Official proceedings of the annual meeting: 1923

78

HEALTH

of the workman by a sensible observance of the facts and teachings of physiological
science.
The health handicaps of the working population are reflected in the variety of
defects and their number found among school children, both in country and city, which
are left uncorrected; and in the defects discovered among the men, twenty-one to
thirty-one years of age, drafted for the army in the world-war.
Early entry into industry often aggravates initial subnormal conditions, and may
create new ones. Child labor becomes a source of economic loss to society. Employment of children too early, or under bad conditions endangers the general health of the
adult worker, and as a consequence undermines his productive power.
In I909, in his report on "National Vitality," Professor Irving Fisher estimated
that 3,000,000 persons were seriously ill at all times in the United States and that 42
per cent of this illness was preventable, with a possible addition to the life span of
fifteen years. It is probably a conservative estimate to say that at any moment 2-3
per cent of the working population are incapacitated for work by illness. It is safe
to say that a much larger proportion of those gainfully employed are constantly working
in a state of ill health which seriously lessens their output. A very small percentage of
those who are absent from work on account of illness continues to receive wages during
the period of disability. Therefore, the illness estimated above for the working population represents an enormous loss in wages.
The budget studies of individual and family expenditures, made by Chapin in
I907 for New York City and by the U.S. Bureau of Labor Statistics in I9x8, have shown
significant increases in health expenditures as the size of the income increases. The
number of serious illnesses, however, seems to be pretty evenly distributed through the
various income groups. Chapin showed that low-income groups appealed more frequently to free medical facilities. The evidence would indicate that poverty is the
reason for low expenditures for health, not the absence of illness in the lower income
groups.
The costs of maintaining the present health organization, devoted mainly to alleviation and curing disability which has already become serious, is very large. Under
a regime of allowing illness and disability to occur and then curing or alleviating them,
doctors, nurses, etc., are maintained from accumulated surpluses in the hands of individuals or groups, or from the productive energies of others than their patients.
5. The dividends of health-a national liability converted into an asset.-Just as a
nation cannot be strong in war with weak and defective men in the ranks, so the great
economic asset of a nation is its strong men and women-effective during a long working
life. In recent years the expenditures on industrial hygiene and preventive medicine
have yielded large returns. The object in the industrial plant has been to increase productivity through the promotion of better health among the workers. Only fifteen
or twenty years ago, in most cases, when an industrial accident occurred, the injured
was sent to the city hospital and not to a first-aid station within the establishment.
Here the responsibility of the employer ceased. Most concerns kept no records of
absence because of illness, and little or no information was available as to the cost of
illness. Men were given jobs after a personal interview, with little or no attempt to
determine their qualifications for a particular job.
But now it is becoming clear in many cases that the company has an investment
in each of its employees, which is impaired or lost in the event of disability. It has