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GOD DOES NOT FIX THE DEATH RATE
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By Dr. Woods Hutchinson A. M.
Second in the Series h,‘y the World's Foremost Medi
cal Writer in Which He Exposes Absurd Theories
and Fallacies Relating to Longevitv—Next Sunday
«\\ h) We Get No \lv»ugm from the Other World™
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By Dr. Woods Hutchinson.
President-Elect American Academy of Medicine
HE old cynie philosophery averred that
nothing was sure but death and taxes
But with the death rate cut down 50
per cent within Afty years and Single Taxers
declaring war to the death on all taxes save
one—and even that possibly to be abolished
when we can control our natural resources—it
looks as If the saying was in need of revision,
Even though there be “a Divinity that shapes
our ends, rough hew them as we will” it s
evident that our skill with the hatchet is lm
proving rapidly.
In the sense that we must all die some day,
which is a consolation rather than otherwise,
tor the happlest life, like the greatest battle,
geta to be a bore sooner or later and begins to
run around in circles, death ig still sure. But
as 10 the time, the method and every other
detall of our final taking leave of the world, we
are almost absolutely free agents, and the sky
is the only limit. To paraphrase Scripture:
“The dirty and unventilated man shall not live
out half his days” And even what the span
of those days, the so-called natural duration of
life, may be is still quite unsure, and. for all
that we can see, unlimited. Nearly sixty years
ago, in the very dawn of sanitary sclence, Chad
wick, the great English heaith pioneer, declared
that he was prepared to plan and build a city
which should have any desired death rate, from
five per thousand per annum up!
He was simply laughed at by both the plous
and the practical men of those days, but within
little more than half a century a lineal descend
and of his in sclence, one Willlam C. Gorgas,
fulfilled his prophecy almost to the letter by
building just such a city, & whole country, in
fact, and that not in the bracing, healthful
porth, but In the woist and most notorious
pest hole In the seething tropics. For two dif
ferent semi-annual periods the death rate of
the white employes in Panama, Including
nearly a third of women and children, touched
six per thousand per annum. And General
Gorgas could work at least two-thirds of the
same miracle all over these United States If
he were appointed secretary to a great National
Department of Health and Public Safety and
given a free hand as to pure water, good food,
alry, sun-lit houses, war on infections, and last,
but by no means least, good wages, It is very
significant that the lowest northern white wage
rate paid in Panama, the first and only “spot
less town” in history, was five dollars a day,
and the lowest colored or tropical white rate
three dollars a day, more than double what they
had been accustomed to at home.
An Apparent Paradox
That Tells a Big Truth.
Here, as everywhere, the apparent paradox
holds: Double the wages and you halve the
death rate and treble the net efficiency. In
deed, when Gorgas was asked what should be
the first step to lower the death rate in a
Northern factory town, he replied, “A minimum
wage of $3!” “Put,” says some one at once,
“we all must die some time of something. Sup
posing that we can save a thousand lives from
poisoned milk in infancy, from the ‘little pesti
lences’ in childhood, or tuberculosis and typhoid
in youth, aren’t we simply shifting the deaths
from one part of the life scale to another, post
poning the day of account, but altering the
final balance and settlement not a whit?” Does
not our boasted increased average length of
life cousist mainly of a huge saving of lives in
infancy, childhood and early youth, by coddling
and hot-housing and promoting the survival of
those who would otherwise have died at those
periods until they can be no longer kept going
and break down and die in spite of us at forty,
forty-five or fifty? This is apparently sup
ported by the curious fact that, while our
death rate for all earlier ages of life has gone
down tremendously, that from forty-eight to
sixty has not only not diminished, but even in
creased slightly, about 5 per cent in males and
2 per cent in females. This straw is eagerly
clutcked at by our life insurance companies to
explain the fact that they are still insuring
lives in the twentieth century with a death
rate of fifteen per thousand at rates fixed in
the nineteenth when the death rate was over
thirty.
At the first sight, this pessimistic contention
seems plausible and has been used as the
basis for bitter attacks upon our modern meth
ods of sanitation and social betterment., But,
as a matter of fact, it has astonishingly little
support or standing in court when the actual
facts are studied. First of all, it rests upon
the purely gratuitous assumption that there is
a fixed and definite limit to the healthiest and
soundest human life, beyond which it is im
posgible to extend our span upon this planet.
This, like most universally accepted assump
tions, is based upon little more than legend and
tradition, and the experience that in the old,
unhappy days, before the dawn of the scientific
era, barely two-thirds of a century ago, the
dars of ignorance and filth, of cowardice and
cruelty, of poverty and piety, which we fatu
ously refer to as “the good old days,” most
human beings who worried through the fam
ines and the pestilences, and the private stab
bings and the public slaughterings, the offal
they were glad to get for food and the sewage
for water, were at the end of three-score or
three-score and ten years pretty well worn out
and ready to drop into the chimney corner and
prate about ‘“Vanitas vanitatum!”
Their bodies had endured more insults, at
tacks and hairbreadth escapes in a month
than ours do now in a year. And it is the
things that have happened to us that make us
old, not the mers length of time we have been
upon the planet. But even If we accept the
mournful, waillng dirge: “The days of our years
are threeacore years and ten, and i by reason
of strength they be fourscore years, yet Is
their strength labor and trouble, for it ia soon
cut off and we fiy away.” as our War song. we
have plenty of leaway before we bump against
the inevitable If everybody lived to be sev.
enty that would roughly mean a death rate of
about twelve per thousand a year In a station
ary community. But, as most modern com
munities are not stationary, in fact are Increas
ing at the rate of two to five per cent per an
num, this means an actual possible death mate
of about six or seven per thousand. And the
best we have ever won yet for a whole country
or large city Is from 13 to 15. So we still have
s long and cheerful way to Tipperary before
we reach even this imaginary Vmit
But it is most singular how the more closely
we study the question of the so-called “natural
term” of life the more Impossible it becomes
to find any positive proof of such a thing. Some
very interesting and carefu] studies of the
natural lifetimes of animals have recently been
made by eminent biologists and statisticlans,
potably Prof. Chalmers Mitehell, director or
the famous London Zoological Soclety's Gar
dens. The investigations covered a large num
ber of species, wild, in captivity and domestic,
with the singular and unexpected result that it
appeared impossible to fix any definite limit
at which life under anything approaching ideal
circumstances must come to an end. Cer
tainly nine-tenths of either wila or domestic
animals were found to die under half their’
maximum age from causes which might be
termed accidental, {. e, which had nothing to
do with the essential exhaustion of their vital
powers. In not a few species, such as some
fresh water fishes which could be accurately
observed in ponds for considerable periods,
not merely life, but also growth appeared to
continue indefinitely until terminated by cap
ture, drought or disease. The famous “mon
ster,” wary old trout, in the deep hole under
the tree roots, or the wise old plke, the despalr
and the delight of the angler, is apparently
only an {llustration of what many “little fishes
in the brook” might attain to If possessed of
adequate Intelligence, wariness and courage.
It was even difficult to fix within fifty per
cent. of what might be called an average
natural term of life for most animals, including
such famillar fellow boarders as dogs, cats and
horses. It was found that the lifetime of a
dog or a horse was, up to twenty years for the
latter and ten or twelve for the former, pretty
much what we chose to make it by our skill or
our ignorance, our care or our neglect, and
well attested cases are on record of nearly
double these equine and canine ages being at
attained. This almost perfectly corresponds
with the results of our study of and experience
with the genus humanum, for the more carefully
we look into the actual facts of the case under
the microscope, in the test tube and on the post
mortem table, the more overwhelmingly are we
driven to the conclusion that the so-called signs
of old age are the clear marks of either mal
nutrition, overwork or of infectious disease
which we were supposed to have recovered
from. it would seem only reasonable that there
should be such a thing as the decay of our body
and its various organs, simply through the
cumulative effects of successive decades of
wear and tear. But so far as clear and distin
guishing marks of senile decay in our internal
organs is concerned, almost every one of them
shows the unmistakable handwriting and foot
prints of some form of infectious disease.
Old Age Hardly
Ever a Cause of Death.
That famous decay and hardening of the
arteries, for instance whose pompous Greco-
Latin name, Arterio-Sclerosis, has been dignl
fied into a new disease of civillzation, is now
clearly traceable in the great majority of cases
to one or another of the infections, or fevers,
after the normal resistance of the body has
been lowered by prolonged muscular over
strain, bad food and bad air. Even more con
trary to popular impression, death by old age is
and always has been one of the rarest of exits
from this world’s stage. Two decades or more
ago Flexner discovered that the great majority
of deaths occurring in hospitals, even in those
who had been crippled in their joints, or heart,
or kidneys, or liver, or nervous system, and
were in a state of serious chronic disease,
were due not actually to that chronic disease
itself, but to a sudden and viclous attack of
what would under other circumstances have
been a trivial infection, like a cold in the head,
an influenza, a tonsillitis, or a mild bronchitis
or pneumonia. So uniformly was this the case
that he coined the phrase: “Terminal infec
tions” to describe these last germs “straws
which broke the camel’s back” of vital re
gistance. So widely has the Idea extended
since that most of our boards of health or
census bureaus, refuse to accept “old age” as
an adequate and intelligible cause of death in
a death certificate.
Although we may perhaps be inclined to
resent this as pure hair splitting, with a vague
sort of feeling that any man who lives to be
seventy-five or over is entitled to die of any
thing he pleases and no questions asked, yet
it is an interesting and consoling thought, with *
applications of considerable practical value,
that so far there is scarcely a single attested
case on record of any human being actually
dying, simply, in the classic phrase, “because
he couldn’t live any longer,” upon’ purely in
ternal grounds. Most deaths from ‘“old age”
are due to pneumonia, of a mercifully painless
and swift type, seldom running more than
four days and often only two. We may even
foal some little sympathy with the man giving
his family history in making application for
life insurance, who, when asked what his
maternal grandfather, aged eighty-five, died of
replied after some minutes of cogitation,
“Well. 1 really couldn’t Say posftively, dut 1
know it wasn't anyihing serioug!™ It is cer
talaly significant and hopeful, that, so far as
the actual facts go, the full, natural, unstarved
uninfected, ynsweatod possible linfit of human
iife has probably never yet been reached. N
leaves all sorts of possibilities open to us in
the future. On the other hand, studies upon
the lower animals have swept Into the limbo
of legend and tradition, where they belong.
& great deal of “skimble-skamble” stuff about
the superior longevity of animals as eon
trasted with man. All the animal centenarians
for instance bave gone into the waste-paper
basket, like their alleged human confreres. No
basis whatever was found to exist for the huge
longevities claimed for the raven, or the turtle,
or the elephant, or any of the other animal
Methuselahs, except the very rich and abun
dant one of our utter and complete ignorance
of the actual date of their birth. For instance
in the elephant, practically all tame eiephants
are born wild and captured after maturity.
Longevity of Certain
Animals a Popular Myth.
Of the few born In captivity none have ever
reached the age of fifty. Mom of them show
all the signs of old age at thirty-five or forty
The royal elephaut that bhad earried five gen
erations of rajahs or kings was found to be a
myth, or else the knife or the polson bow!
had been very busy among the rajahs. Our
atter lack of knowledge about the rate of
growth of the tortoise and of the turtle, and
the ease with which the gulleful practical
joker can carve on the shell of the torpid and
helpless beast any pame and date he chooses,
from “Adam, Year 1.” up, leaving it to be dis
covered next season with open-eyed wonder by
the parlor naturalist. As an amusing !Hustra
tion, & huge tortolse weighing nearly 300
pounds was brought to the New York zoo from
the Galapunos Islands; it was alleged to be
over 200 years old, and to grow about an inch
in diameter & year. For several months It
hibernated. but woke up in the Spring, began
to grow, and in three months gained over 30
per cent. in size and welght. It was probably
between five and seven years oid. This forms
the basis of the huge longevities attributed to
these beasts,
In the case of the raven, it Is simply a case
of “All coons look alike to me,” for the single
pair of ravens that had built their nest con
tinuously for 125 years in one turret of the old
castle may have comprised anywhere from ten
to fifty different generations, for anything that
any human observer could tell to the con
trary. The same utter lack of accurate knowl
edge explains the extraordinary longevity
aseribed to the eagle, the lion, the wiid swan
and the boa constrictor. There is absolutely
no trustworthy record of any elephant over
fifty, or any raven over twenty, nor of any tor
toise over thirty yvears old; and the oldest fish,
flesh or fowl ever positively known in captivity
was a parrot which attained the age of thirty
three in the bird house at the London Zoo.
With apologies to Poe:
“We are driven to agreelng
That no living human being
Ever yet was blessed with seeing,
Bird or beast that reached three-score”
so that all the talk about anlmals taking a
certain time to reach maturity, as evidenced
by the condition of their teeth or the union
of the heads of their bones with their shafts,
or their first mating perfod, and then living so
many multiples of that time, with the en
chanting conclusion that human beings, upon
this principle, ought to reach at least 150 to
200 years, must go by the board completely.
We come as near to living our full natural
span of life as any known animal. In fact, the
conditions under which we live are as
“patural” and healthful as those that surround
any animal; and we have not the slightest
reason to regard ourselves ag inferlor In either
health, vigor or longevity to any of our animal
cousing or bird relatives.
Let us see for a moment what the blgz, mnas
sive figures in the death lists are at the dif
terent periods of life, and how far they coms¢
within our own control. In infancy, the message
of the saroll is so vividly clear that he who
runs may read it. We used to have, in the pre
bacterial days, a death rate during the first
year of life of anywhere from 250 to 350 per
thousand born. In the words of Hood's jingle:
“What different lots our birthdays bring,
For instance, one little mannikin thing
Survives to bear many a wrinkle,
“While death forbids another to wake;
Apd a son that it took nine moons to make.
Expires without a twinkle. * * *
“e -« + Our destinies happy or fatal
One little craft is cast away
On its very first trip in Babbacombe Bay;
While another rides safe at Port Natal.”
Within ten years of the time we had abap
doned “The-Lord - gave, - the - Lord - hath-taken
away” attitude, we found that a third of this
slaughter of she innocents was due to bad alr
and respiratory diseases; another third to dirty
milk, and we impiously proceeded to thwart
the “dispensations of Providence,’ with the
result that in less than forty years our infant
defith rate has been cut down just about this
clearly preventable two-thirds; and a com
munity which loses more than ten infants in
the hundred during their first year considers
itself more or less disgraced. And really
civilized communities like New Zealand and
some of the Swiss Communes, where they
stand for those ridiculous things called “chil
drem; rights” to food, fresh air, play and love,
savd® all but seven, and even five in the hun
dred, of their babies. We are finding that
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DR. WOODS HUTCHINSON.
even though the *“son that expires without a
twinkle” has its cause in tne “sins of the
fathers” and a very important one, whose re
moval will be attended by farreaching im
provements In many other departments of
human life and happiness.
But, challenges some heavy taxpayer and
real estate owner, the real Clrce that turns
men into swine is not woman, the enchantress,
but the possession of and by too many acres
of dirt. “Suppose you tide these weakly and
ailing babes over into their second year, won't
you simply spread the mortality over the next
five years as they slip their anchors one after
another, after costing the community just that
much more for every year they survived?”
Figures Show Infant
Mortality Cut in Half.
Let the figures answer. We only got the
mortality cut in two about five or ten years
ago, but long enough for it to make its damag
ing effects visible upon the vitality of the chil
dren of the next five years, and the damning
results are beginning to show themselves al
regdy. Instead of rising tremendously on ac
count of the unfit and undesiraple infant lives
loaded onto it, the mortality of the next period
of life, up to the fifth year, has gone steadily
down and down, until its reduction is almost
as great as that for the period of infancy.
Passing on up through the Seveu Ages of Man,
the next period, that of childhood proper, from
the fifth to the fifteenth year, shows an almost
equally marked saving of life, partly on ac
count of the good work coming in to our aid,
which has been done against those modern
Herods, the diseases of childhood—scarlet fever,
diphtheria, whooping cough, measles, etc., and
partiy because the children with whom we
have to work are bigger, stronger and with
better resisting power against disease, on ac
count of the good care that has been taken
of them in infancy.
The tide of victory over the flood of short
coffins sweeps steadily on into the next period,
that of young adult life, from fifteen to tweaty
five, for here our fight against tuberculosis,
pneumonia and typhoid comes to our aid, and
clear through the next period, that of manhood
and womanhood, twenty-five to forty-five. The
“Captaing of the Men of Death” are beaten
backward at every point, although the victory
is not quite so complete here as it was in in
tancy. It is only when we reach the climax,
and the beginning decline of life that our
lives begin to waver and the enemy plucks
up courage to try to hold his own. But even
this counts for nothing until about the fiftieth
year, after which, as our ins«rance experts so
loudly trumpet on every occasion, the death
rate remains the same as it did forty years
ago. Indeed, in the period between fifty-five
and sixty-five it falls about 6 per cent. below
the former average. This temporary eheck is
usually attributed to the so-called stresses and
strains of civilization: over-feeding, dissipa
tion, hurry and excitement; and the diseases
which principally cause thig death rate of mid
dle age, Bright's disease, cancer, heart disease,
paralysis and other degenerations of the nerv
ous system, fibroses of the liver and hardening
of the arteries (arterio sclerosis) have been
dubbed the “diseases of civilization.”
The monient, however, that these diseases of
middle life began to be Investigated, it was
found that they had no connection whatever
with eating, drinking, high living or the pres
sure of city life. On the contrary, nearly two
thirds of them were clearly traceable to dam
ages left upon the heart, arterfes, kidneys,
liver and nervous system by the little infec
tions of childhood, the greater Infections of
middle life, typhoid, tuberculosis, syphilis and
rheumatism, and even such trivial annoyances
as colds in the head, sore throats and Summer
sicknesses. In other words, the reason why
the death rate after fifty is not yet declining
is that our work !n saving bables and in
lowering infant and child mortality was not
talrly under way until about twenty-five years
ago, in other words, after our present crop of
fifty-year-olders had reached young adult life.
We men and women of middle age are the
hangovers from the pre-hygienic perlod; and
the young people who are coming up to take
our places will probably not show a third of
the so-called diseases of middle life that we
do, because they were protected during their
Infancy, childhood and young adult life from
the principal cnua?s of these chronic degenera
tions,
The intelligent care and protection now
ziven to the teeth alone will add ten or fifteen
years to our life, to say nothing of the dis
covery that abscesses in the gum and about
the roots of the teeth are one of the chief
curses of chronic rheumatism, particularly of
the most painful and crippling varieties, and
that dirty mouths cause a large share of our
anemias, our dyspepsias and our neuralgias,
Twenty years more and toothaches will be a
curiosity, and plates and dentures and artificlal
teeth almost unknown. The youngsters now
coming np will keep their teeth till they are
sighty, and thelr digestion and elastic gait in
proportion.
What would not we seml-centenarians have
been spared In the shape of choked nostrils,
irregular teeth, perforated ear drums, broken
mouths and pigeon breasts it only the magic
word “adenoids” had been known ‘and acted
upon in our childhood days? The cripples of
our generation are nearly all dead and our
new ones are coming up to take their place;
children's hospitals cure them all now; the
blind asylums are emptying fast, and tenanted
chiefly by old or middle-aged victims. Thanks
to spectacles and artificial teeth, old age is
relieved of half its dreariness and boredom.
Woman Shows No
Increase in Death Rate.
1 may mention In passing that woman has
awgaln shown her customary superior vitality
wnd vigor, and that her death rate at these
Iges so deadly to men shows practically no In
srease, and a distinctly superior decline at all
sther perlods of life. That this comparatively
veavy mortality during the periods from the
fiftieth to the sixty-fifth year is due to a speci
fic cause of this sort is supported by the
cheering fact that after the sixty-fifth year
the death rate again begins to decline, as com
pared with that of the same age forty years
ago, while the percentage who pass seventy
five is larger than it ever was before.
So that we are in a position now to laugh
at those loud and gloomy predictions about
what would happen on account of our short
sighted methods of saving infant life, “promot
ing the survival of the unfit,” and lowering
the general average vitality of the race. The
children of ‘to-day of all ages from the fifth
year on are from one to three inches taller.
six to twenty pounds. heavier, and have from
three-fourths to two inches better chest de
velopment than the children of corresponding
ages thirty years ago. And, what is practically
the same thing, our American children of to
day have the same superiority over the ohid
dren to-day of the particular European cous
try in which their fathers, grandfathers o
great-grandfatiiers were born. How muec)
further this reduction of the death rate can be
carried along through the declining years o
life is a question, but it is one which need nos
concern us much. If we can live a full, active
useful life up to sixty-five, seventy or seventy
five years of age, what happens to us afte
that need distress us little. To live hard and
usefully, and dle as suddenly as possible, ary
the ideals of biological phllosophy. There I 8
neither merit, nor credit, nor comfort, in out
living our usefulness aud our happiness.
Ninety Years About
the Limit of Human Life.
While we are utterly unable to say that thers
is any fixed limit to the duration of human
life, the probabllities ara that even under the
most ideal conditions which can be furnished
by science the vast majority of us will fall
by the wayside before our eighty-fifth or nine
tieth year, and most of us will not only be wili
ing, but glad to do so. There are just as many
old people in the world as there ever were in
proportion to the population. The idea that
old age was more frequently attained In earlier
ages is merely one of the many delusions
connected with “the good old days.” All the
people we have known who belonged to those
earlier days were naturally very old—there
fore that was the characteristic of the whole
generation. They held the same delusions
about thelr grandparents; our grandohildrem
will hold it about us.
So far a 8 we know, there are Just as many
centenarians as ever, for the good and suffi
clent reason that there is not a single legally
authenticated case of any human being having
passed his hundred and first year in all his
tory, either ancient or modern, as has been
proved by careful and exhaustive investi
gatlong by competent sclentists and statistic
jang, Sir George Cornwall, Berry and others.
No one need have the slightest ambition to be
come a centenarian, for of the thousands of
those who are alleged to have reached thelr
hundred and first year, only three names would
ever have been heard of save.for the fact of
their mere turtle-like persistence of life. It
is probable that the next third of a century
will see as large a proportion of the human
race reaching the age of, gay, sixty or sixty-five
as now survives the first ten years of life; aad
as that will mean that we have done our work,
ived our lives, started the next generation om
its way to success, and had an honored and
comfortable decade or two in which to counse!
the rising generation and see the results of
our work and muse over what it was all about,
we shall be as ready for our last sleep 28 we
are now for our pillow after a hard day's
work,
Other articles in this series
—one each Sunday—will be as |
follows: |
No. 3—Why we get no messages from |
the other world. T
No. 4~Why civilized man is losing his
hair. .
No. s—Why we grow fat. ¥
No. 6—Why we get thin. - o