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to present the subject in a manner easily grasped by the American people, attempts have been made to measure the value of health and life by a money standard. As a justification of this, we have the procedures of the courts, based upon statutory enactments, which fix a money value upon life, although in many cases, after mature deliberation, it has been found that the life for which compensation has been asked, was of small value. In like manner, in the treatises which have been written on the public health and its value as a national asset, it has been attempted to portray in dollars the most precious of all human possessions, namely, life. And, in point of fact, it is not wholly unscientific, though undoubtedly unsentimental, to thus value human existence. All useful members of a community render services of some kind, for which payment is made in the coin of the realm. Following one of the established customs of great financial operations, it has been customary to capitalize the human life on its earning capacity, either active or prospective. The infant and the child, measured upon an actual earning capacity, would have practically no value, but this would be an unscientific method of determining worth, because of the fact that the infant and the child represent the necessary preparatory stages of earning capacity. Based upon this fact they both have a real monetary value.
I shall not take up the time of this address with any effort to ascertain the actual values which may safely be assigned to the infant, the child, and the grown-up person. This has been carefully and sufficiently accomplished by other investigators. Abraham Lincoln said that in so far as efficiency is concerned the human race may be divided into three classes, namely, one, those who work effectively; two, those who work to no purpose, and three, those who do not work at all. Judging hy rigid standards which have been set up by students of efficiency, class one is probably the least numerous of the three. Class two is composed of well-meaning people who do work, are willing to work, and anxious to work, but who do not know how, and therefore waste their energies. Class three is made up of the idle rich, the idle poor, and that considerable portion of our population incapacitated by disease or otherwise exempt from taking part in any useful employment.
FUNDAMENTAL PRINCIPLES OF THE CONSERVATION OF MAN.
Primarily, in the study of the conservation of human efficiency, that is of man, man himself and knowledge of what he is, and what he has been, within the years in which man has been studied, in a scientific way, is of the utmost importance. Unfortunately, we have not access to a universal system of demography, inasmuch as only a few countries have adopted scientific demography in its entirety. The world descriptions of human life, health, and efficiency are, therefore, exceedingly fragmentary. We are too apt to hase our ideas upon personal acquaintance
and knowledge of the efficiency of man, than upon a scientific study thereof, and yet, in order to have a proper view of the subject of the conservation of man, the actual state of his health and his capacity for useful labor must engage our attention.
The Division of Vital Statistics of the Census Bureau has done much to furnish the student of humanity with fundamental data, and first of all let us consider what is the expectation of life in the various countries according to the latest authorities which can be secured. The Division of Vital Statisties has prepared the following table, which is to be accepted as the most authoritative which is accessible. No claim is made, of course, for entire accuracy, but it is sufficient to show what the condition was in this country twelve years ago.
It is reasonable to suppose that conditions have improved somewhat in the twelve years which have passed since the compilation of the data submitted.
EXPECTATION OF LIFE IN VARIOUS COLYTRIES ACCORDING TO
LATEST LIFE TABLES.
(The "expectation of life" is sometimes known as the “mean after-life time," "average after-life time," "mean duration of life,” and “average duration of life.” Data are from the international tables in Statistik des deutschen Reichs, Bi. 200, Sterbetafeln, the French Statistique internationale; the English Registrar General's Report; Supplement, 1891-1900, and Census Bulletin No. 15, Twelfth Census. Tables for the United States, or rather for that part of it having fairly complete registration of deaths, will be published in connection with the Reports for 1910, now in preparation.)
EXPECTATION OF LIFE IN YEARS.
At Birth. Year. Years. At Birth. Year. Years. England and Wales
1891-1900 41.13 52.22 49.63 47.77 54.53 51.97 Ilealthy Districts
.1891-1900 52.87 59.13 51.16 55.71 60.53 51.16 France
45.31 53.10 49.25 48.69 55.34 51.53 Italy
.1899-1902 42.83 50.67 51.25 43.17 50.00 51.00 Austria
1900-1901 37.77 49.17 48.22 39.87 49.31 48.51 Belgium
.1891-1900 45.39 53.51 50.32 48.84 55.88 52.78 The Netherlands
.1890-1899 46.2 54.8 51.7 49.0 56.2 53.0 Sweden ...
.1891-1900 50.94 56.25 52.79 53.63 58.04 54.61 Massachusetts
1893-1897 41.09 52.18 49.33 46.61 53.58 50.70 German Empire
.1891-1900 40.56 51.85 49.66 43.97 53.78 51.71 New South Wales
33.86 District of Columbia (white). 1900 41.64 49.30 46.37 45.77 52.89 49.90 Massachusetts (white)
1900 44.29 53.13 50.15 47.SO 51.96 51.70 New Jersey (white)
1900 44.06 52.05 49.27 48.27 54.45 51.59
One of the most remarkable facts presented by the above table is in the marked increase in the expectation of life after the age of one year. In other words, the terrible infant mortality, which prevails in all
countries, is so great that the expectation of life at birth is a number of years less than at the age of one year. In England and Wales, the infant mortality decreases the expectation of life at birth, in round numbers by eight years; in France and Italy about the same; in Austria, by eleven years; in Sweden, by six years; in the German Empire, by eleven years; in Massachusetts, by nine years. In the report of the Bureau of the Census on Mortality Statistics, printed in 1909, and referring to the calendar year 1908, data are collected from seventeen States, the District of Columbia, and seventy-four registration cities, comprising a total of 51.8 per cent. of the total estimated population of the country. The total number of deaths registered in this area in 1908 is 691,574, corresponding to a death rate of 15.4 per 1,000 of population, which is said to indicate a remarkably favorable condition of the public health.
In the mortality statistics for 1910, two years later, the registration area, which included in 1910 an estimated midyear population of 58.3 per cent of the total population of continental United States, the deaths reported were 805,412, representing a death rate of 15 per 1,000 population. The death rate for 1909 was only 11.4 per 1,000. While these variations are marked, the work has not been carried on for a sufficient length of time to do more than to warrant an expression of opinion that the death rate in this country is generally receding. It varies as shown, on both sides, having decreased very considerably from 1907 to 1909, but increased to a very marked degree in 1910 over 1909. The registration area covers the following States in toto, and some of the principal cities in the other States: ('alifornia, Colorado, Connecticut, Indiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, New Hampshire New Jersey, New York, North Carolina (municipalities of 1.000 population and over in 1900), Ohio, Pennsylvania, Rhode Island, Utah, Vermont, Washington, and Wisconsin.
The extension of the system of registration to a larger area and number of population and the improvement in the efficiency of securing data are all to be considered in comparisons of very small periods of time. For one hundred million of population a death rate of 15 per 1,000 indicates a total of 1,500,000 deaths per annum. This figure may be accepted as being sufficiently accurate for all practical purposes at the present time as representing the death rate of today in the United States.
Comparing the United States with other countries and giving the expectation of life at birth as the basis of comparison, we may safely assume that the average expectation of life for the United States is in round numbers 4 years. Comparing this with the other countries we find that Sweden, Ilolland and New South Wales have a lower death rate than the United States. England, France, Belgium and Holland
have almost the same death rate. The German Empire and Austria have a higher death rate. India is the banner country for shortness of life, the expectation of life in India being a little over half that in the United States.
WHAT ARE TIIE DISEASES WHICH ARE MOST ACTIVE IN CAUSING THE DEATH
OF OUR PEOPLE?
In the registration area of 1910, 151,373 infants under one year of age died, in round numbers one-fifth of all the deaths. Assuming the total deaths to be 1,500,000, the number of children dying in the United States every year under the age of one year is 300,000. A striking illustration of the danger of the hot months for children under 2 years of
age is shown by the fact that the number of deaths from diarrhura and enteritis for July and August was 12,535 and 12,565 respectively, while in February the deaths from the same causes were 1,373. From these data it is evident that during the hot two months nearly 1,000 infants under the age of one year die every day in the United States.
The report of the Division of Vital Statistics shows that beginning with the second month of life diarrhea is the most serious cause of infant mortality. While infantile diarrhea and its allied disease, enteritis, is the most frequent cause of death among infants, the greatest destroyer of the human race, without respect to age, is tuberculosis, which caused 10.7 per cent. of the deaths from all causes in 1910. Next in importance in destructiveness is found organic disease of the heart, causing 9.5 per cent. of all the deaths. For all ages diarrhea and enteritis come third in fatality with 7.8 per cent. Close after this comes pneumonia with 6.7 per cent. Kidney disease causes a mortality of 6.6 per cent.
The number of deaths from tuberculosis during the year 1910 was 160.3 per 100.000, or for 100,000,000 people 160,300. The death rate from tuberculosis from 1900 to 1909, inclusive, was 183 per 100,000. Apparently the death rate for tuberculosis is decreasing.
The number of deaths from cancer in 1910 was 76.2 per 100,000, or a total of 76,200; the highest death rate ever recorded from cancer. Evidently the deaths from cancer are increasing in proportion to the population.
I wish sometimes that every house in this country could be burned to the ground, if the people could escape. Why? Because tuberculosis and cancer are house diseases, and if every house were burned, we would not have them any more—at least until we built new houses. But we can purify our houses, we can live out doors, we can sleep out doors most of the year, and by the teaching and practicing of the principles of hygiene and sanitation we need not burn our houses at all. But
people do not know, and worse than that, they do not care. They take no interest in such things. If you were discussing the tariff tonight, the house would not hold the people; if you were discussing trusts, there would be no standing room; but when you discuss this tariff on human life-they are not interested.
Organic disease of the heart: The number of deaths in 1910 was 141.5 per 100,000, which is a very large increase over that of the preceding year of 129.7 per 100,000. The total number of deaths from heart disease was 141,500.
Pneumonia: The death rate from pneumonia for 1910 was 117.7 per 100,000, making a total of 147,700 deaths from this disease. The death rate from this disease increased considerably over that of the preceding year.
Kidney disease: The total number of deaths from kidney disease in 1910 was 99 per 100,000, making a total of 99,000 for an estimated population of 100,000,000. This includes all forms of kidney trouble, nephritis and Bright's disease.
Typhoid fever: The death rate from typhoid fever was 23.5 per 100,000, a total of 23,500 for the estimated population of 100,000,000.
You older men like me who were in the war know that war is hellnot because you are shot—that is glory; but because you die of disease; and if you will read the military history of the Civil War, so-called (I do not know why, for it was not so very "civil'') you will see that while one man died of wounds, four died of disease, because we did not understand the principles of serum phophylaxis. We are not going to have in the next war four men die of fever where one is killed in battle.
One of the curious features in connection with typhoid fever is that some of the most sparsely settled States show the highest rates of fatality, for instance the number of people dying in Colorado of typhoid fever is 41.9; in Montana, 39.9, and Utah, 37 per 100,000. Only one of the thickly populated States equals this—Maryland, 40.7 per 100,000. Some of the lowest death rates for typhoid fever were found in New Hampshire, 10.7; Massachusetts, 12.4; Rhode Island, 13.6; Vermont, 14; New Jersey, 14.5, and Connecticut, 14.7. Of cities of 100,000 population or over in 1910, Omaha, Nebraska, showed the highest rate, namely, 86.7; Minneapolis, Minn., 58.7; Kansas City, Mo., 54.4; Atlanta, Ga., 50.1; Birmingham, Ala., 49,5; Nashville, Tenn., 48.9; Mil waukee, Wis., 45.7; Spokane, Wash., 45.4, and Baltimore, Md., 42. The lowest rates shown for some of the large cities were those of Bridgeport, Conn., 4.9; Paterson, N. J., 7.1; Cincinnati, O., 8.8, and Cambridge, Mass., 9.5 per 100,000. These cities seemingly are as well protected against typhoid fever as some of the cities of Europe, where death rates are as follows: London, 4; Edinburgh, 2 ; Dublin, 10; Paris, 7; Brussels, 19; Amsterdam, 7; Copenhagen, 3; Stockholm, 4; Christiania, 2; Berlin,