantage. The fault lies not in the therapeutic 
 means but in those who use them. Physicians sometimes confuse the 
 two, and make the mistake of opposing the means and user alike. 
 They reject good means of cure because employed by " irregulars." 
 
 The result is that the patient sometimes finds the best means of 
 recuperation in the hands not of medical men, but of uneducated 
 "physical trainers." The public will go and should go to those 
 who will render the most effective help. In order that the medical 
 profession may suppress quackery the way must be not to oppose 
 the use of beneficial therapeutic agents in incompetent hands, but 
 to get their use into competent hands by adopting them them- 
 selves. There is a quackery that is villainous and injurious. This 
 should be suppressed. But there is another quackery which is 
 well intentioned and which, in spite of ignorance, manages to do 
 some good. The good in it should be appropriated by the profession. 
 By always promptly absorbing the best the profession will be in a 
 position to cast out the worst in " irregular " systems of therapeutics. 
 It may then recover the ground which it has too often lost. There 
 was no reason why it should have lost hundreds of thousands of 
 patients to " Christian Science," except that these patients were for 
 the most part benefited, and greatly benefited, by Christian Science 
 after having received no benefit, and often injury, from the jorofes- 
 sion. " Easily physicians, without knowing it, can produce sickness i 
 by pessimistic prophecies, by anxious looks or words. Thus are 
 diseases suggested (unconsciously) by the physician." ° Had the 
 profession made use of mental therapeutics not only could they have 
 saved themselves the enmity of these hundreds of thousands, but 
 they could have nipped in the bud the crude metaphysics which 
 teaches the nonexistence of disease and death and the uselessness of 
 any therapeutic agent except those employed by the promulgator. 
 The example of so-called "Christian Science" is only one of several 
 protests, more or less misguided, against the present practice of 
 medicine. 
 
 Had all or most members of the profession conceded long ago the 
 harmfulness of many, if not most, violent drugs it might linv(> fore- 
 stalled the present antidrug movement among the laity. Tlie mis- 
 guided antivaccination movement is simply the carrying to extremes 
 of the antidrug movement. 
 
 The Greeks were probably the most hygienic people that ever lived 
 and they knew nothing of modern scientific medicine, not even of 
 the circulation of the blood. This shows that man's primitive knowl- 
 
 • Scliofield, loc. cit., pp. 215-216. 
 
nsHEtt.] NATIONAL. VITALITY. 691 
 
 edge or instincts may be sufficient to enable him to keep and develop 
 
 health. 
 
 The old code of medical ethics, though -well-intentioned, was so 
 inelastic and was so susceptible of misconstruction as often to block 
 the way to })rogress. The magnitude and far-reaching effects of this 
 evil were long ago recognized by leading minds in the profession, and 
 after years of agitation such a revision was unanimously agreed upon 
 in 1003 as makes the modern principles of medical ethics purely 
 advisory and far more liberal than formerly. All restrictions as to 
 consultations were removed, medical societies were thrown open to 
 reputable physicians of every school of i^ractice requiring scientific 
 training, and agencies put in operation for such organization and 
 cooperation and to encourage such liberty of individual opinion as 
 is demanded by the spirit of the age. Under the most active efforts 
 of the medical schools, societies, and journals it will doubtless require 
 years of time for this liberal spirit to reach all members of the pro- 
 fession to the extent which is so desirable. But when this is done and 
 when the public can be made to understand that it has been done the 
 projudice whicli has hampered the profession's usefulness, which has 
 made it so difficult to secure and enforce health and medical legisla- 
 tion necessary for the protection of the highest interests of the people, 
 and wliich has so fostered and given opportunity for quackery, will 
 gradually become ancient history. 
 
 A frequent lay comment on some members of the medical pro- 
 fession is that to be true teachers of health they must practice what 
 they preach. A physician can not succeed in controlling drug habits 
 or alcoholism if he has these habits himself. He can not fight ^' patent 
 medicines " if he uses them himself.'^ He can not effectively fight the 
 social evil if he himself practices abortion. The standards of the 
 profession are high. It is the individual who is at fault. A clergy- 
 man who preaches purity from the pulpit while living a double life 
 is disgraced. In the same way, now that physicians are assuming 
 the function of giving instruction in orthobiosis and hygiene, they 
 are being called to account for their own daily lives. Self-interest 
 and altruism alike will lead to needed corrections. The physician in 
 these days of preventive medicine should keep himself well. The 
 challenge "Physician, heal thyself" is being followed by the challenge 
 " Keep th3'self well." Kxniiii!]^ iv.nre than precept is a principle to 
 be applied here as elsewhere. He can not induce his patients to diet 
 or take exercise if he himself is addicted to the fleshpots and the easy 
 chair. Many a physician to-day loses patients because he and his 
 family are on the sick list, or because as a man he practices habits 
 which as a physician he does not approve. 
 
 The physicians in this country now number about 130,000. Their 
 calling is in some respects the noblest in the world to-day. During 
 the present generation the profession has begun to be appreciated for 
 its great services to public and private health and for its self-sacrifice, 
 which is unequaled in any other profession except the ministry. It 
 has now before it an opportunity such as never before existed. Those 
 of us who believe in its mission look forward to incalculable blessings 
 to suffering humanity from greater knowledge better applied. 
 
 <» See A. Jacobi, Journal American Medical Association, September 29, 1906, 
 p. 978, 
 
692 REPOET OF NATIONAIi CONSERVATION COMMISSION. 
 
 Section 3. — Institutional hygiene. 
 
 The large cities have established special contagious hospitals, where 
 prompt isolation of infectious cases may be enforced. The decrease 
 of tuberculqsis may be traced largely to hospital isolation.*^ Leprosy 
 was the first disease to be quarantined ^ and its virtual disappearance 
 in civilized countries has been due, at least in the opinion of many 
 autliorities, to the strict isolation methods universally adopted. 
 
 Of a different kind is the segregation of defective classes of the 
 community. This has led to considerable conservation of their powers 
 and abilities. Institutions for the deaf and blind in the United States 
 contained 14,700 inmates in 1904, and spent for purposes of main- 
 tenance over $3,500,000." In these schools the deaf and dumb and the 
 blind are taught trades and professions, their usefulness being thus 
 much enlarged. 
 
 The New York state commission on the blind recommended in 1907; 
 a state board for the blind to conduct an employment bureau for the 
 blind of that State, to establish schools, and to put into operation 
 measures for the prevention of blindness. It is pointed out that of the 
 100,000 cases of blindness in the United States a great percentage is 
 traceable to disease and accident of a preventable character. The 
 commission estimates that of 1,000 cases in New York, 450 were 
 possibly avoidable and 325 (or one-third) certainly so. 
 
 For, the checking of insanity the crying need is a study of the 
 causes of the malady with a view to its prevention. For, as Doctor 
 Ditman remarks, nine-tenths of the inmates of our insane as^dums are 
 incurable, according to our present knowledge. He adds : " "Wliat an 
 argument for the prevention of the disease ! " "* Much may be ex- 
 pected from the Plvpps fund, for the study of insanity, recently 
 established at Johns Hopkins University. 
 
 In the first place, our medical students should receive constant 
 clinical instruction in mental diseases, particularly in their incipient 
 stages. Almost equally important are popular lectures on the pre- 
 ventable and other causes of insanity given under the auspices of 
 medical schools or local boards of health. Such lectures have been 
 given in New York and Boston, and, judging by the attendance, must 
 prove a valuable agency in diffusing a correct knowledge of the cause 
 and development of mental disease. In this education of the laity 
 popular treatises on mental hygiene would prove most helpful. 
 Such a book as Doctor Clouston's " Hygiene of Mind " could, with 
 advantage, be placed in the hands of every young person, and might 
 even be adopted as a text-book in high schools. Certainly the physi- 
 ology of mind is as deserving of popular consideration as that of 
 digestion, respiration, and the circulation. 
 
 By a clearer insight into the beginnings of mental disease, gained 
 through the popular lecture and a nontechnical literature, society 
 will become so far enlightened that intelligent personal prophylaxis 
 
 <» See Newsholme, " Phthisic death rate," Journal of Hygiene, July, IDOG. 
 
 * See J. M. Eager, M. D., "The early history of quarantine," Yellow Fever 
 Institute Bulletin No. 12, pp. 4-5. 
 
 « Census report on " Benevolent institutions." 1904. 
 
 * Ditman, loc. cit. p. 46. 
 
rtsHKE.] NATIONAL VITALITY. 693 
 
 may be anticipated." A knowledge of danger is the surest means of 
 guarding against it. " Ttie most obvious line of attack must be in 
 the direction of the four great etiological factors of insanity, heredity, 
 alcohol, syphilis, and environment. Abstractly considered these four 
 causes are preventable or removable." * 
 
 As an intermediate step between home and hospital, the sanato- 
 rium offers both cure and prevention. Many tuberculosis sanatoria 
 will take patients only in the incipient and early stages of the dis- 
 ease. Sanatoria are used by many as placas of recuperation. The 
 tired business man and the nervous housewife find at the sanatorium 
 the quiet they need, and a week or two of rest enables them to escape 
 threatened serious ills. 
 
 Many public institutions, in response to popular demand, are to- 
 day installing methods and equipment that are essentially prevent- 
 ive. More than one department store in the large cities filters its 
 air in order that patrons and clerks shall not feel oppressed by vitia- 
 tion of the atmosphere. An indirect result is the prevention oi tuber- 
 cular and other diseases. A leading hotel in Philadelphia has pitched 
 tents on its roof, where a large colony of well people — not sick — 
 sleep out of doors, and the same hotel utilizes its roof in winter for 
 a skating rink. Mothers' clubs are an increasing factor in the spread 
 of a knowledge of hygiene. Recently a case came to light of a new 
 member of a mothers' club who was feeding her 5-months-old baby 
 on sausage, tea cake, etc., and giving it drugs when she wanted to go 
 out. She was greatly surprised when informed of the wrong she was 
 doing. 
 
 Growing interest in the science of home economics, already re- 
 ferred to, is an indication of our increasing realization of the im- 
 portance of healthful homes in the community. While the number 
 of schools and colleges which offer courses in higher domestic science, 
 and in what might be called " true home economics," is growing, they 
 are nevertheless still comparatively few. More teachers should be 
 equipped with scientific knowledge regarding modern sanitation in 
 order that they may give practical courses in grammar and high 
 schools, and higher instruction should include the topics of hygiene 
 and sanitation. Home making may be studied in many details, such 
 as the construction of healthful houses, the purification of food and 
 water supplies, and the cleansing of cities, whereby the enlistment of 
 both boys and girls in all lines of home and municipal hygiene can 
 be secured. 
 
 The churches are now joining in the health movement. The lead 
 has been taken by the Rev. Elwood Worcester and Rev. Samuel 
 McComb at the Emanuel Church in Boston. Trained physicians 
 are employed for diagnosis and for general advice, but great em- 
 phasis is laid on the power of suggestion and of Christian self-con- 
 trol over bodily ills. The object is to get both patient and physician 
 to stop " thinking sick and talking sick," as Doctor Golor has put it. 
 
 "A book which brings the subject home with unusual force to the ordinary 
 \ reader is an autobiographical sketch by a recovered patient, "A Mind that 
 Found Itself." by Clifford W. Beers, New York (Longmans, Green), IDOs. 
 
 * Charles P. Bancroft, M. D., " Hopeful and discouraging aspects of the psy- 
 ■ chiatric outlook," address at meeting of American Medico-Psychological Asso- 
 ciation, Cincinnati, 1908. 
 
694 REPORT OF NATIONAL, CONSERVATION COMMISSION. 
 
 Section 4. — School hygiene. 
 
 In every progressive country to-day the hygiene of school life is 
 coming to be regarded of paramount importance. At the Inter- 
 national Congress on School Hygiene, in London, August 5-10, 1907," 
 there were in attendance at least 500 delegates, rejiresenting the gov- 
 ernments of the world and societies devoted to the advancement of 
 human welfare, and in addition there were 1,500 individuals inter- 
 ested in the improvement of the health of school children and all 
 that this implies. The fact was brought out at the congress that 
 European countries, notably Switzerland, Germany, France, Eng- 
 land, and Scotland, are doing more than the United States in the 
 medical inspection of scliools and that they are seemingly making 
 plans for the im]:)rovement in every direction of the hygienic con- 
 ditions of school life.'' Even in Italy the leading statesmen are ap- 
 parently convinced that the matter of chief importance at the present 
 moment in their educational work is to place it, from start to finish, 
 upon a hj'gienic basis." 
 
 It is the unanimous opinion of all students of the matter that the 
 neglect of the hygiene of school life in the larger sense is, first of all, 
 more or less disastrous to a considerable proportion of the pupils.** 
 With us, as well as in most European countries, children are com- 
 pelled by the state to attend school for a number of years. Many 
 of them suffer constantly from defective vision, hearing, and respira- 
 tion, from nervous overstrain, and from other ailments which are 
 greatly aggravated by the confinement and stress of school life." 
 Pupils are always exposed to infectious diseases. It is no unusual 
 thing in our country to see a contagious disease sweep through a 
 whole school so rapidly that the local board of health can hear of it 
 and order the school closed only after the harm has been done. 
 
 Great as is the injury done bj' the spread of infectious diseases to 
 children thus massed together in schools, the injury resulting from 
 imperfect seating, lighting, ventilation, and sanitation of school 
 buildings is still more serious. In every part of our country, as 
 well as in the progressive countries of EurojDC, those familiar with 
 
 "The proceeding's of the congress contain pnpers by distinguished physicians 
 and educators upon every phase of the hygiene of school life. Existing evils 
 are pointed out and reniedios suggested. Summaries of the papers may be 
 found in the Nineteenth Century, September, 1907, pp. 38S-394. 
 
 ^ In addition to papers presented at the International Congress on School 
 Hygiene, see the following: A series of articles in the School Review (Univer- 
 sity of Chicago) for 1907, by Prof. Hermann Schwartz, entitled "The study of 
 experimental pedagogy in Germany." Many articles in the magazine Zeit- 
 schrift fur Schulgesundheitsiitloge sliow the great interest in Cermany in school 
 hygiene. Professor P.inet. of Paris, has esral)lished a laboratory for the study 
 of childhood in relation to educational work, and he will give particular at- 
 tention to problems concerning physical defects and mental and moral short- 
 comings. For other such institutions see The Psychological Bulletin, Vol. VI, 
 March 15, 1909, pp. 84-103. 
 
 " See, for example. Professor Garlanda's "II Terzia Italia," In which ne 
 shows the only way in which Italy cini regain her old-time vigor and efliciency. 
 
 '^ See M. v. O'Shea : "Dynamic Factors in Education." New York (Mac- 
 millan), 1900, Part II, where the whole subject is discussed. 
 
 "See Oppenheim : "The development of the child," Chap. V. Also Tyler:! 
 "Growth and odumtion;" Purbank : "The training of the human plant;" 
 Burk : "From fmulaniental to accessory," etc.; Pedagogical Seminary, Vol. VI. 
 Kraeplin: "A measure of mental capacity," Popular Science Monthly, vol. 49. 
 
FISHER.] NATIONAL, VITALITY. 695 
 
 the situation are appealing most urgently for improvement in the 
 physicial basis of edwcation. This is not the place to recite the dis- 
 abilities which are said by men competent to sjoeak on the subject 
 
 ■ to result from keeping children for at least eight years in confinement 
 and at hard mental labor under conditions that waste their vitality 
 and develop bodily defects and habits prejudicial to health. The 
 list of such disabilities is a long and impressive one." Unfortunately, 
 we do not, as a people, sufficiently appreciate that the character of 
 social life with us is changing rapidly, and that consequently our 
 children are particularly susceptible to certain diseases and defects; 
 to wit, those arising from the adoption of an indoor life of compara- 
 tive muscular inactivity, with greatly increased demands made upon 
 particular organs, such as the eyes and the brain. 
 
 Doctor Cronin, of New York, maintains that in a school population 
 of G50,000, 30 per cent of the children were from one to two years 
 beliind their proper class. Ninety-five per cent of these backward 
 children were so principallj' because of defects of eye, ear, nose, or 
 throat, which could easily be detected and remedied through effective 
 medical inspection. Experiments at home and abroad have proven 
 beyond any doubt that the majority of children of this sort, when 
 given proper medical treatment, improve markedly in intellect and 
 general conduct. The State attempts to educate these children, but 
 its effects are to a large extent wasted. Doctor Osier calculated 
 that in the special city to which reference has been made there was, 
 on account of a lack of medical supervision of educational work, a 
 yearly financial loss of $1,GGG,666; and of course the loss which came 
 from moral deviation due to defective physical functioning was of 
 far greater importance. Doctor Osier said recently, in effect, that 
 he considered it of greater importance to the nation that the question 
 of sound teeth be intelligently considered than that the consumption 
 of alcohol be restricted, important as the latter problem is. In similar 
 vein, Doctor Newton reports a case of an old, unhygienic school build- 
 ing in a small town being fitted up with a ventilating system, with 
 the result that the cost of the improvement was saved in a short time 
 in salaries that otherwise would have been paid to extra teachers for 
 taking the place of those made sick by the foul air in the building. 
 We now know the major effects at least on intellect and tempera- 
 
 \ ment of sense defects, adenoids, decaying teeth, and minor physical 
 
 \ deformities; and we also know how such deviation from normality 
 can be readily and inexpensively detected and remedied,'' but there 
 are whole States Avhere no advantage whatsoever is taken of this 
 knowledge, and in practically ever}' State in the country there are 
 
 [ communities in which absolutely no attention is paid to any of these 
 matters. The people go on in traditional ways, trusting to luck and 
 disregarding the changes taking place in society. 
 
 "See Shaw: "School hygiene;" Keating: "Mother and child;" Ballantyne, 
 I In the Lancet, Vol. 2, ISftO ; Bancroft : " Physical Education Review," Vol. VII ; 
 Rowe, " The lighting of schoolrooms ; " Burrage and Bailey : " The Sanita- 
 tion and decoration of school buildings." The Magazine of School Hygiene, 
 published under the direction of the School Hygiene Association, contains in 
 each issue articles showing the evils resulting from unhygienic conditions in the 
 '■: schools. 
 
 ^ See, for example, two books by Doctor Warner, of London : " The Study of 
 Children " and " The Nervous System of the Child." The city of Chicago main- 
 tains a department for the study of backward and defective children la the 
 public schools. 
 
696 
 
 EEPORT OF NATIONAL. CONSERVATION COMMISSION. 
 
 The health of our school children, then, should be conserved by a 
 system of competent medical inspection" which should secure the 
 correction of defects of eyes, ears, teeth, as well as defects due to 
 infection or malnutrition. In Europe 
 
 all the investigations disclosed an astonishing amount of ill health among 
 school children; and though the variations from the normal were found to 
 differ In degree, they were on every hand alike in kind. In nearly every 
 Instance they were more pronounced in girls than in boys, and were often most 
 manifest in scholars of the better social classes. Thus there were discovered 
 the following percentages of morbidity among school boys: In Great Britain, 
 20; in Denmark, 29; in Germany, 30; in Copenhagen, 31 ; and in Sweden, 37. 
 The percentages noted among the girls were: In Great Britain, 16; in Copen- 
 hagen, 39; in Denmark, 41; in Lausanne, 43; in Germany, 50; and in 
 Stockholm, 62 — an average morbidity for boys of 29 and for girls of 42 per 
 cent.^ 
 
 Similar results have been reached in certain cities of the United 
 States. A " committee on the physical welfare of scliool children " 
 in New York City examined New York school children and found 
 that " — 
 
 66 per cent needed medical or surgical attention or better nourish- 
 ment. 
 
 40 per cent needed dental care.<* 
 
 38 i^er cent had enlarged glands of the neck. 
 
 31 per cent had defective vision. 
 
 18 per cent had enlarged tonsils. 
 
 10 per cent had postnasal growths. 
 
 6 per cent were undernourished. 
 
 Dr. Walter Cornell has been making an extensive study of eye 
 strain among school children. These were his findings : « 
 
 The relationship of poor vision to scholarship was studied in 219 children. 
 As will be noticed, the dilTerence in marks between those with normal and those 
 with bad vision is greatest in arithmetic and spelling, which studies require 
 more extensive use of the blackboard. 
 
 Bcholarship percentages obtained. 
 
 Children with— 
 
 Normal vision 
 
 Fair vision 
 
 Bad vision 
 
 Arith- 
 metic. 
 
 79 
 70 
 66 
 
 Geo,?ra- 
 phy. 
 
 69 
 71 
 70 
 
 Spelling. 
 
 76 
 77 
 71 
 
 Average. 
 
 75- 
 73+ 
 69 
 
 In New York City 29.5 per cent of 79,0G9 children examined suffered from 
 defective vision. In London 26 per cent of 20,000 children examined by eight 
 
 « See Gulick and Ayres. " Medical Inspection of Schools," Russell Sage 
 Foundation Publication, New York, 190S; see also "The Psychological Clinic," 
 especially Vol. ii. No. 8. 
 
 " G. Woodruff Johnson, M. D., " Effects of school life on children's health," 
 North American Review, vol. 1S2, p. 831. 
 
 " Ditman, loc. cit, p. 41. 
 
 <* This seems a low estimate in spite of the fact that it does not include all 
 cases of decayed teeth, but only those tl;at have been neglected. See Dr. William 
 R. Woodbury, "The People's Disease: How to Prevent it," Boston Medical and 
 Surgical Journal, March 26, 1908. 
 
 • " Backward Children in the Public Schools," Philadelphia (Davis), 1908, p. 7. 
 
'isHER.l NATIONAL VITALITY. 697 
 
 jphllmlmologists had defective vision, and of tliis uuuiber 12.5 per cent suffered 
 roiu vision of one-lialf or less. The autlior exiiniinrd personally 1,156 children 
 ind found 34 per cont with defective vision, and of this number 6 per cent 
 svith vision one-half or less. A small proportion of this number only Is fitted 
 jvith ^classes. The rest suffer from I'oal eye strain. The fault of this deploraiile 
 condition is divided among physicians, school-teachers, and parents. Ignorance 
 )f the existing facts, indifference, and poverty are the real factors to be dealt 
 s^ith. 
 
 Eye strain is the chief source of the functional diseases of our citizens. It 
 )egins in early childhood and continues until senility is conii>lote. It is bound 
 ;o occur in every individual some time in his life, to a greater or less degree. 
 ;t is almost the sole cause of headache, migraine, sick headache, the most fre- 
 luent and habitually morbidizing of human diseases. It is the frequent cause 
 jf gastric and digestional diseases and of nervous and mental diseases. With 
 )cular function it conditions the origin of spinal curvature, either directly or 
 ndii'ectly, through the pathogenic writing posture. Lateral spinal curvature, 
 he effect of visual function, becomes a new secondary source of multifarious 
 uorbidities, such as neurasthenia, pelvic diseases, hysteria, etc. It has been 
 iemonstrated that 27 per cent of European school children have lateral spinal 
 :urvature at the age of 14, and I have proved that at least 70 per cent of our 
 )wn 16 to 18 year old young men of the educated classes have this disease. 
 Surprise at the fact will soon become horror at the national and social tragedy 
 iphich these true figures indicate.<^ 
 
 Investigations in other cities and States ^ have shown similar re- 
 mits, in view of which it is a conservative statement to say that from 
 )ne-half to two-thirds of our school children need medical treatment 
 )f some sort. 
 
 At least one year in each division of schooling, elementary, secondary, and 
 tollegiate, is lost to the majority of students because of unnecessary sickness 
 )r dullness caused by improper living." 
 
 That physical defects are responsible for much of the backwardness 
 )f children, and for a laro-e share of truancy and incorrigibility, is the 
 )pinion of many educators.'' In order to correct physical abnoririali- 
 ies and thereby to hasten mental and moral progress in school life, a 
 lumber of cities have instituted medical inspection of schools. 
 
 So far as inquiry has been able to discover, there were in the month of 
 fune, 1908, 70 cities in the United States, outside of Massachusetts, having 
 {ome form of medical inspection of schools. In the State of Massachusetts 32 
 dties and 321 towns had systems more or less complete. It is at present impos- 
 ;ible to compute, or even to closely conjecture, how many children these systems 
 ■each at the present time. It is entirely certain that they do not reach all of 
 Jie children in the schools of those cities and towns where systems of medical 
 nspection are actually or nominally in operation.'' 
 
 New Yorli City employs 150 physicians, who visit each public school once a 
 lay, shortly after 9 o'clock, to examine those children set aside by the teacher 
 
 •Letter from Dr. George M. Gould, who perhaps more than any other Amer- 
 .can has emphasized the evils of eye strain. 
 
 * See an article by Prof. M. V. O'Shea in the World's Work, Vol. V, in which 
 lie results of extensive investigations were given. See also Dr. W. B. Drum- 
 nond : "An introduction to child study," Chs. IX and X, " Report of Conference 
 )f State Sanitary Officers of New York," Buffalo, October, 1907, and various 
 Baltimore and New York City school reports. 
 
 " Letter from Mrs. Ellen H. Richards. 
 
 * See O'Shea : " When character is formed," Popular Science Monthly, Vol. 
 LI; Rowe: "Physical nature of the child," Chs. 9, 10, 13, 14; Scott: "Sacrifice 
 )f the eyes of school children," Popular Science Monthly, October, 1907; Gould: 
 ['The cause, nature, and consequences of eye strain," Popular Science Monthly, 
 (December, 1905; Travis: "The Young Malefactor, a Study in Youthful Degen- 
 i'racy;" Swift: "Mind in the making," Chs. IV and V; Tanner: "The child," 
 3h, III ; Kirkpatrick : " Fundamentals of child study," Ch. XVII. 
 
 * Letter from Dr. Luther H. Gulick. 
 
698 EEPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 as requiring attention. Chicago employs nearly 100 physicians to visit her 
 public schools. In Chicago during the ten months of the school year ended 
 June 26, 190S, the medical inspectors of schools examined 40(;,!)19 i)upils." 
 
 And one health officer, Doctor Chapin, of Providence, has even 
 established a special fresh-air school for children who suffer from 
 certain forms of tuberculosis or who come from tuberculous families. 
 He says concerning it: 
 
 Our fresh-air school has only been running since last January (1908), and, of 
 course, we have no very definite results. All of the children without exception 
 improved in health, and gained in strength, and also showed good mental prog- 
 ress. The cost of the school per capita is only about HO per cent more than in 
 the ordinary schools, and we believe that the expense is fully justified. If wei 
 had a large enough school, so that it could be graded, the cost of education ; 
 would, owing to saving in fuel, probably be less than in an ordinary school. 
 
 Several States are making progress in these directions. 
 
 Connecticut, Massachusetts, and Vermont have passed laws making examina- 
 tion of eyes, ears, and method of breathing of the public scholars compulsory, 
 while New York, Illinois, and some other States of the Middle ^Vest depend 
 upon the voluntary cooperation of the teachers in making this examination. 
 It would seem, however, that whether it remains voluntary or becomes com- 
 pulsory, its success will be greatly enhanced if women who are conducting 
 teachers' institutions in the department of education devote a half hour or an 
 hour to the exposition of the necessity of such an examination and also in 
 explaining the method in detail and the method of tabulating the results, so 
 that the teachers may be familiar with the tests, etc., when they have to make 
 them. With the great power lodged in the department of education in this 
 State, it would seem justifiable to make this compulsory.* 
 
 We in this country should profit by the experience of older coun- 
 tries in respect to school hygiene. Switzerland has led the nations 
 in its concern for the physical welfare of its children. A number of 
 other European countries are beginning to imitate Switzerland in 
 attaching supreme importance to health and hj^giene in educational 
 work. There is now before the English Parliament a bill the pur- 
 pose of which is to establish a national system of medical inspection 
 of schools, and it seems probable that this measure will be enacted 
 into law. 
 
 It is generally recognized by physicians and educators to-day that 
 many children in the schools are being seriously injured through . 
 nervous overstrain.'^ Throughout the world there is a developing £ 
 conviction that one of the most important duties of society is to de- 1; 
 termine how education may be carried on without depriving children 
 of their health. It is probable that we are not requiring too much 
 work of our ptipils, but they are not accomplishing their tasks 
 economically in respect to the expendittire of nervous energy. Some 
 experiments made at home and abroad seem to indicate that children 
 could accomplish as much intellectually, with far less dissipation of 
 nervous energy, if they were in the schoolroom about one-half the 
 time which they now spend there. German educators and physicians 
 are convinced that a fundamental reform in this respect is needc 1. 
 In fact, among school children we are learning the same lesson as 
 
 "A. L. Craig, " Report of the standing committee on contagious, infectious, and 
 hereditary diseases," Associated Fraternities of America. August 1, 1908. 
 
 'Twenty-eighth Annual Report State Board of Health of New York, 1908. 
 
 "See Dr. Adolph Meyer, "What do Histories of Cases of Insanity Teach Us 
 Concerning Preventive Mental Hygiene during the Years of School Life? " The 
 Psychologic Clinic, June 15, 1908. 
 
KisnEn.l NATIONAL VITALITY. 699 
 
 among factory employees, viz, that high pressure and long hours are 
 not economy but waste of time. 
 
 In American cities one of the greatest needs to-day, in order to 
 conserve the vitality of children, is the establishment of playgrounds 
 easily accessible to all the children of any community. We are told 
 that the physical and the mental are inseparably joined together, and 
 if the one is defective the other Avill suffer through sympathy. Now 
 it appears to be impossible to develop the child physically in any way 
 so efl'ectively as through active play. Formal gymnastics can accom- 
 plish relatively little. The child must have some end to attain that 
 arouses its enthusiasm, and that demands agility and strength and 
 endurance; then its wiiole bodily mechanism will work together in 
 harmony to achieve this end. And this is what a physical training 
 seeks to accomplish — to make the body a fit instrument for the mind. 
 Let the child have some place where it may not only play games 
 freely without fear of the police but where it may run and jump 
 and climb and swing and work in sand and throw stones and wrestle, 
 and it will not fail to make the most out of the body nature has given 
 it as a housing for a sound and efficient mind. 
 
 Even if playgrounds were of no value in social development, they 
 would still be of inestimable service in keeping children out of crime 
 and lessening expense for police, courts, reformatories, hospitals, and 
 prisons — a point wdiich was strongly emphasized in the report of 
 1897 of the committee on small parks in New York. If a boy's 
 energies are not used up in wholesome activity they will surely find 
 expression in illegitimate conduct. The boy will prey upon the in- 
 stitutions which prevent him from living a natural life. '' The great- 
 est enemy to the police is the boy," said a high Philadelphia official 
 recently. Go to the storekeeper, to the shoplceeper, to the house- 
 keeper, and you will hear the same stoiy. The boys steal, break 
 windows, insult, afflict, upset one thing and another, and Avould do 
 . almost anything they hear or see in order to satisfy that burning 
 ' instinct for play. " These beginnings of vice and crime were the 
 onlj^ outlets they have had for the powers with which nature has 
 endowed them. These practices were their only or chief arnusement, 
 and thus happiness to them became synonymous with vice and fiendish 
 delight in evil doing."** 
 
 But in studying the life on the playgrounds the same official sees 
 that they lay the foundations for — 
 
 strong, manly, bright, and liappy lives, rescued from the evil habits and 
 tendencies that produce misery and wretchedness. * * * Through their play 
 in this manner the young are taught how to live together, how to respect each 
 , other's rights, how to be kind, gentle, pure, in language as well as in conduct. 
 The boy's mouth is not defiled by tobacco, liquor, or profane language. The dis- 
 respectful and vulgar treatment which young boys and girls inflict upon each 
 other in the street is done away with. The playground influences are brought 
 into the home, where the younger brothers and sisters treat each other much 
 differently from the way they do now ; or, to put it the other way, the influ- 
 ences of the home, the school, and of the church are thus extended outside over 
 the whole life of the child." 
 
 To playgrounds may be joined school gardens, which Superin- 
 tendent Maxwell in New York has shown would not be expensive, 
 
 I « Secretary of Philadelphia Culture Extension League. 
 S. Doc. 419, 61-2 6 
 
700 BEPORT OF NATIONAL. CONSERVATION COMMISSION. 
 
 or open-air gymnasia, or any other equipment that will give children 
 the opportunity to develop physically. 
 
 Physical education is a part of the training in many public schools 
 and in a still greater number of private schools, but there is room 
 for improvement. After pointing out, in a recent article on physical 
 deterioration, that Germany, France, and Austria have improved 
 their physical development by compulsory physical training in all 
 civil and military educational institutions, the Rev. Percy Stickney 
 Grant advocates the instalment in the United States of: 
 
 1. An effective system of pi^vsical education as a recognized part of all public- 
 school systems. By "effective" I mean one that does for a boy, as far as 
 his physique is susceptible, what army setting-up exercises do for a recruit. 
 
 2. Athletic exercises in schools, using gymnasia, baths, etc. 
 
 3. Open-air exercises and sports under efticient supervision. 
 
 4. Summer camps free of cost, and compulsory attendance for boys of school 
 age." 
 
 The study of hygiene and physiology has been part of the public 
 school curriculum for some time, but has been regarded by physiolo- 
 gists as a somewhat partisan and unscientific treatment of the physi- 
 ological effects of alcohol and tobacco. It should be recognized, how- 
 ever, that it has had a salutary effect and has given school children a 
 better idea of what alcohol means than the most of them had before.^ 
 Local topics of sanitation may well be taken up, as in New Haven 
 last year when the interest of all the city school children was enlisted 
 in behalf of a " clean city." Doctor Stiles, of the Public Health and 
 Marine-Hospital Service, has proposed an annual " health week " in 
 the public schools, and this proposal has found favor in several States. 
 In Georgia Chancellor Barrow has proposed an annual " health day " 
 in the public schools of that State, which would be devoted to lectures 
 on sanitation, on the dangers to be expected from unscreened win- 
 dows, and on the character of the hook-worm disease, with suggestions 
 as to its elimination. 
 
 At present the schools look to parents to instruct their children In the sup- 
 posedly simple matters of regulating eating and drinking, exercise, habits of 
 work, and sexual habits, while the parents vaguely hope (if they think about 
 such matters) to be relieved of these embarrassing duties through the schools. 
 The truth is that neither parents nor schools are to-day able to give this much- 
 needed sort of education. The remedy must be provided by the schools, which 
 in their eagerness to impart conventionalized facts are now quite blind to some 
 of the most pressing needs of their pupils. Through the schools and universi- 
 ties (or other appropriate organizations) the parents of the future must be edu- 
 cated both as to the facts and the moral aspects of bodily hygiene. And it seems 
 not unreasonable to hope that some of the lessons now learned only by bitter 
 experience, after much that is best in life has been sacrificed to ignorance and 
 uncurbed Impulse, will be assimilated sufficiently early in life to mitigate mate- 
 rially the lot of a not inconsiderable part of mankind. I believe the lengthening 
 of the span of human life to be among the attainable results of such teaching. 
 Is it not likely that as men grow wiser an increasing number will deliberately 
 strive so to regulate their lives as to improve the expectation of crowning well- 
 Bpent days with the peculiarly fine satisfaction of old age?" 
 
 If the school building were a model of ventilation, lighting, and 
 sanitation, it would not only conserve the health of the school cliil- 
 
 « Rev. P. S. Grant, North American Review, February 1, 1907. 
 
 * See Dr. Helen Putnam, " Studies of the Present Teaching of Hygiene, 
 Through Domestic Science and through Nature Study," American Academy 
 Medicine (Easton, Pa.), 190.5. 
 
 " C. A. Ilertor. M. D.. " The Common Bacterial Infections of the Digestive 
 Tract," New York (Macmillan), 1907, p. 351. 
 
FisnBH.l NATION All VITALITY. 701 
 
 Iren, but also serve as an object lesson for hygienic instruction. In 
 the same way cooking and domestic science classes could be made to 
 serve the double purpose of providing a hygienic noon meal and 
 :raining the school children, especially the older girls, in the princi- 
 ples and practice of this vitally important subject. Our schools are 
 suffering from the conventional idea that education comes from 
 books. Education is preparation for life, and should make use of 
 jvery efficient method and element, manual training, athletics, ob- 
 servational nature study, laboratory experiments, and object lessons 
 of all sorts, as well as book instruction. 
 
 Section 5. — Voluntary and btisiness organizations. 
 
 A host of distinctly voluntary associations are working for the 
 improvement of hygienic conditions. Among them may be men- 
 tioned the National Association for the Study and Prevention of 
 Tuberculosis, the Society for Sanitary and Moral Prophylaxis, the 
 Chicago Society of Social Hygiene, the Connecticut Society of Men- 
 tal Hygiene, the national and state child labor committees, the Con- 
 fess on School Hygiene, the Children's Aid societies, the Sunshine 
 societies, the American Playground Association, the Visiting Nurses' 
 A-Ssociation, the Red Cross Society, the American Association for 
 Labor Legislation, the numerous temperance organizations, univer- 
 sity settlements, institutional churches. Young IMen's Christian Asso- 
 dation and kindred associations, the American Physical Education 
 Society, the Boston Health Education League, and the American 
 Health League established by the Committee of One Hundred on 
 National Health. 
 
 That various large bodies of men are waking to the importance 
 of health study is shown by the appointment, at the last annual 
 meeting of the Associated Fraternities of .Vmerica, of a committee 
 on infectious, contagious, and hereditary diseases, with Doctor Craig, 
 oi Chicago, as chairman. Labor unions may well follow this exam- 
 ple and provide for the education of their members in the subject 
 af hygiene. This could be effectively combined with their endeavors 
 to shorten the hours of labor. Especially unhygienic is tlie arrange- 
 ment by which a man has no interest in his work beyond that 
 represented by his pay envelope. This fact has been recognized by 
 some farsighted employers of labor, with the result that they now 
 employ social secretaries or " welfare workers " to look after the 
 general well-being of employees. A social secretary watches over 
 the health, comfort, and happiness of the force during working hours, 
 establishes lunch rooms, rest rooms, mutual aid associations, thrift 
 funds, and penny provident banks. Employers, as a rule, become 
 eager for practical suggestions and expert advice on the well-being 
 of their employees as soon as the matter is called to their attention. 
 Doctor Favill, president of the Chicago Tuberculosis Institute, after 
 speaking before the Commercial Club, was urged by 15 or 20 of the 
 large employers present to undertake investigation of their estab- 
 lishments and to make recommendations. 
 
 Dr. Hubert Higgins describes an interesting experiment carried 
 out in a mill near Paris, where there were employed 44 men and 75 
 women and children. A medical officer was employed to supervise 
 the sanitary appliances and reg-ulations and to give careful instruc- 
 
702 REPORT OF NATIONAL. CONSERVATION COMMISSION. 
 
 tion and explanations. He held practical instruction classes with 
 the mothers, lecturing on diet and cooking, cleanliness, the way to 
 take body temperatures, and how to look at the children's throats. 
 
 This experiment was entirely successful, thougti the doctor lived in Paris. 
 There was not a single death in three years. There were one or two cases of 
 scarlet fever and diphtheria, that were promptly and effectively isolated. This 
 experiment was not philanthropic, but financial, the employer realizing that 
 he had better value in worli from healthy hands." 
 
 A few factories now use or permit the use of a reader to read to 
 their employees, where the manual nature of their work is such as 
 not to be hindered by listening to a story. Others use a piano and 
 have their employees march in and out to music. The curious 
 physiological relations between rhythm and work are now being 
 observed by physiologists. Laboratory tests with ergometers seem 
 to show that more work can be done under the stimulus of rhythm. 
 Soldiers and sailors have for ages made use of music and rhythm, and 
 it would not be beyond the range of possibility if the factory system 
 should in some cases find more use for it than at present.*' 
 
 Unconsciously, business corporations have also made changes which 
 tend to improve the sanitary conditions under which their employees 
 work. In a large telephone exchange in Chicago the perfect worldng 
 of the apparatus was much hampered by dust, .so that insulation was 
 seriously affected. To obviate this condition an expensive system 
 was put into operation, by which the air was washed and pumped 
 into the rooms under ideal conditions. What the company aimed at 
 was the perfect health of its apparatus, but it gained in addition a 
 decided improvement in the health of its employees." 
 
 Another similar organization, the New England Telephone and 
 Telegraph Company, at Cambridge, Mass., ventilated its officer 
 during the winter of 1907-8 witli unusual care, with the result that 
 the number of days of work lost by its 60 female emplovees was cut in 
 half. 
 
 The need of industrial efficiency is driving business men to de- 
 mand temperance or even total abstinance among their emploj^ees. 
 This is one of the most powerful motives to-day working against the 
 abu.se of alcohol. In the South employers and the public see that 
 negroes who drink are inefficient and dangerous. Railway officers 
 and the traveling public realize that public safety requires sober 
 locomotive engineers and firemen. Even drinking among sailors is 
 being discountenanced. Doctor Grenfell, the missionary among the 
 Labrador fishermen, says: "Why don't I want to see liquor used at 
 sea? Because when I go down for a watch below, I want to feel 
 that the man at the wheel sees only one light when there is only one 
 light to see." 
 
 Among semipublic institutions witli power to exercise prodigious 
 influence in improving the public hcidtli are tlie life insurance com- 
 panies. Just as fire insurance companies make efforts to decrease 
 the risk of fire, so life insurance com{)anies might well join in public 
 health movements to effect a reduction in the human death rate. 
 
 Wliile the financial motive is sordid, it should be utilized because 
 of its tremendous power. The insurance companies to-day represent 
 
 "Hubert Higgins, " Humaniculture," New Yorlt (Stokes), 1906, pp. 209-211. 
 * See Karl Riicher, "Arbeit and Rythmus," Leipzig, 1902. 
 « See Outlook, May 26, 1906. 
 
»ISHBB.] NATIONAL VITALITY. 703 
 
 an invested capital of over $3,000,000,000. An actuary recently re- 
 marked to me, in connection with this subject, that they could without 
 feeling it contribute gi-eat sums annually to the preservation of public 
 health. "When insurance companies were established, the old dictum 
 that human vitality followed a fixed law served probably to exclude 
 the idea of preventing death claims rather than paying for them. 
 Now that we are learning the preventabilit}^ of disease, the time must 
 come when insurance companies will take an active part in the fight. 
 Even a single company would probably make a good investment if 
 it sought to educate its own " risks." But a far more effective method 
 would be a combination of all companies to improve public health 
 through the enactment of public legislation — by Congress, state legis- 
 latures, municipal governments, and in numberless other ways." 
 
 Among some official agencies meant to promote the social welfare 
 are two recent commissions appointed by the President — the Homes 
 Commission, of 1007, appointed for the purpose of studying the hous- 
 ing conditions in the District of Columbia, and the Commission on 
 Country Life, appointed to study the dailj^ life of the farmer. Farm 
 sanitation will be especially considered. 
 
 Finally, there is a public yet voluntary agent in the progress of 
 hygiene that must not be overlooked, namely, the modern periodical. 
 Not only do the daily papers devote much attention to questions of 
 health and hygienic reform, but the popular magazines have taken up 
 the fight against disease, and are educating the popular mind, more 
 surely than is realized, concerning the natural and normal way of life. 
 It is necessary to add, how^ever, that these same periodicals often 
 nullifj' the benefits derivable from their reading matter by printing 
 the most harmful of patent medicine, quack, drug, and alcoholic ad- 
 vertisements. Public odium should attach to newspapers and maga- 
 zines that advertise hurtful nostrums. It is impossible to estimate 
 the harm wrought to the public health each year through such ad- 
 vertising.'' 
 
 The daily papers are especially culpable in this regard, but weeklies 
 and monthlies are not wholly clear of the taint. When a newspaper's 
 advertising space is once bought by quacks or nostrum sellers, its news 
 columns become closed at once to matter considered objectionable by 
 such advertisers. Frequently news items reflecting directly or indi- 
 rectly on quackery are suppressed. Notable examples of publications 
 that have taken strong ground against such advertising are Collier's 
 Weekly, The Outlook, The Ladies' Home Journal, and a few — a very 
 few — dail}^ papers. 
 
 " Since the above was written the Committee of One Hundred on National 
 Health has urged this matter before the Association of Life Insurance Presi- 
 dents, which body has appointed a committee to draw up plans. Also the Metro- 
 politan Life Insurance Company has organizeJ a bureau of cooperation and 
 information to aid in distributing information to policy holders of the " indus- 
 trial " class. 
 
 * For further discussion of this topic see a pamphlet by Samuel H. Adams on 
 "The Great American Fraud," reprinted by the American JNIedical Association 
 from a series originally appearing in Collier's Weekly, and "A Century's Crim- 
 inal Alliance between Quacks and Some Newspapers," by Champe S. Andrews, 
 Publications of the Committee of One Hundred, 1907. 
 
704 BEPOBT OP NATIONAL CONSERVATION COMMISSIOH. 
 
 Chaptek IX. — Conservation through personal hygiene* 
 
 Section 1. — Its importance. 
 
 Following public and semipublic hygiene, we arrive at what is in 
 many respects the most important subject of all, personal hy<^ione. It 
 is quite true that the individual is often at the mercy of unclean 
 streets, bad drainage, impure water and food, and other shortcomings 
 of public and semipublic hygiene. On the other hand, his own per- 
 sonal interest is necessary in order to form the public opinion which 
 alone can result in effective public and semipublic hygiene, while that 
 interest is still more necessary to make such hygiene apply directly to 
 his own person. Clean streets are of use onh^ as they make the air 
 breathed purer, but they are of little avail to the household which does 
 not ventilate its rooms or which keeps them in a state of filth. The 
 milk supply of a city may be ideal, but all the pains to make it so 
 will be set at naught if the individual consumer allows the milk to be 
 contaminated after it is delivered. The labeling of foods and drugs 
 will not prevent self-poisoning through alcohol, nor will the elimina- 
 tion of preservatives from foodstuffs and the enforcement of sanita- 
 tion in their manufacture be of avail if in their preparation for the 
 table they are subjected to disease and dirt. Thus at every point of 
 hygienic progress, there must be individual cooperation with public 
 efforts. 
 
 When, contrariwise, health organizations and officials are inefficient, 
 the individual may, in spite of these difficulties, often maintain good 
 health. In New York a woman who was the occupant of a tenement 
 overcame tuberculosis by sitting daily on her fire escape. The air 
 was not the best, but it was much better than indoors. Similar results 
 have been obtained by workmen in Brockton shoe factories, who, in 
 spite of insanitary working places, and without cessation of work, 
 conquered tuberculosis by sleeping on the roofs of their houses at 
 night. 
 
 Observation shows that many, possibly most, of the world's most 
 vital men and women have virtually made over their constitutions 
 from weakness to strength. Cornaro, the famous nonogenarian, Kant, 
 and Humboldt are cases typical in different fields of achievement. 
 Cornaro, a Venetian nobleman born about the middle of the fifteenth 
 century and given up to die at the age of 37, forswore all unhygienic 
 habits and began to live " the temperate life," his abstemiousneas 
 applying especially to food. His age at death is variously estimated, 
 but he lived to be at least 97. When over 90 he wrote a treatise on 
 longevity, laying down as the chief rules of a normal life, care in 
 eating and drinking, and the avoidance of melancholy and passion.* 
 
 Centenarians have usually been persistent followers of some rule or 
 rules of rational h3^giene, even though unconsciously.* 
 
 Metchnikoff points out " that part of the supposed inheritance of 
 longevity may not be inheritance, but similarity' of environment, and 
 that it very frequently happens that husband and wife both live to be 
 
 "See L. Cornaro, "The Art of Living Long" (English translation, Wna. F. 
 Butler, Milwaukee), 1903. 
 
 > Metchnikoff, "The Prolongation of Life," p. 141. 
 Ibid., p. 86. 
 
usHEtt.] NATIONAL, VITALITY. 705 
 
 over 100. This could scarcely happen by accident, but must be due to 
 similar habits or environment. 
 
 Humboldt confessed to a fellow-student that in the first years of 
 his childhood his tutors were doubtful whether even ordinary powers 
 of intelligence would ever be developed in him, and that it was only 
 in the advanced part of his boyhood that he began to show any evi- 
 dence of mental vigor. As a boy he suffered from debility which not 
 infrequently produced great prostration." 
 
 Of recent examples may be mentioned a young physician who was 
 given up to die of tuberculosis five years ago, but who to-day can 
 run 25 miles without a rest; and Horace Fletcher, who in his 4:6th year 
 was rejected for life insurance, but who later not only obtained his 
 insurance, but proved his powers of endurance by cycling 190 miles 
 on his 50th birthday. 
 
 And not only can weakness, if recognized early enough, be turned 
 into strength, but strength, however great, may be dissipated in an 
 incredibly short time. 
 
 Personal hygiene means the strengthening of our defenses against 
 disease. Public hygiene seeks to destroy the germs before they reach 
 our bodily defenses. These two branches of hygiene are simply the 
 two forms of warfare, defensive and offensive. Both are of tran- 
 scendent importance, but the defensive warfare is more within our 
 power. We always have our defending garrison, the white blood 
 corpuscles, to deliver us from our enemies.'' 
 
 Section 2 — Branches of personal hygiene. 
 
 Personal hygiene comprises hygiene of environment (air, soil, 
 dwelling, clothing) ; hygiene of nutrition; and hygiene of activity. 
 
 Man is more dependent upon the atmosphere than upon any other 
 environmental factor. His body is bathed in air and his most vital 
 function, respiration, depends upon it. Deprived of air, he will 
 shortly suffocate. If the air is confined and impure, his health will 
 be affected. Ideal air should first of all be pure — i. e., free from in- 
 jurious bacteria, from dust, smoke, and noxious gases. It should 
 also conform to certain standard conditions of humidity and tem- 
 perature. In this field lie the sciences of climatology and meteor- 
 ology. Man learned long ago how to make himself almost inde- 
 pendent of climatic and atmospheric conditions by the use of dwell- 
 ings and clothing. These contrivances, however, while protecting 
 him from the elements, have brought evils of their own. The great 
 scourge of tuberculosis, for instance, is principally an indoor disease. 
 
 Intimately related to the appropriation, through the lungs, of oxy- 
 gen from the atmosphere is the ingestion of food and drink through 
 the alimentary canal. Normal health conditions demand in the case 
 of ingested materials, as in the case of respired air, the greatest possi- 
 ble purity, freedom from injurious bacteria, and the absence of sub- 
 stances hurtful mechanically or chemically. 
 
 Finally, the ideal conditions of health require perfect balance of 
 work, play, and sleep. 
 
 • " Life of Alexander von Humboldt," by Lowenberg Ave-Lallewort and Dore, 
 translated by Jane and Caroline Lassell, New York (Lee & Sliepard), 1873, 
 Tol. I, pp. 30-32. 
 
 * Metchnikoff, " The New Hygiene," p. 14. 
 
706 ■ REPORT OF NATIONAL, CONSERVATION COMMISSION. 
 
 While absolutely perfect conditions in these three branches of hy- 
 giene are unobtainable, hygienic progress consists in approaching 
 these ideals as closely as possible. 
 
 The rules of personal hygiene are expressed in standard medical 
 works on the subject. There is nothing novel in the brief resume 
 which follows. The radical changes in habits of living which are 
 now being advocated and to some extent practiced imply nothing 
 new. They have, for the most part, long been commonplaces of the 
 medical profession. The knowledge is old. It is the application 
 which is new. Medical men have long been telling their patients to 
 get plenty of fresh air and to masticate their food. But until re- 
 cently their advice has fallen on deaf ears. 
 
 Section 3 — The hygiene of environment. 
 
 Air hygiene deals first of all with ventilation." The importance of 
 properly ventilating houses is so great that to secure this end the ar- 
 chitecture of houses will have to be changed. The worst historical 
 instances of bad ventilation are the imprisonment and virtual suffoca- 
 tion of 146 persons in the " Black Hole " of Calcutta and the confine- 
 ment of 300 men in an underground room after the battle of Auster- 
 litz. The evils of overcrowding come mainly from exhaled air and 
 from the effluvia thrown off by the skin. Not only does overcrowding 
 bring bad air, but it also increases the opportunity for infection. 
 
 The air in our houses has impurities of its own. Oil and gas vitiate 
 it. Electric lights are hygienic in this respect. Air is never quite 
 free from dust impurities. Aitkin estimates that country air carries 
 2,000 dust particles per cubic centimeter, city air 3,000,000, and in- 
 habited rooms 30,000,000. 
 
 In a clean hospital ward, when air was agitated by dry sweeping, 
 the number of colonies of bacteria collected on a given exposure rose 
 from 26 to 532, showing the effect of ordinary broom sweeping. The 
 broom is now being replaced by the carpet sweeper, and the carpet 
 sweeper in turn by the vacuum cleaner. Each step represents progress 
 in the elimination of dust. The removable rug is in this regard an 
 improvement over the carpet. 
 
 Air may even be poisoned by the chemicals contained in wall paper 
 or in the plaster of a brick and mortar dwelling. 
 
 The one place where the individual has more control over the air 
 he breathes than anywhere else is his sleeping room. He may be 
 powerless to control the air in his place of work, or even in the rooms 
 where he lives during the day. But, except where he shares a bed- 
 room with others who are averse to modern ideas of ventilation, he 
 can largely control the air supply during sleep, and this means during 
 one-third of his whole time. He can open wide his windows and in 
 many cases arrange actually to sleep out of doors. The growing prac- 
 tice of sleeping out of doors is one of the most significant signs of the 
 times. Only those who have tried it realize the benefits. The air 
 supply in public places would be under the control of individuals, if 
 organized in protest; and our churches, theaters, public halls, railway 
 coaches, and railway sleepers would be properly ventilated if the 
 
 "See Richards and Woodman, "Air. Water, and Food," New York (Wiley), 
 1904; also Carpenter, "Heating and Ventilating Buildings," New York (Wiley), 
 1905; Sykes, " Public Health and Housing" Loudon (King), 1901, 216 pp. 
 
 
FISHER.] NATIONAL. VITALITY. 707 
 
 public demanded improvement. Such a " score card " as Prof. John 
 R. Commons has devised for measuring the relation of housing con- 
 ditions to an ideal standard might well be used in measuring the 
 health utility of public places. 
 
 The windows of living and work rooms may be opened in summer 
 and somewhat in winter, provided a window board is used, to deflect 
 the cold air upward from the sill. It then does not form a cold 
 stratum on the floor, but mixes evenl}^ with the air of the room. This 
 simple device would go far to solve the question of winter shut-ins 
 and their ailments. In many cities sleeping balconies are not uncom- 
 mon among the dwelling houses. 
 
 The many benefits from a pure air supply are only beginning to be 
 realized. For instance, as long as " the outdoor life " is lived a cold 
 is almost impossible. Army officers have noted that as long as the 
 men are on the march and sleep outdoors they hardly ever have colds, 
 but that they become troubled with these as soon as they get indoors. 
 Franklin, a century ago, knew these facts, though few of the present 
 generation are acquainted with them. He believed " that people who 
 live in the forest, in open barns, or with open windows, do not catch 
 cold, and that the disease called ' a cold ' is generally caused by impure 
 air, lack of exercise, or from overeating." He came to the conclusion 
 that influenzas and colds are contagious — a doctrine which, a century 
 and a half later, wa-s proved, through the advance of bacteriological 
 science, to be sound. The following sentence exhibits remarkable in- 
 sight, considering the state of medical art at that time : " I have long 
 been satisfied from observation that besides the general colds now 
 termed ' influenzas ' (w^hicli may possibly spread by contagion, as well 
 as by a particular quality of the air), people often catch cold from 
 one another when shut up together in close rooms and coaches, and 
 when sitting near and conversing so as to breathe in each other's 
 transpiration; the disorder being in a certain state." In the light of 
 i present knowledge what a cautious and exact statement is that." 
 
 Jolm Muir, the geologist and naturalist, says that he finds home 
 the most dangerous place he can visit. 
 
 As long as I camp out in the mountains witliout tents or blankets I get along 
 very well, but the minute I get into a house and have a warm bed and begin to 
 live on fine food, I get into a draft, and the first thing I know I am coughing 
 
 iand sneezing and threatened with pneumonia, and am altogether miserable. 
 Atmospheric evils come from improper ventilation, and affect either 
 the respiratory organs of the body or the skin. It has been supposed 
 until recently that the presence of carbon dioxid gas in vitiated air 
 was the chief evil caused by such air. Impure air will affect the 
 lungs harmfully, but not till the amount of carbon dioxid con- 
 Itained is very large. Guinea pigs, on which the effects of bad air 
 were observed, were not seriously affected by the carbon dioxid till 
 it amounted to 14 per cent of the volume of the air. Fliigge and 
 others have found that the evil of close atmospheres is largely a result 
 of elevated temperature, humidity^ and absence of air currents. Tests 
 were made on men who sat in mipure air, but breathed pure air 
 through tubes, and they presented all the symptoms usually resulting 
 from bad ventilation. 
 
 " From " Benjamin Franklin as Printer and Philosopher," address of Presi- 
 dent Charles W. Eliot before American Philosophical Association, April 30, 190G. 
 
708 EEPORT OF NATIONAL. CONSERVATION COMMISSION. 
 
 Air baths have been shown to be as important for bodily health a! 
 water baths. For this purpose porous clothing should be worn anc 
 no more of it than is needful. Impervious cloth and rubber are prob 
 ably injurious as clothing. Loosely woven worsteds, or linen anc 
 cotton mesh are best adapted to let the air play on the skin. Clothing 
 to be hygienic, should not constrict the body. Tight shoes, anc 
 especially tight corsets, are distinctly injurious, and the injury t( 
 mothers from the latter may be felt b}^ the next generation. Anothe] 
 insanitary feature in clothes is the trailing skirt, which drags indoor 
 the sputum of consumptives and germ-laden dirt from the sidewalk 
 
 Closely connected with air and ventilation is light. The benefit o; 
 sunshine in killing germs and improving bodily vigor in every waj 
 is too well known to need more than mention. Tuberculosis and othe: 
 germs thrive only in dark, damp, ill-ventilated places. 
 
 Light has its most important bearing on the human health througl 
 the sense of sight. Its relation to eye strain has been discussed else 
 where. Headaches, backaches, indigestion, hysteria, and epilepsy ar 
 often aided by glasses. 
 
 Section 4. — The hygiene of nutrition. 
 
 A primary necessity for hygienic living is good drinking water 
 The modern man of means insists upon good water, and, as a result 
 the traveling public is now able to get first-class water in cars, hotels 
 and other public places. The improvement was brought about b; 
 the appreciation by the consumer of the danger of drinking impur 
 water. It is the consumer who has it in his power to bring about tb 
 necessary reforms in public hygiene. When he really values hygieni 
 environment producers will supply it. Professor Sumner has told u 
 that persons in the middle ages sometimes drank out of their casti 
 moats, which contained sewage. Even in New York to-day the roo 
 tanks are sometimes used as baths or laundries; and they accumu 
 late dust and flies very rapidly. Only a few years ago the nldermei 
 in a prominent western town laughed out of court a physician whi 
 called their attention to dangers which were real, but which they be 
 lieved imaginary, from a polluted water supply. 
 
 The scientific study of diet has only just begun and few authori 
 tative results can yet be stated. To avoid a lengthy review o 
 controversial literature it seems best to pass the subject over rapidlj 
 referring the reader for further information to some of the principa 
 books on the subject. 
 
 We have already seen the surprising improvement in enduranc 
 which followed the adoption of thorough mastication in place of th 
 ordinary food bolting. Mr. Gladstone used to be noted for his car 
 in slowly masticating his food, and latterly Mr. Horace Fletcher ha 
 aroused the interest of the public in the subject in Europe and Amer 
 ica." He has also stimulated a large number of physiologists to stud; 
 the subject of mastication, the protein ration, and their relation t 
 strength and endurance. 
 
 • See Horace Fletcher, " The A, B-Z of our Own Nutrition," New Tor 
 (Stokes), 1903; Dr. Hubert Higgins, " Humaniculture," New York (Stokes) 
 1906; and Irving Fisher, "The Effect of Diet on Endurance," publications ct 
 Yale University, Transactions of the Connecticut Academy of Arts and Sciencei 
 1907. 
 
riSHiE.] NATIONAL. VITALITY. 709 
 
 A great deal has been written as to what foods are best. There 
 exist various dietetic cults, such as vegetarians and fruitarians, raw- 
 food advocates, etc. The question of what foods are ideally best is 
 too large a one to be entered upon here. The evidence seems to point 
 to a general conclusion that no hard-and-fast rule of exclusion is 
 advisable, and that the value of different foods varies with the indi- 
 vidual and with his activity, locality, physical condition, etc. His 
 own instinct, restored and educated by avoiding the pernicious habit 
 of food bolting, may be made a truer guide than the wisest physician 
 or physiologist. The same rule applies. to the amount of food to be 
 eaten, as well as to the proportions of protein, fat, carbohydrates," 
 and mineral salts. Food bolting often leads to overeating. 
 
 It should be noted that the conclusions of Chittenden and others 
 are not in favor of a vegetarian regime, but of a low protein regime, 
 whether vegetarian, lacto-vecetarian, or with flesh foods in modera- 
 tion. The main point is moderation of the foods highest in protein, 
 such as the whites of eggs and meats (especially lean meats). 
 
 It would seem that the safest course for the average man is to fol- 
 low the appetite, simply guiding it toward a low protein diet by thor- 
 ough mastication, and by giving the benefit of the doubt to foods low 
 in protein. A reduction in the use of meat will increase, and probably 
 cheapen, our national food supply. The raising of cattle requires 
 much more land than the raising of cereals, fruits, nuts, and vege- 
 tables yielding the same amount of food value. As this will be a most 
 important economic problem during the next hundred years, the ques- 
 tion of the character of our food supply should be most carefully 
 considered in the study of the conservation of natural resources. It 
 is interesting to note, in this connection, that during the last century 
 the consumption of flesh foods in the United States has considerably 
 decreased.^ 
 
 The subject of auto-intoxication as a consequence of excessive pro- 
 tein has already been mentioned.*' To avoid auto-intoxication the 
 putrefactive bacteria may be neutralized by lactic bacilli, such as are 
 contained in sour milk. Another preventive is regular attention to 
 thorough evacuation. 
 
 Diseased foods are, needless to say, dangerous. Oysters are often 
 planted in waters polluted with sewage, with the result that epidemics 
 of typhoid fever have been traced to their consumption. 
 
 The housewife must be the guardian of the family in these respects, 
 and in the cooking, preparation, and arranging of food generally. 
 These now constitute " domestic science," which is justly winning 
 recognition as one of the most potent of all hygienic agencies. When 
 
 <» For a short method of measuring these magnitudes, see Irving Fisher, "A 
 New Method of Indicating Food Values," American Journal of Physiology, Vol. 
 XV, No. V, April 2, 1906 ; and for its practical application see "A Graphic 
 Method in Practical Dietetics," Journal American Medical Association, Vol. 
 XLVIII, April 20, 1907. See also, " Statistics of Diet in Consumptive Sana- 
 toria," American Journal Medical Sciences, September, 1906. 
 
 * See G. K. Holmes, " Meat Supply and Surplus," Bureau of Statistics, De-' 
 partment of Agriculture, Bulletin 55, 1907, p. 47. Mr. Holmes finds that the 
 consumption of dressed meat per capita in the United States decreased between 
 ■ 1840 and 1900, 40 per cent, and between 1S90 and 1900, 25 per cent. 
 
 ° Supra, Chap. V. See also Herter's " Common Infection of the Digestive 
 J Tract" 
 
710 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 the kitchen becomes a scientifically conducted laboratory we shal 
 have the basis of a sound " home economics." 
 
 Section 5. — Drug habits. 
 
 It would scarcely be nn exnjigeration to say that the first rule oi 
 hygiene is to avoid poisons. Poisons may be generated within us 
 or ingested from without. 
 
 Drug habits take numerous forms, and they are more prevalent 
 than most persons realize. The commonest form of intoxication k 
 alcoholic." It is ijiteresting to observe the change which has com«i 
 about in the attitude of scientists toward alcohol. From having en- 
 joyed a high place in materia medica, it is in danger of being com- 
 pletely discredited.* So far as its habitual use is concerned the onlj 
 question which remains in debate is whether in minute quantities it 
 may be innocuous or even beneficial. In any except minute quantitiei! 
 it has been shown to be injurious. 
 
 It lowers the resistance of the white corpuscles, which are the natural de^ 
 fenders of the body. Although the phagocytes belong to the most resistani 
 elements of our body, yet it is not safe to count on their insensibility toward 
 poisons. It is well known that persons who indulge too freely in alcohol sho\^ 
 far less resistance to infectious diseases than abstemious individuals.^ 
 
 Here is the gravest indictment that may be brought against the 
 abuse of alcohol. It is not, however, the only one. The relation o1 
 drinking to insanity,'* peripheral neuritis, Bright's disease, cirrhosis 
 of the Tiver, inflammation of tlie stomach, arteriosclerosis (a mosi 
 common cause of apoplexy ),« tuberculosis; f to crime in all its forms,' 
 and to all the possibilities incident to the hereditary transmission o: 
 a weakened organism'' has been pointed out. If personal hygiene 
 is a duty, it is the duty of every man to recognize the danger fron 
 alcohol to himself and to his progeny yet unborn. Instead of copying 
 the habits of otliers, he may consider the responsibility of causing 
 others to copy his. 
 
 A subcommittee of the Committee of Fifty for the investigatior 
 of the liquor problem published in 1899 a volume on the economic 
 
 " For a discussion of the physiological effects of alcohol, see Physiologica: 
 Aspects of the Liquor Problem, investigations made under the direction oj 
 W. O. Atwater, John S. Billings, II. P. Bowditch, R. H. Chittenden, and W. H 
 Welch, subcommittee of the Committee of Fifty; New York, Houghton & Mifflin 
 1903, 2 vols.; and The Liquor Problem, a Summary of Investigations Conducts' 
 by the Committee of Fifty, 1893-100:5, by John S. Billings, Charles W. Eliot 
 Henry W. Farnam, Jacob li. Greene, and Francis G. Peabody, 1905. 
 
 * The role of alcohol as a predisposing cause of disease has already been noted 
 It has long been known that drunkards have a very slim chance of recovery whai 
 attacked by pneumonia, and it is noted also that the mortality among moderatt 
 drinkers is higher than among total abstainers. This fact has long beer 
 known to life-insurance companies as holding good for many diseases othei 
 than pneumonia. Osier: Modern Medicine, Vol. II, p. 628. 
 
 c Metchnikoff : The New Hygiene, p. 25. 
 
 ^ See •• Twonty-sixth Annual Report of Massachusetts Bureau of Labor," 1905 
 
 * Ditman, loc. cit, p. 47. 
 f See John Iluber, M. D., " Predisposition to tuberculosis," The Medical NewB 
 
 December 20, 1903, p. 12. Also reports of Phlpps Institute, Philadelphia. 
 
 ' See Boies's various works, the " Reports of the Committee of Fifty," and Re 
 port of the Massachusetts Bureau of Labor Statistics, 1895. 
 
 ^ See Henry Smith Williams, M. D., "Alcohol and the Individual." McClure'l 
 Magazine, October, 1908, pp. 704-712. i 
 
^isHEH.] NATIONAL VITALITY. 711 
 
 ispects of the problem. The investigation covered a period of about 
 liree years and was carried on under the general direction of Prof. 
 [lenry W. Farnam, of Yale University. The general conclusions of 
 his investigation were that of the poverty which came under the 
 lotice of the charity organization societies about 25 per cent could 
 je traced directly or indirectly to the use of liquor; of the poverty 
 found in almshouses, about 37 per cent. In the investigation of 
 ^rime, the conclusion was reached that liquor was a first cause in 31 
 wv cent of the criminals studied, and that it entered in as a cause, 
 iirectly or indirectly, in 50 per cent. 
 
 The investigation made by the JNIassachusetts bureau of statistics of 
 abor in 1895 indicated the following percentages due to alcoholism: 
 
 Per cent. 
 
 Jrime 84. 41 
 
 ?aiu>erism 48 
 
 insanity 35 
 
 Several English life-insurance companies — the Sceptre, the United 
 Kingdom, and General Provident and others — have found by their 
 statistics, running over forty years, that abstainers have a death rate 
 ibout 23 per cent lower than nonabstainers." Since the figures of the 
 Mutual Life Insurance Company of New York ^ give the same advan- 
 tage to American abstainers (23 per cent lower death rate), it seems 
 fair to take the available computations of the English life insurance 
 ompanies as a basis for estimating the saving of life that would 
 result in the United States if individuals should decide to give up the 
 jse of alcohol. It should be remembered, however, that the favorable 
 3gure of total abstainers is partly due to the fact that as a class 
 hey practice personal hygiene in all its forms. 
 
 A basis for computing the sickness that might be saved by total 
 ibstinence is furnished by comparison between the sick rates of 
 abstaining and nonabstaining societies, made b}^ Mr. H. Dillon 
 Grouge, public actuary of South Australia, in 1892. He found that 
 :he average weeks of sickness in three societies of abstainers was 
 1.248; in three societies of nonabstainers the average weeks of sick- 
 less was 2.317 (lacking only one-sixth of being twice as much). 
 
 Absinthe in France has become almost as clearly a cause of national 
 degeneration as opium in China. Fortunately for our own country 
 :here exists here a more determined effort than in most, if not all 
 3ther nations, to be rid of alcoholism. The movement has been 
 (formidable enough to arouse anxiety among those whose capital is 
 iinvested in breweries, distilleries, and saloons. The movement 
 reaches its maximum momentum in the west and the south of the 
 United States. It is significant of the rapid change of sentiment in 
 regard to the liquor question that physiologists, physicians, educators, 
 and publicists are now becoming so thoroughly impressed with the 
 importance of suppressing the evils of alcohol. 
 
 The younger members of the Kaiser's family in Germany are 
 opposed to the German habits iji regard to the use of alcohol, and the 
 son of the Kaiser chose for his university one where there was less 
 
 " Letter from Miss C. F. Stoddard, secretary of the Scientific Temperance 
 Federation. 
 
 ^ " Effect of Total Abstinence on the Death Rate," by Joel G. Van Cise, actu- 
 iry of the Equitable Life Assurance Company of the United States. 
 
712 BEPORT OP NATIONAL, CONSERVATION COMMISSION. 
 
 drinkinor than at other universities. President Eliot, of Harvard 
 University, has recently taken a strong position against the use of 
 alcohol, even " in moderation." 
 
 Another common, though less injurious, source of self-poisoning 
 is tobacco, which is known to stunt the growth of the young, to lead 
 to sluggishness and weakened hearts (" tobacco hearts "), and to cause 
 dyspepsia and neurasthenia. 
 
 Snuff taking has almost disappeared as a habit in this country. 
 Chewing tobacco is still common, though no longer defended by 
 hygienists. " Inhaling " is more common, though also usually con- 
 demned on grounds of health. Smoking shows no signs, as yet, of 
 decreasing. In moderation it may not be injurious. There are no 
 definite proofs on either side. But smokers are seldom moderate. 
 
 Doctor Seaver, of the Yale Gymnasium, found that of the 187 men 
 in the class of 1891, Yale College, those not using tobacco during the 
 college course had gained over the users of tobacco in weight 32 per 
 cent, in height 29 per cent, in growth of chest 19 per cent, and in lung 
 capacity 60 per cent." 
 
 Similar returns for the Amherst graduating class of 1891 showed 
 a gain by the nonusers of tobacco of 24 per cent in weight, of 37 per 
 cent in height, and of 42 per cent in growth of chest. In lung capac- 
 ity the tobacco users had lost 2 cubic inches of air space, while the ' 
 nonusers had gained 6^ cubic inches. 
 
 The somewhat injurious effect of tea, coffee, and condiments, 
 though less than many other evils, should be included in any list 
 of the imperfections in respect to hygiene of existing habits of life. 
 
 Section 6. — Activity hygiene. 
 
 Only a generation ago there were scarcely any gymnasia in this 
 country, but to-day the importance of regular exercise and bathing is 
 recognized by everyone. This is far from saying, however, that this 
 important method of conserving our vital resources has more than 
 begun to be exploited. 
 
 First, the bath for the well-to-do, and, latterly, the public baths for 
 the poor, have given all an opportunity to obtain the cleansing and 
 healing agency of water. And in recent years the application of 
 baths has become a science.* 
 
 Baths may be used as social agents. Judge Ben. B. Lindsey, of 
 the Denver juvenile court, insists that every child must take a bath \ 
 before appearing in the court room. Neutral baths, i. e., baths regu 
 
 <* Doctor Anderson, of the Yale Gyranasinm, finds similar results. He also 
 points out a statistical pitfall into which some investigators have fallen. This 
 Is the common statistical fallacy of selection. There are two great groups of' 
 college students, roughly distinguished as athletes and scholarship men. (See 
 Doctor Sargent, " Physitjne of scholars, athletes, and the average student," i 
 Popular Science Monthly, September, 1908.) Smoking is more common in the 
 former group. They are not athletes because they smoke, but smoke because 
 they are athletes. The raw figures of smokers and nonsmokers usually show 
 that the smokers have better physical development, but if we compare the 
 smoking athletes with the nonsmoking athletes and the smoking scholarship 
 men with the nonsmoking scholarship men the results are quite different. For 
 similar statistical fallacies, due to failure to subgroup properly, see Mayo- 
 Smith, " Statistics and Sociology," Macmillan, 1895. 
 
 'See J. H. Kellogg, M. D., "Rational Hydrotherapy," Philadelphia, 1904. 
 
SHBB.] NATIONAL. VITALITY. 713 
 
 ited to the temperature of the body, have been found valuable in 
 blaxing the nerves of the body, and even in the treatment of mental 
 isease. 
 
 As to exercise, a healthy organism must call into play every func- 
 on daily, both mental and physical. One of the evils of the division 
 f labor which civilization has brought is that the sedentary worker 
 oes not have enough physical exercise, but too much mental exercise, 
 hile the situation is just the opposite in the case of the workingman. 
 A well-known physical director, now nearly 50 years old, writes me 
 lat he has this year taken up systematic physical training, which 
 e has neglected for several years because of pressure of work. As 
 result his weight has risen, his chest and arm girths have increased, 
 hile his waist girth has decreased, and he is conscious of decided 
 nprovement in memory and in sleep. This instance is cited as an 
 sample of the physical development possible in a man of middle 
 ye. 
 
 In its bearing on exercise, the growth of modern athletics and its 
 Tects on the physical ideals of men and women is to be welcomed, 
 he revival of the Ol3^mpian games and the spread of popular par- 
 cipation in such outdoor sports as golf, tennis, boating, and horse- 
 ick riding have all had their share in building up a new health 
 eal. Thus we are getting away from the mediaeval idea of morti- 
 jation of the flesh and approaching more closely the Greek concep- 
 on of a beautiful body as the covering for a beautiful soul. The 
 reeks lifted their sports to a higher level than ours by surrounding 
 lem Avith imagination and making them a training in aesthetics as 
 ell as in physical excellence.'* The American idea is at present too 
 losely connected with mere winning, and not enough with develop- 
 ent. In the past the physical athlete has been too much associated 
 [ith the pugilist, and has been looked down upon as having merely 
 nite strength. The intellectual type, on the other hand, has been 
 ntent wholly to neglect bodily development. 
 
 T In the last three years considerable evidence has accumulated to 
 
 low that the sitting posture of the sedentary man tends sooner or 
 
 ter to produce nervous prostration, and that the ordinary chair 
 
 vites to this effect by producing a bent attitude, both in the forward 
 
 jrection and in the shoulders. The effect of the former is to tax 
 
 e splanchnic nerves and congest the portal circulation. The 
 
 'lanchnic area, which is enormous, is a sort of overflow tank for the 
 
 ood. If the muscles of this area are allowed to relax through im- 
 
 •oper position in standing or sitting, the result is the stagnation 
 
 the blood in the abdomen, and this in turn results in a vicious 
 
 Ircle of evil effects. Since much of our life is spent in chairs, this 
 
 ct is of no small importance. Improperly made school chairs and 
 
 ihygienic habits of sitting in them may start off millions of young 
 
 'ves with round shoulders, curved spines, and the later effects of 
 
 )rtal congestion. 
 
 Exercise of mind does not simply mean exercise of intellect. The 
 
 lotions and the will are equaLy a part of a well-developed healthy 
 
 Jan. Late in life Darwin had occasion to lament the fact that his 
 
 fictional capacity had become cramped because he had exercised 
 
 "See G. L. Dickinson: " Ttie Greek View of Life," New York (McClure, 
 lillips), 1906, pp. 131-134. 
 
714 REPORT OF NATIONAL. CONSERVATION COMMISSION. 
 
 his mind in his own branch of work to the exclusion of other things. 
 Whatever our ideas of theology or religion are, it is true that we all 
 ought to have a spiritual sense. Some men lack this spiritual sense 
 and are incapable of understanding the spiritual experience of others: 
 " For toil without purposeful and occupied leisure is unfilled pur- 
 pose, a process arrested midway." » Worry and fear are unhealthy, 
 llope, courage, enjoyment, and an optimistic attitude generally are 
 healthy.^ 
 
 The ordinary workingman works two or three hours too much 
 every day. Nearly every man overworks himself, takes insufficient 
 rest and recreation, and worst of all, cuts off his normal portion ol 
 sleep. Fatigue ought to be " avoided like poison," because, physio- 
 logically, it is really poison. Worry, fear, and anger also produce 
 poisons harmful to the human body. This is suggested at least by 
 the effect upon a nursing infant of violent paroxysms of anger, or 
 periods of intense fear or anxiety on the part of its mother. The 
 intense exhaustion which follows such paroxysms is another case in 
 point. 
 
 An animal lives a much more healthy life than the average man, 
 because an animal follows instinct, while a man to a large extent 
 endeavors to substitute for his instincts rules which are very often 
 false. One of the instincts constantly disregarded by man is that 
 which finds its expression in fatigue. The ordinary man working 
 for some one else is compelled to toil beyond the fatigue limit; and. 
 on the other hand, if a man is in business for himself, he does the 
 same thing of his own will. Although no one knows what sleep is. 
 it serves, according to the best theory, to eliminate poisons and to 
 rebuild tissue. With rest is closely associated recreation. Play 
 practices the power of a child's mind, while contest among children 
 develops self-control." Similarly, adults are rested b}' phiy or recrea^ 
 tion, their minds and bodies are relaxed, while their contests of mimic 
 warfare develop their powers of will and effort. 
 
 Section 7. — Sex hygiene. 
 
 One element in personal hygiene concerns the sex relation. Thi^ 
 can not be treated under other heads, for the sex relation is so purely 
 a personal and individual one. From its normal utilization there u 
 little to fear, but from the effects of illegitimate sexual practices thfj 
 world suffers enormous yearly losses. It is hardly possible to havtj 
 promiscuous sex relations out of wedlock without contracting one oi; 
 the other of the serious venereal diseasCvS. The best authorities report 
 that " every prostitute is diseased some of the time and some prosti- 
 tutes are diseased all of the time." 
 
 One disease, syphilis, infects the blood and therewith all parts oJj 
 the body. For months after infection with this disease the indi- 
 
 <» Simon N. Patten : " The New Basis of Civilization," New Yorlj (Macniillan)| 
 1907, p. 15S. I 
 
 '' Du Bois: "Ttie Psycliic Treatment of Nervous Disorders," New Yorli, 1905! 
 465 pp. Saleeby: "Worry, the Disease of the Age," New York (Stolves), 1907 
 Sidis: "The Psychology of Suggestion," New York (Appleton), 1899, 386 pp 
 Schofleld : " The Force of Mind, or the Mental Factor in Medicine," LondoE 
 (Churchill), 1902, 309 pp. 
 
 " See President G. Stanley Hall : " Play and Dancing for Adolescents," Inde 
 pendent, reprinted in " Mind and Body," Vol. XIV. 1907, pp. 43-48. 
 
nsHER.l NATIONAL VITALITY. 715 
 
 ividiial may communicate it by a kiss as well as by cohabitation; and 
 larticles moistened by his secretions — towels, drinking glasses, pipo5, 
 i?,tc. — may also convey the infection. "While under proper treatment 
 the disease is not always dangerous to life in the earlier years, yet 
 ■:he possibilities of transmitting the contagion should forbid marriage 
 for at least three years. 
 
 \ The most serious results of syphilis, some authorities say, may 
 appear years after its acquisition, when the individual has been 
 lulled into a false sense of security by long freedom from its mani- 
 festations and considers himself cured. Many cases are practically 
 ncurable. Some are fatal in spite of treatment. It may attack any 
 )rgan of the bod}'. Among the many diseases to which it may lead 
 lire apoplex}'', paralysis, insanity, and locomotor ataxia ; and these 
 )ften appear after the man has acquired a family that is dependent 
 ipon him for support. 
 
 The leading insurance companies refuse to insure the life of a 
 syphilitic person for four or five years after the disease was con- 
 racted, and then only upon special terms, for their records prove 
 that syphilis shortens life. 
 
 That the syphilitic parent may transmit the disease to his offspring 
 s common knowledge. Some of his children are destroyed by the 
 inherited disease before birth; others are born to a brief and sickly 
 ;pan of life; others attain maturity, seriously handicapped in the 
 race of life by a burden of ill health, incapacity, and misery produced 
 3y the inherited taint, while still others escape these evil effects.'* 
 
 Forcl, in Die Sexuelle Frage, shows that even Weissmann does not 
 ieny the possibility of poisoning the germ cell and so transmitting 
 iome "' acquired characteristics," as in alcoholism and venereal poison- 
 ng. One of the saddest facts in both cases is that the parent may 
 sscape and the children reap the results in insanity, tendency to con- 
 sumption, and prostitution. 
 
 Another disease — 
 
 Gonorrhea, while usually cured without apparent loss of health, has always 
 ;erious possibilities; it kills about 1 in 200; it impairs the sexual power and 
 ertility of a much larger number ; it often produces urethral strictures, which 
 ater may cause loss of life." 
 
 The persistence of gonorrhea in the deeper parts long after it is outwardly 
 .:ured leads to the unsuspected communication of the disease to women with 
 vhom the individual may cohabit. Much of the surgery performed upon women 
 ^las been rendered necessary by gonorrhea contracted from the husband. Should 
 ihe while infected with this disease give birth to a child, the baby's eyes may 
 ')e attacked by the infection, sometimes with immediate loss of sight Probably 
 !5 per cent ^ of the blindness of children is thus caused. 
 
 Dr. Prince A. Morrow says : 
 
 This social danger comes from frequent Introductions of these diseases into 
 narriage. The frequency of marital contamination does not admit of exact 
 nathematical expression, as both social sentiment and professional ethics unite 
 cover up and conceal it. Possibly 10 per cent of men who marry infect their 
 vives with venereal disease. 
 
 o Circular No. 2, " Self-protection," Chicago Society of Social Hygiene, pp. 7-8. 
 
 *"The average of a great many statistics shows that one-fourth of all blind 
 ioersons owe their attliction to the effects of ophthalmia of the new born." Chas. 
 ■3. May, M. D., ophthalmic and aural surgeon, New York, Transactions of Amer- 
 ican Societies of Sanitary and Moral Prophylaxis, Vol. II, 1908. 
 
 S. Doc. 419, 61-2 7 
 
716 REPORT OF NATIONAL CONSERVATION COMiMlSSlON. 
 
 The report of the Committee of Seven (New York) shows that in 
 private practice nearly 30 per cent of venereally infected women were 
 contaminated by their husbands. The report of the Committee on 
 Sanitary and Moral Prophylaxis (Baltimore) shows that nearly 40 
 per cent of the infections in women seen in i)rivate practice were com- 
 municated in married life. " My own observations at the New York 
 Hospital, extending over a period of several years, would indicate 
 that fully 70 per cent of all women who came there for treatment of; 
 syphilis were respectable married women who had been infected by 
 their husbands," " ^ . . . . ' 
 
 Observation shows that gonorrhea is markedly intensified in viru- 
 lence and danger to the woman in fulfilling the functions for wliich 
 marriage was instituted. Pregnancy and childbearing open the way 
 for germs. One of the most constant effects of gonorrhea in women 
 is permanent and irremediable sterility. Fifty per cent of gonor- 
 rheally infected women become absolutely sterile, and a still larger 
 percentage sterile after the first child is born (one-child sterility). 
 Noeggerath found in 81 gonorrheal women 49 entirely sterile. In 80' 
 sterile marriages Kehrer found 45 caused by inflammatory changes of 
 gonorrheal origin. It is estimated that the husband is directly re- 
 sponsible for 20 to 25 per cent of sterility from his inability to pro- 
 create as the result of gonorrhea. In addition the husband, though 
 not sterile himself, may infect his wife, rendering her sterile. The 
 disease is ultimately responsible for about 70 to 75 per cent of all 
 sterility in married life, which is not of choice, but of incapacity. 
 Lier-Ascher's careful statistics place this proportion at 71.2 per cent. 
 These figures relate to absolute sterility. The chief social danger of 
 gonorrhea as a dejoopulating factor is the creation of secondary steril- 
 ity, or what has been expressively termed "one-child sterility." The 
 large percentage of marriages in which one child represents the total 
 fecundity of the family justifies the conclusion that this sterility is 
 in many cases not of choice, but of procreative capacity extinguished 
 b}' gonorrhea. 
 
 ' In addition, the inflammation set up in the maternal organs may 
 render the mother a permanent invalid or compel her to submit to a 
 mutilating operation to save her life. 
 
 Gynecologists furnish statistical evidence showing that 80 per cent 
 of tiie deaths due to inflammatory diseases peculiar to women ^ and 
 about 70 per cent '^ of all the work done by specialists for diseases of 
 women is caused by gonorrhea. 
 
 In addition to the effect of a low protein diet on endurance, already 
 discussed, and on general health, its relation to the sexual life should 
 be mentioned. Experiments on this subject seem to show that exces- 
 sive meat eating and excessive protein intake tend to irritate the 
 sexual organs and to produce abnormal sexual desire just as they do 
 
 "Morrow, Social Diseases and Jlarriage, Pliiladelpliia (Lea), 1904. 
 
 ^ III report of special coniuiittce of the Aniericau Medical Association, 1901, 
 Plunniston says: "Ninety per cent of iuflaniniatory troubles of uuilornal organs 
 are attributable to gonorrhea." Price says: "That in over 1,000 operations for 
 pelvic trouble 95 per cent were attributable to this infection." Another author- 
 ity gives a percentage of 7."). 
 
 <' Address of Doctor Cleveland, president of American Gynecological Society, 
 at National Congress of Anieiican Physicians and Surgeons, Washington, 1907.1 
 
fi ni:r..] NATIONAl. VITALITY. 717 
 
 a desire for alcoholic stimulation. This fact is of importance in pre- 
 venting secret vice among the yoimg. 
 
 Thanks to the efforts of a few farsightod men like Dr. Prince A. 
 ]\rorrow, Prof. C. R. Henderson, and Mr. Edward Bok, these subjects 
 are being given some of the publicity they deserve. Reticence on 
 these subjects is justified only so far as it makes for youthful inno- 
 CH'nce. But ignorance is not innocence; on the contrary it is the 
 surest road to guilt. 
 
 Section 8. — Personal hygiene in general. 
 
 ' Personal hygiene is only beginning to be generally exploited. Most 
 persons leave their health to be attended to by physicians and health 
 officers, just as many people leave their religion in the hands of a 
 priest or clergyman. So far as practiced at all, personal hygiene has 
 been confined chiefiy to invalids and athletes. Even by them it is 
 usually practiced to tide over an illness or to prepare for a contest. 
 But it is manifest destiny that a wise economy of vitality will sooner 
 or later be practiced. Waste of vital resources is as irrational as 
 waste of natural resources. Neither is inexhaustible and both must be 
 conserved. Thoughtlessness and ignorance are the reasons for the ap- 
 palling waste of both now going on. Even people who do not defi- 
 antly abuse their strength by definite excesses are liable to waste i»t 
 gradually. Slightly unhygienic habits grow, and their effects are 
 doubtless cumulative. It is well known that even a so-called " venti- 
 lated house," if lived in long enough without sufficient outdoor life, 
 may induce tuberculosis. This must be through the repetition of an 
 infinitesimal injury produced through each respiration eighteen times 
 a minute for twenty-four hours a day for half a lifetime. 
 
 So with the use of food preservatives. Food manufacturers have 
 laid much emphasis on the fact that preservatives are " harmless " 
 because used in small quantities, but Doctor Wiley has raised the 
 question whether even very small quantities of these preservatives, 
 if used continuously for a sufficient length of time, are not injurious. 
 !The same applies to the repetition of preservatives in a large number 
 i of different foods. If only one particular food contained a preserva- 
 tive, the effect would be relatively negligible; but as one food after 
 'another has become adulterated, the human stomach is made the daily 
 receptacle of many times the " harmless " amount in any one par- 
 ticular food. The obstacles to hygiene which have accumulated with 
 I civilization are almost as numerous and as small as the barnacles 
 which impede a ship. To remove them is in large part to " return to 
 nature." Many of the inventions of which civilization boasts have 
 had an unhygienic side. The invention of houses has made it pos- 
 sible for mankind to spread all over the globe, but it is responsible 
 for tuberculosis, especially after glass was devised, which while let- 
 ting in the light keeps out the air. The invention of cooking and 
 preparing foods has widened the variety of man's diet, but has led to 
 the decay of his teeth." The invention of the alphabet and printing 
 
 ° See Ottofy, " The Teeth of the Igorots," Dental Cosmos, July, 11)08, where 
 it is shown, statistically si>eaking, that the teeth of Americans are " ten limes as 
 bad as those of the Igorots," while the civilized Filipinos have teeth as bad as 
 those of Americana. 
 
718 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 has made possible the accumulation of knowledge, but it has produced 
 eye strain with all its attendant evils. The invention of chairs has 
 added to human convenience, but has led to sj^inal curvature and 
 abdominal congestion. The device of a division of labor has added 
 to wealth, but has destroyed the normal balance of mental and phys- 
 ical work, recreation, and rest. Similar fault may be found with 
 clothing, especially corsets, shoes, and hats, and with numerous other 
 contrivances. Yet it would be foolish, even if it were possible, to 
 attempt to " return to nature " in the sense of abolishing civilization. 
 We must not go backward, but forward. The cure for eye strain is 
 not in disregarding the invention of reading, but in introducing the 
 invention of glasses. The cure for tuberculosis is not in the destruc- 
 tion of houses, but in devices for ventilation. It is a little knowledge 
 that is dangerous. Civilization can, with fuller knowledge, bring its 
 own cure and make the " kingdom of man " far larger, even in respect 
 to hj'gienic conditions, than " nature " people can ever dream of. 
 
 Unhygienic customs and fashions are exceedingly slow to yield, 
 but they do yield in the end. It should be the part of intelligent men 
 to lead in hygienic reform, not by intolerant and impatient abuse of 
 their fellow-men, but by the quiet force of example. The intolerant 
 and impatient reformer does incalculable harm, for he takes no ac- 
 count of that subtle perversity of human nature which resents his 
 interference. Equally harmful is the man who seeks only to imitate 
 the crowd, who condones the vices of his time and country. 
 
 But we must always bear in mind what has been called the " psy- 
 chology of the crowd." Tarde, Le Bon, Baldwin, Ross, and others 
 have shown that society is largely ruled by customs which grow out 
 of imitation. In order that any social custom shall be changed, 
 initiative is necessary. The upper classes should take the lead, for any 
 reform will spread many times more quickly when the initiative comes 
 from above than when it comes from below. Western civilization has 
 made its marvelously rapid progress in Japan for the simple reason 
 that the Mikado approved, and marvelously slow progress in China 
 for the simple reason that the Empress disapproved. 
 
 We find the same principle at work in the progress of medicine. 
 Hydrotherapy originated with a peasant and required three centuries 
 to come into vogue. The use of sour milk, on the other hand, has been 
 advocated only during the last two or three years, but the initiative 
 came from Metchnikoff, one of the foremost of medical scientists. 
 The consequence is that the so-called "sour-milk craze" has already 
 led to great industries and affected the business of groceries, soda- 
 water fountains, and even liquor saloons. 
 
 The change constituting hygienic reform will be brought about most 
 rapidly by the influences on the young. If children in their homes 
 and schools are given proper models for imitation, the public opinion 
 which they will form may make a revolution in a single generation. 
 Anyone who realizes the almost resistless force of the principle of 
 imitation, especially when applied to children, will receive a new sense 
 of the responsibility he takes in setting an example to the young. 
 There are three classes in particular on whom the responsibility is 
 heavy — teachers, physicians, and parents. If they wish the child to 
 be free from the cigarette habit, they must sacrifice the cigar and pipe 
 habit, even though it be true that cigars and pipes are not injurious to 
 adults. They may believe this, but the children will not The same 
 
nsHKR.] NATIONAL VITALITY. 719 
 
 principle applies to other and more serious infractions of the laws of 
 health. It is probably through the love of the next generation, rather 
 than through an}^ selfish care for the present, that men and women 
 now living will take the most pains to secure the best results in 
 bringing about the change in living conditions for which every 
 hj'gienist hopes. 
 
 Chapter X. — Are hygienic measures eugenic f 
 
 Section 1. — Prolongation of weak lives. 
 
 We have discussed two factors which cooperate to produce vitality, 
 namely, heredity and hygiene; and two corresponding methods of im- 
 proving vitality, namely, by utilizing a possible science of eugenics 
 on the one hand and by utilizing the existing science of hygiene on 
 the other. The question now arises, Are these two methods in conflict 
 with each other? It is charged that hygiene prolongs the lives of unfit 
 and defective classes. We have already seen that in Indiana, institu- 
 tional care of the insane has prolonged the average insane lifetime by 
 some eight years. Referring to the insane, Dr. Charles Dana says: 
 
 For tweuty-five years the explanation of tliis increase in statistics of insanity 
 Las been that more cases were observed and more victims kept in institutions 
 than formerly ; and this is still the explanation. It is my opinion, however, 
 that the incrense is a real one, and it is one to be expected not only from the 
 streniiousness of modern life and increase of city population, but also, because 
 more feeble children are nursed to maturity and mox-e invalid adolescents are 
 kept alive to propagate weakly constitutions or to fall victims themselves to 
 alienation, the period of life susceptible to insanity is longer. 
 
 A fourth of the cases of insanity is due to so-called " moral causes : " Emo- 
 tional strain, shocks, and vicious indulgences. But moral causes are not sufficient 
 to cause insanity if the individual has a strong constitution. Insanity is increased 
 in part, then, because we are saving too many lives by the careful regulations 
 of our health boards. Hence, those who are working so enthusiastically and 
 nobly and successfully in preventing disease achieve results which carry serious 
 responsibilities for the State." 
 
 It is true that we prolong the lives of the insane and defective 
 classes, and that they thus make a greater burden on society. We 
 should see to it that certain of these classes are not permitted to prop- 
 agate their kind. This point has been explained in Chapter VI. 
 
 It is further claimed that infant mortality is but the operation of 
 ]natiiral selection and should not be interfered with if we are to keep 
 up the vital power of the race. Preventive medicine has certainly 
 prolonged the lives of infants or, at any rate, of children in general.'' 
 But has this weakened the race? It is pointed out that the mortality 
 later in life has not decreased, and that in some cases it has even 
 tended to increase. But this fact can be explained in either of two 
 ways. One is on the hypothesis of the extension of the lives of weak 
 
 a " Psychiatry in its relation to the other sciences," by Charles L. Dana, M. D.. 
 before the section on psychiatry at the International Congress of Arts and 
 Science, at St. Louis, September, 1904. See also Janus in Modern Life, by W. M. 
 Flinders Petri, New York (Putnam), 1907. 
 
 * See Edwin Graham, "Infant mortality," Journal American Medical Asso- 
 , elation, September 26, 1908; also Edward B. Phelps, " Statistical study of infant 
 jmortality," Quarterly Publications American Statistical Association, September, 
 1908. Mr. Phelps shows that infant mortality has declined less than is com- 
 monly believed, and that its apparent decline is often due to inaccurate and 
 misleading statistics. 
 
720 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 I 
 
 infants. Tho other is on the hypothesis of the comparative neglect 
 of hygiene among adults. It is surprising that this latter alternative 
 has not been given due consideration. 
 
 Every detail of infant life has latterly been made the subject of 
 special study, and every mother of common intelligence has tried to 
 learn and to apply the results of that study. The times of the baby's 
 meals, the quantit}'^ of its feeding, the modification and sterilization of 
 cow's milk, the hours of sleep, the ventilation of sleeping rooms, and 
 other innumerable details are now attended to with scrupulous care. 
 The change in these respects, even within the memory of most persons 
 now living, is striking. The children have reaped the reward. Pnit 
 n.o corresponding change has taken place in the habits of the adult 
 population. Many families buy one grade of milk for the babies, 
 and another cheaper grade for the rest of the family. This they re- 
 gard as "economy." Parents require their children to keep regular 
 and suitable hours for sleep, but " owl it " themselves. They will 
 keep their children out of doors, and send them into the country, but h 
 subject themselves to the dust, smoke, and close air of the workroom 
 and places of busine^ss. They will not allow their children to use 
 alcohol or tobacco, or even tea or coffee, much less opium, chloral, or 
 other habit- forming drugs, but they take these themselves as a matter 
 of course. They are now insisting on playgrounds for children, but 
 their own amusements are sought in the unhygienic theater, or maybe 
 in the saloon or immoral resort. The child is protected on all sides, 
 with the result that he sometimes lives almost an ideal animal life, 
 with its due proportion of amusement, exercise, rest, and sleep. The 
 parents themselves are tied down to drudgery, overwork, worry, and 
 long hours. The difference, when we reflect upon it, is startling. AVe 
 make hygiene paramount for our children; for ourselves we neglect 
 it totally, partly from the idea of sacrificing ourselves for the sake of 
 our children, partly from necessity, real or imagined, and partly 
 from the thraldom of habit already formed. With such a contrast 
 between the recent improvement of hygiene in childhood and the lack 
 of improvement in middle life, one need not wonder that the mor- 
 tality of one period has improved and that of the other has not. We 
 do not need to invoke the aid of the theory that weak lives have been 
 more prolonged than strong lives. The moral is that hygiene should 
 not stop in childhood. It is natural and proper, however, that the 
 first attempt to apply hygienic Imowledge should begin with children. 
 It is through children that new- ideas usually make their way into 
 custom. " You can't teach an old dog new tricks." Grown persons 
 have habits already formed, and when once a habit is formed it is 
 difficult to change it. 
 
 Habits of living among adults have even grown worse in some 
 respects. Observing practitioners comment on the increasing nervous 
 tension in modern life. The rush of the railway train, the telephone, 
 the elevator are at once an outgrowth and an excitant of this in- 
 creased tension. They are life's pace makers, and the pace is ever 
 quickened. The health officer of New York City attributes to this 
 severer strain the increase of heart and nervous diseases. It would 
 be interesting to know the relative prevalence of adult diseases under 
 conditions of reposeful and exciting surroundings and occupations, 
 but I know of no investigation on this phase of the subject. " 
 
riSHEE.] NATIONAL VITALITY. 721 
 
 While this report was being written the recent figures from Great 
 Britain came to hand. They show that the tendency of the death 
 rates among the later ages to increase seems to have given place to a 
 slightly opposite tendency. The expectation of life at ages 40, 60, 
 and 80 during the decade of 1891-1900 has a little more than held 
 its own as compared with the previous decade. 
 
 Section 2. — Children's diseases urppair loth fit and unfit. 
 
 Another point needs emphasis. AVhen it is said that the lives of 
 weak infants are prolonged it is commonly overlooked that the same 
 pauses also prolong the lives of the strong, and, reversely, that un- 
 hygienic conditions which tend to exterminate the weak tend also 
 CO shorten the lives of the strong. Bad hygiene is merely a common 
 jandicap for all classes. The burden of proof is upon those who 
 jlaim that it has a differential effect and increases the process of 
 sveeding out the unfit. This weeding-out process goes on whether 
 bhere is a great or a small obstruction to overcome. Bad air and 
 jhildren's epidemics are the common environment of all. While 
 :his must produce a greater mortality, it remains to be shown that it 
 KTOuld be more selective. 
 
 That a high infant mortality does not tend to lengthen life, but 
 rather to stunt all life, would seem to be indicated by the evidence, 
 50 far as it can be interpreted. Russia, for instance, has a high 
 nfant mortality. If the statistics are to be trusted, it is 70 per cent 
 ^eater than in the United States; yet Moscow and St. Petersburg 
 lave a general mortality rate which greatly exceeds that of similar 
 ;ities in this country. 
 
 It may be that the more unfavorable the struggle for existence 
 he more rapidly will natural selection re^sult in improved vitality. 
 3ut even if this were true, it would not imply that in a more favor- 
 il)le environment selection would cease. And it may not be true. It 
 nay be that adversity, if too severe, will crush and injure the sur- 
 vivor as well as eliminate the unfit. We do not look for the best 
 rees on the bleak mountain top, but in the genial valley. As we go 
 ip the struggle for existence increases, until even the sturdiest fail 
 o thrive above the " timber line." 
 
 The ftirnier who tries to improve his stocli does not select hardships. Cold 
 ind starvation are now negligible quantities in the great ranches, and the breeds 
 hat were notable for ability to withstand them give way to varieties that may 
 e adapted to neither emergency." 
 
 Venereal diseases, hook-worm disease, malaria, and many other 
 aaladies shorten and weaken life, whether of weak or strong. Re- 
 erring to the racial degeneration probably caused by malaria on the 
 turdy Greek, Maj. Ronald Ross said, in an address before the Oxford 
 1 viedical Society, November 29, 1906 : * 
 
 Now what must be the effect of this ubiquitous and everlasting incubus of 
 i.isease on the people of modern Greece? Remember that the malady is essen- 
 ially one of infancy among the native population. Infecting the child one or 
 wo years after birth, it persecutes him until puberty with a long succession of 
 ebrile attacks. * * * iningine the effect it would produce upon our own 
 
 Simon N. Patten, The New Basis of Civilization, New York (Macmillan), 
 907. 
 
 ^ This quotation is from Dr. L. O. Howard's report to the Conservation Com- 
 lission on " Economic loss to the people of the United States through insects 
 tat carry disease." 
 
722 EEPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 cbildrcn horo in Britain. • ♦ * What would be the effect upon our popula- 
 tion, especially our rural population—upon their nuinhers and upon the health 
 and viper of the survivor? It must be enormous in Greece. People often seem 
 to think that such a plague strengthens a race by killing off the weaker individ- 
 uals; but this view rests upon the luiprovcn assumjition that it is really the 
 weaker children which can not survive. On the contrary, experience seems tc 
 show that it is the stronger blood which suffers most — the fair, northern blood] 
 which nature attempts constantly to pour into the southern lands." If this bi 
 true, the effect of malaria will be constantly to resist the invigorating inllux 
 which nature has provided; and there are many facts in the history of India. 
 Italy, and Africa which could bo brought forward in support of this hypothesis. 
 * ♦ ♦ In prehistoric times Greece was certainly peopled by successive waves 
 of Aryan invaders from the north. * * * That race reached its climax ot 
 development at the time of Pericles. * • • Suddenly, however, a blight fell 
 over all. Was it due to Internecine conflict or to foreign conquest? Scarcely, 
 for history shows that war burns and ravages, but does not annihilate. Thebes 
 was thrice destroyed, but thrice rebuilt. Or was it due to some cause, entering 
 furtively and gradually sapping away the energies of the race by attacking the 
 rural population, by slaying the newborn infant, by seizing the rising genera- 
 tion, and especially by killing out the fair-haired descendant of the original 
 settlers, leaving behind chiefly the more immunized and darker children of their 
 captives, won by the sword from Asia and Africa? * * * j can not imagine 
 Lake Kopais, in its present highly malarious condition, to have been thickly 
 peopled by a vigorous race; nor, on looking at those wonderful figured tomb- 
 stones at Athens, can I imagine that the healthy and powerful people repre- 
 sented upon them could have ever passed through the anaemic and " splenomega- 
 lous " infancy (to coin a word) caused by widespread malaria. Well, I venture 
 only to suggest the hypothesis, and must leave it to scholars for confirmation 
 or rejection. Of one thing I am confident — that causes such as malaria, dysen- 
 tery, and intestinal entozoa must have modified history to a much greater extent 
 than we conceive. 
 
 Evolution in human society is a wonderfully complex thing. Sur- 
 vival of the races has long been dependent on a long period of pro- 
 tection of children by parents, and may in future even depend on 
 protection of other kinds.'' 
 
 Section 3. — Fitness is relative to environment. 
 
 Wliether or not degeneration is actually going on is a question for 
 which the data are insufficient for us to form an intelligent generaliza- 
 tion. That there are very strong forces working in that direction can 
 not be questioned, but there are also very strong forces working in 
 the opposite direction. In discussing degeneration, one point must 
 be borne in mind which has often been forgotten by writers on the 
 subject. Man's fitness to live is relative to the environment in which 
 he is to live. If muscular strength decreases, it is not a sign of de- 
 generation, provided muscular strength is no longer needed. One 
 does not speak of hothouse grapes as degenerates. They doubtless 
 lack the hardy characteristics of wild grapes, but these characteristics 
 are not needed in a hothouse. 
 
 If it should prove true that in some directions humanitarian im- 
 pulses betray us into favoring the survival of the unfit and their 
 perpetuation in the next generation, such shortsighted kindness must 
 be checked. But all the dangers of perpetuating vital weaknesses can 
 be avoided if proper health ideals are maintained. For when such 
 
 "Physicians maintain thnt some diseases, especially typhoid fever and pneu- 
 monia, are more apt to attack the strong than the weak. 
 
 * See Prince Kuropatkin, " Mutual Aid a factor in Evolution," New York 
 (McClure-Phillips), 1902. 
 
FISHBE.] NATIONAL VITALITY. 723 
 
 health ideals become a national possession fewer weak infants will 
 be born into the world. This will come about in three ways: First, 
 marriage and " sterilization " laws will reduce the number of mar- 
 riages of degenerates. Secondly, parents will be more careful of 
 transmitting disease or weakness to their offspring. There is strong 
 reason to believe that inheritance depends largely upon the physical 
 condition of both parents at the time of conception. If at such a time 
 either parent, or both parents, are in a state of intoxication or suf- 
 iferers from venereal disease, this lack of hygiene on their part will 
 ^affect the heredity of the offspring. Immorality, which practically 
 [means lack of sex hygiene, never strengthened a race; on the contrary 
 jit has been the most potent cause of race extinction (of the Hawaiians, 
 Indians, negroes, and others)." Thirdly, the influence of higher 
 ■ideals of health and vitality will tend both to restore the attraction 
 iof a strong and beautiful physique to its rightful place among the 
 various attractions which lead to marriage, and to lessen the allure- 
 ments of such extraneous attractions as wealth. 
 
 <» See F. L. Hoffman, " Race Traits and Tendencies of the American Negro," 
 Publication of American Economic Association, Ch. VII. August, 1896. 
 
Part IV.— RESULTS OF CONSERVING LIFE. 
 
 Chapter XI. — Prolongation of life. 
 
 Section 1. — Life is lengthening. 
 
 We have already seen evidence of the possibility of prolonging 
 life : In Europe the life span is double what it is in India. The death 
 rate of Dublin is over twice that of Amsterdam, and three times that 
 of rural Michigan. Again, making every allowance for inaccuracies of 
 old records, we have strong reason to believe that life is twice as long 
 as three or four centuries ago, and modern accurate records show that 
 it is to-day increasing more rapidly than ever. The rate at which 
 this lengthening proceeds per century is shown in the following 
 table, based on Chapter I. 
 
 Rate of lengthening life (in years, per century). 
 
 I 
 
 
 Jti 
 
 Country. 
 
 Periods. 
 
 Males. 
 
 Females. I 
 
 England 
 
 Do 
 
 France 
 
 Prussia 
 
 Denmark 
 
 Sweden 
 
 United States: 
 Massachusetts 
 
 Do 
 
 India 
 
 1838-1864 to 1871-1881, or 30 years 
 1871-1881 to 1891-1900, or 20 vears 
 1817-1831 to 1898-1903, or 76 years 
 1.S67-1877 to 1891-1 900, or 23 years 
 1835-1844 to 1895-1900, or 57 vears 
 1816-1840 to 1891-1900, or 67 years 
 
 1789 to 1855, or 66 years 
 
 1855 to 1893-1897, or 40 years 
 
 1881 to 1901, or 20 years 
 
 5 
 
 14 
 10 
 25 
 13 
 17 
 
 III 
 
 7 
 
 14 
 
 
 S 
 
 16 
 
 11 
 
 291 
 
 15 
 
 15 
 
 From this table we observe : ' 
 
 First. That the rate of progress is extremely variable in different 
 countries. It is perhaps no accident that the maximum rate obtains 
 in Prussia, which is probably the most progressive country in the 
 discovery and application of scientiiSc. medicine. If progress con- 
 tinues for a century at merely the present rate, human life in Prus- 
 sia will be twenty-five to twenty-nine years longer than at present. 
 The average rate of improvement for all the countries, excepting) 
 India, is about fifteen years per century. 
 
 Second. It is noticeable that in practically all cases the improve- 
 ment is more among females than males. This is one expression of 
 the progress which womankind is now making in all lands. 
 
 Third. This table, as well as the estimate of Professor Finkelnburg 
 already quoted, shows that not only is the average duration of human 
 life increasing, but that the rate of increase is also increasing. The 
 estimate of Finkelnburg that the lengthening of life during the inter- 
 val between the sixteenth century and the end of the eighteenth cen- 
 tury was from eighteen or twenty years to a little over thirty years 
 shows a rate of increase of about four years per century. During 
 724 
 
:iSHEE.] NATIONAL, VITALITY. 725 
 
 ;he following century he estimated that the life span increased from 
 I little over thirt}^ to thirty-eight or forty years, or about nine 
 y^ears per century. In the tabic we see that in England the length of 
 ife was increasing in the middle of the nineteenth century at a rate 
 )f from five to nine years per century, while during the last quarter 
 t was increasing at from fourteen to sixteen years per century. In 
 \lassachusetts the imperfect data indicate that life lengthened in the 
 irst half of the eighteenth century at the rate of about seven years a 
 ;entury. The indication for the last part of the nineteenth century 
 s that it increased at the rate of fourteen years per century. 
 , We may briefly summarize chronologically the general rate of 
 Increase as follows: 
 
 Lengthening of human life per century. 
 
 Years. 
 
 )uring seventeenth and eighteenth centuries 4 
 
 )uring first three quarters of the nineteenth century 9 
 
 'resent rate in Massachusetts 14 
 
 'resent rate in Europe IT 
 
 i'resent rate in Prussia 27 
 
 Section 2. — Table shoicing further pructicable prolongation. 
 
 It would be surprising if the future should not witness a further 
 engthening of human life, and at an increasing rate. Of course 
 here is a limit to the further increase of human life, but there is 
 jood reason to believe that the limit is still far off. 
 
 The following table ° shows that at least fourteen years could be 
 ,dded to human life by the partial elimination of preventable diseases 
 ,ccording to the stated ratios of preventability. This is equivalent 
 o a reduction in the death rate of about 25 per cent. The table is 
 »ased on the causes of death given in the census volume for mortality 
 tatistics for 1906. These causes are arranged according to the aver- 
 ge, or rather median,* age at death from the disease. This median 
 ,ge is given in the second column. The order in this column shows at 
 
 glance the successive onslaught of, or rather fatality from, the vari- 
 us causes of death. The table shows the successive bombardments of 
 lisease to which human life is subject. 
 
 The third column gives the average lost "expectation of life;"" 
 hat is, the expectation cut off by each particular cause of death. 
 
 The fourth column represents the percentage which the deaths from 
 ach particular cause bear to the total number of deaths in 1900 in 
 he registration area. It shows the relative importance of the differ- 
 nt causes of death in the present death rate, but has no reference to 
 he age at death. 
 
 The fifth column contains an estimate, made by physicians, of the 
 atio of preventability of deaths from each cause named. 
 
 * For detailed statement in regard to the construction of this table, see appen- 
 ix to this chapter. 
 
 ''By the "median" age at death is meant the age such that one-half of the 
 eath's occur earlier and one-half later than this age. The " median " is a species 
 f average, but differs from the ordinary arithmetical average. It has tbe great 
 dvantage of ease of computation. 
 
 "The "expectation" is taken from the figures of Abbott for Massncbusotts. 
 893-1897. and is the average of expectation of males and females. See Report 
 itate Board of Health for Massachusetts, 1898. 
 
726 
 
 BEPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 The items in the sixth column are found by multiplying together 
 those in the fourth and fifth columns, and express the percentage whichi, 
 the preventable deaths from each cause named bears to the total num- 
 ber of deaths from all causes. 
 
 The seventh and last column gives the figures for which the table 
 is constructed, namely, the amount of prolongation of life which 
 would come about through preventing deaths according to the ratios 
 of preventability in column 5. "VVlien it is said that a death is pre- 
 ventable, it is not, of course, meant that the person saved from it 
 will never die, but merely that his death is postponed. The term 
 " postponable " would avoid a great deal of confusion on the subject 
 
 The principle on which the last column is constructed is simply 
 the principle of averages. The column shows the prolongation of 
 life which would be caused by postponing the " postponable " deaths 
 by the amounts indicated in column 3. To illustrate this princi 
 pie, suppose ten magnitudes to be averaged arithmetically, and that 
 their average is thirty. To fix our ideas, we may suppose these ten 
 magnitudes to be represented by ten lines drawn on a sheet of paper. 
 It is evident that if one of these ten lines is prolonged the average 
 of the ten will be thereby increased by exactly one-tenth of the pro- 
 longation of that one line. 
 
 Possible prolongation of life. '^ 
 
 u 
 
 I]' 
 
 if 
 
 (1) 
 
 Cause of death. 
 
 4. 
 
 6. 
 
 6. 
 
 7. 
 
 8. 
 
 9. 
 10. 
 11. 
 12. 
 13. 
 14. 
 
 16. 
 16. 
 17. 
 18. 
 19. 
 20. 
 21. 
 
 22. 
 23. 
 24. 
 25. 
 
 Premature birth 
 
 Congenital malformation of 
 
 heart (cyanosis) 
 
 Congenital malformations 
 
 other than of heart 
 
 congenital debility 
 
 H yd rocephalus 
 
 Venereal diseases 
 
 Diarrhea and enteritis 
 
 Measles 
 
 Acute bronchitis 
 
 Broncho-pneumonia 
 
 Whoo])ing cough 
 
 Croup 
 
 Meningitis , 
 
 Diseases of larynx other than 
 
 laryngitis , 
 
 Laryngitis , 
 
 Diphtheria 
 
 Scarlet fever , 
 
 Diseases of lymphatics 
 
 Tonsilitis 
 
 Tetanus 
 
 Tuberculosis other than of 
 
 lungs , 
 
 Abscess 
 
 Appendicitis 
 
 Typhoid fever 
 
 Puerperal convulsions 
 
 (2) 
 A. 
 
 Median 
 
 age of 
 
 deaths 
 
 from 
 
 causes 
 
 named. 
 
 Years. 
 1 
 
 1 
 1 
 1 
 1 
 1 
 1 
 1 
 1 
 1 
 2 
 2 
 
 3 
 3 
 
 3 
 S 
 
 5 
 8 
 8 
 
 23 
 
 24 
 24 
 26 
 28 
 
 (3) 
 
 Expecta- 
 tion of 
 life at 
 
 median 
 age. 
 
 Years. 
 50 
 
 50 
 
 50 
 50 
 50 
 50 
 50 
 50 
 50 
 50 
 50 
 54 
 54 
 
 54 
 54 
 64 
 54 
 54 
 52 
 52 
 
 40 
 39 
 39 
 38 
 o37 
 
 6(4) 
 
 Deaths 
 due to 
 cause 
 named as 
 percent- 
 age of all 
 deaths. 
 
 (5) 
 
 D. 
 Ratio of 
 preventa- 
 bility (post- 
 ponability), 
 i. e., ratio of 
 'preventa- 
 ble" deaths 
 from cause 
 named to 
 all deaths 
 from cause 
 named. 
 
 Per cent. 
 2 
 
 .55 
 
 .3 
 2.3 
 
 .1 
 .3 
 
 7.74 
 .8 
 
 1.1 
 
 2.4 
 .9 
 .3 
 
 1.6 
 
 .07 
 .06 
 1.4 
 .5 
 .01 
 .05 
 .19 
 
 .17 
 
 .08 
 .7 
 
 (6) 
 E=CD. 
 
 Ratio of 
 preventa- 
 ble" deaths 
 from cause 
 named to 
 all deaths 
 from all 
 causes. 
 
 Per cent. 
 40 
 
 
 40 
 
 
 70 
 60 
 40 
 30 
 50 
 40 
 75 
 70 
 
 40 
 40 
 70 
 50 
 20 
 45 
 80 
 
 75 
 60 
 50 
 85 
 80 
 
 Per cent. 
 0.8 
 
 (7) 
 
 F=BE. 
 
 Years 
 added to 
 average 
 lifetime If 
 deathswere 
 prevented 
 in the ratio 
 of prevent- 
 ability of 
 column 5. 
 
 Years. ,, 
 
 .92 
 
 .21 
 
 .11 
 
 4.64 
 
 2.32 
 
 .32 
 
 .16 
 
 .33 
 
 .17 
 
 1.2 
 
 .6 
 
 .36 
 
 .18 
 
 .22 
 
 .12 
 
 1.12 
 
 .6 
 
 .03 
 
 .02 
 
 .98 
 
 .25 
 
 .002 
 
 .02 
 
 .15 
 
 .13 
 
 .05 
 .35 
 1.7 
 .06 
 
 .46 
 
 .02 
 
 .01 
 
 .53 
 
 .14 
 
 .001 
 
 .01 
 
 .08 
 
 .05 
 .02 
 .14 
 .65 
 .02 
 
 • " Expectation " for fpmal(>s. 
 
 • As to some inaccuracies in this column, see Appendix to this chapter, section 4. 
 
ISHEB.] 
 
 NATIONAL VITALITY. 
 Possible prolongation of life — Continued. 
 
 727 
 
 (1) 
 
 Cause of death. 
 
 Puerperal septicemia 
 
 Other causes incident to child- 
 birtli 
 
 Diseases of tubes 
 
 Peritonitis 
 
 Smallpox 
 
 Tuberculosis of lunga 
 
 Violence 
 
 Malarial fever 
 
 Septicemia 
 
 Epilepsy 
 
 General, ill defined, and un- 
 known causes (including 
 "heart failure," "dropsy," 
 and "convulsions") 
 
 Erysipelas 
 
 Pneumonia (lobar and un- 
 qualified) 
 
 Acute nephritis 
 
 Pleurisy 
 
 Acute yellow atrophy of liver.. 
 
 Obstruction of intestines 
 
 Alcoholism 
 
 Hemorrhage of lungs 
 
 Diseases of thyroid body 
 
 Ovarian tumor 
 
 Uterine tumor 
 
 Rheumatism 
 
 Gangrene of lungs 
 
 Anemia, leukemia 
 
 Chronic poisonings 
 
 Congestion of lungs 
 
 Ulcer of stomach 
 
 Carbuncle 
 
 Pericarditis 
 
 Cancer of female genital organs 
 
 Dysentery 
 
 Gastri tis 
 
 Cholera nostras 
 
 Cirrhosis of liver 
 
 General paralysis of insane 
 
 Hydatid tumors of liver 
 
 Endocarditis 
 
 Locomotor ataxia 
 
 Diseases of veins 
 
 Cancer of breast 
 
 Diabetes 
 
 Biliary calculi 
 
 Hernia 
 
 Cancer not specified 
 
 Tumor 
 
 Brlght's disease 
 
 Embolism and thrombosis 
 
 Cancer of intestines 
 
 Cancer of stomach and liver.. . 
 
 Calculi of urinary tract 
 
 Cancer of mouth'. 
 
 Heart disease 
 
 Influenza 
 
 Asthma and emphysema 
 
 Angina pectoris 
 
 Apoplexy 
 
 Cancer of skin 
 
 i Chronic bronchitis 
 
 \ Paralysis 
 
 (2) 
 A. 
 
 Median 
 age of 
 deaths 
 from 
 causes 
 named. 
 
 Years. 
 28 
 
 81 
 31 
 31 
 32 
 33 
 34 
 34 
 84 
 86 
 
 35 
 37 
 
 37 
 39 
 42 
 42 
 43 
 44 
 45 
 46 
 46 
 i& 
 47 
 48 
 48 
 48 
 49 
 49 
 49 
 52 
 52 
 52 
 53 
 53 
 54 
 55 
 55 
 56 
 56 
 57 
 58 
 58 
 58 
 59 
 59 
 59 
 59 
 60 
 60 
 61 
 61 
 63 
 63 
 64 
 64 
 65 
 67 
 70 
 71 
 71 
 
 (3) 
 
 Expecta- 
 tion of 
 life at 
 median 
 age. 
 
 Years. 
 o37 
 
 o35 
 o35 
 34 
 34 
 33 
 32 
 32 
 32 
 32 
 
 SI 
 30 
 
 30 
 29 
 
 27 
 27 
 26 
 25 
 25 
 24 
 
 23 
 23 
 23 
 23 
 22 
 22 
 22 
 20 
 
 021 
 20 
 19 
 19 
 19 
 18 
 18 
 17 
 17 
 17 
 
 ol7 
 16 
 16 
 16 
 16 
 16 
 16 
 15 
 15 
 14 
 14 
 13 
 13 
 13 
 13 
 12 
 11 
 10 
 9 
 S 
 
 (4) 
 C. 
 
 Deaths 
 due to 
 cause 
 named as 
 percent- 
 age of all 
 deaths. 
 
 Per cent. 
 0.4 
 
 .36 
 .1 
 .5 
 .01 
 
 9.9 
 
 7.5 
 .2 
 .3 
 .29 
 
 9.2 
 .3 
 
 .6 
 .27 
 .02 
 .6 
 .4 
 .1 
 .02 
 .07 
 . .1 
 .5 
 .03 
 .4 
 .05 
 .4 
 .2 
 .03 
 .1 
 .6 
 .5 
 .65 
 .09 
 .9 
 .3 
 
 .002 
 .8 
 .17 
 .04 
 .4 
 .8 
 .17 
 .27 
 .9 
 .08 
 
 5.6 
 .26 
 .5 
 
 1.7 
 .03 
 .1 
 
 8.1 
 .7 
 .28 
 .4 
 
 4.4 
 .2 
 .8 
 
 (6) 
 
 D. 
 
 Ratio of 
 preventa- 
 bility(post- 
 pona'bility), 
 '.e., ratio of 
 "preventa- 
 ble" deaths 
 from cause 
 
 named to 
 all deaths 
 from cause 
 
 named. 
 
 Per cent. 
 85 
 
 50 
 65 
 55 
 75 
 75 
 36 
 80 
 40 
 
 
 80 
 
 60 
 
 45 
 80 
 55 
 
 
 25 
 85 
 80 
 10 
 
 
 
 60 
 10 
 
 
 60 
 70 
 50 
 50 
 50 
 10 
 
 
 80 
 50 
 50 
 60 
 75 
 75 
 25 
 35 
 40 
 
 
 10 
 40 
 70 
 
 
 
 
 40 
 
 
 
 
 
 
 10 
 
 
 25 
 50 
 80 
 25 
 85 
 
 
 
 30 
 50 
 
 (6) 
 E=CD. 
 
 Ratio of 
 "preventa- 
 ble" deaths 
 from cause 
 named to 
 all deaths 
 from all 
 causes. 
 
 Per cent. 
 0.34 
 
 .18 
 .06 
 .28 
 .01 
 7.42 
 2.7 
 .16 
 .12 
 
 2.75 
 .18 
 
 8.15 
 
 .18 
 .15 
 
 .15 
 .34 
 .08 
 .002 
 
 .06 
 .05 
 
 .2 
 .03 
 .2 
 .1 
 
 .015 
 .01 
 
 .4 
 
 .32 
 
 .05 
 
 .54 
 
 .22 
 
 .002 
 
 .2 
 
 .06 
 
 .02 
 
 .08 
 .07 
 .19 
 
 2.24 
 
 .003 
 
 2.02 
 .35 
 .07 
 .1 
 
 1.54 
 
 .24 
 .5 
 
 (7) 
 F-BE. 
 
 Years 
 
 added to 
 
 average 
 
 lifetime if 
 
 deathswere 
 
 prevented 
 
 in the ratio 
 
 of prevent- 
 
 abilityt)! 
 
 column 5. 
 
 Years. 
 0.13 
 
 .06 
 .02 
 .1 
 
 .003 
 2.46 
 .86 
 .05 
 .04 
 
 .85 
 .06 
 
 .94 
 .05 
 .04 
 
 .04 
 .09 
 
 .02 
 .0005 
 
 .02 
 .01 
 
 .05 
 
 .007 
 
 .04 
 
 .02 
 
 .008 
 
 .002 
 
 .08 
 
 .06 
 
 .01 
 
 .1 
 
 .04 
 
 .0003 
 
 .03 
 
 .01 
 
 .003 
 
 .01 
 .01 
 .03 
 
 .36 
 
 .0004 
 
 .26 
 
 .05 
 
 .009 
 
 .01 
 
 .17 
 
 .02 
 .04 
 
 • " Expectation " for females. 
 
728 EEPORT OF NATIONAL 
 
 CONSERVATION COMMISSION. 
 
 
 Possible prolong 
 
 lation of Z//«— Continued. 
 
 
 
 (1) 
 
 (2) 
 
 (3) 
 
 (4) 
 
 (6) 
 
 (6) 
 
 (7) 
 
 
 A. 
 
 B. 
 
 C. 
 
 D. 
 
 Ratio of 
 preventa- 
 
 E=CD. 
 
 F=BE. 
 Years 
 
 
 
 
 Deaths 
 due to 
 cause 
 named as 
 percent- 
 age of all 
 deaths. 
 
 bilitv (post- 
 
 Ratio of 
 
 added to 
 
 
 Median 
 
 Expecta- 
 tion of 
 life at 
 
 median 
 
 ponability), 
 
 "preventa- 
 
 average 
 
 . Cause of death. 
 
 age of 
 
 I.e., ratio of 
 
 ble" deaths 
 
 lifetime if 
 
 
 deaths 
 
 from 
 
 causes 
 
 " preventa- 
 ble" deaths 
 from cause 
 
 from cause 
 named to 
 all deaths 
 
 deaths wen 
 prevented 
 in the ratio 
 
 
 named. 
 
 age. 
 
 named to 
 
 from all 
 
 of prevent- 
 
 
 
 
 all deaths 
 
 causes. 
 
 abilitvof 
 
 
 
 
 
 from cause 
 
 
 column 5. 
 
 
 
 
 
 named. 
 
 
 
 
 Years. 
 
 Years. 
 
 Per cent. 
 
 Per cent. 
 
 Per cent. 
 
 Years. 
 
 
 71 
 
 9 
 
 0.2 
 
 0' 
 
 
 
 
 7.S 
 74 
 74 
 
 9 
 8 
 
 8 
 
 0.83 
 
 0.2 
 
 0.25 
 
 10 
 45 
 60 
 
 0.08 
 (1. 09 
 0.10 
 
 O.OO' 
 O.OO'' 
 
 o.or 
 
 88. Diseases of bUidder 
 
 89. Gangrene 
 
 90 Old ae-e 
 
 83 
 
 5 
 
 2 
 
 
 
 
 
 
 
 
 All causes 
 
 38 
 
 
 100 
 
 42.3 
 
 a 42. 3 
 
 14.06 
 
 
 
 RfeSDMfe. 
 
 
 
 
 
 
 
 Diseases of infancy (having me- 
 
 
 
 
 
 
 
 
 
 
 18.5 
 
 47 
 
 8.8 
 
 4.4 
 
 Diseases of childhood (having me- 
 
 
 
 
 
 
 
 
 
 
 4.2 
 
 67 
 
 2.8 
 
 1.51 
 
 Diseases of middle age ( having me- 
 
 
 
 
 
 
 
 dian aee 23 to 49) 
 
 
 
 43 
 
 49 
 
 21.2 
 
 6.82 
 
 Diseases of late life (having me- 
 
 
 
 
 
 
 
 dian age 62 to 83) 
 
 
 
 34.3 
 
 28 
 
 9.5 
 
 1.38 
 
 
 
 
 All causes 
 
 
 100 42. 3 
 
 42.3 
 
 14.06 
 
 
 
 
 
 "Althoiish this is the ratio 
 
 of gene 
 
 •al preve 
 
 ntability 
 
 of deaths 
 
 under ex 
 
 sting con- 
 
 ditions, the death rate, i. e., deaths in relation to population, will not in the end b< 
 aflected in tliis ratio but by only about l.'") per cent. The reason for this paradox is that 
 deaths prevented lead to a larger population (See appendix to this chapter, section 3). 
 
 Similarly, if of the ten lines three are prolonged each a certain 
 stated amount, or are prolonged that amount on the average, the 
 average of the whole ten Avill be increased by three-tenths of this 
 amount. Consequently, if the saved lives from typhoid fever (No. 
 24 in the table) are, on an average, prolonged thirty-eight years, and 
 these saved lives represent l.T per cent of all lives, the average life will 
 be prolonged by 1.7 per cent of thirty-eight years. This is 0.65 oi 
 two-thirds of a year. 
 
 All the calculations are on the assumption of expectations of life, 
 such that the saved lives will die according to the present law oi 
 mortality. Consequently, if the table should be corrected by sub- 
 stituting in each case such an expectation of life as would conform 
 to the improved mortality, the result would be an addition (2.1 
 years)" to the estimate of possible prolongation, which would there- 
 fore Ijecome 16.2 years. The resume of the table shows that of 
 the 14 years of possible prolongation of life 4.4 would be caused 
 by reducing infant deaths under or near 1 year, 1.51 by reducing 
 mortality from children's diseases, 6.82 from reducing the disease- 
 of middle life, especially tuberculosis and typhoid, and only 1.33 
 by reducing the mortality of diseases the deaths from which usually 
 come after 50 years of age. 
 
 •Best estimated graphically, as shown in appendix to this chapter. 
 
loo 000 
 
 So 000 
 
 80000 
 
 70 000 
 
 bo 000 
 
 50000 
 
 4-0000 
 
 30000 
 
 20000 
 
 loooo 
 
 lO 20 30 40 50 60 70 80 90 IOoYeap 
 
 
 
 
 
 
 
 
 
 
 
 
 V 
 
 
 
 
 
 
 
 
 
 
 
 h 
 
 ==:::; 
 
 E 
 
 III 
 
 
 
 
 
 
 
 
 I 
 
 
 / 
 
 -./C5 
 
 ^-.. 
 
 
 
 
 
 
 
 v\ 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 ^- 
 
 ^ 
 
 1 
 
 
 -■^ 
 
 \ 
 
 
 
 
 
 
 \ 
 
 ^E 
 
 > 
 
 ^^. 
 
 
 
 C" 
 
 
 
 
 
 
 ■ 
 
 \ 
 
 x'' 
 
 tS" 
 
 \ 
 
 ^- 
 
 
 
 
 
 
 
 \t 
 
 F^.^ 
 
 
 
 \\ 
 
 
 
 
 
 
 
 
 ^^ 
 
 \ 
 
 ^. 
 
 \\ 
 
 
 
 
 
 
 
 
 
 \ 
 
 \ 
 
 \ 
 
 \ 
 
 
 
 
 
 
 
 
 
 \ 
 
 c 
 
 \\ 
 
 
 
 
 
 
 
 
 
 \ 
 
 c\ 
 
 \\ 
 
 
 
 
 
 
 
 
 
 
 
 \\ 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 \ \ 
 
 
 
 
 
 
 
 
 
 
 
 \\ 
 
 
 
 
 
 
 
 
 
 
 
 \\ 
 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 
 
 
 
 
 
 
 
 
 
 
 \Vv 
 
 \, 
 
 
 
 
 
 
 
 
 
 
 ^ 
 
 t^ 
 
 _ lo 20 30 40 50 60 70 So 90 IooVeAF 
 
 D 
 
 SURVIVORSHIP CURVES, SHOWING SAFE MINIMUM IMPROVEMENT ATTAINABLE. 
 
•isHRR.l NATION AX. VITALITY. 729 
 
 The table shows that seven of the 90 causes of death are responsible 
 'or over half of the shortening of life, namely, diarrhea and enteritis 
 ;No. 7), broncho-pneumonia (No. 10), meningitis (No. 13), typhoid 
 
 No. 24), tuberculosis of lungs (No. 31), violence (No. 32), and 
 )neumonia (No. 38). These alone shorten life needlessly by more 
 ihan eight years. Against these seven causes, therefore, our special 
 efforts should be directed. Pure milk, pure water, pure air, and 
 ■easonable protection from accident are the chief means known at 
 present. \Vlien the public makes up its mind no longer to endure 
 mpure milk, impure water, and impure air, and unreasonable dan- 
 gers to life and limb, life will lengthen eight years, and probably a 
 ^reat deal more. 
 
 In the resume of the table columns 4, 6, and 7 are found from the 
 )riginal table by simple addition. Each figure in the fifth column is 
 'ound by dividing the figure in the sixth by that in the fourth." 
 
 The final figure in this column, 42.3, is the same as the sum of 
 •olumn 6, and means that according to medical opinion 42.3 per cent 
 )f the deaths which occur under present conditions are preventable 
 ;postponable). The death rate, however, will ultimately be reduced, 
 lot in this proportion, but b}^ about 25 per cent,* while the average 
 ■luration of life will be increased about 33^ per cent. 
 
 Section 3. — Diagram sliowing effect of prolongation at different ages. 
 
 The whole process is best seen by means of a survivorship table, 
 I, diagram of which will be found on the next page. 
 
 We have here four curves which represent the survivors in suc- 
 
 essive years from a h)^pothetical and representative list of 100,000 
 
 )ersons born. The two of these curves which should be noted are 
 
 he inner two, namely, those labeled "Mass. 1893-97 " and " Pos- 
 
 ible I." The former is taken, in lieu of any better statistics, as 
 
 ;e])resenting the existing law of mortality in the United States. The 
 
 after shows what the law of mortality would be if the ratios of pre- 
 
 'entability given in the preceding table were put in force. The 
 
 urve Possible I is constructed on the supposition that all the deaths 
 
 i)revented or postponed subsequently^ occur according to the present 
 
 ;aw of mortality; that is, that expressed in the curve Mass. 1893-97. 
 
 The two remaining, or outer, curves are given merely for com- 
 )arison. The lowest, marked " Mass. 1855," shows the mortality 
 vhich held true in Massachusetts in that year accord hig to the 
 stimates of the actuary, E. B. Elliott.'' The difference between this 
 urve and the one above shows the number of years of life actually 
 aved to 100,000 persons subject to the mortality of 1893-1897 instead 
 •f the mortality of 1855. The upper curve (Possible II) shows the 
 Qodification in Possible I on the assumption that the saved lives, 
 nstead of following the present law of mortality (Massachusetts, 
 
 "The result is in each case a weighted average of the individual ratios of 
 reveutability for the individual causes of death. 
 
 * See appendix. 
 
 "See Proceedings of the American Association for the Advancement of 
 icience. 1857, pp. 61, 69; also Sixteenth Registration Report, Massachusetts, 
 857, p. 204. 
 
730 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 1893-1897), follow the law of mortality represented in the curve 
 Possible II itself." 
 
 This diagram shows at a glance what improvement has been made 
 in mortality and at what ages, and what improvement is still pos- 
 sible, and at what ages, according to the preventability known to be 
 easily possible. We see that the curve. Possible I, does not drop as 
 far in the first year of life as the curve Mass. 1893-97. This is 
 because of the great saving of infant lives known to be possible. The 
 years of life which would be saved to the 100,000 persons by the 
 new hygiene are represented by the difference in area between the new 
 curve AB"C"D and the old curve AB'C'D, from which it was con- 
 structed by applying the ratio of preventability. This area can 
 easily be measured by a planimeter, and is found to be 1,280,000. 
 which, divided by the 100.000 persons, means an average addition of 
 12.8 years to the lifetime of each person born. This result differs 
 somewhat from the arithmetical calculation, 14.06, given in the pre- 
 ceding table.'' If the upper curve be used, which assumes that the 
 " saved " lives die not according to the old but the new mortality,, 
 the addition becomes not 12.8 but 14.9 years, as against the 16.1 
 computed arithmetically. We may hereafter refer to this minimum 
 estimate of possible increase of life as, in round numbers. 15 years. 
 The lengthening of life would be from 45 to 00, or one-third. 
 
 The diagram also shows the saving of life which actually took 
 place between 1855 and the period 1893-1897. The area between the 
 curves for these two periods shows that 550,000 years were saved fori 
 a supposed group of 100.000 persons, or 5.5 per person. The wholft 
 area of the new curve AB"C"D is 5,810,000, or 58.1 years per person, 
 which is the new average duration of life, as compared with 45.3 for 
 1893-97 and 39.8 years for 1855. We may divide the diagram by 
 two vertical lines drawn at the ages 17^ and 60 in order to discover 
 what part of the added life occurs between these ages — that is, within 
 the working period — and what parts fall on either side. The addi- 
 tion of 12.8 years to the lifetime of each of 100.000 persons, or 
 1,280,000 years of life in all, is divided into three groups, nameh', the 
 years falling in the period of preparation, 200,000 ; in the working 
 
 " The method of consti-ucting the curves Possible I and Possible II from the* 
 curve Mass. 1S93-9T is by meons of the ratios of preventability given in the 
 r6sum§ of the preceding table. See appendix. 
 
 ^ The discrepancy, 1.3 years, is due to the fact that in constructing the table, 
 based on individual diseases, I was compelled to use for tlie percentages of | 
 deaths by ages (column 4) the percentages obtaining in the calendar year lOOG: 
 whereas the diagram is based on the idea of a stationary population, the dis- 
 tribution of the deaths being represented by the shape of the curve Mass. 
 1893-97. The diagramatic method is therefore more correct. The abnormal 
 age distribution in 1906 results in making some of the figures in the last column 
 of the table too large and some too small. In a general way, the figures for 
 the earlier ages are too large and for the later ages too small, although the 
 figures which are most too large are probably for ages 30 to 35. Consequently 
 the greatest error in excess is for tuberculosis, which is possibly three-fourths 
 of a year too large. No exact corrections are possible, and any systematic 
 corrections, even inexact, would be very laborious. This would correspond to 
 the elaborate actuarial calculations of Hayward in England and Glorer in 
 the United States. See Hayward " On the Construction of Life Tables and on 
 Their Application, etc." Haydock and J. W. Glover, "A Study of Tuberculosis 
 in the United States," Journal of Michigan State Medical Society, February, 
 1909. 
 
risiir.R.] 
 
 NATIONAL VITALITY. 
 
 731 
 
 period, G80,000; in the period of decline, 400,000. The following 
 table will show the whole process: 
 
 tfass. 1855... 
 tfass. 1893-97 
 Possible I 
 
 Preparatory- 
 period (iiges 
 0-17i). 
 
 Years 
 of life. 
 
 12.6 
 13.5 
 15.4 
 
 Per 
 
 cent of 
 
 total. 
 
 32 
 30 
 26 
 
 Working pe- 
 riod of life 
 {llh CO). 
 
 Years. 
 
 21.9 
 25.0 
 31.8 
 
 Per 
 cent. 
 
 55 
 55 
 65 
 
 Period of de- 
 cline (CiO and 
 beyond). 
 
 Years. 
 
 5.3 
 
 6.8 
 
 10.9 
 
 Per 
 cent. 
 
 13 
 16 
 19 
 
 Total. 
 
 Years. 
 
 39.8 
 45.3 
 58.1 
 
 Per 
 cent. 
 
 100 
 100 
 100 
 
 These figures show that in 18r)5 the average person born lived only 
 12.6 years of the 17^ years in the period of preparation for life. In 
 1893-97 he lived 13.5 years. If modern hygiene were applied accord- 
 ing to the ratios of the assigned preventability, the figure would then 
 be 15.4 years actually lived out of the 17|. Of the working period of 
 12^ years (17^-60, the average man living under the mortality of 
 1855 had only about half, or 21.9 years; under the mortality of. 
 1893-97 he had 25.0. and under the " Possible I " mortality he would 
 have 31.8 years. 
 
 In percentage the years in the working period remain 55 per cent 
 3f the total life in all cases. This assumes that with the prolongation 
 Df life the limits of the working period remain 17^ and 60. Since 
 bhe prolongation of life carries with it a postponement of the age of 
 disability, it follows that the proportion of working life would 
 actually increase." 
 
 It will be seen in comparing the curves on the diagram that the 
 ichange wrought in the character of the mortality curve by the new 
 hygiene simply continues the change already in progress. The family 
 iresemblance between all four curves is striking. 
 
 Section 4. — Fifteen years a safe minimum estimate of prolongation possible. 
 
 The estimate of fifteen years as the possible prolongation of life 
 jis merely a minimum estimate. This will be seen from the following 
 important considerations: 
 
 1. The estimate takes no account of future medical discoveries, 
 which are now coming at such a rate that we have every reason to 
 believe they will soon greatly increase the ratios of preventability. 
 Cancer, for instance, has been put down with zero as its ratio of pre- 
 ventability, but the scientific world is intently seeking for methods 
 of prevention and cure. Likewise " old age " has been assumed as 
 unpreventable. Yet Metchnikoff maintains with reason that this 
 is a malady which can be postponed. 
 
 2. The ratio of preventability of the above diseases takes little 
 account of the cumulative influence of hygiene. Certain diseases late 
 in life are now taken to be unpreventable or only slightly prevent- 
 able on the assumption that people reach those ages in their present 
 degree of more or less imperfect health. But on the assumption that 
 personal hygiene had been practiced since birth, the vital resistance, 
 wliich is always a deterrent of disease, would have been strengthened. 
 
 <• See Dr. Edward Jarvis, " Political Economy of Health," Fifth Annual Re- 
 jPort, Mass. Board of TIealtb, 1ST4, p. 338, ff. 
 
 I S. Doc. 419, 61-2 8 
 
732 EEPORT OF NATIONAX. CONSERVATION COMMISSION. 
 
 Professor Sedgwick tells us that evidence will be published demon- 
 strating " Hazen's theorem," that every life saved from typhoid by 
 better water supply means two or three persons saved from deaths 
 from other causes. Our table shows an estimate of at least 85 per cent 
 as the preventability of typhoid, but the coincident preventability of 
 other diseases which this prevention of typhoid would bring about 
 finds no place in the table. The individual estimates given for these 
 other diseases take no account of such indirect action. Similarly, 
 as Metchnikoff has emphasized, venereal diseases, though they sel- 
 dom cause death, do shorten life, the " terminal disease " being quite 
 different. The same is true of malaria and hook-worm disease, which 
 predispose to tuberculosis and other tenninal diseases. But in the 
 table the ratios of preventability of tuberculosis and other diseases 
 were constructed quite irrespective of any effect from reducing 
 venereal diseases, malaria, and other devitalizing diseases. 
 
 In the matter of personal hygiene the cumulative influence is still 
 more indirect, and perhaps still more powerful. It is now often 
 remarked by insurance men that the best risks are not necessarily 
 the best physiques, but may be the valetudinarians who practice per- 
 sonal hygiene. 
 
 There is a vicious circle of disease and a beneficent circle of health 
 The so-called " cause of death " given in death certificates is only the 
 terminal cause. It is often merely the " last straw " of a terrible load 
 gradually accumulated through life. 
 
 Evidentl3^ to exploit the resources of hygiene, we need to consider 
 a thoroughgoing change in health ideals and a consequent revolu- ! 
 tion in the conditions and habits of living. What would then happen 
 to human longevity we can only conjecture. The possible addition 
 to the life span might, for aught we know, be several times the fif- 
 teen years in the table. 
 
 3. The figures for the possible prolongation of life take no account 
 of the ultimate racial effects of the new health ideals. If once a 
 nation becomes thoroughly alive to the importance of maintaining 
 the stamina of its citizens, this will, as we have seen, affect mar- 
 riages — by putting a premium on health as one of the desiderata in 
 a prospective husband or wife. The longevity of succeeding genera- 
 tions would certainlj' be improved — how much, it would be useless 
 to guess. 
 
 The foregoing considerations, added to the fact that the estimates 
 of preventability were made conservatively, will show that the addi- 
 tion of fifteen years is really only a first step. If clean milk will 
 prevent infantile diarrheal diseases, if clean water will prevent 
 deaths from typhoid and at the same time — according to Hazen's 
 theorem — prevent two or three times as many other deaths, and if 
 clean air will prevent tuberculosis, then it is evident tliat mere 
 cleanliness in respect to these necessities will suffice to lengthen life 
 by most if not all of the above estimate. Fifteen years is merely the 
 " ore in sight." If we will work for it, we may get an even richer 
 prize. ' 
 
 Within the past few years the knowledge of the causes of disease has become 
 so far advanced that it is a matter of practical certainty that by the unstinted 
 application of known methods of investigation and consequent controlling action, 
 all epidemic disease could be abolished within a period so short as fifty years." 
 
 <»E. Ray Lankester, " The Kingdom of Man," New York (Holt), 1907, p. 36, 
 
FiSHBE.] NATIOlSTAli VITALITY. 733 
 
 Section 5. — Tfeed of lengthening human life. 
 
 If Metchnikoff's noble dream should be some day realized, the 
 lengthening of human life would at once decrease the burden on the 
 productive period. That period tends to remain 55 per cent of the 
 total years lived, on the assumption that the working period remains 
 17^ to 60, but the upper limit tends to shift forward. In this way, 
 both the absolute and relative length of the working period would 
 be increased. 
 
 The further off the burden of old age is shifted, the easier it is 
 for society or the individual to accumulate the wealth to provide for 
 it. At present the burden of helpless old age is extremely serious, 
 as those countries are beginning to realize which, like Denmark, 
 Belgium, Germany, France, and recently England, have enacted laws 
 to provide old-age pensions. 
 
 As life becomes more complex it requires a longer period of prepa- 
 ration. Preparation is education, and requires time. As the stock 
 of knowledge increases, the period for acquiring it, or rather only 
 enough of it to enable one to earn a livelihood, is constantly tending 
 to increase. The age of leaving school and college is presumably 
 gi'owing greater. 
 
 It would be very much in keeping with the fitness of things if in 
 this century biological science practically applied should shift the 
 limit of the further end of the working period, the limit which we 
 have assumed to be 60, to a later period of life. Human life would 
 then be on a larger scale throughout. It would provide time for a 
 longer and more thorough preparation and at the same time provide 
 sufficient years of working life to repay this investment. 
 
 As Metchnikoff'^ well points out, one result of lengthening life 
 will be a greater utilization of accumulated experience. We shall 
 .have less immaturity of judgment. The principle which leads to 
 the choice for members of the judiciaiy of men of ripe years and 
 knowledge will apply to every field of human activity, even those fields 
 which are now preempted by young men because of the necessity 
 of utilizing their vitality. It will lead to a sane and yet a vigorous 
 conservatism. It will give to society a body of old yet hale men of 
 (experience, whose influence and worth can not be measured. As 
 Metchnikoff has said : 
 
 I Old age, at present practically a useless burden on the conimnnity, will become 
 a period of work valuable to the community. As the old man will no longer 
 be subject to loss of memory or to intellectual weakness, he will be able to 
 apply his great experience to the most complicated and the most delicate parts 
 'of the social life.^ 
 
 We may predict that when science occupies the preponderating place in human 
 society that it ought to have, and when knowledge of hygiene is more advanced, 
 human life will become much longer and the part of old people will become much 
 more important than it is to-day.'' 
 
 Section 6. — The normal lifetime. 
 
 I What is the normal human lifetime? ^ Many estimates have been 
 made, based on all sorts of reasoning, the figures extending from 75 
 
 "Prolongation of Life, p. 329. 
 
 '' Nature of Man, p. 295. 
 
 " Metchnikoff : " Trolongation of Life," pp. 226-227. 
 
 * On the topic of human longevitv, see Metchnikoff: "The Prolongation of 
 Life," Pt. II, Chaps. I, II. Shaler : " The Individual," New York (Appleton),190i, 
 Chap. III. Lankester: "Comparative Longevity," London. 1870. pp. 88-113. 
 
734 EEPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 to 200 years. Flourens's law, of doubtful value, that a mammal lives 
 five times the length of its growing period, can not be applied gener- 
 ally. It is true, the horse full grown at 5 may live 25 years; sheep 
 adult at less than 3 years may live 12; while elephants, which have an 
 unusually tardy development, are reputed to have a lifetime of 2 
 centuries. 
 
 Haller, a distinguished Swiss physiologist of the eighteenth century, thought 
 that man ought to live to 200 years; Buffon was of the opinion that when a 
 man did not die from some accidont or disease he would reach 90 or 100 years." 
 
 In man the growth period is normally continued to some time after the 
 twentieth year; its exact limit has not been ascertained, but from the statistics 
 gathered by the Sanitary Commission during the civil war it seems most likely 
 that it is not usually completed until after the thirtieth year.* 
 
 One method which has been suggested to ascertain the natural 
 length of life is to suppose all diseases to be completely eliminated 
 and those who now die of them to die of old age. The median age 
 for death from old age is 83. Metchnikoff, however, shows the error 
 of assuming present old age to be normal. We may conclude that 
 the normal life exceeds 83. 
 
 There must needs be, of course, a limit to the possible prolongation 
 of life. We find in recent times few authenticated cases of persons 
 who have lived for a hundred years. As Young, former president of 
 the British Actuarial Societv, has shown in his interesting book '^ on 
 centenarians, most cases of supposed centenarians are either cases of 
 conscious or unconscious exaggeration or of error in records. For 
 instance, the Countess of Desmond is said to have lived 130 j'ears, 
 owing to the confusion of two persons of the same name, one of whom 
 lived to be 100 years old, while the other, her mother, died at 30, and 
 their lives were combined in subsequent records. There are, however, 
 some authenticated cases. Thus, the Norwegian Drakenberg was 
 bom in 1626 and lived until 1772. aged 140. " He was married when 
 111 years old, and as a widower of 130 proposed to marry again, 
 although without success."'* 
 
 At Portland, Oreg., ]Mrs. ]\Iary L. Wood died recently at the age 
 of 120 years and under circumstances which permitted the authenti- 
 cation of her case by the Oregon Historical Society. From these and 
 from other cases which might be mentioned, we may conclude that 
 if to-day, notwithstanding all existing chances of death, it is possible' 
 for some persons to live beyond 120, the chances in the future for a 
 larger proportion of such persons will be materially improved. 
 "Whether this proportion could ever become the major part we have 
 as yet no means of knowing. What is needed is studj^^, and Metchni- 
 koff is right in believing that the study is well worth while from 
 every point of view. 
 
 Appendix to Chapteb XI. — Method of computing possible prolongation of life. 
 Section 1. — "Expectations " at mediati ages as sJiort cut to average expectations. 
 
 The table given in Chapter XI is briefly described in the chapter itself. The' 
 following additional explanations are made in regard to the statistical method' 
 employed : ■ 
 
 •Metchnikoff, "Prolongation of Life," p. 84. ' 
 
 * Shaler, loc. cit., p. 61. 
 
 «T. E. Young: "Centenarians," London (C. & E. Layton), 1899. 
 
 * Ree article by Harald Westergaard, (British) Economic Journal, Vol. IX, 
 1899, p. 315. 
 
FisiiEK.] NATIONAL! VITALITY. 735 
 
 The third column, giving the expectation of life which Is lost or cut off by 
 each particular cause of death, is estimated roughly by taking the expectation 
 of life pertaining to the median age reached by those who die from the cause 
 named. This expectation of life is talien from the Massachusetts Life Tables, 
 1893-1897." 
 
 The method of using the median age is sufficiently exact in view of the inexact, 
 or rather, safe, minimum estimates of preventability given in column five. A per- 
 fectly correct method would be much more laborious. Hayward's monograph 
 on the effect on the duration of life of eliminating only one disease (tubercu- 
 losis) requires 190 pages of calculation. I^he true method consists in averaging 
 arithmetically and weighting these averages according to the number dying at 
 the various ages. Specimen computations show that the error involved by the 
 Bhort cut is not great. 
 
 Thus, for tuberculosis it Is found that the average expectation of life lost 
 by consumptives dying in 1906 was 32 years, whereas the expectation of life 
 at the median age was 38 years. The former figure is a hundredfold more diili- 
 cult to compute than the latter. Even the former is not strictly correct, since 
 It applies to the deaths by ages as distributed in 1906, and not as distributed in 
 a " stationary " population. 
 
 Section 2. — Basis of estimates of preventabilitv. 
 
 The estimates of preventability given in column 5 need special explanation. 
 In a few cases, these estimates are based on statistical experience.* 
 
 The groat majority of them are based on clinical experience merely, without 
 any exact statistics. They are thus in the nature of expert guesses. The 
 experts in ail cases are pliysicians. I have not entered any estimate of my 
 own, unless item No. 36 might be so designated. This item is the residuum of 
 deaths from unljnown causes, or ill-delined causes, and is made up to a large 
 extent of cases not properly reported in the death certificates. Inasmuch as the 
 average preventability for all other causes in the table is over 42 per cent, it 
 seemed safe to assign to deaths from these unlcnown causes a ratio of pre- 
 ventability of 30 per cent. But even if the preventability were entered as 0, 
 ;the effect in reducing the result would be less than a year. 
 
 Those who gave to the construction of these estimates the benefit of their 
 experience, observations, and reading were especially asked above all to be con- 
 servative. In order to avoid any possibility of exaggeration of their estimates 
 
 « S. W. Abbott, M. D. : " The vital statistics of Massachusetts for 1897, from 
 the thirtieth annual report of the state board of health of Massachusetts." 
 The expectation is taken as the average of the expectations for males and 
 females. 
 
 ** In addition to the data in regard to special diseases discussed in the text, 
 Dtlier pertinent material has been taken into account by those who made the 
 estimates presented in the table. For instance, from smallpox In London in 
 1901-2 the mortality was 34.6 per cent among the unvaccinated, 20.9 per cent 
 , unong those vaccinated after the disease was apparent, and 10.3 per cent where 
 .here was protective vaccination. In Gloucester In 1895-96 the mortality among 
 ;he unvaccinated was 40.8 per cent and among the vaccinated 9.8 per cent. For 
 children under 1 year the unvaccinated had a mortality of 72 per cent, while 
 ;the vaccinated were not attacked. From cerebro-splnal meningitis the average 
 ioaortallty was 70 per cent (Holt) ; the mortality under serum treatment was 25 
 per cent (Flexner and Jobling). For typhoid fever, Koch and his assistants 
 stamped out the disease in Trier by Isolation of the infected persons and dis- 
 infection. (Osier, The Practice of Medicine, sixth edition.) This would prob- 
 iibly be Impracticable to such an extent In a city on account of the great expense 
 Involved and the difficulty of detecting the bacillus carriers. Other figures for 
 ;yphoid fever are given in the text. For diphtheria In New York City In 1889- 
 jl891 we find the mortality was 37.3 per cent, while in 1902-1904 the mortality 
 isvas 10.8 per cent. The board of health began to use antitoxin In 1895. These 
 I facts were furnished by Professor Blumer. Many data on preventability are 
 given by John C, McVall In The Prevention of Infectious Diseases, New York 
 i(Macmillan), 1907. See especially pages 16-19. Doctor Stiles, of the Public 
 IBealth and Marine-Hosnital Service, is soon to publish figures showing the 
 absolute preventability of hook-worm disease, a malady prevalent In the South, 
 Dut not entering into the census tables. These tables do not cover the Southern 
 States. 
 
736 KEPORT OP NATIONAL, CONSERVATION COMMISSION. 
 
 In the table tholr average was taken, and then the estimate, as entered In the 
 table, was taken either as that average or below it. In no case was the estimate 
 entered as above the average given. When, as was true in a large proportion 
 of cases, the different estimates agreed fairly well, the average was employed, 
 or rather the nearest figure ending in 0, or 5 next below the average. If the 
 individual estimates diverged widelj% an estimate was used below the average, 
 favoring the conservative estimators rather than the oi)tiinistic. Also in cases 
 where only a few estimates were obtainable, the estimate aa entered was put 
 below the average of those given. 
 
 In estimating the percentage of preventability for all the ninety causes of 
 death, IS estimators contributed. The number of estimates of preventability 
 for each cause averaged nearly eight for each cause of death. It will be seen, 
 therefore, that the table represents in a conservative way medical opinion as to 
 the preventability of disease. The physicians who contributed these estimates 
 are: Dr. Joseph M. Flint, professor of surgery, Yale Medical School ; Dr. George 
 Blumer, professor of the theory and practice of Medicine, Yale Medical School; 
 Dr. H. L. Swain, clinical professor, Yale Medical School; Dr. Oliver T. Osborne, 
 professor of therapeutics, Yale Medical School; Dr. J. H. Townsend, secretary 
 of Connecticut state board of health ; Dr. F. W. Wright, health officer of New 
 Haven; Dr. Norman E. Ditman, of Columbia University; Dr. Cressy I.. Wilbur, 
 Chief of Division of Vital Statistics, Bureau of the Census; Dr. L. O. Howard, 
 Chief of Bureau of Entomology, Department of Agriculture; Dr. William C. 
 Woodward, chief health officer of District of Columbia; Dr. Charles V. Chapin, 
 city health officer, Providence, R. I.; Dr. Henry B. Baker, ex-secretary Michigan 
 state board of health, ex-president American Public Health Association ; Dr. 
 J. H. Kellogg, superintendent of the Battle Creek Sanitarium ; Dr. Charles H. 
 Castle, of Cincinnati, Ohio; Dr. Harry M. Steele, of New Haven, Conn.; 
 Dr. L. Emmett Holt, of New York ; Dr. Edwin O. .Tordan, of the Memorial Insti- 
 tute for Infectious Diseases, Chicago, 111.; Dr. Prince A. Morrow, president ot 
 the American Society for Sanitary and Moral Prophylaxis. 
 
 Section 3. — Meaning of " preventable." 
 
 The meaning of the word " preventable" requires some explanation. 
 
 1. It is to be noted that column 5 gives the ratio of preventability for mor- 
 tality and not for morbidity. It means ratio of preventable deaths to all deaths, 
 not to all cases of illness. 
 
 2. Since the word " preventable " implies the hypothesis of different conditions 
 from those which actually exist, it is necessary to specify what hypothetical 
 conditions shall be implied in the term. Doubtless tuberculosis would be over 
 99 per cent preventable if we should conceive as our hypothetical conditions that 
 every individual could live on the prairies of the West, out of doors, be provided 
 with the best of food, most congenial of tasks, and free from overwork and 
 worry. Needless to say, the figures in the table do not imply such Utopian con- 
 ditions, nor do they imply new medical discoveries. One hundred per cent oi 
 evei-y disease might be preventable if we conceived as our hypothesis that the 
 means of prevention are known and applied. The hypothetical condition 
 selected for the meaning of the term " preventable " is contained in the following 
 definition: A "ratio of preventahility '' is the fraction of all deaths lohicJi 
 tcoald be avoided if knowledge now existing among ivell-informed men in the 
 medical profession were actually applied in a reasonable tcay and to a reason^ 
 able extent. The term " reasonable " is of course elastic, and will be somewhat 
 differently interpreted by different persons, biit, as in law, where " reasonable 
 care " is often used as a proviso, it is impossible to make any more specific 
 condition. 
 
 3. Considerable confusion exists in the minds of many people in regard to tW 
 number of deaths which might be prevented, or, as it is popularly expressed, 
 the number of lives which might be saved. Since death is ultimately inevitable 
 for all, no life can be saved except temporarily. It will serve to avoid confusion 
 if " preventable " is explained as " postponable." The question arises when 
 deaths are postponed. How long are they postponed? The answer is. They an 
 supposed to occur according to existing rates of mortality. Thus, those saved 
 from croup (No. 12) at age 2 will later die as do others who are living at age 2, 
 and will therefore have the expectation of life (54 years) pertaining to that age. 
 
 4. The above explanation will serve to meet an objection which otherwise 
 would immediately occur to the reader. If diseases of early life are prevented] 
 the result will necessarily be an increase of the diseases in later life. Foj 
 instance, if all the causes of death could be abolished except old age, there 
 
KisHEtt.] NATIONAL VITALITY. 737 
 
 would be a great increase in the number of deaths from old age, which, instead 
 of constituting the 2 per cent of all deaths, which it does at present, would con- 
 stitute 100 per cent. 
 
 But the fact that all lives saved will add to the later mortality is fully, and 
 more than fully, taken into account in our calculations. When we nssume that 
 certain lives now lost at a given age might be saved, we also assume that they 
 would not be saved again (even from the same disease), but would die off 
 according to the old rates of mortality at successive ages. Their new lease of 
 life would simply be the old expectation of life. As a matter of fact, lives now 
 lost could probably be saved, not only once, but several times. 
 
 AVe may here explain the paradox mentioned in the text — namely, that a 
 proventability of 42.3 per cent of deaths under present conditions does not imply 
 tli:it the death rate would ultimately be reduced 42.3 per cent. 
 
 The death rate would ultimately depend on conditions of the distribution 
 of ages and diseases entirely different from those now prevailing. This will 
 be clear if we think what would happen if the proventability expressed in the 
 tnl)le could be immediately applied. During the ensuing year it would be found 
 that about 42 per cent of present deaths would not occur. A consequence of 
 this, however, would be that the persons whose lives were prolonged would die 
 at a later period, since no death is absolutely prevented, but only postponed. 
 Kxcn if 100 per cent of all deaths were prevented (postponed), but the post- 
 pi mement were fo4- a very short time, the effect in reducing the death rate 
 would be extremely small. On the other hand, if only 1 per cent of the prevent- 
 able deaths were postponed for a sufhciently long time, the ultimate effect would 
 be to reduce the death rate much more than 1 per cent. After the deaths 
 which had been i)Ostponed had reentered, a new equilibrium would be estab- 
 lished. Under these new conditions the ratio of the deaths to the population 
 would not be 42.3 per cent lower than at present, but only about 25 per cent. 
 At present the average duration of life, taken from the Massachusetts table 
 for 1893-1897, is about 45 years. The ratio of proventability in the above table 
 would increase this life by about fifteen years, making it 60 years. The ratio 
 of 45 to GO, showing the increase in the life span, will be the inverse of the 
 ratio 00 to 45 in a " stationary " population, which would show the resulting 
 reduction in the death rate. This is a reduction of 25 per cent. Thus the pre- 
 .ventability of 42.3 per cent of deaths under present conditions and in the man- 
 ner indicated in the table involves a lengthening of life of 33J per cent and a 
 reduction of the death rate, after readjustment of deaths by ages, of about 25 
 per cent. 
 
 Section 4. — Error from abnormal age distribution of deaths in 1906. 
 
 The table as given is constructed for deaths occurring in the calendar year 
 [1906. Its interpretation, however, is to be made on the basis of a survivorship 
 table. In a stationary population the age distribution of deaths in any year 
 ,would be the same as in a survivorship table; but since the United States has 
 not a stationary population, this identity holds only approximately. 
 , The discrepancy accounts for the difference of one and three-tenths years in 
 'the prolongation of life, as calculated in the table and by means of the dia- 
 gram. The latter is the more correct, as it is based on a survivorship table, 
 ,or — what amounts to the same thing — on such mortality as would exist in a 
 stationary poputation. The only way in which this diagram can be vitiated 
 by the slightly abnormal age distribution of deaths in the year 1906 is as this 
 abnormal distribution affects the average ratios of proventability used in con- 
 structing the diagram. These ratios are based on column (5) of the resumg 
 of the table. The four figures from the table are adjusted by graphic interpola- 
 tion in the usual way, so as to form a continuously varying series of figures for 
 successive years of life. These ratios are in each case an average of the indi- 
 vidual ratios for particular diseases, contained in the same column (5) of the 
 larger table. The " weights " are slightly vitiated by the fact that the age dis- 
 tribution of deaths in 1906 is not the normal distribution of a stationary popula- 
 tion. It is only as the " weighting " is thus affected that the diagram can be 
 vitiated through our being forced to use the figures for 1906 instead of those 
 for an ideal stationary population, since such figures are unobtainable. The 
 .error from this source is infinitesimal, and we may depend on the results of the 
 diagram, 12.8 to 14.9 years, as practically free from any appreciable error due 
 to the use of short-cut methods. 
 
738 RI':i'ORT OF NATIONAL CONSERVATION COMMISSION. 
 
 Section 5. — Ratios of preventahility hy ages derived from ratios by diseases. 
 
 In regard to the r6sum6 containing the average ratios of preventability hold 
 Ing true during different ages, it will be observed that they are obtained indl 
 rectly, by calculating from the individual ratios of preventability for difleren 
 dif^'ases given In the table itself. Although these diseases are not absolutelj 
 limited to the times within which their median falls, there is a fairly distinc 
 line of demarcation between the groups, especially between children's diseases 
 and those of middle life. The table shows no disease with a median age o: 
 Incidence between 8 and 23 years, and tlie census table of deaths for 1906 shows 
 that a very small percentage of the total deaths occur between ages 10 and 20 
 Even if the diseases considered for the four epochs of life given in the resumi 
 did extend somewhat into the regions of the adjacent epochs, the effect wouU 
 not change the result appreciably and would be as likely to change It in on* 
 direction as the other. The reason is that the items of the column in th« 
 resume for " ratio of preventability " are obtained by dividing the figures ii 
 column 6 by those in column 4, each of these two being found by adding th« 
 individual figures in the table for each age group concerned. The extensioi 
 of diseases of an age group outside of that group will apply equally to botl 
 terms of the ratio, those in the fourth and sixth columns, and will not substan 
 tially afCect the quotient in the fifth column. 
 
 Section 6. — Alloicance for toeakness of prolonged lives. 
 
 The use In column 2 of the expectations of life derived from the Massachu 
 setts 1893-1897 life table is equivalent to the assumption that If preventable 
 deaths were prevented the lives thus saved would proceed to die off according 
 to the mortality of Massachusetts, 1893-1897. This assumes that since ISgS-lSQ'i 
 there has been no improvement in the expectation of life, and that the savec 
 lives will not share in the improvement which the table itself shows forth. Th« 
 reason that a later life table than for 1893-1897 was not used is that no latei 
 life table is available. If it were, it would show larger figures in column 2 
 and consequently a larger total result for the possible prolongation of life thar 
 fourteen years. 
 
 The reason the " expectation " in column 3 does not take account of the effect 
 of the improvement in mortality resulting from the table is that this improve- 
 ment can not be calculated until column 3 is filled, and we prefer to use as a firsl 
 approximation a conservative figure in column 3, rather than to guess at mor€ 
 likely figures. The conservative assumption used seems also advisable, because 
 of the fact that in the 42.3 per cent of persons in the life table who would bf 
 saved from death and given a new lease of life there would be suffered a greater 
 mortality than that of the average persons that now pass that age in safety, 
 for — on the principle of the survival of the fittest — it is intrinsically probabk 
 that those who now die at any age are weaker than those who do not. 
 
 How much allowance should be made for this factor of differential mortality 
 it is impossible to say with certainty. But in another paper "■ I have dealt with 
 the same question applied to tuberculosis. Taking the figures of Dr. LawrasoD 
 Brown, giving the mortality experience among the apparently cured cases ol 
 tuberculosis discharged from the Adirondack Cottage Sanitarium, and making 
 certain allowances, it seems that if tuberculosis were prevented its present vic- 
 tims would have more than three-fourths of the expectation of life belonging to 
 others. Let us assume that this ratio is equally conservative as applied to all 
 other cases of prolongable life. Now, it so happens that the expectation of life 
 at birth in the Massachusetts life table of 1893-1897 is almost exactly three- 
 fourths of the expectation which our table and diagram shows would be possible 
 if prevention were properly practiced. This would give 45 years as the expecta- 
 tion of life at birth for the saved lives, 01 for other lives, and 59 for all lives. 
 Surely this seems sufficient allowance for the existence of any possible inferior- 
 ity among the lives which would be saved. 
 
 Section 7. — Diagram "Possible I," making this alloicance, compared with "Possible II," 
 
 omitting it. 
 
 If no allowance for inferiority among saved lives were necessary, the results' 
 of the calculation given in the table would be only a first approximation and 
 
 « "The cost of tuberculosis in the United States and its reduction," read before 
 the International Congress on Tuberculosis, 1908. 
 
nsuEB.l NATIONAI. VITALJTT. 739 
 
 would need to be followed by successive and closer approximations. We can get 
 much quicker results by means of the diagram and a planimoter. 
 
 If we apply the ratios of preventability for these four groujis, we are able to 
 construct the new survivorship table on the basis of Mr. Abbott's for 18D:'.-1S97. 
 AH that is necessary is to begin the new survivorship table at the same point 
 that the old begins, and continue from that point and every other point lli rough- 
 out Its course by the following procedure : Through the point draw a Hue down- 
 ward and to the right for one year, at the same percentage slope as Abbott's 
 table shows for that year. This line indicates what survivors there would be if 
 their mortality were not affected at all by the ratio of preventability. The 
 deaths during that year would be represented by the drop of the curve within 
 the year. Next, taking the proper fraction of this drop, as indicated by the 
 ratio of preventability, we pass vertically upward this amount from the end of 
 the line, and from the new point so obtained proceed in like manner for each 
 subsequent year. The result is a series of teeth the upper points of which are 
 points on the required curve. Joining these points, we obtain the curve. This 
 process explains the theory. This gives the table called " Possible I," and takes 
 full account of the fact that the ratios of preventability continue to apply to 
 saved life as much as to other life. The table " Possible I " represents the sur- 
 vivorship table, under the assumption that the lives saved once are given no 
 further advantages, but follow thereafter the old law of mortality, that for 
 1S93-1S97. 
 
 Section 8. — Reciprocal relation between longevity and mortality shown by diagram. 
 
 We may take this opportunity to explain, for the benefit of the general reader, 
 the reciprocal relations existing between the death rate in a stationary popula- 
 tion and the average duration of life. Consider the diagram " Massachusetts, 
 1S!)3-1S97." It shows the life history of 100,000 persons born. Let us suppose 
 a community unaffected by emigration or immigration, and in which there are 
 100,000 births each year. Let us suppose, further, that the 100,000 persons born 
 each year die afterwards according to the law of mortality represented by the 
 curve " Massachusetts, 1S93-1S97." Evidently in such a community there will 
 not only be 100,000 births, but there will be 100.000 deaths each year, and the 
 population will be stationary. It will also be true that the same diagram can 
 be taken to represent the age distribution of this stationary population. Thus, 
 those living at age 10 will be the survivors of the 100,000 born ten years ago, 
 " and the number of such survivors is the ordinate of the curve at 10 years. 
 Thus, every ordinate of the curve represents not only the survivors to a certain 
 age out of 100,000 births, but also represents the number In the population at 
 that age. The area of the curve therefore represents total population (when 
 regarded as made up of vertical sections). It likewise represents the total 
 number of years lived by 100,000 persons (when regarded as made up of hori- 
 zontal sections). Now, the death rate is the ratio of deaths to population — i, e., 
 t!ie ratio of 100,000 to the area of the curve. The average duration of life is 
 the total years lived by 100,000 persons divided by 100,000 — that is, it is the 
 area of the curve divided by 100,000. These are clearly reciprocals. 
 
 Chapter XII. — The money value of increased vitality. 
 Section 1. — Money appraisal of preventable wastes. 
 
 Estimates of the money value of preventable wastes depend on the 
 valuation of human life, of which several appraisals have been 
 attempted. 
 
 Prof, J. S. Nicholson estimated that in Great Britain human labor 
 capitalized was worth five times all other capital." 
 
 Engel computed that each child costs 100 marks at birth, 110 marks 
 the first year, 120 the second, and so on. At 20 he will have cost 
 2,310 marks, or $560. But one-half die before 20. Hence each per- 
 son who reaches the age of 20 actually costs society much more than 
 $5G0; possibly as high as $1,000, if Engel's estimates are correct. 
 Professor Mayo-Smith estimated that men and women between the 
 
 " See " The Living Capital of the United Kingdom," (British) Economic 
 Journal, 1891. 
 
740 
 
 REPORT OF NATIONAL. CONSERVATION COMMISSION. 
 
 ages of 15 and 45 averaged $1,000 in value.* As to the value of immi- 
 grants to this country, he says: "Every immigrant must represent 
 labor value with at least the value of a slave. It is figured that each 
 innnigrant is worth $875." * 
 
 The best method of estimating the economic value of life and ita 
 increased duration is by the capitalization of earning power. Dr. 
 William Farr, of England, has estimated that a baby born to an 
 English agricultural laborer is worth in capitalized earning power 
 about £5, or $25. This is the discounted value of its future earnings 
 estimated on its probable life loss the discounted value of the cost 
 of rearing it during the period of dependence and of maintaining 
 it when helpless through old age. In the same way he estimates the 
 value of a life at other ages — 10 years, 20 years, 50 years, etc.*' 
 
 In lieu of any estimates for the United States we may take Farr's 
 figures for agricultural laborers as representing, roughly, the rela- 
 tive worth of a man or woman in the United States. To obtain the 
 absolute figures, therefore, we need simply to multiply these of Farr 
 by a constant factor representing the ratio between the average earn- 
 ings in the United States and the earnings which Farr uses as the 
 yearly income of an agricultural laborer. 
 
 AVe take, in the absence of any good statistics, $700 per annum as 
 a guess, but a safe minimum'* for the average earnings of workers of 
 all grades, from day laborers to railroad presidents. This assumes 
 that all of the working years are actually employed in work. But 
 since about one- fourth of the persons of working age are not workers, 
 but are supported (for the most part) by earnings of capital, the 
 average should be cut down to three-fourths of this figure, or $525. 
 
 Substituting this figure for the £31 in Farr's table, we can recon- 
 struct it to represent the minimum worth of the average American 
 life at different ages. The following figures are taken from the 
 table thus computed : 
 
 Age. 
 
 Net 
 
 worth of a 
 
 person, in 
 
 dollars. 
 
 Age. 
 
 Net 
 
 worth of a 
 
 person, in 
 
 dollars. 
 
 
 
 90 
 
 30 
 
 4,100 
 
 5 
 
 950 
 2, 000 
 
 50 
 
 2,900 
 
 10 
 
 SO 
 
 -700 
 
 20 
 
 4,000 
 
 i 
 
 
 
 
 From the table from which these figures are taken it is possible to 
 base minimum estimates for (1) the average economic value of the 
 inhabitants of the United States by using the census figures for age 
 
 " Mayo-Smith, Statistics and Sociology, p. 177. 
 
 ^ Mayo-Smith, Emigration and Immigration. 
 
 c See Farr, " Vital Statistics," p. 536. 
 
 ^ See Fisher " Cost of tuberculosis," read before the International Congress 
 on Tuberculosis, Washington, 1908. This is the estimated minimum used in 
 my paper on the " Cost of tuberculosis." The calculntions are based on $1 a 
 day as the ordinary minimum enrnings of unskilled labor, and assume a dis- 
 tribution of a number of earnei-s of high amounts according to the scale of 
 distribution which Professor Pareto finds fairly uniform in form, although not 
 In amount in various countries. The late Honorable Carroll D. Wright, whose 
 opinion was worth more, prohnlily. than that of any other man in the United 
 Stales, stated that he would not regard $1,OUO as excessive. The figure is 
 intended to include the earnings of women (including housewives as earners). 
 
usiiEo.] NATIONAL. VITALITY. 741 
 
 distribution of population; this calculated average is $2,900; (2) the 
 average economic value of the lives now sacrificed Iby jireventable 
 deaths, using the age distribution of deaths, and the percentages of 
 pieventability; this calculated average is $1,700. 
 
 The first figure shows that what might be called the vital assets of 
 the United States for the population of over 85,500,000, as estimated 
 by the census of 1907, amount in value to 85,500,000X$2,900, or 
 $250,000,000,000, which, though a minimum estimate, greatly ex- 
 ceeds the value of all other wealth ; " the second figure enables us to 
 estimate the needless waste of our vital assets. 
 
 If we take the estimate of Professor Willcox of the death rate in 
 the United States, as at least 18 per 1,000 for the 85,500,000 persons 
 estimated by the census as the population of the United States in 
 1907, we have 1,500,000 as the number of deaths in the United States 
 per annum. Of these 1,500.000 deaths, 42 per cent, or 630,000, are 
 annually preventable or postponable. Since each postponement 
 would save on the average $1,700, the national annual unnecessary 
 loss of capitalized net earnings is 630,000X$1,700, or $1,070,000,000, 
 or about $1,000,000,000. 
 
 "We saw in Chapter III that, with our present population, there 
 are always about 3,000,000 persons in the United States on the sick 
 list. For the most part these persons are older than the average. 
 Farr gives a table * showing that morbidity increases with age in 
 geometric progression. By means of his table we may calculate on 
 the same basis as the previous calculations — that of the 3,000,000 
 sick, very close to a third, or 1,000,000 persons, are in the working 
 period of life. Assuming that average earnings in the working 
 period are $700, and that only three-fourths of the one million poten- 
 tial workers would be occupied, we find over $500,000,000 as the mini- 
 mum loss of earnings. 
 
 The cost of medical attendance, medicine, nursing, etc., is con- 
 jectured by Doctor Biggs in New York to average for the con- 
 sumptive poor at least $1.50 per daj^ of illness. The cost per day of 
 other illnesses than tuberculosis is presumably greater, and also the 
 cost per day for other classes is higher than for the poor. Applying 
 this to the 3,000,000 years of illness annually experienced, we should 
 have $1,500,000,000 in all as the minimum annual cost of this kind. 
 
 The statistics of the Commissioner of Labor '^ show that the average 
 expenditure for illness and death amount to $27 per annum. This 
 is for workingmen's families only. But even this figure, if applied 
 to the 17,000,000 families of the United States, would make the total 
 bill for caring for illness and death $460,000,000. The true cost may 
 well be more than twice this sum. Certainly this estimate is more 
 than safe and is only one-third of the sum obtained by using Doctor 
 Biggs's estimate. 
 
 The sum of the costs of illness, including loss of wages and cost of 
 care, is thus $460,000,000-f$500,000.000, or $960,000,000. 
 
 The above estimate is a general one for all illness. It would be 
 possible to offer figures for the particular losses from particular dis- 
 
 " Mr, Le Grand Powers, of the Bureau of the Census, Washington, estimates 
 that the total wealth in America (exclusive of human beings) amounts to 
 §107,000,000,000. 
 
 ''Vital Statistics, p. 510. 
 
 « Eigbicontli Annual Report, 1903, p, 509. 
 
742 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 eases. Thus, from tuberculosis, the gross loss of earnings by illness 
 and of potential earnings cut off by death, together with the expenses 
 of illness, etc., amount to over $1,000,000,000 per annum." 
 
 Of the sum mentioned, the loss to the consumptives themselves 
 amounts to over $660,000,000, leaving $440,000,000 as the loss to other 
 members of the community. At least three- fourths of these costs 
 are preventable. Dr. George M. Kober thinks it is conservative to say 
 that the annual cost of typhoid in the United States is $350,000,000* 
 and Dr. L. O. Howard believes that malaria alone costs the country 
 $100,000,000 annually, and the insect diseases generally $200,000,000.0 
 Pie points out that one great item of loss is the reduced value of real 
 estate in malarial regions. By drainage and destruction of mos- 
 quitoes most of this waste could be saved. The cost of the care of the 
 insane and feeble-minded is estimated by Charles L. Dana at $85,- 
 000,000 annually.** What fraction of these costs is preventable it is 
 difficult to say. The economic loss due to alcohol has been variously . 
 estimated.* Of the billion dollars or more found to represent the cost . 
 of illness, by far the major part is certainly avoidable. This is the 
 belief of the best observers, such as Doctor Gulick, Doctor Kellogg, 
 Mrs. Richards, Doctor Anderson, and others. Unfortunately there 
 are no exact statistics of preventability. We feel safe, however, in 
 concluding that at least half a billion could be saved from the pres- 
 ent cost of illness. This, added to the loss by preventable deaths 
 of potential earnings of a billion, gives at least a billion and a half 
 of preventable waste. This does not include the losses from inef- 
 ficient work due to drunkenness or other vicious habits; nor does 
 it include the cost of " undue fatigue," which we have some reason 
 to believe exceeds in its effect on efficiency the loss from illness. But 
 it would not be possible to state this loss in any definite or convincing 
 figures. 
 
 The actual economic saving annually possible in this country by 
 preventing needless deaths, needless illness (serious and minor), and 
 needless fatigue, is certainly far greater than one and a half billions, 
 and may be three or more times as great. 
 
 Dr. George M. Gould estimated that sickness and death in the 
 United States cost $3,000,000,000 annually, of which at least a third 
 is regarded as preventable.^ 
 
 The trouble is the public does not believe in this waste from being " just 
 poorly," and " so as to be about." It has no conception of the difference 
 between working with a clear brain and steady hand and with a dull and 
 nerveless tool. They must be convinced somehow.* 
 
 ° See Irving Fisher : " Cost of Tuberculosis in the United States, aiad its 
 Retluction." 
 
 ''See his "Conservation of life and health by improved water supply," read 
 before the White House Conference of Governors, 190S. 
 
 " Keport to Conservation Commission on " Economic loss to the people of the 
 United States through insects that carry disease." 
 
 <* See " Psychiatry in its relation to other sciences," by Charles L. Dana, before 
 the section on psychiatry at the International Congress of Arts and Sciences, 
 St. Louis, September, 1904. 
 
 « " Economic aspects of the liquor problem." An investigation made for the 
 Commitlee of Fifty, under the direction of Henry W. Farnam, secretary of the 
 economic subcommittee, 1899, 327 pages. 
 
 f " Disease and Sin," American Medical Journal, August 31 and September 
 7, 1901. 
 
 Letter from Ellen H. Richards. 
 
FisHEH.J NATIONAL VITALITY. 743 
 
 Section 2. — The cost of conservation. 
 
 It costs no more to " raise " a man capable of living for 80 years than It does 
 to " grow " one who has not the capacity of living to be 40 years old.** 
 
 We have seen how much potential value of life is now allowed to 
 be wasted which could be prevented. But the question remains, What 
 would it cost to conserve it? It is, of course, not possible to answer 
 this question definitely and fully. The best we can do is to point out 
 specific instances of the health returns which follow on investments 
 in the improvement of vital conditions. 
 
 The following examples will show the returns which may be ex- 
 pected from well-planned expenditures on behalf of public health: 
 
 The city of Pittsburg is just installing a great municipal filter plant for the 
 purification of its principal water supply, at an expense of upward of $7,000,000. 
 It is reasonable to estimate that in a year or two this should eflect a saving of 
 100 deaths a year from typhoid fever, for the number of typhoid-fever deaths 
 of late years has been 400 or more yearly. Valuing these lives at $5,000 each, 
 as is customary, the saving effected by the purification works should be half a 
 million dollars' worth of human life annually, making the building of the filter 
 a sound and profitable economic as well as humanitarian measure. But if, as 
 Mr. MacXutt and I have shown, Hazen's theorem is true, then for every 100 
 deaths saved from typhoid fever at least 200 will be saved from other causes, 
 which means at least $1,000,000 more saved to the city of Pittsburg annually of 
 its present waste of human life.* 
 
 England reckons that the lives saved through the lowered death rate, from 
 iwhat it was between 1SG6 and 1S75 to what it became in the period reaching 
 from ISSO to 1889, amounted to 858,804. This represents on the English basis 
 of the per capita valuation of each life ($770) a social capital of $650,000,000 
 saved. In ten years England has more than regained the sum spent in fifteen 
 years for sanitary improvements, though the average annual expenditure has 
 been $42,000,000.*^ 
 
 The achievement of Huddersfield, England, is especially noteworthy. The 
 average number of deaths of infants for ten years had been 310. By a system- 
 atic -education of mothers the number was in 1907 reduced to 212. The cost of 
 saving these 98 lives was about $2,000.<* 
 
 A saving of infant life is recorded by Doctor Chapin in Providence : 
 
 We attempted for two years to distribute clean milk to the babies of the poor, 
 but this year we decided that the money could better be spent on trained 
 nurses. Thus far we have expended about $900 for this purpose. Two hundred 
 and thirty-five sick children, of whom very many were very sick, have been 
 cared for. Of these only 20 have died. From a study of our statistics I should 
 ! judge that the reduction in infant mortality effected by the nurses was at least 
 ' 25 deaths, and it may be that as many as 40 lives were saved.^ 
 
 At the funeral of Maj. Walter Eeed, the man who did so much to 
 prove the correctness of Doctor Finley's discovery that the mosquito 
 is the carrying agent for the yellow-fever germ, Gen. Leonard Wood 
 
 "T. S. Lambert: " Sources of Longevity," New York, 1869, p. 6. 
 
 &W. T. Sedgwick: "The call to public health," Science, 1908, p. 198. 
 
 Since the foregoing was written, there has appeared in " Charities," Februai-y 
 6, 1909, " Thirty Five Years of Typhoid " by Frank E. Wing, in which it is shown 
 ' that there were in 1907, in Pittsburg, 4,921 cases of typhoid, of which 622 died; 
 and that the co.st per patient, irrespective of the lives lost, was $128, making the 
 cost for the city $694,000. Reckoning $4,000 as the value of each life lost, 
 the total annual money cost from typhoid in Pittsburg is over $3,000,000, and, 
 according to Hazen's theorem, already mentioned, this is probably not one-half 
 nor even one-third of the total. 
 
 <* Ditman, loc. cit., p. 4. Taken from M. G. Dana ; " Itesults of municipal 
 sanitation," Annals of Hygiene, 1896, Vol. II, p. 391. 
 
 ^ Letter from Dr. Charles V. Chapin, 
 
 • Ibid. 
 
744 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 declarcfl that this di=cnvcry is saving more lives annually than were 
 lost in the Cuban war, and that it is saving the commercial interests 
 of the world a greater financial loss each year than the cost of the 
 entire Cuban war." 
 
 As to what the stamping out of yellow fever means, in money 
 terms, the following is significant: 
 
 It has been estimated that the yellow fever epidemic of 1878 invaded 132 
 towns, caused a mortality of 15.9.14 persons, and that the pecuniary loss to tho 
 country was not less than $100,000,000 in gold.* 
 
 Tlie economic loss to Philadelphia, caused by the smallpox epidemic 
 of 1871-72, has been estimated by Doctor Lee at $22,000,000. This in- 
 cludes loss to travel and traffic on railroads, loss to hotel keepers, 
 merchants, and manufacturers, cost of care of sick, loss of time, and, 
 the expense of burial. A vaccine bureau with physicians, a disinfect- 
 ing station, and the inauguration of a campaign of education capable 
 of forestalling the wliole epidemic would have cost $700,000.^ 
 
 It is reported that San Francisco plans an investment of $30,000,- 
 000 in stone and concrete quays to prevent rodents from infecting the 
 city, and this is regarded by experts as worth while many times over. 
 
 In respect to hook-worm disease, rating the earning per diem of the 
 southern farm laborer at 75 cents, 28 observers report that average 
 laborers infected with hook-worms earn 40 cents per diem. Ten ob- 
 servers having cotton-mill practice report unanimously that the 
 disease is very prevalent among cotton-mill laborers, and rating the 
 average mill laborers at $1.50 per diem, they consider 75 cents as a 
 fair rating for hook-worm bearing laborers.'* 
 
 It would be difficult to even roughly estimate the cost of this disease to the 
 South, but from wlint we Icnow of it in this State I woulci say that it costs South 
 Carolina not less than $30,000,000 per year, and this inability to perform regular 
 and efiioient labor is the smallest part of the cost.® 
 
 It has been figured that the hook-worm disease of the South could 
 be wiped out within a generation f through the expenditure of from 
 one to two millions of dolhirs by federal and state agencies. It costs' 
 about 15 to 75 cents (wholesale) for drugs to cure a case of hook 
 worms. In three months the quantity of red corpuscles in the blood 
 can easily be increased 10 to 50 \y^v cent, according to the severity of 
 the case, and the* absenteeism of the victims could easily be reduced 
 25 per cent. 
 
 Another noteworthy result of well-directed sanitary effort is the reduction of i 
 hook-worm disease in Torto Rico. As you are doubtless aware, this disease 
 causes a ti-emendous lowering of the physical efficiency of the people of thati 
 island. As you may see by the report of the special commission for 3906 and 
 1907 made to Governor Post, 89,000 people were treated, and for the mosti 
 part cured, for 54 cents each.'' 
 
 <» Ditman, loc. cit, p. 12. 
 
 * Walter Wyman, M. D., "Quarantine and Commerce," address before Cincin-; 
 nati Commercial Club, October 15, 1898, p. 8. 
 
 '^ Ditman, loc. cit, pp. 8-10, from Bissell, A Manual of Hygiene. 
 
 ^ Letter from Dr. W. J. Burdell. 
 
 « William Weston, "Uncinariasis," South Carolina Medical Association, 1908, 
 p. 8. 
 
 ^ Dr. Charles W. Stiles, of the United States Public Health and :\larine-Hos-i 
 pital Service, who has studied the hook-worm disease more thoroughly than any 
 one else In the country. 
 
 Letter from Doctor Stiles. 
 
 * Letter from Charles V. Chapin, 1908, 
 
nsHER.] NATIONAL. VITALITT. 745 
 
 Medical inspection in our schools also returns large dividends on 
 small investments. 
 
 Using these duta as a basis, we have the annual expenditure for medical 
 Inspection of ^345,135 in those cities from which we have succeeded in obtain- 
 ng data. It seems probable, although this is frankly a guess, that the total 
 annual expenditure for medical inspection of schools in the United States at 
 :lie present time is perhaps $500,000." 
 
 The money saved by enabling thousands of children to do one year's work in 
 me year, instead of in two or three years, would greatly exceed the total 
 sxpense of examining all school children in all boroughs.* 
 
 Doctor Jessen has shown that the cost of a school dental clinic in 
 Grermany is only one mark per year per child." The cost saved must 
 be very many times this sum. Dr. Herbert L. Wheeler, of New 
 York, estimates that the Children's Aid Dental Clinic in New York 
 
 ;ost $342 for the last fiscal year (35 cents per operation and 70 cents 
 per ciiild treated) . He reckons that the neglect of these slight repairs 
 «70uld later have cost far more in dentistry, as well as over $2,000 
 worth of lost time. These losses are of course of minor importance 
 
 ompared with the pain, inconvenience, and secondary effects on 
 lealth and efficiency which are inevitably associated with bad teeth. 
 
 Mr. Edwin Chadwick, who was once secretary of the English Na- 
 ional Board of Health, stated that a sanitary "engineer ought to 
 
 ontract for the reduction of the sickness and death rate, in such a 
 ';ity as Glasgow, by at least one-third, for a penny a head of the 
 
 ntire population." ^ 
 
 It is necessary, if we are to do our utmost, to spend a thousand pounds of 
 public money on this task where we now spend one pound. It would be rea- 
 sonable and wise to expend ten million pounds a year of our revenues on the 
 nvestigation and attempt to destroy disease. Actually what is so spent is a 
 nere nothing, a few thousands a year. Meanwhile our people are dying by 
 :housands of preventable disease.* 
 
 Mr. Hiram J. Messenger, actuary of the Travelers Insurance Com- 
 3any, of Hartford, has constructed and sent me a table showing that 
 ife insurance companies could probably make money now by taking 
 A hand in the public-health movement, with the purely commercial 
 )bject of reducing their death losses. He says: 
 
 This table shows that if the companies were to expend $200,000 a year for 
 Jiis purpose and as a result should decrease their losses by the almost insig- 
 lificant amount of twelve one-hundredths of 1 per cent, they would save enough to 
 !Over the expense. If such a plan as this were placed on a purely scientific basis 
 ind carried out by good business methods and all the companies pulled together 
 !or the common good, I should expect a decrease in death claims of more than 1 
 )er cent. And a decrease in death claims of 1 per cent would mean that the 
 •ompanies would save more than eight times as much as they expended or would 
 uake a net saving of more than seven times the expense — which would be about 
 I million and a half dollars a year. 
 
 The examples given show tangible returns on the investment of sev- 
 eral thousand per cent as a rule. AVliile it would be impossible to 
 
 " Letter from Dr. Luther H. Gulick. 
 
 ^ Sixty-third Annual Report of the Association for Improving the Condition of 
 he Poor, New York, 1906. 
 
 <^ See "Jahresbericht der Stadtischen Schulzahnklinik in Strassburg," in 
 )dontologische Bliitter 12, No. 15-16, 1907. 
 
 '^ Transactions of the British Social Science Association, 1866, p. 580. Quoted 
 )y Dr. Edward Jarvis, Political Economy of Health, Fifth Report, Mass. Board 
 )f Health, 1874, p. 367. 
 
 »E. Kay Laukester, "The Kingdom of Man," New York (Holt), 1907, p. 148. 
 
746 REPORT OF NATIONAL. CONSERVATION COMMISSION. 
 
 state in general terms how rich a return lies ready for public or pri- 
 vate investments in good health, the foregoing examples and numer- 
 ous others show that the rate of this return is quite beyond the dreams 
 of avarice. Were it possible for the public to realize this fact, motives 
 both of economy and of humanity would dictate immediate and gen- 
 erous expenditure of public moneys for improving the air we breathe, 
 the water we drink, and the food we eat, as well as for eliminating 
 the dangers to life and limb which now surround us. 
 
 Chapter XIII. — The general value of increased vitality. 
 Section 1. — Disease, poverty, and crime. 
 
 In the preceding chapter we have attempted to estimate in money 
 the preventable wastes from disease and death. Although the figures 
 for national losses strike the popular imagination, they have little 
 significance ; in fact, money estimates in this field, even when made on 
 the per capita basis, are of little value except as emphasizing the 
 overwhelming importance of human vitality compared with those 
 interests which are usually measured in money. It is impossible in 
 any true sense to measure human life in terms of dollars and cents." 
 
 The measure of life ma}^ perhaps be found in hapjDiness, or the 
 satisfactions enjoyed between birth and death, less the dissatisfactions. 
 
 Is life worth living? has been a much asked question, especially since 
 Mr. Mallock wrote a book with that title. The witticism sometimes 
 given in answer, " That depends upon the liver," is true in both of its 
 two meanings. A life of happiness is always worth living, and a life 
 of usefulness, which brings happiness to others, is doubly worth 
 living. 
 
 It is hardly necessary to recount all the conditions which tend to 
 produce happiness. No one would question that the most funda- 
 mental condition of all is health, in spite of exceptional cases in which 
 unhealthy people are found happy, and healthy people unhappy. It 
 would be impossible to express in exact terms the extent to which im- 
 proved health could increase human happiness; but every observer 
 of human misery among the poor reports that disease plays the lead- 
 ing role. Students of criminology and vice agree that these are 
 chiefly the result of morbid conditions and habits. Health reform 
 brings in its train great and lasting reductions in poverty, criminality, 
 and vice. 
 
 We began this report by showing the relation between the conser- 
 vation of health and the conservation of wealth. The broadest view 
 of this relation is, as Emerson has said, that "Health is the first 
 wealth," and as such it is treated by many economists.^ 
 
 " Even as a measure of what economists call *' utility," a money estimate is' 
 misleading, for the reason that the " marginal utility " of money varies with 
 different i)ersons. For instance, a week's wages of $10 lost to a poor wage- 
 earner is in such an estimate counted on a par with an expenditure of $10 by 
 a wealthy invalid for a dainty morsel of food, although the loss in "utility" 
 to the former is vastly greater than that to the latter. 
 
 * Among those who have included health in the category of wealth are! 
 Davenant, Petty, Canard, Say, McCullough. Roscher, Wittstein, Walras, Engel,' 
 Weiss, Dargun, Ofner, Nicholson, and Pareto. See Irving Fisher: "The Nature 
 of Capital and Income," New York (Macmillan), 1906, p. 5. 
 
IIS HER.] NATIONAL VITALITY. 747 
 
 Without enlarc-ing or insisting upon this concept, it is obvious that 
 by the conservation of health we may ultiniatoly save billions of 
 dollars of wasted values, and that this conservation is intimately 
 related to conservation of all other kinds." 
 
 We have alread}' seen the vicious circle set up between poverty and 
 disease, each of which tends to produce the other. Metchnikoff '' con- 
 tends that health and morality are correlative, if not interchangeable, 
 tin-ms. A similar idea has been elaborated statistically by Dr. George 
 JNI. Gould.^ The subject is worth much further study. National 
 efficiency is crippled by any one or all of the parts of the vicious 
 circle — disease, poverty, vice, vagabondage, crime. It would be 
 interesting to study the tramp problem, which represents an enor- 
 mous waste of labor power, in relation to all these phenomena. 
 
 Section 2. — Conservation of natural resources. 
 
 It is also true that health begets Avealth, and vice versa. Whatever 
 diminishes poverty or increases the physical means of welfare has the 
 improvement of health as one of its first and most evident effects. 
 Therefore an important method of maintaining vital efficiency is to 
 conserve our natural resources — our land, our raw materials, our for- 
 ests, and our water. Only in this way can we obtain food, clothing, 
 'shelter, and the other means of maintaining life. Conversely, the 
 conservation of health will tend in several ways to the conservation 
 of wealth. First of all, the more vio-orous and lonff-lived the race, 
 the better utilization can it make of its natural resources. The labor 
 power of such a race is greater, more intense, more intelligent, and 
 more inventive. 
 
 The development of our natural resources in the future will be 
 more dependent on technical invention ^ than upon the mere abun- 
 dance of materials. 
 
 Just as in warfare it is not so much the gun as the man behind 
 the gun that makes for success, so in industr}^, as Doctor Shadwell ® 
 has shown, skill, knowledge, and inventiveness are the chief factors 
 in determining commercial success and supremacy. The backward 
 nations, like China, are characterized by lack of modern inventions. 
 The nations which are industrially most advanced have the ^ailwa3^ 
 'the steamship, the power loom, metal working, and innumerable arts 
 and crafts. The change of Japan from a backward to a forward 
 nation is at bottom the introduction of inventions. If conservation 
 prevents lessened fertilit}^, invention makes two blades of grass grow 
 where one grew before. 
 
 Future industrial competition will be increasingly a contest of in- 
 vention. The world rivalry to develop the best system of wireless 
 telegraphy or the best airships is but one example. The future will 
 see the greatest strides taken by the nation which is the most invent- 
 
 "See Edward Devine, "Efficiency and Relief," New Yoric (Mncmillan). 1006. 
 
 * " Prolongation of Life," p. 318. 
 
 <^ " Disease and sin," American Medical Journal, Aug. 31 and Sept. 7, 1901. 
 
 ^ Since the above was written. President Charles S. Howe, of Cleveland, has 
 ^presented this point in detail. See "The function of the engineer in the cou- 
 i serration of the natural resources of the country," Science, Oct. 23, 1908. 
 
 « Arthur Shadwell in his admirable "Industrial Efficiency" (2 vols.). Lon- 
 lon (Longmans), 190G. 
 
 S. Doc. 419, 61-2 9 
 
748 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 ive. Kow, the primary condition of invention is vitality, a clea 
 brain in a normal body. It is no accident that Edison is a healtl 
 culturist, or that Krupp, Westinfjhouse, and other pioneers in Indus 
 trial development have been men of vigor of mind and body. 
 
 Finally, the conservation of health will promote the conservatioi 
 of other resources by keeping and strengthening the faculty of fore 
 sight. One cause of poverty in the individual and the nation is lac] 
 of forethought." 
 
 One of the first symptoms of racial degenerac}' is decay of fore 
 sight. Normal, healthy men care for and provide for their descend 
 ants. A normal, healthy race of men, and such alone, will enac 
 tlie laws or develop the public sentiment needed to conserve natura 
 resources for generations yet unborn. AMien in Rome foresigh 
 was lost, care for future generations practically ceased. Physica 
 degeneracy brought with it moral and intellectual degeneracy. In 
 i-tead of conserving their resources the spendthrift Romans, from th; 
 emperor down, began to feed on their colonies and to eat up theii 
 capital. Instead of building new structures they used their olc 
 Coliseum as a quarry and a metal mine.'' 
 
 The problem of the conservation of our natural resources is there 
 fore not a series of independent problems, but a coherent all-embra 
 cing whole. If our nation cares to make any provision for its grand 
 children and its grandchildren's grandchildren, this provision mus' 
 include conservation in all its branches — but above all, the con^ervai 
 tion of the racial stock itself. 
 
 Chapter XIV. — Things which need to he done. 
 Section 1. — Eniaucration of piincipal measures. 
 
 In order that American vitality may reach its maximum devel- 
 opment, many things need to be done. Among them are the fol- 
 lowing: 
 
 1. The National Government, the States, and the municipalities 
 should steadfastly devote their energies and resources to the protecj 
 tion of the people from disease. Such protection is quite as properlj 
 a governmental function as is protection from foreign invasion, froir 
 criminals, or from fire. It is both bad policy and bad economj 
 to leave this work mainly to the weak and spasmodic efforts ol 
 cltarity, or to the philanthropy of physicians. 
 
 2. The National Government should exercise at least three public 
 lioalth functions: First, investigation; second, the dissemination o: 
 information; third, administration. 
 
 It should remove the reproach that more pains are now taken t( 
 protect the health of farm cattle than of human beings. It shoul(] 
 |)i()vide more and greater laboratories for research in preventive 
 medicine and public hygiene. Provision should also be made fo? 
 better and more universal vital statistics, without which it is impos^ 
 sible to know the exact conditions in an epidemic, or, in general, 
 the sanitary or insanitary conditions in any part of the countrjj 
 
 "See Irving Fisher: "The Rate of Interest," New York (Macniillan), 1007 
 ft See John Rae : "Sociological Theory of Capital," edited by Prof. C. W 
 Mixter, New York (Macmilluu), 1905. 
 
risHEB.] NATIONAL VITALITY. 749 
 
 It should aim, as should state and municipal Ipirislation, to procure 
 adequate registration of births, statistics of which are at present 
 lacking throughout the United States. 
 
 The National Government should prevent transportation of dis- 
 ease from State to State in the same way as it now provides for 
 foreign quarantine and the protection of the nation from the impor- 
 tation of disease by foreign immigrants. It should provide for the 
 protection of the passenger in interstate railway travel from infection 
 by his fellow-passengers and from insanitary conditions in sleeping 
 3ars, etc. 
 
 It should enact suitable legislation providing against pollution of 
 interstate streams. 
 
 It should provide for the dissemination of information in regard 
 to the prevention of tuberculosis and other diseases, the dangers of 
 impure air, impure foods, impure milk, imperfect sanitation, ventila- 
 tion, etc. Just as now the Department of Agriculture supplies 
 : specific information to the farmer in respect to raising crops or live 
 1 stock, so should one of the departments, devoted principally to health 
 i and education, be able to provide every health officer, school-teacher, 
 ; employer, physician, and private family with specific information in 
 rcirard to public, domestic, and personal hygiene. 
 
 It should provide for making the national capital into a model 
 
 sanitary city, free from insanitary tenements and workshops, air 
 
 pollution, water pollution, food pollution, etc., with a rate of death 
 
 i and a rate of illness among infants and among the population gen- 
 
 ! jrally so low and so free from epidemics of typhoid or other diseases 
 
 as will arouse the attention of the entire country and the world. 
 
 There should be a constant adaptation of the pure-food laws to 
 changing conditions. Meat inspection and other inspection should be 
 30 arranged as to protect not only foreigners, but our own citizens. 
 The existing health agencies of the Government should be concen- 
 trated in one department, better coordinated, and given more powers 
 and appropriations. 
 
 3. State boards of health and state legislation should provide for 
 the regulation of labor of women, should make physiological condi- 
 tions for women's work and prevent their employment before and 
 after childbirth; should regulate the age at which children shall be 
 employed, make reasonable regulations in regard to hours of labor 
 and against the dangers in hazardous trades, and especially against 
 the particular dangers of dust and poisonous chemicals; should make 
 regulations for sanitation and provide inspection of factories, schools, 
 asylums, prisons, and other public institutions. AVhere municipalities 
 have not the powers to enact the legislation above mentioned with 
 reference to local conditions, the necessary legislation or authority 
 should be provided by the State. Or where by reason of the small 
 I size of the town no efficient local action is possible, the State should 
 ' exercise the necessary functions. It should in such cases advise and 
 supervise local boards of health. It should have an engineering de- 
 partment and advise regarding the construction of sewers and water 
 supplies. Pollution of such supplies, unless entirely local, should be 
 prevented by the State, which should be equipped with laboratories 
 for the analysis of water, milk, and other foods. Suitable legislation 
 should be passed regulating the sale of drugs, especially preparations 
 
750 REPORT OF NATIONAL CONSERVATION COMMISSION. 
 
 contiiininnr cocaine, opium, or alcohol. Legislation — not too far in 
 advance of public sentiment needed to enforce it — should be passed 
 regulating the sale of alcoholic beverages. State registration of 
 births, deaths, and cases of illness should be much more general and 
 efficient than at present. 
 
 4. Municipal boards of health need to have more powers and 
 greater appropriations; less political interference and better trained 
 health oflicers; more support in public opinion. Their ordinances in 
 regard to expectoration, notification of infectious disease, etc., should' 
 be better enforced by the police departments. 
 
 More legislation should be advocated, passed, and enforced to 
 the end that streets may be kept clean, garbage jiroperly removed, 
 sewage properl}'^ disposed of, air pollution of all kinds prevented, 
 vrhether by smoke, street dust, noxious gases, or any other source. 
 Noises also should be lessened. 
 
 Municipalities need also to take measures to prevent infection being 
 carried by flies, mosquitoes, other insects and vermin, and by prosti- 
 tution. They need to guard with greater care the water supply, and 
 in many cases to filter it; they should make standards for milk pu- 
 rity and enforce them; they should also regularly inspect other foods 
 exposed for sale; provide for sanitary inspection of local slaughter- 
 houses, dairies, shops, lodging and boarding houses, and other estab- 
 lishments within the poAver of the particular municipality; they 
 should make and enforce stricter building laws, especially as relatingi 
 to tenements, to the end that dark-room tenements may be eliminated 
 and all tenements be provided wdth certain minimum standard re- 
 quirements as to light, air, and sanitary arrangements. 
 
 5. School children should be medically inspected and school 
 hygiene universally practiced. This involves better protection 
 against school epidemics, better ventilation, light, and cleanliness of 
 the schoolroom, the discovery and correction of adenoids, eye strain. 
 and nervous strain generally, and the provision for playgrounds. 
 Sound scientific hygiene should be taught in all schools, public, pri- 
 vate, normal, and technical, as also in colleges and universities. 
 
 6. The curricula of medical schools should be rearranged with a 
 greater emphasis on prevention and on the training of health officers. 
 Sanatoria and hospitals, dispensaries, district nursing, tuberculosis 
 classes, and other semipublic institutions should be increased in num- 
 ber and improved in quality. The medical profession, keeping pace 
 with these changes, should be the chief means of conveying their 
 benefits to the public. Universities and research institutions need 
 to take up the study of hygiene in all its branches. Now that the 
 diseases of childhood are receiving attention, the next step should 
 be to study the diseases of middle life. These are diseases, to a large 
 extent, of nutrition and circulation, and consequently these subject- 
 should receive special attention. Intelligent action must rest on 
 knowledge, and knowledge of preventing disease is as yet extremely 
 imperfect. 
 
 7. In industrial and commercial establishments employers may 
 greatly aid the health movement, and in many cases make their phi- 
 lanthropy self-supporting by providing social secretaries, lunch and 
 rest rooms, physiological (generally shorter) hours of work, pro- 
 vision for innocent amusements, seats for women, etc. 
 
 I 
 
!siii:r.] national VITALITY. 751 
 
 Life insurance companies could properly and with much profit 
 ■liib together to instruct their risks in self-care and secure general 
 cgislation and enforcement of legislation in behalf of public health. 
 
 8. The present striking change in personal habits of living should 
 )c carried out to its logical conclusion until the health ideals and the 
 deals of athletic training shall become universal. This chan"-e in- 
 .nlves a quiet revolution in habits of living, a more intelligent utili- 
 ■:ntion of one's environment, especially in regard to the condition of 
 he air in our houses, the character of the clothes we wear, of the 
 iite and architecture of the dwelling with respect to sunlight, soil, 
 ventilation, and sanitation, the character of food, its cooking, the 
 i«e of alcohol, tobacco, and drugs, and last, but not least, sex hygiene 
 n all its bearings. 
 
 9. The fight against disease will aid in the fight against pauper- 
 sm and crime. It is also true that any measures which tend to elimi- 
 late poverty, vice, and crime will tend to improve sanitary condi- 
 tions. 
 
 10. Finally, eugenics, or hygiene for future generations, should be 
 studied and gradually put in practice. This involves the prohibi- 
 tion of flagrant cases of marriages of the unfit, such as syphilitics. 
 
 4he insane, feeble-minded, epileptics, paupers, or criminals, etc. The 
 example of Indiana in this regard should be considered and followed 
 DV other States, as also in regard to the unsexing of rapists, criminals. 
 idiots, and degenerates generally. A public opinion should be 
 =iroused which will not only encourage healthy and discountenance 
 degenerate marriages, but will become so embedded in the minds of 
 the rising generation as will unconsciously, but powerfully, affect 
 their marriage choices. 
 
 O 
 
THE ^EED 
 
 FOR 
 
 HEALTH INSURANCE 
 
 IRVING FISHER 
 
 PROFESSOR, POLITICAL ECONOMY, YALE UNIVERSITY 
 
 PRESIDENTIAL ADDRESS 
 
 Delivered at the Tenth Annual Meeting of the American Association 
 
 for Labor Legislation, in Joint Session with the American 
 
 Economic Association, the American Sociological 
 
 Society, and the American Statistical 
 
 Association, Columbus, Ohio. 
 
 December 27, 1916. 
 
 From 
 
 The American Labor Legislation Review 
 
 Vol. VII, No. 1, 1917 
 
Estate of Rudolph iLekz 
 
 Printer 
 
 Bible House. New York 
 
 I 
 
 i 
 
 I 
 I 
 
THE NEED FOR HEALTH INSURANCE 
 
 Irving Fisher 
 Professor, Political Economy, Yale University 
 
 In the last six months, through the efforts of the American 
 Association for Labor Legislation, a consciousness of the imperative 
 need in this country for health insurance has dawned upon think- 
 ing Americans. Within another six months it will be a burning 
 question in many states. As Dr. Blue, surgeon general of the 
 United States Public Health Service, has said, it is the next great 
 step in social legislation in this country. 
 
 At present the United States has the unenviable distinction of 
 being the only great industrial nation without compulsory health 
 insurance. For a generation the enlightened nations of Europe 
 have one after another discussed the idea and followed discussion 
 by adoption. It has constituted an important part of the policy 
 and career of some of Europe's greatest statesmen, including Bis- 
 marck and Lloyd George. Germany showed the way in 1883 
 under the leadership of Bismarck. This act was the first step in 
 her program of social legislation. Her wonderful industrial pro- 
 gress since that time, her comparative freedom from poverty, 
 reduction in the death rate, advancement in hygiene, and the physi- 
 cal preparedness of her soldiery, are presumably due, in consider- 
 able measure, to health insurance. 
 
 Following the example of Germany, health insurance was 
 adopted successively by Austria, Hungary, Luxemburg, Norway, 
 Serbia, Great Britain, Russia, Rumania, and Holland. Other coun- 
 tries have adopted a subsidized voluntary system, namely, France, 
 Belgium, Switzerland, Denmark, Sweden, and Iceland. Thus the 
 only European countries which, like the United States, are without 
 any general system are Italy, Spain, Portugal, Greece, Bulgaria, 
 Albania, Montenegro, and Turkey. 
 
 Because we have a democratic form of government we have 
 peacefully assumed that our civilization is more advanced than 
 others, but while we have rested complacently on our oars, other 
 nations have forged ahead of us. The war has at last startled 
 us out of our Rip Van Winkle slumber, and we are now passing 
 through a period of national self-examination. 
 
There are special reasons to hope that health insurance may 
 win favor rapidly. The war has made labor scarce and therefore 
 dear. This fact will make not only for high wages, but also for the 
 conservation of labor. Students of the history of slavery find that 
 when slaves were abundant and cheap, masters worked them to 
 death and replaced them when worn out. Consequently, cruelty was 
 condoned and fashionable. On the other hand, when slaves were 
 scarce and dear, the masters took good care of them and a humani- 
 tarian sentiment developed to correspond. I believe it to be a 
 correct economic portent that the world is about to enter upon a 
 period of life conservation. The war has for a time withdrawn much 
 of the world's labor supply and destroyed and maimed a large part 
 of that which it has withdrawn. The world will seek the greatest 
 possible salvage out of the wreck. 
 
 This impulse to conserve has at first been felt in terms not 
 of industry, but of military preparedness. The strong impetus 
 toward preparedness of all kinds has been the result. Witness 
 the recent laws in New York for compulsory physical training 
 in the public schools. Health insurance and other measures for 
 health conservation will in turn be furthered by the same impulse 
 toward conservation. 
 
 Fortunately we have already taken one step in a social insur- 
 ance program. After a long and uphill fight, workmen's compen- 
 sation has had a belated recognition in America. The American 
 Association for Labor Legislation ^vas foremost in this fight, and 
 now at last it is ready for a similar fight to secure workmen's 
 health insurance. For four years an able committee of this Asso- 
 ciation has been studying American conditions and foreign health 
 insurance acts, and constructing a standard bill. This bill, with 
 some variations, has been introduced into the state legislatures of 
 Massachusetts, New York, and New Jersey, and commissions to 
 consider the subject have been appointed in Massachusetts and 
 California and are expected to report in January. It is significant 
 that so large were the throngs which attended the public hearing 
 of the Massachusetts commission on October 3 that the meeting 
 place had to be twice changed during the hearing to larger quarters. 
 During the ensuing year it is expected that the bill will be intro- 
 duced in about twenty state legislatures. 
 
 The United States Public Health Service has issued a special 
 study on Health Insurance by Dr. B. S. Warren and Edgar Syden- 
 stricker. The American Medical Association has a working com- 
 mittee on health insurance of which Alexander Lambert is chair- 
 man and L M. Rubinow secretary. This association has published 
 
a report on social insurance. Several medical societies, including 
 the Pennsylvania State Medical Society and the State Medical 
 Society of Wisconsin, and several public health associations, have 
 endorsed the principle of health insurance. The American Associa- 
 tion for the Study and Prevention of Tuberculosis and many of 
 its affiliated organizations have, through public meetings and other- 
 wise, helped the movement. A number of charitable organizations 
 have also favored the idea and forty-five organizations of various 
 natures, including the American Academy of Medicine, the Inter- 
 national Association of Industrial Accident Boards, the National 
 Conference of Charities and Correction, the New York Chamber 
 of Commerce, and the American Public Health Association have 
 appointed committees to study and report upon health insurance. 
 
 The federal Commission on Industrial Relations recommended 
 health insurance. In accepting favorably the report on health insur- 
 ance of its industrial betterment committee the National Associa- 
 tion of Manufacturers at its annual meeting last May put itself 
 en record as favoring the project. The chairman of the same com- 
 mittee stated in July, 1914: "I give it as my opinion that sickness 
 insurance of some kind, with compulsory contribution on the part 
 of employers, will be enacted into law by many states of the union 
 within the next five years." The Associated Manufacturers and 
 Merchants of New York State have expressed their approval. 
 
 Many trade unions have taken up the subject. Some have 
 strongly favored the idea ; a few leaders have vigorously opposed 
 it, apparently because of a groundless fear that in some way the 
 power of the labor unions would be lessened. Thus some oppose 
 health insurance as they at one time opposed compulsory work- 
 men's compensation. On the other hand several international 
 unions, including the International Typographical Union, have defi- 
 nitely gone on record as favorable. State federations of labor in 
 Ohio, New Jersey, Massachusetts, Missouri, Nebraska, and Wis- 
 consin are favorable. A number of local trade unions have taken 
 favorable action. Many individual labor leaders of prominence 
 have definitely approved it; these include John Mitchell, Ignatius 
 McNulty, Van Bittner, James H. Maurer, Andrew Furuseth, S. 
 E. Heberling, John B. Lennon, James O'Connell, Austin B. Garret- 
 son, William Green, and James Duncan. 
 
 The cordial and almost unprecedented welcome which this 
 movement has received in spite of the opposition of strong vested 
 interests and their industrious and insidious efforts to misrepresent 
 and injure the movement would seem to indicate that the time for 
 health insurance in the United States is ripe. 
 
The plan as put forth by the American Association for Labor 
 Legislation is fully described in its draft of a standard bill and 
 defended in its Brief for Health Insurance. The bill proposes the 
 obligatory insurance of substantially all workingmen and women. 
 In case of sickness the insured will receive medical or surgical 
 service, medicines, and nursing, and a cash benefit amounting to 
 two-thirds of the weekly wages of the insured for the period of 
 illness up to six months. Maternity benefits are provided for 
 childbirth, and funeral benefits for death. 
 
 Benefits are paid for at cost by the joint contributions of the 
 insured employee, his employer, and the state. The cost to the 
 employee will average about 1^ per cent of his wages. The cost 
 to the employer will be an equal amount, while the state will pay 
 half as much as either the employer or the employee. These are 
 the main points covered in the standard bill. I am here concerned, 
 however, not with the merits of this particular plan but with the 
 need of some plan of universal health insurance for workmen. 
 
 The need for health insurance, like that for most other forms 
 of insurance, is twofold. There is the need of indemnification against 
 loss, and the need of diminishing the loss itself. 
 
 Indemnification is the essence of the insurance principle. It 
 spreads the loss of each person in a group over them all. For each 
 individual it converts large fluctuating haphazard losses into small 
 regular and certain costs. Insurance aims to reduce fluctuations — 
 to make the income stream more steady. It is more economical to 
 pay a little premium for fire insurance each year than to suffer a 
 big loss when the fire comes. This insurance principle is of the 
 greatest importance in economics and in business. The well-to-do 
 have long made use of it in fire insurance, marine insurance, life 
 insurance, fidelity insurance, plate glass insurance, steam boiler 
 insurance, and, to some extent, accident and health insurance. The 
 capitalist has long endeavored to eliminate, or at least to reduce, 
 every determinable risk. But the curious and melancholy fact is that 
 outside of workmen's compensation the poor in this country have 
 received, as yet, very little benefits from the application of the in- 
 surance principle. Yet it is the poor whose need of health insur- 
 ance is greatest, and for two important reasons. One is that the 
 worker is more likely to lose his health than the capitalist ; for it 
 is well known from several lines of research that the death rate, 
 and therefore the sickness rate, prevailing among the poor is from 
 two to three times that prevailing among the well-to-do. The other 
 reason is that any loss from sickness is a far more vital matter 
 
to the poor than to the rich. That low-paid workingmen seldom 
 insure against illness is undoubted. 
 
 No very exact or recent estimate on this point seems to be 
 available, but according to a study of the Connecticut Bureau of 
 Labor Statistics in 1891 the great bulk of membership in fra- 
 ternal societies was at that time made up of the well-to-do; only 
 a small fraction, from one-sixth to one-third, consisted of "low- 
 paid mechanics and clerks." Moreover, these societies do not 
 always provide health insurance. Certain it is that as yet the 
 amount of voluntary health insurance in the United States such 
 as that under fraternal societies, labor unions, establishment funds, 
 and insurance companies, covers only a small fraction of working- 
 men and women. Judging from the tentative estimates of Rubinow, 
 only about 5 per cent of our workmen needing insurance actually 
 have it. The other 95 per cent have been deterred by the high cost 
 of such insurance under the voluntary system, by their lack of 
 appreciation of its benefits, by the inertia of custom, and by the 
 sheer desperation of poverty. 
 
 To ascertain the exact extent of health insurance in the United 
 States we need further investigation, but we know with certainty 
 that the amount is small. Even in England, where friendly soci- 
 eties have had voluntary health insurance for generations and devel- 
 oped it far beyond the United States or any other country, the 
 number of the insured was never half that to be reached by the 
 compulsory system. This was demonstrated by the fact that when 
 the compulsory system was actually introduced in 1911 the number 
 of the insured was at once more than doubled. Presumably the 
 half that needed it most was the half that lacked it until the uni- 
 versal system was adopted. From these facts it is apparent that 
 the present insurance facilities in the United States are, and, as 
 far as we can see, always will be hopelessly inadequate. 
 
 It is also true that millions of American workmen cannot at 
 present avail themselves of necessary medical, surgical and nursing 
 aid. When they most need it they cannot pay for it. The Rochester 
 survey of the Metropolitan Life Insurance Company showed that 
 39 per cent of the cases of illness did not have a physician in 
 attendance. 
 
 Workmen's health insurance is like elementary education. In 
 order that it shall function properly it needs must; be universal, 
 and in order to be universal, it must be obligatory. In regard to 
 obligatory military training it has been said that what America 
 most needs to-day is a higher appreciation of obligation and that 
 without it we shall ever be a drifting, weak, and inefficient nation. 
 
The case for compulsory health insurance is, however, far clearer 
 than that for compulsory military training. In health insurance, 
 as in education, we are dealing not with obligatory burdens, but 
 with obligatory benefits. 
 
 Certain interests which would be, or think they would be, 
 adversely affected by health insurance have made the specious 
 plea that it is an un-American interference with liberty. They for- 
 get that compulsory education, though at first opposed on these 
 very grounds, is highly American and highly liberative, that pro- 
 hibitory laws on various subjects such as habit-forming drugs 
 and even alcohol have introduced liberative compulsions in many 
 states in America, and that workmen's compensation acts have 
 introduced liberative compulsion in this very field of workingmen's 
 insurance. The truth is that the opponents of compulsory health 
 insurance are in every case, as far as I can discover, subject to 
 some special bias. They grasp at the slogan of liberty as a sub- 
 terfuge only. 
 
 Oh liberty! liberty! How many crimes are committed in thy name! 
 
 According to the logic of those now shedding crocodile tears 
 over health insurance we ought, in order to remain truly American 
 and truly free, to retain the precious liberties of our people to be 
 illiterate, to be drunk, and to suffer accidents without indemnification, 
 as well as to be sick without indemnification. In fact, if compulsory 
 health insurance is tyranny, all labor laws, all tenement laws, all 
 health laws, all pure food laws, even all laws, are tyranny. In fact, 
 all laws are an interference with some one's liberty, even laws 
 against vice and crime. It is the nature of the Law to restrict. 
 But it is by the compelling hand of the law that society secures 
 liberation from the evils of crime, vice, ignorance, accidents, un- 
 employment, invalidity, and disease. 
 
 We have already seen that most of the enlightened and pro 
 gressive nations of the world have, one after another, adopted com- 
 pulsory health insurance. This would not have happened if it were 
 a real interference with liberty. England, the most liberty loving 
 of nations, the home of laissez-faire, adopted the compulsory sys- 
 tem after careful and deliberate study of the German and other 
 systems. 
 
 It is also noteworthy that where, as in Switzerland, France, 
 and Belgium, the half-way stage has been reached of a subsidized 
 voluntary system, the tendency has been to convert this into a com- 
 pulsory system. Such a change was about to be put on the statute 
 books in Belgium when the present war broke out. 
 
In addition to the primary advantage of universality, there 
 are incidental advantages in the compulsory system. There are 
 important economies in administration owing to the elimination of 
 the cost of collection, the cost of advertising, and the other costs 
 of securing business as well as in the elimination of lapses, and of 
 the necessity for accumulating a large actuarial reserve in invested 
 funds. The advantages are similar to those recently realized by 
 insurance companies in some degree and on a small scale in "group 
 
 insurance." 
 
 The superintendent of insurance of the District of Columbia 
 reports that the people who pay health insurance premiums to 
 agents who collect 10, 15, and 25 cents a week at the homes of 
 policy holders "have to give up $1 for every 40 cents they get 
 back." The National Convention of Insurance Commissioners in- 
 their examination of the fourteen principal companies writing in- 
 dustrial health and accident insurance found that the ratio of losses 
 showed that the policy holders spent $1 to receive back a benefit 
 of between 30 and 46 cents. These figures are in striking contrast 
 to the results of the compulsory system abroad ; even in England 
 where the cost of administration is high because of the supposed 
 necessity of utilizing preexisting friendly societies, the admini- 
 strative cost amounts to only 14 per cent of the income of the 
 national health insurance fund, or something like one-fourth to 
 one-third the cost under the voluntary system. 
 
 Under the voluntary system the policy is apt to lapse just when 
 it is most important that it should not. The Armstrong investi- 
 gating committee in New York (1906) received testimony from 
 one of the largest of the industrial life insurance companies to the 
 effect that one-third of the policies lapse within three months, one- 
 half within a year, and nearly two-thirds within five years! Under 
 the compulsory system there could be no lapses. 
 
 As important as is indemnification, it is far less important than 
 prevention. Almost all insurance sooner or later adds the function 
 of the prevention of loss to that of indemnifying against loss. Fire 
 insurance has led to the use of slow-burning construction and other 
 safeguards against destruction by fire. Marine insurance has led 
 to safety at sea. Some steam boiler insurance companies expend 
 as much as 40 per cent of their income in inspection and other 
 preventive work. Life insurance companies are now instituting 
 devices for extending human life. 
 
 It is well known that the form of social insurance recently 
 adopted in the United States, namely "workmen's compensation," 
 has had the effect of greatly stimulating industrial methods in 
 
accident prevention. Out of workmen's compensation came the 
 "Safety First!" slogan and the public movement which it repre- 
 sents. J. D. Beck, of the Wisconsin Industrial Commission, de- 
 clared that more progress in accident prevention had been made in 
 his state in one year under workmen's compensation than in any 
 previous period of five years. 
 
 The importance of prevention depends in any individual case 
 on the degree of preventability, and in the case of human morbidity 
 the degree of preventability is enormous. Even in the last few 
 years there have been opened up hitherto undreamed of possibilities 
 for adding to life's length, vigor, and happiness. 
 
 The health movement can be far more potent than the safety 
 movement because sickness is more prevalent and more preventable 
 than accidents. Pasteur convinced us that "It is within the power 
 of man to rid himself of every parasitic disease," and his successor, 
 Metchnikoff, went far to show us that the normal life span, the 
 Utopian ideal for future generations, is much beyond the century 
 mark. Without looking so far ahead we may, I think, accept as 
 conservative the calculations of the National Conservation Com- 
 mission that at least 42 per cent of the deaths now occurring in the 
 United States are unnecessary, or that over 630,000 lives could be 
 saved annually by applying existing and known methods of life 
 saving, which would add at least fifteen years to the average dura- 
 tion of human life. These estimates are doubtless over-conserva- 
 tive, as may be judged from the data of the Commission on Indus- 
 trial Relations, from the recent health surveys of the Metropolitan 
 Life Insurance Company, and from other evidence. 
 
 After some fifteen years' study of the preventability of sick- 
 ness, I am convinced that the great virtue of health insurance, for 
 decades, perhaps for centuries to come, will lie in the prevention 
 of illness. It has already achieved considerable life saving in Ger- 
 many, although when the system was established there the idea 
 of the preventability of disease was in its infancy. According to 
 Dr. Zacher, reputed to be the best authority on health insurance in 
 the world, twelve years were added to the worker's life span during 
 thirty years of health insurance. We may properly attribute part, 
 if not most of this increase, to health insurance. This prolongation 
 of life is at the rate of forty years a century, the highest rate of 
 increase known in any country or any period of time. 
 
 Health insurance will afford a very powerful and pervasive 
 stimulus to employers, employees, and public men to take fuller 
 and speedier advantage of possible health saving devices. The 
 standard bill of the Association is so drawn as to give any locality 
 
 10 
 
and any trade the benefit in lower contributions of any reduction 
 in sickness rates which may be achieved, thus creating an immediate 
 financial motive to reduce illness. 
 
 Just as employers have installed safeguards for dangerous 
 machinery in order to reduce the cost of workmen's compensation, 
 so in order to reduce the cost of health insurance they will supply, 
 for instance, better sanitation, ventilation, and lighting, more physi- 
 ological hours of labor, and fuller consideration for the special 
 needs of employed women and children. In localities where the 
 employer provides tenements for his workmen, he will be led to 
 study and improve housing conditions. So-called welfare work 
 will be made more effective and helpful. Employers will collect 
 facts and statistics as to sickness, analyze them and apply such 
 corrections as the facts discovered indicate. Dr. Rubinow states 
 that a large corporation after introducing health insurance tried, 
 for the first time, to discover its sickness rate and found it to be 
 three times what is usual. Further investigation showed that this 
 excessive rate was due to bad conditions, not in the factory, but 
 in the sanitation of the city. As a consequence an effort was made 
 for the first time toward improving these conditions. It is especially 
 to be expected that as soon as employers realize the nerve strain 
 caused by over-long hours and consequent increase of illness and, 
 therefore, the cost to themselves, they will acquaint themselves 
 with the efifects of long hours of labor and reduce them. 
 
 The employee, on the other hand, will be likewise stimulated 
 to welcome and to utilize factory hygiene, and improve his own 
 domestic hygiene and individual hygiene. If there could be any 
 doubt as to the reality or strength of this impulse it would vanish 
 after observing the experience in Connecticut of the employees' 
 relief associations organized to combat tuberculosis. Each work- 
 man contributes at least 25 cents and, as a consequence of that 
 investment, takes a surprising interest in seeing that his money is 
 wisely expended and that tuberculosis cases are promptly discovered 
 and sent away for treatment. The possibilities of self-improvement 
 through learning how to live are far beyond what any one who 
 has not gone over the evidence realizes. The evils of bad air, bad 
 food, imperfect teeth, wrong posture, improper clothing, constipa- 
 tion, self -drugging, alcoholism, etc., are now overlooked by ninety- 
 nine workmen out of a hundred. Here is a wonderful opportunity 
 for effective and intelligent leadership among committees of wage- 
 earners. The employee will be more ready to apply to his own 
 internal machinery a principle, long since applied by his employer 
 to inanimate machinery, the principle of inspection and repairs. 
 
 11 
 
After health insurance has been adopted slight impairments to 
 health will be remedied before they become serious. 
 
 At present we find the United States, in striking contrast to 
 health insured Europe, is suffering from an increase of the death 
 rate after middle life. The increase consists of an increase in 
 degenerative or wear-and-tear diseases, and is due to the growing 
 neglect of personal and other hygiene. The death rate from degen- 
 erative diseases in the United States registration area has increased 
 41 per cent in twenty years. 
 
 One important effect of such attention to the health of the 
 workman will be the prolongation of his life and especially of 
 its earning period. Fewer workingmen will be thrown on the 
 scrap heap in their forties with all the tragic consequences involved 
 to their families as well as to themselves. 
 
 Moreover, the cash benefit gives the workman a better chance 
 for recovery as well as a more perfect recovery if attained; for, to 
 the poor, the obstacles to recovery are largely economic — insufficient 
 food or other necessaries, worry over making both ends meet, 
 and the consequent necessity of a premature return to work while 
 still half-sick. It is found that the longer the time given up to 
 sickness, which means the more care given to get well, the lower 
 the death rate. Critics of German insurance have pointed to the 
 fact that the number of days' absence from work per person on 
 account of illness has increased under health insurance, but as 
 Dr. Rubinow points out, this increase is partly, if not wholly, due 
 to improved and longer care of the sick. Only part, and probably 
 a small part, can be charged up to malingering. 
 
 Again, under compulsory health insurance both employer and 
 employee will cooperate with the general public in securing public 
 water supply, better sewerage systems, better milk, meat, and food 
 laws, better school hygiene, more playgrounds and parks, and proper 
 regulation of liquor and other health destroying businesses. 
 
 Health insurance will also, as it did in Germany, help to meet 
 the crying need for rural sanitation and bring adequate medical and 
 housing care to American farmers and their families. 
 
 Health insurance will operate, as it did in Germany, to stimu- 
 late the general scientific study of disease prevention, the future 
 possibilities of which though unknown are, we may be sure, enorm- 
 ous. A German observer states that social insurance led to new 
 knowledge in the field of occupational diseases, epidemics, and 
 accidents. Dr. Lee K. Frankel, now of the Metropolitan Life In- 
 surance Company, said at one time that "German insurance legis- 
 
 12 
 
lation has been effective in producing a comprehensive industrial 
 hygiene." Dr. Bielefeldt, quoted by Frederick L. Hoffman, says: 
 
 The conviction may be expressed, after the experience of several 
 years, that an effective battle against consumption among the working 
 classes would have been all but impossible without the workmen's 
 insurance of the German empire, and, by the support of their powerful 
 pecuniary resources and with the aid of national social regulations, in the 
 end we are quite certain to be victorious. 
 
 In Great Britain the health insurance act has led to education 
 on the prevention and treatment of tuberculosis, many of the insur- 
 ance committees having arranged for lectures, \moving picture 
 shows, and other means of educating the public. 
 
 I venture to predict that medical and hygienic discoveries and 
 applications will be far more rapid in the future than in the past. 
 What directions these discoveries will take can only be guessed. 
 I expect, however, that a new field will be found in what may be 
 termed industrial psychiatry, the development of which will not 
 only diminish definite diseases but will also diminish industrial 
 discontent and give back to the workman what the economic division 
 of labor has taken away from him — a real interest in his work. 
 The studies of a few of us in economics, particularly Professor 
 Carl Parker of the University of California, and a few in industry, 
 particularly Mr. Robert B. Wolf of the Burgess Sulphite Fiber 
 Company of Berlin, New Hampshire, have led to the conclusion that 
 a fundamental, perhaps the fundamental, cause of industrial unrest 
 is to be found in the fact that most workers at present cannot in 
 their daily tasks satisfy the fundamental human instinct of work- 
 manship. At present many, if not most, workmen are interested 
 only in their pay envelopes. I anticipate that, within a few years, 
 under proper stimulus, psychiatrists will be able to show employers 
 how to make jobs interesting, through a system which enables 
 the workman to understand and keep a record of the results of 
 his efforts and to receive credit for them in the eyes of his fellow 
 workers, his employer, and himself. What little experience is as 
 yet available points to the conclusion that devices for securing a 
 genuine enthusiasm for the job mean much more than any system 
 of scientific management for the health and happiness of the em- 
 ployee, for industry, and for industrial peace. 
 
 Besides health insurance many other stimuli of course exist, 
 but they need reenforcement. Moreover, nothing can equal health 
 insurance as a stimulus to prevention among employers and em- 
 ployees. 
 
 13 . 
 
But prevention of disease and disability is not the only pre- 
 vention to be effected by health insurance. It will indirectly but 
 powerfully tend to reduce poverty. In the first place the simple 
 operation of the indemnity principle itself tends to reduce poverty. 
 F*overty to-day is largely mischance. When a poor man becomes 
 sick, unless he can tide the emergency over by insurance or other- 
 wise, he runs the risk of getting "down and out," for he has little 
 or no margin. Without health insurance a vast number sooner or 
 later exhaust whatever margin they have and sink into poverty — 
 a land from whose bourne few travellers return. Students of 
 gambling condemn games of chance because sooner or later most 
 gamblers must lose enough to throw them out of the game. At 
 present the American workmen without health insurance are gam- 
 bling with their livelihood and in millions of cases are sure to be 
 thrown out of the game. It is not a question of average well-being 
 but of the numbers diverging from the average. One opponent of 
 health insurance says it is not needed in America because the "aver- 
 age" American workman is comfortably situated. Aside from the 
 fact that the most comfortably situated workman needs health 
 msurance, we must not forget that the majority of workmen have 
 less than the average wages and that a large minority have more 
 than the average sickness (of a little over a week) per year. It 
 is true that American wages are, on the average, much higher than 
 German wages, but poverty is, or was before the war, markedly 
 less in Germany than in the United States. This is doubtless 
 largely if not chiefly owing to health insurance. The German 
 laborer has not been allowed to gamble with disease and let it often 
 win away from him his little all. In America, where the working- 
 man is not so protected, we see the results in the casual laborer. 
 Warren and Sydenstricker's Health Insurance, already referred to, 
 states : 
 
 The casual laborers at the docks in New York City are composed 
 largely of workers who have gradually lost their economic status in 
 industry, and the dock worker continues to slip down in the industrial 
 scale until he reaches the class of "shenagoes," the down-and-out long- 
 shoremen who are capable of only light work and who finally become 
 burdens upon public and private charity. According to testimony before 
 the United States Commission on Industrial Relations, most of the 7,000 
 applicants for work at the San Francisco Cooperative Employment 
 Bureau were of the casual labor class, and one-half of the total number 
 of applicants were found to be incapacitated for work on account of poor 
 nutrition, disease and exposure. The records of many investigators of 
 the unemployed abound with similar instances. 
 
 14 
 
Frederick Almy states : 
 
 In Buffalo sickness is more serious in our work for the poor than 
 anything else. It far exceeds unemployment as a cause of poverty. 
 Last winter, 1914-1915, for instance, when the industrial depression was 
 so high, we paid out $13,646 on account of unemployment, and $29,275, 
 or more than twice as much, to families in which there had been sickness 
 during the year. 
 
 Again, the Charity Organization Society of Buffalo reported in 
 1916 that "Last year in Buffalo less than 1 per cent of our poverty 
 was due to lack of work, and more than 76 per cent to sickness." 
 According to an officer of the United States Public Health Service, 
 assigned to the Commission on Industrial Relations, sickness pro- 
 duces seven times as much destitution as industrial accidents. Dr. 
 Devine found among 5,000 families known to the Charity Organiza- 
 tion Society that in 75 per cent illness was a part cause of poverty. 
 The report of the Immigration Commission of 1909 states that "The 
 illness of the breadwinner or other members of the family was 'the 
 apparent cause of need' in 38.3 per cent of the cases, while accidents 
 were a factor in but 3.8 per cent of the total applications for aid." 
 "At the New York legislative hearing on the health insurance bill in 
 1916 it was shown that 37 per cent of the families assisted by the 
 New York Charity Organization Society are dependent because their 
 wage-earners are disabled by sickness, while two-thirds to four- 
 fifths of the expenditure of the New York Association for Improv- 
 ing the Condition of the Poor is for relief necessary because of ill- 
 ness." In the report of the New York Factory Investigating Com- 
 mission (1915), one working woman gives it as her experience that 
 "practically every week, in her factory, there is either a collection or 
 raffle for the benefit of some worker who is sick, who has no 
 resources, and who therefore is an object of the charity of her 
 fellow employees." This custom, states the report, is really of con- 
 siderable significance as an indication of how few are able to accumu- 
 late for times of emergency. It is also significant in showing how 
 dire is the need of health insurance ; for raffles and the like are a 
 sort of stop-gap or make-shift for health insurance. 
 
 We see, then, that the claim that in America we do not need 
 health insurance because the workman is so well-to-do is very 
 evidently not in accord with the facts. As the Brief for Health 
 Insurance of the American Association for Labor Legislation says, 
 and as the above statistics would indicate, "America evidently 
 presents no exception to the finding of Mr. and Mrs. Sidney Webb, 
 that Tn all countries, at all ages, it is sickness to which the greatest 
 bulk of destitution is immediately due.' " 
 
 15 
 
Aside from the reduction of destitution, health insurance will 
 tend to raise slightly the entire wage level. As Professor Moore of 
 Columbia has shown in his Lazvs of Wages the wage level is funda- 
 mentally influenced by industrial productivity. Anything which 
 raises the physical stamina of workmen increases their productivity 
 and earning power. Thus the victims of hookworm disease in the 
 South are poor, and constitute the "poor whites" because they are | 
 afflicted with the "germ of laziness," their power and inclination to 
 work are crippled. The Life Extension Institute found that out 
 of 2,000 workingmen and women over 99 per cent were below their 
 normal working power, i. e., were suffering from some condition 
 or habit which subtracted from their efficiency. These minor 
 impairments of health and efficiency are mostly preventable, and, in 
 fact, in the group referred to, were in part prevented through the 
 suggestions of the institute to the workingmen themselves. 
 
 Finally, we may expect health insurance to help forward indus- 
 trial peace, for it will create machinery for continual conference 
 between employers and employees. 
 
 We conclude that health insurance is needed in the United 
 States in order to tide the workers over the grave emergencies 
 incident to illness as well as in order to reduce illness itself, lengthen 
 life, abate poverty, improve working power, raise the wage level, 
 and diminish the causes of industrial discontent. It is not a panacea. 
 It will not bring the millennium. But there is no other measure 
 now before the public which equals the power of health insurance 
 toward social regeneration. 
 
 16 
 
h 
 
 
 THE PUBLIC HEALTH MOVEMENT 
 
 IRVING FISHER 
 
 "he conservation movement is a movement to 
 vent waste, When the Conservation Commis- 
 n was appointed four years ago, emphasis was 
 ced on the wastes of our natural resources, 
 
 l)y the time the commission made its report 
 lad come to the conchision that by "far the 
 st serious as well as the most preventable 
 stes are the wastes of human life. 
 
 generation ago it was a common impression 
 
 t the average human lifetime was fixed as by 
 
 ecree of fate. When I was in college one of 
 
 revered instructors showed us a mortality 
 
 e, and said with great impressiveness: "There 
 no law more hard and fast than the 4aw of 
 rtality." I believed it, and- even yet many peo- 
 
 are under this delusion. Pasteur did much 
 introdrce a more optimistic view. He stated 
 
 belief in these immortal words, "It is within 
 
 power of man to rid himself of every para- 
 c disease." He staked this opinion on his own 
 
 derful laboratory revelations as to germ life. 
 
 ay we can confirm his words by absolute 
 istics. And now his successor, Metchnikofif, 
 
 surpassed even Pasteur in optimism. Metch- 
 jfF is devoting himself to the prolongation of 
 lan life, and already gives us a vision of the 
 p „.i-.^« ^.i.^f^nnt-Jni-jc; y^,\\] \^Q Tegardcd merely 
 
 V of life, and when the normo: 
 
 sp.i.. ui <i . ..ntury and a quarter "• ■' '■■?■ - f- > 
 ]\ L»Ccuiierri;e. 
 
 he growing consciousness that human life is 
 
 a fixed allotment, which we must accept as 
 
 doom, but a variable, which is within our 
 
 ^er to control, has recently led to extraordi- 
 
 r exertions all over the world to save human 
 
 This impulse has gained strength also from 
 great and almost universal decline in the 
 h rate. Old countries like France and new 
 ntries like Australia are confronted with the 
 ter wof depopulation. Consequently, as hu- 
 1 life becomes scarce, it becomes precious — 
 any other commodity ! These two facts, the 
 3ciousness that much mortality is preventable, 
 at any rate, postponable, and the fact that 
 easingly fewer babies are being born in the 
 Id, are together operating to produce a great 
 ',th movement throughout the world. Noth- 
 will stop it until the whole world is convinced 
 he paramount importance of this problem of 
 lan conservation. 
 
 his world-wide movement for the conserva- 
 of human life has expressed itself in many 
 s — in medical research ; in societies for pre- 
 ing tuberculosis, infant mortality, social dis- 
 5r alcoholism, and vice; in the growth of 
 toria. dispensaries, hospitals and other insti- 
 >'xc ■, i'.!. g.f. v-v.-nvense output of hygienic litera- 
 . not only tec'.inical books and journals, but 
 
 popular article in the magazines and daily 
 spapers; in the di^istant agitation and legis- 
 )n for purer foods, milk supply, meat supply 
 
 1^ water supply; in the movement to limit the 
 r of women and children and to improve 
 
 factory sanitation; in the establishment of social 
 insurance in Germany, England, Denmark and 
 other countries; in the improvement of Depart- 
 ments of Health; in the spread of gymnastics, 
 physical training and school hygiene; in the re- 
 vival of the Olympic games and the effort to 
 revive the old Greek ideals of physical perfec- 
 tion and beauty, and last and most important, in 
 the sudden development of the science of eu- 
 genics. 
 
 In the summer of 1911 there was held in Dres- 
 den a unique world's fair, devoted exclusively 
 to health — the International Hygiene Exhibition. 
 In this were shown the fruits of the v/hole 
 movement in all lands — except, alas, our own ; 
 for to our shame it must be said that we as yet 
 are among the backward nations in this move- 
 ment for the conservation of human life. Our 
 Congress was asked to appropriate $60,000 to 
 erect a building and supply an exhibit to show 
 what we have done for our part in this move- 
 ment, but Congress thought it could not afford 
 so large an expenditure for so small (!) an ob- 
 ject, and the result was that from the millions 
 of people who visited this exhibition one con- 
 stantly heard the question asked: "Where is the 
 United States?" 
 
 And those few .Americans who did go to visit 
 the exhibition foi;nd that o^h^T rntloas ■ ' 
 outstripped us in this movement for i.. ,,.. 
 sanitation and health. Some of the achievements 
 already attained by Oiiicr nations should be re- 
 corded among the wonders 6f the world. One 
 is the striking decline of the death rate in the 
 city of London. Within two decades London's 
 death rate has virtually been cut in two. and is 
 now only thirteen per thousand, or less than that 
 of most cities one-fiftieth its size. 
 
 Probably, however, the greatest achievement 
 of any country is that of Sweden, where the 
 duration of life is the longest, the mortality the 
 least, and the improvements the most general. 
 There alone can it be said that the chances of 
 life have been improved for all ages of life. In- 
 fancy, middle age and old age today show a 
 lower mortality in Sweden than in times past, 
 while in other countries, including the United 
 States, although we can boast of some reduction 
 in infant mortality, the mortality after middle 
 age is growing worse, and the innate vitality 
 of the people is, in all probability, deteriorating. 
 The reason why Sweden of all countries has suc- 
 ceeded in improving the vitality of middle age 
 and old age, while other nations have failed, is, 
 I believe, to be found in the fact that Sweden, 
 of all nations, has seen the problem of human 
 hygiene as a whole instead of^partially. In most 
 other lands, and particularly in the United States, 
 public health has been regarded almost exclus- 
 ively as a matter of protection against germs; 
 but protection against germs, while effective in 
 defending us from plague and other epidemics 
 of acute diseases, is almost pdwerless to prevent 
 
 I 1 
 
the chronic diseases of middle and late life. 
 These maladies — Bright's disease, heart disease, 
 nervous breakdowns — are due primarily to un- 
 hygienic personal habits. Medical inspection 
 and instruction in schools, as well as Swedish 
 gymnastics, have aided greatly in the muscular 
 development of the citizens of Sweden. Swed- 
 ish hard bread has preserved their teeth. The 
 Gothenburg system is gradually weaning them 
 from alcohol. There has even been a strong 
 movement against the use of tobacco. Other 
 countries are tardily following in the path which 
 Sweden has trod so successfully. 
 
 The significant fact is that Sweden has not 
 hesitated to attack the problem of personal 
 habits. I believe we must have a revolution in 
 the habits of living in the community if we 
 are going really to realize the promise of ATetch- 
 nikoff and others as to the prolongation of human 
 life. Health officers in this country have not re- 
 garded it as a part of their duty either to live 
 personally a clean, hygienic life, or to teach oth- 
 ers to do so, or even to investigate what those 
 conditions of well being are which make for 
 personal vitality. 
 
 I can remember, thirteen years ago, talking 
 with a doctor in Colorado as to the habits of 
 living of his patients. I said to him: "You tell 
 me that tuberculosis is a house disease, and that 
 the reason it exists is because people do not open 
 their windows. Why, then, do you not tell your 
 Datients they most open tlieir windows, or sleep 
 'Ut of doors?"' Bfi said, "I wouldn't dare to 
 d'j that; I would loJ5e my practice. They would 
 think I was a cran'|, and meddling in their per- 
 -onal alTairs." Tt)day that battle has been 
 largely won. Today, not only in Colorado and 
 California and in the places where there is per- 
 petual sunshine, sleeping out of doors is com- 
 innii and not confined to invalids, but is indulged 
 in by the community generally. Even in New Eng- 
 land and throughout the country you will find 
 sleeping balconies going up all over. The change 
 has even affected in some degree the architecture 
 of the country, and while as yet only a minority 
 of the people sleep out of doors, yet T believe it 
 is true that the majority of the people in the 
 United States have far more air in their sleeping 
 and living rooms today than ten years ago. The 
 fact which the doctor in Colorado did not dare 
 tell his patients thirteen years ago has in some 
 way been told to the people of the United States. 
 
 But there are many other things that need to 
 be told, after we are sure that they are true. 
 When we have, through our national, state or 
 municipal officers, made thorough investigations 
 and have been able to discover the actual truth 
 as regards eating and drinking, hours of Vork, 
 recreation and play — all those facts that go into 
 what may be called personal habits — then we may 
 gradually overturn existing unhygienic habits of 
 livmg. John Burrs attributes a large part of 
 the great reduction in London mortality to the 
 improved personal habits of working men, par- 
 ticularly -in regard to alcohol. In this country 
 Dr. Evans, both as [health officer of Chicag-o and 
 
 later as health edi 
 has shown how p 
 
 or of a Chicago newspaper, 
 pblic instruction in personal 
 
 habits can be made effective, and it will t 
 largely through affecting personal habits that ti- 
 ll fe insurance companies will improve the longe\ 
 ity of their policy-holders. 
 
 Scientific men today have reached substanti; 
 agreement that alcohol is a poison. When ever; 
 body understands this, the days of alcohol as 
 beverage will be numbered. Sweden in the 30 
 was called drunken Sweden, but today the am 
 alcohol jnovemcnt there has converted Swed( 
 into one of the soberest of countries. 
 
 But the use of tobacco, tea and coffee ougl 
 also to be investigated, so that we may kno 
 how far they are deleterious, and to spread tb 
 knowledge among the people. 
 
 Eashions are in their essence changeable, ar 
 the time will come when the world will not I 
 built on fashion, but on reason. Japan has mac 
 more rapid progress in civilization than ai 
 other nation — because the late Mikado resolvf 
 and publicly stated that the institutions of Jap; 
 must not be tied by tradition, but nmst be bas< 
 on reason. When we have replaced traditic 
 by reason, we shall have gotten a solid basis fij 
 civilization, and this must apply to ancient cu| 
 toms and habits of every kind. I am firmly co 
 vinced that we are looking at only one-half > 
 this public health movement as long as we co 
 fine ourselves to the acute or infectious di 
 eases. We shall not get more than half the r 
 suits obtainable until we realize that there mv 
 be a revolution in the pci': ' habits ;. V 
 people. 
 
 Yet the United States, in spite of its shortcoi 
 ings, has some special triumphs to record. V 
 have, through hygiene under Colonel (nirg.' 
 made it possible to dig the Panama Canal. V 
 have virtually abolished yellow fever on o 
 shores and in Cuba. We have nearly eliminat 
 hookworm disease in Porto Rico and are grad 
 ally doing the same in the southern states. V 
 have found a remedy for one fonn of spin 
 meningitis. We have, in New York, made ; 
 object lesson in the last year of reducing t 
 summer death rate of infants in a striking ma 
 ner. We have, by individual milk stations 
 Boston and other cities and in individual sati 
 toria, dispensaries and other institutions, denin 
 strated that the death rate from specific diseas 
 can often be cut in two. '{ 
 
 Yet we have depended altogether too much ! 
 private initiative. In New York the sumfll 
 death rate of infants was reduced chie 
 through the work of the milk committee a 
 individuals like Nathan Straus. The discoy^ 
 of the wide prevalence of hookworm disease Jjj 
 the discovery of the scrum for spinal meningi 
 came through the gifts of Mr. Rockefeller, 
 is well that individuals should apply themselti 
 to these problems, and without such personal*! 
 terest they could never be solved. Neverthele 
 progress will be many times as rapfci whenTl'li 
 problems for the nation are managed in {/id 
 tional way. There are three great agen :i a^'a 
 which we must look for the saving of human '"I'Se 
 in the future, and it has been the object of ^ tl 
 Committee of One Hundred on National Het '■■ 
 of which I am president, to help stir these th in 
 
 -■I 
 
sncies into activity in this country. They are 
 public press, the insurance companies and 
 government. 
 To a limited extent, all these agencies have in- 
 ased their health activities in recent years, 
 few years ago popular articles on public 
 ilth were seldom seen^ because the i)ublic and 
 press thought the subject of disease unintcr- 
 ing and repulsive. Today, on the other hand, 
 ; can scarcely pick up a popular magazine 
 hout finding not only one, but several, articles 
 ling with questions of public health; and it 
 ; been found possible not only to make these 
 icles interesting, but, by emphasizing the posi- 
 ; or health side, instead of the negative or 
 ease side, to render them attractive and beau- 
 il. And yet, as Dr. Wiley has said, the nevvs- 
 ^ers. in spite of all the good they are doing 
 h their right hands, are, with their left hands, 
 heir advertising columns trying to undo that 
 )d by advertising the fraudulent part of the 
 aling" profession who are trying to line their 
 1 pockets at the expense of the lives of the 
 •lie. 
 
 he second great agency from which, I be- 
 e, we may expect wonderful results in the 
 ire is life insurance. As our committee point- 
 out to the association of life insurance presi- 
 Is several years ago, life insurance companies 
 save money by preventing deaths just as fire 
 irance companies have saved money by pre- 
 ting fires, ?.nd steam boiler insurance com- 
 ies have saved money by preventing explo- 
 IS. Since this suggestion was "made, a num- 
 oi progressive life insurance companies have 
 ! the experiment. The Metropolitan and the 
 itable have established departmenis of human 
 servation, and a rwmber of other and smaller 
 ;ipanies have undertaken similar enterprises. 
 ? Postal Life Insurance Company has recently 
 lished the statistical results of their experi- 
 p, worked out in a most careful manner, and 
 demonstrated absolutely that it pays life in- 
 ance companies to save human life This be- 
 the case, we may expect life insurance com- 
 ies in the future to become active in life 
 servation. Already there are probably fif- 
 million policyholders in the United States 
 ired in companies which are trying to do 
 ething for their health — through medical ex- 
 nations, instruction in hygiene, utilization of 
 ting nurses, participation in civic health 
 /ements and otherwise. To save human life 
 ely to save money is sordid enough, but it is 
 tl to harness commercial motives, when pos- 
 e. in the service of humanity, 
 he third and most important agency is the 
 lernment. State and national health offices 
 becoming yearly stronger and more efiicient ; 
 yet much remains to be done, particularly 
 '.le national government. We need a national 
 jartment of health or a department of labor 
 'Jch shall include in its operations the con- 
 ; jl /ation of human life. We have already 
 ',t(;ed the phosphorus match bill to prevent one 
 'j\{ the worst industrial diseases — phossy jaw. 
 .:! have passed effective legislation in regard 
 ;'j ntcrstate commerce in prostitution. We have 
 
 established a Children's Bureau, and a Bureau 
 of Mines to prevent industrial accidents in min- 
 ing. We have enacted suital)le legislation in re- 
 gard to cocaine and habit-forming drugs. We 
 have a Pure Food Law and laws for the inspec- 
 tion of- meats. Yet, as Dr. Wiley, Mrs. Crane 
 and others who have watched the operation of 
 these laws at close range well know, they need 
 -to be executed with a stronger hand. 
 
 The truth is that as yet we have only made a 
 feeble beginning in public health work, especially 
 in this country. We need, first of all, to do 
 what Sweden has done for a hundred and fifty 
 years — namely, to keep proper vital statistics. 
 Vital statistics are the bookkeeping of health, 
 and we cannot economize health any more suc- 
 cessfully than we can economize money unless 
 we keep books. At present only a little over 
 half of the population of the United States has 
 statistics of its deaths, while the statistics of the 
 births are as yet nowhere sufficiently accurate to 
 be called real statistics. 
 
 Our national statistician, Dr. Wilbur, illus- 
 trates by a story how much better we keep our 
 commercial books than our books of vital sta- 
 tistics. In a western state a girl was entitled to 
 a fortune when she became twenty-one. Reach- 
 ing, as she supposed, her twenty-first birthday, 
 she laid claim to the fortune. Aluch to her sur- 
 prise, her father said: "But you are only nine- 
 teen"; and then the two tried to look up the 
 records. They had no family Bible, they had no 
 public record office to' go to, "and thev were at 
 sea as to how to discover exactly the date wher 
 she was born. However, it suddenlv occurred 
 to her father, who was a farmer, that on the 
 very day his daughter was born a calf was born 
 on his farm, and the birth of the calf had been 
 recorded. In that way he established the date of 
 the birth of his daughter. 
 
 In view of the great lack of our vital statis- 
 tics, therefore, we cannot measure even the death 
 rate, much less the number of preventable deaths 
 in the United States. All that we can do is to 
 study carefully the registration area, and on this 
 basis to work out certain minimum figures. 
 
 Four years ago, as a member of President 
 Roosevelt's Conservation Commission, I endeav- 
 ored to do this and to report on the condition of 
 our "national vitality." I found, after getting 
 together all the statistics available and taking 
 account .(^f the degree of preventability of dif- 
 ferent diseases as estimated by experts, that out 
 of some 1,500,000 deaths annually in the United 
 States at least 630,000 are preventable ! Of these 
 preventable deaths the greater number are from 
 seven causes. These seven causes include three 
 great diseases of infancy; then typhoid fever, 
 which usually makes its attack in the twenties; 
 then tuberculosis, accidents in industry, and 
 pneumonia, which come in the thirties. 
 
 Now 630,000 unnecessary, deaths per ^.-oar- 
 mean over 1,700 unnecessary deaths per day. or 
 more than the lives lost in tie Titanic disaster! 
 The nation cannot continue inlifferent to hygiene 
 as it gradually dawns on the public that for lack 
 of hygiene we suffer a Titanic disaster every 
 day of the year. The popular imagination was 
 
deeply stirred by the image of 1,600 helpless 
 human beings suddenly engulfed in midocean. 
 That was a vivid dramatic picture which the 
 blindest of men could see and understand. It 
 led to immediate oflicial action on both sides of 
 the Atlantic to sai'eguard human life at sea. 
 Yet on land we lose 365 times as many lives as 
 this every year, and never stop to add it up ! 
 Ihoy are scattered and diffused throughout the 
 land— a Wilbur Wright lost from typhoid, a 
 handful of miners in an explosion, some railway 
 employes in an accident, some victims of lead 
 poisoning, a little army of infants, here a few 
 men and there a few. Yet these deaths are just 
 as real and mean an infinitely more serious loss 
 than the deaths from the Titanic disaster. More- 
 over, they could be as easily prevented. 
 
 And concomitant with this unnecessarily great 
 death rate there is, of course, a colossal aggre- 
 gate of needless sickness. We have no real sta- 
 tistics, but by analogy with English statistics we 
 may assume that, on the average, for every death 
 per annum there are two persons sick during the 
 year. This makes about 3,000,000 people con- 
 stantly lying on sick beds in the United States, 
 of which, on the most conservative estimate, at 
 least half need not have been there. 
 
 If, now, on the basis of these figures, we try 
 to compute how much human life is needlessly 
 shortened in the Urited States, we find that it is 
 shortened at least fifteen years. Again, if we 
 translate these preventable losses into comri.ier- 
 inl terms, we find (hat, ev.n by the most' con- 
 
 rvat've reckoningi this country is losing,, over 
 -),uOO woi't^ of wealth-producing power 
 .vr.y J cat. 
 
 What does this inerr," To us. individually it 
 means that we are losing a large part of our 
 rightful life not only by death itself, which cuts 
 ofif many years we might have lived, but also 
 from diseases and disabilities which are not 
 f.ital but cripple the power to work and mar the 
 joy of living. I believe I am far within the facts 
 when I venture the opinion that the average man 
 or woman in the U:iited States is not doing half 
 of the work nor having half of the joy of work 
 of which the humari being is capable. 
 
 With all this room for improvement before 
 our eyes, it is not surprising that the zeal of the 
 health movement is growing fast. Each success 
 serves as justificatidn for further effort. 
 
 One of the most encouraging symptoms of 
 progress is the grekt attention which was paid 
 to public health in the recent political campaign. 
 All three of the party platforms included planks 
 in behalf of publi health. The Democratic and 
 Progressive platforms were particularlv explicit 
 and emphatic, and all the candidates have em- 
 phasized health in speeches and in their record 
 in public life. 
 
 'J hese and other | indications augur well for 
 better legislation, m^re energetic enforcement "of 
 the law and, above all, a more appreciative pub- 
 lic sentiment as to the transcendent importance 
 of the conservation of human life. It is now 
 
 reported that Dr. Roche, secretary of state ; 
 Canada, is in strong sympathy with the propos 
 there for the establishment of a Federal Dcpar 
 ment of Health, and the Republic of China 
 reported to have already established such a d 
 partment. 
 
 From all these indications of actual activit 
 as well as from the logic of the situation, v! 
 are justified in predicting that an age of hum; 
 conservation is at hand. Men and women a 
 waking to their responsibility to the race. E 
 genics will be a vyatchword of the future. '. 
 squander our natural resources is ignoble i 
 deed, but far worse is it to squander our vit 
 resources. The most sacred obligation of ea^l 
 generation is to bequeath its life capital unii 
 paired to the generation which comes aft< 
 Scourges like typhoid and tuberculosis must 
 swei)t oft" the face of the earth. Haljit-formiii 
 drugs, including alcohol (and even tobacco, esp 
 cially for young boys), must be recognized 
 their true light as means of depleting the viiali 
 of nations. Prostitution and the white sla 
 traffic must be condenmed anew as robbers 
 the race. Industries which kill and maim, pois< 
 or infect their workers, which deform anrl stu 
 little children, which incapacitate women for ric 
 mal motherhood, which tlirough overlong hou 
 of toil close each successive day's work with pr 
 gressive exhaustion, must be controlled. M 
 chinery was made for man, not man for machi, 
 ery. Marriage laws and customs must be a 
 justed so as to discourage or forbid the pr • 
 tion by the unfit. All these and other hv; ;: 
 and eugenic reforms will be realized as i 
 pul)rc sentiment beconv^- rlucated to the S' !cn' 
 responsibilities and higher valuations ot hum 
 life. 
 
 The noblest task, therefore, which I can co 
 ceive for any man is to aid in erecting true ide? 
 of perfect manhood and womanhood. Our idea 
 though improving, are not yet worthy to be coi 
 pared with those of Japan or Sweden, and t 
 ideals even of these countries have not j 
 reached the level of those of ancient Greece si 
 imaged for us in imperishable marble. With s 
 perior knowledge, our health ideals should ex( 
 those of any other age. These ideals should n 
 stop with the mere negation of disease, dege 
 eracy, delinquency and dependency. They shot 
 be positive and progressive. They should inclu 
 muscular development, a sound mind in a sou 
 body, integrity of moral fiber, a sense of t 
 splendor of the perfect human body as a tem( 
 of the human soul, a sense of the enjoyment 
 all life's proper functions. As William Jam 
 said, simply to breathe or move our muse" 
 should be a delight. The thoroughly healt 
 person is full of joy and optimism. He rejoice 
 like a strong man to run a race. Said Emerso 
 "Give me health and a day, and I will make** 
 pomp of emperors ridiculous!" Our health ide 
 should be nothing short of an abidmg "sense" 
 the sweetness and beauty, the nobility an] ' 
 ness of human life. 
 
 / 
 
 / 
 
THE "RATIO" CHART 
 
 For Plotting Statistics 
 
 By 
 
 p PROFESSOR IRVING FISHER 
 
 Yale University 
 
 [Reprinted from Quarterly Publications of the American Statistical 
 
 Association, June, 1917.] 
 
13] The ''Ratio" Chart. 577 
 
 THE "RATIO" CHART 
 
 For Plotting Statistics. 
 
 By Professor Irving Fisher, Yale University. 
 
 COMPARING TWO MAGNITUDES BY THEIR DIFFERENCE AND BY 
 ' THEIR RATIO. 
 
 In the last few years there has been a great increase in the 
 appreciation and use of statistical charts. As a consequence, 
 a number of efforts have been made to improve the technique 
 of graphic representation in order that the chart may convey 
 its message more quickly, accurately, and unmistakably. 
 Toward this end Mr. Willard C. Brinton in particular has put 
 us all under obligation.* 
 
 In the present article, I shall describe the nature and ad- 
 vantages of one form of chart on which to plot a statistical 
 curve, — by which is meant any curve or broken line showing 
 the different numerical values of a statistical magnitude at 
 different periods of time. This chart will be found of very 
 great assistance when the only object or the chief object is to 
 display and compare ratios. It may therefore be called the 
 "ratio" chart. t 
 
 The chief reason why ratio charting has not yet been more 
 widely used is, I believe, that its extreme simplicity is not yet 
 realized. Those who have mentioned it in print have usually 
 contented themselves with stating dogmatically how it is to 
 be used without explaining the whys and wherefores, further 
 than that its spacing is " logarithmic " like that of a log- 
 arithmic slide rule. But most persons regard logarithms and 
 slide rules as a species of magic and fight shy of a method, the 
 foundations of which they do not clearly understand. 
 
 •Through the publication of his "Graphic Methods for Presenting Facts," New York (The Engineering 
 Magazine Company), 1914, 371 pp., and through the worlj of the Joint Committee on Standards for 
 Graphic Representation which grew out of the publication of his book. 
 
 tl am not, as I originally supposed, the first to hit on this simple device, although it still remains 
 almost wholly unknown and unused and has never yet, so far as I know, been adequately described. A 
 bibliography of the very meagre literature on the subject is given at the end of this article. It is there 
 shown that the method in essence was used as early as 1863. 
 
578 
 
 American Statistical Association. 
 
 [14 
 
 POP 
 
 IN 
 
 Mill. 
 
 The object of this article is to make the construction of 
 the ratio chart clear to any reader and, at the same time, to 
 point out in some detail its various uses and advantages. In 
 doing this it is quite unnecessary to use even the concept of 
 
 logarithms. 
 
 We may compare any two 
 magnitudes, of like kind, by 
 means either of their differ- 
 once or of their ratio. In the 
 first kind of comparison "an 
 inch on theendof one'snose" 
 is exactly as much as an inch 
 added to the height of the 
 Washington Monument; in 
 the second kind of compari- 
 son, on the other hand, "an 
 inch on the end of one's nose ' ' 
 is an addition of about 40 per 
 cent., or as much as 220 feet 
 added to the height of the 
 Monument. 
 
 The ordinary chart is adap- 
 ted to difference comparisons 
 rather than to ratio compari- 
 sons, whereas the statistician 
 is usually concerned with 
 ratio comparisons far more 
 than with difference compa- 
 risons. ' 
 
 FIG. Id. FUTURE HYPOTHETICAL POPU- 
 LATION OF THE UNITED STATES. OR 
 DINARY OR DIFFERENCE METHOD. 
 Equal vertical intervals represent equal statistical 
 
 differences. A line in ascending at a uniform ratio is 
 
 curved. Uniformity is therefore not evident to the 
 
 eye. 
 
 
 ^ S 
 •^ ^ 
 ^ ^ 
 
 ,^ ^ ^ £ 
 
 lo XJ j^ ^ 
 
 _, <3, O) <^ 0> 
 
 N S < N \»' 
 
 CONVERTING ORDINARY 
 PLOTTING PAPER. 
 
 Fig. 1 d C'd" standing for 
 "difference") shows an ordi- 
 nary plotting chart; that is, 
 a chart with equal vertical 
 spacing, labelled for popula- 
 tion in millions, the labelling 
 being for equal statistical differences, and each interval of verti- 
 
 y£Aff^ 
 
 FIG. Ir. THE SAME. RATIO METHOD. 
 The same assumption. Uniformity is here evident 
 to the eye, being represented by a straight line. 
 
15] The ''Ratio'' Chart. 579 
 
 cal ascent representing an increase of 10 millions over the pre- 
 ceding. 
 
 Since the key-idea of the ratio chart is that equal vertical 
 intervals represent equal ratios of increase instead of equal 
 differences of increase, it may also be constructed from ordi- 
 nary cross ruled plotting paper. This may be done in two 
 steps, (1) labelling the existing lines and (2) interpolating 
 new lines. The first step is to label the existing (equidistant) 
 horizontal lines with numbers increasing in a given ratio. 
 
 Fig. 1 r C'r" standing for "ratio"), shows a ratio chart 
 made from ordinary ruled paper simply by labelling the hori- 
 zontal lines for ratios, each interval of vertical ascent now rep- 
 resenting an increase of 10 per cent, over the preceding. 
 That is, while the first chart is labelled vertically, 100, 110, 
 120, 130, 140, 150, 160, 170, 180, 190, 200, etc. (each number 
 being 10 more than the one below) the second chart is labelled 
 vertically, 100, 110, 121, 133, 146, 161, 177, 195, etc.* (each 
 number being 10 per cent, more than the one below). 
 
 The ratio method consists simply in plotting any statistical 
 curve by using the labels f of Fig. 1 r instead of those of Fig. 1 d. 
 
 Thus, let us plot, say, the (imaginary) population of the 
 United States in millions, beginning with 100 millions in 1910 
 and assuming an increase of 10 per cent, every decade. Since 
 all increases of 10 per cent, are represented in Fig. 1 r by equal 
 vertical distances, it is clear that the curve representing popu- 
 lation, i. e., connecting the series of points in Fig. 1 r lying 
 diagonally on the cross lines, will be a straight line. 
 
 Thus we see the first merit of the ratio method of charting 
 the growth of a statistical magnitude: uniformity in the per- 
 centage rate of growth is pictured by straightness in the plotted 
 line. 
 
 On the other hand, in the ordinary or difference chart, such 
 as that of Fig. 1 d, the same population growth will be repre- 
 sented by an "exponential curve" and its uniformity of per- 
 
 *If we carry the numbers backward, that below 100 will be 91 (for 91:100::10:11); that next below 91 
 will be 83; and so on, indefinitely, down to any number, however small, except zero. Evidently we caa 
 approach as near to zero as we please but zero itself recedes into a bottomless pit; there is no base or zero 
 Hne. 
 
 tOf course in the ratio chart as in the difference chart the numbering may be magnified or reduced id any 
 ratio. Thus instead of the numbers 100, 110, 121, etc., we may substitute 1.00, 1.10 1.21 or .100, .110, 
 .121, etc., etc. 
 
580 
 
 Air^erican Statistical Association. 
 
 [16 
 
 centage rate of growth is altogether lost to the eye. In fact 
 the uninitiated are apt to be misled and to falsely infer from 
 
 such a curve that the 
 rate of growth is in- 
 creasing. 
 
 RERULING THE RATIO 
 CHART SO OBTAINED, 
 
 But the ratio chart, 
 as described above, is 
 not very convenient 
 for plotting points be- 
 tween the ruled lines, 
 because so few of the 
 labels are round num- 
 bers. To make a full 
 fledged ratio chart, 
 new horizontal lines 
 need to be interpo- 
 lated, at their proper 
 places, corresponding 
 to the round numbers 
 120, 130, 140, 150, etc. 
 (Fig. 2 r) and the orig- 
 inal equi-distant ones 
 should be erased.* 
 The contrast, then, be- 
 
 *Plottmg paper for ratio charts 
 may now be obtained ready-made 
 from a few commercial firms, the 
 Educational Exhibition Company, 
 26 Custom House Street, Providence, 
 R. I., John Wenzel, 63 West 107th 
 Street, New York City, Keuffel and 
 Esser Company, 127 Fulton Street, 
 New York City, and the Standard 
 Graph Co., 32 Union Square, New 
 York City. 
 
 The unequally spaced horizontal 
 lines shown in Fig. 2 r become more 
 and more crowded together as we 
 ascend, until it becomes necessary, or 
 advisable, to omit some of them. 
 
 The omission of these lines causes the plotting paper to present the appearance of an intermittent or 
 
 cyclical spacing (Fig. 3 r). 
 
 FIG. 2d. SHOWING GEOMETRICAL (A) AND ARITH- 
 METICAL (B) PROGRESSIONS. DIFFERENCE 
 METHOD. 
 
 A line (A) ascending ,at a uniform ratio in equal periods of 
 time, that is, in geometrical progression is curved (upward). 
 A line (B) ascending by equal differences in equal periods of 
 time, that is, in arithmetical progression, is straight. Note 
 that vertical intervals increasing in geometrical progression 
 (see the Ught figures) are unequally spaced. 
 
 200— T 
 
 
 
 
 
 
 t y\ 
 
 
 
 
 
 
 
 y 
 
 
 /■ 
 
 
 
 
 
 
 
 
 
 / 
 
 / 
 
 
 
 '^'^ 
 
 
 
 
 
 
 / 
 
 
 y^ 
 
 
 
 
 ^lOi 
 
 
 
 
 
 
 / 
 
 / 
 
 
 
 
 
 reo^2- 
 
 
 
 
 
 / 
 
 / 
 
 
 
 
 
 
 /SO — 
 
 
 
 
 
 / / 
 
 
 
 
 
 
 
 no 
 
 ■~ 
 
 
 
 } 
 
 / 
 
 
 
 
 
 
 
 /40— 
 
 
 
 
 // 
 
 
 
 
 
 
 
 
 
 
 
 //" 
 
 
 
 
 
 
 
 /30— 
 
 
 
 / 
 
 
 
 
 
 
 
 
 
 /zo — 
 
 
 / 
 
 F 
 
 
 
 
 
 
 
 
 
 ZOOM. 
 
 / 
 
 
 
 
 
 
 
 
 
 
 
 FIG. 2r. THE SAME. RATIO METHOD. 
 A line (A) ascending at a uniform ratio in equal periods 
 of time, that is, in geometrical progression, is straight. 
 A line (B) ascending by equal differences in equal periods 
 of time, that is, in arithmetical progression, is curved 
 (downward). Note that the vertical intervals increasing 
 in geometrical progression (see the light figures) are 
 equally spaced. 
 
17] 
 
 The "Ratio" Chart 
 
 581 
 
 tween the ratio chart, and the ordinary, or difference, chart, 
 is simply one of spacing, the ratio chart (as in Fig. 2 r) hav- 
 ing the numbers 120, 130, 140, etc. unequally spaced whereas 
 the difference chart (as in Fig. 2 d) has these same numbers 
 equolhj spaced. 
 
 The above description of a method of forming a ratio chart 
 
 FIG. 3r. SCALES OF ELEVATIONS AND SLOPES. RATIO METHOD. 
 
 Showing, at the left, the elevations (and depressions) , representing various ratios of increase (or decrease), 
 and showing, at the right, the slopes representing various per annum rates of increase (or decrease). 
 
 will serve to explain its nature as representing equal successive 
 percentages of increase by equal intervals on the chart. 
 
 In Fig. 3 r we see the full fledged ratio chart, constituting 
 a ruling arrangement convenient for plotting. To familiarize 
 the reader with the graphic representation of ratios, some dark 
 vertical lines are drawn. These show how far up to go to 
 
582 American Statistical Association. [18 
 
 represent an increase respectively of 10, 25, 50, and 100 per 
 cent, (or 2-fold), 5-fold and 10-fold; while the next lines to 
 the right show how far down to go to represent a decrease of 
 10, 25, 50 (i.e. "half of"), and 90 per cent. Any two 
 points on the chart, however far removed from each other 
 horizontally, if the vertical interval between them is equal to 
 the 10 per cent, line, will be such that the statistical magnitude 
 represented by the upper point will be 10 per cent, greater 
 than that represented by the lower. Again the line repre- 
 senting "100 per cent, increase or 2 fold" is the vertical dis- 
 tance between any two points on the chart of which the upper 
 stands for twice the statistical number for which the lower 
 stands. 
 
 The reader is advised to verify these and the other legends 
 by taking any two points at random, reading the figures 
 opposite them in the margin and comparing these figures. 
 
 He may also familiarize himself with the sloping lines at the 
 right ascending respectively at the rates of 1, 2, 5, 10, 25, 50, 
 100 per cent, five fold, and ten fold per annum, as well as those 
 descending at the rates of 1, 2, 5, 10, 25, 50, and 90 per cent, 
 per annum, all drawn radiating from a center through the 
 appropriate points on a vertical line one unit to the right of 
 that center. 
 
 REPRESENTING GROWTH AT A CONSTANT, OR NEARLY 
 
 CONSTANT, RATIO. 
 
 The advantages of the ratio chart over the difference chart 
 are many. They may be seen from a few illustrative examples. 
 
 We have already seen (Fig. 1 r) that mere straightness of 
 the plotted line indicates, in the ratio chart, a uniformity in 
 the percentage rate of growth, whereas in the difference chart 
 such uniformity is represented by an exponential curve (Fig. Id). 
 
 In Fig. 2 d and Fig. 2 r the same lines are repeated and 
 labelled A. The line A represents a uniform percentage rate 
 of growth. It is an exponential curve in the difference chart 
 (Fig. 2 d) and a straight line in the ratio chart (Fig. 2 r). 
 
 For contrast a straight line B is drawn on the difference 
 chart (Fig. 2 d). Its straightness signifies little — merely that 
 the same absolute difference is added each year. But the 
 
19] 
 
 The "Ratio" Chart. 
 
 583 
 
 same absolute difference is a decreasing percentage rate of 
 growth and this fact is clearly interpreted in the ratio chart 
 (Fig. 2 r). We may say that the chief or typical contrast 
 between the two charts is that a straight line represents in 
 the one an arithmetical progression and in the other a geomet- 
 rical progression ; which is only another way of saying that it 
 
 A^TJ 
 
 AMn 
 
 z 
 
 6 /o /a » f6 /s ao da 2-4 £6 as 30 3a y^ J6 
 
 FIG. 4d. UNIFORM PERCENTAGE RATE. DIFFERENCE METHOD. 
 Showing uselessness of curve at extreme ends; also showing how to compare percentage slopes at 
 different points by comparing (inversely) the subtangents for these points. See p. 596. 
 
 represents a progression by equal differences in the one and 
 by equal ratios in the other. 
 
 A serious fault in the difference method is that, in a curve 
 of rapid growth, the difference chart is useful only in the middle 
 portion. At the extreme left such a curve, e. g., an exponential, 
 or uniform percentage, curve (as in Fig. 4 d) becomes almost 
 indistinguishable from a horizontal line and at the extreme 
 right it becomes almost indistinguishable from a vertical line. 
 
584 
 
 American Statistical Association. 
 
 [20 
 
 
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 (£80 
 
21] 
 
 The "Ratio" Chart. 
 
 585 
 
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586 A7nerican Statistical Association. [22 
 
 At either extreme no eye can estimate the percentage rate of 
 growth although that rate may not be different from the rate 
 in the middle. 
 
 A vast number of statistical charts represent rapid and long 
 continued growth, — the statistics of a prosperous business 
 plotted from the beginning; the statistics of a growing country; 
 the statistics of new inventions. We have merely to mention 
 any such familiar examples as statistics of population, wealth, 
 crops, mining, manufacturing, railway mileage, telephones, 
 automobiles, bank deposits, new building, sales of stocks, war 
 debts and other magnitudes rapidly increasing since the war 
 began, in order to realize the thousands or rather, probably, 
 the millions of statistical charts which have been constructed of 
 this kind, most of which are nearly useless at either end. 
 
 Thus Fig. 5 d represents the actual growth of the population 
 of the United States. The reader, however discerning or 
 experienced, cannot discover by mere ocular inspection of this 
 curve whether the increase at the end is faster or slower than 
 at the beginning. Fig. 5 r, on the other hand, shows the facts 
 desired at a glance. It shows a uniform rate of growth be- 
 tween 1790 and 1860 and slight but evident changes since the 
 last named date. 
 
 One great advantage of the ratio chart is in forecasting. 
 Usually, in business, we forecast by assuming a certain ratio of 
 growth. In the ratio chart we have simply to draw a straight 
 line; usually, in fact, merely to produce the one already drawn 
 representing the rate experienced in the past. 
 
 One method by which users of the ordinary chart have 
 attempted to meet its shortcomings in representing statistics 
 of rapid growth is first to draw a "growth axis, " or exponential 
 curve [such as that in Fig. 1 d, Fig. 2 d (curve A), or Fig. 4 d] 
 ascending at the average rate of growth of the statistics under 
 consideration; then calculate the per cents, of deviation each 
 year from this "growth axis"; and finally, plot these devia- 
 tions on a separate chart. 
 
 This procedure, however, involves, in addition to charting 
 the original statistical figures, much subsidiary calculation and 
 charting; and the results, when obtained, are not as exact as 
 the results obtainable more easily by the ratio method. 
 
23] 
 
 The "Ratio" Chart. 
 
 587 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ^-^^ 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 .- 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ^- 
 
 - •' 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ^ - 
 
 - 
 
 "* 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 ■ ""^ 
 
 
 
 
 
 
 
 
 
 
 
 
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 A 
 
 ^ 
 
 
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 -H 
 
 
 
 
 ■ - 
 
 -- 
 
 -- 
 
 — 
 
 ._. 
 
 ._- 
 
 -- 
 
 — 
 
 - "~ 
 
 ~ — 
 
 
 
 
 
 y ~x~jr 
 
 FIG. 6(i. EQUAL RATES OF GROWTH APPARENTLY UNEQUAL. DIFFERENCE METHOD. 
 Segments of two curves ascending at equal rates but having unequal slopes and therefore deceiving 
 the eye. 
 
 COMPARING CURVES. 
 
 If we wish to compare the growth of 
 population in two countries of different 
 sizes, such as Canada and the United 
 States, the ordinary or difference plots, 
 of whi'ch we shall assume that AA' and 
 BB^ in Fig. 6 d are small sections for a 
 given year, will give the impression that 
 the upper curve, i. e., that for the larger 
 country , is ascending at a much faster ratio 
 than the lower, {. e., that for the smaller 
 country. Few would suspect that the two 
 lines AA' and BB' represent precisely the 
 same percentage rate of growth. 
 
 In Fig. 6 r, on the other hand, the 
 equahty of these same two rates of 
 growth is clearly indicated by the paral- 
 lelism of the two lines A A' and BB'. 
 
 Again, if the plots of the two popula- 
 tions appear as in Fig. 7 d, most persons, 
 observing the paralldism of the two lines, 
 would jump to the conclusion that the 
 two populations are growing at the same 
 percentage rate. The fact is that the 
 lower line, AA', is ascending at a greater 
 percentage rate than the upper, BB'. 
 The ratio chart (Fig. 7 r) shows this at 
 a glance. 
 
 S- 
 
 ^ 
 
 / 
 
 A* 
 
 FIG. 6r. EQUAL EATES 
 
 OF GROWTH EVIDENTLY 
 
 EQUAL. RATIO METHOD. 
 
 The two segments are here 
 parallel. 
 
588 
 
 American Statistical Association. 
 
 [24 
 
 In the difference chart, in order to make even a rough eye- 
 estimate of the comparative percentage rates of growth of A A' 
 or BB' (Fig. 6 d or Fig. 7 d),we must: (1) note the position of 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 FIG. 7rf. UNEQUAL RATES OF GROWTH APPARENTLY EQUAL. DIFFERENCE METHOD. 
 Segments of two curves ascending at equal slopes, but at unequal rates and therefore deeei\'ing the eye. 
 
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 6 
 
 
 ^ 
 
 6' 
 
 3 
 
 
 
 
 
 
 
 / 
 
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 A 
 
 
 
 
 
 
 the zero or base-line, XX' \ (2) mentally 
 compare A'X' with AX and B'X' with 
 BX', and (3) compare the two compari- 
 sons. 
 
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 irksome, and inaccurate, especially if, as 
 is not uncommon, the base or zero line 
 has been omitted in order to economize 
 space. Furthermore they involve shut- 
 ting our eyes to the slope or steepness 
 of the lines AA' and BB' , the very 
 feature which first attracts attention. 
 
 Often, in fact, the bottom part of the 
 chart, containing the base line, is cut off, 
 and sometimes, instead of using the same 
 base line for two curves on the same chart the draughtsman 
 will bring one curve nearer the other by using two separate 
 base lines. In either event the result is misleading or confusing 
 and in such cases it is almost hopeless to obtain any clear idea 
 
 FIG. 7r. UNEQUAL RATES 
 OF GROWTH EVIDENT- 
 LY UNEQUAL. RATIO 
 METHOD. 
 
 The two segments are here of 
 different slopes and the steeper 
 slope indicates the greater rate 
 of growth. 
 
25] 
 
 The "Ratio" Chart. 
 
 589 
 
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 FIG. %i. JUGGLING WITH BASES AND 
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 FIG. 8r. THE SAME. RATIO METHOD. 
 
 The comparison between A and B here exactly represents the facts, showing only a faint resemblance, ia 
 marked']contrast with the first comparison in the preceding figure. 
 
590 
 
 American Statistical Association. 
 
 [26 
 
 
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 lyuz 
 
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 iyu4 
 
 lonc 
 
 OB 
 
 
 
 
 
 
 
 
 
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 lyuo 
 
 lOOA 
 
 • 
 
 V 
 
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 j.yuo 
 
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 xyu< 
 
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 lyus 
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 lyUJr' 
 
 
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 iQin 
 
 
 Jiyilr 
 
 1911 
 1912 
 1913 
 1914 
 1915 
 1916 
 1917 
 
 c 
 
 
 1 
 
 
 
 
 
 
 
 
 
 
 — lyiu 
 
 --1Q1 1 
 
 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 lyii 
 
 1019 
 
 
 
 > 
 
 
 
 
 
 
 
 
 
 / 
 
 — j.yiz 
 
 IQ-I Q 
 
 
 
 t 
 t 
 
 
 
 
 
 
 
 
 
 \ 
 
 lyio 
 
 1 Q 1 A 
 
 
 
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 lyi-j 
 
 -- -101 f^ 
 
 
 
 7 
 
 
 
 
 
 
 
 
 
 ^N, 
 
 ^iyi<> 
 
 IQIfi 
 
 
 
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 s 
 
 k_^ 1017 
 
 
 
 
 
 
 
 
 
 
 
 
 
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 9 = 
 
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27] 
 
 The 'Ratio" Chart. 
 
 591 
 
 
 B Z 
 
592 American Statistical Association. [28 
 
 of the comparative percentage growths except by recourse to 
 tedious arithmetical computations. Thus in Fig. 8 d the 
 curves A and B seem to be exactly similar. But they are far 
 less similar than they appear; for the curve A is relative to a 
 remoter base than the curve B. If plotted on the same base 
 and scale as B, the curve A becomes A' and its similarity to B 
 is greatly diminished. But even this degree of similarity is 
 greater than the statistics warrant, as we see when using the 
 ratio chart (Fig. 8 r). This shows the exact degree of simi- 
 larity of the two curves A and B which turns out to be very 
 small. Thus the ratio chart is an effective means of avoid- 
 ing juggling with statistics through base-selection or scale- 
 selection. 
 
 Fig. 9 d and Fig. 9 r, taken from a brief article of mine in 
 the New York Times Annalist of March 17, 1917, show a type 
 of error opposite to the foregoing, and one taken from actual 
 statistics. Fig. 9 d gives the impression that the prices of 
 breadstuff s have fluctuated less than the prices of "all com- 
 modities." On the ratio chart, however, as shown in Fig. 9 r, 
 although exactly the same numbers are plotted, it is seen 
 that breadstuffs have actually fluctuated a trifle more violently 
 than "all commodities." 
 
 For comparing in detail any two curves on ratio charts, 
 such as those in Fig. 9 r, we may do what we have just seen is 
 not properly permissible on a difference chart,^we may move 
 bodily either curve, the upper curve downward or the lower 
 curve upward, until the two are close together. Then the 
 various degrees of parallelism or divergence, at various periods 
 of time, may be seen with the utmost clearness. This is done 
 in Fig. 10 ?•.* Such close comparison will usually give quickly, 
 through the eye, a better practical picture, I think, of the 
 degree of correlation and certainly of the location of the corre- 
 lation, than can be obtained even by laborious calculations of 
 coefficients of correlation. 
 
 Index numbers "wath widely different bases, such as those of 
 Sauerbeck and of the United States Bureau of Labor, if plotted 
 on difference charts without especially selecting the scales or 
 without multiplying or dividing by suitable constants, appear 
 
 •The scale on the right applies to the lower curve, that on the left to the upper. 
 
29] 
 
 The "Ratio" Chart. 
 
 593 
 
 CO 
 
 cr 
 o 
 
 •a 
 
 K 
 
 a 
 in 
 
 5' 
 on 
 
 5- S 
 
 ■3 S 
 
 « 
 
 CO M 
 
 o 
 
 cr CO 
 
 3 O 
 
 c 
 
 C^ 1— I 
 
 2. w 
 
 5 H 
 
 f o 
 
 
 St 
 5> 
 
 
 1878 
 
 1879 
 
 11880- 
 
 1881 
 
 1882 
 
 1883 
 
 18844 
 
 1885- 
 
 1886- 
 
 1887- 
 
 1888- 
 
 1889- 
 
 1890- 
 
 1891- 
 
 1892- 
 
 1893- 
 
 o 
 
 18941 
 
 1895- 
 
 189(i-t-^ 
 
 1897-p^ 
 
 1898- 
 
 1899- 
 
 1900- 
 
 1901- 
 
 1902 
 
 1903- 
 
 1904 
 
 1905- 
 
 1906 
 
 1907- 
 
 1908- 
 
 1909-h 
 
 1910 
 
 1911- 
 
 1912 
 
 1913 
 
 1911 
 
 1915 
 
 191G 
 
 1917 
 
694 American Statistical Association. [30 
 
 far more different from each other than they really are. 
 Ratio plotting will show their exact similarities and differences. 
 
 As was said at the outset, difference charts are useful when 
 difference comparisons are wanted. Not only are such cases 
 rare, however, but often difference comparisons between curves 
 are meaningless, and ratio comparisons are alone possible. 
 This is the case when two curves represent incommensurable 
 magnitudes as, for instance, when a curve of railway gross 
 receipts is compared with one of population or one of the cir- 
 culation of money with one of the price level. In such cases 
 difference plotting involves a very dangerous discretion in 
 selecting the scale and the base in order neither to exaggerate 
 nor to understate the degree of correspondence. For instance, 
 the close similarity in the recent changes in the money in 
 circulation in the United States, on the one hand,, and the 
 price level, on the other, was not evident to me until I plotted 
 the two curves on a ratio chart (Fig. 11 r). This similarity 
 might be almost overlooked on a difference chart if the scales 
 for dollars and index numbers were selected arbitrarily. 
 
 One special, though slight, advantage of the ratio chart is in 
 representing more clearly than in the difference chart the 
 results of multiplying or dividing a statistical series of numbers 
 by a constant, or by another series, and in exhibiting the 
 resultant third series relatively to the other two.* 
 
 ATTEMPTS TO MEND THE FAULTS OF THE DIFFERENCE CHART. 
 
 One attempt to secure better comparability of curves in 
 ordinary plotting is that customary in handling index numbers, 
 — namely to reduce all prices to percentages of the base-period 
 price, so that we may start all the curves at an even 100 per 
 
 *In detail: (1) to multiply or divide by a constant any series of numbers plotted in a curve is merely to 
 shift the curve bodily up or down by the appropriate constant distance; (2) the reciprocals (of a statistical 
 series p lotted i n a curve)forin a second curve symmetrical (relatively to the unity line) to the first curve ; in 
 other words two curves representing reciprocal numbers are such as to coincide if the chart is folded over 
 the unity line; thus a plot representing an index number of prices will be the exact reverse of that repre- 
 senting the purchasing power of money, the one ascending whenever the other descends and at the same 
 angle; (3) the eorve formed by plotting the products of two series will be such that its distances from 
 the unity line will be the sum of the differences of the other two from that line; (4) analogously, a quo- 
 tient of two curves is distant from the unity line the difference of their distances (t. e., distance of the 
 dividend curve less that of the divisor curve). Thus if we plot a curve of acres per capita of wheat 
 lands and another of bushels per acre and then plot the curve of their products, i. e., of bushels per capita, 
 the three curves will be seen to be related as just described; the same would apply to index numbers of 
 prices, of wages, and of purchasing power of wages ("real wages"). 
 
31] 
 
 The "Ratio" Chart. 
 
 595 
 
 cent. If the curves do not greatly diverge this gives approx- 
 imately correct results. But it is a makeshift method and 
 never gives the absolutely exact comparisons of the ratio 
 
 Xndeji. 
 
 '^TcJA' '®" '^'^ '3 '5 /9/^ Id IS 'die Id 11 
 
 Moneu 
 1 n ' 
 Bill Tons 
 
 — &5.0 
 
 - 4.5 
 
 40 
 
 3.5 
 
 30 
 
 FIG. llr. MONEY AND THE PRICE LEVEL. RATIO METHOD. 
 Showing the exact degree in which the price level in the United States has fluctuated in comparison with 
 the amount of money in circulation. Since the war, there has been a close correspondence, changes in the 
 price level following changes in money by two or three months. 
 
 method; and, after the curves have diverged considerably, 
 their correct comparison becomes difficult. 
 
 Another method is that suggested by Professor Alfred 
 
596 American Statistical Association. [32 
 
 Marshall. It consists in making a special geometric con- 
 struction.* But recourse to geometric construction is slow 
 and inexact and does not appeal to the eye. 
 
 As a matter of fact, users of charts, when seeking percentage 
 comparisons, are apt simply to read off the four numerical 
 figures opposite the various points (as A and A' and B and B' 
 in Fig. 6 d or Fig. 7 d) and compute arithmetically the two 
 percentage rates of increase, {i. e., the percentage excess of 
 height of A' over A and that of B' over B) . But such a proce- 
 dure is nothing less than giving up the use of the diagram as 
 a diagram and using it merely as a table of arithmetical figures. 
 A diagram is supposed to interpret figures to the eye and to 
 need no interpretation itself through arithmetical processes. 
 When it does need such interpretation, it fails of its purpose 
 as a quick, clear, convenient, and reliable picture. 
 
 Finally we note that the foregoing correctives and safeguards 
 necessary for using the "difference" method correctly are, in 
 actual fact, almost invariably neglected. Practically no one 
 uses Marshall's subtangent comparison; few even mentally 
 measure the heights of points above the base line, — much less 
 mentally reckon, from these heights, the percentage rates of 
 change; few even notice whether the base line is inserted or omit- 
 ted or whether there are different base Unes for different curves 
 whose inconsistency needs to be allowed for; growth axes are sel- 
 dom constructed; few make any effort to shut their eyes to 
 straightness or parallelism in order to avoid being misled into 
 assuming uniformity or similarity of percentage changes; few, 
 even, use a diagram as a table of figures. 
 
 Professor Marshall says of the ordinary method of curve- 
 plotting: "Its defects are such that many statisticians seldom 
 use it except for the purpose of popular exposition, and for 
 this purpose, I must confess, it has great dangers. " t A business 
 
 • " On the Graphic Method of Statistics, " Jubilee Vol. of the Royal Statistical Society, 1885, pp. 251-60. 
 To help translate the deceptive slope of different lines, such as A A' and BB' in Fig. 6 dor Fig. 7 d, we pro- 
 duce these lines so that they cut the base line. If, when so produced, they are found to cut the base line 
 at the same point, as is the case in Fig. 6 d, where they both cut at Y, then we may know that they have 
 the same percentage slope. If, as in Fig. 7 d, they do not cut the base line in the same point, the one which 
 cuts the further off has the smaller percentage rate of increase and the rates of increase per annum of the 
 two lines at A and B are inversely proportional to the distances at which they cut the base as measured 
 from A'. Thus if, in Fig. 7 d, AT is 14/20 of XZ the percentage change at A is 20/14 of that at B. 
 Again, in Fig. 4 d the S'lopcs at A and A' are equal, as XY^X'V. All of these results may be proved 
 geometrically. 
 
 t "On the Graphic Method of Statistics," Journal of the Royal Statistical Society, 1885, p. 251. 
 
33] The ''Ratio'' Chart. 597 
 
 man whose attention was recently called to the advantages of 
 the ratio chart recharted his business statistics and was startled 
 to discover how he had been misled by the ordinary method. 
 
 After such a severe, but, I beHeve, just, indictment against 
 ordinary or "difference" plotting it may be asked whether, as 
 usually employed, such plotting is not worse than useless. It 
 is certainly true that ordinarily it misleads to some extent. I 
 have sometimes found myself hesitating to use a curve in a pub- 
 lication, because, on the one hand, of the space it would take up 
 if the base line were inserted and, on the other, of the mistaken 
 impression it might make if the base line were omitted. 
 
 The best that can be said for the difference method is: it 
 always shows whether there is an increase or decrease; it 
 usually displays the grosser contrasts at a glance; the base or 
 zero line gives a means, lacking in the ratio method, for plotting 
 zeros, for comparing positive and negative quantities, and for 
 seeing in a simple and self-evident comparison the vertical 
 elevations of points in a curve above the base line. 
 
 WAYS OF UTILIZING DIRECTION IN THE RATIO CHART. 
 
 The eye reads a ratio chart more rapidly than a difference 
 chart or a table of figures. We may recapitulate what most 
 easily catches the eye as follows: 
 
 1. If we see a curve ascending, and nearly straight, we know 
 that the statistical magnitude it represents is increasing at a 
 nearly uniform rate. 
 
 2. If the curve is descending, and nearly straight, the sta- 
 tistical magnitude is decreasing at a nearly uniform rate. 
 
 3. If the curve bends upward the rate of growth is increasing. 
 
 4. If downward, decreasing. 
 
 5. If the direction of the curve in one portion is the same 
 as in some other portion it indicates the same percentage 
 rate of change in both. 
 
 6. If the curve is steeper in one portion than in another 
 portion it indicates a more rapid rate of change in the former 
 than in the latter. 
 
 7. If two curves on the same ratio chart run parallel they 
 represent equal percentage rates of change. 
 
 8. If one is steeper than another the first is changing at a 
 faster percentage rate than the second. 
 
598 American Statistical Association. [34 
 
 9. The imaginary straight Une most nearly representing, 
 to the eye, the general trend of the curve, is its "growth axis, " 
 and represents the average rate of increase (or decrease) ; and 
 the deviations of the curve from this growth axis are plainly 
 evident without recharting. 
 
 10. The slope of the imaginary line between any two points 
 on a curve indicates the average rate of change between the 
 two. 
 
 WAYS OF UTILIZING ELEVATION IN THE RATIO CHART. 
 
 The preceding relates to direction. As to elevation, the eye 
 can, with a little famiharity, translate vertical elevation into 
 numerical ratio; for, as we have seen, a certain elevation re- 
 presents a 10 per cent, increase, another a 100 per cent, in- 
 crease, or doubling, etc., etc.* 
 
 To one accustomed to using the difference chart the use of 
 elevations on the ratio chart may at first be confusing. But 
 only a few minutes are necessary to learn its use; and this use 
 of the mere elevation for measuring the ratios, or vertical 
 distances, between any two points between the two magnitudes 
 represented by those points, is really easier and more exact than 
 the more self-evident method, in the ordinary chart, of com- 
 paring their two vertical distances from the base line.f 
 
 * For roughly interpreting elevations without having to read the marginal figures or measure dis- 
 tances, the original system of equidistant horizontals, as shown in Fig. 1 r, is not inconvenient. The 
 chart is divided into horiaontal 10 per cent, bands and the eye can approximately reckon how far any 
 point on a statistical curve is vertically above any otho* point, — whether one band's breadth, or two, 
 or any fractional part, and, therefore, whether it represents a magnitude 10 per cent, more, or 10 p:r 
 cent, more than 10 per cent, more, i. «. 21 per cent, more, etc. 
 
 fWe may also, if we wish, make much more exact comparisons than those afforded by the glance of an 
 eye. We may exactly measure any slope such as that of a tangent to a curve at any point or such as that of 
 a line connecting any two points on the curve. This may be done in accordance with the constructions of 
 the radiating lines in Fig. 3 r; by drawing a line parellel to that of which the slope is desired, from any 
 convenient point in the horizontal line " 10". Let this cut the vertical Une one unit to the right of said 
 point; the height of this intersection above (or below) line " 10" measures exactly the rate of ascent (or 
 descent) of the slope to be measured. 
 
 Again we may exactly measure any ratio comparison between two points on the same curve — or on differ- 
 ent curves for that matter. All we need to know is the vertical distance between the two points and 
 compare this with the vertical scale above (or below) the line " 10, " as illustrated in Fig. 3 r. Such a com- 
 parison may be made by a draughtsman's dividers, parallel rulers, sliding triangle, or even by using the 
 edge of a sheet of paper and a lead pencil. Thus, if the elevation, as measured, is found equal to the distance 
 between " 1 " and " 2 " (or " 10 " and " 20 " or " 100 " and " 200 ") then the upper point represents a statistical 
 magnitude just twice that represented by the lower point; or again, if the measured elevation is equal to 
 the distance between " 1" and "1.37" (or "10" and "13.7" or "100" and "137") on the scale, then the 
 upper point represents a statistical magnitude 37 per cent, greater than that represented by the lower 
 point. 
 
35] The "Ratio" Chart. 599 
 
 SUMMARY. 
 
 In the ratio method, then, a straight Hne* always represents 
 a constant percentage rate of increase or decrease and, con- 
 versely, a constant percentage rate of increase or decrease is 
 always represented by a straight line; a curve deviating from 
 a straight line invariably implies that the percentage of change 
 deviates correspondingly from constancy; any two curves or 
 two portions of the same curve which are parallel represent 
 exactly equal percentage rates of change; any two curves or 
 portions of curves which show a contrast of direction always 
 indicate a corresponding contrast in percentage change; if the 
 numbers plotted are halved or changed in any other ratio, the 
 resulting curve will simply be raised or lowered but will main- 
 tain exactly the same series of directions and therefore present 
 the same appearance to the eye; if the scale is properly selected, 
 a curve is never nearly horizontal except when it actually 
 represents an almost infinitesimal rate of increase or decrease, 
 nor is it ever nearly vertical except when it actually represents 
 a rate correspondingly enormous; as there is no zero line there 
 is no waste space on its account and the diagrams can be cut 
 off close, both above and below the curve; there can be no 
 juggling with base lines or scales; there is no need of special 
 supplementary geometric constructions, such as Marshall's 
 subtangent construction; there is no need of laborious calcu- 
 lations to reduce original figures to index numbers or per- 
 centages; there is no need of eliminating the growth axis 
 {which, in the ratio method, is simply a straight line, the per- 
 centage deviations from which are apparent without special 
 calculation or replotting). 
 
 The features of a curve which, whether we will or not, most 
 "catch" the eye are concerned with comparative direction, — 
 straightness or curvedness; steepness or flatness; parallelism 
 or divergence. These features therefore ought to be, not 
 
 •It is intereating to note that engineers have found it advantageous to devise special plotting charts 
 which will reduce parabolic, hyp?rbolic and probability curves of the ordinary charts to straight lines on 
 the special charts, e. g., see A. S. Langadorf, "Methods for Determining the Equations of Experimental 
 Curves," Journal of the Association of Engineering Societies, June, 1901, pp. 325-43; L. F. Harza, "Notes 
 on Determination of Experimental Equations," Wisconsin Engineer, December, 190S; George C. Whip- 
 ple, "Element of Chance in Sanitation," Journal of the Franklin Institute, Vol. 182, July 7, 1916, p. 37; 
 Alien Hazen, "Storage to be Provided in Impounding Reservoirs for Municipil Water 3upp'.y," Pro- 
 ceedings of the American Society of Civil Engineers, Nov., 1913. 
 
600 American Statistical Association. [36 
 
 snares nor stumbling blocks, as they are in the "difference" 
 chart, but aids or sign boards as they are in the "ratio" chart. 
 
 And, besides the full utilization of direction, we have, in the 
 ratio chart, that of elevation. While the interpretation by the 
 eye and mind of elevation requires a little preliminary training 
 it soon becomes easier, more rapid and more accurate than 
 the corresponding procedure for difference charts. 
 
 In a word, the ratio chart simply utilizes the natural powers 
 of the eye. Consequently, when one is once accustomed to it, 
 it never misleads, but always pictures a multitude of ratio 
 relations at a glance, with absolute fidelity and without the 
 annoyance of reservations or corrections. 
 
 BIBLIOGRAPHY. 
 
 Professor Jevons seems to have been the first* to employ 
 the idea of the ratio chart. He did not use prepared ruling 
 but employed a table of logarithms and plotted the logarithms 
 of the statistical numbers. While this procedure amounts 
 to the same thing it fails to interpret the method to the aver- 
 age man, for it seems to lose touch with the actual statistical 
 figures. 
 
 W. S. Jevons, Investigations in Currenaj and Finance, London, (Mac- 
 
 millan) 1S84, pp. 53, 128, 150. 
 Alfred Marshall, On the Graphic Method of Statistics, Jubilee Volume 
 
 of the Royal Statistical Society, June 22-24, 1885, p. 258. 
 George H. Wood, Some Statistics relating to Working Class Progress 
 
 since I860, Journal of the Royal Statistical Society, December, 1899, 
 
 p. 660. 
 Arthur L. Bowley, Elements of Statistics, London (King), 1901, pp. 
 
 188-196. 
 R. Benini, Principi4 di Statistica Metodologica, Torino (Unione Tipo- 
 
 grafico-Editrice Torinese), 1906, pp. 144-148. 
 W. J. Cunningham, The Logarithmic Scale in Graphic Charts, Railroad 
 
 Age Gazette, June 25, 1909, pp. 1517-19. 
 Walter T. Ray, Rational Stock Speculation, Norfolk, Va. (published by 
 
 the author), 1914, Vol. 1, pp. 15-20. 
 
 •"During the years" (viz., 1863 to 1884) "which have elapsed since this paper and previous essays on 
 the value of gold were printed, I have not happened to learn that logarithmic diagrams had been Msed 
 before their employment in these inquiries. It must be evident, however, that they furnish the true mode 
 of representing all statistical and other numbers of which the ratios, not the absolute amounts, are in 
 question. Now this is, strictly speaking, the case with almost all numbers used for statistical research, 
 as apart from mere practical accounts." W. S. Jevons, "Investigations in Currency and Finance," 
 London, (Macmillan), 1884, p. 128. 
 
37] The "Ratio" Chart. 601 
 
 WiLLARD C. BrintoN; Graphic Methods for Presenting Facts, New York 
 
 (Engineering Magazine Company), 1914, pp. 132-7. 
 WiLLARD C. Brinton and others, Preliminary Report of the Joint Com,' 
 
 mittee on Standards for Graphic Presentation, 1915, p. 5. Printed by 
 
 the American Society of Mechanical Engineers. 
 Irving Fisher, Plotting Ratios Along with Amounts, New York Times 
 
 Annalist, March 19, 1917, p. 398. 
 John Wenzel, Graphic Charts, Scientific American Supplement, No. 2154, 
 
 April 14, 1917, p. 236. 
 
^ 
 
 SALE OF INTOXICATING LIQUORS 
 
 STATEMENT 
 
 OF 
 
 PROF. IRVING FISHER 
 
 PROFESSOR OF POLITICAL ECONOMY 
 YALE UNIVERSITY 
 
 BEFORE A 
 
 SUBCOMMITTEE ON EXCISE AND LIQUOR LEGIS- 
 LATION OF THE COMMITTEE ON THE 
 DISTRICT OF COLUMBIA 
 
 MARCH 7, 1912 
 
 WASHINGTON : GOVERNMENT PRINTING OFFICE : 1912 
 
 42108—12 1 
 
STATEMENT OF PROF. IRVING FISHER, PROFESSOR OF POLITICAL 
 
 ECONOMY, YALE UNIVERSITY. 
 
 Senator Works. Professor, you have had occasion to study this 
 question of the effect of alcoholic drinks, and the committee is inves- 
 tigating the question of controlling the saloons. We would be very 
 glad to have your views upon that or any other feature of it you 
 desire to take up. You might first tell the committee what your 
 occupation is. 
 
 Prof. Fisher. I am professor of political economy at Yale Uni- 
 versity, and president of the committee of one hundred on national 
 health, which was appointed by the xVmerican Association for the 
 Advancement of Science. 
 
 I have been interested in the question of alcohol for a number of 
 years. I did not know that I was to appear before this committee 
 when I came to Washington, otherwise I should have come with 
 statistics which I can only give now offhand, without the actual 
 figures. 
 
 The Chairman. I would suggest, Professor, that when you return 
 home, if there is any memoranda you desire to send to the committee, 
 we will be glad to have it put into the record. 
 
 Prof. Fisher. I shall be very glad to do that, sir. I have been 
 interested in the problem for a number of years, having some 13 
 years ago lost my own health and regained it a short time after. I 
 became interested in public health in relation to myself and in rela- 
 tion to my profession of political economy, and for the last 12 
 years I have been making a study of the relation of health and dis- 
 ease to economics, its relation to the laboring classes, its relation to 
 industry; and when the committee of one hundred on national 
 health was appointed by the American Association for the Advance- 
 ment of Science five years ago I undertook the preparation of a 
 report, which later was presented to President Roosevelt as a part 
 of the report of the conservation commission of which I was a mern- 
 ber. In this report, which endeavored to cover the subject of public 
 health in the United States, I found it necessary to pay consid- 
 erable attention to the effects of alcohol. 
 
 After making what I believe was a thoroughly disinterested study 
 of the question, being perfectly willing to be convinced that alcohol 
 is a benefit or, within limits, is a benefit, or at any rate not an injury, 
 I came personally very strongly to the conclusion, on the basis of 
 statistics as well as on the basis of physiology, that alcohol, so far as 
 we can observe its effects, is an evil and no benefit. As soon as the 
 effects manifest themselves, they are injurious and not beneficial. It 
 is not what we could properly call a stimulant, but it is a depressant. 
 It is apparentlv a stimulant, because it puts to sleep the nerves that 
 indicate fatigue, so the person says that it relieves fatigue. What 
 it does is to make you unconscious of fatigue. 
 
 This summer I visited the great international hygiene exhibition 
 in Dresden, in which was represented the public-health work of all 
 
 3 
 
4 SALE OF INTOXICATING LIQUORS. 
 
 the nations of the world, with the one exception, I am regretful to 
 say, of the United States of America. That was a world's fair de- 
 voted to health, one of the most wonderful exhibits which has ever 
 been seen, the cost being over a million dollars, and being visited by- 
 many millions of people. 
 
 I was very much surprised to see that in Germany, an alcoholic- 
 using nation, distinctively a beer-dringing nation, that so much at- 
 tention was given to the evils of alcohol, and I found that at this 
 exhibit there were a number of interesting and new statistics on the 
 subject, and facts brought out by physiologists, and a daily demon- 
 stration by a skilled expert on alcohol, which was listened to with 
 ver}'- great attention by all of the visitors there, including the 
 Germans. 
 
 I also found that the Kaiser was encouraging this antialcohol 
 movement in Germany, that he had spoken against alcohol, had given 
 it up absolutely in his own household, had selected the university 
 to which to send his sons, on the basis largely of the fact that that 
 university had less of the fashion of beer drinking than any other 
 university in Gemiany. 
 
 I found also the statistics of Germany, taken from the recent scien- 
 tific movement against alcohol — I want to emphasize that word 
 "scientific," because it is not the kind of an alcohol movement that 
 we are accustomed to think of in this couiitr}^ — showed that there 
 has been a striking diminution in the use of alcoholic beverages, in- 
 cluding beer, in Germany. Concomitant with this there has been a 
 decline in the death rate. 
 
 I was particularly interested to see the statistics for Sweden. I 
 came away from this international exhibition wath the feeling that 
 Sweden is the most advanced nation hygienically in the world. Its 
 people have the longest duration of life, the smallest mortality, the 
 smallest infant mortality, the smallest mortality in old age, the 
 smallest mortality all along the line. Not only that, but its improve- 
 ment in mortality during recent years has been greater than any 
 other nation, although there is less room there for improvement than 
 in any other nation. 
 
 They have kept their vital statistics for 150 years — longer than any 
 other "nation has kept them. They have kept the record, and they 
 have read the record, and when they had found by these vital sta- 
 tistics, wdiich are really vital bookkeeping, that they were losing in 
 a particular way they tried to remedy that. Swedish massage, 
 Swedish gymnastics, Swedish hard bread, Swedish school hygiene, 
 Swedish inspection of school children, and various other facts, have 
 cooperated in this movement toward better living conditions and 
 better health. But in particular there has been a fight against alco- 
 hol there, so that the reduction in the consumption of alcohol has 
 been more striking, I think, than in any other nation. Judging from 
 the impression that I got from looking at the statistics there that 
 is true. At any rate, there has been a very great reduction. I 
 would not dare say offhand what per cent, but looking at the curves 
 there we found that per capita of alcoholic consumption had remained 
 absolutely constant for a number of years, but during the last decade 
 or two had sharply fallen off. 
 
SALE OF INTOXICATING LIQUORS. 5 
 
 The Chairman. What has been the result in the vital statistics 
 since that time? 
 
 Prof. Fisher. The improvement during the past few decades there 
 has been as great as in almost any other nation. I think not as 
 great as in Prussia, but Prussia had more room for improvement. 
 
 The Chairman. The improvement begins, you might say, with 
 the diminution in the use of alcohol? 
 
 Prof. Fisher. The improvement has been going on in the last 150 
 years, but it has been going on more rapidly of late, and especially 
 of the diseases of late in life. 
 
 Senator Works. By what means have they reduced the consump- 
 tion of alcoholic drinks? 
 
 Prof. Fisher. They have, by means of what is called the Guten- 
 berg system, b}^ means of which the State takes charge of the liquor 
 traffic, does not sell to minors, and attempts to discourage the prac- 
 tice, and educates the people w^ho come in to buy alcohol as to its 
 effects upon them. 
 
 The Chairman. The State controls it, or rather the sales ? 
 
 Prof. Fisher. Yes. 
 
 The Chairman. It does not leave it in the hands of private 
 parties ? 
 
 Prof. Fisher. In Germany the fight against it is conducted on 
 other lines, mostly educational. The reason Sweden has shown a 
 greater improvement in mortality in later ages in life as well as 
 earlier ages in life is that they are fighting alcoholic diseases as well 
 as degenerative diseases. There are two great classes into which 
 we may divide diseases: The acute diseases, which are of the in- 
 fectious type, such as pneumonia, smallpox, diphtheria, which are 
 more or less self-limiting, which come suddenly and go suddenly; 
 then there are the chronic diseases, which might be called the de- 
 generative diseases, or constitutional diseases, which come in grad- 
 ually or insidiously, such as rheumatism, gout, Bright's disease, 
 diseases of the heart and nerves. 
 
 In most countries the public-health fight has been almost exclu- 
 sively against the first type, and as a consequence they have im- 
 proved the death rate of the diseases of earlier in life, where the 
 danger from these diseases is greater, and the consequence is that 
 in England, the United States, and other countries there has been 
 a decline in the death rate up to 50 years. Beyond 50 years it is 
 greater than it used to be in some cases. In the United States it is 
 greater than it used to be beyond 60 years. 
 
 In Sweden the opposite is true. It is true all along the line, and 
 the reason for it is that Sweden is fighting the degenerative, the 
 chronic diseases, just as effectively as it is fighting the infectious 
 diseases. The method of fighting the infectious disease is by quar- 
 antine, public-health sanitation. The method of fighting the de- 
 generative disease is through personal hygiene, and the question of 
 Sie individual taking care of himself, the question of fresh air, sleeping 
 out of doors, living out of doors and taking exercise, questions of 
 attire, and questions of mental attitude. These are the methods by 
 vhich the degenerative diseases are combatted, and I believe that 
 in personal hygiene one of the most important branches is the use one 
 makes of alcoholic beverages. 
 
6 SALE OF INTOXICATING LIQUOES. 
 
 Sweden has come to this eonchision, and as a consequence they 
 have found a decline in the death rate not only under 50 years of age, 
 but after. Another most remarkable movement in mortality in 
 Europe has been in the city of London. I think it is one of the 
 wonders of the world that the death rate in London has been de- 
 creased as it is, and it has been a puzzle to me to find out exactly why. 
 I believe it is due to a combination of causes. As a matter of fact, 
 the death rate in London is as low as the death rate among the w^hites 
 in the city of Washington, and lower than the average death rate in 
 Washington, although London is the largest city in the world. This 
 has been due largely to the vigorous work in hygiene undertaken 
 by the London county council, including educational means. A 
 short time ago T had a little correspondence with ISIr. John Burns 
 in regard to the matter. He is a particularly well-posted man on 
 the subject, because he has taken so much interest in it. You know 
 that he was himself originally a labor man and is now secretary for 
 municipal government and has made a particular study of tubercu- 
 losis and of alcohol. 
 
 In his reply to my question as to what in his opinion had caused 
 this wonderful decline in the death rate in the city of London, he 
 gave a number of reasons, and among them, and emphasizing it more 
 than any other, was the reason of the decline in the consumption of 
 alcohol, especially among the working classes. He believes, and T 
 iDclieve, and I believe that every unbiased student of the subject 
 believes, that one of the very worst enemies of the working classes 
 is alcohol. It not only is an enemy to health, but it is an enemy to 
 thrift and to economic well being. These two act and react on each 
 other, because if you undermine the health you take away the earn- 
 ing power. iVlcohol is one of the chief causes of tuberculosis. That 
 is to say, it is one of the chief predisposing conditions. 
 
 Every well-educated expert in tuberculosis, I think, agrees that 
 that is true. A generation ago they would not have believed that 
 whisky was not a good thing for consumption, but now every well- 
 educated expert in tuberculosis believes that alcohol is a predispos- 
 ing cause. In that way it must have caused a great effect in increas- 
 ing consumption among the working classes, where consumption is 
 more predominant than in any other class, and therefore responsible 
 for a large amount of the death rate there and the inability to work, 
 because there is nothing that robs a working man of working power 
 so much as tuberculosis. So on either end \t injures the health of the 
 workman. By injuring his earnings it injures both his health and 
 his economic well being. 
 
 I know that John Burns is right in the belief that the consumption 
 of alcohol has gone down in Great Britain, for only a month ago I 
 believe there was an elaborate article on the consumption of alcohol 
 in Great Britain published in the Journal of the Royal Statistical 
 Society, the great statistical journal of the world, and it shows a de- 
 cline in the consumption of alcohol in Great Britain, and in the city 
 of London, and it has been very striking, similar to the decline in 
 Sweden, and has been coincident with this gi-eat decline in the death 
 rate. 
 
 The insurance companies have taken up the fight against alcohol. 
 The insurance companies which are going into public health ques- 
 tions are teachiiis: their risks in re.c:ard to alcohol. When the Postal 
 
SALE OF INTOXICATING LIQUORS. 7 
 
 Life Insurance Co. a generation ago first took up the statistices of 
 this country and tried to compare the mortality between those who 
 were total abstainers and those who were not, they found that those 
 who were total abstainers had the highest mortality. This fact was 
 greeted with glee by the users of alcohol, but it turned out to be due 
 to the fact that the insurance or nuitual benefit societies, which con- 
 sisted of those who did not consume alcohol, were a select class^ 
 namely, they were the reformed drunkards, and they were people who 
 were just about to die anywa}^ and therefore their mortality was very 
 great. It was due to alcohol, not due to lack of alcohol. Within the 
 last generation, when we have had a set of people coming in who 
 were total abstainers early in life, the opposite is true, so that now 
 you find for the Golden Sceptre, and other societies consisting of 
 total abstainers, the death rate among them is less than the average. 
 I recently saw the statistics of the New York Life Insurance Co. in 
 reference to these matters, and they confirm the facts I have recited. 
 
 There are a number of other facts that I might give if I had my 
 memoranda here, and if the committee would like to ask questions 
 I shall be very glad to explain in further detail anything I have said, 
 or to answer any objections, so far as I am able without preparation 
 or notes. 
 
 Senator Works. Professor, if you have statistics in convenient 
 form on that subject that you would be willing to furnish the com- 
 mittee, and will do it within a few days, we should be very glad to. 
 have them. 
 
 Prof. Fisher. I think I could send them here within a week. 
 
 The Chairmajs. We will withhold the printing of this record for 
 at least a week. If you will send the statistics we will put them in 
 the record. If there are any suggestions that occur to you afterwards 
 that you think will be of benefit you can add them to your statement. 
 
 The following was subsequently submitted in writing by Prof. 
 Fisher : 
 
 The Relation of Alcohol to Health. 
 
 [By Irving Fisher, president of the Committee of One Hundred on National Health.] 
 
 As a statistician and economist, I have made studies during the last 10 years which 
 have led me to the conclusion that while many false and exaggerated statements have 
 been made on the evils of alcohol its general condemnation by scientists of late has 
 not been too strong. 
 
 All physiologists agree that, in large quantities at least, alcohol is a poison. Dr. 
 William H. Welch, professor of pathology at Johns Hopkins University, in Baltimore^ 
 is quoted ' as saying that alcohol in sufficient quantities is a poison to all living organ- 
 isms, both animal and A'egetable. The present state of physiological science indicates 
 that if there exists any "physiological minimum" of alcohol which is harmless or 
 beneficial it is exceedingly small. The best statistics indicate that even "moder- 
 ate" users are injured thereby. 
 
 MUSCULAR ENDURANCE. 
 
 Dr. L. Schnyder,^ of Berne. Switzerland, shows, by means of strength-testing 
 machines, that the use of alcohol diminishes muscular power. A striking loss of 
 muscular endurance from the use of alcohol was also shown by diagrams of ergographic 
 experiments exhibited at the Dresden International Hygiene Exhibition in 1911. 
 
 Careful experiments with alcohol in relation to fatigue have been reported by 
 Rivers,^ who shows that alcohol diminishes the capacity for exertion. Experiments 
 
 1 Bv Henry Smith AVilliams, M. D., LL. D., in his article on "Physiological Effects of Alcohol," pub- 
 lished in McClure's Magazine, and reprinted in The Passing of the Saloon, compiled by George M. Ham- 
 mell, D. D., Cincinnati (Tower Press). 
 
 2 Alcohol and Muscular Force, bv Dr. L. Schnvder. in a compilation on the subject of alcohol by J. 
 Stump (teacher at the Hofwill Semfnarv), Zollikofen. and Robert Willenegger, Zurich, Switzerland. 
 
 3 W. n. R. Rivers, Influence of Alcohol on Fatigue, etc. London, Edward Arnold, 1908, pp. 89-90. 
 
8 SAT.E OF INTOXICATING LIQUORS. 
 
 carried on by Prof. Aschaffenburg with four typesetters, all users of alcohol, showed 
 that on days when Greek wine, containinj^ 18 per cent of alcohol, was given to the 
 men there was considerable diminution of the capacity for work. On the alcohol days 
 two of the men did decidedly less work, while the work of the remaining two was 
 marked by great irregularity. 
 
 Not only endurance of exertion, but of exposure to extremes of temperature, is weak- 
 ened by alcohol. It used to be a common impression that alcohol "warms you up " ; 
 consequently explorers and sea captains usea it. A more careful investigation has 
 shown that this is not true, and now the opinion is exactly the opposite. Amundsen, 
 in hie expedition to the South Pole, used no alcohol except when in winter quarters. 
 Grog "was used as a 'treat' every Saturday night, but when sledging we considered it 
 advisable to carry no spirits." 
 
 That alcohol increases fatigue is now commonly recognized by athletes. "Alcohol 
 gives no resistant increase of muscular power. It is well understood by all who con- 
 trol large bodies of men engaged in physical labor that alcohol and effective work are 
 incompatible."^ It is interesting to know that when the bicycle craze was at its 
 height in this country it reduced the consumption of alcoholic drinks among athletes, 
 for those who were trying to make their century runs demanded temperance drinks. 
 
 The following quotation from an article by a competent authority, Dr. Richard C. 
 Cabot, of Boston, is taken from a bulletin ■^ issued by the l\Ietropolitan Life Insurance 
 Co. for the education in hygiene of its 8,000,000 policy holders. It is significant as 
 showing the attitude of the great life insurance companies toward alcohol: 
 
 "If a man wishes to become an athlete and to go into training the first thing his 
 trainer would tell him would be to cut out alcohol absolutely. In fact, no trainer 
 would undertake to train a man unless he was willing to follow this rule." 
 
 THE LABORING MAN. 
 
 In the same bulletin Richard Wright, of Cambridge, points out the great importance 
 of abstinence from alcohol to the laboring man. The recognition that alcohol inca- 
 pacitates for work and increases the danger of accidents (which may be disastrous 
 not only to the employee but to others, as in the case of locomotive engineers) has 
 led to the repre.ssion of the use of alcohol. Employers are beginning to understand 
 that, on the subject of alcohol at least, the interests of the employer and the employee 
 are identical. In fact, one of the great causes for the reduction of alcohol in recent 
 years has been the fact that the employer has found it to his financial interest to 
 require total abstinence of his workmen. Dr. Grenfell, the missionary among the 
 Labrador fishermen, says: "\\Tiy don't I want to see liquor used at sea? Because, 
 when I go down for a watch below, I want to feel that the man at the wheel sees only 
 one light when there is only one light to see." 
 
 It has been reported that the New York Central Railroad, the Lackawanna, the 
 Pennsylvania, the Baltimore & Ohio, the Wabash, the Rock Island, and the Great 
 Northern have prohibited the use of intoxicants by employees while on duty; also 
 that the LTnited States Department of Commerce and Labor sent circulars to the 
 larger employers throughout the country to obtain information concerning their 
 attitude in regard to the use of liquor by employees and received replies from 1,794 
 establishments, which showed that the use of intoxicating liquors was forbidden 
 either in whole or in part. 
 
 I understand also that the United Mine Workers of America have recently shut 
 out saloon keepers and bartenders from membership in that organization. It is not 
 surprising to find that labor leaders are beginning to appreciate the importance of 
 the subject. This is true particularly in England. One of the best and latest sta- 
 tistical documents in regard to the recent decline in the consumption of alcohol and 
 its causes is that by George B. Wilson on Variations in the Consumption of Intoxi- 
 cating Liquors,^ in which he says: 
 
 "The rise of the great teetotal friendly societies, the Independent Order of Rech- 
 abites and the Sons of Temperance, is but an indication of a marked change in the 
 attitude of the working classes to this question. * * * The attitude also of the 
 leaders of the Labor Party, who are not merely, in the great majority of cases, personal 
 abstainers, but also strong advocates among the workers of total abstinence, has been 
 an important factor. * * * The growth of this great army of total abstainers 
 among the working classes from 177,000 in 1890 to 640,000 in 1910 is a significant 
 
 I The Liquor Problem: A Summary, report of the sulicommittee of Committee of Fifty on Physiologicftl 
 Aspects of the Liquor I'roblem. New York (Iloughton-Milllin ), 1!105. 
 3 Vol. 2"), No. 11. 
 » Journal of the Royal Statistical Society, Vol. LXXV, Part II, January, 1912. 
 
SALE OF INTOXICATING LIQUORS. 
 
 9 
 
 indication of the change that is in proore.s.^, and it is beyond doubt that the working- 
 man who 'drinks' loses caste among his fellows to a far greater extent than he would 
 1 have done 20 years ago." 
 
 MENTAL FITNESS. 
 
 Dr. 
 
 Alcohol decreases the capacity not only for physical but also for mental work. 
 Cabot states: ' 
 
 "While alcohol affects the body, the greatest harm done by it is to the mind and 
 brain. The constant use of alcohol is bad for the stomach and liver. But these effects, 
 while distinctly harmful, are relatively unimportant as compared with the influence 
 of alcohol on the mind and brain. ' ' 
 
 Dr. A. Smith shows, by elaborate tables, that alcohol tends to diminish the ability 
 to memorize figures.^ These and other data^ show that the number of mental errors, 
 such as in adding figures, etc., made by users of alcohol is very much greater than the 
 number made by abstainers. A subcommittee of the committee of 50, appointed to 
 investigate the liquor problem, states: * 
 
 "Experiments made on the effect of the continued daily administration of 40 to 80 
 grams of alcohol show a decrease after a few days in the ability to memorize and to add 
 figures. This depression disappears rapidly on leaving off the alcohol. " 
 
 The effects of beer and wine on mental faculties was tested by Bayer in Vienna, who 
 made observations on 591 public-school children, who were ranked by their teachers 
 in three groups — "good," fair, "and "poor." The results of these observations are 
 given in the following tables:* 
 
 Total, 591 pupilj. 
 
 134 were 
 total ab- 
 stainers. 
 
 164 drank 
 alcohol 
 seldom. 
 
 219 drank 
 
 beer and 71 drank it 
 wine once ; twice daily, 
 daily. 
 
 3 drank it 
 thrice daily. 
 
 Good.. 
 
 Per cent. 
 42 
 49 
 9 
 
 Per cent. 
 34 
 57 
 9 
 
 Per cent. 1 Per cent. 
 28 25 
 58 58 
 14 18 
 
 Per cent. 
 
 Fair. . - 
 
 33 
 
 Poor .... 
 
 
 67 
 
 
 
 
 E. Ivi-aepelin, professor at the Universitat Heidelberg, also tells us that alcohol 
 diminishes rapidity in adding figures. 
 
 INSANITY. 
 
 It is well known that alcohol is a potent cause of insanity. Kraepelin further tells 
 us® that 10 to 30 per cent of all mental illness is due— in part at least — to alcohol, 
 and that the male sex shows at least 10 times as ^eat a frequency of alcohohc insanity 
 as the female. We are told by Dr. Frederick Peterson, president of the New York 
 State ("ommission in Lunacy, "that ''In the State of New York there are now some 
 30,000 insane persons in public and private hospitals. It is believed that about one- 
 fifth of them, or 6,000 patients, owe their insanity to alcohol used either by themselves 
 or by their parents. In the asylums of the United States there are 150,000 insane 
 people, and, if we take the same proportions as before, there are 30,000 persons in 
 this country whom alcohol has made or has helped to make insane. * * * Dr. 
 Macdonald," who is one of the greatest specialists on insanity w^e have in this country, 
 thinks that one insane person causes a loss to the State of nearly $400 a year. The 
 total loss in monev to the State of New York caused through alcohohc insanity must 
 therefore be $2,400,000 and the United States $12,000,000 every year."^ 
 
 CRIME. 
 
 Crime is usually, if not always, a manifestation of mental aberration — temporary or 
 chronic— and this mental aberration is in a great number of cases due to alcohol. The 
 Massachusetts Bureau of Labor investigations showed that "84.41 per cent of all the 
 
 1 JournBl of the Royal Statistical Society, Part II, January, 1912. 
 - Table Bl, in compilation by J. Stump, loc. cit. 
 3 Bv J. Joss, in compilation bv J. Stump, loc. cit. 
 
 * Physiological Aspects of the" Liquor Problem, Vol. II, edited by John S. BiUmgs, Boston (Houghton- 
 Mifflin), 1903. 
 s Taken from Physiological Effects of Alcohol, loo. cit. 
 « Psychiatrie, Leipzig (Barth), 1899. 
 ' In "the Metropolitan, loc. cit. 
 
10 SALE OF INTOXICATING LIQUOES. 
 
 26,672 crimes [for wliicli lliere were convictions in Massachusetts in 1895] were due 
 to intemperate habits, and 82 per cent were committed while the criminal was under 
 the influence of liquor." ' The late Edward Everett Hale, a lifelong observer of 
 social conditions, is reported as saying: 
 
 "If anybody will take charge oi' all Boston's poverty and crime which results from 
 dnnikenness, the South Congregational Church, of which 1 have the honor to be the 
 minister, will alone take charge of all the rest of the poverty which needs relief in the 
 city of Boston.'" 
 
 Richard Wright states: 
 
 "Dr. Stehr's chart confirms scientifically what has long been generally kno^\^l, that 
 accidents and crimes of violence increase rapidly with the drinking of alcohol. This 
 is why Sweden stopped the sale of alcohol during the recent strike in that country, 
 and San Francisco and Chelsea shut up their saloons during the earthquake and fire."^ 
 
 The general conclusions of the committee of 50 after its investigation which cov- 
 ered a period of three years, carried on under the general direction of Prof. Henry W. 
 Famam, of Yale University, were that liquor was a first cause in 31 per cent of the 
 criminals studied, and that it entered in as a cause, directly or indirectly, in 50 per cent. 
 Mr. Samuel J. Barrows states^ that "of 30,000 prisoners examined, * * * 41 p^ 
 cent committed their crime under the influence of alcohol. In Belgium Prof. Thiry 
 makes the general proportion 45 per cent." 
 
 Although police convictions are not a perfect indication of the use of alcohol, but 
 often merely an indication of the vigilance and spirit of the police, they are neverthe- 
 less of some value, especially in England, where the administration of the law is less 
 variable than in this country. George W. Wilson states^ that "there is a real connec- 
 tion between the variations in the consumption of intoxicating beverages in the 
 United Kingdom and the variations in the number of proceedings and con\'iction3 for 
 offenses connected mth intoxication." 
 
 Temperance reform almost invariably leads to a reduction in crime. The prisoi 
 commissioners for Scotland are quoted by Wilson * as showing that "There can ben4 
 doubt that there is less intemperance in the country; the change perhaps not ^erJ 
 perceptible among the class who are habitually or very frequently intoxicated, bul 
 it is noticeable in the great reduction of crime and offenses by persons who occasionally 
 become intoxicated and then commit crimes and offenses of all kinds. " 
 
 SOCIAL EVIL. 
 
 Alcohol leads not only to crime, but to vice. This effect also may be regarded as" 
 due to alcohol by producing an abnormal state of mind. The dean of the Yale Medical 
 School, at a meeting in New Haven, Conn., March 11, 1911, stated that young men 
 usually go astray morally under the influence of alcohol. Forel ^ says that one can 
 scarcely expect to make successful headway against the social evil unless at the same 
 time an uncompromising fight is waged against alccihol. An official in the office of 
 the district attorney in New York reports that the houses of prostitution would, in 
 many cases, probably not be able to exist were it not for the sale of alcohol in them 
 And it is even more certain that their patronage would be greatly reduced were it not 
 for the custom of using alcohol as a beverage in the community generally. 
 
 Anything which diminishes the consumption of alcohol has been shown to diminish 
 the social evil. In this, as in other ways, hygiene and morals are intimately related^ 
 the relation being primarily a physiological one; for alcohol not only produces abnor- 
 mal desire, but reduces the strength of will by which such desire is resisted.' 
 
 DEGENER.\TIOX. 
 
 The influence of alcohol on physical degeneration was recognized by the British 
 parliamentary committee on race degeneration in that country. The report of that 
 committee * showed that they considered alcoholic stimulants harmful to the race. 
 Dr. T. D. Crothers, of Hartford, Conn., states that "There are to-day over a million 
 unrecognized inebriates who are the most defective, dangerous, and degenerate of 
 
 ' What People Have Said About Whisky, loc. cit. 
 
 2 From The Metropolitan, loc cit. 
 
 3 "The temperance tidal wave," in the Outlook, vol. 89, Xo. 10, July 4, 190S, p. 515. 
 * Loc. cit. 
 
 ' Loc. cit., p. 239. 
 
 ' Tlie Se.xual Question, by August Forel, M. D., Ph. D., LL. D., formerly Professor of Psychiatry at and 
 Director of the Insane Asylum m Zurich, Switzerland. New York (Rebnab Co). 
 
 ' The harmful effect of alcohol on sexual life is described by Dr. Gerhard Hahn in chapter 9 of Das Ge- 
 schlechtsleben des Menschen. Leipzig (Barth), 1911. 
 
 8 Report of the Inter-Dcpartmental Committee on Physical Deterioration. Vol. 1, London (Wa\nnau ic 
 Sons), 1904. 
 
SALE OF INTOXICATING LIQUORS. 11 
 
 all classes."'' A series of statistics collected by J. Stump- show a close relation 
 between alcohol and degeneration, insanity, criminality, idiocy, physical defects, etc. 
 Statistics given at the Dresden International Hygiene Exhibition showed that users of 
 alcohol have three and one-fourth times as many bad teetli as abstainers. Dr. Frederick 
 Peterson reports ^ that out of 2,500 idiots, epileptics, and imbeciles admitted to a certain 
 hospital, over 41 per cent had drunken parents, and Dr. Crothers gives figures* to show 
 that over 50 per cent of all inebriates and alcoholics conie from inherited degenera- 
 tions, and are literally the expression of transmitted defects. It is fair to say, liow- 
 ever, that while degeneration may lead to alcoliolism, tliere is no convincing evidence 
 that alcoholism leads to inlierited degeneration. In fact, some scientihc investiga- 
 tions of the Galton Laboratory for Eugenics, at University College, London, tend to 
 show that no such inlieritance exists 
 
 ILLNESS. 
 
 But however true or untrue it may be that inabilities due to alcohol are transmitted 
 from parents to child, certain it is that alcohol actually produces such inabilities in 
 the individual. As Metchnikoff points out, alcohol predisposes to disease; "it lowers 
 the resistance of the white corpuscles, which are the natural defenders of the body. 
 It is well known that people who indulge too freely in alcohol show far less resistance 
 to infectious diseases than abstemious individuals." * The late Sir Andrew Clark, the 
 great London physician, said: 
 
 "I am speaking solemnly and carefully in the presence of truth, and I tell you that 
 I am considerably within the mark when I say to you that, going the round of my hos- 
 pital wards to-day, seven out of every ten owed their ill health to alcohol."^ 
 
 "Statistics of English sick benefit societies — the Sons of Temperance, Odd Fellows, 
 and Foresters — show a remarkal^le superiority of abstainers over users of alcohol," 
 according to J. Stump; ^ "in respect to frequency of illness, the illness of the abstain- 
 ers is about half that of the users of alcohol, and for those between 55 and 65 years 
 of age less than one-fifth." A basis for computing the sickness that might be saved 
 by total abstinence and nonabstaining societies was made by Mr. H. Dillon Gouge, 
 public actuary of South Axistralia, in 1892. He found that the average weeks of sick- 
 ness in three societies of abstainers was 1,248; in three societies of nonabstainers the 
 average weeks of sickness was 2,317 (lacking only one-sixth of being twice as much). 
 Metchnikoff states : 
 
 "According to the careful investigations of a Swedish doctor, Edgren, published in 
 his ' Monograph on Arterial Sclerosis,' one case in every five of this disease is caused by 
 syphilis, and he shows that chronic alcoholism is an even more frequent cause (25 per 
 cent). These two factors, when united, are responsible for nearly half (45 per cent) 
 the cases of arterial sclerosis that occur." ^ 
 
 TUBERCULOSIS. 
 
 That alcohol is predisposing to tuberculosis is stated by Drs. Knopf, Flick, Huber, 
 and other authorities. It was also shown by the exhibit of the German central com- 
 mittee for the prevention of tuberculosis.* Dr. Crothers states:^ "Statistics of con- 
 sumptives show that a very large proportion of these were spirit and beer drinkers 
 in the early stages, with marked symptoms of dyspepsia, faulty nutrition, and ex- 
 haustion." The International Congress on Tuberculosis, at Paris, in 1905, passed a 
 resolution "That, in view of the close connection between alcoholism and tuberculosis, 
 this Congress strongly emphasizes the importance of combining the fight against 
 tuberculosis with the struggle against alcoholism." 
 
 MORTALITY. 
 
 Alcohol is not only responsible for a vast amount of physical and mental and moral 
 infirmities and abnormalities, inefficiency, invalidity, illness, insanity, degeneration, 
 with resulting misery, vice, and crime, but in many cases it directly causes death 
 and in others indirect^^ contributes to the cause of death. This has been true to the 
 extent of exterminating certain races. We have a well-known example in the case oi 
 
 ■< "The Sanitary Side of the Drink Problem." 
 
 2 Loc. cit. 
 
 3 "Alcohol and the child's heritage," The Metropolitan, loc. cit. 
 
 * "Some Distinct Psvchoneiiroses common to all cases of Incbrictv and Alcoholism." 
 
 6 The New Hygiene,by Elie MctchnikofT, Chicago (Keener), 1906. 
 
 6 What People Have Said About ^^'hislvv, loc. cit. 
 
 ' The Nature of Man, bv Elie Metchnilvotf, New York (G. P. Putnam's Sons), 190.3. 
 
 8 In their catalogue entitled "Guidedu Mus6e Ambulant de la Tnberculose," published by Dr. Klehmet. 
 
 s "Tuberculosis Due to Toxfemic State." 
 
12 SALE OF INTOXICATING LIQUOES. 
 
 the American Indians. The same inlluonce which ihey felt in extreme, the whitp 
 men, with a more moderate use of alcohol, still suffers, but in a more moderate deut- -. 
 Sir Victor Uorsleyaud .Mary D. Sturge, M. D.,' show that liquor sellcrshave a mortality 
 62 per cent higher than the average mortality of adult males, while abstainers are 44 
 per cent lower than the average.^ J. Stump's figures ^ show that the abstainers have 
 a mortality only three-fourths as great as that of the nonabstaiuers. His statistics of 
 the United Kingdom Temperance and General Provident Institution, applying to 
 over 31,000 users of alcohol and over 29,000 abstainers, and covering a period of 60 years 
 from 1841 to 1901, show that the mortality from alcohol users is greater than that of 
 abstainers at practically every age of life, the excess being least after 70 years of age, 
 and greatest between the ages of 35 and 40, at which time the mortality from alcohol 
 users is almost double (82 per cent greater than) the mortality of abstainers. 
 
 Since the hguros of the Mutual Life Insurance Co. of New York ■* give the same advan- 
 tage to American abstainers (23 per cent lower death rate), it seems fair to take the 
 available computations of the English life insm'ance companies as a basis for esti- 
 mating the saving of life that would result in the United States if we should all decide 
 to give up the use of alcohol. Of course, however, it should be remembered that the 
 favorable figure of total abstainers is partly due to the fact that as a class they practice 
 personal hygiene in all its forms. 
 
 The committee of the Harveian Society of London, appointed in 1879, says: ^ 
 
 "We find, therefore, upon the whole, reason to think that in the metropolis the mor- 
 tality among any considerable group of intemperate persons will differ from that gen- 
 erally prevailing among adults in the following important particulars, viz: A fom-fold 
 increase iu the deaths from diseases of the liver and chylopoietic viscera; a twofold 
 increase in the deaths from disease of the kidney, a decrease half as much again in 
 those from health disease, a marked increase in those from pneumonia and pleurisy, 
 a considerable increase and an earlier occurrence of those from disease of the central 
 nervous system; a marked decrease of those from bronchitis, asthma, emphysema, 
 and congestion of lungs, a decrease nearly as great in those from phthisis, and a later 
 occurrence, or at least termination, of the disease; a very large decrease in those from 
 old age, with an increase of those referred to atrophy, debility, etc., and the addition 
 of a considerable group referred in general terms to alcoholism, or chronic alcohol- 
 ism, or resulting from accidents." 
 
 Newsholme states : ^ 
 
 "So far it can be stated with a high degree of probability that over 6,000 deaths of 
 men are annually caused in England and Wales by diseases induced by alcoholic 
 indulgence. For every 100 such deaths among men there are, according to the 
 English experience, 81 among women. It is evident, therefore, that nearly 11,000 
 deaths were probably caused in England and Wales in 1904 by the two conditions^ 
 which can with certainty be ascribed to alcohol. This means that about 5 per cent 
 of the total deaths in adults are caused by alcohol. This percentage probably very; 
 greatly understates the real facts." 
 
 The best authority on the subject of the mortality of alcohol users in this country is I 
 undoubtedly Mr. Edward Bunnell Phelps. In his book ^ on this subject he shows j 
 that the male deaths in the area of the United States for which we have accurate' 
 registration of deaths, between the ages of 20 and 74, inclusive, 12 per cent of the' 
 cases of tuberculosis of the lungs are due in whole or in part to alcohol; 16 per cent of 
 the deaths from heart disease; 22 per cent of the deaths from pneumonia; 22 percent; 
 of the deaths from paralysis; 22 per cent of the deaths from apoplexy; 23 per cent of 
 the deaths from suicide; 23 per cent of the deaths from diseases of the arteries; 30 peri 
 cent of the deaths from Bright's disease; 67 per cent of the deaths from cirrhosis of the 
 liver; and 100 per cent of the deaths from alcoholism. There are also deaths from; 
 accidents and other causes partly due to alcohol. Mr. Phelps also states ^ that the 
 net results of an effort to arrive, by means of a statistical investigation, at a tentative 
 approximation of the mortality of alcohol in the United States "indicate that, roughly j 
 speaking, alcohol may have been directly or indirectly responsible for about 66,000; 
 
 1 In Alcohol and the Human Body, London (Macmillan), 1908, p. 350. 
 
 2 These comparisons are based on the registrar general's return and the experience of the Independenj 
 Order of KechalMtes for the years 1878-1887. 
 
 5 Loc. cit. 
 
 * " Efleet of total abstinenee on the death rate," by Joel G. Van Cise,actuary of the Equitable Life Assur 
 ance Co. of the United States. 
 
 5 British Medical Journal, Jan. 20, 1883, p. 07, quoted by Edward Bunnell Phelps in The Mortality 
 Alcohol, New York (Thrift Publishing Co.), 1911. 
 
 6 Taken from The Mortality of Alcohoh loc. cit. (p. 20), where it was introduced as follows: 
 " Dr. Arthur Newsholme, one of the foremost statistical authorities in Great Britain, and a cautious and 
 
 conservative student of mortality due to alcoholism, states in a composite work of 14 medical authoritie| 
 on 'The Drink Problem in its Medico-Sociological .\spects,' edited by T. N. Kelyiiack, M. D., 1907.'' 
 
SALE OF INTOXICATING LIQUORS. 13 
 
 deaths in continental United States in 1908, or for about 1 in every 13 deaths at adult 
 ages, a figure equivalent to 5.1 per cent of tlie total mortality from all causes at all 
 ages." He shows, further, that 5.1 per cent of the total mortality at all ages would be 
 about 7.7 per cent of the total mortality at adult ages. He says": 
 
 ''It should be clearly understood that this figure by no means signifies that alcohol 
 was the direct cause of 66,000 deaths, the number in question presumably including 
 all of the deaths in which alcohol played any appreciable contributory i)art." ' 
 
 Fi-om what has been said, we shouhl expect a decline in the death" rate to follow a 
 reduction in the use of alcohol. This turns out to be the case. The following diagram 
 shows the decline in the consumption of liquor in the United Kingdom from 1890 to 
 1909, the consumption of 1890 being taken as 100 for purposes of comparison. - 
 
 John Burns, the English labor leader and statesman, a very capable observer, 
 intimately acquainted with the working classes and with statistics concerning them, 
 has stated repeatedly that in his opinion there is no doubt that the decline in the death 
 rate is partly due to the decline in the use of alcoholic beverages. The following table 
 shows the remarkable decline in the death rate per 1,000 of population in London: •' 
 
 1890 21.1 1897 17. g" I 1904 16.5 
 
 1891 21. 1 1898 18. 4 I 1905 15.6 
 
 1892 20.3 1899 19. 5 1906 15.8 
 
 1893 20. 9 1900 18. 6 I 1907 15. 3 
 
 1894 17.4 1901 17.2 1908 14.6 
 
 1895 19. 5 1902 17. 4 1909 15.0 
 
 1896 18. 2! 1903 15. 4 1910 13.7 
 
 There has been a fall in the death rate almost every year, and many other causes 
 besides temperance must have contributed to this result. It is interesting to observe, 
 however, that, beginning with 1900, when the gi'eat reduction in the consumption of 
 alcohol began, the fall in the death rate has been more than twice as rapid as previously. 
 
 The history of alcohol in Sweden is especially interesting, for the reason that at 
 one time Sweden was very excessive in the use of alcohcl. This was especially true 
 after 1775, when Gustavus III introduced a State monopoly of manufacturing spirits 
 for the purpose of securing revenue. This system operated in Sweden at that time 
 in the same way that a corresponding system now operates in Russia. In Sweden 
 then, as in Russia now, the people were actually urged to increase their consumption 
 of spirits. At that time the death rate in Sweden was high, and it remained high as 
 long as this system of putting a premium on the use of alcohol was in vogue. The 
 consumption of alcohol increased and seems to have reached a climax in about the 
 year 1830, when the term "drunken Sweden " had become a byword. It was estimated 
 that the consumption of alcohol amounted to 20 liters of pure alcohol per capita per 
 year — nearly five times the present consumption. 
 
 Under the leadership of Peter Weiselgren, dean of Gothenburg, a strong wave of 
 temperance reform set in, which led first to the formation of a public sentiment against 
 alcohol and a reduction in its use, and later to the reform legislation of 1855, which 
 resulted in a still further reduction. These reforms led to the well-known Gothen- 
 burg system, which was finally perfected a decade later. Lender this system the 
 
 1 Mr. Phelps names two factors which explain why the percentage of deaths from alcohol is probably 
 greater in England, as sho^-n by the Harveian Society's investigation, than in the United States, as shown 
 by his own. These two factors are: First, the larger percentage of rural population in the United Stales as 
 compared with the merely urban population considered by the Harveian Society's investigation; second, 
 the much higher ratio of female deaths attributed to alcohol by the Harveian Society's investigation, 
 namely, 5 per cent, as compared with 17 per cent. Mr. Phelps goes on to state: 
 
 "Leaving out all other clearly defined differences between the conditions of London in or about 1880 
 and the United States in 190S, the two factors named fully account for most, if not all, of the difference 
 between the Harveian Society's assumed raito of 14 per cent and this investigation's conclusion of 7.7 per 
 cent as indicative of the proportion of all deaths at adult ages directly or indirectly due to alcohol in London 
 in 1880 and in continental United States in 190S. 
 
 ****** 
 
 "In conclusion, it would seem that in all probability the approximate total of 66,000 deaths assumed to- 
 be the mortahty directly or indirectly due to alcohol in this country in the year 1908 is not only an outside 
 figure, but possibly one somewhat in excess of the real number of deaths which would properly be so charge- 
 able if there were any means of measuring the actual experience of the Nation. Apparently not more than 
 1 in 13 deaths at adult ages is even remotely attributable to alcohol, instead of the 1 in 6 deaths at all ages 
 which Mr. Reid and some other -nTiters on "the subject would have us believe are so chargeable. The con- 
 clusions of this paper have been reached by clearly defined statistical processes, everv detail of which may 
 be critically examined and accepted or rejected, whereas practically all of the preceding figures of the last 
 25 years have been mere generalizations. Which conclusions are fairly entitled to the greater degree of 
 
 Cr6d.GIlC6? '^ 
 
 2 From article by George B. "WOson in the Journal of the Royal Statistical Society, loc. cit. 
 
 3 From the Registrar General's Annual Summary of Marriages, Births, and Deaths in England and 
 AV ales and in London, 1910 (revised). 
 
14 
 
 SALE OF INTOXICATING LIQUORS. 
 
 monopoly of selling liquor is given by special license from the Government to a par- 
 ticular company in each locality. Those who obtain this license are limited in their 
 profits from alcohol to Ihe ordinary interest on their capital, the surplus reverting 
 to the State for public purposes. As these licensed companies also sell food, they have 
 an incentive to increase their sales of food rather than of alcohol, as the sales of alcohol 
 are sub'ject to special restrictions and systematically discouraged, just as a century 
 earlier they had been systematically encouraged. 
 
 1891 
 1890 
 
 1693 
 1892 
 
 1895 
 1894 
 
 1697 
 (896 
 
 (899 
 1898 
 
 190/ 
 1900 
 
 (903 /905 
 »902 (904 
 
 (907 
 1906 
 
 1909 
 •906 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 -f 
 
 
 
 
 
 
 
 "•,, 
 
 
 ff'' 
 
 / 
 
 '••. 
 
 • 
 \ 
 
 
 
 
 0*r ., 
 
 > 
 
 ■•-V.-. 
 
 t 
 
 \ 
 
 
 
 
 \ 
 \ 
 \ 
 
 \ 
 
 \ 
 
 '% 
 
 
 
 
 ■♦v 
 
 \ 
 \ 
 
 / 
 
 p 
 / 
 
 
 
 
 
 
 • 
 * 
 
 
 
 
 V 
 
 
 
 
 
 •^ 
 
 • 
 
 • 
 • 
 
 
 
 
 
 
 
 \ 
 • 
 
 
 
 \ 
 
 • 
 
 • 
 
 
 
 
 
 
 
 \ 
 \ 
 \ 
 
 
 
 • 
 • 
 
 \ 
 \ 
 
 
 
 
 
 
 
 
 1 
 
 \ 
 \ 
 
 \ 
 
 
 • 
 
 \ 
 
 9 
 
 \ 
 
 • 
 
 
 
 
 
 
 
 
 
 \ 
 
 \ 
 \ 
 
 \ 
 
 
 
 
 
 
 
 
 
 
 \ 
 
 120 
 
 i\5 
 
 no 
 
 105 
 
 100 
 
 95 
 
 30 
 
 55 
 
 80 
 
 75 
 
 70 
 
 6S 
 
 60 
 
 Fig. 1. — The per capita consumption of beer, spirits, and wine in the United Kingdom 
 during the years 1890 to 1909, reduced to the standard of 1890. 
 
 The first effect of Swedish temperance reform was to decrease the consumption of 
 spirits and increase that of beer, but latterly the consumption of beer has also de- 
 creased, as well as of spirits and wines, until now Sweden is one of the smallest users 
 of alcohol of the nations of the world, and temperance sentiment is exceedingly strong 
 among the people, especially the working classes. 
 
 I 
 
Liters. 
 
 189G-1900 5. 1 
 
 1901-1905 4.9 
 
 1906-19 10 4. 4 
 
 SALE OF INTOXICATING LIQUORS. 15 
 
 The Rev. Clarence True Wilson, D. D., stated about a year ap;o: ' 
 "Particulars regarding the remarkable plebiscite on prohibition recently taken in 
 Sweden illustrate the thorough nature of the agitation in that Scandinavian country. 
 The State was sown almost knee deep with prohibition tracts; an army of volunteer 
 workers were enrolled; and the question was stirred in every church and chapel 
 throughout the laud. The overwhelming victory for prohibition confirms the judg- 
 ment of a well-known writer that "Sweden has been changed in a few generations 
 from one of the drunkenest countries of the world to the soberest ' * * * In all 
 the country parts of Sweden, with 4,000,000 of population, there are at present only 
 about 140 spirit shops." 
 
 The following table shows the estimated consumption, in terms of pure alcohol, 
 per capita, per annum :- 
 
 Liters. 
 
 1861-1870 5. 3 
 
 1871-1880 6. 1 
 
 1881-1890 4. .5 
 
 1891-1895 4.2 
 
 It is interesting to observe that the death rate in Sweden, while its decline has 
 been under the combined influence of many other mighty factors at work in that 
 country, as to a certain extent in all countries, has exhibited at least an apparent 
 relation to the consumption of alcohol. During the period when Sweden was becom- 
 ing increasingly alcoholic the death rate showed substantially no decline. Since 
 the temperance reform was undertaken in earnest, in the middle of the nineteenth 
 century, the decline of the death rate has proceeded with great rapidity, until now 
 it is about half of what it was 150 years ago. It is significant that the decline in the 
 mortality in Sweden is a decline at all ages — the mortality of octogenarians, for 
 instance, being less than it used to be. This is not true of most other countries, 
 where the fight to lower the mortality has been mostly against infectious or 
 epidemic diseases, instead of against diseases combatted by personal hygiene.. 
 
 The figures for the Swedish death rate per thou,sand of population are as follows 
 
 1751-1760 27. 4 1904 15. 3 
 
 1801-1810 27. 9 1905 15. 6 
 
 1851-1860 21. 7 ' 1906 14. 4 
 
 1891-1900 16. 4 1907 14. 6 
 
 1901 16.1 1908 14.9 
 
 1902 15. 4 1909 13. 7 
 
 1903 15. 1 1910 14. 
 
 The death rate in Sweden is now the lowest of any country in the world. 
 
 "In Sweden the House of Representatives, by a vote of 89 to 86, declared ir 1907 
 approval of the principle of prohibition, which was put into effect temporarily through- 
 out the national strike from the 4th to the 31st of August, 1909, with an immensely 
 beneficial result. Restam-ants only were permitted to serve wine ard beer with 
 meals. The mortality in Stockholm for the 8th to the 14th of August, 1909, was but 
 8.7 pro mille, as against 13.4 pro mille as the average for the corresponding days in the 
 previous 10 years. 
 
 " Official police court statistics during the strike show that at Gothenburg, in August, 
 1908, there were 847 arrests for drunkenness; during August, 1909, but 113; from Sep- 
 tember 1 to September 7, 1908, 188 arrests; September' 1 to 7, 1909, only 3; on Sep- 
 tember 8 the public houses were opened again, and from September 8 to September 19 
 there were 259 arrests. At Stockholm, in August, 1908, there were 1,549 arrests for 
 drunkenness, but 169 only in August, 1909; at Nykoping, 26 arrests for August, 1908; 
 1 only in August, 1909. Orebro showed 100 police court cases, 84 of which were for 
 drunkenness, in August, 1908; 9 only, and none for drunkenness, in August, 1909. At 
 Malmo, in August, 1907, 346 arrests for drunkenness; August, 1908, 443; August, 1909, 
 175, of whom 152 were in the streets adjoining the port. Most of the men arrested 
 were foreigners who came directly from Copenhagen. These improvements were all 
 assigned to prohibition, which was hailed with satisfaction by the great mass of the 
 workingmen. On August 11, at Stockholm, a meeting of 20,000 strikers begged the 
 Government to lengthen the period of prohibition. 
 
 " By request of Parliament, the Government has appointed a committee to investigate 
 and make clear how the provincial boards and assemblies (county councils), the com- 
 munities, and the State may be released from economical dependence upon the drink 
 traffic." 3 
 
 1 "Seeing the World," by Prohibition Biplane, the American Prohibition Yearbook for 1911. Chicago 
 (National Prohibition Press). 
 
 2 Statistisk Tidskrift, 1912, p. 123. 
 
 ' Kev. Clarence True Wilson, D. D., loc. cit. 
 
16 
 
 SALE OF INTOXICATING LIQUORS. 
 
 In Germany the temperance movement is making remarkable headway considering 
 the fact that for renturies beer drinking ha? been almost universal. The reform ia 
 being led by the Kaiser, and the history of all reforms shows that they progress more 
 rapidly when led by the "top" of society rather than from the "bottom." It was 
 especially noteworthy that at the great International Hygiene Exhibition at Dresden 
 in 1911, organized by German genius, a "demonstration" of the alcohol exhibit was 
 made twice a day. In a spirit of liberality, brewers were allowed to make a special 
 exhibit, but the management of the exhibit, in theii" official daily "demonstrations," 
 set forth the most recent scientific conclusions, which are, as has been shown above, 
 against the use of alcohol as a beverage. 
 
 The decline in the consumption of beer in Germany since l^ftd'is shown by the 
 
 following diagram: 
 
 120 
 
 I 10 
 
 100 
 
 )^0D 
 
 90 
 
 80 
 
 70 
 
 60 
 
 50 
 
 AO 
 
 30 
 
 20 
 
 10 
 
 1685 1630 1895 1900 1905 /9I0 
 
 (915 
 
 
 
 • 
 
 • 
 • 
 
 
 
 
 1 
 
 * 
 • 
 
 • 
 
 ..>"* 
 
 3eer 
 
 • 
 • 
 • 
 
 • 
 
 
 • 
 
 ..v-*v 
 
 
 
 
 
 
 
 
 
 
 
 ') 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 y*^' 
 
 
 
 S/o/r/fs 
 
 . ^ . ^« 
 
 
 V,-'^-''" 
 
 v^'^-^ 
 
 '''■~C- 
 
 
 *—• — •--• 
 
 
 Fig. 2. — The use of alcoholic beverages in Germany in liters per capita.' 
 
 The Kaiser is reported as having said: "The nation which takes the smallest quan- 
 tity of alcohol will win the battles of the future." 
 
 'From the "Reichsarbeitsblatt," March, 1910, reproduced from the catalogue of the exhibition on 
 alcoholism, at the International Hygiene Exhibition, Dresden, 1911. Berlin (Massigkeits-Verlag), 1911. 
 
SALE OF INTOXICATING LIQUORS. 17 
 
 "Moltke, himself an abstainer, said: 'Beer is a far more dangerous enemy to Ger- 
 many than all the armies of France.' " ' 
 
 Germany, like Sweden, shows a very rapid decline in the death rate. 
 
 In the United States the per capita consumption of spirits, wines, and beer has as 
 yet shown little sign of decreasing. That of spirits is less than it was in 1840 to 1870, 
 but is about the same as in 1870. The consumption of wines has increased, with some 
 fluctuations, from 1S40 to the present time, while the consumption of beer increased 
 rapidly from 1840 to 1890, since which time it has increased less rapidly. During 
 the last five years the consumption of all three has remained substantially constant.^ 
 It is not unlikely, therefore, that we are passing over the crest of a wave, and shall 
 in the next decade see a substantial decline such as has taken place in several of 
 the countries of Europe. We are a backward country, and far behind Sweden, Ger- 
 many, and England in the appreciation of hygiene in all its branches. Neverthe- 
 less, we are beginning to be aroused to the situation, and the death rate in the United 
 States (registration area) has declined slightly during the last decade. 
 
 LONGEVnT. 
 
 To lower the death rate means to increase the length of human life. Two genera- 
 tions ago it was supposed that alcohol was conducive to longevity. About that time 
 an English Quaker, applying for life insurance, was charged a higher premium be- 
 cause he was a total abstainer. The basis for this opinion seems to have been that 
 the first societies of total abstainers showed a higher mortality. But this was because 
 they consisted of reformed drunkards; their death rate was high — -not because they 
 were abstainers, but because they had previously been drunkards. The discussion 
 to which the rejection of the total abstainer gave rise led to the formation of the 
 United Kingdom Temperance and General Provident Institution, of London, whose 
 investigations later proved that abstainers were longer lived than nonabstainers. 
 
 An investigation of all the deaths of men over 60 years of age in the city of Chicago 
 for the month of April, 1909, showed that those who had been drinkers reached an 
 average age of 68 years, but those who had not been drinkers reached an average of 
 over 72 years. Nineteen who had not been drinkers passed the age of 80. 
 
 Congressman Hobson states:^ 
 
 ' 'The figures of the British Government and English life insurance companies as to 
 the effect of drinking on longevity are stated as- follows: 
 
 "If a man at the age of 20 is a total abstainer and remains a total abstainer, his 
 prospect of life is 44 years, and he will live to the average age of 64; but if he is a 
 temperate regular drinker his prospect of life will be 31 years, and he will live to the 
 average age of 51, after losing 13 years out of his life. If he is a heavy drinker, his 
 prospect of life is 15 years, and he will die at the average age of 35, after losing 29 
 years out of his life. Conservative estimates place the number of confirmed drunk- 
 ards in the United States at something over 1,000,000, of whom 300,000 die every 
 year; the heavy drinkers at over 4,000,000; and temperate regular drinkers at over 
 20,000,000. A soldier wounded in battle and losing 10 years of his life as a conse- 
 quence would be classed as seriously wounded. The confirmed drunkards and 
 heavy drinkers together, 5,000,000 in number, must be looked upon as mortally 
 wounded and the temperate regular drinkers as seriously wounded, making a total 
 of over 25,000,000 Americans wounded by alcohol to-day, more than 10 times as 
 many as wounded in all the battles of the world since the dawn of history. The 
 estimates for the white race make over 125,000,000 white men to-day wounded by 
 alcohol." 
 
 INSURANCE. 
 
 In view of the facts which show the relation of mortality and longevity to the use 
 of alcohol it is not surprising that the life-insurance companies are taking up in 
 earnest the enlightenment of the public on the subject. The Postal Life Insurance 
 Co. issues a series of bulletins, of which No. 5* was entirely devoted to the subject 
 of alcohol and mortality. I quote from this bulletin as follows: 
 
 "In 1880 the per capita consumption of alcoholic beverages in the United States 
 was 10.08 gallons. In 1909 it reached 21.85 gallons, an increase of 117 per cent. 
 Since 1880 the death rate in the registration States from degenerative diseases in 
 which alcohol is conceded to be an important causative factor has increased 104 
 per cent." 
 
 1 Samuel J. Barrows, loc. cit. 
 
 2 See Statistical Abstract of the United States of 1910, p. 544. 
 
 3 Hon. Richmond P. Hobson, " The great destroyer," a speech delivered In the House of Representa* 
 tives, Feb. 2, 1911. 
 
 * Apr. 1, 1911. 
 
 42108—12 2 
 
18 SALE OF INTOXICATING LIQUORS. 
 
 Bulletin No. 6,' of the same company, speaks again of the effects of alcohol: 
 "Some of the world's leading scientists — Aschaffenburg, Hodge, Laitenen, Krae- 
 pelin, and others — have shown the destructive effect of alcohol on the nervous 
 system and its action in lowering the resistence to the bacteria of disease." 
 " The Metropolitan Life Insurance Co., as mentioned above, publishes a bulletin 
 called The Metropolitan. One entire issue of this bulletin, which is sent out to all 
 the company's policy holders, was devoted to the subject of the evils of alcohol. 
 
 Many other insurance companies are issuing health bulletins, in which the use of 
 alcohol on the part of policy holders is discouraged. I understand that out of 49 
 insurance companies which were circularized in regard to this subject, 39 of them 
 replied that they did not consider even moderate drinkers good risks. 
 
 BIASED STATEMENTS. 
 
 1 have tried to quote from authorities who have approached the alcohol question 
 from a scientific point of view. It would be possible to make, with a very good show 
 of reason, much more extreme statements, but more difficult of ])roof, based upon 
 the evidence of those more or less biased by their enthusiasm. 
 
 The bias of enthusiasm, however, is not so liable to be misleading as the bias of 
 commercial interests. I have seen much of the literatm-e issued by brewers and dis- 
 tillers and have been struck by their willful perversion of the truth and the garbled 
 quotations and misleading statements. For instance, at the great international 
 hygiene exhibition the brewers (who were allowed to set forth their claims for beer 
 as a "hygienic" beverage) culled certain exceptional statistics intended to show that 
 brewers were unusually long lived. These statistics were repudiated as misleading 
 by the statistical officer in the city to which they referred. When scientific men called 
 this fact to the attention of the authorities of the international hygiene exhibition, 
 they requested the brewers to remove the misleading statistics. This they refused 
 to do and maintained that they had a legal right to keep the statistics there; where- 
 upon the authorities of the exhibition put opposite the statistics a statement to the 
 effect that they disclaimed any responsibility for the brewers ' statistics. 
 
 One of the most interesting examples of the willful misrepresentation of facts con- 
 cerning alcohol is the case of a celebrated American whisky manufacturer, who has 
 repeatedly stated in the newspapers that whisky — or at any rate his particular brand 
 of whisky — prolongs human life. It so happens that I visited the city where this 
 manufactm-er lives and found that both he and his soti made a point of being total 
 abstainers for the sake of their health. 
 
 POVERTY AND PROSPERITY. 
 
 Since the evidence shows that alcohol impairs labor power, it is not surprising to 
 find poverty coexists with the excessive use .of alcohol and that prosperity increases 
 as the use of alcohol is reduced, as it has increased in Sweden, Germany, England, and 
 in certain places in the United States. It is claimed - that strong drink costs England 
 $2,000,000,000 annually and that the total amount annually spent in the United 
 States is over $4,000,000,000. 
 
 If the conclusions we have reached — that the use of alcohol as a beverage is always 
 a net injury and never a net benefit — these four billions annually are worse than 
 wasted, if a direct tax of that amount were laid on the citizens of the United States 
 they would rise in revolt. And yet such a tax would not be so heavy a burden as the 
 expenditure for alcoholic beverages. The tax would presumably be returned, in 
 part at least, to the public — in the form of public schools, good roads, the administra- 
 tion of justice, and of other governmental functions. But the expenditure for alcohol 
 brings no return to the public and no return — except a delusive gratification — to the 
 individual. On the contrary, it increases public and private burdens. It increases 
 public burdens by necessitating greater expenditures for jails, police, and courts, 
 penitentiaries, insane asylums, hospitals, and j)oorhouses; and it increases private 
 burdens by impairing earning power and undermining moral character. The drinker 
 not only robs his family of the earnings he spends on alcohol, but he robs them of the 
 earnings he loses from unemployment due to drunkenness, from illness, accident, and 
 other disabilities due to the use of the drug and from the resulting shortening of his 
 life; while, further, he robs them of himself, his companionship, and personal care. 
 If all of these disadvantages could be appraised in cash and added to the billions 
 directly spent the total figure would probably be manyfold larger that at first appears; 
 and the worst feature of it is that the greater part of this crushing weight rests on the 
 
 ' Hon. Richmond P. Hobson, " The great destroyer," a speech delivered in the House of Repre- 
 sentatives, Sept. 1, 1911. 
 
 2 American Prohibition Yearbook, loc. cit. 
 
SALE OF INTOXICATING LIQUOES. 19 
 
 shoulders least able to bear it — the shoulders of the workingman. The wealthy can 
 better bear loss of income and efficiency, but such losses to the workman spell poverty 
 and misery. The committee of fifty found that of the poverty which came under the 
 notice of the charity organization societies about 25 per cent could be traced, directly 
 or indirectly, to the use of liquor; of the poverty found in almshouses about 37 per cent. 
 
 Carroll D. Wright, formerly United States Commissioner of Labor, stated: ' 
 
 "I have looked into a thousand homes of the working people of Europe; I do not 
 know how many in this country. In every case, so far as my observation goes, drunken- 
 ness was at the bottom of the misery and not the industrial system or the industrial 
 surrounding of the men and their families." 
 
 Whether or not ''Prohibition Kansas" can be held responsible for all improvement 
 in that State, it is certainly true that the State has made great strides since prohibition 
 was introduced. The American Prohibition Yearbook states:^ 
 
 "As a consequence of having no paupers, the j^oor farms of more than 50 counties 
 have been turned into experiment stations under the control of the State Agricultural 
 College, and are now called 'Prosi^erity farms.' 
 
 "In the 25 cities of Kansas the percentage of home owners is greater and the percent- 
 age of renters smaller than in the cities of any other State in the Union. 
 
 "The wealth of the State has increased at the rate of 112,000,000 per year for the 
 last decade." 
 
 PUBLIC OPINION. 
 
 With so much evidence showing the harmfulness of alcohol, why, then, is it still 
 consumed? The truth is, in my opinion, that the consumption of alcohol is kept up 
 by tradition, by the assumption that so prevalent a practice must have virtues, by 
 the fear of individuals to break away from custom, and by the well known difficulty 
 of emancipating one's self from any drug habit. If we look at the alcohol habit 
 squarely we see that it is merely one of the harmful drug habits — like opium in China, 
 hasheesh in Turkey, cocaine, etc. It is a poison, and its evil effects are so great that 
 every courageous man should help to eliminate it. Had Lincoln lived he intended, 
 after destroying slavery, to attack alcohol. This I have on the authority of a living 
 witness and friend of Lincoln. Lincoln is reported to have said : ^ 
 
 "The liquor traffic is a cancer in society, eating out the vitals and threatening 
 destruction, and all attempts to regulate it will not only prove abortive, but will 
 aggravate the evil. There must be no more attempts to regulate the cancer. It must 
 be eradicated, not a root must be left behind; for, until this is done, all classes must 
 continue in danger of becoming victims of strong drink." 
 
 President Taft has become a total abstainer. The Kaiser of Germany and his family 
 have also given up the use of intoxicating liquors. On this subject. President Emeritus 
 Charles W. Eliot, of Harvard, another recent recruit in the antialcohol column, says:^ 
 
 "Recent researches in physiology and medicine tend strongly to show that even 
 the moderate drinking of alcohol is inexpedient. * * * No longer are men who are 
 to be exposed to cold, heat, fatigue, or hardships of any sort, prepared or braced for 
 such encounters by any form of alcohol. No captain of an ocean liner ever supports 
 himself now against the fierce exposures of the bridge by means of alcohol." 
 
 Dr. Amos P". Wilder, United States consul general, Shanghai, says:* 
 
 "In my journalistic and consular career I have seen so many go down — so many 
 careers wi-ecked, and so much wi-etchedness among the innocent caused by the igno- 
 rance of those who begin the drink habit — that I must respond to any opportunity to 
 aid in informing men, especially young men, what a dangerous thirst they are engen- 
 dering. I am familiar with that confident saying in the flush of strength, 'I can take 
 it or let it alone,' and I know the poor neglected wretch who says he wants a job, or a 
 night's lodging, or a dollar, and finally confesses that what he wants, and must have, is 
 a drink. One can stop and wont: the other would stop, but can't." 
 
 Physicians are beginning to give up alcohol in their practice. The marked decline 
 in the use of alcohol as a medicine is significant of the trend of the times. It will 
 
 {)robal)ly soon come aliout that almost the only alcoholic medicines will be the out- 
 awed "patent" or proprietary medicines containing alcohol. Dr. Mary Sturge * 
 writes that an example of the decrease in the use of alcohol for medicinal purposes is 
 shown in the treatment of fever in the British Metropolitan Asylums Board. WTiile 
 
 1 What People Have Said About Whisky, by H. Parker Willis. 
 
 2 Loc. cit. 
 
 3 In an address to the Massachusetts No-I.icense League, in Boston, 29th of October, 1908. 
 < In an address before the Loyal Temperance Legion, in Shanghai, Oct. 10, 1911. 
 
 6 Quoted by George B. Wilson, loc. cit. 
 
20 SALE OF INTOXICATING LIQUORS. 
 
 the niimher of patients has increased from 19,937 in 1894 to 27,570 in 1909, the cost of 
 stimulants for treatment has decreased from £1,388 in 1894 to £251 in 1909. Dr. 
 Stiirge says: * 
 
 "The immediate deduction from these figures is that whereas up to 10 years ago 
 alcohol was extensively used in the treatment of fevers, it is now recognized that the 
 disadvantages attendant on its employment often outweigh any prospective advan- 
 tages to 1)0 obtained from its routine application." 
 
 "Alcohol is almost entirely banished from the hospital," says George B. Wilson,* 
 who further states: ' 
 
 "In July, 1904, no fewer than 14,718 members of the medical profession petitioned 
 the [British] Board of li^ducation in favor of the compulsory teaching of hygiene and 
 the nature and effects of alcohol in all pul)lic elementary schools. The promoters of 
 this movement were the most eminent leaders of the profession, such as Sir ^^'illiam 
 Broadbent, Sir Thonias Barlow, Sir Lauder Brunton, Sir Victor Horsley, and others." 
 
 The fight against alcohol is only one phase of the general tight for health and effi- 
 ciency. Experience has shown that the best way to get rid of alcohol is to restore 
 the conditions for a healthy life. The introduction of healthful outdoor sports reduces 
 the consumption of alcohol. The evidence presented 1 ly Mr. Wilson ' indicates that one 
 of the most potent factors in reducing the use of alcohol has been the increased inter- 
 est in athletics and out-of-door life in England. Alcohol is an al)normal craving and 
 apparently comes from an almormal method of living, so that the craving is diminished 
 in proportion as normal conditions are restored. It is probable that the use of the 
 bicycle has had some effect on the decline in the consumption of intoxicating drinks 
 in the United Kingdom. At any rate cycling has increased at the same time that 
 drinking has decreased. 
 
 The saloon has always been a sort of workingman's club, and has furnished amuse- 
 ment when few amusements wliich were normal and natural were available. The 
 chief constables of York, Swansea, Gateshead, Coventry, and Airdrie, are c^uoted by 
 Mr. Wilson ' as sul)stantiating his opinion that the growth of simple, innocent, and 
 healthful amusements are counter attractions to the saloon and to the use of alcoliol. 
 It is his belief that the temperance reform is a permanent change in the habits of the 
 people, due to the gradual understanding, through educational means and otherwise, 
 of the physiological evils of alcoiiol and the benefits to be derived from healthier modes 
 of recreation. Mr. Wilson says: • 
 
 "On April 10, 1905, the Right Hon. Austen Chamberlain, M. P., in his speech when 
 introducing the budget, sa'id that he thought that the decline in the consumption of 
 intoxicants in the United Kingdom was due, in a large measure, to the growth of 
 amusements, such as outdoor games, theaters, music halls, cheap railway excursions, 
 etc., which were increasingly absorbing the time and the money of the people." 
 
 "Above all," says the Right Hon. John Burns, M. P.,^ "give the people homes 
 more homes, larger homes, cleaner homes, and sweeter homes. Abolish the slum. 
 Raise wages. Improve the sanitation, appearance, and environment of the factories! 
 and workshops. Humanize industry — then labor will not seek degradation in drink' 
 or low company in public houses. Convert the schools into club rooms, where friendly 
 societies and trade unions and thrift and other organizations can meet and do theirJ 
 business. Disestalilish the puljlic house as a house of call, divest it of all the functions,! 
 traditions, and accessories that through the ages it has taken to itself in matters of 
 local life, civic interest, social attractiveness. Divert to the city hall, the local library, 
 the municipal concert hall, the park, the gymnasium, and the municipal parlor, those 
 good things which drink has craftily yoked to its chariot, then the beginning of the 
 end of the reign of King Bung will have commenced." 
 
 1 Quoted by George B. Wilson, loc. cit. 
 
 " A speech in Free Trade Hall, Oct. 31, 1904. 
 
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