VITALITY TESTS AND VITAL STATISTICS
Two things will disclose the strength or weakness of a bank and the
soundness or unsoundness of a nation's banking policy, namely, a
financial crisis or an expert audit. A searching audit that analyzes
each debit and each credit frequently shows that a bank is solvent only
because it is not asked to pay its debts. It continues to do business
so long as no obvious weaknesses appear, analogous to measles,
adenoids, or paralysis. A frequent disorder of banking results from
doing too big a business on too little capital, in making too many
loans for the amount of cash held ready to pay depositors upon demand.
This disorder always comes to light in a crisis--too late. It can be
discovered if looked for in advance of a crisis. Many individuals and
communities are likewise physically solvent only because their physical
resources are not put to the test. Weaknesses that lie near the surface
can be discovered before a crisis by physical examination for
individuals and sanitary supervision for communities. Whether
individuals or communities are trying to do too much business for their
health capital, whether the health reserves will pay debts that arise
in a crisis, whether we are ill or well prepared to stand a run on our
vitality, can be learned only by carefully analyzing our health
reserves. Health debits are compared with health credits for
individuals by vitality tests, for communities by vital statistics.
Of the many vitality tests none is practicable for use in the ordinary
class room. Scientific training is just as necessary for such tests as
for discovering the quality of the blood, the presence or absence of
tubercle bacilli in the sputum, diphtheria germs in throat mucus, or
typhoid germs in milk. But scientific truth, the results of scientific
tests, can be made of everyday use in all class rooms. State and
national headquarters for educators, and all large cities, can afford
to engage scientists to apply vitality tests to school children for the
sake of discovering, in advance of physical breakdown and before
outward symptoms are obvious, what curriculum, what exercise, what
study, recreation, and play periods are best suited to child
development. It will cost infinitely less to proceed this way than to
neglect children or to fit school methods to the loudest, most
persistent theory.
The ergograph is an interesting strength tester. It takes a picture (1)
of the energy exerted, and (2) of the regularity or fitfulness of the
manner in which energy is exerted. Perhaps the time will come when
science and commerce will supply every tintype photographer with an
ergograph and the knowledge to use it. Then we shall hear at summer
resorts and fairs, "Your ergograph on a postal card, three for a
quarter." We can step inside, harness our middle finger to the
ergograph, lift it up and down forty-five times in ninety seconds, and
lo! a photograph of our vitality! If we have strong muscles or good
control, the picture will be like this:
[Illustration: FIG. 1. Ergogram of T.R., a strong, healthy girl,
before taking 40 minutes' work in the gymnasium. Weight used,
3.5 kg. Distance lifted, 151 cm. Work done, 528.5 kg.-cm.]
If weak and nervous, we shall look like this before taking exercise:
[Illustration: FIG. 2. Ergogram of C.E., a weak and somewhat
nervous girl, before taking 40 minutes' work in the gymnasium.
Weight used, 3.5 kg. Distance lifted, 89 cm. Work done, 311.5
kg.-cm.]
And like this after gymnasium exercise:
[Illustration: FIG. 3. Ergogram of C.E. after taking 40 minutes'
work in the gymnasium, showing that the exercise proved very
exhausting. Weight used, 3.5 kg. Distance lifted, 55 cm.]
In Chicago, two of whose girls are above photographed, the physician
was surprised to have four pupils show more strength late in the day
than in the morning. "Upon investigation it was found that the teacher
of the four pupils had been called from school, and that they had no
regular work, but had been sent to another room and employed
themselves, as they said, in having a good time." The chart on page 127
shows the effect of the noon recess and of the good time after three
o'clock.
Chicago's child-study experts concluded after examining a large number
of children:
1. In general there is a distinct relationship in children between
physical condition and intellectual capacity, the latter varying
directly as the former.
2. The endurance (ergographic work) of boys is greater than that
of girls at all ages, and the difference seems to increase after
the age of nine.
3. There are certain anthropometric (body measurements)
indications which warrant a careful and thorough investigation
into the subject of coeducation in the upper grammar grades.
4. Physical condition should be made a factor in the grading of
children for school work, and especially for entrance into the
first grade.
5. The great extremes in the physical condition of pupils in the
upper grammar grades make it desirable to introduce great
elasticity into the work of these grades.
6. The classes in physical culture should be graded on a physical
instead of an intellectual basis.
[Illustration: FIG. 4]
To these conclusions certain others should be added, not as settled
beyond any possibility of modification, but as being fairly indicated
by these tests.
1. The pubescent period is characterized by great and rapid
changes in height, weight, strength of grip, vital capacity, and
endurance. There seems to accompany this physical activity a
corresponding intellectual and emotional activity. It therefore is
a period when broad educational influences are most needed. From
the pedagogic standpoint it is preëminently a time for character
building.
2. The pubescent period is characterized by extensive range of all
physical features of the individuals in it. Hence, although a
period fit for great activity of the mass of children, it is also
one of numerous individual exceptions to this general law. During
this period a greater per cent of individuals than usual pass
beyond the range of normal limits set by the mass. It is a time,
therefore, when the weak fail and the able forge to the front, and
hence calls for a higher degree than usual of individualization of
educational work and influence.
3. Unidexterity is a normal condition. Rapid and marked
accentuation of unidexterity is a pubescent change. On the whole,
there is a direct relationship between the degree of unidexterity
and the intellectual progress of the pupil. At any given age of
school life bright or advanced pupils tend toward accentuated
unidexterity, and dull or backward pupils tend toward
ambidexterity.... Training in ambidexterity is training contrary
to a law of child life.
4. Boys of school age at the Bridewell (reform school) are
inferior in all physical measurements to boys in the ordinary
schools, and this inferiority seems to increase with age.
5. Defects of sight and hearing are more numerous among the dull
and backward pupils. These defects should be taken into
consideration in the seating of pupils. Only by removing the
defects can the best advancement be secured.
6. The number of eye and ear defects increases during the first
years of school life. The causes of this increase should be
investigated, and, as far as possible, removed.
7. There are certain parts of the school day when pupils, on the
average, have a higher storage of energy than at other periods.
These periods should be utilized for the highest forms of
educational work.
8. The stature of boys is greater than that of girls up to the age
of eleven, when the girls surpass the boys and remain greater in
stature up to the age of fourteen. After fourteen, girls increase
in stature very slowly and very slightly, while boys continue to
increase rapidly until eighteen.
9. The weight of the girl surpasses that of the boy about a year
later than her stature surpasses his, and she maintains her
superiority in weight to a later period of time than she maintains
her superiority in height.
10. In height, sitting, girls surpass boys at the same age as in
stature, namely, eleven years, but they maintain their superiority
in this measurement for one year longer than they do in stature,
which indicates that the more rapid growth of the boy at this age
is in the lower extremities rather than in the trunk.
11. Commencing at the age of thirteen, strength of grip in boys
shows a marked accentuation in its rate of increase, and this
increase continues as far as our observations extend, namely, to
the age of twenty. In girls no such great acceleration in muscular
strength at puberty occurs, and after sixteen there is little
increase in strength of grip. The well-known muscular
differentiation of the sexes practically begins at thirteen.
12. As with strength of grip, so with endurance as measured by the
ergograph; boys surpass girls at all ages, and this
differentiation becomes very marked after the age of fourteen,
after which age girls increase in strength and endurance but very
slightly, while after fourteen boys acquire almost exactly half of
the total power in these two features which they acquire in the
first twenty years of life.
13. The development of vital capacity bears a striking resemblance
to that of endurance, the curves representing the two being almost
identical.
Physiological age, according to studies made in New York City, should
be considered in grading, not only for physical culture classes but for
all high school or continuation classes. Dr. C. Ward Crampton,
assistant physical director, while examining boys in the first grade of
the High School of Commerce, noticed a greater variation in physical
advancement than in years. He kept careful watch of the educational
progress and discovered three clear divisions: (1) boys arrived at
puberty,--postpubescent; (2) boys approaching maturity,--pubescent; (3)
boys not yet approaching maturity,--prepubescent.
The work in lower grades they had all passed satisfactorily, but in
high school only the most advanced class did well. Practically none of
the not-yet-maturing boys survived and few of the almost mature. In
other words, the high school course was fitted to only one of the three
classes of boys turned out of the grammar schools. The others succumbed
like hothouse azaleas at Christmas time, forced beyond their season.
Physiological age, not calendar years or grammar school months, should
determine the studies and the companions of children after the tenth
year. Physiological strength and vitality, not ability to spell or to
remember dates, should be the basis of grading for play and study and
companionship among younger children. Vitality, power to endure
physically, should be the test of work and recreation for adults.
Physicians may be so trained to follow directions issued by experts
that physical examinations will disclose the chief enemies of vitality
and the approximate limits of endurance.
Teachers may train themselves to recognize signs of fatigue in school
children and to adapt each day's, each hour's work to the endurance of
each pupil. One woman principal has written:
School programmes, after they have been based upon the laws of a
child's development, should provide for frequent change of
subject, alternating studies requiring mental concentration with
studies permitting motor activity, and arranging for very short
periods of the former. Anæmic children should be relieved of all
anxiety as to the results of their efforts, and only short hours
of daylight work required of them. The disastrous consequences of
eye strain should be understood by all in charge of children who
are naturally hypermetropic. The ventilation of a class room is
far more important than its decoration or even than a high average
percentage in mathematics, and the lack of pure air is one of the
auxiliary causes of nervous exhaustion in both pupils and
teachers. Deficient motor control is a most trustworthy indication
of fatigue in children, and teachers may safely use it as a rough
index of the amount of effort to be reasonably expected of their
pupils. Facial pallor or feverish flushes are both evidences of
overtasking, and either hints that fatigue has already begun. As
to unfavorable atmospheric conditions, the teacher herself will
undoubtedly realize them as soon as the children, but she should
remember that effort carried to the point of exhaustion, injurious
as it is in an adult, is yet less harmful than it is to the
developing nerve centers of the child.
Because adults at work and at play reluctantly submit themselves to
vitality tests, because few scientists are beseeching individuals to be
tested, because almost no one yearns to be tested, the promotion of
adult vitality and of community vitality can best be hastened by
demanding complete vital statistics. Industrial insurance companies and
mutual benefit societies are doing much to educate laborers regarding
the effect upon vitality of certain dangerous and unsanitary trades,
and of certain unhygienic habits, such as alcoholism and nicotinism.
Progress is slower than it need be because state boards of health are
not gathering sufficiently complete information about causes of
sickness and death. American health and factory inspection is not even
profiting, as it should, from British, German, and French statistics.
Statistics are in ill repute because the truth is not generally known
that our boasted sanitary improvements are due chiefly to the efficient
use of vital statistics by statesmen sanitarians.[7]
The vital statistics of greatest consequence are not the number of
deaths or the number of births, not even the number of deaths from
preventable diseases, but rather the number of cases of sickness from
transmissible diseases. The cost and danger to society from preventable
diseases, such as typhoid, diphtheria, scarlet fever, measles, are
imperfectly represented by the number of deaths. Medical skill could
gradually reduce death rates in the face of increasing prevalence of
infectious disease. With few exceptions, only those patients who refuse
to follow instructions will die of measles, diphtheria, or smallpox.
The scarlet-fever patient who recovers and goes to church or school
while "peeling" can cause vastly more sickness from scarlet fever than
a patient who dies. Dr. W. Leslie Mackenzie, who has recently written
_The Health of the School Child_, said ten years ago, while health
officer of Leith:
Death is the ultimate and most severe injury that any disease can
inflict, but short of death there may be disablement, permanent or
temporary, loss of wages, loss of employment, loss of education,
increase of home labor, increase of sickness outlays, increase of
worry, anxiety and annoyance, disorganization of the household,
general impairment of social efficiency.
The best guarantee against such loss, the best protection of health,
and the most essential element of vital statistics is prompt, complete
record of cases of sickness. Statistics of sickness are confined to
sickness from transmissible diseases, because we have not yet arrived
at the point where we recognize the state's right to require
information, except when the sick person is a menace to the health of
other persons.
The annual report of a board of health should give as clear a picture
of a community's health during the past week or past quarter as the
ergograph gives of the pupils mentioned on page 126. As ragged, rapidly
shortening lines show nervousness and depleted vitality, so charts and
diagrams can be made to show the needless waste of infant life during
the summer months, the price paid for bad ventilation in winter time,
when closed windows cause the sickness-and-death line from diphtheria
and scarlet fever to shoot up from the summer level. In cities it is
now customary for health boards to report weekly the number of deaths
from transmissible diseases. Health officers will gladly furnish facts
as to cases of sickness, if citizens request them. Newspapers will
gladly publish such information if any one will take the pains to
supply it. Wherever newspapers have published this information, it
quickly takes its place with the weather reports among the news
necessities. Marked changes are commented on editorially. Children can
easily be interested, as can adults, in filling out week by week a
table that will show increases and decreases in preventable sickness
due to transmissible diseases.
TABLE X
CASES OF INFECTIOUS AND CONTAGIOUS DISEASES REPORTED
=================+================================================
| WEEK ENDING
+------+------+------+------+------+------+------
| Oct. | Nov. | Nov. | Nov. | Nov. | Nov. | Dec.
| 26 | 2 | 9 | 16 | 23 | 30 | 7
-----------------+------+------+------+------+------+------+------
Tuberculosis | | | | | | |
pulmonalis | 350 | 350 | 317 | 364 | 345 | 337 | 422
Diphtheria and | | | | | | |
croup | 313 | 264 | 283 | 331 | 282 | 343 | 326
Measles | 142 | 212 | 203 | 261 | 293 | 323 | 472
Scarlet fever | 208 | 228 | 231 | 252 | 278 | 323 | 372
Smallpox | -- | 1 | -- | 1 | -- | -- | 2
Varicella | 40 | 83 | 91 | 162 | 136 | 115 | 167
Typhoid fever | 106 | 105 | 107 | 123 | 86 | 77 | 71
Whooping cough | 6 | 13 | 15 | 14 | 27 | 9 | 8
Cerebro-spinal | | | | | | |
meningitis | 6 | 11 | 3 | 4 | 4 | 8 | 15
-----------------+------+------+------+------+------+------+------
Total | 1171 | 1267 | 1250 | 1512 | 1451 | 1535 | 1855
=================+======+======+======+======+======+======+======
=================+=========================================
| WEEK ENDING
+------+------+------+------+------+------
| Dec. | Dec. | Dec. | Jan. | Jan. | Jan.
| 14 | 21 | 28 | 4 | 11 | 18
-----------------+------+------+------+------+------+------
Tuberculosis | | | | | |
pulmonalis | 360 | 354 | 308 | 344 | 432 | 402
Diphtheria and | | | | | |
croup | 369 | 338 | 347 | 308 | 370 | 406
Measles | 471 | 517 | 346 | 581 | 691 | 803
Scarlet fever | 397 | 417 | 426 | 478 | 562 | 585
Smallpox | 4 | 3 | 2 | -- | 2 | --
Varicella | 160 | 198 | 123 | 98 | 199 | 169
Typhoid fever | 62 | 35 | 42 | 37 | 55 | 36
Whooping cough | 12 | 19 | 3 | 25 | 24 | 14
Cerebro-spinal | | | | | |
meningitis | 13 | 7 | 6 | 11 | 16 | 13
-----------------+------+------+------+------+------+------
Total | 1844 | 1888 | 1603 | 1882 | 2351 | 2428
=================+======+======+======+======+======+======
In cities where physicians are not compelled to notify the health board
of danger centers,--that is, of patients sick from measles, smallpox,
or diphtheria,--and in smaller communities where notices are sent only
to state boards of health, parents will find it difficult to take a
keen interest in vital statistics. But if teachers would start at the
beginning of the year to record in such a table the days of absence
from school because of transmissible disease, both they and their
pupils would discover a new interest in efficient health
administration. After a national board of health is organized we may
reasonably expect that either state boards of education or state boards
of health will regularly supply teachers with reports that will lead
them to compare the vitality photographs of their own schools and
communities with the vitality photographs of other schools and other
communities working under similar conditions. Then children old enough
to study physiology and hygiene will be made to see the
happiness-giving possibilities of vitality tests and vital statistics.
[Illustration: VITAL STATISTICS CAN MAKE DISEASE CENTERS AS
OBVIOUS AND AS OFFENSIVE AS THE SMOKE NUISANCE]
Instead of discussing the theory of vital statistics, or the extent to
which statistics are now satisfactory, it would be better for us at
this point to make clear the significance of the movement for a
national fact center for matters pertaining to personal, industrial,
and community vitality. Five economic reasons are assigned for
establishing a national department of health:
1. To enable society to increase the percentage of exceptional men
of each degree, many of whom are now lost through preventable
accidents, and also to increase the total population.
2. To lessen the burden of unproductive years by increasing the
average age at death.
3. To decrease the burden of death on the productive years by
increasing the age at death.
4. To lessen the cost of sickness. It is estimated that if illness
in the United States could be reduced one third, nearly
$500,000,000 would be saved annually.
5. To decrease the amounts spent on criminality that can be traced
to overcrowded, unwholesome, and unhygienic environment.
In addition to the economic gain, the establishment of a national
department of health would gradually but surely diminish much of
the misery and suffering that cannot be measured by statistics.
Sickness is a radiating center of anxiety; and often death in the
prime of life closes the gates of happiness on more than one life.
Let us not forget that the "bitter cry of the children" still goes
up to heaven, and that civilization must hear, until at last it
heeds, the imprecations of forever wasted years of millions of
lives.
If progress is to be real and lasting, it must provide whatever
bulwarks it can against death, sickness, misery, and ignorance;
and in an organization such as a national department of health,
adequately equipped,--a vast preventive machine working
ceaselessly,--an attempt at least would be made to stanch those
prodigal wastes of an old yet wastrel world.
Among the branches of the work proposed for the national bureau are the
following: infant hygiene; health education in schools; sanitation;
pure food; registration of physicians and surgeons; registration of
drugs, druggists, and drug manufacturers; registration of institutions
of public and private relief, correction, detention and residence;
organic diseases; quarantine; immigration; labor conditions;
disseminating health information; research libraries and equipment;
statistical clearing house for information.
Given such a national center for health facts or vital statistics,
there will be a continuing pressure upon state, county, and city health
officers, upon physicians, hospitals, schools, and industries to report
promptly facts of birth, sickness, and death to national and state
centers able and eager to interpret the meaning of these facts in such
simple language, and with such convincing illustrations, that the
reading public will demand the prompt correction of preventable evils.
Our tardiness in establishing a national board of health that shall do
this great educational work is due in part to the fact that American
sanitarians have frequently chosen to _do things_ when they should have
chosen to _get things done_. Almost every state has its board of
health, with authority to require registration of births, deaths, and
sickness due to transmissible disease; with few exceptions the heads of
these state boards have spent their energies in abating nuisances. In a
short time they have degenerated into local scavengers, because they
have shown the public neither the meaning of the vital statistics
gathered nor its duty to support efficient health administration.
The state reports of vital statistics have not been accurate; therefore
in many states we have the anomalous situation of an aggressive
veterinary board arousing the farmer and the consumer of milk to the
necessity of protecting the health of cattle, and an inactive,
uninformed state board of health failing to protect the health of the
farmer and the consumer.
Vital statistics presume efficient health administration. An
inefficient health officer will not take the initiative in gathering
health statistics. If some one else compels him to collect vital
statistics, or furnishes him with statistics, they are as a lantern to
a blind man. Unless some one also compels him to make use of them,
unless we remove the causes of transmissible or infectious diseases and
check an epidemic when we first hear of it, the collection of
information is of little social value. "Statistics" is of the same
derivation as "states" and "statesmen." Statistics have always been
distinguished from mere facts, in that statistics are instruments in
the hands of the statesman. Wherever the term "statistics" is applied
to social facts it suggests action, social control of future
contingencies, mastery of the facts whose action they chronicle. The
object of gathering social facts for analysis is not to furnish
material for future historians. They are to be used in shaping future
history. They are facts collected with a view to improving social
vitality, to raising the standard of life, and to eliminating
permanently those forces known to be destructive to health. Unless they
are to be used this way, they are of interest only to the historical
grub. No city or state can afford to erect a statistical office to
serve as a curiosity shop. Unless something is to be done to prevent
the recurrence of preventable diseases annually experienced by your
community or your school, it is not reasonable to ask the public
printer to make tables which indicate the great cost of this
preventable sickness. A tax collector cannot discharge his duties
unless he knows the address of every debtor. The police bureau cannot
protect society unless it knows the character and haunts of offenders.
A health officer cannot execute the law for the protection of society's
health unless he knows the haunts and habits of diseases. For this he
must look to vital statistics.
But the greatest service of vital statistics is the educational
influence. Health administration cannot rise far above the hygienic
standards of those who provide the means for administering sanitary
law. The taxpaying public must believe in the economy, utility, and
necessity of efficient health administration. Power and funds come
from town councils and state legislatures. To convince and move these
keepers of the purse, trustworthy vital statistics are indispensable.
Information will be used for the benefit of all as soon as it is
possessed by all.
Fortunately the gathering of vital statistics is not beyond the power
of the kind of health officer that is found in small cities and in
rural communities. If years of study of mathematics and of the
statistical method were required, we should despair of obtaining light
within a century. But the facts we want are, for the most part, common,
everyday facts, easily recognizable even by laymen; for example,
births, deaths, age at death, causes of death, cases of transmissible
diseases, conditions found upon examination of children applying for
work certificates, etc. Where expert skill is required, as at state and
national headquarters, it can be found. Every layman can train himself
to use skillfully the seven ingredients of the statistical method which
it is his duty to employ, and to know when to pay for expert analysis
and advice. We can all learn to base judgment of health needs upon the
seven pillars,--desire to know, unit of inquiry, count, comparison,
percentages, classification, and summary.
FOOTNOTES:
[7] Dr. Arthur Newsholme's _Vital Statistics_ should be in public
libraries and on the shelves of health officers, public-spirited
physicians, and school superintendents.