its industrial policy-holders, the average disabling sickness for each of the 376,573 persons over fifteen years of age was 8.4 total days, or 6.9 working days, per year. The recent study of some 40,000 members of the Workmen's Sick and Benefit Fund of America, conducted by the Federal Bureau of Labor Statistics, showed an annual average per member of 6.6 days of disability. The number of days of sickness would, of course, be somewhat larger. Both the Ohio and Illinois health commissions estimated the average loss to be between 8 and 9 days.

THE BURDEN OF SICKNESS

But the burden of illness is not expressed by the number of days lost by the average wage earner. Some people are hardly ever sick, and during any given year only a certain percentage of persons fall sick. The problem arises because there is sufficient illness among this certain percentage of persons to cause serious loss, suffering, breakdown of ability for self-support, and breakup of families. What we practically need to know is the amount and extent of sickness.

The Ohio Health Insurance and Old Age Pension Commission, in a study of 663,163 members of benefit societies; the Illinois Health Insurance Commission, in an investigation of 4,474 wage earners in Chicago; and the Pennsylvania Commission, in a study of 743 families, including 3,198 individuals, of which 1,341 were workers-have thrown light on this subject. Both the

1"Disability Among Wage Earners," Monthly Labor Review, November, 1919, Bureau of Labor Statistics, U. S. Department of Labor.

Illinois and Ohio commissions estimated that about one worker in five lost more than a week's work through sickness. If 20 per cent of all workers suffer loss from this cause, the amount of sickness is found to be considerable. The average loss of time of all sick persons is estimated by the Illinois commission to be more than 50 days a year, and by the Pennsylvania commission to be about 40 days.

It must also be held in mind that the family of small income suffers most. In another study by the Illinois commission of a number of such families (comprising 3,475 persons), about four out of five suffered from sickness of the wage earner.

Sickness

of other members of the family added to the difficulty in more than two thirds of these cases. So it can be seen that sickness is a considerable handicap to the wage earners of the country, and especially to those getting the lower wages, large numbers of whom are immigrants.

Is the burden of sickness heavier among the foreign born than among native Americans? The evidence varies with race and with disease, but on the whole it is apparent that the immigrant bears at least as heavy a burden from sickness as does the native. Furthermore, the financial ability of the foreign born is generally less. Through the co-operation of Profs. H. A. Millis and Ernest W. Burgess, of the staff of the Illinois Health Insurance Commission, it was possible to make an analysis of about 12,000 cases. In several respects the data are not complete, but for the purposes of comparing duration of sickness of the native and foreign born the following table is fairly reliable:

TABLE I

RELATIVE DURATION OF ILLNESS AMONG 2,385 Native and 9,211 FOREIGN-BORN WHITE PERSONS OVER FOURTEEN YEARS OF AGE, STUDIED BY THE ILLINOIS HEALTH INSURANCE COMMISSION.1 (EIGHT HUNDRED AND FIFTY-FOUR NEGROES STUDIED MAKING TOTAL OF 12,450)

It would appear from this table that the proportion of illnesses of long duration is somewhat larger among the foreign born of these Chicago families than among the native born. The difference of the per cents shown in chronic illnesses and those of a month or less, point in this direction and are apparently larger than would be accounted for by statistical errors.

Of course, no general conclusions can be drawn from a single small survey of this type; the data must be taken for what they are worth, and are presented largely to suggest that the elements of race and

1 Illinois Health Insurance Commission, data furnished by Burgess.

nationality be included in succeeding sickness surveys. Results of considerable interest may be expected at a comparatively small additional cost of time and effort. There are other data that throw light on morbidity of the foreign born and answer some important questions.

GENERAL MORBIDITY STATISTICS

Probably the most far-reaching investigation which has compared the physical fitness of the native and foreign born is that made by the War Department in selecting drafted men for the army. The large numbers involved make the results reliable. To understand the statistics which are here cited it is necessary to know the definitions which the War Department gave to Groups A and D among the men examined.1

Group A was composed of men who are vigorous and without any physical defect which might interfere with the full performance of military duties. Group D contained those who were found to have conditions which unfitted them for military service. This last group was made up in large part of those unfit also for most civilian occupations.

Later in the report it is stated that:2

For the purpose of comparing the physical qualifications of natives and aliens, a comparison was made of the rejections in local boards composed dominantly of natives and aliens, respectively. Some 85,000 examinations were assembled from local boards in dominant alien wards of the cities

1 Second Report of the Provost Marshal General to the Secretary of War on the Operations of the Selective Service System to December 20, 1918, pp. 152–153.

2 Ibid., pp. 160-161.

1

of New York, Philadelphia, Chicago, Cleveland, Milwaukee, and Cincinnati, representing a registration of 300,000. Then some 100,000 examinations were similarly assembled from other than city boards in the states of Indiana, Iowa, Kansas, Kentucky, and Ohio, representing also a registration of 300,000. The results were as follows:

It is interesting to note that, as might be expected, this comparison is greatly to the advantage of the native Americans. In every 100,000 men the native born would yield 3,500 more (an additional regiment at war strength) for military service than would a like number of foreign born.

Although issue might be taken with the statement that there is "great advantage" to the native Americans in the comparison, it is apparent that there is a substantial difference between the per cent of rejections in native and alien communities.

An additional light on this subject is thrown by a report from local board for Division No. 129, New York City. This board, realizing a great opportunity,