Mr. STEVENS. Are you referring to the constitutional features of the meat-inspection act of two or three years ago? Mr. SHIRAS. I think that is unconstitutional; that is, it is being utilized in an unconstitutional way. Anyone who knows anything about meat inspection in Chicago and Kansas City knows that the federal inspectors inspect all the meats coming into certain abattoirs and establishments, whether it is intended for local or foreign commerce, and it imposes a burden upon the Federal Government which to my mind is not warranted by the law. I do not say that you read that in the law, because the law does not say so-meat intended for local use it does not say that, it applies to interstate commerce, but, as a matter of fact, the inspectors examine all the animals there irrespective of whether they go into the local market or into inter state commerce. Mr. ADAMSON. The inspector may think they will go into interstate commerce? Mr. SHIRAS. There should be inspection by some government official, and not have the haphazard method of inspection which imposes a duty upon the Federal Government which should be a state duty. It is a matter of administration, and not so much a matter of law. The law, I take it, does not contemplate that. Mr. SIMS. As the law is now administered, do they examine cattle coming from a point in Illinois to Chicago to be used in the State, not beyond that? Mr. SHIRAS. That act I have before me, or will have this week, as well as the act regulating the inspection of meats. One is the quarantine act and the other is the pure-food act. In relation to the inspection of meats, I do not recall the exact language of the provision, and probably you would recall it more clearly than I do at present. Mr. SIMS. But as the law is now being executed, do they inspect cattle in Chicago that is shipped from a point in Illinois, to be used in that State? Mr. SHIRAS. I give you this more as an impression from what I have heard. There is no real effort made to discriminate between meat intended for local consumption and interstate commerce. I have heard that to be so. Mr. SIMS. Suppose it is intended for local consumption and brought in interstate commerce from another State, is it inspected? Mr. SHIRAS. If it comes under the quarantine law, the cattle have to be destroyed, irrespective of whether they are intended for local consumption or interstate commerce. They can not ship any diseased animal. When they reach the market and it is intended that they should be killed and the product of the body go for interstate commerce, then another jurisdiction attaches, and any meat which for any reason is unfit for commercial use is destroyed; but, as I have said, the question of the quarantine power I consider the great health power of not only the Federal Government, but the state governments. It is the one under which health regulations that are of great importance take place. I do not know that that subject is before the members of this committee now. Perhaps I have taken too long in expressing simply my desire to furnish this committee a special or general brief on any subject they see fit to call for, either concerning pending or future legisla tion. That is my duty, and it will be my pleasure, if called upon. Doctor SOWERS. Mr. Chairman, a large number of gentlemen selected to address you are not here. In fact, all of our men here have been heard. A great many of them are from a long distance, and for various reasons have been detained, and I shall ask the privilege of recording briefly their statements so far as they were made before the Senate committee. Mr. STEVENS. Certainly. Doctor SOWERS. Our case is closed, but we would like to reserve the right, if we may, of being heard by some of the gentlemen who may arrive later, if there is no objection. (Thereupon the committee adjourned to meet to-morrow, Saturday, June 4, 1910, at 10.15 o'clock a. m.) The statements submitted by Doctor Sowers follow: THE NECESSITY AND IMPORTANCE OF INCREASED FEDERAL HEALTH ACTIVITYANNUAL DEATH ROLL FROM PREVENTABLE DISEASES IN THE UNITED STATES. [Abstract from statement of Dr. Charles A. L. Reed, p. 79.] Doctor REED. I live at Cincinnati. My official position is chairman of the legislative committee of the American Medical Association. I appear this evening in that representative capacity. * * * In endeavoring to impress the committee of the importance of this subject, let me call your attention to the fact that you were in session this morning practically two hours. During that time in the United States 120 American citizens died from preventable causes. We are here this evening to ask you to do your part toward stopping that loss of life. The figures that I give are based upon the fact that the annual death roll from preventable causes aggregates something over 600,000. Now, Mr. Chairman, it has been asked, What is the American Medical Association? The American Medical Association is an organization of physicians of the United States. It consists of a national body, of state bodies, and of county bodies. The county is the unit of organization. * The aggregate membership of the American Medical Association in these various bodies that I have enumerated is in the neighborhood of 80,000 educated physicians of the United States. Nineteen years ago in this city that association-the national body-adopted a resolution in favor of some such measure as this-in other words, in favor of a department of public health with a secretary in the Cabinet. * * * * The opening remark, I think, must impress you with the importance that something should be done. If in the course of a single year every officer and man in the United States Army and every officer and man in the United States Navy were wiped off the face of the earth from preventable causes, you would give attention to the matter. Precisely that thing, three times over, is occurring every twelve months in the United States. It has been going on for a long time; it is scattered over a vast area, and therefore attracts comparatively little attention. The fact is there, nevertheless. Senator SMOOт. Where do you get your statistics? Senator SMOOT. Preventable diseases? Doctor REED. Yes, sir; from preventable diseases. They are preventable, and the computation is based upon the fact that the registration area is but a little in excess of half of the population of this country, and the figures I have given, which, with your permission, I will file as a supplement. * * * PROLONGATION OF HUMAN LIFE. * * * [Abstract from statement of Prof. Irving Fisher, professor of political economy, Yale University, pp. 39, 40.] The conclusions of the report of our committee to the conservation commission, which has since been presented to Congress as a Senate document, were that the average duration of life in this country could be prolonged fifteen years. That committee made its report with the utmost conservatism. My own part of it was purely that of statistician and collector of results of research of other men. Some sixteen experts in vital statistics and medicine and pathology were consulted with regard to the preventability of diseases. ECONOMIC IMPORTANCE. * Now, the prolongation of life for fifteen years is a very material matter, and it means a great deal to the country; first, sentimentally; *' * and, secondarily, economically, which it is my province to study. Economically, the saving in dollars and cents of the earning power to this country would exceed one and a half billions of dollars a year. I had intended to go into the details with regard to this matter, but * Senator OWEN. That would be cumulative, would it not, one year after another? Professor FISHER. It would gradually accumulate; yes, sir. *The average duration of life is stationary only where medical knowledge is stationary. In India the average duration of life is less than twenty-five years; in Sweden it is over fifty years, and in other countries it is between those. There is a range of 50 per cent, depending on the sanitary conditions of the country. Moreover, in India the average duration of life has remained stationary for the last twenty years, and in Germany it is increasing at the rate of twenty-seven years a century. * * * There are two facts which stand out prominently; first, that human life can be lengthened by hygiene, and that hygiene is a modern institution; secondly, that the prolongation of life possible through hygiene is very great, and this really explains why it is that the countries, not only America, but the states and countries of Europe and all through the world, are doing what they can to prolong life. This country is behind the times. When we are asked what can be done, we answer by what has been done by such laboratories as Koch in Germany and the Pasteur Institute in France. * THE ECONOMIC ASPECT OF PROLONGING HUMAN LIFE. [Abstract from statement of Robert Lynn Cox, general counsel of the Association of Life Insurance Presi dents, p. 19.] Mr. Cox. I am here to speak in favor of this bill on behalf of the life insurance business, as represented by the leading life insurance companies of the United States. I hope my appearance will serve to emphasize the economic aspect of prolonging human life. If the sentimental side is permitted to dominate in the consideration of this question as it has heretofore, tears will again constitute our main contribution to the financial problems presented by untimely and unnecessary deaths. I would not be understood as intimating that Congress fails to respond to sentiment, for evidence to the contrary measured by millions of dollars may be found in every annual appropriation bill. But rather would I be understood as recognizing the duty resting upon you to see that there is reasonable certainty of adequate return in some form or other for every dollar of the people's money you expend. If it can be shown that money spent to prolong human life means large economic gain to the nation as a whole, there would seem to be but one answer to the question of whether you should spend it. To the consideration of this question life insurance companies ought to be able to contribute some valuable information, since their business is founded on the principle that human lives have a money value. *I do not believe that the American people yet understand that it costs money to raise men just as it costs money to raise horses. The Federal Government finds no difficulty in acting when the matter of hog cholera is suggested. * It does not have any particular difficulty in stamping out the foot-and-mouth disease in cattle. And are we to have it suggested to us that it is going to find any difficulty when it comes to dealing with typhoid fever and tuberculosis? We have come to regard these other things as affectingthe material resources of this great nation, and then the Federal Government steps in and says, "We will conserve these resources, and we will protect these interests." Now, of course, I take it that none of us would protest against that. It is very important work, and we are asking that the human kind shall be brought up to the level of the animal kind (p. 14). * * * * * * * Senator SMOOт (p. 15). Just let me ask a question there. Do you think the economic provision of the matter would be satisfied with having little packages of serum. sent out from the department of health in Washington direct to the sick and afflicted, to be used by them in cases of disease, and all the instrumentalities at home for curing these people should be removed? Mr. Cox. I say this of course, I am not here to speak for the medical profession; they can speak for themselves. Senator CRAWFORD. That is the way they do in the case of hog cholera and many other things. PREVENTION OF DISEASE, NOT CURE, THE REAL OBJECT. Mr. Cox. I do not suppose we will adopt quite the method in curing men that we do when we come to curing hogs, nor do I suppose that we are going to distribute serum as we distribute seeds to the farmers, but I do say this, Senator, that if I understand the attitude of the medical profession to-day it is that their entire sympathy is with this movement to prevent disease. We might, I suppose, as laymen, say of them that they ought to be interested in having the entire American people sick in order that they might treat them, but that is not the attitude of the medical profession to-day, and I think more than ever are they giving their attention and their thought to the matter of preventing disease. Now, I do not suppose in seriousness that we will, come down to the treatment of the individual in any case of this sort, but perhaps we will find a way in which we can prevent contamination by wholesale. * * * Senator BRISTOW. Just there let me ask what you want done? I am perfectly agreed with you in all of these things, but what do you want the Government to do? Mr. Cox (p. 16). * I believe that the Government can have the most * * * potent educational influence. * * Senator BRISTOW. You say educational. What system would you suggest that a department or bureau, whichever it was, should adopt in an educational way; the publication of books or the sending out of bulletins or pamphlets, or what, along that line, have you to suggest? Mr. Cox. The people do not know, and have not known, the causes of diseases. When they come to know what the causes are the people will then make way with those causes. Now, first and foremost, I take it to be important that we find out what the causes are, and that we let the people know what they are. Senator BRISTOW. Excuse me if I am interrupting you, but I want to know— Senator BRISTOW. I want to get your idea. You speak of the cause of disease. You think the Government could have some means of ascertaining the cause of disease more readily than it is being done at the present time by the medical profession, do you? You think that the Government in some way can aid that in investigation and discovery? Mr. Cox. I certainly do; yes, sir. Senator BRISTOw. Now, in what way would you suggest? Mr. Cox. Just as they investigate the cause of hog cholera, and other similar diseases-put experts to work upon the question of finding out what causes those diseases. * * * [Abstract from statement of Dr. Franklin C. Wells, medical director, Equitable Life Insurance Company of New York, p. 29.] * Doctor WELLS. Mr. Chairman, * * I have just returned from a long trip through the West, visiting most of the cities in the West, from San Diego to Seattle, and I have been surprised at the very great amount of interest shown in this matter among our medical men and I represent some 25,000 examiners who are intrusted with examining and selecting risks for life insurance. Senator BRISTOW. Doctor, may I interrupt you by asking you what you would recommend specifically that the Government should do? * * * Doctor WELLS. What affects the life insurance company affects the policy holders, and vice versa. We want people to live and they want to. Now, how are we going to do it? As to the details of this bill, I am not free to speak. In certain States of this country we have great difficulty in obtaining information regarding sanitation, regarding epidemics, regarding the longevity of people. I believe that a centralization of this great power, of district or state boards of health, having the relation of assistance to them, supervising and with respect to advice, etc., would be a great step in advance. I believe in that respect that it would be a very great assistance in improving the longevity through increased sanitary measures throughout the different States. * EFFECTS OF SANITATION ON INSURANCE RATES. [Abstract of statement of L. K. Frankel, representing the Metropolitan Life Insurance Company, pp. 10-14.] Mr. FRANKEL. Mr. Chairman and gentlemen of the committee, I am asked by the company which I represent to appear before you to-day in the hope that I may be able to put before you some of the facts in connection with the insurance phase of this question which would not ordinarily come to your notice. The Metropolitan Life Insurance Company is a so-called industrial life-insurance company, or, rather, the greater part of its activities is devoted to the insurance of working men, women, and children. For this reason the organization of a department of public health comes home to those companies with very particular significance. The company which I am here representing to-day, for example, has in force at the present moment over 10,000,000 policies on the lives of workingmen and their families. There are probably in existence to-day in the United States over 20,000,000 of these policies, represented by various industrial insurance companies, representing, as you will see, a very large proportion of the population of the United States. It should be said here to you that at the time industrial insurance was introduced into the United ⚫ States there was practically no experience as to mortality among the workingmen. The premiums which were at that time established had to be based purely on empiric laws and were specifically found on the mortality at that time experienced to be too low. It was necessary to increase them, and the various companies since then have been attempting to intelligently interpret the experience they have gathered from their mortality records. I would like to have placed in your record in particular the experience of the Metropolitan Life Insurance Company, which is based purely upon results obtained and statistics gathered-the experience of the years 1890 to 1894, a period covering four years, and a similar experience from 1896 to 1905. The latter experience, I should add, is based on over forty-eight million years of risks and covering over 767,000 death claims. * * (For statistics, see pp. 10, 11 of hearings.) * Now, due to greater improvement in conditions between the years first mentioned and the years subsequently mentioned, the company ascertained that the mortality had very decidedly improved; that the improvement in tenement-house conditions, improvement in living conditions, improvement in the prevention of disease, particularly during the campaign that had been carried on between 1895 and 1905 in the direction of the prevention of infant mortality; the improvement in condition of furnishing milk to the masses of the population had so affected the mortality that it has been able since then to materially increase the amount of benefits which were given to the workingman over those which were given before. * * * Senator SMOOT. Have all of the benefits accrued through one source; that is, the improvement of conditions affecting health? Mr. FRANKEL. The general improvement in conditions affecting health. The important thing that we are here to bring out, Mr. Chairman, however, is this, the value that this is to the individual affected. By reason of this improvement in health conditions it has been possible for this particular company to return, over and above its policy contracts, over $23,000,000 to the individuals concerned. It has been possible, at two respective intervals, for them to increase by 10 per cent each time the amount of insurance they are able to give for the same premium. Senator CRAWFORD. Who is entitled to the credit of improving those conditions? Who brought it about? Mr. FRANKEL. I should say the general movement that has gone on in the United States within the last twenty years, and particularly even within the last ten years. Senator SMOOT. Through the state boards of health? Mr. FRANKEL. Through the state boards of health, through social changes of all kinds, through improvement of tenement houses in large cities, through improvement of the milk conditions generally, and improvement of water conditions. Senator SMOOT. And through pure food? Mr. FRANKEL. From pure food and due to the improvement of conditions in the cities and agricultural distric's, and the effort that has been made by a variety of agencies throughout the United States to bring this about. The contention that we make is that if this can be done through a diversity of organization it would be far excelled if all this work could be supervised and directed from one common agency. Senator CRAWFORD. Your idea seems to be to coordinate and bring into harmony all those agencies of the Government as a central directing agency that would control as to the governmental functions and would act in an advisory capacity as to all the state agencies? Mr. FRANKEL. It would be practically a clearing house for all agencies-all health agencies. STATE BOARDS OF HEALTH IN FAVOR OF FEDERAL HEALTH AGENCY. [Abstract from statement of Joseph Y. Porter, president of the conference of state boards of health, p. 6.] The CHAIRMAN. Doctor Porter, you may state your official position. DOCTOR PORTER. I am state health officer of Florida and also president of the conference of state boards of health and the state and providential boards of health now in session in this city. |