CHAPTER V Every ambitious man has been impressed by certain lessons (Part 11)

important part. We may have an indi- vidual with inherited neurasthenic tendencies in whom the enteric functions are nearly normal. In such a case expediency measures for the relief of those symptoms which are due to defective organs, become of prime importance. The wearing of corsets by women is one of the group of destructive habits which assist nature in control of over-popu- lation. ( I ) The corset by giving artificial support to the abdominal muscles throws the latter partly out of commission and lessens their tone because nature withdraws energy from structures which do not require a full normal quota of energy. (2) Relaxed muscle walls of the abdomen favor changes in position of organs, due to relaxation of peritoneal supports of viscera. (3) Intestinal stasis follows relaxation of supports, (4) Protoplasm of the individual is poisoned by toxins belong- ing to the condition of intestinal stasis. (5) Defective progeny results from toxic influences upon the protoplasm of the mother. Before the age at which girls begin to apply corsets they run and play quite like boys, and are practically as strong in a physical way. They are as bright and as happy as boys on the whole. Shortly after the application of corsets their char- acters may change quite as distinctly as the feet of Chinese women change under restricting bands. The classic sculptors did not carve a "straight front" about the waist of Diana. In a discussion at one of our medical society meetings, on 334 TO-MORROW'S TOPICS the subject of sterility in women, one of the speakers insisted that men were quite as much to blame as women. A much larger question than one of moral right or wrong in cases of sterility, is the question of imperfect development of the sex apparatus. Any one in our profession who has made ordinary observation in this field is familiar with the fact that most of that part of sterility which is due to anatomic defect, belongs to women. This refers not only to absolute sterility, but more particularly perhaps to the one child sterility. In this latter case one child suffices to bring out permanently any weak points in the generative system of the mother. There is no question of blame whatsoever. It is merely a question of nature's way of striking at a vital point when cultural limitations are being reached and it is necessary to limit population. It is possible that the chosen race will have women with fewer defects of the sort which result in sterility, but in that case nature will presumably have to fall back upon her standard resource of direct microbic destruction of the surplus of population, instead of striking with a concealed hand at the generative organs of the mother sex. Full physical development, outHDf -doors work and plain food will take very many of our neurasthenic young women out of the sterility class and place them in a group that is capable of fairly vigor- ous motherhood. Nature seeks always to restore and to main- tain a mean type. A girl rolling in the grass is more promising than a girl bending over a school desk, so far as the single question of future progeny is concerned. We are to asstune that progressive defects of the generative apparatus are found more particularly in women because they customarily take far less exercise than men take. In congenital structural defects however we seem to have evidence that nature is regulating cultural development and bringing families to a close by strik- ing purposely at the generative organs of women. The woman i TO-MORROW'S TOPICS in civilized life is commonly born with a disproportionate share of defects of generative organs which cannot be wholly remedied in the individual. Through the observation of care in developing herself physically, she may have children who receive the benefit of that exercise of wisdom and kindness on her part toward posterity. It is the rule however to exclaim, "What has posterity done for me that I should go to the trouble of having sense and happiness, just to please future posterity? On with the corset; let no one be afraid! Come. Charmian, the sofa-pillows, — a book ! 'Would you like to read about movements of the heavenly bodies — the Heavenly Twins?" Yes! Now you may go." Just as we see alt about us great waste in various fields in economics, so we observe a great unnecessary waste in human life, although marked progress has been made. For instance, the death rate from tjphoid fever has been reduced 54 per cent. since 1880 as an effect of looking after the sources of infection by our health departments, — and yet some 22,000 people still die yearly in the United States from this disease. The diphtheria death rate has been reduced 80 per cent, since 1880 because of the increased use of anti-toxin, and of methods for guarding against contamination, but 20,000 lives are still lost annually from this malady. Seventy-two Americans die every hour from preventable cause of disease. Although one may say these patients must die eventually, they present an economic loss prematurely. To balance the lessened death rate in some departments of medicine, we have an increase in others. The increase in the mortality rate from kidney disease since 1880 in the city of Chicago is i6j per cent.; in the state of Con- necticut, 139 per cent. From heart disease in Massachusetts. — 105 per cent. From apoplexy in the same state. — 135 per cent. The increase of death from cancer in Philadelphia since 1880 is 79 per cent. From pneumonia in Chicago, 33 per cent. 336 TOMORROWS TOPICS These statistics are furnished by Professor Irving Fisher of Yale University. Quoting further from the statistics of Professor Fisher. The cost of government of the city of New York is enormous and yet the city feels that it can only afford to expend on the Health Department considerably less than 2 per cent, of the yearly budget. In 1912 33,200 New York City people died from ordinary preventable disease. In most of the cities in America the ratio of Health Department expenses to total gov- ernment expenses is less than 2 per cent, while in some cities the ratio of expense for police and fire departments was 23 per cent, in 1912. This gives us an idea of the importance that is placed upon the conservation of human life by our authorities, and is probably due to the basic fact that material prosperity is instinctively valued higher than human life. The death rate from tuberculosis has decreased 41 per cent, since 1880, from typhoid fever 32 per cent., from diphtheria 81 per cent., because we have concentrated our efforts particularly upon these diseases. The mortality from diseases that are not combated in this way increases rapidly; kidney diseases 73 per cent., heart diseases 84 per cent., apoplexy 34 per cent., pneumonia 24 per cent., and spinal meningitis 60 per cent, during the same period. Attention given to the diseases of children in particular has led since 1880 to a reduction of the general average death rate 32 per cent. Doctor Welch, of Johns Hopkins, has recently reported from statistics that the expectation of life for every individual in this country has been increased by twelve years since the middle of the nineteenth century. The death rate has been lowered more particularly among the young; in fact, with them the greatest progress has been made, but the mortality in middle life is growing worse instead of better at the present time. This will be remedied when more complete study of TO-MORROW'S TOPICS 337 insidious chronic bacterial influences has been further ad- vanced. We already know the factors which hasten senescence of protoplasm. Life insurance companies have a very direct interest in collecting statistics relating to decadence, because it affects their capital. They take up the subject in a business way more effectively than it has been done in an humanitarian way of physicians, because of the precedence of property valuation. The Equitable Life Assurance Society has established a depart- ment relating to this subject. Quoting from the address of their Commissioner, Mr. E. E. Rittenhouse, before the Inter- national Conservation Congress on October 2, 1912, the fol- lowing statistics were presented : "Our birth-rate is declining. Over 200,000 infants under the age of five years die annually from preventable disease. "Of the 20,000,000 school children in this country not less than 75 per cent, need attention for physical defects which are prejudicial to health. "The alcohol and drug habits are constantly adding to the degenerate list of the death-roll. "Diseases of vice are spreading, and we lack the moral courage to openly war against them. "Insanity and idiocy are increasing at an alarming rate. "Over 9,000 murders are committed every year in the United States. Only about 116 murderers are executed for these crimes. Our homicide rate is appalling — about 100 per million population, against 13 in Canada, 9 in Great Britain, 15 in Italy. "The diseases of middle age are reaching down into middle life and below. Our vital organs are wearing out too soon. We have an increase of over 100 per cent, in thirty years in the death-rate from diseases of the heart blood-vessels and M m kidneys, including apoplexy. These diseases claim over M L J 338 TO-MORROW'S TOPICS 350,000 Americans annually. Sixty per cent, of them are preventable or postponable if detected in time. "Cancer destroys nearly 75,000 lives annually. The loss from external cancer has increased 52 per cent, in ten years. "Pellagra, a deadly plague, is increasing in the South, but it excites little or no public concern. "Over 150.000 die annually from that preventable plague of tuberculosis. Nearly a million tuberculosis victims are constantly spreading the malady to the well, with virtually no ofHcial supervision or restraint. "Over 1,500,000 people are constantly ill from preventable disease. Over 6,000,000 people will die from preventable cause during the next ten years at the present loss rate. "The sum of $1,500,000,000 is a low estimate of the annual economic loss from preventable deaths. "Our cities spend six and a half times as much money for preventing fire waste as they do for preventing life-waste, although the money lost from life-waste is six times greater. From the same number of "The Human Factor" in which this report of Mr. Rittenhouse appears, we have a contrastrj ing picture under the title, "Our Life-Saving Triumph Panama," with the following statistics: "Col. William C. Gorgas and his sanitary corps were charged with an extraordinary task. They undertook to drive from the pest-ridden seaports, jungles and marshes of the Canal Zone, the deadly fevers and other diseases which have scourged the Lsthmus for 400 years. Their success has challenged the admiration of the world. "They have transformed the world's greatest plague-spot into a zone of salubrity and health. They have given civiliza- tion most convincing proof that sanitarians can conserve human life even under the most appalling difficulties, when they are given money and the authority to do it. 1 d TO-MORROW'S TOPICS 339 "Every American should know the story of what has been done. From the statements and reports of Col. Gorgas we learn the following: "Yellow fever has been banished — ^no case has occurred for six years. "The annual deaths per ten thousand employees from principal diseases has been reduced under American control (since 1904) as follows : From dysentery 25.8 to 2.6. From tuberculosis 15.3 to 4.7. From malarial fevers 87.9 to 9.6. The annual malarial sick-list has been reduced from 821 to 187 per thousand employees. "During the first nine years of French control the general death-rate was 241 per thousand annually. (That mosquitoes spread fevers was not then known). "Under American control it has come down from 41.7 in 1906 to ii.o in 191 1. "The average number of employees under French control was 10,200, and the deaths were 22,189. During nearly the same length of time under American control, the average employed was 33,000, and the deaths were less than 5,000. (This relates to dates, rather than inefficiency.) "The general death-rate in Panama, Colon and the Canal Zone has been reduced from 48.3 per thousand population in 1906 to 21.4 in 191 1. "Could the Amercian people ask for any more convincing evidence that public health is purchasable ? "It is simply a matter of dollars and authority. The cost of accomplishing these wonderful results on the Isthmus has been about $2.43 per person annually in the zone affected. This is less than Key West spends annually for its fire depart- ment, where the death-rate (22.5) is higher than it is in Panama. "Are the lives of the white and black people of the Isthmus 340 TOMORROWS TOPICS of any more value than the lives of the white and black peopk of the states? "If G>lonel Gorgas, under the most extraordinary di& cutties, can conquer the diseases due chiefly to the mosquito and fly pest, why can it not be done in American cities where the obstacles to overcome are relatively trifling and the cost much less? "If we know how to change the deadly swamps and jungles of Panama into healthful abodes for man, what excuse have we for not applying the same knowledge to its full extent to American communities? "It IS difficult to realize that Panama, the former pest-hole of the tropics, is now more healthful than a number of Amer- ican seaport and river cities. "Compare the Panama death-rate of 21.4 with that of Charleston, S. C. (1910 census), 29.7; Savannah, 26.9; Mobile, 23.0; Richmond, 22.6; Key West, 22.5; Memphis, 21.4; New Orleans, 21.3; Washington, D. C, 19.6, and with the many other wealthy and prosperous American cities where the death-rate is from 1 5 to 20. And there are scores of towns and cities with virtually no public health service. "Colonel Gorgas has emphasized the fact and placed it squarely before the American people, that the excessive death- rate from preventable disease in our communities is nothing short of a communal crime." We need not ask what Christian Science would have done at Panama where physical causes for disease were met by physical means for control of disease. Christian Science has its function and is useful in the field for which it is really adapted. The laity do not seem to understand the nature of that opposition which physicians bring to bear against representa- tives of new medical cults. In law, if all lawyers were free TO-MORROWS TOPICS 341 to neglect the past decisions of courts, it would be similar to allowing pathists of various new kinds to practise. If new schools of lawyers were to appear at intervals of a few years and were to go before the legislature and ask to be given free- dom to practise, the legislative committee would say at once "No! property is involved. We cannot allow it." When pathists come forward, however, openly professing to dis- regard the decisions of established courts of medicine, the legislature says, "Give them a chance. Nothing but lives are involved." If property is involved. No! If lives are involved, Yes! An instance of short-sightedness in trade is that of the oyster men, who know that placing oysters in brackish water simply improves the appearance of oysters, while it destroys their flavor and may introduce typhoid fever into many homes. The reason why they do not seem to care about the death of fathers, mothers, brothers and sisters is because these people are all impersonal to them and of small consequence in com- parison with their personal oysters. The tissues of the oyster are charged naturally with salts in such a way as to maintain osmotic balance in salt water. When the oyster is placed in brackish or fresh water an endosmosis occurs on account of the presence of these salts and the tissues become distended with water. The puffy oyster now looks nice and plump, and white with coagulated albuminoids, but it is an invalid. The invalid oyster has dyspepsia. It cannot digest the typhoid bacillus and other microbes that it has fanned into its gills with other food. -These living microbes are then sold to the public as perquisites along with a nice, white, plump oyster. A salt water oyster that has never been "plumped" is a delicious and safe food, but it does not catch the eye like the feeble dyspeptic invalid oyster. Oystermen complain about "sensa- tional published notices" interfering with their business, and