Volume XVII

No. 7

Τ

HE present paper is the result of two

studies made to shed additional light on the question of the economic cost of tuberculosis. This is a phase of the campaign that fixes the attention of a hard-headed public, and it is one which we as tuberculosis workers must emphasize more and more if we are to carry on successfully an increasing and more effective anti-tuberculosis fight.

The two methods of study are entirely distinct, and approach the subject from different angles. The results are merely set down together in the same paper as supplementing each other.

The first method was to make two life tables, one taking into account all deaths, and the other ignoring the deaths from tuberculosis but including the deaths from all other causes. This latter table represents the vital conditions which would exist in an ideal community in which there were no deaths from tuberculosis. The difference in these two tables shows how many years of life are lost to every individual in the community because of the presence of tuberculosis.

This is not a new idea. At the International Congress on Tuberculosis held in Washington in 1908 Professor Glover, of Michigan, presented similar tables, based on the male population and deaths according to the census returns of 1900. My figures are based on the population of the Registration Area in 1910, and the deaths reported in those states for the same year. This area comprises 21 states, and a little over half the population of the entire

A paper presented before the Sociological Section, Sixteenth Annual Meeting of the National Tuberculosis Association, St. Louis, April 22nd, 1920.

country. I included the total population, both male and female, in the single table, with the object of arriving at figures that would show what a death from tuberculosis, whether of white or colored, male or female, old or young, costs the country.

The tables were not carried below age 17 because of the great amount of time required to make the necessary computations, and because the data at the younger ages are not very reliable. Professor Glover began his table at age 20.

The first table, then, shows the number of future years which an individual may expect to live at any age from 17 on, under present conditions of mortality. The second table shows the number of future years which an individual might expect to live in a Utopian community where there are no deaths from tuberculosis. This improvement in survival is due solely to the elimination of cases of tuberculosis with fatal termination.

The uses to which these life tables may be put are manifold. I shall mention only a few. I would call your attention first to a fact which has been somewhat overlooked in discussions of tuberculosis. It was pointed out by Glover from his 1900 life tables and bears repetition. Advanced age is no protection against tuberculosis. The danger from it at age 60 is greater than at age 20. Because the ratio of deaths from tuberculosis to deaths from all causes decreases at the higher ages, the inference has been that tuberculosis was not so prevalent after age 40 or 45. According to our tables, in a population of 1.000,000 age 20, 1,600 deaths would occur within the year from tuberculosis, while in a population

of 1,000,000 aged 60 there would be 1,840 deaths from the same cause. In other words, the death rates at each age are the significant figures and not the proportion of tuberculosis deaths to deaths from all causes.

The direct measure of the loss due to tuberculosis in a community is found in the number of years taken out of the lifetime of that community. This is what these life tables tell. Two and one-half years could be added to the lifetime of every individual who attains age 17 if there were no fatal cases of tuberculosis.

As comparison with the draft figures seems to be very popular just now, I have taken the number of young men 21 to 31 registered under the selective service act, and have computed the total number of years that would be added to their lives if we could in a moment wipe out the mortality from tuberculosis. The years of lifetime thus added would total more than nineteen million.

What this would mean to the nation is made more intelligible by fixing a money value on this loss. If each individual in this group could add the net sum of one hundred dollars to the wealth of the community each year, the money loss on this draft-age group of young men would be nearly two billion dollars. This is not, of course, an annual loss, but a prospective loss to the nation during the future lifetime of this group of young men. This loss to the total population on the same basis would amount to over seven billion, assuming that this earning ability begins at age 20.

There is a gradual decrease in the number of years added to an individual's lifetime with an increase in age. For example: while a person at 17 would live two and one-half years longer if there were no tuberculosis, a person aged 25 would have his lifetime increased only two years, and a person at the age of 40 would have a year more to live than under present conditions.

A similar set of tables has been made by Dr. Louis I. Dublin, Statistician of the Metropolitan Life Insurance Company. He has made separate tables by sex and color, with tuberculosis present, and with tuberculosis not present. These tables are based on the experience of the Metropolitan Life Insurance Company for the years 1911 to 1916. His findings show a slightly greater increase in expectation of life than the ones which I made. This is undoubtedly due to the fact that the population, viz.: the industrial policyholders, are fewer at the younger and older ages, and relatively greater during the years when there is the greatest number of deaths from tuberculosis. Dr. Dublin's figures show the loss in years of lifetime because of tuberculosis in the community to be two and six-tenths for a white female, and three and a half years for a white male. For the colored the loss is five years for both male and female. Dr. Dublin comments as follows on the findings of his life tables:

"Since every added year at these productive ages has great economic value, it can be seen that large expenditures by communities for

the study and prevention of tuberculosis are justifiable as a plain business proposition. But the social consequences of life extension, the savings from decreased sickness and disability, the lessened disruption and impairment of family life, will be even more significant."

A comparison of Professor Glover's figures for 1900 with those of the present table show a slightly but consistently smaller loss in years at each age of life in the present table. Whether the anti-tuberculosis campaign is responsible for this slight improvement I do not know. Perhaps the difference between Professor Glover's figures and mine has no significance whatever. The Metropolitan Life Insurance Company, however, states very frankly that their welfare work has been a profitable investment and has had a decided effect upon mortality from diseases which can be affected by nursing service and by an educational campaign. The death rate from tuberculosis of the lungs among their policyholders was reduced one-third between 1911 and 1919, and the general death rate has been reduced over 2 per 1,000 in seven years. This means a saving of 27,000 lives in one year. If even one-half has been due to welfare work, the saving in money to the Company has been two and one-half million dollars in the single year.

We may conclude then, from the results of the life tables that the eradication of tuberculosis carries with it a saving to the average human life of from two and one-half to three and one-half years, with a corresponding increase in the wealth of the country amounting to billions of dollars. "A gain so great is well worth the venture."

The second study is an effort to find out by means of specific cases just what tuberculosis costs in individual and community loss. The records of the Tuberculosis Division of the Association for Improving the Condition of the Poor of New York City were kindly placed at our disposal, and the summary here presented is the result of a very intensive study of 250

cases.

The following facts are briefly given to show the character of the group studied; that it is fairly representative of the families and individuals usually cared for by such agencies; three-quarters of the patients were men and one-quarter were women. The total group studied including the other members of the families, comprised 1,362 individuals, averaging five and one-half persons to a family. Practically all of the men were married, and of the women more than half were widowed, nearly one-third of the widows having had husbands who died of tuberculosis prior to their application for assistance to this Association.

About one-fifth of the patients were born in the United States, one-third in Italy, nearly one-fifth in Ireland, and the remainder were scattered among various countries, notably Austria and Poland, while there were a few from Bohemia, Canada, England, etc. Only 18 per cent. of these families had ade(Continued on page 210)

LMOST every child has had the experi

A ence at some time or other of having

a wise adult endeavor to entice it into catching a bird sitting on a limb or hopping about the lawn by putting salt on the bird's tail. Some children are foolish enough to attempt the ridiculous. One would think that the time had passed, however, when anyone could be beguiled into thinking that he could put poison on the germ's tail in the shape of the tubercle bacillus and thereby rid himself of tuberculosis.

The Addiline Medicine Company of Columbus, Ohio, claims, in effect, to do just exactly that. In other words, we are informed by the booklet put out by the company that Addiline

"Is a Germicide, that is, a remedy designed to overcome the germs, which are called 'bacilli' in medical language. This ingredient has been tested so thoroughly and completely that it is known to have power to overcome germs. If placed in its pure form in or near a piece of meat which has been flyblown, the larvae, or fly eggs, are quickly killed.

"When used in the human system it must be taken in such a dose that it will not injure any of the organs but will have only the effect of overcoming the tuberculosis disease germs, and finally, by such continued action, stop the germ growth and increase."

Contrasted with this perfectly marvelous and superhuman claim, the readers of the JOURNAL OF THE OUTDOOR LIFE will be interested in learning that, according to an analysis for the JOURNAL OF THE OUTDOOR LIFE by the Saranac Laboratories, it was found that

"The substance consists of petroleum oil with a certain amount of pine oil or oil of thyme, possible a mixture of several essential oils."

Dr. E. R. Baldwin, one of the leading research authorities on tuberculosis, says, "The effect of these oils on tuberculosis would of course be fatal, and the cleverness of the originators is shown in this way. In fact it is a great deal like the Frenchman and the fleapowder: if you can catch the flea and put the powder on him, you certainly can commit homicide! The same thing might happen to the tubercle bacillus if he should happen to fall into this Addiline oil. It is quite another story, though, when it is taken into the stomach, and there is no evidence whatsoever that germicidal effects could be obtained in this way."

The Ohio State Board of Health made a similar analysis and says that Addiline contains petroleum oil and oil of turpentine, and, while it sells for $5.00, it costs approximately 35 cents.

Addiline is being extensively advertised at

the present time, particularly in rural newspapers. Most of the advertisements are headed, "I Cured Myself of Tuberculosis." The advertisement details an account of the perfectly marvelous resurrection almost from the dead, of Mr. J. M. Miller of Columbus, Ohio, who discovered the secrets of Addiline from having known something about drugs and their action on germs through having played around and worked in his father's drug store many years ago. The fact that Mr. Miller's cure is vouched for by no less an individual than John H. Arnold, former Lieutenant Governor of Ohio, gives to gullible people a sense of safety that many fake cure advertisements are not able to offer.

more

As will be noted from the chemists' reports, Addiline is found to be essentially nothing nor less than so-called Russian oil. Russian oil is commonly administered as a remedy for constipation or for other diseases that need a powerful and steady cleanser of the bowels. It is a mineral oil that has no chemical reaction upon the digestive tract. Addiline, then, is apparently, nothing more nor less than Russian oil to which has been added pine oil and one or two other similar drugs of relatively small importance. The booklet calls attention to the fact that, "Addiline often causes eructations or belching. This is not a fault, but an advantage, as the vapors from the remedy are thus brought up and then breathed directly into the lungs, where they have a direct effect on the tuberculosis germs.' Investigations of the JOURNAL OF THE OUTDOOR LIFE indicate that it is practically a physical impossibility to take internally any kind of remedy or drug that will react in a germicidal manner upon the tissues of the lungs. Long before any such germicidal effect would be experienced, the patient would be in condition for the undertaker.

The Addiline Medicine Company, however, is not going to be fooled like some other "consumption cures" have been. While the literature and the letters constantly lay stress upon the absolute necessity of taking Addiline if you wish to be cured, they also emphasize strongly that hygienic living, including fresh air, good food, etc., are necessary. On page 19 of the booklet there are a number of points that are common to the tuberculosis worker. Many of them are copied from ordinary tuberculosis literature under the heading, "How to Aid Addiline." One would hardly think that a remedy of such remarkable qualities as the booklet indicates would need any aid. An internal germicide certainly should need little support.

Coming now to the guaranty, the Addiline Medicine Company blatently advertises that they will send you a four-weeks' trial treatment on receipt of $5.00, and if at the end of (Continued on page 210)