Are we breeding a Nation of Invalids?
FOUR years ago, at a moment when our hospitals were more crowded than ever before, an experiment was undertaken to find out just how much illness there is in Canada and how much Canadians are spending trying to keep well.
The federal Department of National Health and Welfare conducted a Sickness Survey among ten thousand families distributed through ten Canadian provinces. Interviewers visited each of these families every month for a year. At the end of that time they came up with some startling figures.
The results showed that the average Canadian spends one day in every seven suffering from some kind of complaint. They showed that three out of every five Canadians are sick enough to take to their beds at least once a year. Canadians are spending a staggering $373 millions a year on medical services—an amount equal to the federal government’s outlay on the St. Lawrence Seaway. This is in addition to equally heavy sums spent on health by federal, provincial and municipal governments.
In an antiseptic age of medical miracles, when vaccines, vitamins and penicillin have become household words, these figures sound fantastic. Half the prescription slips filled out today are for “wonder drugs”—the antibiotics—which, in nine out of ten cases, didn’t exist fifteen years ago. The nation gulps vitamin pills like candy—one billion of them every year, or sixty-six for every man, woman and child in the country. And yet, collectively, we seem to be as sick as ever—or perhaps even sicker than ever. There are fewer than fifteen million of us. But probably more than two millions are chronically ill and disabled.
It is pleasant to be able to boast that we have virtually knocked out diphtheria, smallpox, scarlet fever, and many other communicable diseases — that we have cut the deaths of children under five years of age in half in the past thirty years and that we may wipe out tuberculosis in another half century. But there is some disturbing evidence that other crippling diseases are on the increase. In the past twenty years, for instance, the number of deaths from heart diseaseon a per capita basis—has doubled. In the past thirty years there has been an increase in
Here’s perhaps the grimmest paradox of our times. While medical science fights to make us healthier and live longer, the inexorable laws of nature are wreaking vengeance on the population of tomorrow
deaths irom cancer of 154 percent. Cancer is generally thought of as a disease of old age hut even among young people under thirty it’s shown a 21 percent increase over a fifteenyear period. Diabetes is running wild. The Metropolitan Life Insurance Company now reports that in the United States this disease is increasing twice as fast as the population. It estimates that by 1935, there will be three times as many diabetics, in proportion to the general population, as there are today.
There’s also more than a suspicion that the dark diseases of the mind are on the upswing. One in every 250 Canadians suffers from some serious mental illness today. It’s a good guess that three out of every seventy need psychiatric help—enough to populate a city larger than Hamilton. Even taking into account our greater hospital facilities and increased prosperity, the situation is an uneasy one: we spend four times as much on mental hospitals today as we did in 1931 and the admission rate to these hospitals has tripled. They are jammed to the rafters, more are being planned and built and there’s still a waiting list of patients who need to be admitted. In Ontario alone there are seventeen thousand mental patients who can’t be accommodated. At the Ontario Training School for retarded children at Orillia there’s a waiting list of fifteen hundred. In fact, sixteen percent of our mental cases in Canada can’t get into hospital.
Boiled down into simple terms, this is our national health picture: In an average sample of twenty-eight people, you’ll only find ten wage earners. In one way or another these ten breadwinners must support the remaining eighteen. One of the twenty-eight will be a pensioner. Four of the twenty-eight will be permanently ill.
What is happening to us? Why should our hospitals be treating almost twenty times as many people as they did at the turn of the century? Is it that we are becoming more hospital conscious? Is it that we are slowly becoming a nation of weaklings? Or is there a subtler explanation? Can it be that there is a fundamental change taking place in our social structure -a change ironically brought about by those very advancements in science and
medicine that have made this the age of miracles?
Certainly three basic changes have been wrought in the fabric of twentieth-century society that, at the close of the Victorian Age, no doctor could be expected to foresee.
The first is that this has become an age of speed and pressures. Many scientists are coming to believe that these pressures have a great deal to do with the prevalence of ailments as widely separated as heart disease and arthritis. Dr. Hans Selye, director of the Institute of Experimental Medicine and Surgery at the University of Montreal, is convinced that “stress,” as he terms it, is the single cause of many diseases. Stress, he says, unbalances the body chemistry. The glands try to restore this lost balance. But if the stress is prolonged the glands have to work so hard excreting hormones that in time they become exhausted and illness results. Selye has been able to show, through
“The average Canadian is sick one day a week;
probably two million citizens are disabled”
experiments with animals, that a long period of stress wears out the heart, the blood vessels and the kidneys.
The second change is that, for the first time, man has achieved the Biblical life expectation of three score years and ten. A baby born in Caesar’s day could expect to live only twentytwo years. In the Middle Ages he could look forward to thirty. In 1900, our grandfathers felt they were lucky if they saw their fortyfifth birthday. But a baby born in Canada this year can expect to live to almost seventy. As a result the number of people over sixtyfive has doubled in the last twenty years. Today they make up 7.6 percent of our population. But they account for fifteen percent of our sick people. We’ve licked the childhood diseases, all right, but as a nation we’re getting older and sicker, simply because we’ve become more and more skilful at keeping ourselves alive.
In doing so we’ve played hob with the old law of the survival of the fittest and this is the third great change in our social make-up. We have made it possible for many people who would have died fifty years ago to survive and have children. Nature operates on a balance as delicate as a Swiss watch movement. There are no doctors in the animal world and no “wonder drugs” either. The sick strains die out before they can propagate and the species remains healthy. But just the opposite seems to be taking place among t he human species and the dramatic rise in the number of diabet ics provides a striking example of it.
A tendency to diabetes can be inherited. Like most hereditary diseases, it is passed along by recessive or “hidden” genes — those tiny particles which we all carry and which determine everything about us from the color of our eyes to our relat ive intelligence. Many of us, who look and feel perfectly well, may be carriers of hidden genes for hereditary diseases. These diseases will show up in our children if we should be unlucky enough to marry someone else who is also a carrier of the same disease.
Diabetes is one of the most common of the many diseases that are inherited in this way. Before the discovery of insulin, a child who developed diabetes was doomed to die within a year. Now he can look forward to perhaps fifty years or more of relatively normal living. He can marry and have children. But if he does, there’s a strong danger that he will pass on to them the tendency to develop diabetes. There are probably close to 150,000 cases of the disease in Canada today and experts predict that in a few more generations there may be very few people who do not carry some hidden genes of this affliction. Nobody would suggest for a moment that the discovery of insulin was a retrogressive step. It simply poses new problems which the nation must face.
Diabetes is only one of five hundred hereditary afflictions that we know of today. A
Copenhagen professor of human genetics, Tage Kemp, has figured that three percent of Europeans and North Americans now suffer from one or other of the severe hereditary diseases.
Some, of course, are easy enough to detect because they are passed directly from parents to children. A familiar example is the tendency to develop cataracts. Amram Scheinfeld, a student of heredity, reports a study made of the descendants of a blind woman suffering from cataracts. There were one hundred of them and one third were also blind—for the same reason. Several well known diseases are inherited in the same way —such as Bright’s disease, a serious form of kidney trouble; ataxia, a loss of muscular coordination; Parkinson’s disease, that tragic malady marked by an uncontrollable trembling; and infantile glaucoma, the blindness caused by pressure
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Are We Breeding a Nation of Invalids?
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on the optic nerve. So are cleft palates and harelips. Modern plastic surgerycan patch up these misfortunes so that men and women are quite comely enough to marry easily. But that doesn’t prevent the offspring of the marriage inheriting the disfigurement.
And the diseases passed on by carriers of hidden genes are far less easy to detect and control. It’s believed now that pernicious anaemia, for example, is passed indirectly from parent to child. According to the University of Toronto Medical Journal this disease, like diabetes, has been on the rise for the last thirty years.
There are a host of other common diseases which are now thought to be inherited in the same way when two people carrying the same recessive genes marry. Epilepsy and amaurotic idiocy (a serious and incurable mental disease) are two of these. Tendencies towards tuberculosis, rheumatic fever, pneumonia and some forms of arterial heart disease, are others.
Many competent researchers are also convinced that malformations of the heart are inherited. Half a century ago the chances were that a person witii a malformed heart would die before he reached maturity. But today, surgery can patch up the heart so that it functions almost as well as a normal one, and people who once died now have children who may inherit the tendency.
Now More Morons Marry
The whole question of hereditary disease is still in the realm of scientific discussion and that discussion takes in the entire field of mental illness. A large number of scientists now believe that several mental illnesses and mental defects are passed on from parent to child, and that about half the mental defectives in Canada have been afflicted in this manner. This theory is supported by studies such as a recent one made in Canada by the National Committee for Mental Hygiene. It chose Nova Scotia as a basis for investigation and it paid special attention to those areas where there was a good deal of intermarriage. In these sections, it found that as high as ten percent of the people were mentally defective as against two percent for the rest of the country.
Where one member of a family is a moron, the chances that another member of the same family will be a moron are five times greater than in completely normal families. Studies of manic depression and schizophrenia also provide evidence of inheritance. Through experiments with identical twins, Dr. Franz Kallman in New York believes that if one parent is a schizophrenic, a child is seven times more likely to become a schizophrenic than is a child with healthy parents. Forty percent of the mental cases in Canadian hospitals suffer from this single disease.
In recent years more and more manicdepressives and schizophrenics have been helped to the point where they can return to the community—an increase of from forty to fifty percent in the last decade. This means that they can marry, set up a normal household and have children, thanks to medical advancement. But if these diseases are hereditary it also means that their children will inherit the tendency toward mental illness and the number of mental patients will increase.
An eminent American geneticist
named H. J. Muller has sounded a further warning note in this dark picture. Muller is worried about that strange and unexplainable process in human evolution known as mutation. Mutation occurs when a gene goes berserk and changes in character and it is these mutations of genes that has made it possible for man to adapt himself to his environment down through the ages. But the trouble is that by far the majority of these mutationsninety percent in factresult in abnormal genes that cause hereditary defects. We all carry these abnormal genes. But some people carry a heavier load than others. The average man carries about eight (out of a total of ten or twenty thousand normal genes). But about one in every thirty persons, says Muller, carries at least thirteen lethal genes. 'These are the people most likely to pass along hereditary diseases. They are also the people who, in earlier days, were the least likely to survive to adulthood. But now they are surviving and, because of this, Muller believes that a backlog of defective heredity is being built up and passed on to future generations.
In the past, nature has taken steps to see that only the healthiest babies get born. I f two people marry who both have recessive genes, nature in many cases steps in and kills the embryo soon after fertilization. Many miscarriage's are caused in this way. But modern science has discovered methods of protecting prospective mothers against miscarriage and of enabling childless couples to have children even after ten years of marriage.
Here, two other factors in twentiethcentury society enter to upset the balance of nature—higher education and the emancipation of women. In 1900, the average Canadian went to school for relatively few years, got married, and settled down (in four cases out of five on a farm or in a farming area). Today the average Canadian spends longer at school and is encouraged not to marry until his schooling is over. Usually it’s still some time before he can afford to marry for now two thirds of our people go to work in the city where they must make a career before marriage. If they do marry, the chances are that the wife will work for a number of years before settling down to raise children. Almost three quarters of a million Canadian wives are now working.
All this defies the fundamental principle that the ideal age for a woman to bear children is from twenty to twenty-four. Yet only a tiny 5.6 percent of all Canadian children are born to mothers in this ideal age group. Geneticists now know that the number of defective children rises sharply in women over thirty and that women of forty-five to fifty have three times as many defective children as women under thirty. It’s a bard fact that two fifths of all mongoloid children are born to mothers over forty years of age. The disturbing thing is—from the point of view of the nation’s health—that a whopping sixty-five percent of all Canadian babies are born to mothers who have passed the “danger age” of thirty.
Here then is another dilemma of the streamlined century: marriage and
childbearing is being postponed to a point where it is dangerous to the nation’s health. The average Canadian girl doesn’t marry until she’s twentyfive—after the ideal period for childbearing has passed.
These various factors, all of them new in our time, are costing us more money than we’ve ever paid before for our health. Every Canadian family now has to dig up an average of $83.10 each year for its health alone. Our
mental hospitals are costing us three times what we spend each year on atomic research. We have so many arthritics that it is like maintaining an army of thirty thousand men idle. Hospitals have become so complex that the cost per patient has increased more than elevenfold since 1900. In those days it cost 76 cents a day to stay in hospital. By 1931 the cost was $3.45. Today it’s $8.64.
And yet there seems little likelihood that we will find an easy solution to these deep national problems. Most of the suggested plans to solve the problem of heredity diseases, for instance, are as explosive as a barrel of TNT, for they invariably include some measure of birth control, planned parenthood and legal sterilization. In fact a large section of the country can’t even get advice on heredity. 'There are only two doctors who specialize in the field, and counsel the public on a regular basis— one connected with McGill, the other with the University of Toronto (see Maclean’s, Dec. 1, 1954).
Health Costs Still Soar
Most provincial governments are attempting to prevent mental defectives from breeding haphazardly by segregating them in hospitals but we still can’t accommodate them all. Alberta has come to grips with the problem by sterilizing one thousand people under its twenty-seven-yearold sterilization law. British Columbia is the only other province that has such a law on the books but the subject is so controversial that the law has never been put to use.
Most governments are generally alive to the necessity of healthy births. Canada’s own baby bonus has helped relieve some of the financial burden of early families in less well-to-do homes. Margaret Mead, the well - known American anthropologist, has suggested a plan whereby parents should subsidize their children financially to encourage them to marry early and have families in their twenties. Certainly any nation that can lick this problem can expect to spend less on its health.
All the same, there’s no suggestion that the cost of health is going to go any way but up in this country. In the next twenty-five years Canada is going to need more hospitals and more hospital beds, especially for the mentally ill and the chronically ill. In Ontario alone, according to a report by the Ontario Health Survey Committee published in 1952, seventeen thousand more beds were needed in mental hospitals — and the picture hasn’t changed much since then.
The problem of the aged will con-
tinue to increase. One fifth oi all the people admitted to mental hospitals today are patients over sixty-five, suffering from that familiar disease of old age, senile psychosis. As our age limits rise we’re going to have to make more and more room for the older members of our population who are mentally ill.
Another disturbing factor is that many of the patients in general hospitals today are really chronic cases. They’ll always be sick. According to the Health Study Bureau, an American research group which reviewed Canadian health needs in 1948, we need eight times more beds than we now have for these chronic patients. This simply means we’ll have to dig into our pockets and finance more hospitals.
We’ll also have to provide more and more pension schemes and security measures for old people. In proportion to the population there are five times as many people over the age of sixty today as there were seventy-five years ago. It’s sobering to remember that less than half of these people can afford to support themselves.
And as long as electric and insulin shock treatments, unknown a generation ago, are returning mental patients to normal life, we can—if the genetics researchers are right in their theories— expect a heavy proportion of their offspring to populate future mental homes as yet unbuilt and unpaid for.
Undoubtedly, these rising costs will produce more and more pressure for some sort of national health plan. If it comes it will cost a great deal of money. 'The Ontario Government recently released a report which claimed that a provincial health scheme would cost $192 millions a year. A survey conducted by L. Richter, an economist who was associated with Dalhousie University in Nova Scotia, indicates that the country would need fifty-five percent more medical services if a national health scheme were brought in. Yet, in spite of all our present spending (the national liquor bill last year was nearly a billion dollars), less than half of us appear to be able to afford all the medical care we need.
It seems likely that in the next quarter century more “wonder drugs” will be discovered from substances as common as the mold that produced penicillin. More elaborate (and perhaps more expensive) techniques will be evolved for keeping us alive longer. These will undoubtedly make us a happier and perhaps a healthier nation. But, if the present evidence is any guide, each new discovery will continue to produce problems of its own, still unforeseen, as nature, cheated in her design, continues to exact her tribute. ★