Health and Labor Force Participation over the Life Cycle (review)

This multiauthored volume documents factors affecting the health and working life of men who fought in the Civil War on the Northern side. Census data from 1850 and 1860 for the cohort of military age, data from military medical and pension records, birth and death records, and health data from the mid- and late nineteenth century were included in the analyses. There are weaknesses inherent in the data available; nevertheless, the authors' comprehensive collection and statistical analyses reveal much interesting information.

The chapter on the influence of prior exposure to disease on wartime health and mortality is valuable. The authors do not utilize the records of the physical examinations done on enlistees, and particularly draftees, in 1863 and subsequently, when good examinations were done and published in the Official Records of the War of the Rebellion, but their conclusions are compatible with those data. They point out that nearly 12 percent of recruits died while in service, two-thirds from disease. They document that rural farmers were more likely than city boys to become ill and die of disease, an observation made during the war. The finding that native-born recruits were less likely than immigrants to die of disease is a new observation—attributed to generally poorer health and nutritional status among the immigrants, but without supporting data.

The authors discuss the enormous frequency and high mortality of typhoid fever, as well as measles, affecting recruits; these and other diseases were wisely grouped as "immunity diseases," and the effect of urban, rural, and foreign backgrounds on their frequency in recruits was analyzed. (The authors have wisely included cases of typhomalarial and continuous fever as typhoid fever; although not all were typhoid, the majority probably were. On the other hand, they have included both intermittent and remittent fevers as malaria, which probably was erroneous but did not affect their conclusions.) Farmers were at a disadvantage regarding both immunity and nonimmunity diseases, despite having a supposed nutritional advantage: a chapter on the height of Union army recruits concluded that farmers were at a distinct advantage regarding health status, measured by height, and there was a positive correlation between wealth and height, primarily at low levels of wealth. Although the authors conclude that height is the result of an interplay of genetics, location-specific characteristics, and family characteristics, they use it as a measure of nutritional status. In this study, wealth had little effect on mortality; the influence of infectious diseases was so strong that it overwhelmed the effect of economic status. After the first year, background factors faded in importance in predicting death from disease. The authors stress the need for further studies to reconsider the interrelationship between epidemiologic environments, early-life conditions, and later health.

A study of the prevalence of chronic respiratory disease among army veterans, based largely on pension data, found a positive correlation with age for lower respiratory disease (LRD). Among men in the cohort studied—aged 55 to 74, between 1895 and 1910—the prevalence of chronic respiratory disease was increasing. The authors suggest that the data may reflect the beginning of the effect of cigarette smoking and industrial pollutants on health, and they provide a fine history of cigarette manufacturing. Surprisingly, the incidence of LRD in farmers was similar to that of high-risk categories who had been exposed to smoke, dust, or fumes. Unfortunately, the authors do not classify tuberculosis with other lower respiratory diseases; consumption was common, and almost all the diagnosed cases were pulmonary.

The history of the pension system, as a precursor of Social Security, is particularly interesting. Originally, only those with service-connected disability, or with disease acquired in service, qualified; in 1890, any disabled veteran who had served at least ninety days in the war became eligible. Changed again in 1907, the system now considered old age as an infirmity. The authors' research demonstrated the importance...