Popular Science Monthly/Volume 86/April 1915/Some Results of Periodic Health Examinations
| SOME RESULTS OF PERIODIC HEALTH EXAMINATIONS |
By EUGENE L. FISK, M.D.
DIRECTOR OP HYGIENE, LIFE EXTENSION INSTITUTE, INC.
OF the terrible engines of destruction that science, the handmaiden of war as well as of peace, has brought to the firing line in this present world conflict, there is none more terrible for offense, more potent for defense, than that war engine supplied by nature—man.
Even the prevision of military experts was at fault as to the line along which modern warfare would be waged. When it was reported from Balkan battle fields that desperate bayonet charges figured in the strife, many were incredulous and ascribed such reports to the violent imagination of newspaper correspondents remote from the field.
But there is abundant evidence that a country at war must, in the final test, rely for success upon the marching, shooting, bayonet-thrusting, trench-digging, misery-enduring qualities of the common soldier, of that primitive war engine that dates from the cave-dweller and beyond.
Some eminent and patriotic gentlemen have lately formed a National Security League, for the purpose of testing the preparedness of this country for war—preparedness, according to them, connoting armaments, ships guns, ammunition and a trained "citizen soldiery. The physical sufficiency of our citizens for war seems to be taken for granted—all they need is training. In fact, as a feature of preparedness, it has been suggested that the physical standard for the acceptance of recruits be lowered.
But when the test of battle comes, when the vital organs of the bodies of our soldiers are put under a tremendous strain, what then? Preparedness will then mean something in addition to guns and ammunition and men. Just as a gun will be of little use unless of modern make and firing capacity, so will a soldier be of little use unless he is a sound, efficient and enduring man.
It is evident, therefore, that the present state of Amerian vitality, as well as its general trend, is a proper subject for a consideration in any investigation of the preparedness of this country for military defense. Fortunately, this physical preparedness for war is the best kind of preparedness for peace, for industrial progress, for a forward and upward-moving civilization.
The Present State and Trend of American Vitality
In attempting to measure American vitality, I believe we should fix as a standard organic soundness and at least functional normality, and then endeavor to ascertain how far below such a standard of optimum condition the citizens of this country are registering. We should also endeavor to ascertain whether the movement is toward the optimum or away from it.
To ascertain the trend of American vitality, we are largely dependent upon the census and registration mortality statistics. These, unsatisfactory as they are, in regard to scientific accuracy, nevertheless strongly support the view that the movement of vitality is not toward the optimum, notwithstanding the steady fall in the general death rate. The diseases due to the germs, the communicable diseases, which chiefly affect young lives, are being rapidly eliminated, but the diseases due to faulty living habits, characterized by the wearing out or the giving out of the vital machinery, are heavily on the increase in this country. There is no evidence, however, that these diseases are on the increase in Great Britain. Nor is there in Great Britain, as in this country, any evidence of a rising mortality among those in middle life and later who are chiefly affected by these degenerative maladies. The same may be said of Germany, where the death rate at every age period has steadily fallen during the past thirty years, notwithstanding a tremendous industrial progress.
This masking of the encroachment of the degenerative and regressive class of diseases by the fall in the death rate from the communicable diseases is a source of danger, in that it begets a feeling of false confidence and inhibits much-needed activity for the real up-building of a resistant race rather than mere protection of the non-resistant from one class of maladies.
The present state of American vitality and physical efficiency as compared to the best attainable state can only be accurately measured by thorough physical examination of all citizens. The examination of all citizens is at present not practicable, but much can be learned from the results already attained in the examination of representative groups. The figures that I present in this paper are derived from two classes of individuals examined by the Life Extension Institute.
First: Insurance policyholders, to whom the privilege of free medical examination at certain intervals has been extended by the life insurance companies having contracts with the Institute to perform this service.
Second: Employees of commercial houses, banks, trust companies, etc., to whom this privilege has been extended by their employers who contracted with the Institute for this service.
| Per Cent. | ||
| Normal | 2.40 | |
| Imperfect—Advice needed regarding physical condition or living habits | 97.60 | |
| Not aware of impairment | 93.04 | |
| Referred to physician for treatment | 65.75 | |
Classification of Impairments
Moderate to Serious
| Per Cent. | ||
| Organic heart disease | 4.50 | |
| Arteriosclerosis—thickened arteries | 6.27 | |
| High or low blood-pressure | 23.50 | |
| Urinary—albumin, sugar, casts | 53.60 | |
| Individuals showing combined disturbance of circulation and kidneys | 15.83 | |
| Nervous | .92 | |
| Lungs—possible tuberculosis | 1.40 | |
| Venereal | .77 | |
Minor to Moderate
| Per Cent. | ||
| Functional circulatory—rapid, slow or intermittent pulse | 7.17 | |
| Urinary | 25.05 | |
| Digestive organs | 12.32 | |
| Constipation | 27.53 | |
| Nose and throat | 15.92 | |
| Ears | 10.30 | |
| Decayed teeth and infected gums | 11.76 | |
| Anemia | 2.69 | |
| Skin | 3.42 | |
| Errors in diet (pronounced) | 30.85 | |
| Errors in personal hygiene | 68.04 | |
Physical Defects
| Per Cent. | ||
| Faulty vision—uncorrected | 5.51 | |
| Flat foot | 4.11 | |
| Faulty posture | 9.58 | |
| Rupture—no truss | 1.12 | |
| Overweight—important | 12.23 | |
| Underweight—important | 9.13 | |
| Unclassified | 12.30 | |
| Per Cent. | ||
| Normal | 3.14 | |
| Imperfect—advice needed regarding physical condition or living habits | 96.86 | |
| Not aware of impairment | 96.69 | |
| Referred to physicians for treatment | 59.00 | |
Classification of Impairments
Moderate to Serious
| Per Cent. | ||
| Organic heart disease | 5.38 | |
| Arteriosclerosis—thickened arteries | 13.10 | |
| High or low blood-pressure | 25.81 | |
| Urinary—albumin, sugar, casts | 35.63 | |
| Individuals showing combined disturbance of circulation and kidneys | 12.77 | |
| Nervous | .73 | |
| Lungs—possible tuberculosis | .99 | |
| Venereal | .46 | |
Minor to Moderate
| Per Cent. | ||
| Functional circulatory — rapid, slow or intermittent pulse | 11.37 | |
| Urinary (high and low specific gravity, crystals, indican, etc.) | 21.62 | |
| Digestive organs | 6.12 | |
| Constipation | 14.70 | |
| Nose and throat | 34.53 | |
| Ears | 16.96 | |
| Decayed teeth and infected gums | 22.22 | |
| Anemia | 2.72 | |
| Skin | 6.38 | |
| Errors in diet (pronounced) | 13.70 | |
| Errors in personal hygiene | 31.60 | |
Physical Defects
| Per Cent. | ||
| Faulty vision, uncorrected | 16.03 | |
| Flat foot | 3.19 | |
| Faulty posture | 7.38 | |
| Rupture—no truss | 1.79 | |
| Overweight—important | 5.45 | |
| Underweight—important | 19.16 | |
| Unclassified | 7.38 | |
The above statement shows the percentages that the various impairments are of the whole number of employees examined. Many employees, of course, show several combined impairments. Average age 30.
The first group is composed of individuals who apply voluntarily for this service. It has been assumed that many of these people had at least a subconsciousness of impairment. Nevertheless, 93 per cent, of those found impaired were, according to their statements, unaware of any impairment.
Although the second group were not compulsorily examined, a practically unanimous consent to the examination removed any element of self-selection, and the group may be regarded as fairly representative of the average condition obtaining among the employees of such business institutions in large cities.
In studying these figures, it should be borne in mind that the particular purpose back of this system of examining is to secure a complete picture of the individual, and thus all impairments or imperfections found have been carefully recorded without regard to the present state of knowledge as to their significance. Examination for life insurance, for tuberculosis, for eligibility for employment, for ascertaining the influence of particular occupations or hazards, etc., and other physical examination for special purposes might produce a different record. In the institute's work, however, information is sought for the sole purpose of assisting the individual to raise himself to a higher standard of health and efficiency; hence, any departure from the normal is recorded, and particular attention is given to harmful living habits carrying potential impairment.
The noteworthy features of the record are as follows:
| 1. The high percentage of impairments or imperfections. |
| 2. The high percentage of disturbances or impairments of the heart, blood vessels and kidneys. |
| 3. The large percentage of individuals in both groups who were not aware of impairment—93 per cent, among insurance policyholders and 96 per cent, among commercial groups. |
Among the insurance policyholders 65 per cent., and among the commercial groups 59 per cent., were sufficiently impaired to be referred to physicians for treatment with full report of the conditions found. In appropriate cases instruction in personal hygiene was also given.
Those in the commercial group were examined by trained examiners of the home-office staff, all of whom followed uniform methods and standards. All laboratory work was done at the home office, thus eliminating possible errors from differing standards of examination or technique. Those in the life-insurance group were scattered throughout the country, but were examined by physicians specially selected and instructed regarding the standards and methods to be observed.
Probably the most striking and important fact revealed by these examinations is the large percentage of young men showing arteriosclerosis, or thickening arteries. This condition is one of slow growth, and it is not, after all, surprising, in view of the high and increasing death rate from cardiovascular troubles in middle life, that we should find the beginnings of these chronic changes in early life.
The lesson from these figures is that we must often start in at 25 or earlier to prevent a death from apoplexy at 45.
The checking of the degenerative maladies is not such a spectacular matter as the stamping out of typhoid, yellow fever or tuberculosis, but the possibilities for effective work through personal hygiene and guidance in correct living habits are quite as great. All along the line we find magnificent opportunities for improvement, teeth, eyes, nose, throat, ears, circulation, living habits, etc.
Those who accept the average man as a fairly able-bodied citizen seldom realize how far below his attainable condition of physical soundness and efficiency he is.
To some, this may seem like a study in pessimism. It may smack of pathological detective work which seeks to uncover human frailties and conjure up a Cassandra-like vision of "Woe, woe, to the human race." This is a superficial and pitifully inadequate view of activities fraught with tremendous possibilities for racial advancement.
What about the harmful effect of mental suggestion? For some years we have had a surfeit of "mental suggestion." Everything from stone-in-the-kidney to bow-legs has been ascribed to mental suggestion, or to something buried in the psyche, and there has been a tendency to encourage a timidity regarding even the thought of disease. This does not make for a brave and virile race. Men who consider themselves physically brave will shiver at the thought of tuberculosis, cancer, or heart disease. It is well to defend ourselves from disease, but not well to fear it. Just as it is well to prepare against a foreign enemy while not fearing to meet him eye to eye. Unfortunately, a considerable proportion of our population is constitutionally pusillanimous with regard to disease. Such people must be safeguarded from undue worry, but we should endeavor to train them to a more courageous attitude towards life and its disease perils. To avoid looking for impairment lest we find it, and at the same time find an opportunity to check the sapping of our physical foundations, is certainly a naive philosophy. Will the "scare" be less when the actual breakdown occurs? It will then be a scare without hope as against a scare with hope.
The mind should not be constantly focused upon physical condition, but common-sense measures taken for the correction of the impairments, and then renewed courage and confidence should accompany the knowledge that there is no obscure or unknown or neglected condition at work undermining vitality.
In conclusion, I would urge that physical examinations be conducted along standard lines, as far as possible, in order that the data may be assembled in homogeneous form whenever possible. A complete survey of the body should be made, in order that any abnormality of any region may be recorded for future study, as well as for immediate use in benefiting the individual.
In carrying out the theory that this is a study in optimism, and not in pessimism, permit me to suggest to those who have been well satisfied with existing conditions that there is ground for felicitation in the fact that so many people are below par. If a farmer finds that his ground, good as he thought it was, is capable of producing double the quantity of corn and potatoes, must he then repine and become a pessimist?
I think we should view the matter in this way: Good as we may think we have reason for felicitating ourselves on being, it is a joyful thought that there is so much room for improvement. Strong and self-reliant as we are, as a nation, let us rejoice that what we are does not constitute the pinnacle of strength, and that future development may give us reason for even greater confidence in our power to endure and to prevail.