Here is the third chapter of the second part (Level of living) of the translation from Machinisme Bien-être (1951), by Theodore Caplow (The causes of wealth, 1960).

 Chapter VII : HEALTH AND LIFE EXPECTANCY

IT WOULD SEEM DIFFICULT to reject one criterion of human progress: the lengthening of the average span of life. The individual must be alive that he may achieve civilization. Existence is a prerequisite of thought. The man with forty crowns knew very well that in the eighteenth century in France, one out of two men died before his twentieth year. Admirable conditions to promote an intellectual civilization! In order to be elected to the Academy, it was first necessary to triumph over chickenpox.

The prolongation of life expectancy is the essential phenomenon of modern times — at once a consequence of technical progress and a reason for the acceleration of that progress. This prolongation sums up and synthesizes the improvements that have taken place in both the level of living and the style of life.

The reasons for the prolongation of life expectancy

The lengthening of the average duration of human life proceeds from numerous causes, all of them determined directly or indirectly by scientific progress.

One of the most obvious of the indirect causes is the improvement of the level of living of the great masses. Mortality has been much higher in the poor classes than in the comfortable and rich classes. The fact that mortality is much lower today in the poorest classes of advanced nations than it was in the richest classes around 1750 shows that the essentially medical factor is preponderant.

Here, as in every other field, scientific progress has led to the discovery of causal relationships, permitting men to manipulate and modify a phenomenon and to prevent or to provoke other phenomena that cannot be directly influenced. Here, as everywhere, familiarity with stable or relatively stable causalities leads to predictability, and predictability permit action.

Hence the importance, greater in this respect than in any other, of the speed with which action can be taken to prevent or cure diseases. Physiology describes normal causalities. Pathology describes morbid causalities. Therapy combats morbid developments by trying to release opposed causalities against them. Thus medical and surgical therapy is to biological science what technical progress is to science in general.

The progress of biology in the past fifteen years surpasses the popular imagination. The sulfa drugs (1935), penicillin (1941), streptomycin (1946), chloromycetin (1948) , and aureomycin (1949), have conquered practically all of the infectious maladies — typhus, typhoid fever, tuberculosis, cholera, pneumonia, pleurisy. Venereal diseases can be treated with penicillin plus the earlier medications of mercury, arsenic, and bismuth as auxiliaries. They have been definitely curable since 1948.

We have been able to isolate and to obtain from animal glands the hormones that function in the human body as catalysts for the accomplishment of such organic functions as physical growth and mental development.

Furthermore, since 1930, we have known how to manufacture by synthesis a whole series of glandular secretions having regulative or substitutive functions, such as insulin, adrenalin, folliculin, cortisone. These serums permit replacement or supplementation of the products of several glands — the pancreas, the ovaries, the thymus — when they are inadequate.

The use of physical treatments such as radiation therapy, electromagnetic waves, and ultrasonic vibration open other new avenues of progress to medical science.

The science of nutrition and the knowledge of vitamins have led to a reduction in the diseases of malnutrition, such as rickets and scurvy, and have provided remedies for deficiencies in blood production, such as those leading to pernicious anemia.

Surgical therapy has also accomplished almost inconceivable advances since 1950 by the use of new methods of anaesthesia and patient care, as in heart and stomach surgery, and by the use of new operative techniques, often made possible by the antibiotics. Neurosurgery is moving out of a laboratory phase in to general use.

Finally, prothesis is in the midst of a revolution. From the pioneer efforts at the end of the eighteenth century when the first wooden legs gave cripples a satanic character, to the artificial limbs of 1955, progress has been decisive. Sight is being more closely corrected, hearing can be improved, and in dental prothesis we see the tendency to a real incorporation of inanimate matter in the human body and the positive correction of anatomical faults and infirmities.

The removal of handicaps leads to aesthetic surgery which may be considered as including beauty care — the permanent wave, the massage, and other cosmetic treatments — and more serious operations ranging from the reduction of varicose veins to plastic remodeling.

All of these techniques reduce the suffering of the sick and improve the lot of millions of human beings. Most of them also contribute to the lengthening of the average life and to an increase in our powers of action.

The lengthening of the average expectation of human life in the course of the past two hundred years is one of the least debatable phenomena of contemporary economic development. As the reader must suspect by now, this evolution in time has produced a disparity in space, so that in the world of today there are some nations whose situation is close to that of 1750; in others the average length of life has more than doubled.

Mortality in the traditional epoch

Reliable data on the mortality of large populations cannot be found earlier than the middle of the eighteenth century. Thus we do not have much real evidence except for the very end of the traditional epoch.

In France, from 1750 to 1800, the mean annual mortality — the ratio of the total number of deaths in one year to the total population at the mid-point of that year — seems to have been of the order of 30 to 35 per thousand. With the beginning of official statistics, between 1806 and 1810, the rate recorded was 26 per thousand. The Swedish and Finnish demographic statistics, the oldest of the modern world concerning whole nations, go back to 1750 and show for the second half of the eighteenth century an average rate of the order of 25 to 30 per thousand.

If the reader remembers the first part of this book, he will understand why the mortality rates of the traditional epoch were not only very high in comparison to the present rates of advanced countries, which have fallen below ten per thousand in the last 20 years, but also why they varied greatly from one year to another. The extreme instability of the level of living resulted in an extremely fluctuating death rate.

At a time when the average death rate was of the order of 30 per thousand, in the course of the years 1750 to 1800, a rate of 37.2 was recorded in Sweden in 1772 and 52.6 in 1773. In Finland we note a rate of 41 in 1791, 60 in 1808, 59 in 1809, 78 in 1868. These figures give a faint idea of what the mortality must have been in earlier epidemics or famines such as that of 1709 in France[1].

Excessive death rates are still found in those nations of the contemporary world which have remained closed to technical progress and have only profited from a very trifling improvement in the level of living. From 1931 to 1935 the statistics of India and of Ceylon still showed rates around 25 per thousand. The Egyptian rate was 28 per thousand before 1940. As for China, no general statistics have yet been published, but local investigations carried out between 1929 and 1935 give figures of 30 to 40 per thousand as normal.

These death rates, which are the easiest to obtain from civil registers, do not speak to the imagination until we understand that a rate of 33 per thousand corresponds to an average life span of 30 years and to a median life expectancy of 10 to 20 years[2].

Life Expectancy Trends Since 1830

We may sum up as follows the trends observed since 1830 in the technically advanced countries:

1) Average and median life expectancies have been greatly increased; the median life expectancy even more than the mean.

2) The variations and fluctuations from one year to another have been much reduced.

3) The poorer classes have made relatively greater gains than the prosperous classes.

In sum, the effective duration of human life has increased and been equalized at the same time.

These facts will appear clearly from inspection of the following tables.

One last time we are happy to cite the name of Villermé, since we regard him, together with Vauban and Levasseur, as founder of this science of the level of living, so necessary to human welfare and so neglected. Villermé wrote in 1835: "To find men suitable for military service, 193 recruits were required from the prosperous classes and 343 from the poorer classes[3]." This simple fact calls attention to the considerable differences of physical conformation produced by the differences in level of living which we noted in the early chapters of this book.

All the statistics of military conscription show the growth of average stature during the past century. For reasonably prosperous districts in the south of France, the increase of average height exceeds five centimeters and sometimes reaches seven or eight.

Even more dramatically, Villermé notes, as part of a remarkable study that he conducted at Mulhouse concerning mortality in the period 1823 to 1834, that the life expectancy at birth was 28 years among the rich, and — one cannot write this without a feeling of revolt — one year and three months among the "simple weavers." We should like to be able to say that Villermé had made an error of calculation. Not at all. For every 100 births among these workers whose level of living we previously described, there were 30 deaths in the first six months and 20 deaths in the nine months following. Of the 100 infants, only 27 reached age 10, 17 age 20, 6 age 40, and only one reached the age of 60.

From Villermé, op. cit., Vol. II, p. 251. This table includes those occupational groups from which more than 100 deaths were recorded in the period, with the exception of servants (93) and foremen (80). The median life expectancy at birth for all of France at that time was about 20 years. As may be seen from the table, the mortality in the industrialized department of Haut-Rhin was much higher, and in the factory town of Mulhouse, much higher still.

There is still a high mortality among the poor. This has been demonstrated by such studies as those of Huber and Hersch in France, Whitney in the United States, and the official statistical office of Great Britain[4]. But the observed range between the extremes observed after 1920 has been relatively slight and is being rapidly reduced. According to figures furnished by the Registrar General's Decennial Supplement, which represents the most serious investigation we have on this subject, the mortality rate of the poorest classes was 48 per cent higher than the most favored classes in 1921-23 and only 24 per cent higher in 1930-32. We are far from the difference of 500 to 1000 per cent implied by the statistics of Villermé, Moreover, this gap of 24 per cent refers to the situation a generation past, before the strengthening of social insurance and the discovery of antibiotics.

While in 1830 the richest groups of the French population had a life expectancy of about 28 years, the poorest groups today have a life expectancy of more than 60 years. The mean life expectancy for the entire French population has a valor of approximately 67.

However, as in other matters concerned with the level of living, France does not hold the world record. Holland, Sweden, Norway, Denmark, Switzerland, England, the United State, Canada, and many other countries enjoy life expectancies varying from 68 to 72 years. On the other hand, as we have already mentioned, some rates in the modern world have been, until the last few years, hardly higher than those of the end of the traditional epoch. The median life expectancy for India in the decade 1921-30 was only 26. However, since 1952 or 1955, underdeveloped countries have made extraordinary progress  in this realm. China has published the same infant mortality rates for 1958 as those of France for 1950. The sudden acceleration of progress in reducing mortality has caused predictions of the world population to jump from 3.3 to 6 billion, for the year 2000.

The importance of the struggle against death in the earliest period of life leads us to reproduce here some of the admirable statistics on infant mortality. Humanity itself must have been in a kind of infancy not to have paid any attention until so recently to the fate of its little children. It is only since 1806 that France has known the average number of her newborn who died in the course of their first year. The following table follows this trend and permits comparison with the United States, a comparison which authorizes our hopes for the near future.

Bourgeois-Pichat has calculated the corrected rates of infant mortality, excluding death due to congenital malformation. These corrected rates show, even better than the crude rates, the results of social hygiene. Had it nothing to its credit but this one accomplishment, scientific and technical progress would deserve the respect of men of feeling.

The above evidence shows the relationship existing between the phenomena of levels of living and styles of life, studied throughout this work, and the phenomena of mortality. More generally, the reader may now comprehend the interdependence and intercorrelation of the following apparently independent factors: the productivity of labor, the duration of work, the raising of school ages, the intensity of production, the purchasing power of the working masses, the development of the structure of consumption, and the related development of the structure of production; crises of overproduction; divergent price trends and shifts in the labor force; imbalance of foreign trade. The correlations are so close that it is sufficient to know one of the characteristics of the system within a more or less autonomous economic region to know all of the others, and so to be able to solve problems that a few years ago would have seemed as impossible as trying to determine the speed of a ship from the age of the captain or the height of the mast. For example, we are now really able to deduce from the number of men employed in agriculture the approximate relation of the price of bread to the hourly wage of the laborer, or the approximate average school age, or the approximate life expectancy, and so on and so forth. Conversely, each of the factors seems to determine the order of magnitude of the others. The independent variable of the entire system is technical progress, measured by the productivity of labor.

More exactly, the relations that exist between the duration of human life, the level of living and the style of life — again, we are concerned not with mathematically precise relations but with trends — can be translated into such facts as the following:

1) Before 1800, the nations of the world were relatively homogeneous regarding the level of living and the average life expectancy. Technical progress destroyed that homogeneity. It released a movement whose speed, very different in different countries, eventually led to vast differences.

2) In this development, France occupies an average situation. She does not approach the high achievements of progress that might be expected, given her past and present role in the scientific and philosophical domain.

3) The accentuation of inequalities from nation to nation has been accompanied by a reduction of the inequalities recorded within each nation. This is especially true for the most advanced countries. Poor countries are high-rent countries with marked social inequality and a wide dispersion of wages and of average life expectancies.

4) The same forces that tend to lengthen life expectancy lead to the reduction of seasonal and annual fluctuations of mortality. In the traditional era, the first years of life were extremely hazardous, and mortality rates were greatly influenced — as was the level of living — by the seasons and even more by weather. By way of contrast, in technologically advanced nations, the level of living, style of life, and mortality tend to become increasingly independent of natural conditions and free of seasonal and annual fluctuations.

This constitutes a kind of demonstration on a global scale of what Pierre Vendryes[5] has called the autokinetic human tendency: the tendency to achieve more and more autonomy with respect to the external environment.

The consequences of increasing freedom from the environment are obviously innumerable. Some of them are distressing to the humanist, but I cannot believe, myself, that man is increasing his autonomy for no better purpose than to sacrifice the very reason behind his search for freedom ‑ his intellectual and moral individuality.