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UNITED STATES DEPARTMENT OF LABOR
JAMES J. DAVIS, Secretary

BUREAU OF LABOR STATISTICS
ETHELBERT STEWART, Commissioner

BULLETIN OF THE UNITED STATES \
lk
T
BUREAU OF LABOR S T A T I S T I C S / ........... NO.
INDUSTRIAL

ACCIDENTS

AND

HYGIENE

r-A7
DU#

SERIES

CAUSES OF DEATH
BY OCCUPATION
OCCUPATIONAL MORTALITY EXPERIENCE
OF THE METROPOLITAN LIFE INSURANCE
COMPANY, INDUSTRIAL DEPARTMENT
1922-1924 : BY LOUIS I. DUBLIN, PH. D.
AND ROBERT J . VANE, JR.

[• T3 I
f 8

I

oiX

FEBRUARY, 1930

UNITED STATES
GOVERNMENT PRINTING OFFICE
r
WASHINGTON : 1930

For sale by the Superintendent of Documents, Washington, D. C.




-

-

Price 25 cents




Contents
Page

Introduction___________________________________________________________________
C hapter 1.— The group as a whole_________________________________________
C hapter 2.— Mortality according to occupation___________________________
Bakers____________________________________________________________________
Blacksmiths_______________________________________________________________
Carpenters________________________________________________________________
Chauffeurs__________________________________________ ___________________
Cigar makers and tobacco workers_____________________________________
Clerks, bookkeepers, and office assistants_____ _______________________
Coal miners (underground)______________________________________________
Compositors, printers, and pressmen___________________________________
Electricians_________________ , ___________________________ ________________
Farmers and farm laborers______________________________________________
Fishermen, oystermen, sailors, and marine workers___________________
Furniture and other wood workers_____________________________________
Iron and steel mill workers______________________________________________
Iron foundry workers______________________
__________________
Janitors and building employees______
___________________
Laborers______________________________
________________
Longshoremen and stevedores___________________________________________
Machinists___________________________________ ___________________________
Masons and bricklayers____________________________ _____________________
Merchants and storekeepers________________________ ____________________
Painters, paper hangers, and varnishers__
-----------------------------------Plumbers, gas fitters, and steam fitters___
___________________
Policemen___________________________________
___________________
Railway enginemen and trainmen_________
_ ________ _____________
Railway track and yard workers________________________________________
Saloon keepers and bartenders__________________________________________
Shoe factory workers_________________________________________________ —
Stationary engineers and firemen---------------- ------------------------------------------Store clerks and salesmen________________________________________________
Tailors and other clothing workers_____________________________________
Teamsters and drivers___________________________________________________
Textile mill workers______________________________________________________
Watchmen and guards___________________________________________________
C hapter 3.— Principal causes of death______________________________________
Typhoid fever____________________________________________________________
Influenza___________________________________________ - — *--------------------------Pneumonia (all forms)___________________________________________________
Other diseases of the respiratory system_______________________________
Tuberculosis of the respiratory system_________________________________
Cancer (all form s)________________________________________________________
Diabetes__________________________________________________________________
Cirrhosis of the liver_____________________________________________________




in

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3
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81
83
86
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91
93
93
95
97
99
101
107
108
110

IV

CONTENTS

C h a p t e r 3 . — Principal causes of death— Continued.

P age

Cerebral hemorrhage, apoplexy, and paralysis_________________________
Other diseases of the heart______________________________________________
Nephritis (acute and chronic)________________________ ___________________
Accidental or undefined violence________________________________________
Homicide (all forms)____________________________________________________
Occupational diseases____________________________________________________
C h a p t e r 4.— Concluding statem ent________________________________________
List of references______________________________________________________________

112
114
116
118
122
123
127
129




BULLETIN OF THE

U. S. BUREAU OF LABOR STATISTICS
No. 507

WASHINGTON

F e b r u a r y , 1930

CAUSES OF DEATH, BY OCCUPATION
INTRODUCTION
which
of in­
Odustrialwas based on the occupational mortality experience Insurance
policyholders insured with the Metropolitan Life
UR first monograph entitled “ Causes of Death, by Occupation,”

Co., was published by the United States Department of Labor. This
pamphlet, known as Bulletin No. 207 of the Bureau of Labor Statis­
tics, analyzed the causes of death (among the 2,000,000 then insured)
of 94,269 white males 15 years of age and older who died during the
three years 1911 to 1913. The data contained in this bulletin have
been favorably received, widely reprinted, and extensively used by
agencies engaged in the practical improvement of industrial con­
ditions. Highly gratifying has been the influence this publication
has exerted in the settlement of labor difficulties and in the general
improvement in industrial hygiene. It has been quoted in labor
arbitrations in various industries, especially in the printing and
publishing trades and in the clothing and textile industries; and it
has been employed in the solution of problems of industrial relations
in the railroad field.
Such favorable response has been coupled with an insistent demand
for more recent statistics. Our mortality data are illustrative of
the changing health of the wage earners of the Nation. Improve­
ments in machinery, changes in industrial processes, new findings
regarding the sanitation of factories, reductions in the hours of labor,
increases in wages, and the extensive welfare activities characteristic
of modern industry have profoundly influenced the health of workers.
The betterment of living conditions and improved standards of living
have made their impress very definitely upon the longevity and
vitality of wage earners and have been immediately reflected in lower'
death rates. To-day workers 20 years of age may expect to live, on
the average, five years longer than similar workers could in 1912.
It is for these reasons that we have thought it desirable to bring our
report up to date; for only by the widespread dissemination of such
facts can we arrive at a sound means of bettering working con­
ditions and raising still further the level of industry.
Tuberculosis has always been the predominating scourge of the
American workman; but since 1912 tuberculosis of the respiratory
system alone has declined over 50 per cent. Other causes of death




1

2

CAUSES OF DEATH, BY OCCUPATION

have decreased in varying amounts. Only a few conditions, like
cancer, have shown a rising death rate. Consequently, it now seems
desirable to extend our previous analysis of occupational mortality.
The present bulletin is based upon a far larger experience than the
earlier one. It now covers 3,250,000 white male policyholders
insured in the industrial department of the Metropolitan Life
Insurance Co. Of this exposure, 112,364 died during the years
1922, 1923, and 1924. Our aim is to provide reliable, recent,
and useful information regarding a typical cross section of the wageT
earning population. Industrial physicians, health officers, and pri­
vate practitioners will be in a position to discover from what
diseases these workers died and at what ages. Labor arbitrators and
others interested in the improvement of working conditions will
learn about some of the less satisfactory aspects of the present indus­
trial situation and, having this knowledge, will be in a far better
position to find a solution for their problems.
The method of analysis has been in general the same as that used
in the previous study. As we do not know the number of insured
persons in each occupation, we have been compelled to use the method
of proportionate mortality; that is, to find out for each occupation
the part that any cause of death has played in the total mortality,
taking into account the factor of age. There can no longer be any
doubt as to the utility of this method in working out practical
problems of industrial hygiene. Certain safeguards,, to be sure, have
to be thrown around our discussion, since we lack accurate knowledge
of the occupational status of living policyholders; but we are espe­
cially fortunate in having at our disposal the actual death rates for
the group as a whole and in the light of this information, differences
in the proportionate mortality take on added significance. For­
tunately, we now have, also, the data of the Registrar General of
England and Wales on the effects of occupation on mortality; these
figures cover recent years and supplement the historic material of
that office. These British statistics give death rates for each occupa­
tion and so have been useful in checking the conclusions derived from
the study of our data.
The causes of death have been classified as heretofore according
to the standard method used by the Census Bureau of the United
States Department of Commerce, while the occupations have been
classified according to an abridged and modified list of titles based
on the Classified Index to Occupations of the Bureau of the Census.
Comparability with our previous study and with data of the Census
Bureau has been maintained. It will, therefore, be possible to con­
sider the newer material in the light of the old and to compare it
with publications of similar insurance experience such as those issued
by Dr. Frederick L. Hoffman from time to time and also with those
of the Census Bureau.
The authors desire to acknowledge their indebtedness to Dr. Wade
Wright for many helpful criticisms, to Dr. Paul W. Cohen and to
Miss Bessie Bunzel, who from the very beginning have assisted in
the compilation of this material.




CHAPTER 1
The Group as a Whole
group of
the Metropolitan
covered
study consists mainly of people in the United
THEand by this industrial policyholders of in manufacturing
States
Canada who earn their livelihood
plants, mines, transportation industries, and mechanical pursuits.
They constitute a fairly homogeneous social and economic group
which may be described as the urban wage-earning population. The
actual occupations of living policyholders were not available; but
the occupational classification of the 105,467 occupied white males
who died in the three years covered by this study is known. While
no substitute for the former, it, nevertheless, is representative of the
general occupational make-up of the group. The following table
shows their distribution in 1911-1913 and 1922-1924:
T able

1 . — Occupations of white male decedents, aged 15 years and over,
1911-1913 and 1922-192Jj.

Occupation

Laborers (undefined).......................................... ............................... ......................
Clerks, bookkeepers, and office a s s is t a n t s ______________ _______________
Teamsters, drivers, and chauffeurs_______ _______ _______________________
Machinists................................................ ....... .............
...............
__
Farmers and farm laborers............ ................. ........... ..
. _____________ ____
Policemen, watchmen, and guards____ ________ _________________________
Carpenters............. ............. ............... ...........................
.........................
Textile (except cordage, hemp, dyeing and finishing) mill workers
Store clerks and salesmen_____________________ _ _ _ . _________________
Merchants and storekeepers________ ______ _ _ ____________________________
Painters, paper hangers, and varnishers________________________________
Railway track and yard workers .................
. _
Janitors and building employees.________________ _ ................ .. _ ___
Children, students, and scholars_________________________________________
Coalminers (underground)____________ _______________ ____ ___________
Professional service____ _____ ____ ________ ________________________________
Iron and steel mill workers____ _____ _____________________________________
Stationary engineers and firemen_________ ________ ________ . ................ ..
Agents, canvassers, and traveling salesmen____________ _________________
Shoemakers and shoe-factory workers____________ _________ ___________
Masons, bricklayers, and plasterers__________ _ _ _ . _ . ......................
Plumbers, gas fitters, and steam fitters__________________________________
Iron-foundry workers. ______________________ _________________ ______ _____
Waiters and hotel servants_________ _ ___________ _______________ _______
Tailors and garment-factory workers_____________________________________
Compositors, printers, and pressmen__________________ _______ ________
Hucksters and peddlers______________________________ _______ ______ ______
Blacksmiths____ ________ _______ ____________________________ ____________
Street-railway w orkers_____________ _____________________________________
Electricians . _
_______________________ ______ ______________________
Cabinet and furniture makers_______ _. _________________________________
Railway enginemen and trainmen_____________________________ _______
Barbers and hairdressers................................................. .........................................

Per cent of total

Number
of deaths,
1922-1924

1911-1913

i 10,026
5,140
5,001
4,835
4, 681
i 3,832
1 3, 582
3, 512
3, 302
3,133
2,740
2,617
1 2,583
2,378
1,960
1,784
1, 587
1. 565
i 1, 524
i 1, 500
i 1,423
1,263
1, 234
1 1,113
i 1,046
937
932
876
860
855
i 846
769
768

11.4
4.4
6.9
3.3
4.1
2.6
4.2
2. 5
2.5
2.4
2.9
2.0
1.9
1.5
1.7
?. 3
.8
1.5
1.3
1.5
1.9
1.2
1.7
.8
1.2
1.1
.9
1.4
.9
.6
.8
1.0
.6

1922-1924

9. 5
4.9
4.7
4.6
4.4
3.6
3. 4
3. 3
3.1
3. 0
2. 6
2. 5
2.4
2.3
1.9
1.7
1.5
1.5
1.4
1.4
1.4
1.2
1.2
1.1
1.0
.9
.9
.8
.8
.8
.8
.7
.7

(See footnote 1 at end of table, p. 4.)




3

4

CAUSES OF DEATH, BY OCCUPATION

T able

1 .— Occupations of white male decedents, ages 15 years and over,
1911-1913 and 1922-192k— Continued

Occupation

Per cent of total

Number
of deaths,
1922-1924

1911-1913

1922-1924

Sailors and marine workers............ .......................................... ...... .........
Street and sewer cleaners........................ ........................................ .........
Longshoremen and stevedores_____ ____ ______ ________ ___________
Bakers________________ _____________ ____ _________ ___________
Cigar makers and tobacco workers
Tinners (shop) and tinware workers______ . ___
______________
Saloon keepers and bartenders..-_____ ___________ _____________
Hostlers and stablemen____________ ___________
___________ ___
______ ____ ______ ____ ___________
Leather-goods workers ___
Coopers______________ ___________________ ____________________
All other occupations_____ _________ _____ _____________________

i 692
617
594
591
508
467
457
363
278
i 233
20,463

0.8
.6
.7
.7
.7
.7
2.3
.9
.7
.6
16.5

0 .7
.6
.6
.6
.5
.4
.4
.3
.3
.2
19.4

All occupations (excluding “ retired” ) ___________ ____ ____ ___

105, 467

100.0

100.0

i For purposes of comparison, the classification of occupations used in the 1911-1913 study has been retained
in this table. The number of deaths given in the table for this occupation is not the same, therefore, as that
appearing in other sections of this report because of changes in classification procedure since the earlier
study was published.

It appears at once that the occupational make-up of the group a
has remained fairly constant since the earlier study of 1911-1913 (1).
In both periods the greatest number of deaths occurred in the group
entitled “ Laborers.” The first 10 occupations in the list in 19221924 were responsible for 44.5 per cent of the deaths; in 1911-1913
they accounted for 44.3 per cent of the total. Only one entry,
“ Painters, paper hangers, and varnishers,” disappeared from its’posi­
tion among the 10 leading occupations, being replaced by “ Merchants
and storekeepers,” the eleventh in the earlier list. A few noteworthy
differences, due to major national readjustments in industry, are
recorded during the decade. The number of deaths among saloon
keepers and bartenders has decreased 79 per cent; among hostlers
and stablemen, 56 per cent; and among blacksmiths, 31 per cent.
Similarly, the progressive expansion of the metal industries has
caused an increase of 53 per cent in the number of deaths among
machinists and of 108 per cent among iron and steel mill workers.
In some occupations at least a part of the proportional differences
shown in the above table results from a change in mortality; but, un­
fortunately, because of the method used in this study, we can not deter­
mine with assurance which industries have been thus affected. We
may say that in spite of the changes in the proportionate representa­
tion of individual occupations, the general complexion of the group as
a whole has not been altered essentially in the last 10 years, and the
comparability of the two groups remains essentially undisturbed.
Although these industrial policyholders are typical of the wageearning population of the country, they include in their number
fewer agricultural workers, professional people, executives, and
small, independent business men than does the entire working popu­
lation. Differences in the occupational composition of the two
classes can not be measured with absolute accuracy, as we do not know
the occupations of living policyholders. However, unpublished data
in the files of the United States Bureau of the Census showed the
° F o r sources o f data as indicated by ita lic figures in parentheses
th is bu lletin see corresponding num bers in list o f references, page 1 29.




in the
[Ed.J

te x t

of

5

THE GROUP AS A WHOLE

occupations of gainfully employed white males of the United States
registration States who died in 1920. Their distribution by broad
industrial classes may be compared with a similar distribution of our
deceased policyholders. More than 25 per cent of the occupied males
of the registration States were engaged at the time of their death in
agriculture, forestry, or animal husbandry, whereas only a little
over 5 per cent of our male policyholders were so employed. This is
because the operations of the company are largely concentrated in
American cities and towns. There were more gainfully employed
males in professional occupations and semiprofessional pursuits in
the general population than in the Metropolitan group, the percent­
ages being 3.9 and 1.7, respectively.
Other main industrial classes were better represented among the
insured males, with the exception of the extraction of minerals, where
the percentages were about the same, 2.7 and 2.5, respectively, for
males in the registration States and for insured males. Over one-half
(51.7 per cent) were classified under the heading “ Manufacturing
and mechanical industries,” whereas 42 per cent of the males in the
registration States were thus designated. Transportation pursuits
(including steam and street railway workers, sailors, longshoremen,
teamsters, etc.) accounted for 13.1 per cent of the insured males and
6.7 per cent of the other group. Public-service occupations, includ­
ing watchmen and guards, policemen, city firemen, and soldiers,
contained 5.1 per cent of the policyholders, as compared with 2.5
per cent of the males in the registration States. The percentages of
deaths among insured males and among males of the registration
States, in the remaining industry groups, were, respectively: Trade,
9 and 8.5; domestic and personal service, 6 and 4.2; and clerical,
5.6 and 4.1 per cent.
In this section we shall consider the mortality experience of this
group of insured lives as a whole; that is, without regard to particu­
lar occupations. Fortunately, there are available complete records,
both of the number of living policyholders and of the number of
deaths, classified according to age, sex, cause of death, and other
items, which should give a very instructive picture. This is cer­
tainly one of the most extensive series of figures existing in the entire
field of industrial hygiene, covering, as it does, an exposure of three
and a quarter million workmen during a period of three years.
The following table presents the death rates by age periods for the
Metropolitan industrial policyholders, as compared w^ith the rates at
the'same ages for men in the general population of the United
States registration States. Both sets of figures are for the year 1923.
T a b l e 2 . — Death rates of white males, ages 15 and over, all causes, 1923:

Metropolitan industrial department and United States registration States
compared
Death rate per 100,000 for ages (years)—
Population group
15 and
over

15 to
24

25 to
34

35 to
44

45 to
54

55 to
64

1. United States registration States...................
2. Metropolitan insured males............................

1,384. 5
1,183. 5

363.8
347.2

457.7
556.1

717.4
946.6

1,207.4
1, 725.4

2, 527. 8
3,385.3

8.304.6
7.574.7

Per cent, Group 2 of Group 1..............................

85.5

95.4

121.5

131.9

142.9

133.9

91.2




65 and
over

6

CAUSES OF DEATH, BY OCCUPATION

Curiously enough the mortality rate of the insured group, at all
ages combined, is lower than that of males in the registration States,
the figures being 11.8 and 13.8 per thousand, respectively. This
condition is due to lower mortality in the first age group, 15 to 24
years, and in the last, 65 years and over. At age 25, however, the
mortality rate of the insured is already higher and it remains so
up to age 64, increasing progressively from age 25 to 54 ye'ars. In
the age period 45 to 54 years, the death rate for the insured exceeds
that for the general population group by 43 per cent. In the suc­
ceeding age period (55 to 64 years) the rate is 34 per cent higher.
These rates reflect primarily the results of industrial exposure. In
the beginning, the group of policyholders is in its best physical con­
dition and suffers from a lower mortality rate than does the general
population. At age 25, the situation changes; and thereafter, largely,
we believe, as a result of industrial hazards of one kind or another,
the mortality rate is heavier than that of the general male popula­
tion. The rates for the last age period, when the insured again
T
make a more favorable showing, are not reliable because most of
our industrial policies terminate at age 74. It, therefore, follows
that the average age of policyholders in the class 65 years of age
and over is lower than that of the corresponding population group;
and consequently, other things being equal, one would expect their
mortality rate to be lower.
The effects of industry are also clearly revealed in the differential
death rates for males and females of the same economic class. Com­
paring the death rates as given in the following table for male
policyholders and for their wives and sisters as represented by our
female industrial policyholders, we find some striking differences.
After age 10, the mortality rates for males are consistently higher
than for females, with the single exception of the age period 15 to
24 years. Since the industrialization of women is then at its height,
the question of the relative susceptibility of men and women to the
exactions of industry upon their health is definitely raised. After
this age, the large majority of these women become housewives and
we notice a much lower rate of mortality for them in each succeeding
age period than for men. This, we think, is largely traceable to the
absence of industrial hazard in the lives of most women.
T a b l e 3 . — Death rates of males and of females, ages 10 pears and over, all

causes, 1923: Metropolitan Life Insurance Co., industrial department

Death rate per 100,000 for ages (years)—
Sex
10 to 14

W hite m ales......................... ...........
_________ _________

198.6
162.4

Per cent, male of female...............

122.3

15 to 24

65 and
over

25 to 34

35 to 44

45 to 54

55 to 64

347.2
556.1
491.9
W353.3 females
hite

946.6
677.9

1, 725. 4
1,188. 0

3, 385. 3
2, 576.1

7, 574. 7
6,726. 7

139.6

145.2

131.4

112.6

98.3

113.1

Even more marked differences suggestive of the effects of indus­
trial exposures are found when the mortality of industrial males



7

THE GROUP AS A WHOLE

is compared with that of persons who are for the most part engaged
in nonhazardous pursuits. We may take for this comparison, white
male policyholders insured in the ordinary department of the Metro­
politan Life Insurance Co., who are composed mainly of the clerical,
professional, and commercial classes. Agricultural workers and the
better-paid mechanics are also represented in fairly large numbers.
Age for age considered, the mortality rates for the industrial group
run from one and one-half times to more than two times the rates for
policyholders in the ordinary department. This is shown in the
following table;
T a b l e 4 . — Death rates for all causes, 1923: Regular ordinary department (total

males) compared with industrial department (white males)
Death rate per 100,000 for ages (years)—
Insurance class
20 and
over

20 to 24

25 to 34

35 to 44

45 to 54

55 to 64

65 and
over

Industrial department, males.
Ordinary department, males___

1,404.1
550.0

400.6
255.2

556.1
268.4

946.6
422.0

1, 725. 4
790.1

3,385. 3
1,868. 0

7,574.7
5,604.1

Per cent, industrial of ordinary.

255.3

157.0

207.2

224.3

218.4

181.2

135. 2

In terms of life expectation, the severer status of the industrial
worker is equally impressive. The industrial worker at age 20,
when he begins his career, has an expectation of life of 42 years; or
in other words he may expect to reach age 62. The 20-year-old
worker engaged in nonhazardous occupations, however, may expect
to attain age 69, or seven years additional. Industrial workers are
at a disadvantage in each succeeding period; at age 30 the difference
is 6.6 years; at age 50, 4.2 years; and at age 70, 1.3 years, always in
favor of the nonindustrial groups. These facts are shown in Table 5.
T a b l e 5 . — Expectation of life of ivhite male policyholders insured in the Metro­

politan Life Insurance Co., ordinary and industrial departments, 1923
Expectation of life in
years

Expectation of life in
years
Per cent
difference

Age

20.................... .
25_______ _.
30.......... ...........
35____________
40................ ..
45......................

42.10
37. 89
33. 72
29. 71
25. 88
22.23

49.31
44. 82
40. 31
35. 82
31.42
27.15

Per cent
difference

Age

Ordinary
Industrial
department department

Industrial
Ordinary
department department

17.1
18. 3
19. 5
20.6
21. 4
22.1

50. .
55
60
6 5 . .. .................
70

18. 79
15. 60
12. 73
10.15
7.96

22. 96
18.99
15.32
12.02
9.23

22. 2
21. 7
20.3
18.4
16.0

The above comparisons between the death rates of various groups—
males insured in the industrial department of the Metropolitan Life
Insurance Co., males of the registration States, males insured in the
ordinary branch of the Metropolitan, and females of the wage-earning class reveal the influence of industrial environment on mortality



8

CAUSES OF DEATH, BY OCCUPATION

rates and life expectation. The difference in the mortality rates for
these groups gives a rough measure of the tax which industrial work
exacts and reflects the hazards to which workers are exposed. Other
items obviously account for a part of the disparity in these figures.
Heredity and innate differences play some part in the end result.
But probably the most important factors are the conditions inciden­
tal to industrial employment, including deleterious dusts, excessive
fatigue, bad posture, crowded workrooms, dampness, extreme
changes of temperature, and sometimes specific occupational poison­
ing, to which industrial workers are so frequently exposed. We shall
see later the great susceptibility of workers in a given occupation to
specific causes of death which are related to each of these industrial
hazards.
Up to this point we have considered only the total mortality of the
group without regard to specific causes of death. In Table 6 we
present the more detailed findings for the principal causes among
white male industrial policyholders 15 years of age and over
and the percentage of increase or decrease in 1923 as against 1912,
the mid-years of our two studies.
The causes of death showing the highest death rates in 1923 were
other diseases of the heart with 188.7 per 100,000, tuberculosis of
the respiratory system (149.7), and influenza, pneumonia (124).
In 1912, tuberculosis of the lungs with a rate of 319.9 was the
leading cause of death. Organic diseases of the heart with a rate
of 203.9 was second and nephritis (acute and chronic) with a rate
of 178.1 per 100,000 was third. At ages 15 to 24, in 1923
accidental or undefined violence was the leading cause of death,
with a rate of 89, and tuberculosis of the respiratory system
was second with 80.2. In the next age period tuberculosis took
the lead with a rate of 162.5, accidental violence being next with
a rate of 95.9. “ Influenza, pneumonia ” became prominent in this
age period and was the third highest cause, with a rate of 61.2. In
the age period 35 to 44 years the order was still the same—tuber­
culosis and accidental violence showing the highest rates, amount­
ing to 196.1 and 118.3, respectively. After age 44 years, diseases of
the heart became the chief cause of death with death rates of
253.3 in the age group 45 to 54, and of 681.3 in the 55 to 64 year
group. In the first of these periods, tuberculosis was second in
numerical importance with a rate of 218.5; but in the latter, it was
superseded by cancer, which showed a rate of 436.2, and by
nephritis and cerebral hemorrhage, both of which had a rate of
363.
Almost every cause of death has shown a highly gratifying down­
ward trend of mortality. Tuberculosis of the respiratory system,
one of the most important causes, has fortunately shown a very
great improvement, the death rate decreasing from 319.9 per 100,000
in 1912 to 149.7 in 1923, a fall of 53.2 per cent in the earlier rate.
Workers 25 to 34 years of age and 35 to 44 years were the most
favorably affected, the decrease amounting to 60.2 and 62.6 per cent
respectively. Nephritis has shown a significant but smaller decrease
of 38.0 per cent, the rates declining from 178.1 for all ages in 1912 to
110.5 in 1923. The mortality rate from this disease showed the



THE GROUP AS A WHOLE

9

greatest decline in the age period 35 to 44, where it went down 55.7
per cent. Mortality from pneumonia also showed the substantial
reduction of 26.2 per cent, the rate in 1923 being only 92.5. The
younger workers enjoyed the greatest decline, the reduction amount­
ing to 42.4 and 35.2 per cent, respectively, in the age periods 25 to
34 and 35 to 44. The fatal accident rate was reduced from 140.6
in 1912 to 121.2 in 1923, a decline of 13.8 per cent. Diseases of the
heart1 showed little change for all ages. The death rate declined
7.5 per cent or from 203.9 per 100,000 to 188.7. In the age period
35 to 44, however, the reduction amounted to 33.5 per cent.
Some of the lesser causes of death display a most marked
diminution, notably typhoid fever, cirrhosis of the liver, and suicide,
with decreases of 72.2, 65.4, and 42.2 per cent, respectively. The
effects of better industrial hygiene are clearly seen in the 50 per cent
decline in the death rate from chronic lead poisoning, a disease almost
exclusively occupational in origin.
Several exceptions to the general downward trend of mortality
are found. Thus cancer has increased in frequency from 77.6 per
100,000 in 1912 to 94.9 in 1923, a rise of 22.3 per cent in the death*
rate. In the important age periods 45 to 54 and 55 to 64 the rates
increased 15.5 per cent and 30.6 per cent, respectively.
Influenza went up 157 per cent and automobile accidents almost 500
per cent at all ages, between the years 1912 and 1923. Diabetes and
homicide registered increases but of a lesser amount, being, respec­
tively, only 13 and 18 per cent for all ages. Cancer, influenza, and
automobile accidents increased at every age period; diabetes at every
period after age 45; and homicide at every period except the 45 to 54
and 55 to 64 year groups.
The greatest differences in the total mortality rates for various social
groups, it will be recalled, were found when the mortality of males
insured in the industrial department of the Metropolitan Life In­
surance Co. was compared with that of males insured in the ordi­
nary department of the same company. This condition is shown
with particular clearness in relation to the principal causes of
death in these two classes. White males 15 years of age and over
insured in the industrial department suffered from higher death
rates for every cause of death than did males insured in the ordi­
nary department. The death rates for tuberculosis, age period for
age period, are from two and one-half to nearly four times as high
among the industrial workers as among the professional, mercan­
tile, and agricultural group. Pneumonia is more than twice as
prevalent among industrial as among nonindustrial workers. In
like manner, the degenerative diseases such as cerebral hemorrhage,
nephritis, and organic diseases of the heart show death rates that
are two, and in some cases more than three, times as high as in the
nonindustrial group. The increased accident hazard is important,
the death rate of wage earners being more than twice that of non­
industrial workers.
1 Changes in classification procedure have materially affected the comparability of the
figures for heart disease. (See discussion on p. 114.)




10

CAUSES OF DEATH, BY OCCUPATION

T a b l e 6 . — Number of deaths and death rates, 1923, and per cent decline in

white males, aged 15 and over, by age periods,
Age period (years)

15 to 24

15 and over
Line
No.

Cause of death

1920 interna­
tional list
numbers

1

All causes_________________________

2
3
4
5
6

1
Typhoid fever____ ______ _________
Influenza, pneumonia..........- ___
11,100-101
11
Influenza________________ _____
Pnftiimnnin, (all forms)
100,101
Pneumonia (lobar and un­
defined)____
_____________
101
Other diseases of the respiratory
s y s te m _________________________
97-99,102-107
Tuberculosis of the respiratory
system . _ ____________________
31
Syphilis, tabes dorsalis, and
general paralysis of in s a n e .___
38, 72, 76
43-49
Cancer (all forms) _________________
Rheumatism (acute and chronic) _
51, 52
Diabetes __ _____________ ________
57
Alcoholism________________________
66
Cirrhosis of the liver_____________
122
Chronic poisoning by mineral
and organic substances_________
67-68
Chronic lead poisoning______
67(a)
Other chronic poisonings____
67(b), 68
Cerebral hemorrhage, apoplexy,
paralysis________________________
74, 75
Other diseases of the heart _____
90
Diseases of the arteries___________
91
Arteriosclerosis_______________
91(b)
Nephritis (acute and chronic)___
128,129
Suicides (all forms).. ___
______
165-174
Accidental or undefined violence. 175-196, 201-203
Other acute poisonings (gas
excepted)______ _ _ ______
177
_________
Conflagration..
178
Accidental burns (conflagra­
tion excepted)__________ , .
179
Accidental mechanical suffo­
cation_____________
_ ...
180
Accidental absorption of irrespirable or poisonous gases.
181
Accidental drowning ________
182
Accidental traumatism by
fall__________________________
185
Accidental traumatism in
mines and quarries_________
186
Accidental traumatism by
machines___________________
187
Railroad accidents___________
188(a)
Street-car accid en ts____
188(h)
_
Automobile accidents_
I 8(c)
Other
accidental
electric
shocks. _ ____________ ______
196
Homicides (all forms)____________
197-199

7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38

Exposure— ........................ .................

i Bold-face figures denote increase,




N um ­
ber of
deaths
1923

Death
rate per
100,000,
1923

Per cent
Death
decline
rate per
in death
100,000,
rate,1
1923
1912-1923

Per cent
decline
in death
rate,1
1912-1923

38,427

1,183. 5

27.0

347.2

26.0

202
4, 025
1, 020
3,005

6.2
124.0
31.4
92. 5

72.2
9.9
157.4
26.2

9.7
32.6
11.3
21.3

60.1
16.4
222.9
13.4

2, 256

69.5

34.1

17.0

26.7

592

18.2

36.4

3.7

35.1

4,862

149. 7

53.2

80. 2

49.4

854
3, 082
132
578
327
405

26. 3
94.9
4.1
17.8
10.1
12.5

.4
22.3
50.0
12.7
35. 7
65.4

1. 6
3.4
3.9
4.1
.4
.4

15.8
36.0
15.2
6.8
55.6
55.6

41
26
15

1. 3
.8
.5

35.0
50.0

.3
.1
.3

200.0

2, 862
6,127
650
543
3, 588
647
3,936

88.1
188. 7
20. 0
16. 7
110.5
19.9
121.2

19. 5
7. 5
40.8
(2
)
38.0
42.2
13.8

1.4
26.0
1

26.3
7.1

8.2
5.0
89.0

(2
)
47.1
60.0
.2

61
36

1.9
1.1

24.0
8.3

.8
.4

60.0
20.0

105

3.2

18.5

1.7

15

.5

213
466

6.6
14.4

(2
)
28.0

1.7
19.4

518

16.0

38.2

4.9

35.5

136

4.2

4.5

3.0

23.1

181
458
130
845

5. 6
14.1
4.0
26.0

16.7
48. 5
50. 6
465.2

5.6
11. 2
1. 7
17. 6

27.3
47. 7
52.8
433.3

85
314

2. 6
9.7

7.1
18.3

3.2
7.0

3.2
34.6

3, 246, 984

(2
)

.3

1,150, 758

13.3
(2
)
(2
)
13.4

11

THE GBOUP AS A WHOLE

death rates, 1912 to 1923, from specified causes of death, in all occupations,
Metropolitan Life Insurance Co, industrial department
Age period (years)

35 to 44

25 to 34

Death
rate per
100,000,
1923

55 to 64

45 to 54

65 and over

Percent
Percent
Per cent
Percent
Percent
Death
Death
Death
decline
Death
decline
decline
decline
decline
rate per
rate per in death rate per in death
rate per
in death
in death
in death
100,000,
100,000,
100,000,
100,000,
rate,1
rate,1
rate,1
rate,1
rate,1
1923
1923
1923
191219121923
1912-1923
1912-1923
1912-1923
1923
1923

Line
No.

556.1

43.1

946.6

41.2

1, 725.4

26.3

3,385.3

16.4

7, 574. 7

13.4

1

5.0
61.2
15.9
45.3

81.3
25.7
341.7
42.4

3.9
117.6
29.3
88.2

80.7
17.9
306.9
35.2

4.0
191.3
43.0
148.4

78.7
12.7
144.3
26.4

4.9
352.2
82.5
269.8

70.5
4.1
116.0
18.0

1.7
696.8
180.9
515. 9

79.8
3.5
101.0
18.4

2
3
4
5

37.7

46.9

71.2

42.9

120.9

29.4

189.9

30.8

327. 4

26.8

6

5.0

54.1

12.1

28.4

31.5

12.5

56.7

26.5

139.9

45.5

7

162.5

60.2

196.1

62.6

218.5

49.6

200.0

38.0

183.4

22.4

8

14.5
9.7
2.0
6.6
5.1
1.8

1.4
47.0
25.9
14.3
61.4
86.4

47.0
42.4
3.7
8.3
20.0
8.6

1.7
8.8
45.6
5.7
41.0
78.9

58.4
166.6
4.5
26.0
24,0
23.2

3.3
15.5
71.5
2.8
28.1
72.6

61.6
436.2
7.8
72.4
22.8
56.3

5.1
30.6
49.4
60.9
5.0
51.7*

58.6
755.4
10.9
115.6
14.2
79.6

19.9
29.3
71.6
10.8
50.7
51.9

9
10
11
12
13
14

1.2
.4
.8

71.4
20.0
300.0

1.5
1.3
.2

58.3
50.0
80.0

3.5
2.5
1.0

18.6
35. 9
150.0

2.2
1.9
.4

60.0
55.8
66.7

100.0
100.0
100.0

15
16
17

4.8
39.6
1.0
.4
25.0
14.3
95.9

55.1
26.4
37.5
(2
)
50.8
45.6
18.0

22.4
86.6
6.8
1.8
67.5
26.2
118.3

38.6
33.5
9.3
0
55.7
45.3
21.2

100.9
253.3
16.5
9.0
175.1
35.5
148.1

19.0
3.3
14.5
(2
)
38.2
44.4
24.6

363.0
681.3
55.6
48.1
363.0
45.9
213.1

15.0
1.7
46.9
(2
)
39.4
38.0
6.3

1.097.1
1.854.1
325.8
305.7
1,056.0
60.3
310.7

9.4
3.7
35.8
00
18.7
10.3
15.9

18
19
20
21
22
23
24

1.3
1.7

43.5
756.0

3.3
.9

60.9

3.5
1.2

31.4
7.7

3.7
1.1

32.7
38.9

4.2

100.0
41.7

25
26

16.7

2.8

7.7

5.5

1.8

6.0

62.2

13.4

59.5

27

1.1

(2
)

(2
)

28

2.1
.1

(2
)

.6

(2
)

1.0

(2
)

2.9
13.4

(2
)
26.4

7.7
11.0

(2
)
39.6

12.2
10.5

(2
)
46.7

19.8
11.2

8.6

50.0

12.8

53.1

27.2

39.4

3.7

14.0

6.4

52.4

5.5

1.8

4.7
13.9
2.6
22.5

88.0
53.2
55.9
603.1

5.0
13.6
4.8
27.3

35.9
44.3
29.4
396.4

5.5
15.5
5.0
28.0

3.5
14.3

2.8
14.4

2.0
12.7

48.7
39.6

1.5
9.0

763,197

545, 239

400, 368

2 Figures for 1912 and 1923 are not comparable.




-----

(2
)
35.3

23.4
7.5

(2
)
65.3

29
30

45.5

17.1

79.6

34.3

31

4.5

27.4

3.3

31.2

32

41.0
51.1
70.1
495.7

7.8
20.1
9.7
46.6

2.5
49.9
34.5
441.9

8.4
27.6
15.9
70.3

16.7
37.8
42.4
432.6

33
34
35
36

11.8
15.9

1. 5
5.6

150.0
30.0

4.2

16.7

37
38

268,011

119,411

12

CAUSES OF DEATH, BY OCCUPATION

Notwithstanding the relatively unfavorable mortality of workers,
it is highly gratifying that their death rate has rapidly declined
and their life expectation has considerably increased during recent
decades. Between 1912 and 1928 the death rate has declined from
>1,621.7 per 100,000 to 1,183.5 per 100,000. Not only has there been
a total decline of 27 per cent during the period, but a substantial
decline in the death rate has characterized every age group. On
account of this reduced mortality, almost 14,000 fewer deaths have
occurred among the three and a quarter million policyholders in
the single year of 1923 than would have taken place had the
mortality rates of 1912 prevailed. This lessened mortality amounts
in terms of life expectation to an average increase of five years for
each industrial worker at age 20; and there has been some increase
in longevity at every age period. The greatest reduction in mor­
tality has taken place in the important working ages 25 to 34 years
and 35 to 44 years, when the rates declined 43.1 and 41.2 per cent,
respectively. Less progress is recorded after age 55, the decline
amounting to only 16.4 per cent in the age period 55 to 64 years.
While it is true that the death rate has declined among all classes,
our group of workers has exhibited a greater improvement, age for
age, than has the general population. Table 7 shows the percentage
of decline in mortality of white males insured in our industrial de­
partment as compared with insured white females and with white
males of the general population (United States registration States
of 1910).
T a b l e 7 . — Per cent of decline in death rates among white males and white

females insured in industrial department of Metropolitan Life Insurance Co.
and among white males of the registration States of 1910
Metropolitan Life In­
surance Co., 1912 to
1923
Age period
White
males

White
females

Registra­
tion States,
1911 to 1923,
white
males

15 years and over___________ _____

27.0

21.1

3.5

15 to 24___________________________
25 to 34___________________________
35 to 44___________________________
45 to 54___________________________
55 to 64_____________ _________ ____
65 years and over. .................. ........

26.0
43.1
41.2
26.3
16.4
13.4

21.1
27.5
28.2
17.5
13.7
12.1

19.3
29.0
23.2
15.7
6.1
13.6

1 Increase.

Age for age considered, the decline in the death rates for our in­
sured group has been from 7 to 18 per cent greater than the decline
for males of the registration States and from 1 to 16 per cent greater
than for females of the industrial population. The greatest gain
for all classes has been at the ages 25 to 34 and 35 to 44 years; and
at these ages also, the rate of decline for industrial males exceeds
by the greatest margin the decline in the rate of the other classes.
It would be very instructive if we could make similar comparisons
between the trend in the death rates for individual causes of death
for males of the registration States and for males insured in our



THE GROUP AS A WHOLE

13

industrial department. Unfortunately, the data necessary to make
these comparisons are not available. However, we can say that our
figures, although incomplete, indicate that the decline in mortality
among industrial males has been more rapid for all of the more
important causes of death. This fact has been conclusively shown
for tuberculosis in a recent study entitled 6 Special Aspects of the
4
Declining Tuberculosis Death Rate in the United States ” (2). It
was pointed out in that paper that the maximum decline in the death
rate from tuberculosis among industrial males between the years
1911 and 1925 occurred at the ages between 20 and 45 years and that
at these ages the rate of decline was about 20 per cent greater among
industrial males than among males in the general population.
What factors have brought about this vast improvement in the
health and longevity of industrial workers ? Surely among the many
causes must be included the wide expansion of workmen’s compen­
sation, preventive industrial medicine, the safety movement, the
reduction in the hours of labor, elimination of the sweatshop, better
plant sanitation, the wider education of the workers regarding the
dangers inherent in certain occupations, and the more intelligent
care now taken to safeguard the health of workers. But even more
important has been the improved standard of living which the in­
creased prosperity of the American wage earner has provided. The
outlook for the future is bright indeed. There is every reason to
believe that the continuation and expansion of health activities in
industry, noticeable everywhere, will result in further reductions in
mortality. The trend in the death rates according to our recent
figures is still downward. It is not unreasonable to expect, there­
fore, that in the not far distant future the mortality rates of indus­
trial workers will more nearly approach, if they do not quite equal,
those of the more favored classes of the population.
68357° - — 30—




2




CHAPTER 2
Mortality According to Occupation
in
preceding chapter that, as class,
dustrial workers
a
from the princi­
W E HAVE shownhavethe higher mortality rate In thisasectionin­
pal causes of death than do other occupied groups.
of
our report we shall analyze the mortality of the more important
occupations among industrial policyholders, to determine which are
contributing unduly to the unfavorable showing. It would be well
if, in addition to the distribution of the occupations of the deceased,
there were available the occupational distribution of living policy­
holders. We should then be able to present death rates for each
of the occupations in question. Such rates, especially if prepared
for the various age periods of life, would undoubtedly be a very ac­
curate measure of the hazard to life in the various occupations.
Unfortunately, information with reference to the occupations of liv­
ing policyholders is not available because the constant shifting in the
type of work engaged in makes it impractical to keep such detailed
records.
Proportionate mortality.—We may nevertheless measure approxi­
mately the hazards involved in certain occupations by presenting the
proportionate mortality from certain causes of death in each occupa­
tion. This method has the virtue of showing at once what causes
mortality in each age period. With proper precautions, occupations
can be compared among themselves and valuable facts obtained for
the practical purposes of industrial hygiene. Our first step was to
obtain the general proportionate distribution of the principal causes
of death among the group as a whole as- is shown in Table 8. The
number of deaths in 10-year age periods, from each cause, and the
percentage distribution of the causes within each age period are
presented.
Similar tables will be presented for each occupation studied and
the proportionate representation of any one cause of death in a cer­
tain occupation will be compared with the corresponding figure for
all occupations. The ratio of these percentages may be conveniently
called the relative index of mortality. For example, referring to
Table 13 we find that among cigar makers and tobacco workers,
aged 15 to 24 years, 41.4 per cent of the deaths are due to tuber­
culosis of the respiratory system. For all occupied males of the
same ages, the corresponding proportion of deaths is 23.5 per cent.
(Table 8.) The relative index for tuberculosis among cigar makers
and tobacco workers for the 15 to 24 year period is, therefore,
176.2. Thus it is obvious that tuberculosis of the respiratory system
is a relatively much more important cause of death among young
cigar makers and tobacco workers than it is among workers as a
whole.




15

16

CAUSES OF DEATH, BY OCCUPATION

T a b l e 8 . — Number and per cent of deaths from specified causes in all occupa

Metropolitan Life Insurance

Ages, 15 years
and over
Line
No.

1920 interna­
tional list
numbers

Cause of death

Age period
(years)

15 to 24

N um ­
Per
Number Per
cent of ber of cent of
of
deaths
total deaths total

Typhoid fever_________________ _____ ______
Influenza, pneumonia______________________
11 100,101
11
Influenza______________________________
Pneumonia (all forms)_____ ____________
100,101
97-99,102-107
Other diseases of the respiratory system. .........
Tuberculosis of the respiratory system_______
31
Syphilis, tabes dorsalis, and general paralysis of
38,72,76
insane............ ............ ...... ......... ........... .........
Cancer (all forms)__________________________
43-49
Rheumatism (acute and chronic)____________
51,52
57
Diabetes__________________________________
Alcoholism___________________________ _____
66
122
Cirrhosis of the liver________________ _______
67,68
Chronic occupational poisonings1
______ _____
Chronic lead poisoning1________________
67(a)
Other occupational and chronic poisonings
67(b), 68
74, 75
Cerebral hemorrhage, apoplexy, paralysis___
90
Other diseases of the heart....... ........... ............ .
Arteriosclerosis____________________________
91(b)
Nephritis (acute and c h r o n ic ).____________
128,129
Suicides (all forms)____________ _________—
165-174
175-189,192-196,
Accidental or undefined violence____________ r
I
201-203

,

Occupational accidents 1

T o ta l..
All occupational causes 1
........
Occupational accidents !.
Occupational homicides 1
Occupational diseases 1. .
Nonoccupational causes_____
1 Deaths from causes directly incidental to occupation.




2,083
8,138
1,614
14,172
2,375
8,632
370
1,529
854
1,128
80
70
10
7, 616
16, 217
1,389
9, 414
1,894

0
.6
9.7
2
.0

7.7
1.5
13.4
2.3

8
.2
.4
1.4
.8

1
.1
.1
.1

7.2
15.4
1.3
8.9

1
.8

313
1,053
286
767
134
2, 798

2.6
8.8
2.4
6.4
1.1
23.5

51
128
119
146
14
17
4
3
1
58
903

.4
1.1
1.0
1. 2
1
1

317
193

2.7
1.6
24.8

177
178
179
181
182
185
186
187
188(a)
188(b)
188(c)
196
197-199

10,916

10.4

2,953

3,592

3.4

.1

162

.2

.5
7.6

819

76

F175-189,192-196,
I
201-203

Septicemia (secondary cause)______________
Other acute accidental poisonings (gas ex­
cepted)________________________________________
Conflagration___________________________________
Accidental burns (conflagration excepted)_____
Accidental absorption of irrespirable, irritating,
or poisonous gases____________________________
Accidental drowning___________________________
Accidental traumatism by fall_________________
Accidental traumatism in mines and quarries..
Accidental traumatism by machines___________
Railroad accidents_____________ _______ _________
Street-car accidents________ ______ ______________
Automobile accidents__________________________
Other accidental electric shocks_______________
Homicides (all forms)_____________ ________ _____
Occupational homicides *.................... ........... .
All other causes........................................................... .

597

10, 221

144

.1
.6
1.3
1.3
,4
.5

12
20
24
61

.2
.2
.5

.5

1,155
388
2,292
271
865
42
15, 584

14.8

57
713
170
102
155
301
65
599
100
213
4
2,513

105,467

100.0

11,927

100.0

3,955
3,592
42
321
101, 512

3.7
3.4

839
819
4
16
11,088

7.0

1.380
1.380

1
.1
.4
2
.2

.3
96.3

6
.0
1.4
.9
1.3
2.5
.5
5.0

MORTALITY ACCORDING TO OCCUPATION
tiom (excluding “ retired” ),
Co., Industrial department

17

by age periods, white males, 1922 to 1924,

Age period (years)

25 to 34

35 to 44

45 to 54

Number Per Number Per
of
of
cent of
cent of
total
deaths
deaths
total

Number
of
deaths

55 to 64

Per
cent of
total

Number
of
deaths

65 and over

Per
cent of
total

Number
of
deaths

Per
cent of
total

Aver­
age
age at
death
(years)

Line
No

118
1,210
276
934
123
3, 572

1.0
10.0
2.3
7.7
1.0
29.4

77
1, 752
358
1, 394
215
3,129

0.5
11.6
2.4
9.3
1.4
20.8

52
1,971
340
1,631
331
2,558

0.3
10.0
1.7
8.3
1.7
13.0

30
2,424
441
1,983
412
1, 546

0.1
9.7
1.8
7.9
1.6
6.2

7
1,811
382
1,429
399
569

292
239
48
141
121
47
8
6
2
134
854
8
539
336

2.4
2.0
.4
1.2
1.0
.4
1

712
647
48
139
279
128
18
18

4.7
4.3
.3
.9
1.9
.9
.1
1

3.5
9.6
.3
1.4
1.3
1.6
1
1

405
1,386
28
1, 003
439

2.7
9.2
.2
6.7
2.9

5.9
15.2
.6
9.7
2.1

447
3, 302
55
493
144
386
17
15
2
2,729
4,941
366
2,762
357

1.8
13.2
.2
2.0
.6
1.5
.1
1

1.1
7.0
.1
4.4
2.8

683
1, 894
58
274
259
305
23
19
4
1,169
2,982
120
1,908
404

10.9
19.7
1.5
11.0
1.4

190
2,422
42
336
37
245
10
9
1
3,121
5,151
867
2,885
165

14.4
23.8
4.0
13.3
.8

2,014

16.6

1,840

12.2

1,696

8.6

1,541

6.2

872

4.0

38.8

21

774

6.4

744

4.9

583

3.0

467

1.9

205

.9

38.7

22

.

.
.

.

8.4
1.8
6.6
1.8
2.6
.9
11.2
.2
1.6
.2
1.1

28.9
48.3
46.9
48.7
52.0
38.2

1
2
3
4
5
6

47.0
57.5
39.4
51.6
45.4
55.1
48.5
48. 8
46.5
60.7
55.7
65.6
55.7
44.2

7
8
9
10
11
12
13
14
15
16
17
18
19
20

12

.1

12

.1

10

.1

23

.1

7

44.4

23

38
35
49

.3
.3
.4

39
35
42

.3
.2
.3

38
24
55

.2
.1
.3

25
16
48

.1
.1
.2

2
10
25

40.7
45.8
41.2

24
25
26

72
249
189
77
81
259
68
458
87
291
11
2,058

.6
2.0
1.6
.6
.7
2.1
.6
3.8
.7
2.4
1
16.9

109
174
241
92
80
211
62
364
47
185
8
2,611

.7
1.2
1.6
.6
.5
1.4
.4
2.4
.3
1.2
.1
17.4

149
134
269
70
75
166
60
334
26
111
9
2,858

.8
.7
1.4
.4
.4
.8
.3
1.7
1
.6

.6
.3
1.2
.2
.3
.6
.3
1.3

12.2

77
29
210
10
25
73
48
212
1
14
3
2,493

II. 5

47.5
29.4
46.7
36.7
36.9
37.5
43.9
39.2
30.6
34.2
42.9

14.5

145
81
301
38
66
145
85
325
10
51
7
3,051

27
28
29
30
31
32
33
34
35
36
37'
38

12,153

100.0

15, 041

100.0

19, 656

100.0

25,054

100.0

21,636

100.0

49.0

39

810
774
11
25
11,343

6.7
6.4
.1
.2
93.3

799
744
8
47
14, 242

5.3
4.9
1
.3
94.7

690
583
9
98
18,966

3.5
3.0

568
467
7
94
24,486

2.3
1.9

249
205
3
41
21,387

1.2
.9

39.7
38.7
42.9
50.5
49.4

40
41
42
43
44

.




.

.

.5
96.5

.2

.4
97.7

.1
.4
.1
1.0
.1
.3
.2
1.0
.1

.2
98.8

18

CAUSES OF DEATH, BY OCCUPATION

Standardized relative index.—The relative indexes for all ages
combined do not reflect the actual mortality picture in any given
occupation, because age distribution varies so greatly from occupa­
tion to occupation, and differences in age distribution unduly weight
and distort the result. It is quite apparent that except in unusual
instances, occupations having a preponderance of persons in the older
age divisions will show (for all ages combined) a low percentage
of deaths from tuberculosis and other diseases to which men succumb
more frequently at the younger ages; and, conversely, a higher
percentage of deaths from heart disease and other diseases char­
acteristic of later life. We have, therefore, not calculated the usual
relative indexes for all ages 15 years and over. Nevertheless, for
convenience of discussion, it would be very desirable to provide a
single figure which would show whether the occupation is character­
ized by relatively low or high percentages of deaths from any par­
ticular cause. To meet this need, standardized percentages for prin­
cipal causes of death and for each occupation during the main work­
ing period of life (ages 15 to 64 years)1 have been worked out. The
ratios between the standardized percentage for a given cause in a
selected occupation and the corresponding percentage for all occu­
pied males will be referred to as the standardized relative index.
The standardized relative index for the principal causes of death
will be found in the table for each occupation. It is a helpful device
for picking out the relatively most important causes of death. Its
use eliminates, to a large extent, the factor of age distribution in
the several occupations; it does not, however, eliminate the factor
of differential occupational death rates. Since this is so, these indexes
do not afford an accurate measure of the relative frequency of deaths
from a specific cause among men actively engaged in different occu­
pations and must not be confused with the more accurate indexes
based upon actual death rates. It is entirely possible, for example,
that an index above 100 may be shown by the proportionate mortality
method for a given cause and occupation even when the actual death
rate is below average. This will occur when both the total death
rate for the occupation and the death rate from the given cause in
that occupation are lower than average, the first being propor­
tionately lower than the second. On the other hand, proportionate
mortality indexes below 100 will be found when the death rate for
a cause of death is above the average but not as much above average
as the total death rate. Variations in the total death rate, it will be
seen from these illustrations, should be taken into account in using
these indexes as a basis to form an opinion as to whether an occupa­
tion is characterized by a high or low death rate for a specific dis­
ease. We have, therefore, brought together and discussed in a paragraph at the beginning of each occupational section important facts
brought out in this study as well as data available from other sources
1 T h e to ta l num ber o f deaths for each occupation w as assum ed to be the sam e as fo r a ll
occupied m ales, and to be sim ilarly distributed by 10-year age periods— ages 15 to 6 4 years.
T h e proportionate distribution of the deaths am ong th e several causes o f death a ctu ally
found fo r a given occupation w as then applied to the assum ed num ber o f deaths in each
age period, 15 to 64 years.
T h e sum o f the death s th u s calcu lated fo r a selected cause
o f death, divided by the to ta l num ber o f deaths from all causes am on g a ll occupied m ales,
ages 15 to 64 years, gives the standardized percentage, or the proportion o f deaths w hich
w ould have been due to th a t cause o f death if the to ta l num ber o f deaths from all causes
a t each age division, had been the sam e for th at occupation as for all occupied m ales.




MORTALITY ACCORDING TO OCCUPATION

19

which would indicate whether an occupation is characterized by a
high or low total death rate.
Tebb and Greenwood (3) found, it is interesting to observe, that
in spite of many exceptions of the type indicated in the foregoing
paragraph, the correlation at ages 35 to 45 between the proportion­
ate mortality from phthisis and the death rate from phthisis in the
Registrar General’s occupational groups (mortality experience of
1900-1902) was as much as 0.754±0.04. This is a better result than
we should expect to find for causes less affected by occupational
stress; but it certainly indicates that high or low proportionate mor­
tality indexes generally point to high or low death rates.
Entirely apart, however, from the question of whether or not these
indexes measure the relative frequency of death from specific dis­
eases among men actively engaged in different occupations, the point
must be again emphasized that they always show which causes of
death are most dependent upon working conditions. Even if the
death rate is low for every cause of death among men engaged in an
occupation the fact that some causes of death are relatively not so
favorable as others may be significant of untoward conditions and
is a fact of importance to the industrial physician charged with the
care of the health of these men.
Average age at death.—The average age at death has been deter­
mined for each of the occupations, and is to be found in a footnote
to each occupational section. It must not be assumed, however,
that these average ages are in any sense measures of the mortality
of persons in the various occupations. They are dependent in large
measure upon the age distribution of the living workers in each of
the occupations. It is obvious that the average age at death will be
low in such occupations as clerks, bookkeepers, and office assistants,
where the largest number of persons exposed are in the earlier age
periods. On the other hand, a high average age at death will be
found in those occupations in which a considerable proportion of the
workers are in the advanced age periods, as for example, among
laborers. Yet the mortality rate of laborers is clearly much higher
per thousand exposed than the mortality rate found among clerks,
bookkeepers, and office assistants. The determining factor is, then,
the distribution of the ages of the living in each occupation. Data
covering this point are not available in our experience, but, in spite
of these limitations, it is nevertheless of interest to note the average
ages of the deceased.
Our original tabulations analyzed 72 individual occupations. The
number of deaths for many of these occupations was too small to
yield reliable results except in the case of the few most important
causes of death. We shall, therefore, consider in detail only 33 occu­
pations. Significant facts for the remaining occupations will be dis­
cussed when we summarize our findings for each cause of death. In
our previous study we considered only 19 occupations; but we have
extended this number because other data are so scanty and many re­
quests for information on occupations not investigated have reached
us. We have, consequently, included this time some occupations such
as carpenters, merchants, and storekeepers which have, apparently,
no special health hazards. It is instructive to find that some oi



20

CAUSES OF DEATH, BY OCCUPATION

these occupations show unusually low percentages for certain
diseases.
Bakers2
P revious analyses of the mortality of bakers have shown a some­
what lower death rate than among all occupied males. The medicoactuarial investigation of 1913 (^), which analyzed the occupational
mortality of persons insured under ordinary plans of life insurance
(1885-1908), reported a ratio of 98 per cent of actual to expected
deaths among journeymen bakers. In the experience of England and
Wales, 1921-1923(5), bakers and pastry cooks had a death rate 14 per
cent below that of all occupied and retired males. These figures seem
to contradict the general opinion that bakers suffer from a high death
rate because they are obliged to work in a confined atmosphere laden
with dust and are exposed to heat and sudden variations in tem­
perature. Undoubtedly the hazards of the occupation have been
exaggerated; but it is very probable, at the same time, that bakers
experience a very high morbidity rate from respiratory diseases of
a nonfatal type. A study of the health of food handlers (6) made
in New York City some years ago, disclosed that bakers suffered
inordinately from chronic bronchitis and emphysema. Pharyngitis
was also a frequent impairment, probably as a result of the dusty
atmosphere in bakeries. The outstanding features of the present
investigation are the high indexes for syphilis, cancer, tubercu­
losis, and diabetes.
T a b l e 9 . — Number and per cent of deaths from specified causes among white

male bakers,

by age

Cause of death

periods, 1922 to 1924

Stand­
Ages 15 years
Per cent of deaths during age p e r io d - ard­
and over
ized
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and rela­
tive
ber
24
34
cent
44
54
64
over
index «

Number of deaths.....................................................

591

Typhoid fever ..........................................................
Influenza, pneumonia..................... .......................
Influenza ..............................................................
Pneumonia (all forms)__________ _________
Other diseases of the respiratory system .........
Tuberculosis of the respiratory system_______
Syphilis, tabes dorsalis, and general paralysis
of insane...... .............................................................
Cancer (all forms)....................................................
Rheumatism (acute and chronic).......................
D iabetes......................................................................
Alcoholism..................................................................
Cirrhosis of the liver...... .........................................
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart....................................
Arteriosclerosis...........................................................
Nephritis (acute and chronic).............................
Suicide (all forms)....................................................
Accidental or undefined violence........................
Occupational accidents - . ..............................
Homicide (all forms)................................................
All other causes..........................................................

4
51
6
45
8
88

0.7
8.6
1.0
7.6
1.4
14.9

23
66
3
10
5
6
33
97
8
57
12
33
2
5
82

3.9
11.2
.5
1.7
.8
1.0
5.6
16.4
1.4
9.6
2.0
5.6
.3
.8
13.9

Total..................................................................
Occupational deaths................................................
Nonoccupational deaths........................................

47

69

4.3
6.4

78

118

1.4
14.5
4.3
6.4
10.1
1.4
31.9~ 27.5

11.5
1.3
10.3
1.3
28.2

2.9
2.9

10.3
2.6

1.4
1.4

4.2
13.6
1.7
1.7
.8
.8
3.4
18.6

2.1

0.8
8.5
8. 5
.8
12.7

6.4

10.1

1.3
2.6
2.6
1.3
7.7

2.1

1.4
5.8
7.2

5.1
3.8
5.1

12.7
1.7
4.2

1.4
20.3

1.3
15.4

13.6

21.3
2.1
4.3
21.3

170

109

7.6
1.2
6. 5
2.4
7.6

5.5
5. 5
.9
3.7

60
102
93
116

4.1
16.5
.6
2.9

.9
15.6

172
126

.9
.9

120

16.5
24.8
5.5
18.3
.9
.9

52
104

1.8
5.9
18.8
1.2
9.4
1.2
4.7
.6
.6
14.7

93
62

4.6

591 100.0 100.0 100.0 100.0 100.0 100.0 100.0
2
589

.3
99.7

2.1
97.9 100.0 100.0 100.0

.6
99.4 100.0

---

a See page 18 for explanation of standardized relative index.
2 Includes foremen and workmen in bakeries where breads, cakes, pies, biscuits, and
crackers are made. (Bakers’ store clerks are not included.) The average age at death
is 50.2 years. (See p. 19.)




MORTALITY ACCORDING TO OCCUPATION

21

Respiratory diseases.—Pneumonia is slightly higher than average,
the standardized relative index being 102. The relative indexes are
somewhat above 100 in every age period up to age 54. The highest
relative index (131) appears at the ages 25 to 34. In the period
55 to 64, the relative index falls to 82. There are too few deaths
attributed to influenza and other respiratory diseases for the figures
to be conclusive.
Tuberculosis of the respiratory system,—Tuberculosis is appar­
.
ently more prevalent among bakers than among all occupied males.
The standardized relative index is 116. The ratios are higher than
the average in the age periods 15 to 24, 35 to 44, and 55 to 64, the
relative indexes being, respectively, 136, 136, and 123. The medicoactuarial investigation reported a death rate from tuberculosis
among journeymen bakers 15 per cent above the standard; but this
finding is not borne out bv the English occupational statistics, which
record only an average death rate from tuberculosis among bakers
and pastry cooks. The proportionate mortality for all ages 15 years
and over was lower in 1922-1924 than in 1911-1913, the percentages
being 14.9 and 18.8 for the two periods, respectively. Tuberculosis
has apparently not gone down as rapidly among bakers as among
all occupied males. The cellar bakery is not yet a thing of the past ;
and night work and its concomitant irregular habits of living will
probably remain for a long time an inherent characteristic of the
occupation. Preventive measures could well be directed toward
remedying these conditions.
Syphilis, tabes dorsalis, general paralysis of the insane.—Although
few deaths are recorded, the ratios are so consistently high that the
figures are not without significance. The standardized relative index
is 172. In an occupation where we should expect to find a low ratio
because of the strict supervision carried on by public health de­
partments, this is a surprising condition. The prevalence of trans­
missible diseases among food handlers should be a matter of great
concern to a community. Only stringent periodic physical examina­
tions can adequately protect the public from such a hazard.
Cancer (all forms).—The standardized relative index for cancer
is 126. The high relative indexes point to a high death rate from
this cause. In the age periods 45 to 54 and 55 to 64, where cancer
becomes a leading cause of death, the relative indexes are 142 and
125, respectively. The present state of our knowledge concerning
this disease does not, however, warrant the conclusion that occupa­
tion is a causative factor in these high ratios.
Suicide (all forms).—Although the ratios for this cause have
been greatly reduced since 1911-1913 and the number of deaths in
the present study is not large, the indications are that the rate is
still somewhat higher than that for all occupied males. Especially
high relative indexes are recorded at the ages 25 to 44. English sta­
tistics for 1921-1923 also show a higher death rate from suicide
among bakers and pastry cooks than among all occupied and retired
males. There is perhaps some relationship between the high ratio
for this cause and the high incidence of syphilis.
Other oawes.—The other important causes of death with the ex­
ception of accidental violence and diabetes do not exhibit significant
differences, Accidents, however, are especially low throughout, the



22

CAUSES OF DEATH, BY OCCUPATION

standardized relative index being only 62. There were 10 deaths
from diabetes, giving a standardized relative index of 120.
Blacksmiths 8
T he c l a s s i f i c a t i o n “ Blacksmiths ” includes not only blacksmiths
doing horseshoeing but also the industrial blacksmiths or forgemen.
The composition of the group has changed considerably since our
earlier study and all comparisons of mortality with that study must
take this change into consideration. As a result of the gradual dis­
appearance of the horse as a draft animal, there were far fewer
of the first type of blacksmith and, conversely, far more industrial
blacksmiths in the present investigation than in our previous study.
In the occupational mortality investigation of England and Wales
1921-1923 (J), smiths and skilled forge workers had a mortality
T
rate 5 per cent lower than average, the rates for cancer, diabetes,
and the respiratory diseases being somewhat higher than average.
In the present study cerebral hemorrhage, pneumonia, syphilis,
and cancer show notably higher than average percentages.
T a b l e 1 0 . — Number and per cent of deaths from specified causes among white

male blacksmiths,

Cause of death

Number of deaths. ................................ ......... .......

age periods, 1922 to 1924

Ages 15 years
Per cent of deaths during age period— Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
44
64
54
ber
cent
over index

Total................................ ........... ........... .........
Occupational deaths. ............ ................................
Nonoccupational deaths........................................

23

44

83

178

254

294

4.3
13.0
4.3
8.7

11.4
2.3
9.1

14.5
2.4
12.0

8.7

20.5

19.3

13.5
2.2
11.2
1.1
11.2

8.3
.8
7.5
.8
6.7

8.5
1.7
6.8
.3
1.0

2.3
2.6
8.7
2.3
11.8
.3
1.8
.5
.9
2.3
12.3
17.1 ~~4.~3~ 4.5
1.9
9.1
9.2
4.5
1.1
18.2
6.8 26.1
8.7
2.3
1.7
.5
4.3
.3
2.3
.6
14.3 34.8 22.7

8.4
6.0
1.2

5. 6
12.9

1.2
12.6

1.1
1.1
1.1
5.6
10.7
8.4
2.2
9.6
2.8
1.1

2.8
.4
1.6
15.7
19.3
1.2
8.3
1.6
5.9
2.0
.4

.7
13.6
.7
2.4

1.1
14.6

13.8

876

1
Typhoid fe v e r .............................................. ...........
Influenza, pneumonia— .................................. . P
O
15
Influenza.......................................... - ........... ..
75
Pneumonia (all forms)...... ................. ..........
Other diseases of the respiratory system-------5
Tuberculosis of the respiratory system.......... ..
67
Syphilis, tabes dorsalis, and general paralysis
23
of insane_____________________________________
Cancer (all forms)------------------------------ --------103
Rheumatism (acute and chronic). - ................
3
16
Diabetes
___________________________________
4
Alcoholism____________________________________
Cirrhosis of the liver__________________________
8
Cerebral hemorrhage, apoplexy, paralysis___
108
Other diseases of the heart....................................
150
Arteriosclerosis_____________________________
17
Nephritis (acute and chronic)_______ ________
81
Suicide (all forms)____________________________
10
Accidental or undefined violence...... ............. .
60
Occupational accidents..................................
15
Traumatism by machines ______________
4
Burns (conflagration excepted) .............. .
3
5
Homicide (all forms)............................... ...............
..................... ............. .................
All other causes
125

0.1
10.3
1.7
8.6
.6
7.6

1.2
1.2
4.8
7.2
9.6
6.0
1.2
1.2
1.2
1.2
19.3

.3
18.0
24.8
4.8
11.2
3.1
.3

1.7
98.3

8.7
91.3

2.3
97.7

1. 2
98.8

2.8
97.2

135
127
77
134
82
96
96

.3
.3
10.2

876 100.0 100.0 100.0 100.0 100.0 100.0 100.0
15
861

105
120
34
76

-

2.0 ,
.3
98.0 99.7

° See page 18 for explanation o f standardized relative index.
3 Includes blacksmiths, horseshoers, and hand-forge workers in the various industries
(excludes drop-forge workers). The average age at death is 56.9 years.
(See note,
p. 19.)




MORTALITY ACCORDING TO OCCUPATION

23

Respiratory diseases.—Blacksmiths, like workers in other occupa­
tions in the metal industry exposed to heat and sudden variations of
temperature, have very high ratios for pneumonia, The stand­
ardized relative index is 120. Up to age 54, the relative indexes are
well above the average. Excluding the age period 15 to 24, where
there are only two deaths, the highest relative index, 135, is in the
age period 45 to 54 years. The ratios for other respiratory diseases
can not be interpreted because of the paucity of data.
Tuberculosis of the respiratory system.—On the whole, deaths
from tuberculosis are less frequent in this occupation than among
all occupied males, the standardized relative index being 76. The rel­
ative indexes are very low, increasing more or less gradually from 37
in the age period 15 to 24 years, to 108 in the age period 55 to 64. The
actual death rate is therefore undoubtedly low. The fine physique
of men engaged in this sort of work explains the low mortality from
tuberculosis. The proportion of deaths for all ages 15 years and
over declined from 14 per cent to 7.6 per cent since 1911-1913.
Cancer (all forms) — The ratios for cancer are consistently high
and recall the greater frequency reported in 1911-1913; the stand­
ardized relative index is 127. Up to age 54 the relative indexes are
much in excess of the average. In the age period 55 to 64 the ratio
is about normal, the relative index being 96. In England and Wales
the cancer death rate is about 12 per cent higher than that of all
occupied and retired males. Occupation may be a causative influence
as these workers are exposed to radiant heat and continual burns by
hot metal. An analysis based on a much larger number of cancer
deaths classified according to the organ or part of the body affected
could perhaps throw further light and substantiate this assumption.
Cerebral hemorrhage, apoplexy, paralysis.—The proportionate
mortality from this cause is inordinately high. The standardized
relative index is 134. Only in the age period 45 to 54 is the relative
index less than 100. The relative index of 144 based on 40 deaths
in the age period 55 to 64 is the most significant figure. Excessive
physical labor is perhaps a contributory cause of these high ratios.
Other diseases of the heart.—The low ratios for heart diseases
are a reflection of the robust health of those choosing this occupation.
The standardized relative index is 82. The relative indexes are all
low, ranging from 57 in the age period 15 to 24 to 98 in the age
period 55 to 64. The relative indexes increase gradually with age.
Nephritis (acute and chronic).—The death rate for nephritis is
probably lower than the average. The standardized relative index
is 96. In the age periods when nephritis is an important cause of
death, the relative indexes are low, being 87 in the years 45 to 54,
and 76 at 55 to 64 years. The small number of deaths at the younger
ages makes the ratios at those periods unreliable.
Accidental or undefined violence—It would appear from the pro­
portionate mortality accident ratios that the actual death rate does
not deviate much from the average. The standardized relative index
is 96. From 15 to 34 and 45 to 54 the relative indexes are some­
what more than 100. Machinery accidents and burns were few in
number and exhibit average percentages. Occupational accidents
account for 25 per cent of all accidental deaths.



24

CAUSES OF DEATH, BY OCCUPATION

Carpenters4
C a r p e n t e r s suffer from accident hazards of the building trades.
Their industrial environment, on the other hand, does not seem to be
productive of excessive death rates for any of the important diseases.
In England and Wales (5) the death rate of carpenters is 16 per cent
less than that of all occupied and retired males and the chief causes
of death all share in the favorable death rate. The report comments
that carpenters and agricultural laborers are the only occupational
groups wherein the mortality rate for each of the important causes
of death is lower than the general average. In the present investi­
gation syphilis, accidents, and cancer show notably higher than
average percentages, but in view of the probable low total death rate
the indexes do not suggest excessive mortality from these causes.

T able 1 1 .— Number and per cent of deaths from specified causes among white

male carpenters, by age periods, 1922 to 1924
Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
54
44
64
ber
cent
over index *

Cause of death

Number of deaths............... ..................... ...............

3,499

127

188

382

Typhoid fever __________ _____________________
Influenza, pneumonia............. ........... ...................
Influenza..............................................................
Pneumonia (all forms)___________________
Other diseases of the respiratory system-------Tuberculosis of the respiratory system_______
Syphilis, tabes dorsalis, and general paralysis
of insane_________________ ______ ______ ______
Cancer (all forms)______________________ ______
Rheumatism (acute and c h r o n ic )............... . .
Diabetes__________________ ________ ___ ________
Alcoholism______________
___________________
Cirrhosis of the liver
__________
Chronic occupational poison ings.___________
Lead poisoning.
.
..... ......... .......
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart....................... ...........
Arteriosclerosis .
Nephritis (acute and chronic)...... ......................
Suicide (all forms)
___
Accidental or undefined violence......................
Occupational accidents. .............
.......
Traumatism by fall _
.
.
Homicide (all forms)....................... .......................
All other causes _
_
_ .
_
_____

14
295
62
233
52
325

0.4
8.4
1.8
6.7
1.5
9.3

2.4
5.5
2.4
3.1
1.6
15.7

1.1
11.7
3.2
8.5
1.6
25.0

0.5
11.5
3.1
8.4
.8
21.2

1.0
8.2
2.0
6.1
1.9
11.8

0.1
8.4
1.4
7.0
2.0
7.0

90
412
11
33
24
49
2
2
330
601
74
344
43
322
96
78
16
462

2.6
11.8
.3
.9
.7
1.4
.1
.1
9.4
17.2
2.1
9.8
1. 2
9.2
2. 7
2. 2
.5
13.2

.8
3.9
.8
.8

4.3
1.6
.5
.5
1.6

6.5
3.1
.3
.8
1.3
.8

4.1
12.3
.5
.5
1.5
1.9
.2
.2
4.9
15.8
.3
9.0
1.7
8.3
2.6
2.0
.2
15. 8

2.0
17.9
.1
1.3
.7
1.5
.1
.1
10.1
16.9
1.4
9.5
1.4
6.9
1.7
1.5
.2
12. G

Total

___

_

Occupational deaths
Nonoccupational deaths.

.8
2.4

1.1
4.8

1.6
1.6
38.6
11.8
7.9
2.4
21.3

4.8
1.6
21.8
6.9
5.9
3.2
14.9

2.6
10.2
.3
4.2
2.1
15.4
4.7
3.7
.5
17.8

587 1,004 1,211
7.4
1.2
6.2
1.1
3.1
1.0
11.6
.3
1.0

111
84
114
90
133
129
59

1.7
15.4
23.7
4.7
14.0
.5
4.5
1.5
1.3
.2
9.8

________________

103
3,396

85
129

3,499 100.0 100.0 100.0 100.0 100.0 100.0 1100.0

________

92
88

______
_

2.9
97.1

11.8
88.2

6.9
93.1

4.7
95.3

3.1
96.9

2.0
98.0

1.6
98.4

i See page 18 for explanation of standardized relative index.

Respiratory diseases.—Influenza and other diseases of the respira­
tory system are somewhat higher than the average, the standardized
relative indexes being 111 and 114, respectively. Pneumonia, how­
ever, is less frequent than among all occupied males. The stand­
4 Includes foremen and workmen in the construction and maintenance of wooden build­
ings, factories, and ships: Carpenters, joiners, stair builders, house framers, and house
and roof shinglers. The average age at death is 56.6 years. (See note. p. 19.)




MORTALITY ACCORDING TO OCCUPATION

25

ardized relative index is 84. The ratios are low except in the age
period 25 to 34. It should be noted that in the ages 25 to 34 all
types of respiratory diseases are frequent.
Tuberculosis of the respiratory system.—Tuberculosis is produc­
tive of relatively few deaths. The standardized relative index is 90.
The percentages are about average or below average up to age period
55 to 64, where the index is 113. The relative index is lowest for
the age period 15 to 24, where it is 67.
Syphilis, tabes dorsalis, general, paralysis of the insane.—The
ratios from this cause are high at every age period. The stand­
ardized relative index is 133.
Cancer (all forms).—Carpenters have the highest relative inci­
dence of cancer among the 33 larger occupations for which stand­
ardized relative indexes were calculated. The standardized relative
index is 129. Deaths from cancer are excessive after age 44 and in
the first age period. In England and Wales the death rate for can­
cer (all forms) is only slightly below the average, but higher than
average rates are recorded for cancer of the oesophagus.
Accidental or undefined violence.—The accident hazard is greater
among carpenters than among all occupied males. The standardized
relative index is 129. A very high relative index, 156, is found in
the first period. Higher than average percentages are found in each
age period except 45 to 54, where the relative index is 97. Falls
accounted for almost 25 per cent of all accidental deaths.
Chauffeurs 5
E a r l i e r studies of occupational mortality do not show the death
rate of chauffeurs. Recently, however, Arthur Hunter (7) of the
New York Life Insurance Co. reported on the mortality of public
taxicab and auto truck operating chauffeurs insured under ordinary
plans in his company for the years 1916 to 1926. The actual number
of deaths among chauffeurs was found to be 145 per cent of the num­
ber which might have been expected according to the death rates on
standard lives. In the English mortality study (5), however, drivers
of motor vehicles and steam wagons had death rates 14 per cent be­
low the average. All the principal causes except syphilis showed
average, or below average, death rates. Especially interesting is the
fact that the death rate from accidents was 14 per cent below the
average, whereas our study of American chauffeurs shows a stand­
ardized relative index for accidents of 146. There are more deaths
from accidents in our study than from any other cause, except tuber­
culosis. Notably higher proportions of death are recorded in our
study also for syphilis, cancer, and homicide. The extremely
high percentages of deaths for homicides are an outstanding fea­
ture of the mortality of this group and should be of great significance
to the public authorities, as they indicate that despite our system of
licensing and checking up on chauffeurs, many undesirables have
used this occupation as a cloak to cover their illegal activities.
5 Includes truck, taxi, and private automobile chauffeurs.
is 32.9 years. (See note, p. 19.)




The average age at death

CAUSES OF DEATH, BY OCCUPATION

26
T able

1 2 .— Number and per cent of deaths from specified ca/uses among white
male chauffeurs, by age periods, 19.22 to 1924
Age 15 years
and over
Cause of death
N um ­
ber

Number of deaths..

372

523

294

135

10
116
24
92
18
331

0.7
8.3
1.7
6.6
1.3
23.6

1.9
6.5
1.9
4.6
1.1
25.3

0.2
9.0
1.5
7.5
1.0
29.2

0.3
9.5
2.4
7.1
2.4
22.1

0.7
8.1
1.5
6.6
1.5
11.9

35
57
5
12
15
5
23
133
5
65
28
304
148
94
135
47
191

2.5
4.1
.4
.9
1.1
.4
1.6
9.5
.4
4.6
2.0
21.7
10.6
6.7
9.6
3.4
13.6

.5
.8
.3
.3
.3

4.4
4.8

.3
7.3

2.5
2.7
.4
1.0
1.3
.6
.8
7.3

2.7
2.2
32.3
16.1
9.9
14.8
4.6
14.0

3.4
1.9
19.9
8.4
5.9
8.2
4.8
14. 1

3.0
11.1
.7
1.5
.7
1.5
3.7
17.0
.7
5.9
3.7
11.9
5.9
3.0
4.4
1.5
14.8

1,400

...
Typhoid fe v e r ____
Influenza, pneumonia
________ ______ ____
Influenza_____________
Pneumonia (all forms)_____________
Other diseases of the respiratory system ___
Tuberculosis of the respiratory system______
Syphilis, tabes dorsalis, and general paraly­
sis of insane______________________
Cancer (all forms)____________________________
Rheumatism (acute and chronic)____
____
Diabetes____________________________
Alcoholism_________ ________________
Cirrhosis of the liver____________________
.
Cerebral hemorrhage, apoplexy, paralysis-. _
Other diseases of the heart_______________
Arteriosclerosis_________________________
Nephritis (acute and chronic)________________
Suicide (all forms) ________________
_ .
Accidental or undefined violence_____________
Occupational accidents___________________
Occupational automobile accidents _.
Automobile accidents__________
Homicide (all forms)__________________ ____ .
All other causes___ ______ ________
_________
Total_________________

Per
cent

Per cent of deaths during age period— Stand­
ard­
ized
rela­
15 to 25 to 35 to 45 to 55 to 65 and tive
44
54
64
34
24
over index i

.7
2.0
1.4
10.5
.7
7.1
1.7
19.0
10.2
5.8
8.5
.7
12.6

55

21

9.1

4.8

9.1

4.8

3.6

4.8

63
91
75
97

14.3

137
112

5.5
14.5
1.8
3.6
12. 7
18.2
1.8
7.3

122
9.5
19.0
4.8
19.0

12. 7 ~~4.~8~
10.9
9.1
9.1
4.8
1.8
7.3
19.0

______ 1 1.400 100.0 100.0 100.0 100.0 100.0 100.0 100. 0

Occupational deaths
Nonoccupational deaths______________________

148
1,252

10.6
89.4

16.1
83.9

8.4
91.6

10.2
89.8

5.9
94.1

95
102
73
146

-

10.9
89.1 100.0

1 See page 18 for explanation of standardized relative index.

Respiratory diseases.—This occupation shows low ratios for the
respiratory diseases. The standardized relative indexes for influenza,
pneumonia, and other diseases of the respiratory system are 63, 91,
and 75, respectively. The occupation teamsters and drivers, which
is exposed to very similar conditions, exhibits much higher ratios.
Chauffeurs are perhaps of a higher economic level and may also
be a better selected group physically. They are also, on the whole,
better protected from the elements.
Tuberculosis of the respiratory system.—The proportionate mor­
tality for tuberculosis does not differ much from the average in the
several age periods. The standardized relative index is 97. Ex­
cluding the indefinite period 65 and over, where there was one
death, the highest relative index is 108 in the age period 15 to 24.
The actual death rate from this cause is probably not far from
the average.
Cancer (all forms).—The standardized relative index for cancer
is 112. Cancer ratios are high after age 24. Occupational in­
fluences which predispose to cancerous growths are not evident. In
England and Wales chauffeurs had an average death rate from
cancer.
Alcoholism.—Though the actual number of deaths from alcohol­
ism is small, there appears to be a greater incidence among chauf­
feurs than among all occupied males, a condition which was found
also among teamsters and drivers.



MORTALITY ACCORDING TO OCCUPATION

27

Cerebral hemorrhage, apoplexy, paralysis.—The standardized rel­
ative index is 95. The number of deaths is small, and the ratios
are therefore subject to large chance variations.
Other diseases of the heart.—The standardized relative index is
102. Heart disease exhibits high ratios in the age periods between
25 and 54. The highest relative index is 114, in the age period 35
to 44. The differences from the average are not large, but the
indications are for a slightly higher incidence of heart impairment
among these men.
Nephritis (acmte and chronic).—Low ratios for nephritis are the
rule. The standardized relative index is 73.
Accidental or undefined violence.—Accidents caused more deaths
than any other cause except tuberculosis. The standardized rela­
tive index is 146. The proportionate mortality is high in every
age period. The highest relative index appears in the age period
55 to 64, where it is 205. About one-half the accidental deaths
were of occupational origin. The highest relative index for occu­
pational accidents, 574, appeared in the age period 55' to 64 years,
but is based on a small number of deaths. The highest indexes for
te.amsters, however, were also found at the older ages. The older
man is probably not as capable as the younger of coping with the
exigencies of these occupations. There were 135 automobile casual­
ties, of which 94 or 69.6 per cent were of occupational origin.
Homicide {all forms).—There were 47 deaths from this cause,
of which 42 occurred in the first two age periods. The relative
indexes were 256 and 200 in the age periods 15 to 24 and 25 to 34,
respectively. None of the deaths was of occupational origin, and
a review of the original records indicates that in a majority of the
cases the deceased chauffeur was to some extent culpable.
Cigar Makers and Tobacco W ork ers6
T h e c o m p o s i t i o n of this group of workers has changed somewhat
since our earlier study (1). The number of deaths has decreased
from 693 to 508. Since this decrease has been mostly at the younger
ages, the effect has been to raise the average age at death more than
six years. The decrease in deaths is due to an actual reduction in the
number of men employed in this industry as a result of greater ma­
chine production, a decreased demand for cigars, and a replacement
of male by female workers, especially at the younger ages. The total
death rate of tobacco workers is probably not above that of all occu­
pied males insured in our industrial department. Cigar makers in the
medico-actuarial investigation of 1913 (4) showed a ratio of actual
to expected deaths of 108 per cent; and in England and Wales (5)
tobacco factory operatives had a death rate about 15 per cent
higher than the average. All of the older studies of occupational
mortality record very high rates for tuberculosis. High ratios are
also found for this cause in the present study.
6
Includes forem en and* w o rk m e n : B rand ers, bunch m akers, cappers and nip w rappers,
casers, classers, cutters, dippers, driers and dry-liouse men, hangers and shakers-out, lum p
m akers, pressers, prizer hands, rollers, sam plers, shapers, sizers, snuff m akers, sorters,
steam w rappers, steam -box hands, stem m ers, strippers, tiers, w eighers, and w rappers.
Th e average age a t death is 5 5 .9 years.
(See note, p. 1 9 .)




CAUSES OF DEATH, BY OCCUPATION

28

T able 1 3 . — Number avid per cent of deaths from specified causes among white

male cigar makers and tobacco workers, by age periods, 1922 to 1924

Cause of death

Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N u m ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
34
44
54
ber
24
cent
over index

50

0
.6

Typhoid fever______________________ _________
Influenza, pneumonia_______________________
Influenza_________________________ _______
Pneumonia (all forms)........ .........................
Other diseases of the respiratory system____
Tuberculosis of the respiratory system_____
Syphilis, tabes dorsalis, and general paraly­
sis of insane__________________ __________
Cancer (all forms)................... ...............................
Rheumatism (acute and ch ronic)................
Diabetes_____________________________________
Alcoholism _________________________ _______
Cirrhosis of the liver_________________ _______
Cerebral hemorrhage, apoplexy, paralysis...
Other diseases of the heart_____ _____ _______
Arteriosclerosis__________ ________ ______ _____
Nephritis (acute and chronic)...........................
Suicide (all forms).............. ......................... .........
Accidental or undefined violence______ _____
Occupational accidents................................
Homicide (all forms)................................... .........
All other causes............................ .........................
Total.......... ............. ............... ........... ...........
Occupational deaths_________________ _______
Nonoccupational deaths______________ ______

3.4
5.6
5.6

8.7
2.4
6.3

1
.6

•162

2
.0

Number of deaths.. _ ........................ ...................

0
.6
6
.2

22.0
4.0
18.0

41.4

16.0

508 100.0

2

506

100.0

.4
99.6

1 1
.1 .2

8.7
3.1
5.6
3.1

4.0
4.0

6.9
6.9
3.4
13.8
3.4
3.4
20.7

.6

5.6

3.7
1
.2
6 1 3.1
.8 .2
8 17.9 14.9
.0
.6
1 1 2.5
.1 .2
4.0
1.9
4.0
2.3
.2
2 1 1.9 1
.0 .1
12.4
10.2 13.6
4.0
8 13.6 16.7 19.3
.0
3.1
.6
2
.0
8 8 11.1 13.0
.0 .0

55.6
5.6

10.4

9.1
3.4
5.7

161

11.1
11.1

4.0
10.0

6
.0

17.0

2.3
5.7

3.1
6.8
.6

1.9
5.6

13. 6

11.7

124
78
43
135
103
118

134
80

9.9

73

100.0 100.0 100.0 100.0 100.0

3.4
96.6 100.0 100.0 100.0

100.0

1 See page 18 for explanation of standardized relative index.

Respiratory diseases.—The standardized relative indexes for pneu­
monia and for other diseases of the respiratory system are low, l3eing
78 and 43, respectively. The standardized relative index for in­
fluenza, on the other hand, is high, being 124. The number of
deaths, however, from influenza and other diseases of the respiratory
system are too few to give reliable results.
Tuberculosis of the respiratory system.—The standardized relative
index for tuberculosis is 135. The proportionate mortality ratios
are very high up to age 34 and also in the age period 45 to 54.
The highest relative index (189) is in the age period 25 to 34 years.
In England and Wales in 1921-1923, the death rate was twice that
of all occupied and retired males. Other investigations, including
the medico-actuarial investigation and our earlier study, confirm these
findings. There has evidently been an improvement in the tubercu­
losis rate since 1911-1913, but most of it has taken effect at the older
ages. In the age period 15 to 24 years the proportion of deaths from
tuberculosis to all deaths was 48.5 per cent m 1911-1913 and 41.4
per cent in the period 1922-1924. In the next period the propor­
tions were 44.9 per cent and 55.6 per cent, respectively. The num­
ber of deaths at these ages is small, however. Causes for the high
incidence of tuberculosis in this industry are controversial. The
most recent investigators tend to minimize the 'direct occupational
influence of tobacco dust. Dr. H. R. M. Landis (8) reports that
in his examination of cigar workers, none of them, even after many
years of exposure, showed lung changes different in any way from
those found in city dwellers. The tendency for men of poor phy


MORTALITY ACCORDING TO OCCUPATION

29

sique to enter this occupation may account in part for their high
rates from this disease.
Cancer (all forms),—The standardized relative index .for cancer
is 118. At the age period 55 to 64, when the number of deaths is
large, the index is 136. In England and Wales the death rate was
24 per cent above the average.
Cerebral hemorrhage, apoplexyy paralysis.—The standardized
relative index is 134. The relative index in every age period where
deaths have been recorded, except for the indefinite period 65 and
over, is much above normal. The highest relative index is 173, in
the age period 45 to 54 years. In England and Wales, in striking
contrast to our figures, the death rate from this cause among tobacco
workers is only a little more than half that of all occupied and
retired males.
Other diseases of the heart.—Heart disease is a less frequent cause
of death than among all occupied males. The standardized relative
index is 80. In every age period the proportionate mortality ratio
is much less than the normal. In England and Wales again the
picture is different; tobacco factory operatives experienced a mor­
tality rate from valvular diseases of the heart 48 per cent higher,
while other heart diseases were 4 per cent higher than the average
for all occupied and retired males.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 98. In the age periods 55 to 64 and 65 and over,
where a large number of deaths is recorded, the relative indexes are
101 and 98, respectively. The relative indexes in other age periods
are inconclusive because of the small number ,of deaths on which the
ratios are based.
Suicide (all forms).—Very high suicide ratios are shown at every
age. The highest relative index (396) appears in the age period
25 to 34. That this condition is not casual is corroborated by the
similarly high proportionate mortality ratios from this cause in
1911-1913. English tobacco workers, however, show a lower than
average death rate from suicide.
Accidental or undefined violence.—There is virtually no industrial
accident hazard among tobacco workers. The standardized relative
index for all types of accidents is 73. The ratios are very low up to
age 54, after which they are above the average.
Clerks, Bookkeepers, and Office Assistants7
C l e r k s a r e on the whole a selected class. Their occupation is sed­
entary and exposes them to no apparent serious health or accident
hazard. The only recent American study giving death rates for a
group of clerical workers is the intercompany group insurance mor­
tality experience for the years 1922 to 1926 (P), where clerical work­
ers show a ratio of actual to expected deaths of 76.1 per cent,
while that for all industries is 90.2 per cent. In England and Wales
(5) the death rate of clerks is about the same as the average for all
occupied and retired males. The death rate of clerks insured in our
7 Includes bookkeepers, clerks, stenographers, typewriters, office boys, proof readers,
copy holders, post-office clerks, shipping clerks, and stock clerks. The average age at
death is 40 years. (See note, p. 19.)

68857°—30--- 3



CAUSES OF DEATH, BY OCCUPATION

30

industrial department is very probably less than the average for white
male industrial policyholders.
In the present study clerks have greater than average percentages
of deaths from tuberculosis, diabetes, cerebral hemorrhage, and heart
disease. The fatal accident rate, on the other hand, is very low, the
standardized relative index being only 50. These findings are in
agreement with those of our analysis of mortality by occupation in
1911 to 1913 ( i). In England and Wales clerks showed higher than
average death rates from tuberculosis, syphilis, diabetes, diseases of
the digestive system, cirrhosis of the liver, and suicide.
Table 1 4 .— Number and per cent of deaths from specified causes among white,
male clerks, bookkeepers, and office assistants, bp age periods, 1922 to
1924
Ages 15 years
Per cent of deaths during age p e rio d - Stand*
and over
ardized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
44
54
24
34
64
over index *
ber
cent

Cause of death

Number of deaths _

.

Total___ _____ _________________________
Occupational deaths___________________ ______
Nonoccupational deaths____________________

1,313

990

749

841

766

481

1.1
9.8
2.0
7.8
1.2
22. 7

2. 6
10.4
2.1
8.3
1.3
31.8

1. 6
9. 5
2.3
7.2
1.3
38.4

0. 5
12.0
2.8
9. 2
.8
24.6

9.6
1.7
8.0
1.2
15.1

8.2
1.6
6.7
1.7
6.3

7.9
1. 2
6.7
.4
1. 7

2.1
6.2
.6
1. 5
,4
.9
4.5
14. 6
.5
7. 6
1.8
7.2

,2
.9
1.3
1.7
.4
.4
10.1

2.1
2.2
.6
1. 5
7
.5
1.0
9.4

3.1
1. 6
14. 0
1.4
1. 0
19.2

5.6
1. 5
7.6
.5
1.1
15. 4

4.7
5.2
.4
.8
.9
.4
2.8
11.7
.1
6.9
3.1
4.1
.3
1. 5
19.4

4.2
8.9
.4
1. 3
.8
2. 3
5.4
18.1
.6
10.0
1.8
5.0
.5
.4
15. 1

.9
13.6
.1
2. 7
.1
1. 2
12.7
20.4
1.4
10.4
1.0
3.3
.5

1.9
13.9
.4
.4
.2
1.0
11.0
26.6
2.0
16.4
1.9
2. 5
.4

15.9

11.6

5,140

54
Typhoid fever
Influenza, pneumonia
_ __
_
503
Influen za__ ______
_
_
...........
104
Pneumonia (all forms)-.
_____________
399
Other diseases of the respiratory s y s t e m ____
61
Tuberculosis of the respiratory system ............ 1,165
Syphilis, tabes dorsalis, and general paralysis
of insane_________________ ___________________
110
Cancer (all forms)............................. .......................
319
Rheumatism (acute and chronic).......................
32
Diabetes______________________________________
77
Alcoholism __
.............. .............................
23
Cirrhosis of the liver ............................................
46
Cerebral hemorrhage, apoplexy, paralysis___
231
Other diseases of the heart___________________
749
Arteriosclerosis____________________________ __
27
Nephritis (acute and chronic) _____________
391
Suicide (all forms) .
_______________________
91
Accidental or undefined violence .................
369
36
Occupational accidents......................
Homicide (all forms)
_ ____________________
_
38
All other causes__________________ ___________
854

'
16! 6

99
97
90
123
93
102
121
108
116
102
50

100.0 100.0 !100.0 100.0 100.0 100.0
5,140 100.0 1
38
5,102

. 7 1 1-4
99.3 ' 98.6

.4
.5
99.5 j 99.6

.5
99.5

.7
99.3

.4
99.6

1 See page 18 for explanation of standardized relative index.

Respiratory diseases.—Respiratory diseases are on the whole less
frequent causes of death than among all occupied males. The stand­
ardized relative indexes for influenza, pneumonia, and other diseases
of the respiratory system are 99, 97, and 90, respectively. English
clerks have lower than average death rates for respiratory diseases;
however, the death rate for influenza is average.
Tubwculosis of the respiratory systems.—The standardized rela­
tive index for tuberculosis is 123. The relative indexes decrease pro­
gressively from 135 in the age period 15 to 24 years to 102 in the age
period 55 to 64 years. The high indexes are confirmed by our earlier
study, where the relative indexes ran from 137 in the period 15 to 24
to 102 in the period 55 to 64, and by the experience of England
and Wales where the death rate from tuberculosis among clerks is
24 per cent above the average. The sedentary nature of this occupa­



MORTALITY ACCORDING TO OCCUPATION

31

tion, poor posture, and faulty ventilation are possibly important
causative factors of high rates for tuberculosis. Also contributory
is the fact that men of weak constitution are attracted to this occupa­
tion. The percentage of deaths for all ages 15 years and over has
declined from 35 per cent in 1911-1913 to 22.7 per cent in 19221924. Clerks have therefore shared proportionately in the general
decline of the death rate from tuberculosis.
Cancer (all forms).—The standardized relative index for cancer
is 102. The percentage of deaths for all ages 15 years and over has in­
creased from 3.1 per cent in 1911-1913 to 6.2 per cent in 1922-1924.
The death rate has therefore very probably shown a considerable
increase since the previous study. However, the increase is due in
part at least to an increase of three and a half years in the average
age of the group at death.
Rheumatism (acute and chronic).—The ratios for rheumatism are
high up to age 54 years. Although the number of deaths is small,
the uniformly high ratios point to a high incidence of this disease
among clerks. Men afflicted w
rith rheumatism necessarily have to
choose sedentary employment, since they are unable to do work
requiring physical exertion. The high ratios may be due to this
element of selection.
Diabetes.—The standardized relative index for diabetes is 121.
High ratios for diabetes are noted also among most of the seden­
tary occupations, notably among merchants and storekeepers and
tailors and other clothing workers. In England and Wales, the
T
death rate from diabetes among clerks is 18 per cent above the
average.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized rela­
tive index is 108. Only in the age period 55 to 64, where the relative
index is 117, is the ratio much above the average. In England and
Wales clerks have an average death rate from this cause.
Other diseases of the heart.—The standardized relative index is
116. The relative indexes decrease progressively from 133 in the age
period 15 to 24 to 104 in the age period 55 to 64. High relative
indexes were found in our earlier study for the ages 15 to 44 years.
There seems to be no direct occupational influence affecting this cause
of death, although selection of work because of impairment is again
suggested. The high ratios from rheumatism in this occupation
coupled with the high ratios for heart disease suggest a greater
incidence of rheumatic heart disease especially at the younger ages.
In England and Wales, however, the death rates from valvular and
other diseases of the heart are about average.
Nephritis (acute and chronic).—-The standardized relative index
for nephritis is 102. Up to age 34, however, the ratios are con­
siderably above the average. The death rate from chronic nephritis
among English clerks is 6 per cent higher than among all occupied
and retired males.
Accidental or undefined violence.—The most favorable aspect of
the mortality of clerks is the extremely low accident rate. The
standardized relative index is 50. This is one of the lowest ratios
recorded in our analysis. The relative indexes are similarly low in
every age period. Occupational accidents account for 10 per cent
of all accidental deaths. The percentage of deaths for all ages>15
years and over has remained, since 1911-1913, at a figure of 7.2.



32

CAUSES OF DEATH, BY OCCUPATION

Coal Miners (Underground) 8
T h e d e a t h rate among coal miners in the United States is un­
doubtedly very high. In the medico-actuarial investigation of
1913 (4) the ratio of actual to expected deaths among working
anthracite coal miners was 191 per cent and among bituminous miners
132 per cent. In the intercompany group mortality investigation
1922-1926 (9), the ratio was 146.2 per cent for underground bitumi­
nous mining and 122.9 per cent for anthracite mining. Coal mine
accidents alone, judging from the comprehensive reports of the
United States Bureau of Mines (10), are responsible for about 5
deaths annually per 1,000 underground workers who work 300 days
a year. Such a fatal accident rate is clearly indicative of a very
high total death rate. In the experience of the Metropolitan Life
Insurance Co., 22 per cent of all deaths among coal miners is due to
accidental violence. The outstanding features of the mortality of
coal miners as revealed in this study are the very high ratios for
respiratory diseases and accidents, the low ratios for tuberculosis,
and the large proportion of deaths clearly occupational in origin.
More than one-firth (21.5 per cent) of the deaths are assigned
specifically to occupational causes. Occupational accidents account
for 15.8 per cent of all deaths, while occupational diseases are re­
sponsible for an additional 5.7 per cent.
T able 1 5 .— Number and per cent of deaths from specified causes among white

male coal miners (underground), by age periods, 1922 to 1924

Cause of death

Ages 15 years
Per cent of deaths during age period— Stand­
and over
ard­
ized
rela­
N u m ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
34
44
54
64
24
over index «
ber
cent

191

Number of deaths_______ ______ _______________

1,960

Typhoid fever ................................................ .. - Influenza, pneumonia........... ................. ...............
Influenza_________________________________
Pneumonia (all forms)___________________
Other diseases of the respiratory s y s t e m ____
Tuberculosis of the respiratory system___
Syphilis, tabes dorsalis, and general paralysis
of insane
.............................. .........
Cancer (all forms).......................................... .........
Rheumatism (acute and chronic)......................
Diabetes................................. ....... .............................
Alcoholism
...............
Cirrhosis of the liver____________ _____________
Chronic occupational poisonings.......................
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart........ ............... ...........
Arteriosclerosis_______________ ________________
Nephritis (acute and chronic) ....... ...................
Suicide (all forms)___________________________ _
Accidental or undefined violence. .....................
Occupational accidents..................................
Traumatism in mines _________________
Homicide (all forms)............................. .................
All other causes___ ______ _____________________

17
317
76
241
83
139

0.9
16.2
3.9
12.3
4.2
7.1

26
107
5
12
6
20
1
100
268
21
132
26
432
310
306
14
234

1.3
5.5
.3
.6
.3
1.0
1
5.1
13.7
1.1
6.7
1.3
22.0
15.8
15.6
.7
11.9

Total.............. ...................................................
Occupational deaths_____________ ____ _____
Nonoccupational deaths........................................

193

299

435

503

339

2.6
13.1
3.7
9.4

1.6
9.3
3.1
6.2
1.0
13.5

1.3
19.1
4.3
14.7
2.3
10.4

0.7
17.5
3.2
14.3
5.7
6.4

0.4
17.1
4.4
12.7
5.2
5.8

16.2
4.1
12.1
6.8
4.7

3.3
2.7
.7
1.3
.7
.7

2.1
5.7
.2
.5
.7
1.1

1.0
9.7

2.3
7.7
.3
4.7
2.0
31.4
22.7
22.1
1.3
7.7

3.9
18.9

4.7
.5

.5
.5
.5
.5

.

2.6

1.0
7.3

.5
3.1
54.5
40.8
40.3
.5
17.8

3.1
2.1
45.6
32.6
32.6
3.6
9.8

5. i
1.4
17.2
13.8
13.6
.2
12.6

1.0
.2
1.0
.2
6.8
16.5
1.4
9.1
.8
11.1
6.6
6.6
.2
12.5

.6
6.8
.3

188
150
238
48
53
66
51

2.1
11.8
18.0
3.8
12.9

65
92

4.4
2.4
2.4

228

68

11.8

1,960 100.0 100.0 100.0 100.0 100.0 100.0 100.0
421
1, 539

21.5
78.5

41.9
58.1

34.2
65.8

26.4
73.6

22.1
77.9

14.7
85.3

7.7
92.3

a See page 18 for explanation of standardized relative index.
8 Includes foremen and workmen in coal mines: Line drivers, pit miners (in coal mines
only), cagers, crib men, drillers, laborers in coal mines, trimmers, shaft tenders, and
timbermen in coal mines. The average age at death is 49.1 years. (See note, p. 19.)




MORTALITY ACCORDING TO OCCUPATION

33

Typhoid fever.—The number of deaths from typhoid fever is
small. Nevertheless, the high ratios indicate that the death rate
from typhoid fever among coal miners is considerably higher than
that among all occupied males. The relative indexes are high in
every age period after age 24. Sanitation in coal mines and in coal
mining communities is often deficient and could be greatly improved.
Respiratory diseases.—Very high ratios are found for all the
respiratory diseases among coal miners and point definitely to the
health hazards of this occupation. Earlier studies by Frederick L.
Hoffman (11) and our own data for the years 1911 to 1913, as well
as the recent report of the Registrar General of England and Wales,
confirm these findings. In the present study, the respiratory dis­
eases account for 20.4 per cent of all the deaths among coal miners.
The standardized relative index for influenza is 188. A high
relative index is found in every age period, the highest being 244
at the ages 55 to 64 years. The proportionate mortality for in­
fluenza alone has increased from 1.5 per cent for all ages 15 years
and over in 1911-1913 to 3.9 per cent in 1922-1924. These figures
undoubtedly represent an increase in the actual death rate from this
cause. It is worthy of mention here that in a study of influenzapneumonia mortality during the epidemic in the last quarter of 1918,
the death rate from this cause among bituminous coal miners insured
under our group policies was found to be more than twice that of all
insured white male industrial policyholders ages 15 years and older.
Pneumonia is the third highest cause of death among coal miners,
being exceeded only by accidents and heart disease. The stand­
ardized relative index is 150. Other diseases of the respiratory
system also show high ratios, the standardized relative index being
238. This very high index is due to the large number of deaths
from miners’ asthma, which disease was given either as the primary
cause or as a contributory cause of death in virtually all of the
111 deaths from occupational diseases occurring among these miners.
Taking into consideration the very high total death rate in this
occupation, it is quite evident from the ratios given above that the
death rates for respiratory diseases among coal miners are excessive.
Tuberculosis of the respiratory system.—That coal miners have
a very low death rate from tuberculosis has been confirmed by al­
most every mortality investigation. In this study, coal miners had
relatively fewer deaths from tuberculosis than any of the 72 occu­
pations analyzed. The standardized relative index is 48. The ra­
tios are low in every age period up to age 64. While the heavy
mortality from accidents makes the proportion of deaths from other
causes low, it should not be inferred that this is the whole explana­
tion for the low ratio for tuberculosis. I f we relate the deaths
from tuberculosis to deaths from all causes, excluding accidents for
both all occupied males and coal miners, the ratios remain lower for
miners in every age period. The precise factors causing the re­
markably low incidence of tuberculosis among coal miners are still
obscure. Collis (12) notes that coal mining does not bring workers
together as closely as do manufacturing industries and suggests that
this condition may be a contributory influence to the low mortality
from tuberculosis in the industry.



34

CAUSES OF DEATH, BY OCCUPATION

Coal miners have not shared proportionately in the general de­
cline of the tuberculosis death rate. In fact, the percentage of deaths
has actually increased from 5.8 per cent for ages 15 years and over in
1911-1913 to 7.1 per cent in 1922-1924. We may therefore assume that
there has been no appreciable decline in the tuberculosis mortality
rate. It must be kept in mind, however, that coal miners have had in
the past very low death rates from tuberculosis and it is not to be ex­
pected that this rate would decline as fast as in the case of all occupied
males, where there was considerably more room for improvement.
Cancer (all forms).—The standardized relative index for cancer is
66. The ratios are similarly very low at every age. Because of the
very high death rate from all causes combined, these low ratios for
cancer can not be interpreted as representing lower than average
death rates. In England and Wales, the death rate from cancer
among coal miners is 13 per cent less than that of all occupied and
retired males.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized rela­
tive index is 65; and the ratios are low in every age period. The
actual death rate, however, is probably not very different from that
of all occupied males because of the high total death rate. In Eng­
land and Wales the death rate from cerebral hemorrhage among
coal miners is 9 per cent greater than the average. The proportion­
ate mortality has decreased from 6 per cent for all ages in 19111913 to 5.1 per cent in 1922-1924.
Other diseases of the heart.—The standardized relative index for
other diseases of the heart is 92. This index probably represents a
death rate which is considerably higher than the average. The
greater incidence is possibly a result of strenuous labor. It may
also be associated with the high frequency of miners’ asthma as well
as the acute respiratory diseases. There has been a large increase
in the proportionate mortality from this cause. The proportion
rose from 9.6 per cent in 1911-1913 to 13.7 per cent in 1922-1924.
Nephritis (acute and chronic).-—The standardized relative index
for nephritis is 68. The ratios are low in every period, but on
the whole are not low enough to suggest a low death rate from this
cause. In England and Wales the death rate from chronic nephritis
among coal miners is 24 per cent less than among all occupied and
retired males.
Accidental or undefined violence.—Accidental violence accounts
for more deaths among coal miners than any other cause. Twentytwo per cent of all deaths are due to accidents. The standardized
relative index is 228. The ratios are much higher than the average
in every age period. The highest relative index is 275 in the age
period 25 to 34 years. Out of a total of 432 fatal accidents, 306
are due to coal mine accidents. Coal mine accidents alone ac­
counted for 15.6 per cent of the deaths from all causes. The total
number of occupational accidents is 310. The proportionate mor­
tality from all accidental causes shows a slight increase over that
in 1911-1913, the percentage rising from 20.4 per cent to 22 per cent.
Other causes.—The standardized relative- indexes for syphilis
and diabetes are 53 and 51, respectively, suggesting a low death
rate for these diseases. The ratios for suicide, homicide, and cir­
rhosis of the liver, although for the most part below average, are



35

MORTALITY ACCORDING TO OCCUPATION

suggestive of high death rates.
is quite small.

The number of deaths in each case

Compositors, Printers, and Pressmen9
A n u m b e r of studies has shown that the death rate for the print­
ing trades as a whole differs but little from the average. A high
rate for tuberculosis, however, is found in all mortality studies of
this occupation. In England and Wales (5) hand compositors had
an average death rate and machine compositors a death rate 13 per
cent below that for all occupied and retired males. The death rates
from tuberculosis in these occupations were, respectively, 29 and
32 per cent above the average. Printing machine minders and
assistants had an average death rate with a mortality from tuber­
culosis 25 per cent greater than among all occupied and retired males.
The medico-actuarial investigation (4) reported in 1913 that the ratio
of actual to expected deaths among journeymen compositors was
102 per cent and that among journeymen pressmen the ratio was
117 per cent. In both classes, deaths from tuberculosis were about
50 per cent above the normal, the excess being greater at the
younger ages of entry than at the older ages. The standardized
relative index for tuberculosis in the present study was 131.
Nephritis also showed a high standardized relative index (116).
On the other hand, the standardized relative index for accidents
(67) was one of the lowest recorded.
T able 1 6 .—

Number and per cent of deaths from specified causes among white
male com positors, printers, and pressm en, by age periods, 1922 to 192 J
f

Cause of death

Stand­
Ages 15 years
Per cent of deaths during age period—
ard­
and over
ized
rela­
N u m ­ Per 15 to 25 to 35 to 45 to 55 to 65 and
tive
24
ber
34
44
54
64
cent
over index °

N umber of deaths. . . _________ ______________

937

Typhoid fever_________ ______ _____
________
Influenza, pneumonia ______________________
Influenza__________________________________
Pneumonia (all forms) ___
Other diseases of the respiratory system
Tuberculosis of the respiratory system. _
Syphilis, tabes dorsalis, and general paralysis
of insane________ _________ ______ ________ __
Cancer (all forms)..... ........................ ..........
Rheumatism (acute and chronic)____________
Diabetes.
___ _____ ______ _______ _________
Alcoholism________ _______ ______ _____________
Cirrhosis of the liver___ ______ _______ _____ _
Chronic occupational poisonings____ ________
Lead poisoning __________ ______ _________
Cerebral hemorrhage, apoplexy, paralysis. _
Other diseases of the heart____________________
Arteriosclerosis____________
_____. . . _______
Nephritis (acute and chronic)
_____________
Suicide (all forms). . . . . .
___________________
Accidental or undefined violence_____________
Occupational accidents___________________
Traumatism bv machines ...........................
Homicide (all forms) _ ______________ _______
All other causes________ _____ _________________
Total_________ _____________________ _____

3
85
15
70
12
201

Occupational deaths__________________________
Nonoccupational deaths______________________

6
931

141
0.3
9.1
1.6
7.5
1.3
21.5

166

144

203

178

105

0.7
5.0
1.4
3.5
3.5
34.0

1.2
9.0
.6
8.4
1.2
39.8

16.0
4.2
11.8
.7
21.5

7.4
1.5
5.9
1.5
17.2

7.9
.6
7.3

10.5
1.9
8.6
1.0
4.8

9.0

28
3.0
2.4
6.9
2.8
3.5
7.2
.7
67
2.4
3.5
10.8 12.9 11.4
.4
.7
4
.6
1.4
1.3
12
1.2
1.4
2.8
1.0
1.0
6
.6
.6
1.4
.6
1.0
.9
8
1.5
2.2
1.0
1
1
,5
1
.1
.5
.7
54
5.8
2.4
2.8
5.4 10. 1 15.2
9.9
122 13.0
8.4
7.6 12.8 22.5
16.2
11
.7
1.7
1.2
.6
3.8
1.0
87
9.3
4.3
4.2
4.9
13.8 12.4 16.2
24
1.4
2.6
1.8
2.1
3.4
2.2
4.8
79
8.4 22.0
4.5
3.4
6.6
9.7
7.6
5
.5
2.1
,5
1.0
3.5
6
.6
.5
1
.1
.7
132 14.1 16.3 17.5 22.9 12.3
8.4
6.7
937 100.0 100.0 100.0 100.0 100.0 100.0 100.0
.6
99.4

2.1
97.9 100.0 100.0

1.0
99.0 100.0

77
92
79
131
132
101
105

98
104
116
67

1.0
99.0

a See page 18 for explanation o f standardized relative index.
9 Includes foremen and w ork m en : Hand compositors and typesetters, type printers,
typographers, plate printers, job printers, pressmen, press feeders, linotype and monotype
operators. The average age at death is 44.2 years.
(See note, p. 19.)




36

CAUSES OF DEATH, BY OCCUPATION

Respiratory diseases.—The standardized relative indexes for in­
fluenza, pneumonia, and other diseases of the respiratory system are
uniformly low, being, respectively, 77, 92, and 79. Low relative
indexes were found for pneumonia at every age in our earlier study.
In the English investigation, printers show average or lower than
average death rates for the respiratory diseases.
Tuberculosis of the respiratory system.—The uniformly high ratios
for tuberculosis are in marked contrast to the low ratios for nontuberculous respiratory diseases. The standardized relative index
is 131, the relative indexes in the several age periods varying between
103 in the age period 35 to 44 and 145 in the age period 55 to 64. An
even higher index (185) is recorded in the indefinite period 65 and
over. Similarly in our earlier study high indexes were found in every
age period up to 64 years. In fact, a high mortality from tuberculosis
among printers has been found in virtually every occupational
mortality investigation, American and foreign. The causes of this
unfavorable situation are not definitely known. Several observers
have associated the prevalence of tuberculosis among printers with
lead poisoning and lead absorption. It is difficult, however, to recon­
cile the theory that, lead absorption predisposes to the contraction of
tuberculosis with the fact that painters, among whom lead poison­
ing is undoubtedly a far greater hazard than among printers,
have a much lower percentage of deaths from tuberculosis. In fact,
the tuberculosis mortality for painters, as recorded in our analysis
as well as in the report of the Registrar General of England and
Wales, does not differ appreciably from the average. Chronic lead
poisoning may, like any other chronic debilitating disease, weaken
resistance to infection; but the evidence presented does not show this
consistently among workers exposed to lead.
More recent investigators, among them S. Kjaer (13) seem to
ascribe greater importance to the general insanitary conditions of
some printing plants in which workers are exposed to dust, carbon
monoxide, and poor ventilation. Disregard of personal cleanliness
and irregular habits among the workmen are also considered con­
tributory factors. Much improvement has taken place in the mor­
tality from tuberculosis among printers since our earlier study. The
percentage of deaths at all ages 15 years and over has declined from
34.1 in 1911-1913 to 21.5 in 1922-1924. Correspondingly lower per­
centages are recorded at every age period up to 65 and over.
Cancer (all forms).—The standardized relative index for cancer
is 101. No extraordinary features regarding cancer incidence are
found among printers.
Lead poisoning.—Fatal lead poisoning is apparently of rare oc­
currence among printers, compositors and pressmen. Only one death
is recorded from this disease out of a total of 937 deaths in the
present investigation, while in the earlier study 4 such deaths were
recorded out of a total of 1,056. Undoubtedly this does not repre­
sent the true situation, as some cases of lead poisoning were probably
not recognized by the attending physicians and were recorded in this
analysis under some other title. Nevertheless, the actual number
of deaths is probably small. It should not be inferred from these
figures, however, that lead poisoning is an unimportant hazard in
the printing trades and that it has little influence on the mortality



MORTALITY ACCORDING TO OCCUPATION

37

of men engaged in them. There is much trustworthy evidence that
many of these men have absorbed lead to a harmful degree. Dr.
Louis I. Harris (13), for example, reports that out of a total of 900
members of the New York Typographical Union No. 6, who were
examined, about one-fifth were in some degree affected by lead poi­
soning. The indirect effects of lead absorption are reflected in the
high indexes for nephritis and arteriosclerosis found in the present
study.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized rela­
tive index is 98. The proportionate mortality is high at the young
ages when this cause of death is relatively unimportant. At the old
ages, however, the percentages are below the average.
Other diseases of the heart.—The standardized relative index is
104. Heart disease causes more than the average proportion of deaths,
except in the ages 35 to 54 years, when the relative indexes are low.
The highest relative index is 130, in the age period 15 to 24 years;
a high index (120) is also found in the period 25 to 34. In our earlier
study, printers showed high relative indexes at every age period.
Arteriosclerosis.—Although the number of deaths from this cause
is very small, the relative indexes are very high in every age period
except the first, where no deaths are recorded. Here again the
insidious action of lead is suggested as a contributory factor.
Nephritis (acute amd chronic).—The standardized relative index is
high (116) and suggests the influence of the lead hazard. The rela­
tive indexes are high after age 45, when the bulk of the deaths from
this disease occurs.
Accidental or undefined violence.—The ratios from accidental
causes are very low at every age period up to 64, the standardized rela­
tive index being 67. The occupational factor is practically negligible,
although the number of machinery accidents in the age period 15
to 24 is high.
Electricians1
0
T h e t i t l e “ electrician” includes all types of electrical workers
except electrical linemen. The outstanding occupational hazard of
electricians, accidental electric shock, is responsible for 7 per cent
of all deaths. Accidents of all kinds cause 20 per cent of the total
number of deaths. There are more deaths from accidents than
from any other cause. No death rates are available for American
electricians, but the high percentage of deaths from accidents indi­
cates that the total death rate is above the average. In England and
Wales (5), electrical engineers, fitters, and wiremen, have an aver­
age total death rate.
The number of accidental deaths is so large among American elec­
tricians that other causes of death become relatively less important
than if accidents had occurred with only average frequency. Never­
theless, syphilis, diabetes, and cancer maintain higher than aver­
age ratios. English electrical engineers, etc., have higher than
average death rates from tuberculosis, syphilis, diseases of the diges­
tive system, suicide, and accidents.
1
0 Includes electricians: Power house, chandelier, wiring, cold-storage warehouse, ele­
vator, subway and surface car, and building; dynamo and motor tenders. The average
age at death is 37.4 years. (See note, p. 19.)




38

CAUSES OF DEATH, BY OCCUPATION

T able 1 7 .—

Number and per cent of deaths from specified causes among white
male electricians, by age periods, 1922 to 1924

Ages 15 years
Per cent of deaths during age period—
and over

Stand
ardized
rela­
55 to 65 and tive
64
over index1

Cause of death
Num ­
ber

Per
cent

15 to 125 to
24
34

35 to
44

45 to
54
i

Nnmhfir of dflaths

855

236

198

146

Typhoid fever__ ________________ ______________
Tnflnanza, pnp.nmonia
Influenza
._
___ ___________
_
_ ________
Pneumonia (all forms)__
Other diseases of the respiratory system . . . .
Tuberculosis of the respiratory system_______
Syphilis, tabes dorsalis, and general paralysis
of insane__________________ _______ _______ . . .
Cancer (all forms)____________________________
Rheumatism (acute and chronic)____________
Diabetes__________ ______ _____________________
_____________
Alcoholism_______________
Cirrhosis of the liver_________ _______________
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart....................................
Arteriosclerosis______________ _____ ___________
Nephritis (acute and chronic).- ____________
Suicide (all forms)____________________________
Accidental or undefined violence. _____ . . .
Occupational accidents________________
Traumatism by fall___ _______________
Traumatism by machines _____________
Electric shock____________ ________ _______
Homicide (all f o r m s ) ____ ________ ______
All other c a u s e s _____________ __________

3.6 ;
6
0. 7
8.3 ! 9.7
78 1 9.1
22
2. 6 i 4. 7 ; 2.1
3. 6
6.5
7.6
56
1.1
.8
9
1.2
153 17.9 18.9 26.7

11.1
4. 0
7. 1
1.0
20.2

8.2
.7
7.5
.7
8.9

9.7
9.7
1.4
5.6

2.9
2.9

91
94
72
86

7.1
5.6

7.5
8.9

4.2
16.7

2.9
5.9

181
116

1.5
2.0
.5
1.0
11.6

1.4

2.8

5.9

140

Total__________ _____ _________ __________
Occupational deaths________________________ __
Nonoccupational deaths..................................

169

1.2
35
4.1
5.3
1.2
45
1
.1
1.8
17
2.0
5
.6
4
.5
26
3.0
5.3
9.6
82
.5
4
51
6.0
1.2
23 , 2.7
1.2
176 ' 20.6 38. 5
90 10. 5 20. 1
2. 2
2. 4
19
. 6 I 1.2
5
60
7.0 14.2
9
1. 1 I . 6
131 15. 3 S 17.2

1.7
2.1
.4
2.1
.4
.4
5.5
7.6
4. 7
22.0
11. 4
,8
8.9
13’ i

4.0
3. 5
15. 7
8. 1
3.0
1.0
4. 0
.5
14. 6

72

34

.7
1.4
6.8
8.3 23.5
13.7 16. 7 i 14.7
.7
1.4
5.9
8.9
6.9
14.7
1.4
1.4
13. 7
8.3 " 5. 9"
7.5
1. 4
2. 9
2.7
1.4
5.9
.7
4.1
1.4
.7
17.8 | 15.3
14.7

79
90
79
143

855 loo.o iion. 0 100. 0 1
100.0 100. 0 100.0 100.0
91
764

10.6
89. 4

20. 1
79.9

11. 4
88. 6

8. 1
91.9

8. 2
91.8

1.4
98.6

2.9
97.1

1 See page 18 for explanation of standardized relative index.

Respiratory diseases.—The standardized relative indexes for influ­
enza, pneumonia, and other diseases of the respiratory system are
91, 94, and 72, respectively. In view of the probably high total death
rate, the ratio for pneumonia indicates an average and possibly an
above-average death rate for this disease. A similar group of work­
ers in England and Wales shows average or less than average death
rates for the respiratory diseases.
Tuberculosis of the respiratory system.—The standardized rela­
tive index for tuberculosis is 86. The ratios are low in every age
period up to 64. The death rate from tuberculosis, however, is prob­
ably not so low as the ratios suggest, as the total death rate in this
occupation is somewhat high. English electricians have a death rate
from tuberculosis 10 per cent above the average.
Syphilis, tabes dorsalis, and general paralysis of insane.—Elec­
tricians have the highest relative index for syphilis found in any
of the 33 occupations analyzed in detail. The standardized rela­
tive index is 181. The death rate from syphilis among English
electrical engineers, fitters, and wiremen is 57 per cent higher than
among all occupied and retired males.
Cancer (all foi^ms).—The standardized relative index is 116. In
England, the cancer death rate among these men is about average.
Diabetes.—Although the number of deaths from diabetes is small,
the ratios are uniformly higher than those among all occupied males.



M O R T A LITY ACCORDING TO OCCUPATION

39

The standardized relative index is 140. Occupation is no apparent
factor in these high ratios.
Cerebral hemorrhage, apoplexy, paralysis.—Too few deaths are
recorded for this cause to give conclusive figures. The standardized
relative index is 79. The death rate from cerebral hemorrhage is
probably not much less than average. In England and Wales the
death rate from these causes is about average.
Other diseases of the heart.—The standardized relative index for
other diseases of the heart is 90. The death rate from heart disease
among English electrical engineers, fitters, and wiremen is about
average.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 79. English electricians have a death rate from
chronic nephritis 22 per cent less than that of all occupied and retired
males.
Accidental or undefined violence.—Accidents cause a large num­
ber of deaths among electricians, being responsible for more than
one-fifth of all the deaths. The standardized relative index is 148.
Occupational accidents were the cause of a little more than one-half
the accidental deaths. Electric shock caused 7 per cent of the deaths
from all causes and more than one-third of the deaths from accidents.
Farmers and Farm Laborers1
1
A g r i c u l t u r a l workers are noted for their long life.
Life tables
for 1910, published by the United States Census Bureau ( H) , for
example, show that white males 20 years of age living in cities might
have expected on the average 40.5 additional years of life; while
white males of the same age in the rural areas could Tiave expected
a remaining life span of 45.9 years. In England and Wales (5)
farmers and their relatives had a mortality rate 33 per cent lower
than that of all occupied and retired males. The rates for four other
agricultural groups were similarly 29 to 47 per cent below the
average. These figures indicate the generally healthful conditions
of life prevailing among farmers and farm laborers. We may as­
sume therefore that the death rate for our group of farmers and
farm laborers is well below the average for male industrial policy­
holders. The present investigation reveals, nevertheless, somewhat
higher than average percentages of deaths for tuberculosis, cancer,
cerebral hemorrhage, apoplexy and paralysis, accidents, suicide, influ­
enza, and typhoid fever. Only influenza and typhoid fever, how­
ever, show indexes large enough to suggest death rates actually
higher than average. The standardized relative index for influenza
is 121, high ratios being recorded for every age period except 15
to 24. Typhoid fever shows extremely high indexes at every age,
varying between 180 in the period 25 to 44 and 333 in the period
45 to 54. Both causes in our earlier study also showed very high
ratios.
11
Includes
keepers), fru it
laborers, dairy
(See note, page

farm ers and plan ters, florists and flower grow ers (n ot includ in g store­
grow ers, gardeners, nurserym en, turpentine farm ers, orch ardists, fa rm
farm ers, and truck farm ers.
T h e average age eit death is 5 6 .3 years.
19.)




40

CAUSES OF DEATH, BY OCCUPATION

T able

1 8 . — Number and per cent of deaths from specified causes among white
male farmers and farm laborers, by age periods, 1922 to 1924

Cause of death

Number of deaths____________________________
Typhoid fever_________________________________
Tnflnp.nza,, pnftiimonia
Influenza. _ _
_ _
. ..........................
Pneumonia (all forms)______________ _____
Other diseases of the respiratory system_____
Tuberculosis of the respiratory sy ste m ... . . .
Syphilis, tabes dorsalis, and general paralysis
of insane.______ ____________________ ________
Cancer (all forms)_______________ ___________
Rheumatism (acute and chronic)____________
Diabetes_____ _______ _____ _______ ____________
Alcoholism________ __________________ _____ ____
Cirrhosis of the liver ..................
_
__
Chronic occupational poisonings_____________
Lead poisoning............... ................................
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart____________ ______ _
Arteriosclerosis________________ _______ _______
___
Nephritis (acute and chronic)______ __
Suicide (all forms)____________________________
Accidental or undefined violence______ ___
Occupational accidents___________________
Traumatism by machines________________
Injuries by animals (not poisoning)_____
Homicide (all forms)____________________ _____
A ll other causes............... ............. ...........................
Total__________ ____________________ _____

Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
44
54
64
ber
cent
over index1

370

273

335

47
442
112
330
56
468

1.0
9.4
2.4
7.0
1.2
10.0

7.6
9.2
1.6
7. 6
,5
24.1

1.8
7.0
3.3
3.7
1.1
34.8

0.9
11.0
3.6
7.5
1.5
21.5

1.0
8.7
2.0
6.7
.7
14.3

0.3
10.3
2.1
8.2
1.1
5.7

57
437
12
51
31
55
1
1
495
823
88
405
65
376
97
13
9
19
753

1.2
9.3
.3
1.1
.7
1.2

.3
.5
1.1
.5
.3
.3

.7
2.6
1.1
.7

4.8
5.1
.3
1.2
1.5

3.0
10.1
.2
1.0
2.0
1.5

1.1
12.6
.2
1.4
.5
1.5

10.6
17.6
1.9
8.7
1.4
8.0
2.1
.3
.2
.4
16.1

.3
5.9

.7
8.8

1.5
3.9

1.4
1.9
23. 5
6.2
1.1
1.1
1.6
21.1

2.6
3.7
15.0
2.6
1.1

5.1
2.7
15.5
5.4
.3

12.6
20.2
1.4
8.8
1.1
5.6
1.4

.7
18.7

1.5
22.1

5.7
13.3
.3
8.0
2.7
9.5
2.5
.5
.3
.3
17.8

4,681

601 1,305 1,797

.1
.2
15.3

0.1
9. 2
2.5
6.7
1.6
2.8

121
87
69
107

.3
78
10.3
101
.2
1.0
77
.2
1.4
.1
.1
16.1
103
23.4
91
3.8
11.9 ......... 77
.4
3.7
102
.9
.1
.1
.1
13.5

4,681 100.0 100.0 100.0 100.0 100.0 100.0 100.0

Occupational deaths
.
_ __
106
Nonoccupational deaths_________ _______ _____ 4, 575

2. 3
97.7

6. 5
93.5

2. 6
97.4

6. 0
94.0

2. 7
97.3

1. 5
98.5

1.1
98.9

i*See page 18 for explanation of standardized relative index.

Typhoid fever.—The relative indexes for typhoid fever are high
at all ages and in some age periods the percentages reach three times
the average. Undoubtedly this situation develops from the faulty
sanitation still found in farming regions. One encouraging finding,
however, is that farmers show a much lower proportionate mortality
at each age period in the years 1922-1924 than in 1911-1913. For
all ages (15 years and over) the proportions were 1.4 per cent in
the earlier, as compared with 1 per cent in the later period.
Respiratory diseases.—The standardized relative index for influ­
enza is 121. It is interesting to note that whereas influenza exhibits
high relative indexes at every age period except 15 to 24, pneumonia
and other respiratory diseases are comparatively low, the standard­
ized relative indexes being 87 and 69, respectively. In the earlier
study farmers also showed high relative indexes for influenza at
the same ages.
Tuberculosis of the respiratory system.—Previous studies of farm­
ers’ mortality have shown especially low death rates from tubercu­
losis. In England and Wales in 1921-1923 the death rate from all
causes among farmers and their relatives was 33 per cent less than
that found among all occupied and retired males, whereas the rate
for respiratory tuberculosis was 59 per cent below the average. Sim­
ilarly, in our earlier study, lower than average percentages were



MORTALITY ACCORDING TO OCCUPATION

41

found at every age period, the relative indexes seldom being higher
than 75. It is indeed surprising therefore to note that in the pres­
ent study the standardized relative index for tuberculosis among
farmers is 107 and that higher than average percentages are recorded
in each period except 55 to 64, when the index is 92. At the other
ages the indexes vary from 103 to 118. While this is a reversal of
previous conditions, it must not be inferred hastily from these higher
indexes that the death rate from this cause is now higher among
farmers than among our industrial males. I f the very low total
death rate for farmers be taken into account, a standardized relative
index of 107 certainly does not indicate a higher‘than average death
rate but rather suggests a rate somewhat below average. The rela­
tively greater importance of tuberculosis among farmers in the
period 1922-1924 than in the period 1911-1913 in all probability
results from the fact that the tuberculosis death rate has not declined
nearly so rapidly among farmers as it has among all occupied males.
The proportion of deaths from tuberculosis for all ages 15 years and
over was 34.6 per cent lower among all occupied males in 1922-1924
than in 1911-1913, whereas the proportion of deaths from tubercu­
losis among farmers was 3.1 per cent higher.
The findings of Allen K. Krause (15) regarding the trend of death
rates from tuberculosis in urban and rural areas of New York State
(exclusive of New York City) between 1913 and 1925 tend to confirm
the results of our study. In summing up his conclusions Krause
says: “ This trend, it is plain, is a mounting ratio of rural to urban
tuberculosis, which has been going on for at least 13 years, to reach
a point at present which puts rural well ahead of urban mortality.
During the last five years the trend has been greatly accentuated, as
it expresses, no doubt, a static or slightly rising rural rate set against
an accelerated urban decline.” Apparently the antituberculosis cam­
paign, including as it has an intensive study of the effects of indus­
trial environment on the incidence of tuberculosis, has brought about
a marked improvement in the mortality of urban wage earners, which
bids fair in time to reduce urban mortality below that of farmers,
who have heretofore enjoyed a more favorable position as regards
tuberculosis.
Cancer (all forms).—The standardized relative index for cancer
is 101. Because of the high average age of farmers their cancer mor­
tality is of special interest. Almost 80 per cent of the deaths from
all causes in this group occurred after age 44 when cancer begins to
assume its leading position. In the ages after 44 the percentages of
death do not differ much from the average. Higher than average
percentages are recorded at ages 25 to 34 and 35 to 44, the relative
indexes being 130 and 119, respectively. In England and Wales
agricultural pursuits exhibit low death rates for cancer.
The percentage of deaths from cancer at all ages 15 years and
over increased from 7.6 in the period 1911-1913 to 9.3 in the period
1922-1924, indicating an increased mortality from this cause in keep­
ing with the general increase in cancer between the two periods.
Cerebral hemorrhage, apoplexy, paralysis.—These diseases are sig­
nificant only at the older ages. The relative indexes up to age 44
are extremely low. In the age period 45 to 54 the percentage of



42

CAUSES OF DEATH, BY OCCUPATION

deaths is about average, but after 54 the relative indexes are some­
what high. The standardized relative index is 103.
Other diseases of the heart.—Except for the age period 25 to 34,
where the relative index is 126, this cause of death exhibits relative
indexes which are about average or lower than the average. The
standardized relative index is 91. The ratios when compared with
those of 1911-1913 seem to show that farmers have shared in the
general decline of the death rate from heart disease.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 77. The relative indexes are low at every age. Ex­
cluding ages 65 and over, the highest index (83) is in the age period
45 to 54. The figures indicate a low death rate from this disease.
The proportionate mortality for this disease was also low in 19111913\ .
Suicide ( all forms).—-The relative indexes for suicide are high in
the age periods 15 to 24 (119), 25 to 34 (132), and 45 to 54 (129).
The ratios were even higher for most ages in 1911-1913. The
English figures for 1921 to 1923 showed a death rate for farmers
24 per cent above the average.
Accidental or undefined violence.—The standardized relative in­
dex is 102. Low ratios prevail, except between the ages of 35 and
54. In the age period 35 to 44 the relative index is highest, 127.
The proportionate mortality for all ages 15 years and over was 8.1
per cent in 1911-1913 and 8 in 1922-1924, which indicates no marked
change in the death rate from this cause.
Other causes.—Average or lower than average percentages indic­
ative of a favorable mortality are found at the several age periods,
with rare exceptions, fo r syphilis, rheumatism, diabetes, alcoholism,
arteriosclerosis, and homicide.
Fishermen, Oystermen, Sailors, and Marine W orkers 1
2
T he o n l y reliable death rates for American workers in water
transportation and fishing pursuits are given for a few selected
occupations in the medico-actuarial investigation of 1913 (,£) • In
that report, the ratio of actual to expected deaths for officers in
coastwise trade (not traveling to the Tropics) was 138 per cent; for
officers on ocean steamers, 156 per cent; on the Great Lakes, 118
per cent; on rivers, lakes, sounds, and harbors (excluding the Great
Lakes), 107 per cent; for inshore fishermen, 73 per cent. Deep-sea
fishermen were insured in small numbers and their mortality was
about twice the normal.
In England, in the past, the Registrar General (3) as well as the
Board of Trade have compiled statistics on the mortality of mer­
chant seamen based on the census data and official registration of
deaths. This method, however, has been proved faulty because of
the lack of correspondence in the two sets of data. In the mortal­
ity investigation of 1921-1923 the Registrar General, therefore, omit­
ted the customary figures for merchant seamen from the statistical
12
Includ es clam , crab, lobster, seal, shell, w hale, shrim p, oyster, and “ other ” fisher­
men ; can al, river, and sm all lake boat captain, deckhand, firem an, stoker, engineer, pilot,
ferrym an , sm all boatm an, bargem an, purser, m ate, stew ard, porter, w aiter, and c o o k ;
d e e p -se a : stoker, firem an, engineer, and n a vig atin g officer.
T h e average age at death is
4 7 .9 years.
(See note, p. 1 9 .)




43

M O R T A LITY ACCORDING TO OCCUPATION

tables and appended to the report an estimate of the death rate of
merchant seamen in which the errors of the earlier figures were vir­
tually eliminated. It was finally estimated that the death rate for
English seamen between the ages 20 and 65 years, was 77 per cent
greater than that for all occupied and retired males. It seems clear,
therefore, from the data cited that seamen have a very high death rate.
The death rate for our fishermen, oystermen, sailors, and marine
workers while undoubtedly Higher than that for all occupied males is
probably not so high as that of British merchant seamen, since the
insured group includes a large number of men in less hazardous
occupations in inland water transportation.
The mortality data for specific diseases are difficult to interpret
because of the frequently inaccurate certification of causes of death.
It is not uncommon for the causes of death of men dying at sea to
be certified by nonmedical men. For this reason the Registrar
General of England and Wales has deemed it advisable to estimate
death rates only for tuberculosis, cancer, and accidents, the three
causes for which he believes registration of deaths is most accurate
and complete. It is safe to assume that the errors of certification
are not so great in our insured group because of the large number
of men in inland waterways and in coastwise transportation in­
cluded in it. A more detailed analysis is therefore given of the in­
surance data than the Registrar General has deemed justifiable.
T a b l e 1 9 .— Number and per cent of deaths from specified causes among white

male fishermen, oystermen, sailors, and marine workers, ~b age periods,
y
1922 to 192k

Cause of death

Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
ber
34
44
cent
24
54
64
over index1

111

Number of deaths___________________________

10
70
11
59
8
105
21
59
3
16
4
6
53
119
6
84
15
174
124
107
17
9
7
122

Total___________ _______ ________________
Occupational deaths__________________________
Nonoccupational deaths_____________________

182

5.0
28.6

10.7
2.4
8.3
.6
10.1

0.5
6.0
1.1
4.9
1.6
6.0

2.5
1.7

3.2
3.2

5.9
10.7

1.7
.8

.8
.8

1.8
.6

1.8

7.6

.8
4.8

1.8
.9
46.8
36.0
35.1
4.5
2.7
1.8
14.4

2.5
4.2
30.3
19.3
13.4
5.9
1.7
2.5
10.9

6.5
2.4
25.8
22.6
16.9
.8
2.4
.8
17.7

3.0
14.8
.6
8.9
1.8
19.5
12.4
14.2
1.2
.6
10.7

.5
10.4
.5
3.3
.5
12.1
18.1
1.6
17.0
.5
6.6
3.8
2.7
.5
.5
14.3

177
6.8
1.1
5.6
1.1
1.1
8.5
1.1
2.3
.6
2.8
14.1
24.9
1.1
14.1
1.1
5 1
k
2.8
1.1
.6
15.3

882 100.0 100.0 100.0 100.0 100.0 100.0 100.0
125
757

14. 2
85.8

36.0
64.0

i See page 18 for explanation of standardized relative index.




169

0.8
12.1
1. 6
10.5
3.2
16.9

.9
.9

2.4
6.7
.3
1.8
,5
.7
6.0
13.5
.7
9.5
1.7
19.7
14.1
12.1
1.9
1.0
.8
13.8

124

1.7
5.0

18.0

1.1
7.9
1. 2
6.7
.9
11.9

119

5.4
7.2
.9
6.3

882

Typhoid fever________________________________
Influenza, pneumonia________________________
Influenza_________________________________
Pneumonia (all forms)______________ ____ _
Other diseases of the respiratory system ____
Tuberculosis of the respiratory system______
Syphilis, tabes dorsalis, and general paralysis
of insane_____________________ ______________
Cancer (all forms)____________ _______________
Rheumatism (acute and chronic)____________
Diabetes_____________________ ______ __________
Alcoholism_______________ ___________ _____ _
Cirrhosis of the liver.________ _______ _________
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart____ ______________
Arteriosclerosis___________ ____________________
Nephritis (acute and chronic)_______________
Suicide (all forms)_________________ ■_________
_
Accidental or undefined violence____________
Occupational accidents__________________
D ro w n in g -..________________ ____________
Traumatism by fall______________________
Traumatism by machines_______________
Homicide (all forms)_________________________
All other causes----------------------------------------------

19.3
80.7

22.6
77.4

13.0
87.0

3.8
96.2

2.8
97.2

64
86
82
86
100
89
126
83
84
115
186

44

CAUSES OF DEATH , BY OCCUPATION

The outstanding cause of death and characteristic hazard of
workers at sea is accidental violence. In our study the standardized
relative index is 186. Up to age 54 the ratios average about twice
the normal. The highest relative index (227) is found in the age
period 45 to 54 years. Almost one-fifth of all the deaths at all ages
are due to accident. Drowning alone accounts for 12.1 per cent of
the deaths from all causes. In the medico-actuarial investigation
the following data were given for deaths from accidental violence.
Among deep-sea fishermen, 45 per cent of the deaths were from ac­
cident; the death rate from accident among those whose duties keep
them on rivers, lakes, sounds, and harbors was three times the
normal; among those on the Great Lakes, four times; among those
engaged in the coastwise trade and on ocean steamers, five times
the normal. In the estimate of the Registrar General of England
and Wales one-fourth of all the deaths among merchant seamen were
due to accident.
Typhoid fever shows the greatest excess over the average propor­
tion of deaths from disease. To be sure, the actual number of
deaths is small; but the exceedingly high ratios in the significant
ages leave no doubt that the death rate for this cause is much
greater than that for all occupied males. The relative index for all
ages 15 years and over is 183. The conditions imposed by watertransportation pursuits are in large measure responsible for the
inordinate incidence of typhoid fever among these workers. Sani­
tation on smaller vessels, especially freight and fishing boats, is far
from adequate. Furthermore, some of the ships travel to foreign
ports where the disease is endemic.
Diabetes has a standardized relative index of 126, indicating a
high death rate from this cause.
Nephritis is the only other disease showing higher than average
ratios. The standardized relative index is 115. The death rate
from this cause is probably considerably above the average. In view
of the very high total death rate in this occupation, however, all of
the other numerically important diseases apparently have death rates
which are above average. Syphilis appears to be substantially
more frequent than among all occupied males. The standardized
relative index is 100. The standardized relative indexes for the
other causes range around 85 per cent, being 89 for cancer, 86 for
pneumonia, 86 for tuberculosis, 84 for other diseases of the heart,
and 83 for cerebral hemorrhage. In England and Wales in 19211923 the death rate from respiratory tuberculosis among merchant
seamen was 36 per cent above the average and that from cancer 15
per cent above the average.
Furniture and Other Wood W orkers1
3
T h e g r o u p of furniture and other woodworkers consists es­
sentially of wage earners in factories producing wooden products,
who, on the whole, are not apparently exposed to any especially
severe hazards. Saw-mill workers have not been included in this
group, because of the more hazardous nature of their work. The
1
3 Includes foremen and workmen engaged in the manufacture of wooden products:
wagon and carriage builders, cabinet and furniture makers, coopers, pattern makers, and
miscellaneous woodworkers. The average age at death is 53.8 years. (See note, p. 19.)




45

M O R T A LITY ACCORDING TO OCCUPATION

death rate for men in these selected woodworking industries in all
probability is less than that for industrial policyholders as a group.
The intercompany group insurance mortality experience for the
years 1922-1926 (9) shows a ratio of actual to expected deaths of
79.3 per cent for furniture and woodworking factories, while that
for all industries combined is 90.2 per cent. In England and Wales
(5) the death rates for several groups of similar occupations are
average or below average. In our industrial mortality experience
notably higher than average percentages are recorded for cancer,
influenza, and tuberculosis, while other diseases of the heart,
nephritis, and accidents are low.
2 0 .— Number and per cent of deaths from specified causes among white
male furniture and other wood workers, by age periods, 1922 to 1924

T able

Ages 15 years
Per cent of deaths during age period— Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
54
ber
44
64
over index i
cent

Cause of death

154

Number of deaths........................ ................... —
Typhoid fever--------------- -------------------------------- Influenza, pneumonia________________________
Influenza_________________________ _______ _
Pneumonia (all forms)______________ _____
Other diseases of the respiratory system ------Tuberculosis of the respiratory system---------Syphilis, tabes dorsalis, and general paralysis
of insane—------------------------ ---------------- ---------Cancer (all forms).............. ..................... ....... .......
Rheumatism (acute and chronic)................ ..
Diabetes................................... ....................... ...........
Alcoholism________________________ _____ ______
Cirrhosis of the liv e r ..._________________ _____
Chronic occupational poisonings_____________
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart___________________
Arteriosclerosis_______________________________
Nephritis (acute and chronic)________________
Suicide (all forms)_____________ ____ _____ _____
Accidental or undefined v io len c e.-...............
Occupational accidents________ __________
Traumatism by machines________________
Homicide (all forms)___ _____ _________________
All other causes_________ _______ ____ ________ _

9
173
39
134
18
232
38
206
4
19

12
19

1

167
292
24
173
41
130
21
7

2.2
7.4
1.0

12.8

23
1,783

538

4.7
9.4
3.1
6.3

1.3
10.4
3.2
7.1

.8

.6

32.3

32.5

25." 8

13.6

3.2
1.9
1.3
1.3

5.1

4.0
11.6

2 1
.1 .6

11.4

.2

1 1
.1 .6
.7
1
.1

0.5
15.7
2.5
13.1

8
.1
.5
2.5
.5

.1

9.2
16.2
1.3
9.6
2.3
7.2

1
.2

.4
.3
13.4

5.5

1
.6

1.3
)8. 7

1.9
6.5

1.5
7.1

3.9

4.0

2 4.5
.6
9.6
2 1
.6 .0

3.1
12.6

15.6

16.0

1.3
14.9

.6

100.0

T o ta l..--------------------------------- ----------------Occupational deaths_________________________ _
Nonoccupational deaths_________ _______ _____

0.5
9.6

,5
.5
14.1

11.0

2
.0
9.0
2
.0

9.6
2.3
7.4

1
.1

3.0

1
.0

15.4
.4
1.4

1
.0
1.7
.2
1 1
.0 .6
13.0

6.3
1.5
4.8

10.9
18.4

1 1
.0 .6

.7
14.3

124
107
63
118
109

122

1.3
15.2
24.5
2.4
13.6

109

"77

8.3
1.7
7.3
1.7

12.1
2.7
5.7

.6

3.9
.4

13.3

11.3

11.7

1
.0
1
.0

1
.1

91

.2

100.0 100.0 100.0 100.0 100.0
5.5
94.5

2 1
.6 .0

97.4

99.0

1.7
38.3

.4

1 See page 18 for explanation of standardized relative index.

.

Respiratory diseases — Influenza is prevalent in this occupational
group, the standardized relative index being 124. The relative in­
dexes are high in every age period up to 64. Pneumonia, with a
standardized relative index of 107, is relatively slightly more im­
portant than among all occupied males. Other diseases of the
respiratory system cause few deaths. The standardized relative
index is 63.
Tuberculosis of the respiratory system.—The ratios fc*r tubercu­
losis are higher than among all occupied males in every age period.
The standardized relative index is 118, pointing to a high actual
68357°— 30------- 4




46

CAUSES OF D EATH , BY OCCUPATION

death rate from this cause. The dust generated in some of the
woodworking processes is perhaps a factor in the high incidence
of tuberculosis. In England and Wales, sawyers, wood turners, and
machinists had an average death rate from tuberculosis; while the
rate for cabinetmakers was 21 per cent above the average.
Cancel (aU forms).—The standardized relative index for cancer
l
is 122. The relative indexes are higher than average in every age
period in which cancer is a frequent cause of death. No occupa­
tional factors contribute, apparently, to these high ratios. It is
interesting to note, however, that in England and Wales, sawyers,
wood turners, and machinists had a death rate from cancer 10 per
cent higher than that of all occupied and retired males, and cabinet­
makers had one 22 per cent higher.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized rel­
ative index for these causes is 109.
Other diseases of the heart.—Deaths from heart disease are below
average in every age period up to 64 and give a standardized relative
index of 88.
Nephritis {acute and chranic).—The ratios for nephritis are low.
The standardized relative index is 91.
j
Smdde (all forms).—The number of deaths from suicide is inex­
plicably large. In two age periods, 15 to 24 and 55 to 64, the rela­
tive indexes are over 190. It is very high also in the period 35 to
44 (155).
Accidental or undefined violence.—These woodworking processes
are not hazardous to life from the point of view of accidents. The
standardized relative index is 77, low relative indexes being found
in every age period. Relatively fewT fatal occupational accidents
occur in this group.
Iron and Steel Mill W ork ers1
4
O ur t a b u l a t i o n s provide for two divisions of the iron and steel
industry—iron and steel mill workers and iron foundry workers.
The hazards in both branches are very similar, though differing in
severity. Although the occupational groupings of other mortality
investigations for which death rates are available are not exactly
comparable with our own, the rates for the several branches of the
industry are nevertheless instructive. They indicate a high total
mortality for these men. The mortality rate of rolling-mill work­
ers in the medico-actuarial investigation of 1913 (It) was about 17
per cent above the standard; that of forgemen and foundrymen was
18 per cent above. The death rate from accidents was about one
and one-half times the standard in these classes, and pneumonia was
also high among them. In England and Wales (5) persons engaged
in smelting, rolling, and converting iron and steel had an average
total mortality, although the rates for respiratory diseases, cancer,
and accidents were higher than the average. The death rate of iron
foundry, furnace men and laborers was 12 per cent above the
14 Includes annealers, bloomers, furnace blowers, breakers, bushelers, casters, catchers,
chargers, cupola tenders, hammermen, heaters, ladlemen, puddlers, rammermen, rollers,
roughers, smeltermen, spanners, in iron and steel mills which manufacture sheet iron,
steel beams, structural iron, iron pipe, rails, wire, and rods. The average age at death is
49.2 years. (See note, p. 19.)




47

M O R T A LITY ACCORDING TO OCCUPATION

average; while that of metal molders was 14 per cent above the
average. In both classes respiratory diseases were high. The
respiratory diseases stand out in our study also. The standardized
relative index for pneumonia among iron and steel mill workers
is 142, while among the iron foundry workers it is 220, a higher
index than is found for any other occupation. Among both classes
the ratios for influenza and for other diseases of the respira­
tory system are well above the average. Exposure to extremes of
temperature, dusts, and gases, and the fatiguing character of the
work are all highly conducive to the contraction of respiratory
affections. The complete agreement of all investigations on these
points leaves little doubt that the conditions surrounding these
occupations are the chief causative factors of the high rates.
T able

2 1 .— Number and per cent of deaths from specified causes among white
male iron and steel mill workers, by age periods, 1922 to 1924

Cause of death

Number of deaths.......................... ......... ..............
Typhoid fever_________________ _____ _____ ____
Influenza, pneumonia _____________ _______
In flu en za____ ________ ___________________
Pneumonia (all fo r m s ) ,____ ____________
Other diseases of the respiratory system_____
Tuberculosis of the respiratory system_______
Syphilis, tabes dorsalis, and general paralysis
of insane
_ - ___________
_ ______________
Cancer (all forms)
_
Rheumatism (acute and chronic) _ _..
___
Diabetes______ ________________________________
Alcoholism___
_ _________
Cirrhosis of the liver__________________________
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart_______________ ____
Arteriosder-osis__________ _________ __________
Nephritis (acute and chronic) ..
_______
Suicide (all forms)___ __ ____ _______
Accidental or undefined violence
__________
Occupational accidents ________________
Burns (conflagration excepted)
.............
Absorption of irrespirable, irritating,
or poisonous ga se s ______________
____
Traumatism by fall___ ___________________
Traumatism by machines__ _________
Homicide (all forms)__________________________
All other causes
__________________________
Total_________________ _____ ___________ _
Occupational deaths_________________ ________
Nonoccupational deaths.____ ________________

Ages 15 years
Per cent of deaths during age period— Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
34
24
44
54
64
over index i
ber
cent

142

1, 587
13
204
37
167
33
190

0.8
12.9
2.3
10.5
2.0
12. 0

48
137
4
26
11
29
106
207
19
132
29
186
68
9

3.0
8. 6
.3
1. 6
,7
1.8
6. 7
13. 0
1.2
8.3
1.8
11.7
4.3
.6

7
23
29
17
196

.4
1.4
1.8
1.1
12.4

174

267

327

397

280

4.2
10.6
2.1
8.5
.7
18.3

0.6
14.9
3.4
11.5
1.1
18.4

1.1
15.4
3.0
12,4
1.5
20.2

0.6
14.4
2.4
11.9
3.4
13.5

0.3
13.6
2.0
11.6
1.5
6.5

7.5
1.4
6.1
3.2
2.9

7

5.7
3.4

4.3
11.0

1. 5
13.9

2.5
11.1
17.9
2.0
12.1
.8
4.8
1.0
.3
.3
.8
.5
.3
9.6

.7
1.4

1.1

.7
7.7

.6
1.1
6.9

5.2
3. 7
.7
1.5
3.0
1.1
.7
8.2

3. 5
2.1
33.8
11.3
1.4

4.6
2.9
21. 3
8.6
.6

4.9
3.0
15.7
7.1
.7

1.5
.6
2.1
5.8
10. 1
.3
6. 7
2.4
9. 2
3.1
.6

1.4
2.1
7.7
3. 5
12.0

.6
1.7
5. 2
2. 3
14.9

2.2
1.9
2. 2
11.6

.6
1.8
.3
.3
13.8

1.8

1.1
10.7
.4
2.1
.4
2.9
13.6
20.7
3.6
12.9
.7
3.6
1.4
.4

123
142
122
86
127
107
107
94
86
93
119

.4
.7
.4
13.9

1, 587 100. 0 100.0 100. 0 100.0 100.0 100.0 100.0
72
1, 515

4. 5
95.5

11.3
88.7

8.6
91.4

7.5
92.5

3.4
96.6

1.5
98.5

1.4
98.6

1 See page 18 fo r explanation o f standardized relative index.

Respiratory diseases.—All the respiratory diseases, but especially
pneumonia, are much more frequent causes of death among iron and
steel mill workers than among all occupied males. The standardized
relative index for influenza is 128. The proportionate mortality
ratios for pneumonia are very high throughout all ages up to 64. The
standardized relative index is 142. The relative indexes vary from
133 to 149. The highest relative index (149) appears in the age
period 25 to 34. Other diseases of the respiratory system are also
higher than among all occupied males, the standardized relative index



48

CAUSES OF DEATH , BY OCCUPATION

being 122. These high ratios are characteristic of industries where
hot metal is worked.
Tuberculosis of the respiratory system.—The standardized rela­
tive index for tuberculosis is 86. The ratios are low up to age 44,
but increase at the older ages. The figures at the later ages are
nearly average and indicate a higher than average tuberculosis rate
in view of the high total death rate. The robust health of men
entering this industry is undoubtedly responsible for the lower rates
at the young ages, the cumulative effects of the hazards to which
they are exposed being revealed by the higher relative indexes at
the older ages. Dust is probably a factor in some of the occupations
in the industry and is responsible for some of the mortality.
Cancer (all forms).—The standardized relative index for cancer
is 107. The relative indexes are somewhat above normal at the ages
45 to 64. In England and Wales the cancer death rate among steel
workers is 16 per cent above the average.
Diabetes.—The standardized relative index is high (107). English
iron and steel workers had a death rate only 67 per cent of the
average.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized rela­
tive index is 94. In the significant ages 45 to 64 the ratios are
average.
Other diseases of the heart.—The ratios for this cause are some­
what below the average in most age periods, the standardized rela­
tive index being 86. The death rate from heart disease is probably
not very different from that found among all occupied males. In
England and Wales persons engaged in smelting, rolling, and con­
verting of iron and steel show death rates for heart diseases well
below the average.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 93. The death rate is probably about average.
Suicide (all forms).—The proportionate mortality ratios for sui­
cide are higher than among all occupied males up to age 54. The
highest relative index (131) is found in the age period 15 to 24.
The high suicide ratios are coincident with high ratios for syphilis.
These two causes of death are apparently often correlated.
Accidental or undefined violence.—Accidents are relatively more
frequent among iron and steel mill workers than among all occupied
males. The standardized relative index is 119. The highest rela­
tive index is 136 in the age period 15 to 24. The relative indexes
decrease at the older ages. Accidental traumatism by machines
accounted for 1.8 per cent of all deaths as compared with 0.5 per
cent among all occupied males. Although there are only nine
deaths from burns, excluding those due to conflagration, the relative
index is high. Occupational accidents accounted for more than onethird of all accidental deaths.
Iron Foundry Workers1
5
T h e h a z a r d s of iron foundry workers resemble those of iron and
steel mill workers. Fatal accidents, however, are not so frequent, but
1
5 Includes foremen and workmen in iron foundries: Molders, core makers, bushelers,
chippers, cupola tenders, pourers, scratehers, stove and range assemblers, and repairers.
The average age at death is 50.1 years. (See note, p. 19.)




49

M O R T A LITY ACCORDING TO OCCUPATION

respiratory diseases are apparently much more common. Iron foun­
dry workers in the present investigation show the highest proportion
of deaths from pneumonia of all occupations in the study. There
are actually more deaths from this cause than from any other cause,
a condition found in no other occupation. In England and Wales
(5) the death rate among iron foundry, furnace men and laborers was
12 per cent higher than among all occupied and retired males, while
among metal molders the death rate was 14 per cent higher. The
death rates from respiratory diseases were high among both classes.
T a b l e 2 2 .— N u m b e r a n d p e r c e n t o f d e a th s fr o m

sp e c ified c a u s e s a m o n g w h ite

m a le i r o n f o u n d r y w o r k e r s , b y a g e p e r io d s , 1 9 2 2

to 1 9 2 4

Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
54
64
over index1
44
ber
cent

Cause of death

Number of deaths.................................................. .
Typhoid fever..........................................................
Influenza, pneumonia....... .................................. .
Influenza.................................. ............... ...........
Pneumonia (all forms)________________ _
Other diseases of the respiratory system ____
Tuberculosis of the respiratory system______
Syphilis, tabes dorsalis, and general paralysis
of insane____________________________ _______ _
Cancer (all forms)................................ ........... .......
Rheumatism (acute and chronic)____________
Diabetes.____ ____ _____ _________ _____________
Alcoholism------------------------------------ ------ -------Cirrhosis of the liver.________________________
Cerebral hemorrhage, apoplexy, paralysis. . . .
Other diseases of the heart___________________
Arteriosclerosis................................ ....................... .
Nephritis (acute and chronic)_______________ _
Suicide (all forms)___ _______ _______ _________
Accidental or undefined violence...... ............... .
Occupational accidents__________________
Burns (conflagration excepted)....... ......... .
Traumatism by machines----------- ----------Homicide (all forms)_________ _______ ______
All other causes............................. ..................... ..
Total________________________ ________ _
Occupational deaths_______________ ________ _
Nonoccupational deaths_____________________

82

6
236
40
196
27
180

102
3
5
7
10
83
178

12
102
21
99
27
3

12
11
124

0.5
19.1
3.2
15.9

3.7
18.3
2.4
15.9

2 1
.2 .2

14.6

28.0

2.3
8.3
.2
.4

8.3
1.7

.8
23.8

3.7

~2
L

339

205

0.4
19.6
3.2
16.5
1.4
15.4

0.3
19.8
3.2
16.5
2.4
9.7

7.8
4.4
8.3

21.8
4.6
17.3

2
.0

16.8

1 1
.6 .0
.5
1 3.6
.6
4.8
8
.6
3.2
2.4
15.9
4.0

.5
5.1
1.5
11.2
3.0

2 1
.8 .8

7.7
.7
.4
.7
1.4
6.7
13.7
.4
10.2
2.5
6.7

8 23.2
.0
2 6
.2 .1
1
.8
.2 1
.7
.2
1 2.4 1 1 1
.0
.6 .0 .1
.9
7.3
.8
2
.0

10.0

12.2

15.1

1,234 100.0 100.0
29
1,205

285

5.6
4.1

1
.2

6.7
14.4

1
.0

29.4
5.6
23.8

197
0.5

126

2.4
97.6

6
.1

93.9

15.2

9.5

14.5

1
.0

182

220

117
105

1.5
11.2
.5

1
.0

16.2
1.5
9.7

12.7
28.3
2.4
12.2

4.4
1.5

.5

7.7

5.9

82

1 1
.8 .0
2
.0

100.0 100.0 100.0 100.0
4.0
96.0

96.4

2
.1

97.9

1.5
98.5

1 See page 18 for explanation of standardized relative index.

.

Respiratory diseases —More than one-fifth (21.3 per cent) of the
deaths of iron foundry workers are due to respiratory diseases. The
standardized relative index for influenza is 182. The highest
relative index (244) occurs in the age period 25 to 34 years. Pneu­
monia is relatively more than twice as frequent as among all occupied
males, the standardized relative index being 220. In this occupational
group only is pneumonia the highest cause of death. The high­
est relative index is 309 in the age period 25 to 34 years. The
ratios are very high at every age period. The standardized rela­
tive index for other diseases of the respiratory system is 117.
These facts are corroborated not only by our previous study of
1911-1913, but by every mortality investigation analyzing this
occupation. In England and Wales the death rates from influenza,
bronchitis, and pneumonia among iron foundry, furnace men and
laborers were, respectively, 79, 82, 127 per cent above the average.



50

CAUSES OF D EATH , BY OCCUPATION

The conditions responsible for these high ratios for respiratory
diseases are undoubtedly of occupational origin. Fumes, dust,
fatigue, and especially sudden and extreme variations of tempera­
ture are highly conducive to the contraction of respiratory diseases.
Tuberculosis of the respiratory system.—The standardized rela­
tive index for tuberculosis is 105. The highest relative index in
a significant age period is 157 in the age period 55 to 64 years. The
very highest ratio (319) appears in the indefinite age period 65 and
over* Low rates are recorded only from ages 25 to 44 years, when
they are about 81 per cent of the average. These figures do not
necessarily indicate a favorable mortality from this cause. The pro­
portionate mortality is of necessity low, as a result of the high total
death rate due to the excessively high death rate from nontuberculous
respiratory diseases. At the older ages, however, the very high ratios
point to a high death rate. It is possible that the repeated occurrence
of nontuberculous respiratory diseases finally makes the worker
more susceptible to the attack of the tubercle bacilli. Wright (16)
found a high death rate from tuberculosis in the older age groups
among foundry workers insured under group insurance plans. He
believes this unusual amount of tuberculosis in the older age groups
strongly suggests the existence of a dust hazard cumulative in
effect. The death rate from tuberculosis has probably declined
considerably in the last 10 years. The proportionate mortality ratio
has decreased from 21.9 per cent for ages 15 years and over in
1911-1913 to 14.6 per cent in 1922-1924.
Cancer ( all forms).—The standardized relative index for cancer
is 93. The death rate is probably not less than the average for
all occupied males.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized
relative index is 94. The death rate is probably not very different
from the average. The ratios are high up to age 55 years; but
the relative index is low after age 55, when the greatest number of
deaths from these diseases occur. The high ratios at the younger
ages are subject to considerable error because of the small number
of deaths recorded.
Other diseases of the heart.—The standardized relative index of
other diseases of the heart is 82. The ratios are less than average at
every age period up to 64 and the total death rate is probably less than
the average for all occupied males. Our earlier study for the years
1911-1913 showed high ratios for these causes after age 44. English
iron foundry, furnace men and laborers showed a death rate
from valvular diseases of the heart 6 per cent above the average
and a death rate from other diseases of the heart 13 per cent below
the average. Metal molders showed a low death rate for valvular
diseases of the heart and a slightly higher rate for other diseases
of the heart. Among our iron and steel mill workers the standard­
ized relative index is also low (86).
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 88. The ratios do not point to abnormal death rates
from this cause.
Accidental or undefined violence.—Accidental violence does not
appear to be a more frequent cause of death in this group than
among all occupied males. The standardized relative index is 88.
The ratios are less than average in every age period and contrast



51

M O RTALITY ACCORDING TO OCCUPATION

strikingly with the high ratios for iron and steel mill workers.
There are only 3 deaths from burns among the 1,234 deaths recorded
for iron-foundry workers.
Janitors and Building Employees 1
6
T h e r e i s considerable variation in the type of workers included
in this group. The average age at death is 57.7 years. Twothirds of all deaths occurred after age 54, whereas less than half of
the deaths of all occupied males occurred at these ages. The mor­
tality rate is apparently somewhat higher than that for all occupied
males. In the medico-actuarial investigation (4) the number of
deaths among janitors was 12 per cent more than expected, though
no single cause accounted for an inordinate number of deaths. In
the present study other diseases of the respiratory system, with a
standardized relative index of 130, and nephritis, with a stand­
ardized relative index of 121, show the highest ratios. Cerebral
hemorrhage and other diseases of the heart are about 10 per cent
higher than the average, the standardized relative indexes being, re­
spectively, 109 and 110. There are no apparent hazards connected
with the work of these men to which we can attribute the high ratios
for these diseases. Perhaps the explanation lies in the fact that
men, incapacitated for their ordinary work because of the debilities
of old age, take janitor jobs.

T a b l e 2 3 . — Number and per cent of deaths from specified causes among tohite

male janitors and building employees, by age periods, 1922 to 192k

Cause of death

Number of deaths__________ ______________

Stand­
Ages 15 years
Per cent of deaths during age period—
ard­
and over
ized
rela­
N u m ­ Per 15 to 25 to 35 to 45 to 55 to 65 and
tive
44
24
34
54
64
over
cent
ber
index °
2,243

___46

2~ ~ o T
2.2
Typhoid fe v e r_______ _______________________
223
9.9
8.7
Influenza, pneumonia________________________
2.1
46
4.3
Influenza ________________________________
Pneumonia (all forms) _____________ _____
177
7.9
4.3
40
2.2
Other diseases of the respiratory system -------1.8
8.2
Tuberculosis of the respiratory system_______
183
17.4
Syphilis, tabes dorsalis, and general paralysis
49
2.2
of insane
__________________________ _____
224 10.0'
Cancer (all forms) . . ____ _____________________
.3
Rheumatism (acute and chronic)____________
6
1.4
31
Diabetes
_________________________________
17
.8
Alcoholism _ _
___________________________
24
1.1
Cirrhosis of the liver__________________________
2
.1
Chronic occupational poisonings_____________
1
Lead poisoning.
_ __ __________
1
Other poisonings___________________ ______
215
9.6
Cerebral hemorrhage, apoplexy, paralysis----~6~5~
446 19.9
Other diseases of th6 h e a r t__ __ _ ___________
33
1.5
Arteriosclerosis________________________________
254 11.3
2.2
Nephritis (acute and chronic)_____________ __
4.3
28
1.2
Suicide (all forms)___ _____ __________ _______ _
8.1
Accidental or undefined violence ___________
181
41.3
2.9 32.6
66
Occupational accidents__________________
45
2.0
4.3
Traumatism by fall_______________ _____
Homicide (all forms)
____ __________________
9
.4
6.5
276 12.3
8.7
All other causes_______________________________
2,243 100. 0 100.0
Total. .......................................................... ..
Occupational deaths............................................ ..
69
Nonoccupational deaths.............................. ......... 2,174

3.1
96.9

32.6
67.4

81

213

419

718

766

8.6
1.2
7.4
2.5
27.2

9.9
2.3
7.5
1.9
21.1

10.7
1.0
9.8
1.0
12.9

9.3
1.7
7.7
2.1
5.2

0.1
10.3
2.9
7.4
1.8
2.2

3.7
1.2
1.2
1.2
1.2
1.2

5.6
6.1

2.9
11.0
.5
1.7
1.4
.2

2.2
11.0
.3
1.0
.6
1.3
.1

2.5
4.9
12.3
16.0
7.4
3.7
1.2
14.8
100.0

.5
2.3
1.4
.5
.5

.8
11.1
.1
2.0
.1
1.3

.1
3.8
6.4
11.1 12.8
12.2 18.6 21.0 24.0
.5
.7
1.4
2.5
8.0
10.0 11.8 12.9
2.3
1.7
1.3
.7
9.4
8.2
8.6
4.4
4.2
2.4
3.1
.8
2.3
1.9
2.8
.9
1.4
.5
13.1 11.2 12. i
12.8
100.0 100.0 100.0 100.0

7.4
92.6

4.7
95.3

3.1
96.9

2.5
97.5

96
95
130
91
110
96
68

109
110
121
120

.9
99.1

a See page 18 for exp lanation o f standardized relative index.
16 Includes building porters, ja n ito rs, w indow
starters ; in schools, offices, w arehouses, railroad
age a t death is 5 7 .7 years.
(See note, p. 1 9 .)




cleaners, elevator operators, elevator
station s, and buildings.
T h e average

52

CAUSES OF D E A TH , BY OCCUPATION

Fatal accidents occur relatively more frequently than among all
occupied males. The standardized relative index is 120. Falls
caused relatively more deaths than among all occupied males in each
age period and are responsible for about one-fourth of all the acci­
dental deaths.
Laborers1
7
T h e t i t l e “ Laborers ” includes building laborers and laborers of
various undefined classifications. On the whole, the group is of
low economic status because their work is unskilled; it is also of a
strenuous nature. Their death rate is undoubtedly well above the
average. In England and Wales (5) the mortality rate of a group
of general and undefined laborers was 44 per cent higher than the
average for all occupied and retired males. Every important cause
of death except diabetes and appendicitis contributes to the higher
death rate in that investigation. In the present study the important
causes showing greater than average percentages of death are influ­
enza, pneumonia, and accidents.
T a b l e 2 4 . — Number

and per cent of deaths from specified causes among white
male laborers, by age periods, 1922 to 1924
Ages 15 years
and over

Cause of death
N um ­
ber

Number of deaths

_

_

_

704

____ 10, 240

44
Typhoid fever__________ ________ _________ ____
Influenza, pneumonia__________________ ______ 1,143
209
Influenza______________________________
934
Pneumonia (all f o r m s ) ________________
177
Other diseases of the respiratory system _____
Tuberculosis of the respiratory system_______ 1,175
Syphilis, tabes dorsalis, and general paralysis
of insane______________________ _____ ________
205
Cancer (all forms)___________ _________ _______
916
26
Rheumatism (acute and chronic).......................
Diabetes____ _______ _________ _________ _______
98
Alcoholism________ _________
_ _ __
135
104
Cirrhosis of the liver__________________________
Chronic occupational poisonings.......................
2
Lead poisoning.......... ................... ..
__
2
Cerebral hemorrhage, apoplexy, paralysis___
809
Other diseases of the heart................................... 1, 734
Arteriosclerosis______________ ______ __________
234
Nephritis (acute and chronic)...... ............... .......
898
Suicide (all forms)_______ . . ............................
183
Accidental or undefined violence....................... 1,034
Occupational accidents..................................
266
Traumatism by m achines______ ________
53
Traumatism by fall........ ..................... ...........
162
Vehicular accidents........................................
343
Homicide (all forms)...............................................
83
All other causes........................................... ............. 1,240
Total

Per
cent

Per cent of deaths during age p e rio d - Stand­
ard­
ized
rela­
15 to 25 to 35 to 45 to 55 to 65 and tive
34
44
54
64
over index0
24

725 1,268 2,032 2,750 2,761

0.4
11.2
2.0
9.1
1.7
11.5

3.0
9.1
2.6
6.5
.6
25.9

1.4
10.2
2.2
8.0
1.4
25.9

0.3
13.9
2.3
11.6
1.5
19.1

0.2
11.9
1.8
10.1
2.2
14.2

0.1
12. 5
2.3
10.2
1.8
6.9

8.8
1.7
7.1
1.8
3.0

2.0
8.9
.3
1.0
1.3
1.0

.3
.6
.3
1.7
.4
.3

5.0
3.9
.3
.2
3.5
1.2

3.1
10.5
.3
.9
2.3
1.1

1.3
12.7
.1
1.2
.7
1.3

.7
10.5
.1
.9
.3
.9

95
98

7.9
16.9
2.3
8.8
1.8
10.1
2.6
.5
1.6
3.3
.8
12.1

.9
4.1

2.9
1.4
.8
.8
1.9
.3
.1
.1
1.1
6.9
.3
3.0
2.9
18.5
5.4
1. 5
1.9
5.4
2.8
17.4

2.4
8.4
.6
5.5
3.2
14.7
5.1
.7
2.6
3. 7
2.4
14.0

4.4
15.0
1.0
8.0
2.1
10.7
2.8
.5
2.0
3.8
.5
11. 7

10.7
19.6
2.2
9.6
1.7
6.6
1.3
.2
.9
2.5
.3
10. 6

13.9
25.5
5.2
13.2
.6
4.2
.6
.1
1.4
1.4

92
94

2.1
2.0
28.3
7.4
2.1
1.6
10.4
2.0
18.6

109
120
111
100

68

83
115

10.1

.............................................................. 10,240 100.0 100.0 100.0 100.0 100.0 100.0 100.0
=

Occupational deaths..............................................
Nonoccupational deaths____________ _________

285
9, 955

2. 8
97. 2

7. 7
92. 3

5. 5
94. 5

5.1
94.9

3. 2
96.8

1.5
98.5

.7
99.3

a See page 18 for explanation of standardized relative index.
17Includes hod carriers, excavation laborers, house wreckers, house movers (laborers),
house shorers and bracers, and unclassified laborers. The average age at death is 53.2
years.
(See note, p. 19.)




M O R T A LITY ACCORDING TO OCCUPATION

53

Typhoid fever.—The typhoid fever ratios are high up to age 34;
thereafter they are average or below average, but are based on few
deaths. Laborers are often exposed to water of a questionable
quality. The percentages of deaths, however, are much lower in each
age period than in 1911-1913 and probably represent a true decrease
in the death rate in the more recent period.
Respiratory diseases.—Respiratory diseases are more frequent
causes of death among laborers than among all occupied males. The
standardized relative index for influenza is 109. The highest relative
index (128) is found in the age period 55 to 64 years. Pneumonia
shows high relative indexes at every age. The standardized relative
index is 120. The highest relative index (129) is in the age period
55 to 64 years. Other respiratory diseases also show high ratios.
The standardized relative index is 111. In our earlier study the res­
piratory diseases also showed ratios well above the average. In Eng­
land and Wales the death rates for influenza, bronchitis, and pneu­
monia among laborers were, respectively, 34, 95, and 69 per cent
above the average. It is difficult to define the specific hazards con­
tributing to the excessive rates from these diseases. Exposure to
the weather, to dust, heat, and alcoholism are probably all contrib­
utory factors.
Tuberculosis of the respiratory system.—The standardized relative
index for tuberculosis is 100. As in our earlier study the ratios are
higher than the average in some age periods and lower in others.
Except for the indefinite age period 65 and over the highest relative
index is 111, in the age period 55 to 64; the lowest relative index (88)
is in the period 25 to 34 years. Although the standardized relative
index is close to the average, the specific death rates by age are
probably higher than among all occupied males, because of the
high total death rate. The death rate among laborers in England
and Wales was 65 per cent above the average. Laborers have shared
proportionately in the decline of the tuberculosis death rate. The
percentage of deaths declined from 16.4 per cent for ages 15 years
and over in 1911-1913 to 11.5 in 1922-1924.
Cancer (all forms).—The standardized relative index for cancer
is 98. The highest relative index is 109, in the age period 45 to 54.
The death rate is probably higher than the average. In England
and Wales the death rate from cancer among laborers is 38 per cent
higher than among all occupied and retired males.
Diabetes.—The standardized relative index is 68. The ratios are
very low in every age period except 15 to 24 years, when the relative
index is 142. The low ratios point to a low death rate from this
cause. Laborers in England and Wales according to the Registrar
General showed a death rate for diabetes 21 per cent below the
average. The English authorities concluded after studying the mor­
tality from diabetes in five social classes that “ it affects chiefly the
classes provided with the financial means of overeating and underexercising.” Our findings for this occupation tend to support this
conclusion. In explanation of the low ratios for laborers it should
be pointed out that men suffering from diabetes are frequently
unable to do strenuous work and must, therefore, shift to lighter
jobs.



54

CAUSES OF D EATH , BY OCCUPATION

Alcoholism—An inordinate number of deaths are attributed to
alcoholism in every age period. The highest relative index based on
a large number of deaths is 184 in the age period 35 to 44 years.
In the first age period the relative index is 400, but is based on
only three deaths. The high ratios for nephritis and cirrhosis of the
liver that usually accompany excessive drinking do not obtain in
this instance. The effect of alcoholism is reflected, however, in the
higher ratios for arteriosclerosis. The proportion of alcoholic deaths
has increased among laborers, whereas among all occupied males
the proportion has declined since our earlier study.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized rel­
ative index is 92. A high relative index appears in the age period
15 to 24, but is based on few deaths. An average proportionate
mortality ratio is recorded in the age period 25 to 34 years; but
after age 35 the ratios are all less than the average. The percent­
age of deaths for all ages 15 years and over increased from 6.9 per
cent in 1911-1913 to 7.9 per cent in 1922-1924.
Other diseases of the heart.—The standardized relative index is
94. Except for the age period 15 to 24 years, where the relative
index is 54, the ratios are about average. Because of the high
total death rate the actual death rate from this cause is, therefore,
probably higher than among all occupied males. In England and
Wales the death rates for valvular diseases and other diseases of
the heart among laborers are, respectively, 50 and 27 per cent
higher than the average for all occupied and retired males. The
percentage of deaths for all ages 15 years and over increased from
14.1 per cent in 1911-1913 to 16.9 per cent in 1922-1924.
Arteriosclerosis.—The relative indexes are high in every age pe­
riod, the highest relative index being 167 in the age period 45 to 54.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 83. The proportionate mortality ratios are below
average throughout. In England and Wales, however, the death
rate from chronic nephritis among laborers is 27 per cent above
the average.
Suicide (all forms).—Contrary to our earlier findings, laborers
show high proportions for suicide. In 1911-1913 the ratio was high
only for ages 15 to 24, where the relative index was 171. In the
present study the highest relative index (125) is also in this age
period.
Accidental or undefined violence.—The standardized relative
index is 115. The ratios are high in every age period. The high­
est relative index is 124, in the age period 45 to 54. It is evident
that the fatal accident rate is considerably higher than the average.
The proportion of deaths for all ages 15 years and over increased
from 8.3 per cent in 1911-1913 to 10.1 per cent in 1922-1924, in­
dicating that the accident death rate has not decreased to the same
extent as did the other causes of death. About one-quarter of the
accidental deaths are of occupational origin.
Homicide (all forms).—The relative indexes for homicide are
appreciably higher than the average in every age period except
45 to 54. The highest relative index is 200, in the age period 35
to 44,



55

M O RTALITY ACCORDING TO OCCUPATION

Longshoremen and Stevedores 1
8
No m o r t a l i t y statistics have as yet been published in America
showing actual death rates for longshoremen and stevedores. A
small group of longshoremen insured in the ordinary department
of the Metropolitan Life Insurance Co. during the years 1920-1926
show a mortality about 50 per cent in excess of the average. The
proportionate mortality ratios for longshoremen insured in our
industrial department indicate, through the inordinate proportion
of deaths from pneumonia, nephritis, and accidental violence, that
the death rate in this occupation is probably much higher than the
average for all occupied males. English statistics (5) offer con­
firmatory evidence. In 1921-1923, the death rate for stevedores was
62 per cent above the normal; and that of other dock laborers, 53
per cent above. All the numerically important causes share in the
higher mortality, except cerebral hemorrhage, apoplexy, and
paralysis, which are low among stevedores. Lower than average
death rates are also recorded for diabetes, cirrhosis of the liver, and
influenza.
T a b l e 2 5 . — Number and per cent of deaths from specified causes among white

male longshoremen and stevedores, by age periods, 1922 to 1924
Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N u m ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
44
ber
cent
34
54
64
over index a

Cause of death

Number of deaths.. _______________________ _

594

Typhoid fever
Influenza, pneumonia_______
______ . . .
_
Influenza________________ ____ _____________
Pneumonia (all forms) . . .
_ _ _
Other diseases of the respiratory system .
Tuberculosis of the respiratory system ____
Syphilis, tabes dorsalis, and general paralysis
of insane________________________________ _ _
Cancer (all forms) _________
Rheumatism (acute and chronic)________ ___
Diabetes___________ _________ ________ _ ___ _
Alcoholism__________________________ __ _ __
Cirrhosis of the liver_________________ _____ __
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart___________________
Arteriosclerosis.............................. .. _ _ . __
Nephritis (acute and chronic)________________
Suicide (all forms)___________
___ __
Accidental or undefined violence
______ _
Occupational accidents_ _ . _ _ _ _ _ .
_
D row ning.. ____________
_
_
Traumatism by fall_____ ______ _______
Traumatism by machines. _ _ _ _ _ _
Homicide (all forms)_________ _ ___ ______
All other causes
_____ __
. _ _ ______

1
67
4
63
8
76

0. 2
11.3
.7
10.6
1.3
12.8

18
41
2
3
18
5
19
96
5
55
8
92
46
21
20
4
11
69

3.0
6.9
,3
.5
3.0
.8
3. 2
16.2
.8
9. 3
1.3
15. 5
7. 7
3. 5
3.4
.7
1.9
11.6

Total

.................... _ _ _ _ _ _

_______

Occupational deaths___ _____ _________________
Nonoccupational deaths___________ ____ ______

26
7.7

82

7.7

9.8
2. 4
7.3

19.2

19. 5
4.9

3.8
3.8

1. 2
3.7

7.7

11.0

7. 7
3.8
23.1
7.7
7.7
3.8

4.9
1.2
25.6
12.2
6.1
4.9
1. 2
9.8
8. 5

3.8
19.2

153

140

137

56

0. 7
11.1
.7
10. 5
1. 3
13.1

15.0
.7
14. 3
.7
16.4

10.2

8.9

16. 2 ’ 8.’ 9"
2. 9
1.8
8.8

32
130
87
89

4.6
4.6

2.9
11.4
,7

2.2
10. 2

110
88

7.2

1.4
.7
2.9
12.1

1. 3
9.8
8.5
2.0
21.6
11.1
3.9
5. 2
7
14.4

7.9
.7
13. 6
8. 6
3.6
4.3
.7
.7
12.9

1. 5
2.2
.7
5.1
22.6
2. 2
12.4
1.5
8.0
2.9
1. 5
,7
,7
.7
8.8

7.1
1.8

70
10. 7
39.3
3. 6
14.2
3.6
1.8
1.8

46
106
114
137

8.9

594 100.0 100.0 100.0 100.0 100.0 100.0 100.0
46
548

7.7
92.3

7. 7
92.3

12. 2
87.8

11.1
88.9

8.6
91.4

2.9
97.1

1.8
98.2

° See page 18 for explanation o f standardized relative index.
13 Includes dockmen, dock hands, dock laborers, longshorem en, w allopers (d o c k ), steve­
dores, laborers un loading ships.
The average age a t death is 4 6 .9 years.
(S ee note,
p. 1 9 .)




56

CAUSES OF DEATH , BY OCCUPATION

Respiratory diseases.—Of the respiratory diseases, pneumonia is
the only one which has a sufficient number of deaths to warrant a
reliable inference. The standardized relative index is 130. The
relative indexes are high in every age period except 25 to 34 years,
where the index is 95. The highest relative index (172) appears in
the age period 45 to 54. The high pneumonia ratio can perhaps be
explained by the continual exposure of longshoremen and stevedores
to inclement weather and a general weakened resistance to disease
that results from the excessive use of intoxicating liquors. Expo­
sure to harmful dusts is suggested by the English authorities as a
possible cause of the high mortality from pneumonia among English
stevedores.
Tuberculosis of the respiratory system.—The standardized rela­
tive index for tuberculosis is 89. Up to age 44 the relative indexes
are very low. In the age periods 45 to 54 and 55 to 64 the ratios
are much higher than those of all occupied males, the relative indexes
being, respectively, 126 and 142. ^ The higher ratios at the older ages
are perhaps the result of weakened resistance caused by cumulative
injury to the lungs from frequent respiratory disturbances. The
tuberculosis rate apparently has been greatly reduced, especially at
the early ages, since 1911-1913. For all ages 15 years and over the
proportion of deaths declined from 29.2 per cent to 12.8 per cent.
The actual death rate, however, is probably still above the average.
In the English figures these men showed a rate 123 per cent above tfre
average.
Alcoholism.—The number of deaths attributed to this cause is
very small; nevertheless the consistently high relative indexes are
striking and certainly indicate that the actual death rate from alco­
holism is very high.
Cancer (all fowns).—The standardized relative index for cancer
is 88. No deaths are recorded up to age 35. The ratio is high
in the age group 45 to 54 (119), but low in the period 55 to 64 (77).
Consequently the whole picture regarding cancer mortality is very
inconclusive. English stevedores had a death rate from cancer 47
per cent above the average.
Cerebral hemorrhage, apoplexy, paralysis.—The ratios for this
cause are remarkably low. The standardized relative index is 46, the
lowest figure for this cause found in any of the numerically more
important occupations. Low ratios were also found in our earlier
study. The number of deaths in both studies, however, is too small
to give conclusive results. It is interesting to note that these dis­
eases and diabetes and influenza were the only important ones show­
ing lower than average death rates for stevedores in England.
Other diseases of the heart.—The proportionate mortality for this
cause is somewhat higher than the average. The standardized rela­
tive index is only 106, but above average indexes are found in every
age period except 45 to 54. In the age periods 25 to 34 and 55 to
64 the relative indexes are quite high, being, respectively, 157 and
115. These ratios probably indicate high death rates because of the
large total death rate in this occupation.
NephHtis (acute and chronic).—The standardized relative index
for nephritis is 114. High ratios are found in every age period
except 45 to 54, where the relative index is only 81. In our earlier



M O R T A LITY ACCORDING TO OCCUPATION

57

study Bright’s disease was high in all ages over 54 years and low
in the younger ages. The high ratios from this disease are con­
firmed, however, by the English figure, which showed a death rate
from chronic nephritis among stevedores 57 per cent higher than
among all occupied and retired males.
Accidental or undefined violence.—Accidents are the chief occu­
pational hazard of longshoremen, the standardized relative index
being 137. Only in the first and last age periods, where the deaths
are few, are the relative indexes less than average. The highest rela­
tive index is 177 in the age period 35 to 44 years. Occupational
accidents cause an excessive number of deaths, accounting for 7.7
per cent of the deaths from all causes and for 50 per cent of the
deaths from accidents.
Homicide (all forms).—The unusual number of deaths from homi­
cide in the age period 25 to 34 is worthy of mention. There are
eight deaths from this cause in that age period out of a total of 11
deaths for all ages. The relative index is 408. No explanation
is offered for this peculiar phenomenon. It may be merely the
result of chance variation. The figures for all ages, though based
on few deaths, indicate a high homicide rate for longshoremen and
stevedores.
Machinists 1
9
M a c h in is t s as a group probably experience lower mortality rates
than males of our industrial department. A large group of machin­
ists insured in our ordinary department in the years 1915 to 1926
experienced a mortality about 10 per cent above that of standard
lives insured in that department. In England and Wales in 19211923 (5) several similar occupational groups had death rates below
those for all occupied and retired males and individual causes of
death showed average ratios. In the present investigation notably
higher than average percentages were found for syphilis, and for
influenza, the standardized relative indexes being 122 and 112, respec­
tively. Tuberculosis and diabetes each showed an index of 107.
Typhoid fever.—Three-fourths of all the deaths from this disease
occur in the first two age periods. In the first period the ratio (92)
is lower than average, but in the second it is higher (110). In
our earlier study higher ratios occurred at these ages, being, respec­
tively, 131 and 119. We should infer from this that the death rate
from typhoid has gone down faster among machinists than among
all occupied males.
19
Includes lathe hands, bench hands, die m akers, tool m akers, gear cu tters and m akers,
m achine hands and repair m en in autom obile, car, railroad , m achine, and other establish ­
m ents where iron and steel are m ade in to a finished product through the use o f lathes,
plan ers, and the u su al equipm ent o f a m ach in e shop.
T h e average age a t death is 4 5 .2
years.
(See note, p. 1 9 .)




58

CAUSES OF D EATH , BY OCCUPATION

T a b l e 2 6 . — Number and per cent of d-eaths from specified\causes among white

male machinists, by age periods, 1922 to 1924

Cause of death

Ages 15 years
Per cent of deaths during age period— Stand­
and over
ard­
ized
rela­
N u m ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
44
54
ber
64
cent
over index i

590

902

871

814

992

666

32
488
112
376
70
820

0.7
10.1
2.3
7.8
1.4
17.0

2.4
11.2
4.2
6.9
1.2
29.3

1.1
9.4
1.9
7.5
.3
32.5

0.5
12.1
2.4
9.6
2.2
19.7

0.4
10.1
1.7
8.4
2.1
13.8

0.1
9.5
1.9
7.6
1.1
5.9

8.4
2.4
6.0
2.0
1.7

139
329
21
72
30
40
1
275
670
46
412
111
493
133
44
46
37
749

2.9
6.8
.4
1.5
.6
.8

.2
1.2
.8
1.4
.2

5.4
5.5
.5
1.1
1.0
.9

4.4
8.2
.7
1.4
.9
1.0

2.4
12.2
.3
1.9
.6
1.9

0.6
122
10.4
95
.2
1.5 “" ’ "107
.2
.3

5.7
13.9
1.0
8.5
2.3
10.2
2.8
.9
1.0
.8
15.5

.5
5.1

3.0
1.9
.2
1.6
.7
.3
.1
1.6
8.4

3.1
2.5
22.4
4. 7
.7
2.2
2.0
16.6

4.9
1.8
12.5
3.2
1.2
.8
1.8
18.0

2.2
8.6
.1
7.9
4.0
10.9
3.7
.5
1.1
.6
16.8

5.7
16.1
.5
10.3
2.3
8.0
2.9
1.2
.9
.4
13.9

10.4
21.2
.7
10.5
1.7
6.0
1.7
.9
.7
.1
13.4

13.5
22.2
5.1
14.0
1.4
4.2
.5
.9
.3

Number of deaths................................... .......... .. _. I 4,835
Typhoid fever_____________ _________ _________ !
Influenza, pneumonia___________________ _____
Influenza.............................................. .............. !
Pneumonia (all forms) __ ................ .............
Other diseases of the respiratory system _____
Tuberculosis of the respiratory system ............
Syphilis, tabes dorsalis, and general paralysis
of in san e......................... .......................................
Cancer (all forms)___________ ______ _________
Rheumatism (acute and chronic).................. ..
Diabetes................................... ........... .......................
Alcoholism.............................................. ............... ..
Cirrhosis of the liver__________________ _____
Chronic occupational poisonings_____________
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart.............................. ..
Arteriosclerosis______ ______ _________ _________
Nephritis (acute and chronic).............................
Suicide (all forms).................... ..
......................
Accidental or undefined violence. _ ...................
Occupational accidents................ .................
_______
Traumatism by fall__________
Traumatism by machines___________ ____
Homicide (all forms)____________ _______ ______
All other causes________________ ____ __________

112
100
99
107

96
103
104
89

14.6

Total____________________________________ 4,835 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Occupational de a th s_________________________
141
Nonoccupational deaths.........
............ __ 4,694

2.9
97.1

4.7
95.3

3.8
96.2

3.8
96.2

3.1
96.9

1.8
98.2

.5
99.5

1 See page 18 for explanation of standardized relative index.

Respiratory diseases.—Most of the percentages for respiratory
diseases are very close to average figures. The standardized relative
index for influenza is 112 and that for pneumonia is 100. Other
diseases of the respiratory system show high relative indexes from
ages 35 to 54, but the standardized relative index is 99.
Tuberculosis of the respiratory system .—The standardized relative
index for tuberculosis is 107. Previous studies, including our earlier
one, have shown high tuberculosis ratios for machinists. In the ages
15 to 24 and 25 to 34, the proportionate mortality is above the aver­
age, the relative indexes being 125 and 111, respectively. After
age 34 the proportionate mortality is about average, although in
the age period 45 to 54 the relative index is 106. The percentages
are much lower than they were in 1911-1913, indicating a consider­
able decline in the rate during the period.
Cancer (all forms).—The standardized relative index for cancer
is 95. High relative indexes are found in the age periods 15 to 24
and 35 to 44. The percentages of deaths are consistently higher
than in 1911-1913, showing that machinists have probably shared
in the general rise in the cancer death rate.




M O R T A LITY ACCORDING TO OCCUPATION

59

Diabetes.—The standardized relative index is 107. The relative
indexes are quite high up to age 44 but thereafter are average or
below average.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized rela­
tive index is 96. In only one age period, 25 to 34, is there a marked
variation from the ratios of all occupied males (146). The death
rate for this cause of death has probably declined since 1911—
1913
as is the case among all occupied males.
Other diseases of the heart.—The standardized relative index is
103. The relative indexes for the several age periods indicate no
marked differences from the average in the mortality of machinists
from this cause.
Nephritis (axute and chronic).—The standardized relative index
for nephritis is 104. Only in the age period 55 to 64 is the relative
index less than 100. The highest relative index is found in the age
period 35 to 44, where it is 118. An occupational influence, however,
is not evident.
Suicide (all form s)— Except in the age period 25 to 34, the
ratios for suicide are appreciably high. The highest relative index
appears in the age period 65 and over, where it is 175. Curiously
enough, a very high index (156) is found also in the age period 15
to 24. A high proportion of deaths from this cause was also found
in our earlier study, as well as by others who have made mortality
investigations. An occupational influence can not be assigned to the
death rate for suicide; but it is interesting to note in this occupation,
as in a number of others, the concomitant high proportionate mor­
tality ratio for syphilis.
Accidental or undefined violence.—The standardized relative in­
dex is 89, with low ratios at all ages except 65 and over. Occupa­
tional accidents account for 27 per cent of all accidental deaths.
Machinery accidents alone cause nearly 10 per cent of the accidental
deaths, giving a figure about twice the average. Falls, however,
cause relatively fewer deaths than among all occupied males.
Masons and Bricklayers2
0
T h e m e d i c o - actum al analysis of occupational mortality (^)
found a slightly higher mortality among bricklayers than the stand­
ard. The ratio of actual to expected deaths was 108 per cent, al­
though deaths from accidents reached about twice the normal figure.
In England and Wales (J) bricklayers show a very favorable death
rate, or one only 85 per cent of that of all occupied and retired
males. The fatal accident rate for English bricklayers is just about
the average. In the present investigation the standardized relative
index for accidents is 123. High indexes are also recorded for
pneumonia and cancer.
20
Includes forem en an d w orkm en : St onem asons, bricklayers, m asons, bricksetters> and
tile layers.
The average age at death is 56.^ years.
(See note, p. 1 9 .)




60

CAUSES OF DEATH , B Y OCCUPATION

T a b l e 2 7 . — Number and per cent of deaths from specified causes among white

male masons and bricklayers, by age periods, 1922 to 1924

Cause of death

Number of deaths _ _
Typhoid fever
_ _
______
Influenza, pneumonia________________________
Influenza..............................................................
Pneumonia (all forms)___________________
Other diseases of the respiratory system _____
Tuberculosis of the respiratory system_______
Syphilis, tabes dorsalis, and general paralysis
of insane
..
_
_ _ .
Cancer (all forms)........................ ...........................
Rheumatism (acute and chronic) - ....................
Diabetes_____ _______ _______ _____ _____________
__
_
_
___ ________ _____
Alcoholism.. _
Cirrhosis of the liver
.
_ __
Cerebral hemorrhage, apoplexy, paralysis. __
Other diseases of the heart............ ................. ..
Arteriosclerosis.....................
.
Nephritis (acute and chronic)........................... ..
Suicide (all forms)________________ ___________
Accidental or undefined violence.......................
Occupational accidents________ ________ _
Traumatism by fall—.................. ......... .........
Homicide (all forms)
......................
All other c a u s e s ........................ ......
Total.......... .......................................................
Occupational deaths................................... ...........
Nonoccupational deaths---------------------------------

Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N u m ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
ber
34
44
54
64
cent
over index 1

29

72

102

215

296

355

6.9
17.2
6.9
10.3
13.8

1.4
9.7
1.4
8.3
1.4
23.6

13.7
1.0
12.7
2.0
17.6

6.0
.5
5.6
1.9
14.4

10.5
1.0
9.5
1.4
7.8

11.0
2.3
8.7
2.3
3.1

88
114
98
88

3.4

1.4
4.2

5.9
5.9

1.9
11.2
.5

2.0
11.5

.8
12.1

88
111

1.4

2.0
1.0
1.0
2.0
6.9

.7
1.4
3.7
9.8
22.0
1.4
9.1
1.7
7.1
3.0
2.7

1.7
.3
1.4
13.0
23.1
5.6
12.1
.3
2.5
1.1
.8

54

10.1

10.7

1,069
3
109
16
93
19
104

0.3
10.2
1.5
8.7
1.8
9.7

20
111
1
11
10
18
93
190
27
103
17
94
35
30
9
130

1.9
10.4
.1
1.0
.9
1.7
8.7
17.8
2.5
9.6
1.6
8.8
3.3
2.8
.8
12.2

3.4
3.4 " 9 . 7 "
3.4
27.6
3.4
3.4
17.2

4.2
2.8
19.4
8.3
8.3
5.6
15.3

4.9
2.9
19.6
7.8
6.9
14.7

1.9
.5
7.0
13.0
1.4
11.6
2.3
10.2
3.3
2.8
1.9
14.4

101
97
89
123

1,069 100.0 100.0 100.0 100.0 100.0 100.0 100.0
35
1,034

3.3
96.7

3.4
96.6

8.3
91.7

7.8
92.2

3.3
96.7

3.0
97.0

1.1
98.9

1 See page 18 for explanation of standardized relative index.

Respiratory diseases.—The standardized relative index for pneu­
monia is 114. High relative indexes are displayed at every age
period except 45 to 54 years. A very high relative index in the age
period 15 to 24 is probably not significant because it is based on few
deaths. The number of deaths from influenza and other diseases of
the respiratory system are likewise too few to give reliable ratios.
The relatively large proportion of deaths from pneumonia in this
occupation is possibly due to outdoor exposure. In our earlier
analysis bricklayers and plasterers were combined. The ratios for
pneumonia varied but little either above or below the general average.
Lower than average death rates were recorded for respiratory
diseases in the English study.
Tuberculosis of the respiratory system.—The standardized relative
index for tuberculosis is 88. There is a gradual increase in the rela­
tive indexes for this cause at each successive age period up to 64.
Whereas the relative indexes are low up to age 44, thereafter the per­
centages of deaths are distinctly higher than the corresponding fig­
ures for all occupied males. A similar age trend occurred also in
1911-1913 among bricklayers and plasterers combined. The highest
relative index (126) occurs in the age period 55 to 64. The progres­
sively increasing relative indexes reflect very likely the result of the
cumulative effect of exposure to dust and exposure to all kinds of
weather. There has been a considerable decline in the relative in­
dexes at each age up to 54 since the earlier study, suggesting a corre­



M O R T A LITY ACCORDING TO OCCUPATION

61

sponding decline in the actual death rate. For all ages 15 years and
over the proportionate mortality for tuberculosis decreased amaz­
ingly, falling from 19 per cent in 1911-1913 to 9.7 per cent in
1922-1924.
Cancer {all forms).—The standardized relative index for cancer
is 111. The relative indexes are high in every age period except
55 to 64 years. The increase of the percentages over those in 19111913 is considerably greater than the increase which has occurred
among all occupied males. The number of deaths involved is small,
however, and the inference that the death rate from cancer is in­
creasing at a more rapid rate than among all occupied males is
consequently hardly warranted. It is difficult to see an occupa­
tional influence in these figures. In the English study of 1921-1923
bricklayers had an average death rate from cancer.
Other diseases of the heart.—The standardized relative index is
97. With the exception of the ratios in the age periods 25 to 34
(139) and 55 to 64 (112) the relative indexes are quite low. It is
unlikely that the death rate for this cause differs substantially from
that of all occupied males.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 89. The figures do not show significant differences
by age period. Only in the age period 45 to 54 is the ratio above
normal, the relative index being 120. On the whole, it appears
that there is a low incidence of nephritis among bricklayers.
Accidental or undefined violence.—Masons and bricklayers share
the accident hazard common to all the building trades. The stand­
ardized relative accident index is 123 and the proportionate mor­
tality is higher than the average in every age period up to 64. The
highest relative index (161) appears in the age period 35 to 44 years.
The proportion of deaths from falls ranges from two to five times the
normal. A relatively large number of occupational fatal accidents
prevails in every age period except 15 to 24 years. Occupational
accidents account for 37 per cent of all accidental deaths.
Merchants and Storekeepers 2
1
No r ecent American statistics giving death rates for merchants
and storekeepers are available; the English data, however, are in­
structive. In the report of the Registrar General, 1921-1923 (5),
proprietors and managers of wholesale and retail businesses have an
average death rate. Low death rates were recorded for tuberculosis
and accidents and high death rates for the degenerative diseases.
In our analysis also the degenerative diseases show very high ratios.
The ratios are so high as to leave little doubt that the actual death
rates are higher than the average. Yerv low ratios are found for
tuberculosis and accidents.
21
Includes w holesale and retail dealers in various sm all lines : Stationery, books, boots
and shoes, candy, tobacco, groceries, drugs, coal and wood, carpets, dry goods, hardw are,
flowers, f r u i t ,. furn itu re, fixtures, glassw are, harness, hats, jew elry, m usic, op tical goods,
new spapers, produce, and butcher shops.
T h e average age a t death is 54 years.
(See
note, p. 1 9 .)

68357°— 30'-------5




62

CAUSES OF DEATH , BY OCCUPATION

T a b l e 2 8 . — Number and per cent of deaths from specified causes among white

male merchants and storekeepers, by age periods, 1922 to 1924

Cause of death

Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
34
54
ber
24
44
64
cent
over index1

Number of deaths........................ ......................... .

3,133

Typhoid fever________________________________
Influenza, pneumonia_____ ______ ____________
Influenza............................................................ .
Pneumonia (all forms)__________________ _
Other diseases of the respiratory system ____
Tuberculosis of the respiratory system.......... .
Syphilis, tabes dorsalis and general paralysis
of insane........................................................... .......
C ancer (all forms) .................................................. .
Rheumatism (acute and chronic) ______ _____
D iabetes.................. ................................................. .
Alcoholism.................... ............. ............................. .
Cirrhosis of the liver______________ __________ _
Chronic occupational poisonings...................... .
Lead poisoning. .................................... ...........
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart.................................. .
Arteriosclerosis.................................... ................... .
Nephritis (acute and chronic)........................... .
Suicide (all forms).................................................. .
Accidental or undefined violence.......................
O ccupational accidents ................................ .
Homicide (all forms).................._......................... .
All other causes....................................................... .

7
270
55
215
56
242

0.2
8.6
1.8
6.9
1.8
7.7

60
262
9
101
20
60
1
1
331
578
52
393
65
151
19
43
432

1.9
8.4
.3
3.2
.6
1.9

T o ta l........................................ ..................... .
Occupational deaths_____________ ___________ _
Nonoccupational deaths...................................... .

68

240

457

661

938

769

1.5
4.4
1.5
2.9

0.8
10.0
2.5
7.5
.8
26.7

0.4
11.4
1.5
9.8
2.4
15.5

0.3
6.8
1.8
5.0
2.1
7.3

8.2
1.3
6.9
1. 7
2.7

9.0
2.2
6.8
1.7
2.3

82
81
107
77

.8
1.7
.4
2.1
2.9
2.1

3.5
4.4
.4
.9
1.3
1.8

2.1
12.5
.3
4.4
.2
2.2

1.2
9.0

71
92

3.8

204

.8
10.4
.4
6.7
3.3
9.6
.4
4.2
16.3

5.7
12.7
8.8
2.8
7.2
1.3
1.3
19.5

2.0
7.7
.5
3.0
.8
2.7
.2
.2
8.3
19.7
.6
12.4
3.3
5.1
.6
2.3
15.0

13.5
20.8
.9
14.4
1.5
2.7
.3
.7
11.2

15.6
20.7
5.1
15.3
1.0
2.7
.4
.1
11.4

3,133 100.0 100.0 100.0 100.0

100.0

2.9
97.1

.8
99.2

22
3,111

10.6
18.4
1.7
12.5
2.1
4.8
.6
1.4
13.8

.7
99.3

23.5
1.5
2.9

1.5
16.2
2.9

"22.T
2.9
5.9
17.6

.8
99.2

1.3
98.7

1.0
137
128
131
65

100.0 100.0
.4
99.6

.4
99.6

1 See page 18 for explanation o f standardized relative index.

Respiratory diseases.—Influenza and pneumonia are less important
causes of death in this group than among all occupied males. The
standardized relative indexes for pneumonia and influenza are 81 and
82, respectively. The ratios in the individual age periods are, with
few exceptions, below the average. Other diseases of the respiratory
system, however, cause a large number of deaths after age 35. The
standardized relative index is 107. English “ shopkeepers ” have
death rates from influenza and pneumonia slightly above the average.
Tuberculosis of the respiratory system.—The standardized relative
index for tuberculosis is 77. The ratios decrease progressively from
100 in the age period 15 to 24 years to 44 in the period 55 to 64. The
low tuberculosis ratios are perhaps a reflection of the better economic
condition of these workers as compared with the industrial population
as a whole. This is borne out by the fact that store clerks and sales­
men who work in about the same environment have a standardized
relative index of 104.
Cancer (all forms).—The standardized relative index for cancer is
92. The relative indexes are low at the older ages when cancer is
of greatest importance. The death rate is probably less than that of
all occupied males. English shopkeepers have a lower than average
death rate from cancer.
Diabetes.—The standardized relative index for diabetes is 204. The
proportions are consistently high throughout with the exception of
the age period 35 to 44, when the proportion is average. In Eng^



M O R T A LITY ACCORDING TO OCCUPATION

63

land and Wales the death rate from diabetes for a similar occupa­
tional group was 48 per cent above the average.
Cirrhosis of the liver.—This disease is inordinately frequent. The
highest relative index is 525, in the age period 25 to 34. It is high
in every age period except the first, where no deaths are recorded.
It is surprising to note that the ratios generally are low for alcohol­
ism and syphilis, which are the commonest causes of cirrhosis of the
liver.
Cerebral hemorrhage, apoplexy, pan^alysis.—The standardized rela­
tive index is quite high (137), indicating a high death rate for these
diseases. The death rate for English shopkeepers is 9 per cent above
the average. After age 34 the relative indexes run from 211 in the
age period 35 to 44 years to 124 in the age period 55 to 64.
Other diseases of the heart.—At every age except 65 and over this
cause of death is more prevalent than among all occupations. The
standardized relative index is 128. At the younger ages the excess
is greater than at the later periods of life.
Nephritis (acute and chronic).—Nephritis, like the other degener­
ative diseases, is a more frequent cause of death than among all occu­
pied males. The standardized relative index is 131.
Smcide (all forms).—The ratios for suicide are above average in
three of the five working age periods. English shopkeepers had a
death rate from suicide 62 per cent above the average.
Accidental; or undefined violence.—Accidental or undefined violence
is a relatively unimportant cause of death among storekeepers. The
standardized relative index is 65. The ratios are very low in every
age period. Occupational accidents are very few.
Homicide (all forms).—The hazard of homicidal death among
shopkeepers seems to be very great. The relative index is high at
every age, reaching the maximum in the age period 45 to 54, where
it is 383. The ratio is also more than three times the average in
two other age periods, namely, 15 to 24 and 55 to 64 years. Shop­
keepers having large sums of money in their possession, are fre­
quently attacked by bandits, and so this cause of death may perhaps
be counted occupational in character. However, none of the deaths
was classified as definitely of occupational origin, which would
indicate that the facts were incompletely reported on the death
certificate.
Painters, Paper Hangers, and Varnishers 2
2

A n u m b e r of mortality studies have revealed a somewhat higher
than average total death rate for painters. The medico-actuarial
investigation of 1913 (4) reported the ratio of actual to expected
deaths among journeymen house painters to be 111 per cent. In
England and Wales in 1921-1923 (5), the death rate among painters
and decorators was about 7 per cent higher than that among all
occupied and retired males. These studies and also our 1911-1913
investigation (1) disclose high mortality from lead poisoning,
nephritis, cerebral hemorrhage, and accidental violence. In the
^Includes house, building, and bridge painters, all scaffold painters, frescoers, grainers,
decorators, wood finishers, carriage painters, interior finishers, paper hangers, and un­
specified painters (does not include sign writers, letterers, and gilders). The average
age at death is 51.9 years. (See note, p. 19.)




64

CAUSES OF D EATH , BY OCCUPATION

present analysis we find confirmatory evidence of the higher incidence
of these causes of death, although considerable improvement has
taken place since our previous study. It is interesting to note that
there were 54 deaths from chronic occupational lead poisoning among
painters, which was over three-fourths of all deaths from this cause
among white male industrial policyholders.
T a b l e 2 9 . — Number and per cent of deaths from specified causes among white

male painters, paper hangers, and varnishers, by age periods, 1922 to
1924
Ages 15 years
Per cent of deaths during age p e rio d - Stand*
and over
ardized
rela­
N u m ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
5.4
24
34
44
64
over index1
ber
cent

Cause of death

Number of deaths________ _______ _______ _____
Typhoid fever ______
_______________________
Influenza, pneumonia________ ________________
Tnflnp.nzfl _______________________________
_ ________
Pneumonia (all forms) _. _
Other diseases of the respiratory system-------Tuberculosis of the respiratory system _ _
_
Syphilis, tabes dorsalis and general paralysis
of insane
_________ ____________________
_Cancer (all forms)-------------------------------------------Rheumatism (acute and chronic) ___ _.
Diabetes
_
__ _________ ___ ____ _____
Alcoholism
_
_ _
_ _
_
__ _____
Cirrhosis of the liver ________ ______ _
Chronic occupational poisonings_________
Lead poisoning__________________ ______
_
_
. _
Other poisonings___ _
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart____________
Arteriosclerosis__________________________ _____ !
Nephritis (acute and chronic)________________
Suicide (all forms) ___________________________ '
Accidental or undefined violence.____________ i
Occupational accidents. ________ . . . ._
Traumatism by fall____________ ________
Homicide (all f o r m s ).________________________
A ll other causes_________________ ________ _____
Total

_______

________________

_

Occupational d e a th s _______________ ____ __
Nonoccupational deaths______________________

107

249

452

650

707

575

3.7
13.1
.9
12.1
.9
26.2

9.6
1.6
8.0
1.2
28.1

10.4
1.8
8.6
1.1
21. 5

7. 5
.5
7.1
.9
12.3

7.5
1.0
6.5
1.3
6.6

6.3
.9
5.4
1.0
1.9

3.6
' 2.6
2.0
.9
8.6
,2
.8
1.2
.9
1.2
1.0
1.2
.8
1.2
2.0
,9
1.2
| 2.0
.9
i
.4
1 9. 1
15.3 ~2.~8~ 7.6
1. 5
10.5 ; 2.8
4.0
2.4
1. 9
1. 5
10.8 29.0 17.7
8.4
4.3 12.1
4.6 i 6. 5
8.0
1. 6
.6
3.7
12.4 14.0 16.5

4.2
4.4
2
.9
2.0
.9
3.3
3.3

3.4
10.8

2.3
10.6
.3
1.3
1.1
1.3
1.8
1.8

.9
11.1
.2
1.0

12.0
16.8
1.7
12.6
1.0
9.9
4. 5
5.0

17.9
23.1
4.0
14.1
.9
5.9
1.6
2.6

ll. 9

9.2

2,740
4
223
28
195
30
333
71
235
6
26
28
34
55
54
1
248
420
42
289
41
298
117
126
16
341

0.1
8.1
1.0
7.1
1.1
12. 2

5.3
10.8
.2
6.2
2. 2
11.7
4. 2
5. 3
.9
13.7

.6
1. 2
1.8
2. 5
2.3
.2
5.4
14.9
.9
12.0
1. 7
10.2
3. 5
3.8
.6
13.2

54
100
76
102
106
93
61

1.2
1.2
1.2
109
91
111
118

2, 740 100.0 100.0 100.0 100.0 100.0 100.0 100.0
173
2, 567

6. 3
93.7

13.1
86.9

9.6
90.4

7. 5
92.5

6.0
94.0

6. 5
93.5

2. 8
97.2

1 See page 18 for explanation of standardized relative index.

Respiratory diseases.—The percentages for respiratory diseases
in almost every age period are appreciably less than the correspond­
ing figures for all occupied males. Pneumonia, however, displays
a very high relative index in the age period 15 to 24 (189). The
standardized relative indexes for influenza, pneumonia, and other
diseases of the respiratory system are, respectively, 54, 100, and 76.
The ratios for these diseases were also low in our earlier study.
Tuberado sis of the respiratory system.—The death rate from tu­
berculosis is apparently not appreciably different from the average.
The relative indexes do not deviate much above or below 100, except
in the age period 15 to 24, where the excess is 12 per cent. The
standardized relative index is 102. The average mortality is cor­
roborated by the experience of England and Wales for 1921-1923
and by our earlier study. The decline in proportionate mortality
from this cause since 1911-1913 has been very favorable, indicating



M O R T A LITY ACCORDING TO OCCUPATION

65

a decline in the death rate at least equal to that among all occupied
males.
Cancer (all forms).—The standardized relative index for cancer
is 93. The percentage of deaths is appreciably above average in
only one age period, 45 to 54, where the relative index is 113. At
all other ages the percentages are about average or below average.
The cancer death rate we should infer, therefore, does not deviate
greatly from the average. Low ratios were found also in our earlier
study. In England and Wales the death rate from cancer among
painters and decorators is about 7 per cent higher than among all
occupied and retired males.
Lead poisoning.—Two per cent of all the deaths in this occupa­
tion result from lead poisoning, the highest proportion occurring
in the age period 35 to 44 years, where it is 3.3 per cent. Secondary
effects of lead poisoning are shown in the higher than average ratios
for apoplexy, paralysis, and nephritis. There were exactly the same
number of deaths in 1911-1913 as in 1922-1924. The proportionate
mortality in each age period was practically the same. But, as there
were probably more painters insured with the company in the later
period, these figures apparently indicate an actual decline in the
death rate from lead poisoning. It should be pointed out in this
connection that there has been a decline of 50 per cent in the death
rate from lead poisoning among white males 15 years and over
between the years 1912 and 1923. Such a large decrease in the total
death rate could be brought about only if conditions among painters
improved, as more than half of the deaths from lead poisoning
occurred among painters.
In England painters are apparently less exposed to the lead hazard
than in America. In the former country, less than 1 per cent of
all deaths are due to lead poisoning, as compared with 2 per cent
in our group of painters.
Cerebral hemorrhage, apoplexy, and paralysis.—The proportionate
mortality for this cause is higher than among all occupied males at
the significant ages, except in the age period 45 to 54 years, where
the relative index is 92. The standardized relative index is 109.
The highest relative index is 196, in the age period 35 to 44. Lead
absorption is undoubtedly an important causative factor in these
high ratios.
Other diseases of the heart.—The standardized relative index is
91. The percentages for this cause are high in the age periods 25
to 34 and 35 to 44, where the relative indexes are 109 and 117,
respectively. At the other ages the percentages are all less than
average. This occupation does not appear to exert any harmful
influence on the heart. In England and Wales, however, the death
rate from valvular heart disease among painters is 13 per cent above
the average.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 111. The percentages are higher than those among
all occupied males at the older ages, when nephritis is of greater
importance. In the age period 45 to 54 the relative index is highest
(124) and at the ages 55 to 64 it is 115. One can see here also the
cumulative effect of lead upon the kidneys. The high relative in­
dexes at the older ages are confirmed by pathological investigations



66

CAUSES OF D EATH , BY OCCUPATION

and by our previous study covering the years 1911-1913. The death
rate from chronic nephritis among painters in England and Wales
is 90 per cent higher than that of all occupied and retired males.
Accidental or undefined violence.—As in the other building trades,
the proportionate mortality from accidental violence is higher than
that of all occupied males. The standardized relative index is 118.
Only in the age period 35 to 44 is the relative index low (96). The
highest relative index (160) is in the age period 55 to 64. It seems
certain, therefore, that painters, paper hangers, and varnishers have
a high death rate from accidental violence. Falls account for 42
per cent of all accidental deaths, while among all occupied males
the corresponding figure is 13 per cent. The relative indexes for
occupational accidental deaths are high in every age period except
35 to 44. In the medico-actuarial investigation also, accidents ac­
counted for more than the normal proportion of deaths. English
painters, on the other hand, showed an average death rate from ac­
cidents. The percentage of deaths for all ages 15 years and over
in the Metropolitan experience has increased from 8.7 per cent in
1911-1913 to 10.8 per cent in 1922-1924. Although this is a greater
proportionate increase than is found for all occupied males, it should
not necessarily be construed as representing an unfavorable trend
in the death rate, but as probably due to a steeper decline in the
death rate for other causes of death among painters.
Plumbers, Gas Fitters, and Steam Fitters2
3

On t h e whole, the death rates for these occupations are probably
lower than those for all occupations combined in our industrial ex­
perience. In the report of the Registrar General for 1921-1923 (5),
plumbers and also gas fitters and pipe fitters show lower than aver­
age mortality rates. The medico-actuarial investigation of 1913 (4)
reports the ratio of actual* to expected deaths among journeymen,
plumbers, and steam fitters to be 99 per cent. In the present in­
vestigation the proportionate mortality is notably above average
for nephritis, syphilis, and suicide. The percentages of deaths from
influenza, cerebral hemorrhage, apoplexy, and paralysis, and acci­
dental violence are also somewhat higher than average. Deaths
from heart diseases are relatively infrequent.
Respiratory diseases.—Of the respiratory diseases, pneumonia is
the only one which accounts for a sufficient number of deaths to give
reliable ratios. The standardized relative index is 90. The relative
indexes are high only in the age period 15 to 24 (109), and in the
indefinite period 65 and over (146). It appears, therefore, that the
death rate from pneumonia among plumbers is probably lower than
that of all occupied males.
13Includes pipe fitters, gas fitters, steam fitters, plumbers, plumbing repairers, pipe
2
cutters, and plumbers’ helpers. The average age at death is 45 years. (See note, p. 19.)




67

M O R T A LITY ACCORDING TO OCCUPATION

Table 3 0 .— Number and per cent o f deaths from specified causes among w hite
male plumbers, gas fitters, and steam fitters, by age periods, 1922 to 1924

Cause of death

Ages 15 years
Per cent of deaths during age p e rio d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
44
64
over index®
ber
54
cent

Number of deaths............................... ............. .......

1,263

Typhoid fever........................................... ...............
Influenza, pneumonia________________________
Influenza........... .
_
Pneumonia (all forms)____________ _______
Other diseases of the respiratory system____
Tuberculosis of the respiratory sy s te m ...........
Syphilis, tabes dorsalis, and general paralysis
of in san e________________________________ _
Cancer (all forms)____________________________
Rheumatism (acute and chronic)......... .............
Diabetes
................................ ..................... .....
Alcoholism.................................... ........... .................
Cirrhosis of the liver. __.......................... ...............
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart............................ .......
Arteriosclerosis....................................................
Nephritis (acute and chronic)________________
Suicide (all forms)___________ _________ _____
Accidental or undefined violence_____________
Occupational accidents__________ ______
Traumatism b y fall______________________
Absorption of irrespirable, irritating, or
poisonous gases..............................................
Homicide (all forms)................................................
All ether causes.........................................................

5
121
23
98
10
196

0.4
9.6
1.8
7.8
.8
15.5

42
89
3
18
9
10
75
143
13
131
37
150
41
26

3.3
7.0
2.0
.2
1.0
1.4
2.0
.7
.8
5.9
11.3 ” 2.~0‘
1.0
10.4
5.0
2.9
3.0
11.9 28.0
3.2
6.0
2.1
3.0

11
15
196

.9
1.2
15.5

T o ta l................................................ ...............
Occupational deaths_____________ ________ ____
Nonoccupational deaths........................................

100

227

3.0
9.0
2.0
7.0

0.4
10.1
2.6
7.5
1.3
26.0

23.0

2.0
20.0

2.2
2.6
.4
1.3

275

330

9.8
1.5
8.4
.7
23.6

0.3
9.1
.6
8. 5
.9
11.5

6.9
3.6

206

125

8.7
3.4
5.3
4.9

11.2
1.6
9.6
1.6
.8

103
90
36
95

3.9
11.2

1.6
13.6

126
93

.5

.8

96

14.4
27.2
4.8
12.0

108
75
131

4.0

111

5.3
2. 6
16. 7
6.6
1.8

1.8
1.8
1.5
3.3
7.6
.4
8.4
4.0
10.9
3.6
1.8

2.4
9.4
.3
1.8
1.2
.9
6.4
12.4
.3
15.5
3.0
9.1
1.8
2.1

1. 5
11.7
14.6
2.4
12.1
3.4
9.2
1.9
3.4

.4
2.6
20.3

1.1
1.5
14.2

1.2
.9
14.5

1.0

.8

16.0

8.0

1.3
6.6

1,263 100.0 100.0 100.0 100.0 100.0 100.0 100.0
42
1,221

3.3
96.7

7.0
93.0

6.6
93.4

3.6
96.4

1.8
98.2

1.9
98.1 100.0

® See page 18 fo r exp lanation o f standardized relative index.

Tuberculosis of the respiratory system.—The standardized relative
index for tuberculosis is 95. The highest relative index (114) is in
the age period 35 to 44. The relative indexes are less than average
at every other age. In England and Wales, the tuberculosis death
rate for plumbers and for gas fitters and pipe fitters in 1921-1923 was
somewhat less than that for all occupied and retired males. In the
United States the medico-actuarial investigation of 1913 reports that
journeymen plumbers and steam fitters had a death rate from tuber­
culosis which was above the standard. The latter statement is con­
firmed by the ratios of the Metropolitan industrial experience of
1911-1913. In that experience the relative index was slightly below
average in the first age period, but the relative indexes were progres­
sively higher in each age period up to 55 to 64 years. The present
analysis indicates a favorable decline. The percentage of deaths for
all ages, 15 years and over, has decreased from 31.6 per cent in 19111913 to 15.5 per cent in 1922-1924.
Cancer (all forms).—The standardized relative index for cancer
is 93. At ages 35 to 64 when the percentages for this cause are signifi­
cant the relative indexes are low. The very high relative indexes
between the ages 15 to 34 are inconclusive because of the small num­
ber of deaths recorded at those ages.
Lead poisoning.—The exposure to lead in this occupation is not
severe enough to cause deaths from lead poisoning. During the three
years in which 1,263 deaths were recorded among plumbers, gas



68

CAUSES OF D EATH , BY OCCUPATION

fitters, and steam fitters, not one was reported as due to lead intoxica­
tion. In the earlier study one death was recorded. It may well be,
however, that this is merely the result of inaccurate reporting of
causes on death certificates. English plumbers are apparently ex­
posed to a greater lead hazard, as there were 14 deaths recorded from
lead poisoning among them in the years 1921-1923. The far-reaching
constitutional effects of lead absorption are clearly reflected in our
figures, however, by the high ratios for cerebral hemorrhage and
nephritis. The recent English figures also showed high death rates
for these diseases, as did also our earlier analysis.
Cerebral hemorrhage, apoplexy, paralysis.—This cause is one of
the few principal ones showing consistently high ratios. The stand­
ardized relative index is 108. That this is not a casual occurrence
is corroborated by the high death rate for cerebral hemorrhage
among plumbers, gas fitters, and pipe fitters in England and Wales
in 1921-1923. The rate for ages 20 to 65 was 43 per cent higher than
average among plumbers, and 36 per cent higher among gas fitters
and pipe fitters. Lead absorption, as has already been suggested, is
probably an important factor. The decline in the death rate for this
cause since 1911-1913 has apparently been relatively greater than
among all occupied males.
Other diseases of the heart.—The proportionate mortality ratios for
heart disease point to a favorable death rate from this cause. The
standardized relative index is 75. The relative indexes are low in
every age period except 65 and over and are generally lower also
than those in 1911-1913.
Nephritis (acute and chronic).—Nephritis exhibits the highest
relative indexes of any of the main causes of death. The stand­
ardized relative index is 131. The indexes vary from 110 to 185,
the latter appearing in the age period 15 to 24 where only five deaths
are recorded. Of the significant figures, 160 in the age period 45 to
54 is the highest. In England and Wales the death rate from chronic
nephritis among plumbers is almost twice the average. Lead absorp­
tion is probably an important causative factor in this result.
Suicide (all forms).—There appears to be no condition inherent
in the occupation under consideration to which the high ratios of
deaths by suicide can be attributed. The highest relative index is
243 in the age period 55 to 64. The number of deaths is small enough
undoubtedly to allow large deviations, but the consistently high
ratios suggest a true excess in the mortality from this cause.
Accidental or undefined violence.—The standardized relative index
for accidents is 111. The ratios are higher than average in every age
period except 35 to 44. The highest relative index is 148 in the age
period 55 to 64. Occupational accidents are fewer than among all oc­
cupied males. The proportion of deaths from falls, however, is con­
siderably higher than average in every age period. There were also
relatively more deaths from absorption of irrespirable gases than
among all occupied males.
Policem en2
4
I t i s c o m m o n knowledge that the policeman’s duties are fraught
with danger. The degree of hazard, however, is perhaps not fully
24
Includes city policemen, marshals, detectives, constables, and sheriffs.
age at death is 47.9 years.
(See note, p. 19.)




The average

69

M O R T A LITY ACCORDING TO OCCUPATION

realized. Not less than 8.6 per cent of the deaths at all ages occurred
in the line of duty; of these, 4.7 per cent were due to accidental
causes, in the restricted sense used in this text, and 3.9 per cent were
due to homicide during active service. The latter figure is very
probably an understatement because of inaccurate reporting, for
homicide (all forms) was responsible for 7 per cent of the deaths.
The high proportion of homicidal deaths is corroborated by the
analysis of the mortality of city policemen made by the late Freder­
ick S. Crum (17) of the Prudential Life Insurance Co. From
information supplied by the chiefs of police, Crum found that 7.7
per cent of all the deaths of policemen between 1915 and 1918 were
due to homicide. The actual death rate from this cause was 1 per
1,000. Up to age 24, 40.9 per cent of the deaths of insured policemen
were of occupational origin, and from 25 to 34 years 20.5 per cent
of the deaths were so classified. After age 34 years, however, the
proportion becomes distinctly less. Of the important diseases, pneu­
monia, diabetes, and nephritis cause the heaviest excess of deaths
in our industrial department experience; heart disease is probably
also somewhat more prevalent than the average at the older ages.
These high ratios suggest a high total death rate, which is confirmed
by the medico-actuarial investigation (If). City policemen had a
ratio of actual to expected deaths of 139 per cent and marshals,
sheriffs, and constables 134 per cent.
T able

3 1 .— Number and per cent of deaths from specified causes among white
male policemen, bp age periods, 1922 to 1924

Cause of death

Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
44
54
64
over index 1
ber
cent

Number of deaths _______________ ________ ___

700

22

132

142

148

164

92

Typhoid fever.......................... ........... .....................
Influenza, pneumonia_____ ______ _____________
Influenza__________________________________
Pneumonia (all forms)___________________
Other diseases of the respiratory system_____
Tuberculosis of the respiratory system_______
Syphilis, tabes dorsalis, and general paralysis
of insane____________________________ _____
Cancer (all forms)______
___________________
Rheumatism (acute and chronic)__________
Diabetes_______________________ ________ ______
Alcoholism_________ ______ _________________ __
Cirrhosis of the liver_________ _______________
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart___ _____ ________ __
Arteriosclerosis_____________ ____________ . . .
Nephritis (acute and chronic)________________
Suicide (all forms)________ ______ ________ _____
Accidental or undefined violence
___
...
Occupational accidents______________ . . .
Vehicular accidents________ _____________
Homicide (all forms)__________________________
Occupational homicides__________________
A ll other causes___ ________ ___________________

2
66
7
59
8
75

0.3
9.4 13.6
1.0
8.4 13.6
1.1
10.7 ' l 8 . T

0.8
4.5

11. 5
2. 7
8.8
.7
6.8

8.5
1.2
7. 3
1.2
2.4

12.0

4.5
.8
18.9

0.7
10.6
.7
9.9
1.4
21.1

19
56
1
12
2
5
34
89
6
78
23
81
33
48
49
27
94

2.7
8.0
.1
1.7
.3
.7
4.9
12.7
.9
11.1
3.3
11. 6
4.7
6.9
7.0
3.9
13.4

3.0
1.5

3.5
4.2

4.1
6.8

4.5

.7
.7
.7
2.1
4.9

2.3
6.1
26. 5
12.9
14.4
18.2
7.6
12.9

8.5
4.9
11.3
4.2
5.6
4.9
3.5
19.7

2.0
.7
1.4
5.4
15. 5
.7
15.5
3.4
7.4
2.0
5.4
6.8
4.7
11.5

Total...... ..................... ..................... ...............
Occupational deaths_______. . . ____________ _
Nonoccupational deaths______________ _______

55
108
61
70

2.4
17.1

10.9

105
104

3.7

2.2

119

12.0
23.9
3.3
10. 9
2.2
5.4

71
82

4.5

40.~9~
27.3
31.8
22.7
13.6

1.2
7.3
18.9
1.2
18.3
.6
3.0
.6
.6
1.8
1.2
12.2

5.4
13.0

700 100.0 100.0 100.0 100.0 100.0 100.0 100.0
60
640

8.6
91.4

40.9
59.1

20.5
79.5

1 See page 18 for explanation of standardized relative index.




12.0
2.2
2.2

7.7
92.3

6.8
93.2

1.8
98.2 166.6

141
120

70

CAUSES OF D E A TH , BY OCCUPATION

Respiratory diseases.—The number of deaths for diseases of the
respiratory system, other than pneumonia, is too small to warrant
consideration. The proportionate mortality for pneumonia is suffi­
ciently higher than the average to indicate an excessive death rate
from this cause. The standardized relative index is 108. In the age
period 15 to 24 the relative index is highest (213), although the three
deaths in this period are too few to give a reliable index. From
35 to 54 years the index is 106. Exposure to the weather is probably
an important causative factor in these high ratios.
Tuberculosis of the respiratory system.—The proportionate mor­
tality for tuberculosis is generally much less than for all occupied
males. The standardized relative index is 70. In the age period
35 to 44, however, the relative index is 101. The figures are difficult
to interpret because of the wide variations in the ratios, but they
suggest a lower than average incidence of this disease.
Cancer (all forms).—The standardized relative index for cancer
is 104. The relative indexes are low in every age period, except 55
to 64, where the ratio is 30 per* cent in excess of that of all occupied
males.
Other diseases of the heart.—The standardized relative index is 82.
Up to age 44 heart disease is relatively unimportant. Thereafter,
however, normal ratios are exhibited. The highest relative index
is 102, in the age period 45 to 54. Because of the high total death
rate these ratios indicate an excessive number of deaths from diseases
of the heart at the older ages.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 141. At the ages 35 to 64 nephritis shows the highest
relative indexes of any of the important diseases. The highest rela­
tive index (166) appears in the age period 55 to 64. Exposure to
the weather is probably an important causative factor.
Suicide (a1 forms).—There are no deaths from suicide in the
1
first age period out of a total of 22 deaths from all causes. The
ratios are very high in the ages 25 to 54, the highest relative index
in these ages being 218 in the age period 25 to 34. A very low
ratio is recorded for the period 55 to 64 years, but the ratio is again
high in the last period. The figures indicate on the whole, a high
mortality from suicide among policemen. The familiarity with and
the ready availability of firearms is an important factor. We note
also a greater incidence of syphilis, a disease frequently associated
with high suicide rates.
Accidental or undefined violence.—The standardized relative index
is 120. In the age periods 15 to 24 and 25 to 34 the relative indexes
are high, being 165 and 160, respectively. Thereafter the propor­
tionate mortality is less than among all occupied males up to age
64. This may be due in part to the fact that many policemen are
taken from active duty at the older ages. Occupational accidents
account for 41 per cent of all accidental deaths and are very im­
portant up to age 34. In the age period 15 to 24 the relative index
is 396 and at 25 to 34 it is 202.
Homicide (all forTns).—Homicide looms up as one of the im­
portant causes of death among policemen in every age period except
65 and over. The relative indexes vary from four to over twelve



M O R T A LITY ACCORDING TO OCCUPATION

71

times the normal. In the first age period, 15 to 24, when more than
22 per cent of all deaths are due to homicide, it is the second largest
cause of death, being surpassed only by accidental violence.
Railway Enginemen and Trainmen 2
5
T h e o u t s t a n d i n g feature in regard to the mortality of railroad
enginemen and trainmen is the large number of deaths due to acci­
dent. The health of these workers is, on the whole, good; not only
are there no severe health hazards, but, in addition, many workers
are employed only after careful physical examination and are there­
after examined periodically. Because of the severe accident hazard,
however, the death rate for this group of railroad workers has prob­
ably been above the average. No death rates are available for a
comparable classification of railroad men, but some mortality data
are at hand for a few of the individual occupations included under
this title. In the medico-actuarial investigation (^) the ratio of ac­
tual to expected deaths among passenger trainmen was 137 per cent.
The death rate from accidents was six times the normal. The ratio
for locomotive engineers was 160 per cent; and the death rate from
accidents was eight times the normal. Among locomotive firemen
the mortality ratio was 190 per cent, with a death rate fr6m accidents
of nine times the normal.
There has been, however, a most gratifying reduction in the fatal
accident rate among, these workers since the medico-actuarial studjr
was completed, which has favorably affected the total death rate.
We are fortunate in having for comparison a special study of the
mortality of locomotive engineers published in the December, 1923,
Statistical Bulletin of the Metropolitan Life Insurance Co., which
shows clearly how great this improvement has been. The results
of this study are so instructive that we are reprinting the article in
full.

The special hazards of the locomotive engineer’s occupation seem not to
reduce his longevity prospect below that of males in the general population.
From figures recently submitted by the Locomotive Engineer’s Mutual Life and
Accident Insurance Association, it was calculated in our office that the Ameri­
can locomotive engineer in 1922 at the age of 28 had an expectation of 41.14
years, and this may be compared with the figure of 40.55 years for 1921
among males in the United States registration States at age 27.2 The mor­
6
tality experience of American males insured in the ordinary departments of
life-insurance companies for the period 1900-1915 showed an expectation of
39.36 years at age 28. This figure would now be much higher in view of the
vastly improved mortality experience since the table was prepared. Locomo­
tive engineers, therefore, appear to have an expectation of life about as good
as that for the average American male of corresponding age.
The last 10 years have seen a substantial decline in mortality among loco­
motive engineers, Between ages 31 and 55, the declines ranged from 32 to
44 per cent. Beyond age 55 the evidence is not clear because of the relatively
small numbers exposed to risk. In the following table we show certain age
data for mortality from all causes of death combined.
2 Includes railway engineers and firemen operating freight or passenger trains— coal or
5
oil burning locomotives; railway trainmen, freight (conductors, brakemen, flagmen, train­
men) ; railway trainmen, passenger (conductors, brakemen, baggagemen, flagmen, railway
mail and express employees, and ticket collectors). The average age at death is 43.2
years. (See note, p. 19.)
2 Life-table values for United States registration States available only at central ages;
6
that is, 27, 32, 37, etc.




72

CAUSES OF D E A TH , BY OCCUPATION

Death rates per 1,000, and expectation of life, at specified ages, Brotherhood of
Locomotivc Engineers, 1922 and 1912
Expectation of life

Death rate per 1,000

Age
period
1922

1912

Per cent
decline,
1922-1912

Brotherhood
o f
Locomotive
Engineers, 1922

Central
age

26
31
36
41
46
51
56
61
66
71
76
81

to
to
to
to
to
to
to
to
to
to
to
to

30___
35___
40___
45___
50___
55___
60___
65___
70-----75___
80___
85___

2.89
2.96
4.19
6.08
7. 81
12.56
25. 05
28.95
51. 72
85. 75
94. 67
100. 78

2. 89
4. 73
7. 42
9. 69
11.54
19. 30
25.03
34. 01
55. 85
70. 77
103. 45
295.45

37.4
43.5
37.3
32.3
34.9
i .l
14.9
7.4
1 21.2
8.5
65.9

28
33
38
43
48
53
58
63
68
73
78
83

Expecta­
tion of
life

41.14
36.68
32. 27
28.00
23. 86
19. 87
16. 45
13.39
10. 57
8. 71
7.31
5.15

United S t a t e s
registration
States,
males,
1921

Central
age

27
32
37
42
47
52
57
62
67
72
77
82

American M en U lt.,
1900-1915

Expecta­
tion of
life

Central
age

40. 55
36.46
32.41
28.47
24. 61
20. 87
17. 36
14.12
11.23
8. 75
6.68
5.06

28
33
38
43
48
53
58
63
68
73
78
83

Expecta­
tion of
life

39.36
35.19
30.99
26.84
22. 83
19.05
15.58
12. 47
9. 77
7.49
5. 62
4.14

1 Increase.

The most gratifying fact in this mortality experience is the decline in the
accident death rate. In 1912, fatal accidents occurred at a rate of 318 per
100,000; in 1922, the rate was 167 per 100,000. This reduction of nearly onehalf reflects a vast improvement in safety provisions for the operating per­
sonnel of our American railway systems and accounts for a large part of the
saving in mortality at the age range from 31 to 55 years. The typhoid fever
death rate for this occupation declined from 29 per 100,000 in 1912 to 2 per
100,000 in 1922. The tuberculosis death rate showed a drop from 55 to 40
per 100,000 in 10 years.
Increases were recorded in the crude death rates for certain of the diseases
characteristic of middle life and old age. Bearing in mind the change in age
distribution of this group between 1912 and 1922, we “ standardized ” the calcu­
lation of death rates for diseases of the heart and blood vessels— that is to say,
we assumed the age distribution of 1922 to hold for 1912 also, and found that
for organic heart diseases the death rate in 1922 was 74 per cent higher than
in 1912. Among males in the United States registration area, between 1910
and 1921, there was a decrease of 9 per cent for comparable ages in the
standardized death rate. For cerebral hemorrhage and apoplexy the increase
in the death rate between 1912 and 1922 was 11.4 per cent, but among males
in the general population there was a decrease of 2.2 per cent. These increases
in the death rate for two important diseases of middle life and old age were
not sufficient, however, to affect adversely the life-expectation figures, possibly
because most of the deaths fell in the advanced ages having a small proportion
of the total exposure to risk. Bright’s disease showed a decrease of 36 per
cent between 1912 and 1922 for locomotive engineers, as compared with a de­
crease of 23 per cent for males in the general population.

We can use this study as a basis for comparison in analyzing the
mortality experience of the group of railroad enginemen and train­
men under study in the present investigation, bearing in mind that
the industrial group includes firemen, conductors, and brakemen as
well as engineers.




73

M O RTALITY ACCORDING TO OCCUPATION

T able 3 2 . — Number and per cent of deaths from specified causes among white
m ales , r a ilw a y e n g in e m e n an d tr a in m e n , by age periods, 1922 to 1924

Cause of death

Number of deaths.................................................
Typhoid fever________________________________
Influenza, pneumonia_______________________
Influenza___________________
...............
Pneumonia (all forms)__________________
Other diseases of the respiratory system____
Tuberculosis of the respiratory system______
Syphilis, tabes dorsalis, and general paralysis
of insane------------- --------- -------------------------------Cancer (all forms)____________ _____ __________
Diabetes______________________________________
Alcoholism________________________ ________
Cirrhosis of the liver___________________ ____
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart----- ----------------------Arteriosclerosis_______________________________
Nephritis (acute and chronic)_______________
Suicide (all forms)____________________________
Accidental or undefined violence------------------Occupational accidents__________________
Railroad accidents.------- -------------------------Homicide (all forms)_____ _____ ____ _____ ____
All other causes----------------------------------------------

Ages 15 years
Per cent of deaths during age period— Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
34
24
54
64
44
ber
over index1
cent

2
41
12
29
3
85
17
50
16

2

10
46
71
3

66
6
230
183
174

0.3
5.3

2
.2
2.7

6
.0

8
.6
22.6

1
.0

14.7

1.4
4.3
1.9
.5
3.4

9.2
.4

124

0
.8
7.3
1
.6

6
.2
1
.2

5.0
.6
15.5
4.3
2.5

1
.2
.6
1
.2
.6
6
.8

1
.0

11.0

45.7
37.5
35.1
2.4
12.5

5.6

8
.0
2.7
10.7
3.6
.9
2.7
9.8
12.5

184
585

23.9
76.1

53.4
46.6

38.0
62.0

5.5
2.2
3.3
1.1
1.1

1 2
.6 .2
11.0
2
.2
2
.2
2.4

12.1
1.6

2.5
32.9
25.5
23.6

12.9
17.7

18.7
18.7

13.4

2.9
67.1
53.4
54.8
1.4

3.6
2.7

13.7
12.1
10.5
8.1

1
.2

16.1

25.5
74.5

75
43
12
61
97
154

18.7

13.4

.8

2
.2
3.3

2
.2
2
.2

118
75

241

13.2

18.8

100.0 100.0

100.0 100.0 100.0

Total------------ --------- -------------------------------Occupational deaths__________________________
Nonoccupational deaths_____________________

6.3
1.4
4.8
.5
17.3

1
.6

3.8
.4
11.1

6.5
2 .1
.3
1.3

208

161
0.6

73

769

8.9
91.1

10.5
89.5

2
.2

97.8

1 See page 18 for explanation of standardized relative index.

Typhoid fever.—There were only 2 deaths from typhoid in 19221924 out of 769 deaths from all causes. The low incidence of
typhoid is even more gratifying when viewed in the light of the
tremendous decline in mortality which has occurred since 1911-1913.
In that period there were 26 deaths from typhoid fever out of a
total of 947 deaths from all causes, high relative indexes being
recorded especially at the younger ages. Much of the improvement
is due to the activities of the railroads themselves in the betterment
of sanitary facilities for their employees; some of it is the tangible
result of the general public health movement.
Respiratory diseases.—The respiratory diseases are infrequent
causes of death. The standardized relative indexes for influenza,
pneumonia, and other diseases of the respiratory system are, re­
spectively, 75, 43, and 12. Although the ratios are based on but
few deaths, they undoubtedly represent low death rates from these
causes. In England and Wales, also, locomotive engine drivers,
firemen, and cleaners have low death rates from the respiratory
diseases. In the medico-actuarial investigation the mortality from
pneumonia among locomotive engineers was likewise below normal.
Tuberculosis of the respiratory system.—Tuberculosis is also much
less frequent than among all occupied males. The standardized rel­
ative index is 61 and the ratios are very low in every age period.
These figures are confirmed by the several studies mentioned above.



74

CAUSES OF D EATH , BY OCCUPATION

The proportionate mortality for all ages 15 years and over decreased
from 14 per cent in 1911-1913 to 11.1 per cent in 1922-1924. Among
locomotive engineers the death rate from tuberculosis declined from
55 per 100,000 in 1912 to 40 per 100,000 in 1922. Medical selection
and supervision are clearly important factors in the very low inci­
dence of tuberculosis among these men.
Cancer (all forms).—The standardized relative index is 97. The
death rate from cancer is probably above the average.
Diabetes.—The standardized relative index for diabetes is 154.
To be sure, the number of deaths upon which the ratio is based
is quite small; but we have confirmatory evidence of a high mor­
tality from this cause in the figures of the Registrar General of Eng­
land and Wales, 1921-1923. In that study, the death rate from
diabetes among locomotive engine drivers, firemen, and cleaners was
34 per cent higher than among all occupied and retired males and
diabetes was the only cause of death which showed an appreciably
excessive death rate in this occupational group. The reason for the
high death rate from this cause is quite obscure, though some condi­
tion in the occupation, possibly nervous strain, is perhaps influential.
Joslin (18) in his recent work on diabetes recorded the fact that one
chief surgeon of a railroad found 44 instances of glycosuria among
1,673 engineers and further study showed that the majority of these
men with glycosuria were really diabetics. About 20 per cent of all
the engineers were overweight. He cites also that at the meeting of
the medical and surgical section of the American Railway Associa­
tion (Circular No. M. & S. 61) it was stated that the chief surgeon
of a certain railroad employing approximately 50,000 men in its
train operations and movements reported that 0.05 per cent of all
trainmen have diabetes; of the engine men alone 1.07 per cent were
diabetics. The age factor, he says, may be of importance in evalu­
ating these statistics.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized
relative index is 118. The ratios are high at the older ages. The
proportionate mortality for all ages 15 years and over increased
from 3.4 per cent in 1911-1913 to 6 per cent in 1922-1924. This
trend is in agreement with that shown in the special study of loco­
motive engineers, where the increase in the death rate between 1912
and 1922 was 11.4 per cent.
Other diseases of the heart.—The standardized relative index is
75. The ratios are low in every age period. The trend, however,
since our earlier occupational mortality study is upward. The pro­
portion for all ages 15 years and over increased from 5.4 per cent in
1911-1913 to 9.2 per cent in the present study. The marked increase
in the rate for heart disease was also a feature in the special study
of locomotive engineers, the death rate in 1922 being 74 per cent
higher than in 1912.
Nephritis (acute and chronic).—Nephritis is relatively a more
common cause of death among railway enginemen and trainmen than
among all occupied males. The standardized relative index is 114.
It is probable that the death rate from nephritis has declined con­
siderably since the earlier study. Among locomotive engineers
there was a 36 per cent decline in the death rate from Bright’s dis­
ease between 1912 and 1922.



M O R T A LITY ACCORDING TO OCCUPATION

75

Accidental or 'undefined violence.—Accidental violence is the first
cause of death among railway enginemen and trainmen and accounts
for 29.9 per cent of all the deaths. In the age period 15 to 24, 67.1
per cent of the deaths are due to accidents. High ratios are found
in every age period up to 65. The standardized relative index is
241. The highest relative index is 275 in the age period 25 to 34.
Railroad accidents alone cause 22.6 per cent of the deaths from
all causes at ages 15 years and over and 54.8 per cent of the deaths
in the age period 15 to 24 years. The tremendous decrease in the
importance of accidental violence as a cause of death is outstanding,
as we have already said. The proportionate mortality for all ages
15 years and over decreased from 42.3 per cent in 1911-1913 to 29.9
per cent in the present study. Among locomotive engineers there
was a reduction of almost one-half in the fatal-accident rate. The
figures clearly indicate what a well-organized safety movement can
accomplish.
Railway Track and Yard W ork ers2
7
R a i l w a y track and yard workers experience an extremely high
mortality from accidental violence. In our earlier study, 19111913 ( i) , 20.8 per cent of all the deaths were attributed to accidents,
while 15.9 per cent of all the deaths were due to accidents in the
years 1922-1924. It is the high fatal-accident rate which is un­
doubtedly responsible, in a great measure, for the high total death
rate among these railroad workers. The medico-actuarial report
(4) gives ratios of actual to expected deaths in two similar railroad
groups; those whose work takes them more or less into the yards
showed a ratio of 141 per cent and those who supervise the tracks,
one of 126 per cent—the rates for accidents being four and three
times the normal, respectively. The relative indexes in this occupa­
tion for accidental causes do not vary much according to age. The
large number of deaths from accidents tends to make the proportion
of deaths from all other causes low. Nevertheless, influenza shows
a standardized relative index of 118 and cancer a standardized
relative index of 101.
Respiratory diseases.—Of the respiratory diseases, influenza dis­
plays the highest relative indexes, with a standardized relative index
of 118. Pneumonia ratios do not differ much from the normal. The
standardized relative index is 92. The number of deaths from other
diseases of the respiratory system is too small to give reliable ratios.
Tuberculosis of the respiratory system.—The proportionate mor­
tality ratios for tuberculosis are ail lower than the normal. The
standardized relative index is 87. The death rate from tuberculosis
is probably not very different from the average.
Cancer (all forms).—The standardized relative index for cancer is
101. In the first age period no deaths are recorded. High relative
indexes are noted at the ages between 25 and 54. In the age period 55
to 64, however, the relative index is 87, and the ratio is low also in
the indefinite period 65 and over. No occupational influence affect­
ing the death rate from this cause is apparent.
2
7 Includes section laborers, switchmen, track walkers, roundhouse workers, car cleaners,
airbrake inspectors and repairers, crossing watchmen and flagmen, car sealers, and track
repairers and graders. The average age at death is 52.2 years. (See note, p. 19.)




76

CAUSES OF D EATH , BY OCCUPATION

T a b l e 3 3 . — Number and per cent o f deaths from specified causes among tohite

male railway track and yard workers, by age periods, 1922 to 192k

Cause of death

Number of deaths

_

.................. ...............

Typhoid fever . .
................................ .........
Influenza, pneumonia
. ._ . .........................
Influenza__ ________________________ ____
Pneumonia (all forms). ____________ _____
Other diseases of the respiratory system . . . .
Tuberculosis of the respiratory s y s te m ______
Syphilis, tabes dorsalis, and general paralysis
of insane........................................................... .......
Cancer (all forms). ___________ _____ ______ _
Rheumatism (acute and chronic) ___________
Diabetes______ ______ _______ __________________
Alcoholism_______________ ____________________
Cirrhosis of the liver
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart_________________ _
Arteriosclerosis
............................................... ..
Nephritis (acute and chronic)................... .........
Suicide (all forms)...................................... .............
Accidental or undefined violence............... .......
Occupational accidents _________________
Railroad accidents.......... ................. ...............
Homicide (all forms)............................... ...............
All other causes. .......................... .........................
T o ta l................................................................
Occupational deaths................................................
Nonoccupational deaths__________ __________

Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
44
54
64
24
34
over index1
ber
cent

156

250

345

513

751

602

1.9
9.6
3.2
6.4
1.9
16.0

0.4
7.2
.4
6.8
.4
27. 6

1.2
10.4
4.3
6.1
1.7
18. 6

11.5
2.7
8.8
.8
11.7

0.1
9.3
1.6
7.7
1.2
5.9

8.8
1.7
7.1
1.0
2.0

118
92
81
87

1.9
2.0
8.9
3.2
.3
1. 3
.4
1.9
1. 6
.5
.4
1.0
7.9
2.0
15.2 "~5.~8~ 5.2
1.8
3.8
3.2
8.8
1. 7
1.3
1. 6
15.9 46.2 29. 6
10.3 30.8 22.4
9.3 27. 6 20.4
.6
2.4
.6
9.6 14.4
12.5

4.9
5.8
.6
.9
1.7
.6
2.0
8.7
.9
2.0
2.9
22.3
14.2
13. 3
1.2
13.6

2.7
10.9
.4
1.4
1.2
1.0
4.7
13.3
.6
10.1
2.3
13.3
8.6
7. 6
.2
14.0

1.2
11.5
.1
1.9
.3
2.0
12.1
19.8
1.6
9.9
1. 6
10.9
6.7
6.3
.3
10.4

1.0
10.3

83
101

2.2

97

2,617
9
251
57
194
29
274

0. 3
9. 6
2.2
7.4
1.1
10.5

51
232
7
41
14
26
207
398
47
231
44
415
270
244
15
326

.5
13.3
21.4
4.8
14.0
.7
7.0
3.8
3.0
.2
13.0

ioo
92
86
177

2, 617 100.0 100.0 100.0 100.0 100.0 100.0 100.0
274
2,343

10.5
89.5

30.8
69.2

22.4
77.6

14.5
85.5

8.8
91.2

6.9
93.1

3.8
96.2

1 See page 18 for explanation of standardized relative index.

Cerebral hemorrhage, apoplexy, paralysis.—The standardized rela­
tive index is 100.
Other diseases of the heart.—The standardized relative index is
92. The deviations from the average, however, are not large enough
to be interpreted as indicative of low death rates. The rates are
probably slightly higher than those for all occupied males.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 86. At the ages 45 to 54 and 55 to 64, where the
number of deaths is large enough to give reliable ratios, the relative
indexes are 104 and 90, respectively.
Accidental or undefined violence.—Accidental or undefined violence
is the primary hazard among these railroad workers, the standardized
relative index being 177. The ratios run from 155 to 186. The latter
figure appears in the age period 15 to 24 years. Occupational acci­
dents account for 65 per cent of all accidental deaths. Railroad acci­
dents are the cause of 59 per cent of the accidental deaths and over
9 per cent of all the deaths in this occupation. The death rate from
accidental violence has undoubtedly decreased at every age since
1911-1913.




77

M O R T A LITY ACCORDING TO OCCUPATION

Saloon Keepers and Bartenders2
8
T his t i t l e includes saloon keepers and bartenders insured in
Canada, and those men in the United States who have remained
in their old establishments selling soft drinks and who continue to
be designated as saloon keepers and bartenders. There were only
457 deaths in the three years 1922-1924, as compared with 2,190 in
the years 1911-1913 (1). Because of the-small numbers, the pro­
portionate mortality ratios in many instances are not conclusive.
The occupation, however, is an extremely interesting one because of
the light it throws on the effects of alcoholism.
All previous studies agree in showing excessive death rates for the
occupations in this group. The medico-actuarial investigation (4)
reported upon 13 occupation classes involving exposure to the liquor
hazard. Every class except proprietors and managers of distilleries
showed a ratio of actual to expected deaths well above the average.
Proprietors of saloons, billiard rooms, pool rooms, and bowling alleys
who attended bar had a ratio of actual to expected deaths of 173,
while those who stated they did not attend bar had a ratio of 182.
Barmen in England and Wales in 1921-1923 had a death rate almost
twice that of all occupied and retired males. High death rates were
exhibited from every cause except diabetes and appendicitis. Pro­
portionate mortality ratios can not show such a condition as this.
They do, however, point out clearly those diseases most affected by
alcoholism.
T able 3 4 . — Number and per cent o f deaths from specified causes among white

male saloon keepers and bartenders, by age periods, 1922 to 1924

Cause of death

Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
44
54
64
ber
cent
over index®

Number of deaths____________ _____ __________

457

56

122

140

93

41

Influenza, pneumonia........................ ...................
Influenza ____ _______________________
.
Pneumonia (all forms)___________________
Other diseases of the respiratory system .
Tuberculosis of the respiratory system_______
Syphilis, tabes dorsalis, and general paralysis
of insane.______ __________________ _______ _ .
Cancer (all forms).......................... ..................... __
Diabetes____ _____ ____ _____ ________ ______ _
Alcoholism ___________
.______
____ _____
Cirrhosis of the liver__________________________
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart____________________
Arteriosclerosis....... ............................. ........... .........
Nephritis (acute and chronic). ______________
Suicide (all form s)._________ __________________
Accidental or undefined violence_____________
Homicide (all forms)_____ _____ _______________
All other causes_____ ______ ___________________

44
7
37
4
70

12.5
9.6
3.6
1.5
8.9
8.1
.9
15.3 l a o - 21.4

10.7
1.6
9.0
1.6
23. .0

10.7
1.4
9.3

6.5

7.3
2.4
4.9

26
37
9
15
24
27
61
1
59
6
19
12
43

3.6
5.7
8.1
1.8
2.0
1.8
3.3
1.8
5.3
5.9 --------"Yi"
13.3
.2
12.9 20.0 14.3
3.6
1.3
5.4
4.2
2.6 ’ 20.~6’ 12.5
9.4 20.0 14.3

6.6
4.1
1.6
7.4
5.7
2.5
11.5

7.1
7.1
1.4
2.9
9.3
7.1
15.0

13.9
.8
2.5
1.6
6.6

10.0
1.4
5. 0
1.4
7.1

Total........................................ .........................
Occupational deaths.................... _____.................
Nonoccupational deaths__________ _____ ______

5

14.3

6.5
2.2
7.5
4.3
16.1
5.4
1.1
2.2
9.7
15.1
1.1
12.9

2.4
4.9
14.6
2.4
12.2
19.5

5.4

17.1
2.4
2.4

10.8

56
88
65
114
179
101
157
94
84

14.6

175
34

457 100.0 100.0 100.0 100.0 100.0 100.0 100.0
1
456

.2
99.8 100.0 155.0 100.0 100.0

1.1
98.9 100.0

° See page 18 for explanation of standardized relative index.
2 Includes bartenders and proprietors of cafSs, saloons, and liquor stores.
8
age at death is 48 years. (See note, p. 19.)

68357°— 30------- 6




Tlie average

78

CAUSES OF D EATH , BY OCCUPATION

Although the number of deaths from alcoholism is small, the con­
sistently high ratios point to an inordinate incidence of this condi­
tion. The highest relative index (390) appears in the age period
35 to 44. Nephritis and cirrhosis of the liver also have very high
relative indexes. The standardized relative index for nephritis is
175. The relative indexes for cirrhosis of the liver are from four
to six times the normal in the age periods 25 to 54. That the greater
frequency of these diseases is a direct effect of alcoholism is corrobo­
rated by every mortality study of persons who drink alcohol to ex­
cess. Syphilis is associated with alcoholism and occurs very fre­
quently as a cause of death in the liquor trades. This study shows
a standardized relative index for syphilis, tabes dorsalis, and general
paralysis of the insane of 179. Homicide is another cause of death
indirectly attributed to the excessive use of alcoholic liquor. Deaths
from homicide for all ages combined are relatively three times as
frequent as the average. Tuberculosis is also a more frequent cause
of death than among all occupied males. The standardized relative
index is 114. Cerebral hemorrhage and heart disease show lower
proportionate mortality ratios, the standardized relative indexes
being 94 and 84, respectively. The standardized relative index for
accidents in this experience is so low (34) as to merit special com­
ment. It is interesting to note, however, that English barmen had
a more than average accident rate.
Shoe Factory W ork ers2
9
S hoe m a n u f a c t u r i n g , as a whole, is not inherently a hazardous
industry. The medico-actuarial investigation (4) reports a ratio of
101 per cent actual of expected deaths among shoe manufacture
operatives. The death rate in England and Wales (5) for two types
of shoe factory operatives was 10 and 12 per cent above the average.
In both studies, tuberculosis is the cause of an excessive number of
deaths. That this condition is not casual is confirmed by several
other analyses of deaths in this industry. In the Metropolitan in­
dustrial experience, tuberculosis displays high proportionate mor­
tality ratios in every age period from age 25 to 64. The standard­
ized relative index is 118. The highest relative index (131) appears
in the age period 55 to 64. In the first age period a normal ratio
prevails. Except for a few dusty processes, employing relatively
few people, it is difficult to point to any specific hazards which
would account for the high tuberculosis incidence. Probably the
explanation is the general insanitary condition of the factory, fatigue,
and the fact that weaker individuals are attracted to this type of
work.
29 Includes foremen and workers in the process of manufacturing shoes: Beaders,
binders, bottomers, corders, crimpers, crowners, shoe cutters, tinkers, edgers, heel makers,
liners, solers, vampers, and welters. The average age at death is 47.4 years.
(See
note, p. 19.)




79

M O R T A LITY ACCORDING TO OCCUPATION

T a b l e 3 5 . — Number and per cent o f deaths from specified causes among w hite

male shoe factory workers, by age periods, 1922 to 1924

Cause of death

Ages 15 years
Per cent of deaths during age period— Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
44
54
64
over index*
ber
cent

Number of deaths _ _

834

Typhoid fever______________________ _________
Influenza, pneumonia..................... ........... ...........
Influenza__________________ _______________
Pneumonia (all forms)______________ _____
Other diseases of the respiratory system..........
Tuberculosis of the respiratory system_______
Syphilis, tabes dorsalis, and general paralysis
of insane____________ _____ ___________ _______
Cancer (all forms).......................... ................. ........
Rheumatism (acute and chronic)____________
Diabetes_____ _____ ______________________ _____
Alcoholism
_____________________ _____ ______
Cirrhosis of the liver________________ _________
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart..................................
Arteriosclerosis_____________ ___________ ______
Nephritis (acute and chronic)....... ............. .......
Suicide (all forms)_________ ______ _____________
Accidental or undefined violence..................... .
Occupational accidents _ .......... ............... ..
Traumatism by machines....... ................. .
Homicide (all forms)........................................... ..
All other causes__ ...................... ....................... .

7
80
17
63
9
137

0.8
9.6
2.0
7.6
1.1
16.4

16
72
2
9
8
5
54
126
13
68
24
64
3
1
4
136

Total.................................................. ...............
Occupational deaths.................... ........... ...............
Nonoccupational d e a th s ____ ______ _____ ____

109

116

132

130

185

162

0.9
6.4
1.8
4.6
.9
23.9

2.6
11.2
2.6
8.6
.9
35.3

0.8
12.1
1.5
10.6
.8
25.8

0.8
11.5
2.3
9.2
1.5
15.4

0.5
8.1
.5
7.6
.5
8.1

8.6
3.7
4.9
1.9
.6

78
103
62
118

.9
.9
1.9
.9
2 .6
8.6
1.8
.2
.9
1.1
1.7
1.0
.6 . . . . . .
6.5
6.3 13.8
15.1
1.6
8.2 ~2.~8~ " _3 .T
3.4
4. 6
2.9
7.8
7.7 22.0
.9
.4
.9
.9
.1
.9
26.6 13.8
1U

3.8
3.0

1.5
9.2

3.2
13.0

.6
17.3

86
96

.8
.8

.8
1.5
.8
3.0
16.2
.8
9.2
3.0
4.6

1.6
1.6
.5
9.7
16.2
1.6
15.1
1.6
5.4

1.9

66

1.9
15.4
24.1
4.9
8.0
1.9
1.2

.8
19.2

13.0

.6
11.1

” LY 'To
9.8
.8
6.0
3.8
9.8
.8

.8
18.2

84
101
111
73

834 100.0 100.0 100.0 100.0 100.0 100.0 100.0
5
829

.6
99.4

.9
99.1

.9
99.1

.8
99.2

.8
99.2

io .’o
o "

.6 .............
99.4

1 See page 18 for explanation of standardized relative index.

Pneumonia is also more prevalent than among all occupied males
from age 25 years to 54, the highest relative index being 114 in the
age period 35 to 44. The standardized relative index is 103. Acci­
dental violence is very low throughout. The standardized relative
index is 73. Out of a total of 834 deaths from all causes only 1
fatality was due to machinery. Suicide is particularly prevalent at
every age. In the age period 15 to 24 the percentage of deaths from
suicide is almost three times the normal and for all ages combined
the relative index is 161. Other causes of death do not exhibit
important or significant variations and, apparently, the total death
rate does not differ markedly from the average.
Stationary Engineers and Firemen 3
0
T h e m o r t a l it y rate of stationary engineers and firemen insured
in our industrial department is probably somewhat higher than the
average for all occupied males. In the medico-actuarial investiga­
tion of 1913 (4), the mortality of a group of stationary firemen not
engaged in hazardous industries was 10 per cent more than expected.
A group of stationary engineers insured in the ordinary department
of the Metropolitan Life Insurance Co. during the years 1915 to
1926 showed an average mortality when compared with standard
80 Includes steam boiler and engine operators in factories, power houses, building con­
struction, mines (above ground), and shipyards. The average age at death is 53,8 years.
(See note, p. 19.)




CAUSES OF D EATH , BY OCCUPATION

80

lives, while stationary firemen showed an excess mortality of over
75 per cent. English stationary engine and crane drivers had a
mortality rate which was 6 per cent less than that of all occupied
and retired males in the years 1921-1923 (5).
The highest standardized relative index found for any cause in
the present study (124) is for cancer. Other causes showing not­
ably high percentages of deaths are pneumonia and other dis­
eases of the respiratory system, diabetes, nephritis, and accidental
violence. An outstanding feature of the mortality of these workers
is the very low percentages found for tuberculosis.
T a b l e 3 6 . — Number and per cent o f deaths from specified causes among w hite

male stationary engineers and firemen, by age periods, 1922 to 1924

Cause of death

Ages 15 years
Per cent of deaths during age period— Stand
and over
ardized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
44
54
24
34
64
over index i
ber
cent

................................................

9
138
25
113
24
116

38

Total

_

________________________

Occupational deaths____________ ______________
Nonoccupational deaths______________________

39
193
7
33
7
17
122
264
23
174
23
149
66
15
20
220

97

224

358

493

355

5.3
3.1
15.8 11.3
2.1
2.6
13.2
9.3
5.3
13.2 ’ 22.' 7"

0.9
10.7
1.8
8.9
1.8
12.9

0.3
8.4
1.7
6.7
2.0
9.2

9.1
1.8
7.3
.6
4.5

0.3
6.2
.8
5.4
2.3
1.4

2.5
2.1
2 1
12.3
.4
1.0
2.1
2.1
.4
1.1
2.6
2.1
7.8
16.9 ~2.~6~ 6.2
1. 5
4.1
2.6
11.1
2.1
1.5
2.6
9.5 26.3
19.6
4.2 15.8 11.3
1.0
3.1
1.3
10.5
4.1
.4
2.1
2.6
14.1 21.1
19.6

5.4
7.6
.9
1.3
1.3

4.2
12.3

1,565

Typhoid fever
____________________
_
Influenza, pneumonia_ _____________ ______
Influenza____ ______ ______________________
Pneumonia (all f o r m s ) ..________ ________
Other diseases of the respiratory system
Tuberculosis of the respiratory system_______
Syphilis, tabes dorsalis, and general paralysis
of insane
_____________________________
Cancer (all form s) __________________________
Rheumatism (acute and chronic)____________
______________ ______________
Diabetes
_________ _____
________
Alcoholism
Cirrhosis of the liver________________ ________
Cerebral hemorrhage, apoplexy, paralysis___
Other diseases of the heart____________________
________
Arteriosclerosis
Nephritis (acute and chronic)________________
Suicide (all forms)________ ____________________
Accidental or undefined violence____________
Occupational accidents. ____________ ____
_
Burns (conflagration excepted)_ _______
Traumatism by machines______________
Homicide (all forms)_________________________
All other causes______ _________ ______________

Number of deaths

0.6
8.8
1.6
7.2
1.5
7.4

.9
12.9
9.4
1.3
15.6
5.8
.9
1.3
.4
16.5

.8
.6
2.2
5.0
17.0
1.1
8.9
1.4
8.9
3.9
.6
1.1
.8
16.8

1.2
15.6
.6
3.2
1.0
10.1
17.6
1.6
14.4
1.4
7.5
3. 7
1.2
.8

1.1
14.9
.3
2.5
.6
.8
14.1
22.5
3.1
12.7
1.4
4.5
1.1
.6
.3

11.4

95
107
119
68
100
124

11.3

118
87
97
116
114

1, 565 100.0 100.0 100.0 100.0 100.0 100.0 100.0
68
1,497

4.3
95.7

15.8
84.2

11.3
88.7

5.8
94.2

3.9
96.1

3.9
96.1

1.4
98.6

1 See page 18 for explanation o f standardized relative index.

Respiratory diseases.—Of the respiratory diseases, pneumonia is
the only one responsible for a sufficient number of deaths to permit
analysis. The standardized relative index is 107. The relative
indexes are high only at the younger ages. After age 34 the percent­
ages are consistently less than those of all occupied males.
Tuberculosis of the respiratory system.—The death rate from
tuberculosis is clearly very low. The standardized relative index is
68. The relative indexes are very low in every age period, never
exceeding 77. The reasons for this result are not clear, since these
men, especially firemen, are generally obliged to work in very hot,
and often dusty, confined spaces. Their freedom from tuberculosis
is perhaps due to the fact that only sturdy individuals can carry on
this type of work.



M O R T A LITY ACCORDING TO OCCUPATION

81

Cancer (all forms).-—Cancer is the second largest cause of death
among stationary engineers and firemen and accounts for 12.3 per
cent of the deaths from all causes combined. The standardized
relative index is 124. The relative indexes are high in every age
period except 15 to 24, when no deaths from this cause are recorded.
It is interesting to note that in England and Wales the death rate
from cancer (all forms) among stationary engine and crane drivers
was slightly above the average and the rate for cancer of the
stomach was 30 per cent higher than that of all occupied and retired
males. It is possible that exposure to radiant heat may be a contribu­
tory factor.
Cerebral hemorrhage, apoplexy, paralysis.—The proportionate
mortality from this cause is rather low, the standardized relative
index being 87. Low ratios are found at all of the significant ages.
Other diseases of the heart.—The ratios are high at the ages 35
to 54 years, but the low ratios in the other age periods bring the
standardized relative index down to 97. This figure, however, prob­
ably represents an actual death rate somewhat higher than the aver­
age because of the higher total death rate. In England and Wales
the death rate from valvular diseases of the heart among stationary
engine and crane drivers is 26 per cent above that of all occupied
and retired males, while the death rate for other heart disease is 21
per cent below the average.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 116. The highest relative index (140) occurs in the
age period 35 to 44. The ratio is also high in the age period 55 to
64 years, where the relative index is 131. The relative indexes for the
other age periods range from 92 to 96.
Accidental or undefined violence.—The relative index is high in
every age period. The standardized relative index is 114. The ex­
cessive number of deaths from accident is clearly of occupational
origin, the relative indexes for occupational accidents running from
118 to 229. Burns and machinery accidents cause an inordinate
number of deaths. In the age period 15 to 24, fatalities from
machinery accidents account for 10.5 per cent of all the deaths in
that age period, as compared with 1.3 per cent among all occupied
males.
Store Clerks and Salesmen 3
1
T h e d e a t h rate for salesmen and clerks in retail stores, an occupa­
tion possessing no apparent serious occupational hazard, is probably
below average. Notably high standardized relative indexes are found
for diabetes and nephritis, while the ratios for accidents are very
low. In England and Wales (5) for the years 1921-1923, salesmen
and shop assistants as a class had an average total death rate.
However, open shop (fish, meat, etc.) workers showed a very high
rate—28 per cent above average.
3
1 Includes clerks, cashiers, salesmen, messengers, and window dressers in wholesale and
retail stores ; meat cutters in retail butcher stores ; clerks, buyers, and floorwalkers in
department stores. The average age at death is 42,7 years, (See note, p, 19.)




82

CAUSES OF DEATH , BY OCCUPATION

T a b le

3 7 .— Number and per cent of deaths from specified causes among w hite
male store clerks and salesmen, by age periods, 1922 to 1924

Cause of death

N ” ttiher nf deaths
Influenza, pneumonia.............
................ ..
Influenza___________________ ______________
Pneumonia (all forms)_____________ ______
Other diseases of the respiratory system .........
Tuberculosis of the respiratory system_______
Syphilis, tabes dorsalis, and general paralysis
of insane
_____________________ _____ _______
Cancer (all forms) ............ ......... ...........................
Rheumatism (acute and chronic)............ .........
Diabetes_________ ______ ________________ ______
Alcoholism
_
______ ______ _.
Cirrhosis of the liver
Chronic occupational poisonings
Lead poisoning
Cerebral hemorrhage, apoplexy., paralysis___
Other diseases of the heart____ _______ _______
Arteriosclerosis _________________________ . _
Nephritis (acute and chronic)...... ................... ..
Suicide (all forms)
__ _
Accidental or undefined violence................ ..
Occupational accidents__________________
Homicide (all forms)__ ______________________
All other causes........................... ................. ...........
T o t a l ..............................................................
Occupational deaths
..........................
Nonoccupational deaths __________ .

Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
64
44
54
over index i
24
34
ber
cent

578

551

621

537

394

1.8
0.3
8.5
8.1
1.8
2.0
6.8
6.1
1. 6,
k *9
24.3 33.9

0.5
11.6
3.3
8.3
.7
20.0

0.8
8.4
1.0
7.4
1.1
12.9

7.3
1.3
6.0
1.1
6.3

6.6
2.0
4.6
1.8
1.5

4.9
4.7
.2
1.6
1.3
1.1
.2
.2
3.4
10.0

3.5
7.2
.3
1.8
1.3
1.6

1.8
13.4
.2
3.2
.4
2.2

.8
10.4
.8
2.8

8.1
16.3
.5
12.2
2.4
7.1
.5
.2
14.3

9.7
19.9
1.1
12.8
1.5
3.0
.4

14.5
27.2
5.1
13.7
.8
2.3
.5

16.2

10.4

621

3,302
21
281
62
219
39
577

0. 6
8.5
1.9
6.6
1.2
17.5

87
206
16
60
20
36
1
1
190
490
30
294
76
285
21
35
558

2.6
6.2
.5
1.8
.6
1.1

.8
1.3
.8
1.0

5.8
14.8
.9
8.9
2.3
8.6
.6
1.1
16.9

.6
11.1
2.7
1.8
18.8
1.1
1.8
23.0

3.6
2.4
.7
1.0
.5
.3
1.4
8.8
.2
4.0
3.8
10.6
.9
2.6
16.8

10.0
3.1
6.9
.4
1.5
18.3

87
86
74
104
110
95
137

1.5
106
109
121
67

3, 302 100.0 100.0 100.0 100.0 100.0 100.0 100.0
23
3,279

.7
99.3

1.1
98. 9

.9
99.1

.5
99.5

.6
99.4

.4
99.6

.5
99.5

1 See page 18 fo r explanation o f standardized relative index.

Respiratory diseases.—The proportionate mortality for respiratory
diseases is, on the whole, less than among all occupied males. In only
a few ages are the relative indexes more than 100. The standardized
relative indexes for influenza, pneumonia, and other diseases of the
respiratory system are 87, 86, and 74, respectively. Low relative
indexes are found also for pneumonia and influenza among mer­
chants and storekeepers, who have the same occupational environ­
ment. Salesmen and shop assistants in England and Wales also
showed low death rates from these diseases in the years 1921-1923.
Tuberculosis of the respiratory system.—The ratios for tubercu­
losis are about average, the relative indexes fluctuating slightly above
or below 100 up to age 64. The standardized relative index is 104. In
only one age period, 25 to 34, is there an appreciable variation,
which shows a ratio 15 per cent above that for all occupied males.
Although from the standpoint of hygiene the industrial environment
in this occupation is very similar to that found among bookkeepers
and office assistants, the proportionate mortality for tuberculosis
is much lower. This difference is perhaps attributable to the greater
activity of store clerks and salesmen.
Cancer (all forms).—The relative indexes for cancer are high
in the ages 15 to 44. The highest relative index (120) is in the
period 25 to 34. In spite of the high ratios recorded for this cause
at the younger ages, it would appear that the death rate is not
higher than that of all occupied males. The standardized relative



M O R T A LITY ACCORDING TO OCCUPATION

83

index is 95. In the age period 45 to 54, when the cancer rate assumes
an important position, the relative index is 75 and in the next age
period, 55 to 64, the ratio is about average. There are apparently
no occupational influences affecting the cancer rate among store
clerks and salesmen.
Diabetes.—The standardized relative index is 187. High relative
indexes are recorded in every age period after 35. English sales­
men and shop assistants have a death rate from diabetes 46 per cent
above the average.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized rel­
ative index is 106. The relative indexes are high up to age 54. In
the age period 55 to 64 the relative index is 89. In England and
Wales salesmen and shop assistants have average mortality.
Other diseases of the heart.—The standardized relative* index is
109. The proportionate mortality is high in every age period. The
relative indexes decrease with age, the maximum being 146 in the age
period 15 to 24 and the minimum 101 in the age period 55 to 64.
This tendency is perhaps associated with physical weakness among
the younger people entering this occupation and their gradual
weeding out.
Nephritis (acute and chronic).—Nephritis shows high mortality
percentages after age 34, the highest relative index (149) appearing
in the age period 35 to 44. The standardized relative index is 121.
English salesmen and shop assistants as a group showed a death
rate from chronic nephritis 5 per cent below the average.
Suicide (all forms).—A high proportion of deaths from suicide is
found in every age period. The highest relative index (136) is
recorded for the age period 25 to 34. With the exception of this one
ratio, the relative indexes do not indicate actually higher death
rates, in view of the probably favorable total death rate.
Accidental or undefined violence.—The relative indexes for acci­
dents are conspicuously low at every age period, the highest being
83 in the age period 45 to 54 and the lowest being 48 in the age
period 55 to 64. The standardized relative index is 67. Occupa­
tional accidents are very few.
Tailors and Other Clothing Workers 3
2
T h o u g h garment workers are usually described as being engaged
in unhealthful occupations, all available death rates for this group
are very close to average. In the medico-actuarial investigation
(li), the number of deaths among journeyman tailors was 99 per
cent of the number expected. In the intercompany group insurance
mortality experience (9), clothing workers showed a ratio of actual
to expected deaths of 80.1 per cent as compared with a percentage
of 90.2 for all industries. In England and Wales (5), the death
rate among tailors, tailors’ pressers, and machinists was 2 per cent
above the average and among cutters of textile goods and clothing
(not machine cutters) it was 17 per cent above the average. Cer­
32
Includ es forem en and w orkm en in garm ent factories and tailo r shops, m akin g suits,
coats, cloaks, and o v e r a lls : T a ilo rs, cloth cu tters, buttonhole m akers, clothing cu tters,
cloth in g designers, m achine operators on suits,, coats, cloaks, an d overalls, cloth in g
pressers and trim m ers.
M akers o f w aists, ties, caps, handkerchiefs, scarfs, shirts, collars,
cuffs, corsets, gloves, and other sm all articles of clothing.
(E xclu d es all tex tile w orkers.)
T h e average age a t death is 5 3 .8 years.
(S ee note, p. 1 9 .)




84

CAUSES OF D EATH , BY OCCUPATION"

tain causes of death are more frequently found than among all occu­
pied males; but these are counterbalanced by low rates for other
diseases, thus maintaining the total death rate at an average level.
Tuberculosis, especially at the younger ages, has been found much
more prevalent among these workers. The present study indicates
that tuberculosis is still a problem of the industry. Higher ratios
are also found for cancer, other diseases of the heart, and nephritis.
Diabetes is extremely prevalent, the proportion of deaths from this
cause being 85 per cent above the average for the ages 15 to 64 years.
The very low accident ratio is the most gratifying feature of the
mortality picture.
T a b l e 3 8 . — Number

and per cent o f deaths from specified causes among w hite
male tailors and other clothing workers, by age periods) 1922 to 1924
Ages 15 years
Per cent of deaths during age p e r io d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
44
34
54
64
ber
cent
24
over index1

Cause of death

Number of d e a t h s . ______________

1,175 i______
I

.

Typhoid fever___ ______________________ ______
Influenza, Dneumonia _________________
Influenza_____________ _______ ____________
Pneumonia (all forms) __ ________________
Other diseases of the respiratory system .
Tuberculosis of the respiratory system . . .
Syphilis, tabes dorsalis, and general paralysis
of insane______ ______________________________
Cancer (all forms)____________________________
Rheumatism (acute and chronic) _______ _____
Diabetes______________________ ______________
Alcoholism.................... ............................... .............
Cirrhosis of the l i v e r .. ________ _______________
Cerebral hemorrhage, apoplexy, paralysis.. .
Other diseases of the h e a rt___________________
Arteriosclerosis_________ _ ______ __
Nephritis (acute and chronic)________________
Suicide (all forms) __
_ _
_ _ _
Accidental or undefined violence____ _______
Homicide (all forms)____________________ . _
All other causes_________________ ________ _____
T o t a l ................ ............. ...........................
Nonoccupational deaths...................... ....

_ _

57

4 i 0.3
3. 5
108 1 9.2
5.3
1.4
16
92
7.8
5.3
22
1.9
136 ; 11.6 ’ 42." I"
1
2.2
26
121 10.3
4
.3
36
3.1
1.8
4
.3
11
.9
101
8.6
232 19.7 10.5
1.5
18
123 10.5 1 3.5
20
1. 7
3. 5
4.7 I 19.3
55
6
.5 ! 1.8
8.8
148 12.6

90

124

241

390

273

1.1
14.4
3.3
11.1

0.8
8.9
1.6
7.3
.8
23.4

9.1
2.5
6.6
2.9
10.8

9.2
.8
8.5
2.3
4.9

8.4
.7
7.7
1.8
2.6

78
97
104
118

4.1
11.6
.8
3.3
.4
.4
5.8
20.3
.'8
10.8
1.2
2.1
.4
14.9

1.5
14.9
.3
4.9
.5
1.0
10.8
20.8
1.8
11.5
1. 5
3.3

1.5
9.9

89
113

2.6

185

1.8
15.4
26.0
2.6
12.1
.4
3.7

10.8

11.4

34." 4

2.4
6.5

3.3
1.1

8.9
1.1
3.3
3.3
6.7
3.3
18.9

.8
.8
.8
2.4
13.7
.8
11.3
4.0
8.1
.8
13.7

94
123
115
56

1,175 100.0 100.0 100.0 100.0 100.0 100.0 100.0
1,175 100.0 100.0 100.0 100.0 100.0 100.0 1100.0

1 See page 18 for explanation of standardized relative index.

Respiratory diseases.—Standardized relative indexes for influenza
and pneumonia and other respiratory diseases are 78, 97, and 104,
respectively.
Tuberculosis of the respiratory system.—The standardized rela­
tive index for tuberculosis is 118. The relative indexes are high
up to age 44, the highest relative index (179) being found in the age
period 15 to 24 years. In the following age periods the ratios are
117 and 113, respectively; but after age 44 the ratios are below
average. The high ratios in the younger ages especially indicate
the disadvantages of this occupation when considered in connection
with the racial composition of these workers. In this country gar­
ment workers are recruited largely from Jewish and Italian stocks,
among whom tuberculosis is less frequently found than among other
foreign race stocks. In England and Wales clothing workers ap­



M O R T A LITY ACCORDING TO OCCUPATION

85

parently suffer inordinately from tuberculosis, for among cutters ancl
tailors the death rates for tuberculosis of the respiratory system are,
respectively, 88 and 42 per cent higher than the average.
Several investigators, notably Schereschewsky (19), Landis (£0),
and Robinson and Wilson (#i), found, on physical examination of
garment workers, an excessive number of cases of tuberculosis. They
attributed their high figures to low wages, the stress and strain of
piecework, faulty posture, and insanitary home conditions. More
recently Price (0#), who has had under constant observation the
health of more than 100,000 garment workers, found that about 1
per cent of the workers in this industry have tuberculosis, a finding
not very different from the average among all occupied persons.
Among tailors and clothing workers insured in the industrial
department the percentage of deaths from tuberculosis for all ages
15 years and over has decreased from 18.9 per cent in 1911-1913
to 11.6 in 1922-1924. Undoubtedly there has been a marked im­
provement in the economic position of these workers since the
earlier studies were made. The old sweatshops have been largely
abolished, wages have been increased, hours of labor shortened, and
factory conditions generally improved. Nevertheless, the high pro­
portions found in this investigation show clearly that there is still
room for improvement, especially among the younger workers.
Cancer (all forms).—The standardized relative index for cancer
is 113. No deaths were recorded up to age 34. After age 34, except
for the indefinite age period 65 and over, the ratios are higher than
average. In the age period 35 to 44 years the relative index is 151;
the figure decreased to 113 in the age period 55 to 64.
Diabetes.—The standardized relative index for diabetes is 185.
The number of deaths at the younger ages is too small to yield
significant ratios. Between the ages 45 and 64 years, however, the
percentages are more than twice the average. The high ratio is
probably due to the racial composition of the group. Jews, among
whom diabetes is known to be very common, form a large proportion
of American clothing workers.
Other diseases of the heart.—The standardized relative index is
123. The relative indexes are high at every age period. The highest
relative index (149) is found in the age period 35 to 44. There is no
apparent direct occupational influence on the incidence of these
diseases.
Nephritis (acute and chronic).—The standardized relative index
for nephritis is 115. The highest relative index (169) appears in the
age period 35 to 44.
Suicide (all forms).—Up to age 44, the relative incidence of suicide
is quite high. Schereschewsky has pointed out that the garment
workers suffer inordinately from neurasthenia and suggests that low
wages and irregularity of employment are important causative fac­
tors. There is undoubtedly a direct relationship between the preva­
lence of neurasthenia and the frequency of suicidal deaths.
Accidental or undefined violence.—Accidental causes are response
ble for relatively few deaths in the clothing industry and are unim­
portant from an industrial point of view. The standardized relative
index is 56. No fatal occupational accidents were recorded.



CAUSES OF DEATH , BY OCCUPATION

86

Teamsters and Drivers 3
3
T eam sters have been found to have higher death rates than the
average. In the medico-actuarial study (%) they showed a ratio of
actual to expected deaths of 116 per cent. Death rates from acci­
dents and pneumonia were 50 per cent above the standard. In the
English study (5) the mortality of men driving horse-drawn vehicles
was 38 per cent higher than that of all occupied and retired males.
All the important causes of death showed higher death rates than the
average, diseases of the respiratory system being especially high. In
the present study accidents and syphilis show high standardized
relative indexes. The indexes for all the other numerically im­
portant causes with the exception of diabetes run from 92 to 103,
indicating, in view of the high total death rate, a somewhat higher
than average incidence of these causes among teamsters and drivers.
T a b le

3 9 .— Number and per cent o f deaths from specified causes among w hite
male teamsters and drivers, by age periods, 1922 to 1924
Ages 15 years
Per cent of deaths during age p e rio d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
44
34
ber
54
64
cent
over index1

Cause of death

_ __________

3,601

331

566

733

Typhoid fever................................................ ...........
Influenza, pneumonia___________________ _____
Influenza
_
_
___________
Pneumonia (all form s)
_ __________
Other diseases of the respiratory system _____
Tuberculosis of the respiratory system ______
Syphilis, tabes dorsalis, and general paralysis
of insane
_______________________
Cancer (all forms) __________________________
Rheumatism (acute and ch ronic)...................
Diabetes
__ _______________________________
A lco h olism ....... ...................................... ..............
Cirrhosis of the liver _________________________
Cerebral hemorrhage, apoplexy, paralysis. __
Other diseases of the heart____ _______________
A rteriosclerosis. ________________________ _____
Nephritis (acute and chronic)..... ........................
Suicide (all form s)...................................................
Accidental or undefined violence____________
Occupational accidents................................ ..
Automobile accidents............ .........................
Vehicular accidents (excluding auto­
mobile accidents)...................... .......... ......
Homicide (all forms)______ ______ _____________
All other causes ........................................ ...........

19
369
73
296
57
560

0.5
10.2
2.0
8.2
1.6
15.6

3.6
8.2
1. 5
6. 6
1.5
19. 9

0.5
12.2
3.2
9.0
2.5
25. 6

0.4
13.8
2. 5
11.3
1.1
23.6

101
270
14
41
50
38
218
473
47
282
54
490
224
104

2.8
7.5
.4
1.1
1.4
1.1
6.1
13.1
1.3
7.8
1.5
13.6
6.2
2.9

.3
1.8
1.2
1.2
.6

2. 5
1.9
.7
.7
1.6

.6
3.3

1.1
8.3

1.2
1.5
28.1
9.4
8.2

3. 7
3.0
19.8
9.5
4.4

4.0
3.3
.4
1.1
2. 0
.7
2.5
8.9
.3
6.8
2.2
13.5
6.4
2.3

151
38
480

4.2
1.1
13.3

6.0
3.9
23.0

6.7
2.3
13.6

4.6
1.0
14.6

Number of deaths

-

T o t a l ................................................................
Occupational deaths _ _______________________
Nonoccupational deaths_____________ ______

742

701

528

10.8
1.9
8.9
1.3
14.2

0.1
7.3
1. 3
6.0
1.0
8.6

7.8
1. 7
6.1
2.5
2.1

.9
1.9
1.8
5.7
14.4
.7
8. 5
1.5
11.6
5.4
2.7

2.0
14.0
.3
1.7
1.3
2.0
10.4
18.3
1.7
10.8
.3
9.6
5.6
1.1

1.1
11.6
.2
1.1
.2
1.1
14.6
21.8
5.3
12.9
.6
6.3
2.5
1.3

2.7
.5
11.9

3.9
.1
10.6

11.0

5.0
9.4

97
102
95
103
111
101
84
96
92
92
124

2.3

3,601 100.0 100.0 100.0 100.0 100.0 100.0 100.0
225
3,376

6.2
93.8

9.4
90.6

9. 5
90.5

6.5
93.5

5.4
94.6

5.6
94.4

2.5
97.5

1 See page 18 for explanation of standardized relative index.

Respiratory diseases.—On the whole, the diseases of the respira­
tory system are probably more frequent in this occupation group
than among all occupied males. The standardized relative index
for influenza is 97. The relative indexes at ages 25 to 54 are high,
3
3 Includes drivers and teamsters: Mail, express, moving van, truck, warehouse, cab,
hack, and retail store. Drivers were classified with this group when no mention was
made in the death certificate as to whether they were driving automobiles or horse-drawn
vehicles. The average age at death is 46.6 years. (See note, p. 19.)




M O R T A LITY ACCORDING TO OCCUPATION

87

the highest relative index (139) being recorded in the age period 25
to 34. Pneumonia is high in every age period up to age 54. The
standardized relative index is 102. The highest relative index (122)
appears in the age group 35 to 44. In the medico-actuarial inves­
tigation of 1913 the proportion of deaths from pneumonia among
teamsters was 50 per cent greater than the standard. Other respira­
tory diseases show very high ratios in our group from age 15 to 34.
After age 34, however, the proportionate mortality is quite low.
The standardized relative index is 95. The high incidence of respira­
tory diseases in this occupation is probably associated with exposure
to inclement weather and with alcoholism. These high ratios con­
trast strangely with the low ratios found for chauffeurs.
Tuberculosis of the respiratory system.—The standardized rela­
tive index for tuberculosis is 103. The proportionate mortality from
ages 15 to 34 years is low. The actual death rate in this age period,
however, is probably above the average in view of the high total
death rate. The fact that the relative indexes increase with age,
reaching a maximum (139) in the age period 55 to 64 suggests the
presence of a cumulative tuberculosis hazard in this occupation; but
the exact nature of this hazard is difficult to define.
Cancer (all forms).—The standardized relative index for cancer
is 101. Except for the very high relative index (164) in the age
period 15 to 24, the relative indexes indicate death rates from cancer
slightly above average. The high ratio in the first age period is
probably a chance variation as few deaths were recorded at these
ages.
Syphilis, tabes dorsalis, and general paralysis of insane.—The
standardized relative index is 111, indicating a high death rate for
these diseases.
Alcoholism.—Alcoholism causes 1.4 per cent of all the deaths. The
relative indexes are high in every age period. The death rate from
this cause is unquestionably high. The frequency of this cause of
death undoubtedly contributes to the higher ratios found for respira­
tory diseases, cirrhosis of the liver, arteriosclerosis, and accidental
violence.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized
relative index is 96. The percentages for these causes are about
average in the several ages and are indicative of a higher than aver­
age death rate, because of the probably high total death rate.
Other diseases of the heart.—The standardized relative index is
92. Average proportionate mortality is also recorded for this cause
of death at most ages. In the age period 25 to 34, however, the rela­
tive index is 119.
Arteriosclerosis.—The percentages are above the average after age
34. The higher ratios are associated with very high ratios for
alcoholism in this occupation.
Nephritis (acute and chronic).—The standardized relative index
is 92. The proportionate mortality points to average or slightly
higher than average death rates from this cause.
Accidental or undefined violence.—The ratios for accidental vio­
lence reflect the characteristic hazard of teamsters and drivers. The
standardized relative index is 124, which may be compared with an
index of 146 for the kindred occupation, chauffeurs. The relative



88

CAUSES OF DEATH , BY OCCUPATION

indexes are quite high in every age period, the highest indexes being
recorded at the older ages. The nervous and physical exactions of
this pursuit are apparently best met by younger men. Occupational
accidents account for almost one-half of all accidental deaths.
Automobiles are responsible for more than the average number of
deaths, the relative index for all ages 15 years and over being 132.
Injuries by vehicles other than automobiles also cause a large pro­
portion of the accidental deaths, 151 out of 490 fatal accidents being
thus classified. The high ratios for accidental violence are con­
firmed by the combined insurance company experience reported in the
medico-actuarial investigation of 1913. In this report the deaths
from accidents among teamsters are 50 per cent greater than the
standard.
Homicide (all forms).—Homicide is above the average in only
the first age period, 15 to 24 years, when the relative index is 21 (.
This compares with a ratio of 256 for chauffeurs. After this age
the percentages for teamsters are below average, while chauffeurs
show a very high ratio (200) in the next age period, 25 to 34 years.
Textile Mill W orkers3
4
P e r r y , i n his exhaustive study of cotton-mill workers of Fall
River from 1908 to 1912 {23), found a higher death rate for male
cotton-mill operatives than for nonoperatives, ages 15 to 44 years.
In the medico-actuarial investigation (4), cotton-factory operatives
and woolen-mill operatives had ratios- of actual to expected deaths
of 108 and 113 per cent, respectively. The most recent American
figures are for the intercompany group insurance mortality ex­
perience covering the years 1922 to 1926 (9). In this study
textile industries (excluding hemp, jute, rope, and cordage, and
bleaching, dyeing, printing, and finishing) showed a ratio of
actual to expected deaths of 87.4 per cent as compared with 90.2
per cent for all industries combined. The report of the Registrar
General of England and Wales, 1921 to 1923 (5), records that among
16 titles of occupations in the textile industry all but three showed
total mortality rates above the average for all occupied and retired
males.
In view of the high total death rate in our industrial department,
it is very probable that the death rate for insured textile workers
is not above the average for all occupations.
In the present investigation the highest relative indexes are
found for cerebral hemorrhage (127), influenza (119), tuberculosis of
the respiratory system (116), and nephritis (112). English textile
workers showed consistently high death rates for all degenerative
diseases. Only 7 of the 16 titles, however, showed above average
death rates for tuberculosis.
3
4 Includes operatives in cotton, silk, wool, and linen mills (card-room workers, spinners,
weavers, pickers, bailers, beamers, braker hands, combers, creelers, doffers, quillers, reelers,
shearers, spoolers, warpers, winders, knitters, darners, lacers, loopers, ribbers, seamers,
clippers, passementerie workers, flax dressers, stretchers, throwsters, burlers, nappers,
and skeiners), and all operatives in carpet, sail, awning, tent, thread, mat, veil, sack,
shoddy, stocking, and other minor textile industries. (Excludes cordage, hemp, and dye­
ing and finishing mill workers.) The average age at death is 49.8 years. (See note,
p. 19.)




89

M O R T A LITY ACCORDING TO OCCUPATION
T a b l e 4 0 . —Number

and per cent o f deaths from specified causes among white
male textile mill workers (except cordage, hemp, dyeing, and finishing),
by age periods, 1922 to 1924

Cause of death

Number of deaths..................................................
Typhoid fever........ ................... ............................
Influenza, pneumonia................. ............. ......... ..
Influenza.............................................. ..............
Pneumonia (all forms)----------------------------Other diseases of the respiratory system..........
Tuberculosis of the respiratory system--------Syphilis, tabes dorsalis, and general paralysis
of insane-------- -----------------------------------------Cancer (all forms)_ . ---------- ------ --------- -----------Rheumatism (acute and chronic)-----------------Diabetes---------------------------------------------------------Alcoholism-----------------------------------------------------Cirrhosis of the liver-------------------------------------Cerebral hemorrhage, apoplexy, paralysis...
Other diseases of the heart----- ----------------------Arteriosclerosis--------- ---------------- ---------------------Nephritis (acute and chronic)----------------------Suicide (all forms)------- -----------------------------—
Accidental or undefined violence-----------------Occupational accidents----------------- --------Traumatism by machines----------------------Homicide (all forms)------------------------------------All other ca u se s............................ - ............... —
T o ta l...................... .......................................
Occupational deaths............................ ........... —
N onoccupational deaths---------------------------—

Ages 15 years
Per cent of deaths during age period— Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
44
54
34
64
cent
over index i
ber

3,512

414

42
316
79
237
48
517

1.2
9.0
2.2
6.7
1.4
14.7

44
293
5
43
24
29
318
489
55
349
53
286
30
20
20
581

1.3
8.3
.1
1.2
.7
.8
9.1
13.9
1.6
9.9
1.5
8.1
.9
.6
.6
16.5

378

424

611

896

789

6.0
8.7
3.1
5.6
1.4
29.5

2.1
10.6
2.9
7.7
.8
31.7

1.2
9.2
3.1
6.1
1.2
26.2

0.7
9.7
2.1
7.5
.8
14.9

8.5
1.7
6.8
1.6
6.1

8.4
1.8
6.6
1.9
2.3

1.1
1.6

2.5
9.8
.3
1.6
1.3
.8
9.7
11.6
1.0
10.5
2.9
7.0
.8
.3
.3
14.6

.2
.7
3.6

1.9
5.3

3.5
4.2
.2
1.4
1.9
.2
3.1
7.1

1.9
1.0
22.7
1.4
1.4
2.4
20.3

5.0
1.6
12.4
1.1
.8
1.1
22.8

7.1
2.6
8.0
2.1
1.4
.7
22.2

1.0
.2
.2

1.9
.3

.9
13.2
1.2
.6
1.7
12.1
18.6
1.3
13.3
1.0
5.4
.3
1
.1
14.5

.

119
85
83
116

.3
63
11.0
100
.1
1.0
91
.3
.9
16.2
127
23.6
82
4.7
13.8 " " " 1 1 2
.6
2.5
81
.4
.3
12.4

3, 512

100.0 100.0 100.0 100.0 100.0 100.0 100.0

34
3,478

1.0
99.0

1.4
98.6

1.1
98.9

2.4
97.6

1.1
98.9

.4
99.6

.4
99.6

1 See page 18 for explanation o f standardized relative index.

Typhoid fever.—The proportionate mortality from typhoid fever
is extremely high at every age period. The relative indexes are all
over 200 up to age 54, after which no deaths occurred. Although
the percentages of deaths from this cause among textile workers are
lower than in 1911-1913, the relative indexes are much larger because
the decline of typhoid among all occupied males probably has been
greater than that among textile mill workers. The high ratios in
this occupation are probably due to poor sanitary supervision of the
small mill towns in which the industry is established. A geographi­
cal analysis of this group according to States indicates that the
ratios are very much higher in southern than in northern mills.
Respiratory diseases.—As a group, respiratory diseases are not
responsible for an inordinate number of deaths in this occupation.
Influenza, however, exhibits percentages which are about 25 per cent
in excess of the average in every age period up to age 54. The
standardized relative index is 119. The ratios for pneumonia and
other respiratory diseases are consistently low, the standardized rela­
tive indexes being 85 and 83, respectively.
Tuberculosis of the respiratory system.—The proportionate mor­
tality for tuberculosis is high. The standardized relative index is
116. The highest relative index (126) is in the age period 35 to 44
years. Although the percentages are less than in 1911-1913 they are
still above those of all occupied males. In the English report for
1921-1923, 7 of the 16 occupational titles showed death rates from tu


90

CAUSES OF D E A TH , BY OCCUPATION

bereulosis above the average. Very high death rates, however, were
recorded for only three titles. One class, namely, wool and worsted,
card, comb or frame (not spinning frame) tenters, showed a rate
59 per cent above average. The introduction of the latest types of
ventilators and humidifiers should greatly improve atmospheric
conditions in textile mills and thus effect a material improvement in
the mortality from tuberculosis among these workers.
T
Cancer (all forms).—The percentages of deaths for cancer are
about average. The standardized relative index is 100. The relative
indexes are higher, however, than in 1911-1913. It appears therefore
that the cancer rate among textile workers has increased to a greater
extent than among all occupied males. It would be interesting to
obtain figures for particular occupations in this industry, but un­
fortunately the occupation code does not permit this. In England,
an excessive incidence of cutaneous cancer of the scrotum has been
observed among mule spinners. The skin area particularly involved
is the left side of the scrotum. The condition is found only rarely
in this country.
Diabetes.—As in our earlier study, the relative index for diabetes
is higher at most age periods than that for all occupied males. The
highest relative index (158) is in the age period 25 to 34. The
standardized relative index, however, is 91.
Cerebral hemorrhage, apoplexy, paralysis.—The standardized rela­
tive index is 127. This figure is higher than that for any other im­
portant cause of death among textile workers. High ratios are
found in every age period. In 1911-1913, however, the proportion­
ate mortality was appreciably higher than average only in the age
period 45 to 54. Textile workers, therefore, have apparently not
experienced as great a decline in the death rate from this cause
as workers generally. Except for a large proportion of deaths from
nephritis, the usual conditions associated with high rates from cere­
bral hemorrhage are absent. Syphilis and alcoholism are also not
very common and heavy labor or overstrain can be ruled out as caus­
ative factors. The English figures are remarkable in that they show
high death rates not only from cerebral hemorrhage and nephritis
but from all the degenerative diseases, including heart disease and
arteriosclerosis, which are, with few exceptions, higher than average
in the 16 occupations of the textile industry analyzed in the report
of the Registrar General. It is concluded in that report that condi­
tions of work in textile mills apparently promote degenerative
changes of the kidneys, heart, and blood vessels. As has already
been pointed out, our latest figures for American textile-mill workers
agree with the English findings only as far as cerebral hemorrhage
and nephritis are concerned. The specific industrial conditions con­
ducive to degenerative changes are obscure. Perhaps the hot and
humid atmosphere surrounding some of the processes in textile mills
is an etiological factor.
Other diseases of the heart.—The percentages for heart disease
compare favorably with the average. The standardized relative in­
dex is 82. The variations from the ratios of 1911-1913 are not sig­
nificant. English textile workers, however, showed high death rates
for heart diseases.



91

M O R T A LITY ACCORDING TO OCCUPATION

Nephritis (acute and chronic).—The standardized relative index
for nephritis is 112. After age 24., nephritis shows percentages
which are somewhat higher than among all occupied males. The
highest relative index (121) appears in the age period 55 to 64. In
England and Wales both cotton and woolen mill operatives show
much higher death rates from chronic nephritis than do all occupied
and retired males.
Accidental or undefined violence.—The percentages for accidental
or undefined violence are much smaller than average. The stand­
ardized relative index is 81. Occupational accidents are few.
Watchmen and Guards8
5
T h e h i g h average age at death (60.5 years) of watchmen and
guards is their characteristic feature. The occupation is frequently
a terminal one which is often undertaken after the worker has been
more or less disabled and is therefore unable to carry on his regular
occupation. Up to age 44 the deaths are so few that the ratios are
inconclusive for specific causes of death. Then again, more than
one-third of the deaths occurred in the indefinite age period 65
years and over, which makes it very difficult to evaluate our mortality
figures.
T a b le

4 1 .— Number and per cent o f deaths from specified causes among white
male watchmen and guards, by age perods, 1922 to 192If

Cause of death

Number of deaths................... ..................... .......
Typhoid fever................ ......... ............... ................
Influenza, pneum onia................... ...................
Influenza-------------------- ----------------------------Pneumonia (all forms)----------------------------Other diseases of the respiratory system------Tuberculosis of the respiratory system..........
Syphilis, tabes dorsalis, and general paralysis
of insane........ ........................................................
Cancer (all form s).--------------- ------------------------Rheumatism (acute and chronic)----------------Diabetes___________________ __________________
Alcoholism................................................ ................
Cirrhosis of the liver........ ...................... ..............
Cerebral hemorrhage, apoplexy, paralysis.._
Other diseases of the heart............................ ......
Arteriosclerosis______________________ _____ ___
Nephritis (acute and chronic)..... ......................
Suicide (all fo rm s)..___ ___________ _________
Accidental or undefined violence____________
Occupational accidents------------ -------------Traumatism by fall....................................... .
Homicide (all forms)..... ..................... ................. .
Occupational homicides......... ........... ..........
A ll other c a u s e s . ____ _____ _______ _________
Total.................. ........... ........... ................... ..
Occupational deaths.......................... ................... .
N onoccupational deaths........................ ..............

Ages 15 years
Per cent of deaths during age p e rio d - Stand­
and over
ard­
ized
rela­
N um ­ Per 15 to 25 to 35 to 45 to 55 to 65 and tive
24
34
44
54
ber
cent
64
over index
14

3,132
2
255
43
212
52
212

0.1
8.1
1.4
6.8
1.7
6.8

58
344
8
62
9
37
374
646
67
379
48
216
50
34
23
13
340

1.9
11.0
.3
2.0
.3
1.2
11.9
20.6
2.1
12.1
1.5
6.9
1.6
1.1
.7
.4
10.9

7.1
7.1

47

156
0.6
6.4
1.3
5.1
4. 5
23.7

4.3
2.1
2.1
29.8
6.4
2.1
2.1
4.3
6.4

___
71.4
14.3
7.1
14.3
7.1

500 1,205 1, 210
0.2
9 .0
1.2
7.8
1. 2
11.6

5.8
5.1

2.2
12.4
.2
1.8
2. 6
.2
2.2
.6
3. 2
7.6
14.1
8.5
16.8
1.8
6.4
9. 6~ 9.8
3.2
4.3
2.0
14.9
5.8
7.8
6.4
1.8
2.6
.6
4.3 ~~2.~6~
.4
2.1
1.3
.4
6.4
11.5 12.8

_
_

8.9
1.5
7.4
1.0
5.9

7.4
1.3
6.1
2. 2
2.6

1.6
12.2
.2
2.1

1.3
10.4
.3
2.1
1
.7
15. 9
23.3
3.0
14.0
1.1
5.1
.9
1.1
.3
.2
10.0

1.3
11.5
21.1
1.8
11.8
1.5
7.4
1.7
1.4
.7
.4

1 .0
1

.

62
78
96
81
114
105
125
108
106
109
145

3,132 100.0 100.0 100.0 100.0 100.0 100.0 100.0
70
3, 062

2.2
97.8

14.3
85.7

8.5
91.5

4.5
95.5

2.4
97.6

2.3
97.7

1.4
98.6

a See page 18 for explanation of standardized relative index.
3 Includes building, bank, and asylum guards and watchmen.
6
death is 60.5 years. (See note, p. 19.)




The average age at

92

CAUSES OF DEATH , BY OCCUPATION

The outstanding feature of the mortality record is the high fre­
quency of homicidal deaths, more than one-half of which were of
occupational origin. Although the actual number of deaths from
this cause is small, the relative indexes are consistently very high.
For all ages combined the relative index is 213. Only in the age
period 45 to 54, where the relative index is 67, is the proportion of
deaths less than among all occupied males. The degenerative dis­
eases have slightly higher than average percentages. The stand­
ardized relative indexes for cerebral hemorrhage, other diseases of
the heart, and nephritis are, respectively, 108, 106, and 109. Dia­
betes is more common than among all occupied males, the standard­
ized relative index being 125. The respiratory diseases are com­
paratively infrequent causes of death. Accidental violence has a
standardized relative index of 145. The highest relative index
(288) occurs in the age period 15 to 24; but this figure is probably
a chance variation, the number of deaths for all causes combined in
this age period being only 14. Occupational accidents account for
23 per cent of all accidental deaths.




CHAPTER 3
Principal Causes of Death
SEVERAL places in the preceding chapters we have referred
the
INbriefly toineach ofchapterprincipal causes of death in relation to
occupation;
this
we shall bring this scattered material
together for convenient reference and special analysis, Under each
cause of death the occupations will be listed in order according
to their proportionate mortality as that is shown by their standard­
ized relative indexes. We note as we proceed with such a classi­
fication, that occupations having a similar exposure to specific health
hazards frequently fall into small groups, thus suggesting that there
is a definite cause and effect relationship between a particular in­
dustrial hazard and a particular cause of death.
In the preceding chapter, we have limited our reference to the
mortality records of 33 occupations. This was because the small
number of deaths in the remaining occupations did not warrant
detailed analysis. In this chapter we have included the full list of
72 occupations in relation to the most important causes of death,
namely, pneumonia, tuberculosis of the respiratory system, diseases
of the heart, nephritis, and accidents. This additional material has
given us a larger number of occupations exposed to specific health
hazards and should enhance the value of our analysis. Except
where otherwise indicated, only occupied white male industrial
policyholders 15 years of age or over are included.
No standardized relative indexes were calculated for the numeri­
cally less important causes of death. Since the proportionate mor­
tality ratios for different occupations vary considerably when classi­
fied by age periods, no accurate listing of occupations in order of
mortality is practicable. Only those occupations have been se­
lected for discussion, therefore, which showed high ratios for a
given cause of death in at least three age periods-.
Typhoid Fever
I n r e c e n t years typhoid fever has been a minor cause of death.
It was responsible for only 597 deaths among our white male indus­
trial policyholders 15 years and older during the years 1922-1924.
The average age at death, 28.9 years, compares with 31.1 years in
our earlier study of 1911-1913. Table 42 presents death rates per
100,000 for the year 1923 and the per cent of decline in the
death rate since 1912, classified according to age periods.

Table 4 2 .— Death rates in 1923 and per oent of decline in death rate from
typhoid fever between 1912 and 1923
Age period (years)
Item

Death rate per 100,000 in 1 9 2 3 ..........................
Per cent of decline in death rate, 1912 to 1923..

68357°'— 30-------7




15
and
over

15-24

25-34

35-44

45-54

55-64

65 and
over

6.2
72.2

9.7
60.1

5.0
81.3

3.9
80.7

4.0
78.7

4.9
70.5

1.7
79.8

93

94

CAUSES OF D EATH , BY OCCUPATION

The death rate among white male wage earners 15 years and older
in 1923 was 6.2 per 100,000, representing a decline of 72.2 per cent
since 1912— a greater relative decline than was registered for any
other cause of death. This great decline in the typhoid fever
death rate stands out as a prominent achievement in the practical
application of public-health knowledge to modern life and industry.
The highest death rate is found in the ages 15 to 24 years, where it
is 9.7 per 100,000. In 1912 the highest rate, 26.8 per 100,000, ap­
peared in the age period 25 to 34. Marked decreases in the death
rate are recorded in every age period. The greatest decline (81.3 per
cent) took place in the age period 25 to 34 years.
The importance of typhoid fever in relation to other causes of
death is shown in Table 43, which gives according to age periods
the per cent of deaths from typhoid fever in the years 1922-1924
aad in 1911-1913.
T a b le

4 3 . — P er cent o f deaths from typhoid fever, 1922-1924 and 1911-1913

Item

Per cent of total deaths, 1922 to 1924.................................
Per cent of total deaths, 1911 to 1913.................................

Age period (years)

Ages
15
and
over

15-24

25-34

35-44

45-54

55-64

65 and
over

0.6
1.5

2.6
5.2

1.0
2.7

0.5
1.4

0.3
.8

0.1
.4

0.0
.2

Typhoid fever is of less importance in relation to other causes
than it was in our earlier study, being responsible for 0.6 per cent
of all deaths in 1922 to 1924, as compared with 1.5 per cent in the
period 1911-1913. #This situation has developed out of the fact
that the death rate for typhoid fever has declined much more than
has the death rate from all causes combined between the two periods
under discussion. The disease is of the greatest importance in the
age period 15 to 24 years, when it accounted for 2.6 per cent of all
deaths. This is also the age period in which the highest death rate
occurs.
The incidence of typhoid fever bears a direct relationship to the
sanitation of the community. Hence, its prevalence in particular
occupations is chiefly dependent on the location of the industry.
Thus high ratios are recorded among farmers and farm laborers,
since sanitation in rural communities is undoubtedly less highly
advanced than in cities. Textile mill workers, likewise, probably owe
their high incidence of typhoid fever to the location of many plants
in semirural southern communities. Men employed in seafaring oc­
cupations also show high ratios. Here again the facilities for sani­
tation are often limited and there is great room for improvement.
Furthermore, these men are frequently exposed to typhoid in foreign
ports where it is prevalent. The higher ratios among coal miners
are clearly due to the difficulties in maintaining adequate sewage
disposal in the mines as well as to poor sanitation of the small,
semirural mining towns. Stationary engineers and firemen show
higher-than-average ratios, perhaps because many of them are in



95

P R IN C IP A L CAUSES OF DEATH

construction camps, mines, quarries, etc., where sanitary provisions
are temporary and crude. High ratios were found also for iron and
steel mill workers.
Among the occupations with especially low ratios for typhoid
fever are longshoremen and stevedores, watchmen and guards, rail­
way enginemen and trainmen, and policemen. Saloonkeepers and
bartenders, among whom there were 457 deaths from all causes, had
none from typhoid fever.
Influenza
T h er e were 2,083 deaths from influenza among our white male
industrial policyholders 15 years of age and older during the years
1922-1924. The average age at death was 46.9 years. In 19111913 the average age at death was 53.3 years. Table 44 presents
death rates per 100,000 for the year 1923, together with the per cent
of increase in the death rate since 1912, classified by age periods.
T a b le

4 4 .— D eath rates in 1923 and per oent o f increase in death rate from
influenza between 1912 and 1923

Item

Death rate per 100,000 in 1923__........................ ...............
Per cent of increase in death rate, 1912 to 1923________

Age period (years)

Ages
15
and
over

15-24

25-34

35-44

45-54

55-64

65 and
over

31.4
157.4

11.3
222.9

15.9
341.7

29.3
306.9

43.0
144.3

82.5
116.0

180.9
101.0

The death rate among white male wage earners, ages 15 years and
older, in 1923 was 31.4 per 100,000. The lowest rate, 11.3 per 100,000,
is found in the age period 15 to 24. The rate increases with age up
to 82.5 in the age period 55 to 64 years. The death rate in 1923 was
157.4 per cent greater than in 1912, the greatest increase being re­
corded in the age period 25 to 34 where the rate in 1923 was almost
four and one-half times that of 1912. We can not draw conclusions,
however, as to the trend of this disease by a comparison of the rates
for two single years as there are wide fluctuations in the death rate
from influenza from year to year. Furthermore, the year 1923 was
one in which influenza was extraordinarily prevalent.
The importance of influenza in relation to all other causes of
death is shown in Table 45, which gives the per cent of deaths from
influenza in the years 1922-1924 and 1911-1913.
Table 4 5 .— P er cent o f deaths from influenza, 1922-1924 and 1911-1913

Item

Per cent of total deaths, 1922 to 1924......... .......................
Per cent of total deaths, 1911 to 1913......... .......................




Age period (years)

Ages
15
and
over

15-24

25-34

35-44

45-54

55-64

2.0
.8

2.4
.6

2.3
.5

2.4
.6

1.7
.7

1.8
1.0

65 and
over

1.8
1.3

CAUSES OF D EATH , BY OCCUPATION

96

Influenza was responsible for 2 per cent of the deaths in 1922-1924
and of 0.8 per cent of the deaths in 1911-1913. In the earlier period
it was of greatest relative importance at the older ages; but in
1922-1924 it reached its greatest importance among the younger
workers.
The highest proportion of deaths from influenza was found for
coal miners (underground). The occupations following in order of
incidence were iron-foundry workers, furniture and other wood­
workers, cigar makers and tobacco workers, and iron and steel mill
workers. Farmers and farm laborers are high up on the list with
an index of 121. The very high standardized relative index for coal
miners (188) and for iron-foundry workers (182) point unmistak­
ably to the influence of occupational exposure.
As we should expect, there is a close correlation in the occupational
incidence of influenza and pneumonia. We have computed the
coefficient of correlation of the standardized relative indexes for
influenza and pneumonia to be 0.499 ±0.088. There is also a close
agreement in the incidence of other respiratory diseases and influenza
and pneumonia, although several exceptions may be found, largely
the result of the small number of deaths in many occupations for
influenza and other diseases of the respiratory system. Coal miners,
iron-foundry workers, and iron and steel mill workers are among
the five occupations showing the highest ratios from each of these
three diseases. Since pneumonia is the most important respiratory
disease, its standardized relative index is the most reliable index of
the cause and effect relationship between occupational hazard and
diseases of the respiratory system. The detailed discussion of the
respiratory diseases as a group has therefore been given in the section
on pneumonia.
T a b le

4 6 .— Occupations in order o f standardized relative indexes for influenza,
1922 to 1924

Occupation

Coal miners (underground)................... __ _.
Iron-foundry workers_________ ________ ____
Furniture and other wood w orkers_______
Cigar makers and tobacco workers________
Iron and steel mill workers.
.................... .
Farmers and farm laborers_ _____ . . . . .
_
Textile (except cordage, hemp, dyeing, and
finishing) mill workers____
________ . .
Railway track and yard workers__________
Machinists_________________________________
Carpenters
- ..
Laborers _
______________________________
Blacksmiths
.............
..... __
Plumbers, gas fitters, and steam fitters___
All occupations (excluding retired)
Clerks, bookkeepers, and office assistants..
Teamsters and drivers ____________________
Janitors and building employees _. ______




Stand­
ardized
relative
index,
ages 15
to 64

Occupation

187.9
181.6
123.7
123.5
122.8
120.7

i
j
1
:
j

119.2
118.1
111.9
110.8
108.9
105.0
102.9
100.0
99.1
96.6
95.6

;j
'
!
j
I
|
1
j
j
1

Stationary engineers and firemen. _ ..........
Electricians__________ ___________ _______ ___
Masons and bricklayers____________________
Store clerks and salesmen _______
______
Merchants and storekeepers_____________ _
Shoe-factory workers_______________________
Tailors and other clothing workers _______
Compositors, printers, and pressmen______
Railway enginemen and trainmen____ . . .
Fishermen, oystermen, sailors, and marine
workers__________________________ ________
Chauffeurs____________________________ _____
Watchmen and guards ____________________
Bakers______________________________________
Saloon keepers and bartenders_____ _______
Policem en_________________________________
Painters, paper hangers, and varnishers.__
Longshoremen and stevedores.......................

Stand­
ardized
relative
index,
ages 15
to 64

95.3
91.4
87. 7
86.8
81.6
78.4
78.4
77.4
75.4
64.4
62.6
62.4
59.9
56.0
55.1
54.1
31.5

97

PR IN C IPA L CAUSES OP DEATH

Pneumonia (All Forms)
T h e r e w e r e 8,138 deaths from pneumonia among our white male
industrial policyholders 15 years of age and older during the years
1922-1924. The average age at death was 48.7 years. Table 47
presents death rates per 100,000 for the year 1923 and the percent­
age decline in the death rate since 1912, classified according to age
periods.

Table 4 7 .— D eath rates in 1923 and per cent o f decline m death rate from
pneumonia (all form s) betiveen 1912 and 1923

Item

Death rate per 100,000 in 1923_________________________
Per cent of decline in death rate, 1912 to 1923........ .......

Age period (years)

Ages
15
and
over

15-24

25-34

35-44

45-54

55-64

65 and
over

92.5
26.2

21.3
13.4

45.3
42.4

88.2
35.2

148.4
26.4

269.8
18.0

515.9
18.4

The death rate among white male wage earners, ages 15 years and
older, in 1923 was 92.5 per 100,000. The lowest rate, 21.3, is found
in the age period 15 to 24. The rate increases sharply with age and
reaches 269.8 in the age period 55 to 64. There was a decline of 26.2
per cent in the death rate for all ages since 1912. Substantial de­
creases are recorded in every age period. The greatest decline (42.4
per cent) took place in the age period 25 to 34 years.
The importance of pneumonia in relation to other causes of death
is shown in Table 48, which gives the per cent of deaths from pneu­
monia (all forms) in the years 1922-1924. (Comparable figures
for 1911-1913 are not available.)
T a b le

4 8 . — Per cent of deaths from pneumonia (all form s) , 1922-1924

Item

Per cent of total deaths, 1922 to 1924__________________

Age period (years)

Ages
15
and
over

15-24

25-34

35-44

45-54

55-64

65 and
over

7.7

6.4

7.7

9.3

8.3

7.9

6.6

Pneumonia was responsible for 7.7 per cent of all the deaths in
1922-1924. It is of the greatest relative importance in the age
period 35 to 44 years, when it accounted for 9.3 per cent of all
the deaths.
Fatigue due to strenuous labor, inhalation of irritating gases and
dusts-* heat accompanied by sudden variations of temperature and
exposure to inclement weather, together with wetting and chilling,
all appear to be factors which make the worker highly susceptible
to the organisms producing pneumonia. The wide variations in the
proportionate mortality of pneumonia among the different occupa­
tions leave no doubt that industry is a causative factor in the in­



98

CAUSES OF D EATH , BY OCCUPATION

cidence of this disease. The five occupations with the highest stand­
ardized relative indexes were iron-foundry workers with 220, cord­
age and hemp mill workers with 184, polishers (iron and steel
products) with 183, coal miners (underground) with 150, iron and
steel mill workers with 142. The following occupations, in addition
to the first five, have standardized relative indexes for pneumonia
more than 20 per cent above the average: Rubber-factory workers
(135), hucksters and peddlers (132), roofers (131), longshoremen
and stevedores (130), brick, tile, and terra cotta workers (127),
boiler makers (124), glass workers (121). It is interesting to note
that among the occupations with the very highest ratios for pneu­
monia, influenza, and other diseases of the respiratory system are
found coal miners (underground), iron-foundry workers, and iron
and steel workers. It is quite certain, therefore, that the industrial
environment in these occupations contributes largely to the contrac­
tion of infections of the respiratory system. Laborers also have
high indexes for these three diseases, while blacksmiths and furni­
ture and other wood workers have high indexes for influenza and
pneumonia.
Table 4 9 .— Occupations in order o f standardized relative indexes for
pneumonia (all fo r m s), 1922 to 1924

Occupation

Stand­
ardized
relative
index,
ages 15
to 64

Iron-foundry w orkers.. _________ ________
Cordage and hemp mill workers _. ______
Polishers (iron and steel products).. ____
Coal miners (underground)______________
Iron and steel mill workers _ __________ __.
Rubber-factory w orkers_____________ ____
Hucksters and peddlers. _
____________
Roofers____________ _____ ___________________
Longshoremen and stevedores . __________
Brick, tile, and terra-cotta workers..............
Boiler makers___________ ___________________
Glassworkers______________________________
Laborers____ _______ _______________________
Blacksmiths
____________ ____________
Miners (underground), excluding coal
miners ___________________________ ______ .
Stonecutters________________________________
Street and sewer cleaners _. _______. . .
Masons and bricklayers________ __________
Cement and lime w orkers... . . ............. . .
Oil-refinery workers____ __________________
Plasterers.................. ............... ................. ...........
Policemen............................................ .................
Furniture and other wood w orkers_______
................
Stationary engineers
Shoe-factory workers_____________ . ______
Bakers..................................... ...............................
Teamsters and drivers ..................................
Saw and planing mill workers------- ------------Chemical and explosives factory workers. Painters, paper hangers, and varnishers. _.
M a ch in ists....................................................... ..
Hostlers and stablemen________ _______ ____
All occupations (excluding retired)________
Structural-iron workers........... ................... ..
Laundry workers.......................... ........... .........
Tailors and other clothing workers________
Clerks, bookkeepers, and office assistants..
Street-railway workers......................................




220.1
184.4
183.2
150.2
141.9
134.8
132.1
130.9
130.4
127.1
123.6
120.5
119. 7
119.7

Occupation

Barbers and hairdressers
Janitors and building employees__________
Waiters and hotel servants.................... .
Electricians_____________________________
Compositors, printers, and pressmen
Railway track and yard w o r k e r s .___
Pottery workers
___ __ _
Chauffeurs. _______________________________
Cooks (hotel and restaurant) .
Plumbers, gas fitters, and steam fitters___
Brass-foundry workers . __________________
Hotel and restaurant keepers.. ___________
Tinners (shop) and tinware workers.
Paper and pulp mill workers. _
Sailors (N a v v )_______________ ______ _______
117.3
Shoemakers (cobblers)_ __________________
_
117.3
Saloon keepers and bartenders. ............ ......
115.4
Farmers and farm laborers
. . ._
113.7 ! Textile (dyeing, bleaching, and finishing')
111. 7
mill workers_________ ____ __
109.4
Fishermen, oystermen, sailors, and marine
108.4
workers__________________ ________ _______
107.6
Store clerks and salesmen_________ ________
107.4
Textile (except cordage, hemp, dyeing,
107.2
and firemen
and finishing) mill workers .
102.9
C arpenters............................................. ..............
101.9
Letter carriers.......... ............. .............................
101.8
Merchants and storekeepers _
101.7
Firemen (city department)________ ______ _
101.4
Watchmen and guards___________ _______
100.4
Cigar makers and tobacco workers________
100.4
Hat workers (wool and felt hats). ...............
100.1
Agents and canvassers.
___
100.0
Slaughter and packing house workers
99.2
Cutlers and grinders...........................................
98.8
Electric linemen_____________ _____ ________
97.0
Railway enginemen and trainmen
...........
96.9
Soldiers........................ ................. .........................
96.3

Stand­
ardized
relative
index,
ages 15
to 64

96.1
95. 3
94. 4
94. 3
92. 4
91. 9
91. 2
91.0
90. 8
89. 6
89. 6
89. 4
89. 3
88. 4
88.4
88.2
87. 8
87.3
87.2
86.4
85.8
84.9
83.8
83.0
81.1
79.7
78.3
78.0
74.3
72.1
70. 7
52.9
47. 9
43.4
28.6

99

PR IN C IP A L CAUSES OF DEATH

All of these findings are in agreement with earlier studies of
occupational mortality, especially the previous study by the Metro­
politan Life Insurance Co. of the causes of death by occupation,
covering the years 1911 to 1913. They also agree very closely with
the findings of the Registrar General of England and Wales, in
the decennial report on occupational mortality for the years 1921
to 1923. The 10 occupations in the British study showing the high­
est death rates from pneumonia, in descending order, are brassfoundry laborers, grinders of cutlery, stevedores, cotton blow-room
operatives, iron-foundry laborers, cotton carders, puddlers, metal
polishers, “ other ” dock laborers, and costermongers. The most
noteworthy exceptions to these general findings are the low percent­
ages of deaths found in our study for cutlers and grinders, brassfoundry workers, and pottery workers, all of whom are exposed to
the hazards which we have found associated with a high percentage
of deaths from pneumonia. The number of deaths from all causes
for each of these classes was small. Their low percentages may
therefore be due to chance variation.
The five occupation groups showing the lowest indexes are sol­
diers, railway enginemen and trainmen, electric linemen, cutlers
and grinders, and slaughter and packing house workers. A few
sedentary occupations are also found with low indexes.
Other Diseases of the Respiratory System1
T h e r e w e r e 1,614 deaths from other, diseases of the respiratory
system among our white male industrial policyholders 15 years of
age and older during the years 1922-1924. The average age at
death was 52 years. Table 50 presents death rates per 100,000 for
the year 1923, and the per cent of decline in the death rate since
1912, classified according to age periods.
Table 5 0 .— D e a t h rates in 1923 and per cent o f decline in death rate from
other diseases of the respiratory system between 1912 and 1923
Age period (years)
Item

Death rate per 100,000 in 1923_________________________
Per cent of decline in death rate, 1912 to 1923 ...............

Ages
15 and
over

18.2
3(3.4

15-24

25-34

35-44

45-54

55-64

65 and
over

3.7
35.1

5.0
54.1

12.1
28.4

31.5
12.5

56.7
26.5

139.9
45.5

The death rate among white male wage earners, ages 15 years
and older, in 1923 was 18.2 per 100,000. The lowest death rate, 3.7
1 Includes the follo w in g titles o f the Intern atio nal L ist o f Causes of D eath : 9 7 , diseases
o f the nasal fossae and their annexa ; 98, diseases o f the laryn x ; 99, b r o n c h itis; 1 02, pleurisy ;
1 03, congestion and hem orrhagic in fa rc t o f the l u n g ; 1 0 4 , gangrene o f the l u n g ; 1 0 5 ,
a s t h m a ; 10 6 , pulm onary em physem a ; 1 0 7 , other diseases o f the respiratory system (tuber­
culosis excepted).




100

CAUSES OF D EATH , BY OCCUPATION

per 100,000, is found in the ages 15 to 24 years. The rate increases
with age and reaches 56.7 in the age period 55 to 64 years. Between
1912 and 1923 the rate for all ages decreased 36.4 per cent, sub­
stantial decreases being recorded in every age period. The greatest
decline (54.1 per cent) occurred in the age period 25 to 34 years.
The importance of these diseases of the respiratory system in rela­
tion to other causes of death is shown in Table 51, which gives the
per cent of deaths from these diseases in the years 1922-1924. (Com­
parable figures for 1911-1913 are not available.)
T able

5 1 .-

-P e r

cent

of deaths from other diseases
system, 1922-1924

Age period (years)

Ages
15 and
over

Item

1.5

Per cent of total deaths, 1922 to 1924 -

of the respiratory

55-64

1.1

1.0

1.4

1.7

1
.6

65 and
over

1
.8

Other diseases of the respiratory system were responsible for 1.5
per cent of the deaths in 1922-1924. These diseases are relatively
of least importance in the age period 25 to 34, when they accounted
for 1 per cent of all the deaths. They are of greatest relative
importance in the period 65 and over, when they accounted for 1.8
per cent.
The occupations showing the highest relative indexes for other
diseases of the respiratory system are underground coal miners, jani­
tors and building employees,* iron and steel mill workers, stationary
engineers and firemen, and iron-foundry workers. We have already
discussed under pneumonia the occupational influences affecting the
diseases of the respiratory system. The specific effect of dust on
diseases included in the title “ other diseases of the respiratory sys­
tem ” is clearly revealed in the unusually high standardized relative
index (238) for underground coal miners. This finding is the result
of the large number of deaths from miners’ asthma assigned to this
title.
T able 5 2 .— Occupations in order of standardized relative indexes for other
diseases of the respiratory system, 1922 to 192 J
/

Occupation

Coal miners (underground)......... ..................
Janitors and building employees_ ______ _
_
Iron and steel mill w orkers_______________
Stationary engineers and firemen__________
Iron-foundry workers........... ............... .............
Carpenters. ............ ................... ............... ...........
Laborers____ __________ _________ ______ ____
Merchants and storekeepers........ .................
Tailors and other clothing w orkers.-...........
All occupations (excluding retired). ______
Machinists_______________ _________ ________
Masons and bricklayers.._________________
Watchmen and g u a r d s .__________________
Teamsters and drivers....... ...............................
Bakers______________________________________
Clerks, bookkeepers, and office assistants. _
Longshoremen and stevedores_____________
Textile (except cordage, hemp, dyeing, and
finishing) mill workers...................... ...........




Stand­
ardized
relative
index,
ages
15 to 64
237.9
129.6
122.4
119.0
116. 7
113.6
111.2
106.7
104.3
100.0
98.7
98.4
95.7
95.0
92.5
90.1
87.2
82.6

Occupation

Fishermen, oystermen, sailors, and marine
workers___
_________ __________ _____
Railway track and yard workers__________
Compositors, printers, and pressmen______
Painters, paperhangers, and varnishers___
Chauffeurs.............................................. ..............
Store clerks and salesmen________ _____ ____
Electricians_____________ _____ ______________
Farmers and farm laborers_________________
Saloon keepers and bartenders_______ __
Furniture and other wood workers............ .
Shoe-factory workers_________ ______________
Policemen
__ ________
___________ _____
Cigar makers and tobacco workers.. _ __
Plumbers, gas fitters, and steam fitters___
Blacksmiths______ __________________________
Railway enginemen and t r a in m e n ..._____

Stand­
ardized
relative
index,
ages
15 to 64

82.3
81.4
79.3
75.8
74.8
73.8
72.3
68.5
65. 2
62.7
62.3
61. 4
42.6
36.2
34.3
12.4

101

PR IN C IPA L CAUSES OF DEATH

Tuberculosis of the Respiratory System
T h e r e w e r e 14,172 deaths from tuberculosis of the respiratory
system among the white male industrial policyholders, age 15 years
and over, during the years 1922-1924. The average age at death
was 38.2 years, as compared with 37.1 years in 1911-1913. Table
53 presents death rates per 100,000 for the year 1923, together with
the per cent of decline in the death rate since 1912, classified by age
periods.
Table 5 3 .— D eath rates m 1923 and per cent o f decline in death rate from
tuberculosis of the respiratory system between 1912 and 1923
Age period (years)
Item

Death rate per 100,000 in 1923_________________ _______
Per cent of decline in death rate, 1912 to 1923.......... ..

Ages
15 and
over

149.7
53.2

15-24

25-34

35-44

45-54

55-64

65 and
over

80.2
49.4

162.5
60.2

196.1
62.6

218.5
49.6

200.0
38.0

183.4
22.4

The death rate among white male wage earners age 15 years and
over in 1923 was 149.7 per 100,000. The rate rose from a minimum
of 80.2 per 100,000 in the age period 15 to 24 years to a maximum
of 218.5 at ages 45 to 54 years and then receded to 200 in the age
period 55 to 64 years. There was a decline of 53.2 per cent in the
death rate for all ages between 1912 and 1923. Notable decreases
were recorded at every age period, the greatest diminution being 62.6
per cent in the age group 35 to 44 years. As was to be expected, the
decline in the rate has been greatest at those ages of life at which the
highest death rates were registered in 1912. By all odds, the very
substantial reduction in the tuberculosis death rate among male
wage earners, at the time of life when family responsibilities are
greatest, has been the most encouraging single feature of public
health work during the decade under consideration.
The importance of tuberculosis in relation to other causes of death
is shown in Table 54-, which gives the per cent of deaths from this
cause in the years 1922^-1924 and 1911-1913.
Table 5 4 .— Per cent of deaths from tuberculosis of the respiratory system,
1922-1924 and 1911-1913
Age period (years)—
Item

Per cent of total deaths, 1922 to 1 9 2 4 ............... .............
Per cent of total deaths, 1911 to 1913................................

Ages
15 and
over

13.4
20. 5

15-24

25-34

35-44

45-54

55-64

65 and
over

23.5
33.8

29.4
40.9

20.8
32.9

13.0
18.5

6.2
8.6

2.6
2.9

‘ Tuberculosis was responsible for 13.4 per cent of the deaths in
1922-1924 and 20.5 per cent of the deaths in 1911-1913. This decline
in relative importance has been due to the fact that the death rate
for tuberculosis has decreased to a much greater extent than the total



102

CAUSES OF D EATH , BY OCCUPATION

death rate. Tuberculosis in the years 1922-1924 was the second larg­
est cause of death among white male wage earners 15 years of age
and over, whereas in 1911-1913 it was the primary cause. At the
ages 25 to 34 and 35 to 44, however, it was still the largest cause of
death in the later period. It was of greatest relative importance
among those in the ages between 25 and 34 years.
Industrial environment has long been recognized as a most impor­
tant contributory factor in the causation of tuberculosis. Abundant
data, both American and foreign, substantiate this conclusion. No
more convincing proof, however, is afforded of the important role
which industry plays in the causation of tuberculosis than the strik­
ing differences in the mortality picture of males and females insured
in our industrial department. Taking the figures for 1923 as illus­
trative, we find that between the ages of 1 and 9 the rate for males
exceeds that of females by about 10 per cent. On the other hand,
from ages 10 to 19 years the rate for females is about twice that for
males; while in the age period 20 to 24 years the excess of female
over male mortality is 28 per cent. At age 25 the situation changes,
and from then on the rate for males exceeds that of females at every
age up to 74 years, the maximum difference being recorded in the
age period 55 to 64 years, when the male rate is about two and onehalf times that of the female rate. Males are therefore at the greatest
disadvantage in the working ages of life, when the number of men
engaged in industry is largest; and during those years women, for
the most part, are employed in the sheltered occupations of the
home. The same situation is revealed when we compare the mor­
tality from tuberculosis of male industrial policyholders with that of
males in the general population. In 1923 the mortality of male pol­
icyholders up to age 19 was lower than that of males in the general
population. Beginning with age 20, the rate for insured males be­
comes greater and remains greater up to age 74, the maximum
difference being recorded in the age period 45 to 54 years. A p­
parently the child of the wage earner starts out in life with a better
physical endowment than the child of his more prosperous neighbor,
but breaks down later in life under the stress and strain of his
industrial employment.
What are these industrial influences which result in the higher
mortality from tuberculosis among wage earners? An examina­
tion of Table 55 reveals at once the very harmful effect of exposure
to hard and sharp siliceous and other mineral and metallic dust.
Miners (underground), excluding coal miners, have the highest
mortality, the standardized relative index being 82 per cent above
the average. Pottery workers, stonecutters, cutlers and grinders,
polishers, and glassworkers are all exposed in varying degrees to
this type of dust and are likewise among the occupations with the
highest ratios of deaths from tuberculosis.
Valuable data might be obtained if we had a classification of
occupations by type of mineral dust to which the workers are
exposed. It would then be possible to estimate the relative harmful­
ness of each type of dust. Unfortunately the classification in use
does not allow such a grouping.
That alcoholism predisposes to tuberculosis is corroborated by
the relative positions of waiters and hotel servants, and saloon keepers



PR IN C IPA L CAUSES OF DEATH

103

and bartenders. Both groups have very high indexes for tubercu­
losis, that of the former being 141 and the latter 114.
A number of occupations where there is exposure to organic dusts
are high up on the list. Thus among those with high tuberculosis
indexes are found barbers and hairdressers, furniture and other
wood workers, bakers, textile-mill workers, hatters and hat work­
ers (wool and fur felt), and cigar makers and tobacco workers.
These data are in general agreement with other studies in various
countries. In none of these occupations, however, do we meet with
extremely high indexes such as are found where there is exposure
to silica. X-ray studies of certain workers exposed for years to
organic dusts showed that these men had no pulmonary changes
other than those found in people living in cities. It is conceivable,
therefore, that organic dust merely conveys the tubercle bacilli in
large numbers to their sites of growth.
Cigar makers and tobacco workers have long been identified as
occupations with an inordinate incidence of tuberculosis. In Table
55 they appear sixth in the list, with a ratio of 135. Although the
cause of such excessive rates is controversial, it seems probable that
a combination of influences is at work. Exposure to dust and nico­
tine and the general insanitary conditions of the workshops are
perhaps all injurious to the health of the worker. We must not
overlook the fact, however, that wages are low and that an occupa­
tion such as this is likely to attract men of poor physique and low
resistance.
Cordage and hemp mill operatives include a number of workers
in jute who are exposed to inorganic dust, as well as many workers
exposed to purely organic dust.
Laundry workers have a standardized ratio of 134. The ex­
cessive number of deaths from tuberculosis in this occupational
group can perhaps be accounted for in part by the hot and humid
atmosphere of the plant. A small number of the workers are also
exposed to infected materials.
A few occupations in which poisoning is a hazard are separately
included in the table. Thus, brass foundry workers have a rela­
tive index of 126. Painters, paper hangers, and varnishers, and
rubber factory operatives are only slightly above the average, the
standardized relative indexes being only 102 and 109, respectively.
Chemical and allied trades and dyeing, bleaching, and finishing of
textile products have ratios that are slightly lower than the aver­
age. The correlation between exposure to poison and incidence of
tuberculosis is hard to see in these figures. The conglomerate oc­
cupational groups are no doubt responsible in part for the irregu­
larity. For an accurate estimation of the effect of industrial in­
toxication on the phthisis rate we should have a more detailed
occupational classification. Incidentally, it is interesting to note that
the lower ratio for chemical workers in this study is in agreement
with the latest figure in England and Wales, where the death rate
from tuberculosis among chemical workers is about 75 per cent of
that of all occupied and retired males. It has frequently been sug­
gested that these workers are protected to some extent by the inhala­




104

CAUSES OF D EATH , BY OCCUPATION

tion of gases and fumes which have an antiseptic effect. The subject
merits a thorough investigation.
We now come to a group of general factory employments that
display a relatively high incidence of tuberculosis, though not as­
sociated with any specific industrial hazards. This class includes
tailors and other clothing workers, compositors, printers and press­
men, shoe factory operatives, cobblers, and slaughter and packing
house employees. Collis and Greenwood ( 24) have tersely stated
the possible cause of high rates in such occupations, as follows:
The role of the factory is, by confinement in monotonously ventilated rooms
and by causing general fatigue, to reduce the resistance of the operative to
those sources of infection to which he is exposed in the natural course of
life, to make him react more sharply to home influences than does his wife
or sister.

The high ratio for clerks, bookkeepers, and office assistants is prob­
ably explainable on the same theory. The element of selection of
these occupations by men of poor physique must also be considered.
An examination of the occupations showing low ratios for tuber­
culosis with a view to ascertaining whether industrial conditions may
exert a favorable as well as an unfavorable influence is complicated
by the fact that most of these occupations are associated with the
highest ratios for accidents. Coal miners, with a standardized rela­
tive index of 48, is the last occupation on the list. Much experimen­
tation and many conjectures attempt to explain the consistently low
incidence of tuberculosis among coal miners the world over. No con­
sensus of opinion has been reached. It appears to be possible that
there is something in the chemical properties of coal which exerts a
protective influence against the tubercle bacillus. In the proportion­
ate mortality ratios the low incidence of tuberculosis among coal min­
ers is exaggerated because of the high accident rate, but the relative
freedom from tuberculosis is still evident, even when allowance is
made for this factor. Cement and lime workers also show a lower
ratio than the average. It has been held that lime dust, like coal, has
a protective action. In this study, the very high ratio for accidents
accounts entirely for the low ratio from tuberculosis. The number
of deaths, however, is too few to give conclusive results. Railroad
workers, the skilled building trades, and a number of outdoor occu­
pations are among the lowest on the list. In most of these occupa­
tions, likewise, the accident ratio distorts the picture. In fact, the
accident ratios are so high for most of these outdoor workers that it
is safe to conclude that the incidence of tuberculosis among them
does not differ much from the average. Certainly no markedly
favorable influence is discernible.
It is surprising to note that unlike previous mortality studies, the
standardized relative index for farmers and farm laborers does not
fall below the average for all occupations. In fact, the standardized
relative index is actually 7 per cent above the average. It is our
opinion that the actual death rate from tuberculosis among farmers
and farm laborers is not higher than among our industrial males.
The higher proportion of deaths from this disease, in all probability,
is due to the fact that the death rate from all of the principal causes
of death, including tuberculosis, is lower among farmers than among



PR IN C IPA L CAUSES OF DEATH

105

all occupied males, but the death rate from tuberculosis is relatively
not as low as that from other causes. The data available are not suf­
ficient to decide the question. It will be seen from the table that the
percentage of deaths from tuberculosis among farmers is about 4
per cent greater in 1922-1924 than in 1911-1913, while the propor­
tion for all occupied males has declined about 34 per cent during
the period. Apparently farmers and farm laborers have not partici­
pated in the general improvement in tuberculosis mortality brought
about by intensive public health activities during the past decade;
as a result, their former great advantage over the industrial worker
has been to a large extent, if not entirely, wiped out.
In the last column of Table 55 is given the per cent of decline
between the years 1911 (second six months) to 1913 and 1922 to 1924
in the crude proportion of deaths from tuberculosis for ages 15
years and over in each occupation. When the figure for a particular
occupation is compared with that for all. occupied males, we obtain
a rough estimate of the relative change of the importance of tubercu­
losis in that occupation. It is gratifying to observe that nearly
every occupation has shared, in some measure, in the general decline
of the disease. What is more important, substantial decreases have
been recorded for some of the occupations where the incidence of
tuberculosis was greater than that for all occupied males. Among
these are cutlers and grinders, 42.8 per cent; cigar makers and to­
bacco workers, 56.1 per cent; compositors, printers, and pressmen,
38.6 per cent; brass foundry workers, 44.7 per cent; and barbers and
hairdressers, 41.8 per cent. The greatest decrease, 64.7 per cent, is
recorded among street and sewer cleaners. A few increases have
been registered, but most of these are probably not indicative of real
increases in the death rate. Thus, coal miners show an apparent
increase of 36.5 per cent. This is probably due to the fact that
the decrease, if any, for tuberculosis has been much less propor­
tionately than that for all other causes. The increase indicated for
farmers is probably also explainable on the same grounds.
The enormous increase in the ratio for soldiers is not significant,
because there was a considerable difference in the age distribution
of deaths among insured soldiers in the two periods, due, in all
probability, to the changed character of the Army personnel brought
about by the war. In the period 1911-1913 the average age at death
of insured soldiers was 45.6 years and in the period 1922-1924, 29.3
years. It should be pointed out that any group of persons about 29
years of age will show a higher crude proportion of deaths from
tuberculosis than a similarly employed group about 45 years old.
We can not, therefore, compare the crude proportionate mortality
from tuberculosis for soldiers in the two periods. Likewise, the
average age at death of sailors (Navy) was 29.3 years in the period
1911-1913 and 27.7 years in the period 1922-1924,




106

CAUSES OF DEATH , BY OCCUPATION

Table 5 5 .— Occupations in order o f standardized relative indexes for tubercu­
losis of the respiratory system, 1922 to 1924, and per cent o f deaths due to
tuberculosis, 1922 to 1924 and 1911 ( second 6 months) to 1913

Occupation

Pottery workers____________________________________________ _____ Stonecutters . . ______________________________ _______ _____ _____
Waiters and hotel servants.................................. .....................................
Cutlers and grinders_______________________ ____________ _________
Cigar makers and tobacco workers_____________ _________ _______
Laundry workers___________________________ ___________________ . .
Compositors, printers, and prpssmfvn ,
Brass-foundry workers__________________________ _________ _______
Barbers and hairdressers........................................ ........... ....... ...............
Glass workers___________________________ ___________ _________ _____
Polishers (iron and steel products)............................................... .........
Shoe-factory workers _ ___ __________________ _____ _______ _______
Tailors and other clothing workers.................................................... .
Furniture and other wood workers______________________________
Cordage and hemp mill workers................ . ..........................................
Slaughter and packing house workers..... ............... . ......................... ..
Shoemakers (cobblers)___________________________ . ____________
Bakers_________________________ _____ __________________ __________ _
S o ld ie rs.................. ......... ........... ....................... ................................... .......
Hat workers (wool and felt hats)________________ _______ ________
Textile (excluding cordage, hemp, dyeing, and finishing) mill
workers ___________________________________________________ _____
Saloon keepers and bartenders......... ................. ............................. .......
Cooks (hotel and restaurant).............. ............................. ......... .............
Rubber-factory workers.......................................................... ...............
M a c h in is ts ..__________________________ ______ ________ ________
Farmers and farm laborers......... ............. ............. ...................................
Street-railway workers____________________________ ____________
Iron-foundry workers_____________________ ________ ________ ____
Store clerks and salesmen__________ _________ _________ __________
Brick, tile, and terra-cotta workers____________ __________________
Teamsters and drivers___________ ___________ _____ _______ ____
Tinners (shop) and tinware workers_________________ _________
Painters, paper hangers, and varnishers.......... ............... ...............
Oil-refinery workers................... ....................... .................................
Laborers.................... ....................... ............. ............... .......................
A ll occupations (excluding retired)...................... ...........................
Hucksters and peddlers.......................................................... ...............
Plasterers................................................................................... .................
Hotel and restaurant keepers__________ _________ ____________
Chemical and explosives factory workers.............................. ..
C hauffeurs..............................................................................................
Textile (dyeing, bleaching, and finishing) mill workers...... .........
Sailors (N a v y )...................................................... ....................... .........
Plumbers, gas fitters, and steam fitters.............................. .........
Agents and canvassers..................................................... ...........
Janitors and building employees................................................... ..
Carpenters........................ ......................................................................
Longshoremen and stevedores............................................. .. .
Masons and bricklayers......................................................................
Railway track and yard workers............................................
Letter carriers........................................................... ................... .........
Iron and steel mill workers.................................................. ..
Electricians................................................ .............................................
Fishermen, oystermen, sailors, and marine workers........................
Boiler makers.............................................................................................
Electric linemen............... .....................................................................
Paper and pulp mill workers............................................................
Cement and lime workers....................................................................
Hostlers and stablem en..................................................... ...........
Sawmill and planing mill workers.................. ............... ...................
W atchmen and guards.............................................. ............... ............
Merchants and storekeepers________ __________ ___________ .
Blacksmiths................................................................................ ....
Street and sewer cleaners........ ............................................................
S tructural-iron workers....................... ........... ......... ............... ...........
Policemen___ ______ ______________________________________ . . .
Firemen (city department)......................................... .................
Stationary engineers and firemen................................. ............... ..
Roofers....... ................................................................................. .. .
Railway enginemen and trainmen......................................................
Coal miners (underground).................................................................




1 Increase.

Standard­
ized rel­
ative in­
dex, ages
15 to 64
years,
1922 to
1924

Per cent of deaths
due to tubercu­
losis
(ages 15
years and over)
1922 to
1924

Per cent
of decline
between
1911 (sec­
ond 6
1911 (sec­ months)
ond 6
to 1913
months) and 1922
to 1913
to 1924

182.2
176.2
144.3
140.7
135.4
135.1
134.2
130.6
126.1
125.9
123.5
122.8
121.8
118. 2
118.2
118.1
117.9
117.5
116.5
116.1
116.0
115.9

28.9
26.4
19.5
22.1
14.7
10.4
20.3
21.5
17.2
15.2
18.6
22.7
21.0
16.4
11.6
12.8
13.9
15.2
9.6
14.9
35.1
12.8

28.0
29.9
27.6
(2
)
25.7
23.7
28.0
35.0
31.1
26.1
28.3
34.8
29.7
(2
)
18.9
19.9
34.1
24.7
(2
)
17.8
13.0
25.4

1 3. 2
11. 7
29. 3
(2
)
42.8
56.1
27. 5
38.6
44. 7
41.8
34. 3
34.8
29. 3
(2
)
38. 6
35. 7
59. 2
38. 5
(2
)
16. 3
1 170. 0
49. 6

115.9
114.1
113. 6
108.5
107. 3
107. 2
106.0
104.6
103.9
102. 9
102.8
102.4
101.8
100. 5
100. 2
100.0
99.2
98.4
98. 2
97.4
96. 5
95.3
95.3
95.1
94. 5
91.1
89. 5
88. 6
87.8
87.0
87.0
86.3
85.9
85.7
85. 3
84. 7
84.4
84. 2
81. 5
81.1
80.5
77.1
75.8
75.0
74. 4
70.4
69. 5
67.7
64.7
61. 2
47.6

14. 7
15.3
15.1
15.3
17.0
10.0
15.2
14.6
17.5
13.6
15.6
13.1
12.2
16.0
11.5
13.4
11.4
11.0
11.7
13.4
23. 6
8.7
24.7
15.5
13.3
8.2
9.3
12.8
9.7
10.5
12.6
12.0
17.9
11.9
15.0
14.6
11.7
12.7
8.5
10.0
6.8
7.7
7.6
6.0
11.8
10.7
10.6
7.4
10.6
11.1
7.1

21. 2
24.9
(2
)
25.7
24.9
9.6
29.0
22.8
27.8
17.1
(2
)
23.3
21.1
22. 2
16.1
20.2
22.1
18.7
(2
)
13.1
(2
)
16.6
18.8
31.0
20.8
17.3
14.4
29.3
18.1
10.3
26.3
15.8
32.6
14.0
25.9
11.8
26.7
14.9
17.8
16.5
(2
)
10.9
13.0
17.0
20.1
(2
)
12.8
13.2
22.1
12. 7
5.2

30.7
38.6
(2
)
48 5
31.7
14 2
47.6
36.0
37.1
20 5
(2
)
43.8
42. 2
27. 9
28. 6
33.7
48.4
41.2
(2
)
1 2.3
(2
)
47.6
1 31.4
50.0
36.1
52.6
35.4
56.3
46.4
1.9
52.1
24.1
45.1
15.0
42.1
1 23.7
56. 2
14.8
52. 2
39.4
(2
)
29.4
41. 5
64. 7
41.3
(2
)
17. 2
43.9
48.0
12. 6
1 36. 5

J N ot available.

1

107

PR IN C IPA L CAUSES OF DEATH

Cancer (All Forms)
T h e r e w e r e 8,632 deaths from cancer among our white male in­
dustrial policyholders 15 years of age and older during the years
1922-1924. The average age at death was 57.5 years, as compared
with an average age at death of 57.8 years in 1911-1913. Table 56
presents death rates per 100,000 for the year 1923, together with the
percentage increase in the death rate since 1912 classified by age
periods.
Table 5 6 .— Death rates in 1923 and per cent o f increase in death rate from
cancer (all form s) between 1912 and 1923
Age period (years)
Item

Death rate per 100,000 in 1923............................ .................
Per cent of increase in death rate, 1912 to 1923.............

Ages
15 and
over

94.9
22.3

l/>-24

25-34

35-44

45-54

55-64

65 and
over

3.4
36.0

9.7
47.0

42.4
6.8

166.6
15.5

436.2
30.6

755.4
29.3

The death rate among white male wage earners 15 years of age
and older in 1923 was 94.9 per 100,000. Up to age 34* cancer is one
of the minor causes of death; but thereafter the rate increases very
rapidly with age. In the age period 55 to 64 the rate was 436.2, the
second largest cause of death. Cancer is one of the few important
causes of death that has increased in frequency since 1912. For all
ages combined the death rate in 1923 was 22 per cent higher than
in 1912. The greatest increase is recorded in the age period 25 to
34, where the rate was 47 per cent higher than in the earlier year.
Part of the increase is due to the fact that the disease is more fre­
quently diagnosed accurately than in previous years, but this does
not account for the entire increase.
The importance of cancer in relation to other causes of death is
shown in Table 57, which gives the per cent of deaths from cancer
in the years 1922-1924 and 1911-1913.
Table 5 7 .— Per cent o f deaths from cancer (all form s) in 1922-1924 and in
1911-1913
Age period (years)
Item

Per cent of total deaths, 1922 to 1924_____ ____________
Per cent of total deaths, 1911 to 1 9 1 3 . _______________

Ages
15 and
over

8.2
4.9

15-24

25-34

35-44

45-54

55-64

65 and
over

1.1
.7

2.0
.8

4.3
2.3

9.6
5.9

13.2
8.7

11.2
7.3

Cancer was responsible for 8.2 per cent of the deaths in 1922-1924.
It is of greatest relative importance in the age period 55 to 64 years,
where it accounted for 13.2 per cent of all the deaths. Except for
influenza, which was especially prevalent in 1923, cancer has shown
a greater increase in relative importance since 1912 than any other
disease.



108

CAUSES OF D EATH , BY OCCUPATION

No correlation of specific conditions and the incidence of cancer
is apparent from the anal}7 of occupational mortality in our indus­
sis
trial department. None of the 33 occupations for which the stand­
ardized relative index was calculated shows an extremely high pro­
portion of deaths. Carpenters show the highest index (129), followed
by blacksmiths, bakers, stationary engineers and firemen, and furni­
ture and other wood workers. Coal miners are credited with the
lowest cancer index. The next lowest ratios are found among long­
shoremen and stevedores, fishermen and oystermen, sailors and marine
workers, merchants and storekeepers, and plumbers, gas fitters, and
steam fitters.
Recently the British Medical Research Council (25) made an ex­
haustive investigation of cancer mortality according to site of cancer
and occupation, based upon the occupational mortality statistics of
the Registrar General of England and Wales covering the years 1910
to 1912 (5). The conclusions of the council in part were as follows:
When we come to summarize briefly the results of the present investigation,
it must be acknowledged that, though confirmatory evidence has been obtained
of some views already more or less generally accepted as to the close associa­
tion of some types of cancer w ith exposure to particular risks incurred in
7
certain forms of employment, e g., chimney-sweeps’ cancer and mule-spinners’
cancer, evidence in support of such a connection between the nature of the
employment and other forms of cancer, especially those localized internally,
can not be regarded as more than suggestive.

The results of the analysis of the occupational mortality of indus­
trial policyholders as shown in Table 58 are entirely consistent with
this opinion.
T able

5 8 .— Occupations in order of standardized relative indexes for cancer
(all form s) , 1922-192^

Occupation

Carpenters________________ ______ _________
Blacksmiths________ _____ ___________ _____
Bakers_____________________________________
Stationary engineers and firemen________
Furniture and other wood workers______
Cigar makers and tobacco workers. ___
Electricians----------------- -------------- --------------Tailors and other clothing workers_______
Chauffeurs________________________________
Masons and bricklayers__________________
Iron and steel mill workers_______________
Watchmen and guards____ _____ _________
Policemen_________________________________
Clerks, bookkeepers, and office assistants
Teamsters and drivers____________________
Railway track and yard workers________
Farmers and farm laborers_______________
Saloon keepers and bartenders___________

Stand­
ardized
relative
index,
ages
15 to 64

129.3
127.4
125.6
124.4
122 . 2

118.2
115.5
112.6
112.1
110.9
106.5
104.9
103.6
101.7
101.4

101.2
101.2
100.9

Occupation

Compositors, printers and pressmen___
All occupations (excluding retired)____
Textile (except cordage, hemp, dyeing, and
finishing) mill workers _______ ________
L a b o r e r s ____ ______ ___________________
Railway enginemen and trainmen_____
Janitors and building employees_______
Shoe-factory w
rorkers___...................... .......
Store clerks and salesm en............. .........
Machinists___________________ ______ ____
Painters, paper hangers, and varnishers___
Iron-foundry workers_________________ ___
Plumbers, gas fitters, and steam fitters___
Merchants and storekeepers_______________
Fishermen, oystermen,sailors, and marine
workers._________________________________
Longshoremen and stevedores_____________
Coal miners (underground)_______________

Stand­
ardized
relative
index,
ages
15 to 64

100.7
100.0
99.5
97.8
97.1
96.3
95.7
95.4
94.5
93.3
92.8
92.6
91.7
88.6
88.4
65.7

Diabetes
T h e r e w e r e 1,529 deaths -from diabetes among our white male
industrial policyholders 15 years of age and older during the years
1922-1924. The average age at death was 51.6 years. In 1911-1913
the average age at death was 49.7 years. Table 59 presents death



109

PR IN C IPA L CAUSES OF DEATH

rates per 100,000 for the year 1923 together with the percentage
change in the death rate since 1912, classified by age periods.
Table 5 9 .— Death rates in 1923 and per cent of increase or decrease in death
rate from diabetes between 1912 and 1923
Age period (years)
Item

Ages
15 and
over

Death rate ner 100.000 in 1923
17.8
Per cent of increase or decrease in death rate, 1912 to
1923_____________________________________
+12. 7

lf>—
24

25-34

3.5-44

45-54

55-64

65 and
over

4.1

6.6

8.3

26.0

72.4

115. 6

- 6 .8

-1 4 . 3

-5 . 7

+ 2 .8

+ 6 0 .9

+ 1 0 .8

The death rate among white male wage earners, ages 15 years
and older, in 1923, was 17.8 per 100,000. The rate is comparatively
low at the younger ages, "but increases to 72.4 per 100,000 in the
age period 55 to 64 years. Between 1912 and 1923 the death rate
from diabetes for all ages 15 years and older increased 12.7 per cent.
The greatest increase (61 per cent) is recorded in the age period
55 to 64 years. Up to age 45 the rates were slightly less than in
1912.
The importance of diabetes in relation to other causes of death is
shown in Table 60, which gives the per cent of deaths from diabetes
in the years 1922-1924 and 1911-1913.
T a b le

6 0 . — P er cent of deaths from diabetes, 1922-1924 and 1911-1913
Age period (years)
Item

Per cent of total deaths, 1922 to 1924__________________
Per cent of total deaths, 1911 to 1913__________________

Ages
15 and
over
15-24

25-34

35-44

45-54

55-64

65 and
over

1.2
1,0

1.2
.7

0.9
.7

1.4
1.0

2.0
1.3

1. 6
1.0

1.4
1.0

Diabetes was responsible for 1.4 per cent of all the deaths in
1922-1924, as compared with 1 per cent in the years 1911-1913. In
every age period diabetes was of greater relative importance in the
later than in the earlier study. It is of greatest relative importance
in the age period 55 to 64 years, where 2 per cent of the deaths were
due to this disease.
Although exceptions are numerous, the listing of occupations
shows a high proportion of the sedentary and inactive occupations
have high ratios for diabetes, while most of the more strenuous oc­
cupations show lower than average ratios. The occupations with
the highest standardized relative indexes are merchants and store­
keepers, 204; tailors and other clothing workers, 185; saloon keepers
and bartenders, 157; railway enginemen and trainmen, 154; and
electricians, 140.
Joslin (18) finds obesity to be correlated to a high degree with
diabetes. It may be that obesity is more common among men in sed­
entary and inactive pursuits. This seems to be borne out in the case
68357°— 30------ 8




110

CAUSES OF DEATH , BY OCCUPATION

of locomotive engineers. According to Joslin, one railroad surgeon
found 20 per cent of a group of 1,673 railroad engineers to be
overweight. The severe nervous strain to which they are subjected
has also been suggested as a possible factor in the high diabetes
rate for locomotive engineers. Among tailors and clothing workers,
in addition to the sedentary character of the work, there is the
racial factor. A large proportion of these workers are Jews, who
are known to suffer inordinately from diabetes. Joslin (18) stresses
the fact that these people as a group habitually overeat. He ascribes
the high incidence to this rather than to inherent racial predis­
position.
The prevalence of diabetes among sedentary workers may also be
partially accounted for by the shifting of diabetics in laborious
occupations to jobs requiring less strenuous exertion.
In the report of the Registrar General of England and Wales the
occupations with the highest death rates from diabetes are: Glass
blowers, skilled glasshouse workers, other skilled glass workers (not
in glasshouse), tin and copper miners, wool sorters, cotton blowroom operatives, publicans, wool weavers, dentists, textile ware­
housemen, and tobacco factory operatives. The coincidence of high
rates among three glass-working occupations together with the pe­
culiar age distribution of deaths from diabetes in these occupations
is accepted as possibly significant of some occupational influence.
In our study of glass workers only one death from diabetes was
recorded in a total of 323 deaths from all causes; whereas one could
have expected about 4 or 5 deaths.
T able

6 1 . — Occupations in order of standardized relative indexes for diabetes,
1922 to 1924
Stand­
ardized
relative
index,
ages
15 to 64
years

Occupation

M erchantsand storekeepers----------------------Tailors and other clothing workers............. .
Saloon keepers and bartenders................. ..
Railway enginemen and trainmen________
Electricians.......................................................... .
Store clerks and salesmen............................. .
Fishermen, oystermen, sailors, and marine
workers_________________ _________________
Watchmen and guards.................................... .
Chauffeurs............................... ........... ............... .
Clerks, bookkeepers, and office assistants.
Bakers____________ . . ______ . . ______________
Policemen....................... ................. ................... .
Stationary engineers and firemen.. . ............
Machinists.............. ....................... ..................... .
Iron and steel mill workers________________
Compositors, printers, and pressmen_____
All occupations (excluding retired)............

203.6
185.3
156.7
154.4
140.2
137.2
126.4
125.1
122.3
120.5
119.5
119.4
118.2
107.1
106.6
105.1

100.0

Occupation

Railway track and yard workers_______ _
Plumbers, gas fitters, and steam fitters___
Cigar makers and tobacco workers_______
Textile (except cordage, hemp, dyeing,
and finishing) mill workers...... ................
Teamsters and drivers____________________
Furniture and other wood workers_______
Farmers and farm la b o re rs..........................
Blacksmiths_______ _______ ________ _______
Longshoremen and stevedores......................
Laborers___________________________________
Janitors and building employees................
Shoe-factory workers................................ .........
Painters, paper hangers, and varnishers...
C a r p e n t e r s ._____________________ ______
Masons and bricklayers..............................
Coal miners (underground).......................
Iron-foundry workers............... ....................

Stand­
ardized
relative
index,
ages
15 to 64
years

97.4
96.1
90.5
83.5
81.4
77.2
76.9
69.5
67.7
67.6

66.1
60.8
58.7
54.1
50.7
27.3

Cirrhosis of the Liver
T h e r e w e r e 1,128 deaths from cirrhosis of the liver among our
white male industrial policyholders 15 years of age and older, dur­
ing the years 1922-1924. The average age at death was 55.1 years



111

PR IN C IPA L CAUSES 01' DEATH

as compared with the average age at death of 52 years in 1911-1913.
Table 62 presents death rates per 100,000 for. the year 1923 together
with the per cent of decline in the death rate since 1912, classified
by age periods.
T able

6 2 . — Death rates in 1923 and per cent of decline in death rate from
cirrhosis of the liver between 1912 and 1923
Age period (years)
Item

Death rate per 100,000 in 1923........................ .....................
Per cent of decline in death rate, 1912 to 1923........ ........

Ages
15 and
over

12.5
65.4

15-24

25-34

35-44

45-54

55-64

65. and
over

0.4
5.5. 6

1.8
86.4

8.6
78.9

23.2
72.6

56.3
51.7

79.6
51.9

The death rate among white male wage earners 15 years of age
and older in 1923 was 12.5 per 100,000. The rate was 0.4 per
100,000 in the age period 15 to 24 years and increased with age
to 23.2 at the ages 45 to 54 and 56.3 in the age period 55 to 64.
There was a decline of 65.4 per cent in the death rate from cirrhosis
of the liver between 1912 and 1923. The decrease was greatest
(86.4 per cent) at ages 25 to 34 years. In every age period the
death rate declined more than 50 per cent. It is interesting to note
that the death rate from cirrhosis of the liver decreased to a greater
extent than that of alcoholism.
The importance of cirrhosis of the liver in relation to other causes
of death is shown in Table 63, which gives the per cent of deaths
from this cause in the years 1922-1924 and 1911-1913.
T able

6 3 . — Per cent of deaths from cirrhosis of the liver, 1922-1924 and
1911-1913
Age period (years)
Item

Per cent of total deaths, 1922 to 1924__ ________________
Per cent of total deaths, 1911 to 1913__________________

Ages
15 and
over

1.1
2.3

15-24

25-34

35-44

45-54

0.1
.2

0.4
1.2

0.9
2.6

1. 6
3.8

55-64 65 and
over

1.5
3.1

1. 1
1.8

Cirrhosis of the liver was responsible for 1.1 per cent of the
deaths in 1922-1924. There has been a considerable decline in its
relative importance since 1911-1913. This condition was brought
about by the fact that there was a greater reduction in the death rate
from this cause than in the total death rate between the two periods.
Hepatic cirrhosis is relatively of greatest importance at the ages
between 45 and 54 years, when it accounted for 1.6 per cent of all
the deaths.
Saloon keepers and bartenders showed a far higher ratio for this
cause of death than any other occupation. This is in agreement
with the findings of the Registrar General of England and Wales,
who records that the comparative mortality figures for cirrhosis



112

CAUSES OF DEATH , BY OCCUPATION

of the liver among the liquor trades varied from over 4 to more than
11 times that of all occupied and retired males. In our study, high
ratios were also found for merchants and storekeepers, iron and steel
mill workers, and railway enginemen and trainmen. The lowest ratios
are shown by fishermen, oystermen, sailors, and marine workers;
shoe-factory workers; chauffeurs; tailors and other clothing workers;
and iron-foundry workers. The Registrar General of England and
Wales finds a high correlation between cirrhosis and chronic ne­
phritis. In our study saloon keepers, merchants and storekeepers,
and railway enginemen and trainmen show high percentages of
deaths from both these causes. On the other hand, with the excep­
tion of saloon keepers and bartenders, there is no correspondence
in our study between the occupations showing the highest ratios
for cirrhosis of the liver and those showing the highest ratios for
alcoholism. We should look to some other influence, perhaps occu­
pational, for an explanation of the high ratios for railway enginemen and trainmen and merchants and storekeepers. It must be re­
membered also that the number of deaths from cirrhosis in each
occupation is small and the percentages are therefore subject to wide
fluctuations. The high ratios in these two occupations may be
merely accidental.
Cerebral Hemorrhage, Apoplexy, and Paralysis
T h e r e w e r e 7,616 deaths from these conditions among our white
male industrial policyholders 15 years of age and older during the
years 1922-1924. The average age at death was 60.7 years. In
1911-1913 the average age at death was 60.9 years. Table 64 pre­
sents death rates per 100,000 for the year 1923 together with the
per cent of decline in the death rate since 1912, by age periods.
Table 6 4 .—Death rates in 1923 and per cent of decline in death rate from
cerebral hemorrhage, apoplexy, and paralysis, between 1912 and 1923
Age period (years)
Item

Death rate per 100,000 in 192-3..............................................
Per cent of decline in death rate, 1912 to 1923...............

Ages
15 and
over

88.1
19.5

15-24

25-34

35-44

45-54

55-64 65 and
over

1.4
26.3

4.8
55.1

22.4
38.6

100.9
19.0

363.0
15.0

1097.1
9.4

The death rate among white male wage earners 15 years of age
and older in 1923 was 88.1 per 100,000. Like the other degenerative
diseases, cerebral hemorrhage is a minor cause of death at the young
ages. In the age period 15 to 24 years the rate was 1.4 per 100,000.
The rate rises to 100.9 in the age period 45 to 54 and to 363 in the
period 55 to 64 years. There was a decline of 19.5 per cent in the
death rate for all ages since 1912. A substantial decline in the death
rate was recorded for every age, the greatest decline (55.1 per cent)
being recorded in the age period 25 to 34 years.
The importance of cerebral hemorrhage in relation to other causes
of death is shown in Table 65, which shows the per cent of deaths
from this cause in 1922-1924 and in 1911-1913.



113

PR IN C IP A L CAUSES OF DEATH

T able 6 5 .— Per cent of deaths from cerebral hemorrhage, apoplexy, and
paralysis, 1922-1024 and 1911-1913
Age period (years)
Ages
15 and
over
15-24

Item

Per cent of total deaths, 1922 to 1924.
______________
Per cent of total deaths, 1911 to 1913- _ ______________

7.2
6.2

0.5
.5

25-34

11
.
1.2

35-44

45-54

55-64

65 and
over

2.7
2.3

5.9
5. 2

10.9
9.6

14.4
13.4

Cerebral hemorrhage, was responsible for -7.2 per cent of all the
deaths in 1922-1924, and for 6.2 per cent of the deaths in 1911-1913.
Its greater relative importance in the later period is due to the fact
that the death rate from these diseases has not declined as fast as
the total death rate from all causes. The proportion of deaths in
the age period 55 to 64 years (10.9 per cent) is the highest among
the significant age periods.
The occupations showing the highest proportion of deaths from
cerebral hemorrhage, apoplexy, and paralysis are merchants and
storekeepers, blacksmiths, cigar makers and tobacco workers, textile
operatives, and railway enginemen and trainmen. Painters and
janitors also have high ratios for this cause of death. The lowest
proportion is found among longshoremen and stevedores. Bakers,
coal miners, policemen, electricians, fishermen and oystermen, etc.,
also show low proportions. Occupational characteristics common
to the various occupations showing either high or low ratios are not
apparent. The high ratios of painters perhaps reflect the effect
of lead absorption. As we should expect, there is a fairly close
correspondence between the occupational incidence of cerebral hemor­
rhage, apoplexy, and paralysis and nephritis. Nine of the 15 occu­
pations showing higher than average ratios for cerebral hemorrhage,
apoplexy, and paralysis also show higher than average ratios for
nephritis.
T able 6 6 .— Occupations in order of standardized relative indexes for cerebral
hemorrhage, apoplexy, and paralysis, 1922 to 1924

Occupation

Merchants and storekeepers ........................
B la c k sm ith s-.............. - ______ _____________
Cigar makers and tobacco workers. _____
Textile (except cordage, hemp, dyeing, and
finishing) mill workers___________________
Railway enginemen and trainmen............. ..
Painters, paper hangers, and varnishers...
Janitors and building employees ................
Furniture and other wood w orkers..............
Watchmen and guards_____________________
Plumbers, gas fitters, and steam fitters___
Clerks, bookkeepers, and office assistants .
Store clerks and salesmen. __________ _____
Farmers and farm laborers-........................ ..
Masons and bricklayers........................ ..
_
Railway track and yard w orkers............. ..
All occupations (excluding retired)________
Compositors, printers, and pressmen______




Stand­
ardized
relative
index,
age? 15
to 64

136.8
134.3
133.8
127.2
118.1
109.3
109.3
108.5
108.0
107. 8
107. 5
106.2
102.9
101.0
100.1
100.0
97.6

Occupation

Machinists___________ ______________________
Teamsters and drivers_______ ______ . . . _.
Chauffeurs. __________ ______________________
Iron and steel mill workers. ______________
Iron-foun dry w orkers ___ ______ ________
Tailors and other clothing workers________
Saloon keepers and bartenders. __________
Laborers. ................ ............... ......................... ..
Carpenters _ _
_ __ ................ .............. .....
Stationary engineers and firemen__________
Shoe-factory workers...................... ...................
Fishermen, oystermen, sailors, and marine
workers ______ ___________________
. ..
Electricians___ __ _________ ______ _________
Policemen__________________________________
Coal miners (underground)________________
Bakers_______ _ ________ _______ ___________
Longshoremen and stevedores ___________

Stand­
ardized
relative
index,
ages 15
to 64

95.9
95.8
94.6
94.4
93.6
93.6
93.5
92.3
91.5
86.9
84.2
83.2
79.4
71.3
65.4
52.1
45.5

114

CAUSES OF DEATH , BY OCCUPATION

Other Diseases of the Heart
T h is group of heart diseases is responsible for more deaths than
any other cause. There were 16,217 deaths from these diseases of
the heart among our white male industrial policyholders 15 years
of age and older during the years 1922-1924. The average age at
death was 55.7. In 1911-1913 the average age at death was 55.6
years. Table 67 presents death rates per 100,000 for the year 1923
together with the per cent of change in the death rate since 1912, by
age periods.
T a b le

6 7 .— Death rates in 1923 and per cent of increase or decrease in death
rate from other diseases of the heart between 1912 and 1923

Item

Death rate per 100,000 in 1923_________________________
Per cent of increase or decrease in death rate, 1912 to
1923__________________________________________________

Ages
15
and
over

Age period (years)

15-24

25-34

35-44

45-54

55-64

65 and
over

188.7

26.0

39.6

86.6

253.3

681.3

1854.1

- 7 .5

- 7 .1

- 2 6 .4

- 3 3 .5
1

- 3 .3

+ 1 .7

+ 3 .7

The death rate among white male wage earners, ages 15 years and
older, in 1923 was 188.7 per 100,000. In the age period 15 to 24
years the rate was 26.0. The rate increased in each successive 10-year
period, reaching the high levels of 253.3 and 681.3 at the ages 45 to
54 and 55 to 64, respectively. Between the years 1912 and 1923
the death rate from heart disease decreased by 7.5 per cent. The
decline is, however, understated due to the fact that there was a
change in the classification of causes of death in the interim. The
effect of this change was to increase the number of deaths assigned
to this cause in the age period 45 to 54 years by about 17 per cent
and in the period 55 to 64 years by about 5 per cent and averaging
about 4 per cent for all ages 15 years and over. The greatest decline
(33.5 per cent) was recorded in the age period 35 to 44 years. I f
the same classification code had been used in 1923 as in 1912, the rate
for the age period 45 to 54 years would have shown a decline of
about 20 per cent instead of 3.3 per cent and the rate for the period
55 to 64 years would have shown a decline of over 3 per cent instead
of an increase of 1.7 per cent.
The importance of other diseases of the heart in relation to the
other causes of death is shown in Table 68, which gives the per
cent of deaths from heart disease in the years 1922-1924 and 19111913 by age periods.
T able 6 8 . — Per cent of deaths from other diseases of the heart, 1922-1924
and 1911-1913

Item

Per cent of total deaths, 1922tol924_ .............................
Per cent of total deaths, 1911 to 1913.................................




Age period (years)

Ages
15
and
over

15-24

25-34

15.4
12.0

7.6
5.8

7.0
5.4

45-54

55-64

65 and
over

9.2
15. 2
7,7 j n .

19. 7
15.9

23.8
20.4

35-44

PR IN C IPA L CAUSES OF DEATH

115

Other diseases of the heart were responsible for 15.4 per cent of
all the deaths in the period 1922-1924. In the years 1911-1913,
12.0 per cent of all the deaths were due to heart disease. The disease
has therefore become relatively more important in spite of the de­
crease in the actual death rate because the decline in the death rate
for heart disease has not been as great as that for all causes between
the two periods. The decline in the death rate from tuberculosis
has been so much more rapid than that for heart disease that the
latter is now the first cause of death, supplanting the former, which
held that position in 1911-1913.
T able

6 9 .— Occupations in order of standardized relative indexes for other
diseases of the heart, 1922 to 1924

Occupation

Sailors (N a v y )_____________________________
Boiler makers_____________ _____ _____ ______
Merchants and storekeepers..____________
Roofers ___________________________________
Cooks (hotel and restaurant) ........................
Tailors and other clothing workers________
Textile (dyeing, bleaching, and finishing)
mill workers. _ ___
_ _________________
Waiters and hotel servants________________
Clerks, bookkeepers, and office assistants „
Barbers and hairdressers............................ .....
Shoemakers (cobblers).................................... ..
Hostlers and stablemen___________ ________
Brick, tile, and terra-cotta workers____ __
Hucksters and peddlers_ _________ _____
_
Plasterers _________ ________________________
Janitors and building employees ...............
Store clerks and salesmen __________ _____
Agents and canvassers____ ________ _____
Tinners (shop) and tinware workers . .........
Longshoremen and stevedores____ _____ ___
Watchmen and guards_____________________
Street-railway workers__________ _______ ___
Bakers. ______________________ ____ _________
Compositors, printers, and pressmen____
Machinists ________ _________ ____ _______ _
Street and sewer cleaners................... .............
Chauffeurs ________________________________
Laundry workers- ________________________
Shoe-factory workers. _____________________
Rubber-factory w orkers...................... ............
_____________
Letter carriers ___________
Brass-foundry workers...................... ...............
All occupations (excluding retired)..............
Pottery workers. ____________ _____________
Stationary engineers and firemen__________
Masons and bricklayers.
............ ......... ........
Cutlers and grinders______ _____ ___________
Laborers
________________________________

Stand­
ardized
relative
index,
ages 15
to 64

180.1
128.6
128.2
123.6
123.5
122.9
117.5
117.0
115.5
112.1
111.4
111.3
110. 5
110.4
110.1
109.5
109.2
107.1
106.8
106.4
106.1
104.6
104.0
103.9
103.0
102.4
101.6
101.0
100.7
100.6
100.2
100.1
100.0
97.2
97.2
96.6
95.9
94.4

Occupation

Railway track and yard workers__________
Coal miners (underground)......... ...................
Teamsters and drivers ____________ ______
Farmers and farm laborers..............................
Painters, paper hangers, and varnishers...
Electricians_____________ __________ _______
Carpenters ...................... ......................................
Furniture and other wood w orkers_
_ __
Iron and steel mill workers .............. ............
Slaughter and packing house workers
Saloon keepers and bartenders..
________
Fishermen, oystermen, sailors, and marine
workers______________________________ ____
Hotel and restaurant keepers.........................
Textile (except cordage, hemp, dyeing, and
finishing) mill workers...................................
Blacksmiths............. ............................... ..............
Iron-foundry workers ...................................
Policemen
_ _
Glassworkers_______________________ __ _
Cement and lime workers ...............................
Saw and planing mill workers
Cigar makers and tobacco workers
Railway enginemen and trainmen................
Plumbers, gas fitters, and steam fitters___
Chemical and explosives factory workers..
Stonecutters. ............ ............... ......... .
Paper and pulp mill workers........................
Electric linemen ______________ __________
Firemen (city department)
__ _
Polishers (iron and steel products)___
Oil-refinery w orkers........................................
Cordage and hemp mill workers . . .
Hat workers (wool and felt hats). . _
Structural-iron workers. _________
Miners (underground) excluding coal
miners. .
Soldiers..................................
_. ..................

Stand­
ardized
relative
index,
ages 15
to 64

92.2
92.2
91.8
90.7
90. 5
89.7
88.0
87. 5
85.5
85.3
84.3
84.1
83.8
82.1
82.1
82.0
81.9
80.9
80.8
80.8
80.3
75.3
74.8
73.1
73.0
71.4
71.0
69.1
65.0
64.7
64.4
62.3
57.3
37.9
37.4

The listing of occupations according to their standardized rela­
tive indexes shows no tendency for the occupations to group accord­
ing to common hazards. However, the presence of so many seden­
tary and inactive occupations high up in the list (for example, mer­
chants and storekeepers, with a ratio of 128; tailors, 123; clerks, 116;
barbers, 112; and shoemakers, 111) suggests that men with impaired
hearts naturally selected those occupations. It is interesting to ob­
serve that with the exception of sailors in the Navy (where the
total number of deaths was yery small) the very highest ratio, that



116

CAUSES OF D EATH , BY OCCUPATION

for boilermakers, was only 29 per cent above the average. This
in itself would indicate that industrial conditions play a less im­
portant role in the causation of heart disease than in other dis­
eases. The Registrar General of England and Wales also found the
range of mortalit}^ for the several occupations to be less than that for
other important diseases. The Registrar General considers it highly
suggestive, however, that 15 out of the 16 textile occupations suffer
higher than average death rates from circulatory diseases. On the
other hand, textile workers in our study show an index of only 82.
Dyers and bleachers of textiles, however, show a ratio of 118. The
Registrar General’s figure also suggests a relationship between silica
dust and heart diseases, but virtually all of the occupations offering
exposure to silica dust in our study show a lower than average ratio.
Here again, we must point out that the proportion of deaths for
pottery workers, cutlers, grinders, iron-foundry workers, as well as
coal miners and other miners, are affected by the very high death rates
from other causes, notably tuberculosis, pneumonia, and accidents,
and that for this reason the proportion of deaths from heart dis­
ease is low.
Nephritis (Acute and Chronic)
T h e r e w e r e 9,414 deaths from acute and chronic nephritis among
our white male industrial policyholders 15 years of age and older
during the years 1922-1924. The average age at death was 55.7
years. Table 70 presents death rates per 100,000 for the year 1923,
together with the percentage of decline in the death rate since 1912,
by age periods.
T able 7 0 .— Death rates in 1923 and per cent of declinc in death rate from
nephritis (acute and chronic) between 1912 and 1923
Age period (years)
Item

Death rate per 100,000 in 1923_________________________
Per cent of decline in death rate, 1912 to 1923________

Ages
15 and
over

110.5
38.0

15-24

25-34

35-44

45-54

55-64

65 and
over

8.2
47.1

25.0
50.8

67.5
55.7

175.1
38.2

363.0
39.4

1056.0
18.7

Nephritis was the fourth largest cause of death among white male
wage earners in 1923, the death rate for ages 15 years and older
being 110.5 per 100,000. In the age period 15 to 24 years the rate
was 8.2 per 100,000. It increased with age to 363 in the age
period 55 to 64 years. A decline of 38 per cent was recorded in
the death rate for all ages since 1912. The greatest decline (55.7 per
cent) was registered in the age period 35 to 44 years,




117

PR IN CIPAL CAUSES OF DEATH

The importance of nephritis in relation to other causes of death
is shown in Table 71, which gives the per cent of deaths from acute
and chronic nephritis in the years 1922-1924. Comparable figures for
1911-191-3 are not available.
Table 7 1 .— Per cent of deaths from, nephritis (acute and chronic), 1922-1024
Age period (years)
Item

Per cent of total deaths, 1922 to 1924________________

Ages
15 and
over

8.9

15-24

25-34

35-44

45-54

55-64

65 and
over

2.7

4.4

6.7

9.7

11.0

13.3

Acute and chronic nephritis combined were responsible for 8.9
per cent of all the deaths in 1922-1924. Nephritis is of greatest re­
lative importance in the older ages and in the last significant age
grouping, 55 to 64 years, it is responsible for 11 per cent of the
deaths.
The occupations with the highest relative indexes are soldiers
(199), saloon keepers and bartenders (175), firemen (city depart­
ment) (158), hotel and restaurant keepers (152), and roofers (144).
Alcoholism is suggested as the jDossible cause of the high ratios for
saloon keepers and hotel and restaurant keepers. Lead is possibly
a factor in the high ratio of roofers. We note in this connection
that several other trades in which there is exposure to lead poisoning
have high relative indexes, notably plumbers, gas fitters, and steam
fitters, painters, paper hangers, and varnishers, and perhaps also
compositors, printers, and pressmen. On the other hand, the ratio
for pottery workers (36) is the lowest in the list. The very high
ratios for city firemen and city policemen are worthy of notice and
suggest the possibility of some common occupational influence.
Death rates by occupations are in part influenced by the shifting of
those impaired with the nephritides from strenuous to lighter oc­
cupations and, as in the case of heart disease, we find most of the
sedentary and inactive occupations among those with high indexes.
Occupations showing the lowest ratios are pottery workers (36),
cement and lime workers (48), miners (underground) excluding
coal miners (54), electric linemen (58), and coal miners (under­
ground) (68).
The complete list of occupations with their standardized relative
indexes for nephritis (acute and chronic) is shown in Table 72.




118

CAUSES OF DEATH , BY OCCUPATION

Table 7 2 .— Occupations in order o f standardized relative indexes for nephritis
(acute and chronic), 1922 to 192If

Occupation

Soldiers..................... ..................... . . . ......... ......
Saloon keepers and bartenders____________
Firemen (city department)_____ _____ ____
Hotel and restaurant keepers......................
Roofers___________ _______ ________ _________
Policemen______ ________ ___________________
Plumbers, gas fitters, and steam fitters___
Merchants and storekeepers_______________
Barbers and hairdressers__________ _____
Store clerks and salesmen_________________
Janitors and building employees__________
Compositors, printers, and pressmen_____
Stationary engineers and firemen_________
Tailors and other clothing workers..........
Fishermen, oystermen, sailors, and marine
workers_______________ ________ __________
Cutlers and grinders______________ _______ _
Longshoremen and stevedores____________
Railway enginemen and trainmen________
Agents and canvassers......... ......... ............. .
Saw and planing mill w orkers.....................
Textile (except cordage, hemp, dyeing,
and finishing) mill workers........... ...........
Shoemakers (cobblers)_________ _____ _____
Painters, paper hangers, and varnishers-.
Shoe-factory workers__________ _______ ____
Brass-foundry workers___________ ________
Letter carriers_____________ ________ ______
Watchmen and guards.................. .................
Street-railway workers................................ .
Oil-refinery workers.__.................. ............. .
Machinists_________________________ _____ _
Brick, tile, and terra-cotta workers---------Clerks, bookkeepers, and office assistants..
Hucksters and peddlers..............................
Tinners (shop) and tinware workers___
All occupations (excluding retired)------Hostlers and stablemen_________________
Boiler makers_____________________ ______

Stand­
ardized
relative
index,
ages
15 to 64

199.2
174.8
157.8
151.6
144.1
140.8
131.4
130.6
122.4
121.3
120.7
116.1
116.1
115.2
114.9
114.3
114.1
114.0
112.4
111.8
111.8
111.5
111.3
110.9
110.1
109.0
108.8
108.6
106.9
104.3
102.0
102.0
101.4
100.7

100.0
98.5
98.1

Occupation

Cigar makers and tobacco workers_____
Blacksmiths....... ........... ............................. ..
Polishers (iron and steel products)_____
Street and sewer cleaners________________
Structural-iron workers_______ _______ ...
Iron and steel mill workers...... .................
Bakers................................................................
Teamsters and drivers__________________
Furniture and other wood workers_____
Stonecutters_____________________________
Cooks (hotel and restaurant)...... ......... ..
Masons and bricklayers_________________
Chemical and explosives factory workers. .
Iron-foundry workers_____ _____ __________
Railway track and yard workers_________
Carpenters___________ ___________ _________
Laborers___________________________________
Textile (dyeing, bleaching, and finishing)
mill workers____________________________
Cordage and hemp mill workers_________
Laundry workers_________________________
Paper and pulp mill workers____ ________
Electricians_______________________________
Slaughter and packing house workers____
Farmers and farm laborers_______________
Rubber-factory workers___ ______ ________
Chauffeurs___ _______ ______ _____ _________
Glassworkers___________________ __________
Sailors (N a v y )_________________ __________
Plasterers__________________________________
Waiters and hotel servants_____________
Hat workers (wool and felt hats)_________
Coal miners (underground)______________
Electric linemen.__ _______________________
Miners (underground), excluding coal
miners_________________ ______ ________
Cement and lime workers______________
Pottery workers_ _______ _______ ______
_

Stand­
ardized
relative
index,
ages
15 to 64

97.7
96.2
96.0
95.1
94.1
92.8
92.5
91.8
90.8
89.8
89.4
88.9

88.0
87.8
85.9
85.1
&3.0
82.7
79.2
78.8
77.4
77.0
74.6
73.4
73.0
72.9
71. 7
71.2
69.5
67.8
58.1
54.0
47.9
36.1

Accidental or Undefined Violence
A c c i d e n t a l deaths directly attributable to industrial hazards
play an important part in the total mortality of American wage
earners. Various estimates place the annual number of such fatal
industrial accidents among the 43,000,000 gainfully occupied per­
sons in the United States at from 20,000 to 35,000. In 1927 almost
1,700 railroad employees were killed in occupational accidents. In
the same year more than 2,200 men lost their lives in coal-mine acci­
dents. The railroads and the mines are the heaviest contributors
to the total, but all trades and professions are represented. Among
white male industrial policyholders 15 years of age and older during
the years 1922 to 1924 there were 10,916 deaths from accidental or
undefined violence, of which about one-third were certified as of
occupational origin. The average age at death from accidents of
all types combined was 38.8 years, compared with 39.3 years in the
period 1911-1913. Table 73 presents death rates per 100,000 for the
year 1923 together with the percentage of decline in the death rate
since 1912, classified by age periods.




119

P R IN C IPA L CAUSES OF DEATH

T able 7 3 .— Death rates in 1923 and per cent of decline in death rate from
accidental or undefined violence between the years 1912 and 1923
Age period (years)
Item

Death rate per 100,000 in 1923___.................. .....................
Per cent of decline in death rate, 1912 to 1923...... ..........

Ages
15 and
over

121.2
13.8

15-24

25-34

35-44

45-54

55-64

65 and
over

89.0
.2

95.9
18.0

118.3
21.2

148.1
24.6

213.1
6.3

310.7
15.9

The death rate among white male wage earners, ages 15 years and
over, from accidents of all types was 121.2 per 100,000. The rate
rises steadily with age from 89 in the age period 15 to 24 to 310.7
in the age period 65 and over. Referring to Table 6 it is seen that
automobile accidents caused the greatest number of accidental
deaths, the death rate from this cause being 26 per 100,000 for all
ages combined. Following in order were falls, with a rate of 16
per 100,000; drowning, with a rate of 14.4 per 100,000; and railroad
accidents, with a rate of 14.1 per 100,000. Automobiles were also
responsible for the greatest number of accidental deaths in every
age period except the youngest and the oldest. In the age period
15 to 24 accidental drowning was of greatest importance, while in
the age period 65 and over the greatest number of deaths was
ascribed to falls. In these two age periods automobiles caused the
second largest number of deaths. Railroad accidents were second
in importance between the ages of 25 and 44 and falls were second
at ages 45 to 64.
As might have been expected, the greatest proportion of deaths
of occupational origin is found for accidental traumatism in mines
and quarries, virtually all deaths from this cause being so classified.
Other causes of death showing a high proportion of deaths of oc­
cupational origin are, in order: Machinery accidents, over 90 per
cent occupational; accidental electric shock, about 80 per cent occu­
pational; railroad accidents and burns (conflagration excepted),
each about 50 per cent occupational; and deaths from falls and
from conflagration, each about 40 per cent occupational.
There was a decline of 13.8 per cent in the death rate from acci­
dents between the years 1912 and 1923. Appreciable decreases were
recorded in every age period except 15 to 24 years, where the rate
remained practically stationary. The greatest decline (24.6 per cent)
occurred in the age period 45 to 54 years. Substantial declines
in the death rate were recorded for acute poisonings, accidental
drownings, accidental falls, railroad accidents, and street car acci­
dents. On the other hand, the death rate for automobile accidents
increased 465 per cent and there were likewise heavy increases in
deaths from burns, machinery accidents, and the accidental absorp­
tion of deleterious gases.
The importance of accidental deaths in relation to the other causes
of death is shown in Table 74, which gives the per cent of deaths
from accidents or undefined violence in the years 1922-1924 and
1911-1913, classified by age periods.



120

CAUSES OF DEATH , BY OCCUPATION

Table 7 4 .— Per cent of deaths from accidental or undefined violence, 19221924 and 1911-1913
Ago period (years)
Item

Per cent of total deaths, 1922 to 1924... _ _ _ _ _ _
__
Per cent of total deaths, 1911 to 1913__________________

15 and
over

10.4
9.3

15-24

25-34

35-44

45-54

55-64

65 and
over

24.8
19.2

16.6
12. 5

12.2
9.9

8.6
8.5

6.2
6.5

4.0
4.4

Accidents were responsible for 10.4 per cent of all deaths in the
years 1922-1924 and 9.3 per cent in the years 1911-1913. The pro­
portion of deaths was higher in the later period at every age from
15 to 54 years. Accidents have, therefore, become of relatively
greater importance in spite of the decline in the death rate, because
the death rate from this cause has not declined as fast as that for
all causes combined. Accidents attain their greatest relative im­
portance in the age period 15 to 24 years, when they account for
24.8 per cent of all the deaths and constitute the leading cause of
death. In our earlier study tuberculosis was the chief cause of
death in this age period, but the death rate from this cause declined
markedly while the accident rate remained about the same as it had
been. Between the ages of 25 and 44 years accidents are the second
largest cause of death. They are of least importance at the older
ages.
When the occupations are listed according to their standardized
relative indexes for accidents, electric linemen are found to have
the highest index (281). Over 60 per cent of the accidental deaths
among these workers were caused by electric shock, while accidental
falls accounted for an additional 19 per cent. The only other oc­
cupation showing a high percentage of deaths from electric shock
is electricians, the seventeenth occupation on the list. Deaths from
electric shock accounted for 34 per cent of the accidental deaths among
these men, while falls accounted for 11 per cent. Both railroad
occupations and the twro mining occupations included in this study
are found among the 10 highest. Railway enginemen and trainmen
are second on the list, with a standardized relative index of 241,
while railroad track and yard workers, with an index of 177, are
T
ninth. Railroad accidents accounted for 76 per cent of the accidental
deaths among the former and 59 per cent among the latter. The
third occupation on the list, coal miners (underground), has an index
of 228. Other miners are eighth, with an index of 185. Traumatism
in mines caused 71 per cent of the accidents among coal miners
(underground) and 62 per cent of the accidental deaths among other
underground miners.
The building trades are represented by a number of occupations
well up on the list. Structural-iron workers, with an index of 219,
are fourth, and roofers are sixth, with an index of 188. Further
down the list are carpenters (129) and masons and bricklayers (123).
The characteristic hazard of the building trades, accidental falls,
accounts for 60 per cent of the accidental deaths among roofers, 32
per cent of the accidental deaths among masons, 31 per cent among
structural-iron workers, and 24 per cent among carpenters.



PK IN C IP A L CAUSES OF DEATH

121

City firemen are fifth on the list, with an index of 197. Ap­
proximately 37 per cent of their accidental deaths are due to con­
flagration. Almost as many deaths (34 per cent) were caused by
vehicular accidents. The relative index for policemen (120), it is
interesting to observe, is much lower than that for firemen. How­
ever, the figure for policemen excludes occupational homicides, which
accounted for about 4 per cent of all deaths.
Fishermen, oystermen, sailors, etc., appear seventh on the list,
with an index of 186. Of the total accidental deaths, 61 per cent
were due to drowning and 10 per cent to falls. Longshoremen and
stevedores, the nineteenth occupation, also showed large percent­
ages of deaths from drowning and falls, the former accounting for
23 per cent and the latter for 22 per cent of all accidental deaths.
Chemical and explosives factory workers showed the highest index
(174) of any of the manufacturing groups. Burns accounted for 14
per cent of the accidental deaths among these workers. It would be
T
interesting to give the figure for deaths due to explosions but no pro­
vision is made in the international list for such a separation. Other
manufacturing industries with high ratios are cement and lime (170),
oil refineries (161), brick, tile, and terra cotta (160), saw and planing
mills (144), paper and pulp mills (141). The high proportion of ma­
chinery accidents and of drownings among sawmill workers are
worthy of note. The former accounted for 27 per cent of all acci­
dents and the latter for 8 per cent. About 20 per cent of the acci­
dental deaths among paper and pulp-mill workers were caused by
machinery.
The relative index for chauffeurs is quite high (146) and may be
compared with 124, the figure for teamsters and drivers. Forty-four
per cent of the accidental deaths among chauffeurs were caused by
automobile accidents, while only 21 per cent of the accidental deaths
among teamsters were so classified. Among teamsters, accidents
from other vehicles were of more importance than automobile acci­
dents, accounting for 31 per cent of all accidental deaths.
At the other end of the list we find that among cordage and hemp
mill workers no fatal accidents occurred, although a total of 77
deaths from all causes was recorded. The sedentary occupations,
as one might expect, are among those with the lowest ratios. Clerks
have a standardized relative index of 50 and merchants 65. The
light manufacturing occupations, clothing workers and bakers, show
relative indexes of 56 and 62, respectively.
The order of occupations shown in Table 75 is in very close agree­
ment with what we should anticipate from a knowledge of the haz­
ards in the different occupations and from the known fatal accident
rate in those industries for which such figures are available. In
all probability if we had the true occupational accidental death rates
for each of the occupations listed some changes in the order of the
occupations would occur, but there is every reason to believe that the
number of such changes in position would be few.




122

CAUSES OP DEATH , BY OCCUPATION

Table 7 5 .— Occupations in order of standardized relative indexes for accidental
or undefined violence, 1922 to 1924
Stand­
ardized
relative
index,
ages 15
to 64

Occupation

Electric linemen..................................................
Railway enginemen and trainmen________
Coal miners (underground)
Structural-iron w o r k e r s ______________
Firemen (city department)........................... ..
Roofers_______ _____ _____ ___________________
Fishermen, oystermen, sailors, and marine
workers___________________________________
Miners (underground), excluding coal
miners_________ _____ ______________________
Railway track and yard workers__________
Chemical and explosives factory workers..
Cement and lime workers.................... ..........
Oil-refmery workers_______________ _______ _
Brick, tile, and terra-cotta w o rk e rs.______
Chauffeurs________ ______________ _____ _ _
Watchmen and guards_______________ _____
Sawr
mill and planing mill workers_________
Electricians_____________________ ______ _____
Paper and pulp mill workers______________
Longshoremen and stevedores.....................
Carpenters_________ ______ __________
Teamsters and drivers_________ _____ ______
Masons and bricklayers___ ______ _________
Janitors and building em p loy ees... ______
Policemen_____ ________________________ ____
Iron and steel mill workers............................
Boiler makers_____________ _________________
Painters, paper hangers, and varnishers. _ _
Laborers
_______________ _____ ___________
Stationary engineers and firemen.................
Tinners (shop) and tinware workers______
Stonecutters_______________ ______ _____ _____
Polishers (iron and steel p ro d u c ts)...
.
Plumbers, gas fitters, and steam fitters___
Hostlers and stablemen................ ...................
Soldiers. __________________________________
Farmers and farm laborers_________ _______
All occupations (excluding retired) ..............

281.4
240. 7
228.3
218. 5
197.3
188.4
185.5
184.8
177.3
173.9
170.1
160.7
159.9
145.8
145.2
143.9
143.4
141.2
137.3
128.7
124.2
123.3
119.8
119.5
119.4
119.4
118.0
115.4
114.4
114.3
113.0
112.6
110.5
110.4
102.9
101.8
100.0

Stand­
ardized
relative
index,
ages 15
to 64

Occupation

Street and sewer cleaners................................
Rubber-factory w orkers_________
_ _
Blacksmiths............. .......................
Hat workers (wool and felt hats)
Plasterers.......... ..................... .........
Cooks (hotel and restaurant).........
Cutlers and grinders......... ....................... .........
Machinists......... ............. .............................
Hucksters and peddlers____________ _______
Sailors (N a v y )...... .................................
.
Iron-foundry workers_____ _____ ______ _____
Street-railwray workers......................................
Textile (except cordage, hemp, dyeing, and
finishing) mill workers.. .................1_____
Letter carriers____ _________ __________ _____
Slaughter and packing house workers_____
Textile (dyeing, bleaching, and finishing)
mill workers....... ........................... ...................
Shoemakers (cobblers)......... ............................
Furniture and other wood workers _
Hotel and restaurant keepers................... ..
Laundry workers____ ____*__ _
Cigar makers and tobacco workers________
Shoe-factory w orkers......................................
Agents and canvassers.......................................
Waiters and hotel servants...................... ........
Store clerks and salesmen__________ _______
Compositors, printers, and pressmen
Merchants and storekeepers____ _________
Bakers_____________ ________
Glassworkers .................. ......... .........................
Tailors and other clothing workers . _ _
Brass-foundry workers_____________________
Clerks, bookkeepers, and office assistants..
Barbers and hairdressers..................................
Pottery workers_____________________ ______
Saloon keepers and bartenders_______ __
Cordage and hemp mill workers.............. .

99.0
98.9
95.5
94. 5
93.5
90. 6
89.7
88.7
88.3
87. 7
87.5
84.5
81.1
80.6
80.6
79.9
77.8
76. 7
75.7
75.1
72.9
72.7
70.2
69.8
66.9
66. 5
65.4
61. 6
56. 3
55. 5
51.1
50.0
46.6
40.6
33. 5
0

1 N o deaths recorded.

Homicide (All Forms)
T h e r e w e r e 865 homicidal deaths among our white male industrial
policyholders 15 years of age and older during the years 1922-1924.
The average age at death was 34.2 years. Table 76 presents death
rates per 100,000 for the year 1923 together with the percentage of
change in the death rate since 1912, classified by age periods.
Table 7 6 .— D eath rates In 1923 and per cent of increase or decrease in death
rate from homicide (all form s) between 1912 and 1923
Age period (years)
Item

Ages
15 and
over

Death rate per 100,000 in 1923..............................................
9.7
Per cent of increase or decrease in death rate, 1912 to
1 9 2 3 .......................................................................................... + 1 8 .3




15-24

25-34

35-44

45-54

55-64

65 and
over

7.0

14.3

12.7

9.0

5.6

4.2

+ 3 4 .6

+ 1 4 .4

+ 3 9 .6

-1 5 .9

-3 0 .0

+ 1 6 .7

123

PR IN C IPA L CAUSES OF DEATH

The death rate among white male wage earners 15 years of age
and older from homicide in 1923 was 9.7 per 100,000. In the age
period 15 to 24 years the rate was 7. In the next age period the maxi­
mum rate, 14.3 per 100,000, was recorded. It then declined gradually
to 5.6 in the age period 55 to 64 years. The homicide rate for all ages
combined in 1923 was 18.3 per cent higher than that in 1912, increases
being recorded for all ages under 45 and also after age 64. The
largest increase, 39.6 per cent, was registered in the age period 35
to 44 years. Between the ages 45 and 64 years, however, the rates
have decreased considerably, the decline amounting to 15.9 per cent
in the age period 45 to 54 and to 30 per cent in the period 55 to 64
years.
The importance of homicide in relation to other causes of death
is shown in Table 77, which gives the per cent of deaths from homi­
cide in the years 1922-1924. Comparable figures for 1911-1913 are
not available.
T able 7 7 .— Per cent of deaths from homicide (all fo r m s), 1922 to 1924
Age period (years)
Ages
15 and
over

Item

Per cent of total deaths, 1922 to 1924.................................

0.8

15-24

25-34

35-44

45-54

55-64

65 and
over

1.8

2.4

1.2

0.6

0.2

0.1

Homicide accounted for 0.8 per cent of all the deaths in 19221924. In the age period 25 to 34 years, homicidal deaths were of
T
greatest relative importance, constituting 2.4 per cent of all the deaths
at those ages.
Policemen, as might be expected, show the highest percentage of
deaths due to homicide. The occupational factor in this result is
self-evident. Saloon keepers and bartenders also exhibit very high
ratios. Here, too, occupation is responsible, since these men are
frequently exposed to brawls which often lead to homicidal assaults.
Death by homicide is also relatively common among watchmen and
guards, longshoremen and stevedores, merchants and storekeepers,
and chauffeurs. Watchmen and guards, like policemen, are directly
exposed to this hazard through actions of criminals. Merchants and
storekeepers are perhaps the innocent victims of bandits who raid
the retail stores. It was thought that perhaps chauffeurs were also
frequently attacked by bandits but a check-up of those original
records for which full information was available failed to substan­
tiate this assumption, and showed moreover that in a majority of
cases the chauffeur himself was culpably concerned. The lowest
ratios are credited to compositors, printers, and pressmen; shoe-factory workers; furniture and other wood workers; cigar and tobacco
workers; and bookkeepers and office assistants.
Occupational Diseases
T h e Metropolitan Life Insurance Co. makes a special effort to have
physicians recognize the influence of occupation in assigning causes
of death. The physician is asked to state in his report on the cause




124

CAUSES OF D EATH , BY OCCUPATION

of death whether the previous occupation of the deceased was in
any way contributory to the death of the policyholder. Where it
appears probable that the physician signing the death certificate has
overlooked the question, a follow-up is made to determine this point.
Our mortality statistics are intended to reveal, therefore, every death
of occupational origin which the facilities of the physician enable
him to recognize. And yet a careful study of the experience leaves
no doubt that in spite of the special precautions to discover these
diseases, by far the larger number of them remain undetected. A
simple comparison will display this fact. Dr. Wade Wright
in
A Clinical Study of Fur Cutters and Felt Hat Workers, reports that
43 per cent of the group were considered to be in some degree
poisoned by mercury. In our own statistics of 156 deaths among
felt and wool hat makers not one occupational disease had been reg­
istered. Our figures are of little value then as a measure of the ex­
tent of fatal occupational diseases in the United States. They
merely serve to emphasize the fact that many wage earners die of
industrial diseases which have not been recognized by the general
practitioner. The figures are of some interest, however, in showing
which diseases are recognized and which are most frequently
reported.
In the present study 321 deaths, or 0.3 per cent of all the deaths
for all ages combined, were classified as due to specific occupational
diseases. In the age period 15 to 24 years the proportionate repre­
sentation of occupational diseases is only 0.1 per cent. The ratio
increases with age up to the period 45 to 54, where it is 0.5 per
cent. In the following 10-year, period it drops to 0.4 per cent. The
gradually increasing incidence at the older ages may reflect the
generally cumulative and chronic nature of the occupational diseases.
In Table 78 the deaths due to occupational diseases are classified:
T able 7 8 .— Occupational diseases reported on death certificates as contributory
or term inal causes of death, 1922 to 1924

Cause of death

Miners’ asthma.................................... - .........
Lead poisoning.......... ............... .......................
Anthrax
_
________________________
Organic poisoning____ _________ _________
Mineral poisoning (except lead)_________
Infections:
Septicaemia__________ ________ _______
Tetanus______________________________
Others________________________________

Number
of deaths |

116
72
3
4
10

Cause of death

Number
of deaths

Heart disease due to strain______________
Pneumoconiosis........ ................... ....................
Traumatic tuberculosis................................
Miscellaneous.......... .........................................

12
44
4
13

T o ta l........................................................

321

19
18
6

The great majority of these deaths were caused by pneumoconi­
osis (including miners’ asthma) and lead poisoning. Together
these two diseases were responsible for 232 of the 321 deaths. The
greater number of cases of pneumoconiosis were found to have oc­
curred among coal miners. Painters accounted for the vast majority
of the deaths from lead poisoning. It is interesting to observe in
this connection that the death rate from chronie lead poisoning has
declined 50 per cent among male industrial policyholders 15 years



PR IN C IPA L CAUSES OF DEATH

125

and older between 1912 and 1923. The rate in the latter year was
0.8 per 100,000. Other mineral poisons caused 10 deaths. Infections
following injury caused 43 of the 321 deaths and anthrax took the
lives of three workers. Twelve deaths were ascribed to sudden heart
failure from overstrain. It is evident from these figures how diffi­
cult it is at the present time to estimate the incidence of occupa­
tional diseases. We can safely conclude, however, that the pneu­
moconioses and lead poisoning are the occupational diseases pro­
ducing the greatest number of fatalities directly.
68357°— 30------ 9







CHAPTER 4
Concluding Statement
to be drawn from our analysis
of white male
insured
the industrial depart­
T HEof conclusions wage earners InsuranceinCo. mayofbethe mortality
ment
the Metropolitan Life
stated very
briefly. In the first place, we find that within the same social class
the death rates of male wage earners are uniformly higher than those
of females. Their death rates also exceed those prevailing among
males in the general population and among males insured under ordi­
nary policies in the same company. Differential death rates of
various age groups show that this disparity increases year by year
up to about age 54. We believe this indicates that exposure to in­
dustrial hazards is cumulative in its deleterious effect. Compared
with workers in nonhazardous employments, wage earners are at a
disadvantage in respect to every important cause of death. The
death rate from tuberculosis, age for age considered, is especially
high in the industrial group and ranges from two and a half to
nearly four times that o f the nonindustrial population. Deaths from
pneumonia and accidents are over twice as frequent; while death
rates from the degenerative diseases are from two to three times
as great.
Gratifying, indeed, has been the decline in the mortality of all
classes during the past two decades. Improvement in vitality has
characterized all the main working ages of life, and death rates have
been cut down more rapidly in the group of industrial wage earners
than in other classes. Individuals and organizations working to pro­
mote industrial health and safety may take pride in their efforts,
which undoubtedly have served well in bringing about this improve­
ment. But, at the same time, much intensive work remains to be
done if advances are to continue.
Employing, as we have, the proportionate mortality method of
analysis, we have been able to bring out sharply the wide variation
that exists in the percentage distribution of the deaths from violence
and the principal diseases in various occupations within the several
age periods. It is reasonably clear that industrial environment tends
to favor certain diseases. When occupations with high percentages
for a selected cause of death are brought together, a common indus­
trial hazard is frequently found, thus suggesting that a definite cause
and effect relationship exists between a given industrial hazard and
a particular cause of death. Conversely, low percentages presumably
denote the absence of any specific disadvantage in the occupation. A
positive association is most clearly marked in the case of accidental
violence, tuberculosis, the nontuberculous respiratory diseases, alco­
holism, and such a strictly occupational disease, for example, as lead
poisoning. Typhoid fever is generally prevalent among workers
where the water supply is questionable. In regard to cancer, heart




127

128

CAUSES OF D EATH , B Y OCCUPATION

disease, and other degenerative diseases, however, the results do not
ordinarily reveal a connection with any industrial hazard. Differ­
ences in the percentage distribution of each of these causes among the
several occupations do exist; but the groupings of occupations do
not lend themselves to ready interpretation.
We realize only too well the limitations of our method of analysis
and the pitfalls which must be avoided in interpreting our results.
We have probably fallen into many ourselves in spite of all precau­
tions. The lack of information regarding the number of living
policyholders in the different age groups is a serious handicap which
precludes the possibility of computing occupational death rates.
Undoubtedly such death rates would be a much more accurate meas­
ure of the hazards to life in the various occupations than we now
have. Consequently, it would be highly desirable to obtain death
rates classified according to age and cause of death for a much
larger number of occupations than our study covered. The absence
of trustworthy occupational mortality statistics in the United States
hinders the work of industrial hygienists, and an investigation such
as ours can only partially overcome the lack of reliable data that
now exists. We can not too strongly urge, therefore, that the Fed­
eral Bureau of the Census compile and tabulate data showing the
mortality of workers engaged in different occupations. The reports
of the Registrar General of England and Wales give much more
complete information on occupational mortality than is available
in this country. Death rates are classified according to age and
cause of death in five different social classes of the population. The
reports, moreover, give information for each occupation within the
different economic classes and denote as well the particular occu­
pations exposed to specific hazards. They have, therefore, been
invaluable in aiding the British Medical Research Council to deter­
mine the weak spots in industrial management and to inaugurate
additional studies.
We should have similar studies here modeled on the same plan.
I f this has proved feasible in England, it should also be a possible
undertaking in America. Certain inherent difficulties in securing
trustworthy data make the procedure a little more complicated in
the United States than in England, such as the greater mobility of
labor and the shifting of men from one occupation to another. The
mixture of nationalities also hinders the task of obtaining clear
statements of occupational status from large groups of foreign
workmen. But these obstacles can be overcome or their effect mini­
mized. The results obtained will amply justify the time and money
expended in investigating hazards of occupation. The Director of
the Census is fully aware of the importance of better occupational
statistics and has already taken steps to secure them. Every indus­
trial hygiene worker, every physician, and every employer, as well as
organized groups of doctors, employers, workers, and the general
public should assist Census Bureau officials to gain helpful infor­
mation and cooperate with them to the end that our knowledge of
industrial hazards may be broadened; that the measures needed to
eliminate them should be determined; and that the best program for
conserving the health of workers should be put into effect.



LIST OF REFERENCES
1. United States Bureau of Labor Statistics Bui. No. 207: Causes of Death
by Occupation, by Louis I. Dublin.
2. Tubercle, London, October, 1927. Special Aspects of the Declining
Tuberculosis Death Rate in the United States, by Louis I. Dublin and George
H. Van Buren.
3. Medical Research Committee, special report, series No. 22, 1919. An
Inquiry into the Prevalence and Aetiology of Tuberculosis among Industrial
Workers, by M. Greenwood and A. E. Teblb.
4. Association of Life Insurance Medical Directors and the Actuarial So­
ciety of America, New York, 1913, Medico-Actuarial Mortality Investigation,
Vol. I l l : Effect of Occupation on Mortality.
5. Great Britain. Registrar General. Decennial Supplement, England and
Wales, 1921, Part II, Occupational Mortality, Fertility, and Infant Mortality.
London, 1927.
6. New York City Department of Health, Monograph No. 17, August, 1917:
The Health of Food Handlers, by Louis I. Harris and Louis I. Dublin. Re­
vised and reprinted by Metropolitan Life Insurance Co.
7. Actuarial Society of America. Transactions, October 20 and 21, 1927.
Vol. X X V III, Part II, No. 78, p. 184.
8. Journal of Industrial Hygiene, Boston, Mass., July, 1919, p. 128. The
Pathological and Clinical Manifestations Following the Inhalation of Dust, by
H. R. M. Landis.
9. Committee on Group Mortality Investigations (E. E. Cammack, iEtna Life
Insurance Co., chairman). Report: Combined Group Mortality Experience,
1913-1926.
10. United States Bureau of Mines. Coal-mine Fatalities in the United
States. Annual Bulletins.
11. United States Bureau of Labor Statistics Bui. No. 231: Mortality from
Respiratory Diseases in Dusty Trades, by Frederick L. Hoffman, pp. 406-414.
12. Journal of Industrial Hygiene, Boston, Mass., November, 1922, p.
308. A Study of Mortality of Coal Miners, England and Wales, by Edgar L.
Collis.
13. United States Bureau of Labor Statistics Bui. No. 392: Survey of
Hygienic Conditions in the Printing Trades, by S. Kjaer, pp. 199, 208.
14. United States Bureau of the Census. United States Life Tables,
1890, 1901, 1910, and 1901-1910, pp. 106, 114.
15. American Review of Tuberculosis, Vol. X III, No. 3, March, 1926, p. 290.
Urban and Rural Trends of Tuberculosis Mortality Contrasted, by Allen K.
Krause.
16. Metropolitan Life Insurance Co. Policyholders’ Service Bureau. Report:
Mortality Statistics as an Indication of Health Hazards of Foundry Workers,
by Wade Wright.
17. The Spectator, New York City, July 29, 1920, p. 17. Mortality Among
American Policemen, by F. S. Crum.
18. Joslin, E. P. The Treatment of Diabetes Mellitus. Philadelphia, Lea
& Febiger, 1928. pp. 150, 160,162.




129

130

LIST OF REFERENCES

19. United States Public Health Service Bui. No. 71, May, 1915, p. 98.
Studies in Vocational Diseases, by J. W . Schereschewsky.
20. Henry Phipps Institute for the Study, Treatment, and Prevention of
Tuberculosis. Eighth report: Factors Affecting the Health of Garment Makers,
by H. It. M. Landis and J. S. Reed. Philadelphia, 1915, p. 80.
21. United States Public Health Service Bui. No. 73, March, 1916, p. 24.
Tuberculosis Among Industrial Workers, by D. E. Robinson and J. G. Wilson.
22. Journal of Industrial Hygiene, Boston, Mass., January, 1924, p. 339. The
Physical Examination of Fifty Thousand Garment Workers, by George M.
Price.
23. United States Bureau of Labor Statistics Bui. No. 251: Preventable
Death in Cotton Manufacturing Industry, by Arthur Reed Perry.
24. Collis, E. L., and Greenwood, Major: The Health of the Industrial
Worker. London, J. & A. Churchill, 1921, p. 138.
25. Great Britain. Medical Research Council. Special report, series No.
99, 1926: An Investigation into the Statistics of Cancer in Different Trades
and Professions, p. 32.
26. Journal of Industrial Hygiene, Boston, Mass., November, 1922, p. 296.
A Clinical Study of Fur Cutters and Felt Hat Workers, by Wade Wright.




LIST OF BULLETINS OF THE BUREAU OF LABOR STATISTICS
The following is a list of all bulletins of the Bureau of Labor Statistics published since
July, 1912, except that in the case of bulletins giving the results of periodic surveys of the
bureau, only the latest bulletin on any one subject is here listed.
A complete list of the reports and bulletins issued prior to July, 1912, as well as the bulletins
published since that date, will be furnished on application. Bulletins marked thus (*) are out
of print.
Conciliation and Arbitration (including strikes and lockouts).
♦No. 124. Conciliation and arbitration in the building trades of Greater New York.
[1913.]
•No. 133. Report of the industrial council of the British Board of Trade on its inquiry
into industrial agreements. [1913.]
No. 139. Michigan copper district strike. [1914.]
No. 144. Industrial court of the cloak, suit, and skirt industry of New York City.
[1914.]
No. 145. Conciliation, arbitration, and sanitation in the dress and waist industry
of New York City. [1914.]
♦No. 191. Collective bargaining in the anthracite-coal industry. [1916.]
♦No. 198. Collective agreements in the men’s clothing industry. [1916.]
No. 233. Operation of the industrial disputes investigation act of Canada. [1918.]
No. 255. Joint industrial councils in Great Britain. [1919.]
No. 283. History of the Shipbuilding Labor Adjustment Board, 1917 to 1919.
No. 287. National War Labor Board: History of its formation, activities, etc.
[1921.]
No. 303. Use of Federal power in settlement of railway labor disputes. [1922.]
No. 341. Trade agreement in the silk-ribbon industry of New York City. [1923.]
No. 402. Collective bargaining by actors. [1926.]
No. 468. Trade agreements, 1927.
No. 481. Joint industrial control in the book and job printing industry. [1928.]
Cooperation.
No. 313. Consumers’ cooperative societies in the United States in 1920.
No. 314. Cooperative credit societies in America and in foreign countries. [1922.]
No. 437. Cooperative movement in the United States in 1925 (other than agriculture).
Employment and Unemployment.
♦No. 109. Statistics of unemployment and the work of employment offices in the United
States. [1913.]
No. 172. Unemployment in New York City, N. Y. [1915.]
♦No. 183. Regularity of employment in the women’s ready-to-wear garment industries.
[1915.]
♦No. 195. Unemployment in the United States. [1916.]
No. 196. Procedings of the Employment Managers’ Conference held at Minneapolis
Minn., January 19 and 20, 1916.
♦No. 202. Proceedings of the conference of Employment Managers’ Association of Bos­
ton, Mass., held May 10, 1916.
No. 206. The British system of labor exchanges. [1916.]
No. 227. Proceedings of the Employment Managers’ Conference, Philadelphia, Pa.,
April 2 and 3, 1917.
No. 235. Employment system of the Lake Carriers’ Association. [1918.]
♦No. 241. Public employment offices in the United States. [1918.]
No. 247. Proceedings of Employment Managers’ Conference, Rochester, N. Y., May
9-11, 1918.
No. 310. Industrial unemployment: A statistical study of its extent and causes.
[1922.]
No. 409. Unemployment in Columbus, Ohio, 1921 to 1925.
Foreign Labor Laws.
♦No. 142. Administration o f labor laws and factory inspection in certain European
countries. [1914.]
No. 494. Labor legislation of Uruguay. [1929.]




(I)

Housing.
♦No. 158. Government aid to home owning and housing of working people in foreign
countries. [1914.]
No. 263. Housing by employers in the United States. [1920.]
No. 295. Building operations in representative cities in 1920.
No. 500. Building permits in the principal cities of the United States in [1921 to]
1928.
Industrial Accidents and Hygiene.
♦No. 104. Lead poisoning in potteries, tile works, and porcelain enameled sanitary
ware factories. [1912.]
No. 120. Hygiene of the painters’ trade. [1913.]
♦No. 127. Dangers to workers from dusts and fumes, and methods of protection.
[1913.]
♦No. 141. Lead poisoning in the smelting and refining of lead.
[1914.]
♦No. 165. Lead poisoning in the manufacture of storage batteries. [1914.]
♦No. 179. Industrial poisons used in the rubber industry. [1915.]
No. 188. Report of British departmental committee on the danger in the use of
lead in the painting of buildings. [1916.]
♦No. 201. Report of committee on statistics and compensation insurance cost of
the International Association of Industrial Accident Boards and Com­
missions.
[1916.]
♦No. 207. Causes of death, by occupation. [1917.]
♦No. 219. Industrial poisons used or produced in the manufacture of explosives.
[1917.]
No. 221. Hours, fatigue, and health in British munition factories. [1917.]
No. 230. Industrial efficiency and fatigue in British munition factories.
[1917.]
♦No. 231. Mortality from respiratory diseases in dusty trades (inorganic dusts).
[1918.]
♦No. 234. Safety movement in the iron and steel industry, 1907 to 1917.
No. 236. Effects of the air hammer on the hands of stonecutters. [1918.]
No. 249. Industrial health and efficiency. Final report of British Health of Muni­
tion Workers’ Committee.
[1919.]
♦No. 251. Preventable death in the cotton-manufacturing industry.
[1919.]
No. 256. Accidents and accident prevention in machine building.
[1919.]
No. 267. Anthrax as an occupational disease. [1920.]
No. 276. Standardization of industrial accident statistics.
[1920.]
No. 280. Industrial poisoning in making coal-tar dyes and dye intermediates.
[1921.]
No. 291. Carbon-monoxide poisoning. [1921.]
No. 293. The problem of dust phthisis in the granite-stone industry. [1922.]
No. 298. Causes and prevention of accidents in the iron and steel industry, 1910-1919.
No. 306. Occupation hazards and diagnostic signs: A guide to impairments to be
looked for in hazardous occupations.
[1922.]
No. 392. Survey of hygienic conditions in the printing trades. [1925.]
No. 405. Phosphorus necrosis in the manufacture of fireworks and in the preparation
of phosphorus. [1926.]
No. 425. Record of industrial accidents in the United States to 1925.
No. 427. Health survey of the printing trades, 1922 to 1925.
No. 428. Proceedings of the Industrial Accident Prevention Conference, held at
Washington, D. C., July 14-16, 1926.
No. 460. A new test for industrial lead poisoning. [1928.]
No. 466. Settlement for accidents to American seamen. [1928.]
No. 488. Deaths from lead poisoning, 1925-1927.
No. 490. Statistics of industrial accidents in the United States to the end of 1927.
Industrial Relations and Labor Conditions.
No. 237. Industrial unrest in Great Britain. [1917.]
No. 340. Chinese migrations, with special reference to labor conditions. [1923.]
No. 349. Industrial relations in the West Coast lumber industry.
[1923.]
No. 361. Labor relations in the F^airmont (W. Va.) bituminous-coal field. [1924.]
No. 380. Postwar labor conditions in Germany. [1925.]
No. 383. Works council movement in Germany. [1925.]
No. 384. Labor conditions in the shoe industry in Massachusetts, 1920-1924.
No. 399. Labor relations in the lace and lace-curtain industries in the United States.
[1925.]
No. 483. Conditions in the shoe industry in Haverhill, Mass., 1928.




(II)

Labor Laws of the United States (including decisions of courts relating: to labor).
No. 211. Labor laws and their administration in the Pacific States.
[1917.]
No. 229. Wage-payment legislation in the United States.
[1917.]
No. 285. Minimum-wage laws of the United States: Construction and operation.
[1921.]
No. 321. Labor laws that have been declared unconstitutional.
[1922.]
No. 322. Kansas Court of Industrial Relations. [1923.]
No. 343. Laws providing for bureaus of labor statistics, etc. [1923.]
No. 370. Labor laws of the United States, with decisions of courts relating thereto.
[1925.]
No. 408. Laws relating to payment of wages. [1926.]
No. 444. Decisions of courts and opinions affecting labor, 1926.
No. 467. Minimum wage legislation in various countries. [1928.]
No. 486. Labor legislation of 1928.
Proceedings of Annual Conventions of the Association of Government Labor Officials of the
United States and Canada. Name changed in 1928 toi Association of Governmental Officials
in Industry of the United States and Canada.
♦No.
No.
No.
No.
*No.
♦No.
No.
No.
No.

266.
307.
323.
352.
389.
411.
429.
455.
480.

Seventh, Seattle, Wash., July 12-15, 1920.
Eighth, New Orleans, La., May 2-6, 1921.
Ninth, Harrisburg, Pa., May 22-26, 1922.
Tenth, Richmond, Va., May 1-4, 1923.
Eleventh, Chicago, 111., May 19-23, 1924.
Twelfth, Salt Lake City, Utah, August 13-15, 1925.*
Thirteenth, Columbus, Ohio, June 7-10, 1926.
Fourteenth, Paterson, N. J., May 31 to June 3, 1927.
Fifteenth, New Orleans, La., May 15-24, 1928.

Proceedings of Annual Meetings of the International Association of Industrial Accident Boards
and Commissions.
No. 210. Third, Columbus, Ohio, April 25—
28, 1916.
No. 248. Fourth, Boston, Mass., August 21-25, 1917.
No. 264. Fifth, Madison, Wis., September 24-27, 1918.
*No. 273. Sixth, Toronto, Canada, September 23-26, 1919.
No. 281. Seventh, San Francisco, Calif., September 20-24, 1920.
No. 304. Eighth, Chicago, 111., September 19-23, 1921.
No. 333. Ninth, Baltimore, Md., October 9-13, 1922.
No. 359. Tenth, St. Paul, Minn., September 24-26, 1923.
No. 385. Eleventh, Halifax, Nova Scotia, August 26-28, 1924.
No. 395. Index to proceedings, 1914—
1924.
No. 406. Twelfth, Salt Lake City, Utah, August 17-20, 1925.
No. 432. Thirteenth, Hartford, Conn., September 14—
17, 1926.
No. 456. Fourteenth, Atlanta, Ga., September 27—
29, 1927.
No. 485. Fifteenth, Paterson, N. J., September 11-14, 1928.
Proceedings of Annual Meetings of International Association of Public Employment Services.
No. 192. First, Chicago, December 19 and 20, 1913 ; second, Indianapolis, September
24 and 25, 1914; third, Detroit, July 1 and 2, 1915.
No. 220. Fourth, Buffalo, N. Y., July 20 and 21, 1916.
No. 311. Ninth, Buffalo, N. Y., September 7-9, 1921.
No. 337. Tenth, Washington, D. C., September 11-13, 1922.
No. 355. Eleventh, Toronto, Canada, September 4— 1923.
7,
No. 400. Twelfth, Chicago, 111., May 19-23, 1924.
No. 414. Thirteenth, Rochester, N. Y., September 15-17, 1925.
No. 478. Fifteenth, Detroit, Mich., October 25-28, 1927.
No. 501. Sixteenth, Cleveland, Ohio, September 18-21, 1928.
Productivity of Labor.
No. 356. Productivity costs in the common-brick industry. [1924.]
No. 360. Time and labor costs in manufacturing 100 pairs of shoes, 1923.
No, 407. Labor cosits of production and wages and hours of labor in the paper boxboard industry.
[1926.]
No. 412. Wages, hours, and productivity in the pottery industry, 1925.
No. 441. Productivity of labor in the glass industry. [1927.]
No. 474. Productivity of labor in merchant blast furnaces. [1928.]
No. 475. Productivity of labor in newspaper printing. [1929.]




(H I)

Retail Prices
♦No. 121.
*No. 130.
No. 164.
No. 170.
No. 357.
No. 369.
No. 495.

and Cost of Living.
Sugar prices, from refiner to consumer. [1913.]
Wheat and flour prices, from farmer to consumer. [1913.]
Butter prices, from producer to consumer. [1914.]
Foreign food prices as affected by the war. [1915.]
Cost of living in the United States. [1924.]
The use of cost-of-living figures in wage adjustments. [1925.]
Retail prices, 1890 to 1928.

Safety Codes.
♦No. 331. Code of lighting: Factories, mills, and other work places.
No. 336. Safety code for the protection of industrial workers in foundries.
No. 350. Specifications of laboratory tests for approval of electric headlighting
devices for motor vehicles.
No. 351. Safety code for the construction, care, and use of ladders.
No. 375. Safety code for laundry machinery and operations.
No. 378. Safety code for woodworking plants.
No. 382. Code of lighting school buildings.
No. 410. Safety code for paper and pulp mills.
No. 430. Safety code for power presses and foot and hand presses.
No. 433. Safety codes for the prevention of dust explosions.
No. 436. Safety code for the use, care, and protection of abrasive wheels.
No. 447. Safety code for rubber mills and calenders.
No. 451. Safety code for forging and hot-metal stamping.
No. 463. Safety code for mechanical power-transmission apparatus— first revision.
Vocational and Workers’ Education.
♦No. 159. Short-unit courses for wage earners, and a factory school experiment.
[1915.]
♦No. 162. Vocational education survey of Richmond, Va. [1915.]
No. 199. Vocational education survey of Minneapolis, Minn. [1917.]
No. 271. Adult working-class education in Great Britain and the United States.
[1920.]
No. 459. Apprenticeship in building construction.
[1928.]
Wages and Hours of Labor.
♦No. 146. Wages and regularity of employment and standardization of piece rates
in the dress and waist industry of New York City. [1914.]
♦No. 147. Wages and regularity of employment in the cloak, suit, and skirt industry.
[1914.]
No. 161. Wages and hours of labor in the clothing and cigar industries, 1911 to 1913.
No. 163. Wages and hours of labor in the building and repairing of steam-railroad
cars, 1907 to 1913.
♦No. 190. Wages and hours of labor in the cotton, woolen, and silk industries, 1907
to 1914.
No. 204. Street-railway employment in the United States. [1917.]
No. 225. Wages and hours of labor in the lumber, millwork, and furniture industries,
1915.
No. 265. Industrial survey in selected industries in the United States, 1919.
No. 297. Wages and hours of labor in the petroleum industry, 1920.
No. 356. Productivity costs in the common-brick industry. [1924.]
No. 358. Wages and hours of labor in the automobile-tire industry, 1923.
No. 360. Time and labor costs in manufacturing 100 pairs of shoes, 1923.
No. 365. Wages and hours of labor in the paper and pulp industry, 1923.
No. 394. Wages and hours of latJor in metalliferous mines, 1924.
No. 407. Labor cost of production and wages and hours of labor in the paper boxboard industry. [1926.]
No. 412. Wages, hours, and productivity in the pottery industry, 1925.
No. 413. Wages and hours of labor in the lumber industry in the United States, 1925.
No. 416. Hours and earnings in anthracite and bituminous coal mining, 1922 and
1924.
No. 435. Wages and hours of labor in the men’s clothing industry, 1911 to 1926.
No. 438. Wages and hours of labor in the motor-vehicle industry, 1925.
No. 442. Wages and hours of labor in the iron and steel industry, 1907 to 1926.
No. 452. Wages and hours of labor in the hosiery and underwear industries, 1907 to
1926.




(IV)

Wages and Hours of Labor—Continued.
No. 454. Hours and earnings in bituminous-coal mining, 1922, 1924, and 1926.
No. 471. Wages and hours of labor in foundries and machine shops, 1927.
No. 472. Wages and hours of labor in the slaughtering and meat-packing industry,
1927.
No. 476. Union scales of wages and hours of labor, 1927. [Supplement to Bui.
No. 457.]
No. 482. Union scales of wages and hours of labor, May 15, 1928.
No. 484. Wages and hours of labor of common street laborers, 1928.
No. 487. Wages and hours of labor in woolen and worsted goods manufacturing, 1910
to 1928.
No. 492. Wages and hours of labor in cotton-goods manufacturing, 1910 to 1928.
No. 498. Wages and hours of labor in the boot and shoe industry, 1910 to 1928.
No. 499. History of wages in, the United States from colonial times to 1928.
No. 502. Wages and hours of labor in the motor-vehicle industry, 1928.
No. 503. Wages and hours of labor in the men’s clothing industry, 1911 to 1928.
No. 504. Wages and hours of labor in the hosiery and underwear industries, 1907 to
1928.
Welfare Work.
♦No. 123. Employers’ welfare work. [1913.]
No. 222. Welfare work in British munitions factories. [1917.]
♦No. 250. Welfare work for employees in industrial establishments in the United
States. [1919.]
No. 458. Health and recreation activities in industrial establishments, 1926.
Wholesale Prices.
No. 284. Index numbers of wholesale prices in the United States and
countries. [1921.]
No. 453. Revised index numbers of wholesale prices, 1923 to July, 1927.
No. 493. Wholesale prices, 1913 to 1928.

foreign

Women and Children in Industry.
No. 116. Hours, earnings, and duration of employment! of wage-earning women in
selected industries in the District of Columbia. [1913.]
♦No. 117. Prohibition of night work of young persons. [1913.]
No. 118. Ten-hour maximum working-day for women and young persons. [1913.]
No. 119. Working hours of women in the pea canneries of Wisconsin. [1913.]
♦No. 122. Employment of women in power laundries in Milwaukee. [1913.]
No. 160. Hours, earnings, and conditions of labor of women in Indiana mercantile
establishments and garment factories. [1914.]
♦No. 167. Minimum-wage legislation in the United States and foreign countries.
[1915.]
♦No. 175. Summary of the report on conditions of woman and child wage earners in
the United States. [1915.]
♦No. 176. Effect of minimum-wage determinations in Oregon. [1915.]
♦No. 180. The boot and shoe industry in Massachusetts as a vocation for women.
[1915.]
♦No. 182. Unemployment among women in department and other retail stores of
Boston, Mass. [1916.]
No. 193. Dressmaking as a trade for women in Massachusetts. [1916.]
No. 215. Industrial experience of trade-school girls in Massachusetts. [1917.]
♦No. 217. Effect of workmen’s compensation laws in diminishing the necessity of
industrial employment of women and children. [1918.]
No. 223. Employment of women and juveniles in Great Britain during the war.
[1917.]
No. 253. Women in the lead industries. [1919.]
Workmen's Insurance and Compensation (including laws relating thereto).
♦No. 101. Care of tuberculosis wage earners in Germany. [1912.]
♦No. 102. British national insurance act, 1911.
No. 103. Sickness and accident insurance law of Switzerland, [1912.]
No. 107. Law relating to insurance of salaried employees in Germany.




(V)

[1913.]

Workmen's Insurance and Compensation (including: laws relating thereto)— C ontinued.
*N o. 1 55. C om pen sation fo r accidents to em ployees o f the U nited S tates.
[ 1 9 1 4 .]
N o. 2 1 2 . Proceedings o f the conference on social insurance called by the In tern atio n al
A sso cia tio n o f Ind ustrial A ccident B oards and C om m ission s, W a s h in g ­
ton , D. C., Decem ber 5 - 9 , 1916 .
*N o . 2 4 3 . W o rk m e n ’ s com pensation legislation in th e U nited S ta te s and foreign
countries, 1 9 1 7 and 1 918 .
N o. 30 1 . C om parison o f w orkm en’ s com pensation insurance and ad m in istra tio n .
[1 9 2 2 .]
N o. 3 1 2 . N a tio n a l h ealth insurance in G reat B ritain , 191 1 to 1 9 2 1 .
N o. 3 7 9 . C om parison o f w orkm en’ s com pensation law s o f the U nited S ta te s as o f
J an u ary 1, 1 925 .
N o. 4 7 7 . Public-service retirem ent system s, U nited S tates and Europe.
[ 1 9 2 8 .]
N o. 4 9 6 . W o rk m e n ’ s com pensation legislation o f the U nited S tates and C anada as
o f Jan u ary, 1929 .
W ith text of legislation enacted in 1 9 2 7 and 1 9 2 8 .

Miscellaneous Series.
♦No. 1 74. Su bject index o f the
No.
N o.
N o.
No.
N o.

208.
242.
254.
268.
282.

pu blications o f the

U n ited

S tates

B ureau

of

L a bor

S ta tistic s up to M ay 1, 191 5 .
Profit sharin g in the U nited States.
[ 1 9 1 6 .]
F ood situ ation in central Europe, 191 7 .
In tern a tio n a l labor legislation and the society o f nation s.
[1 9 1 9 .]
H isto r ic a l survey o f in tern ation al action affecting labor.
[1 9 2 0 .]
M u tu a l relief association s am on g G overn m ent em ployees in W a s h in g to n ,
D . C.
[1 9 2 1 .]

N o. 2 9 9 . P ersonal research agencies : A guide to organized research in em ploym ent
m anagem ent, in d u stria l relations^ train in g, and w orking con d itio n s.
[ 1 9 2 1 .]
N o. 31 9 . The B ureau o f Labor
[ 1 9 2 2 .]

S t a t is t ic s : Its

history,

activities,

and

orga n ization .

N o. 3 2 6 . M eth od s o f procuring and com puting sta tistica l in form ation o f the B ureau
o f L abor S ta tistic s.
[1 9 2 3 .]
N o. 3 4 2 . In tern a tio n a l Seam en’s U nion o f A m e r ic a : A study o f its h isto ry and
problem s.
[1 9 2 3 .]
N o. 2 4 6 . H u m a n ity in governm ent.
[ 1 9 2 3 .]
N o. 3 7 2 . C onvict labor in 1923 .
No. 3 86. C ost o f A m erican alm shou ses.
[1 9 2 5 .]
N o. 3 9 8 . G row th o f legal-aid w ork in the U nited S tates.
[1 9 2 6 .]
N o. 4 0 1 . F a m ily allow ances in foreign countries.
[ 1 9 2 6 .]
N o. 4 6 1 . L abor organizations in Chile.
[ 1 9 2 8 .]
N o. 4 6 2 . P a rk recreation areas in the U nited S tates.
[ 1 9 2 8 .]
N o. 4 6 5 . Beneficial activities o f A m erican trade-unions.
[ 1 9 2 8 .]
N o. 4 7 9 . A c tiv itie s and fun ction s o f a State departm ent o f labor.
[ 1 9 2 8 .]
N o. 4 8 9 . C are o f aged person® in the U n ited S tates.
[1 9 2 9 .]
N o. 4 9 1 . H andbook o f labor sta tistics : 1 9 2 9 edition.
N o. 5 0 5 . D irectory o f hom es fo r the aged in the U nited S tates.
[ 1 9 2 9 .]
N o. 5 0 6 . H andbook o f A m erican trade-unions, 1 9 2 9 edition.




(VI)


Federal Reserve Bank of St. Louis, One Federal Reserve Bank Plaza, St. Louis, MO 63102