USA > Maine > Genealogical and family history of the state of Maine, Volume I > Part 106
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sions were revised in 1905, so that now those soldiers and sailors who are entitled to these pensions receive $1,968 more every year than they did in 1904. When this difference is mul- tiplied by the mumber receiving these pensions it amounts to millions of dollars that is being paid to soldiers and sailors in consequence of the revision of the pensions according to the paper read by Dr. Holt.
The paper upon this subject which attracted such universal attention was the one read be- fore the section of ophthalmology of the American Medical Association at its annual session in Boston, Massachusetts, in June, 1906. The Boston Herald published a good report of the paper, and from this and other reports made of it it was copied into a large number of papers throughout the United States and foreign countries. In recognition of the importance of the subject and its scope and usefulness, we venture to quote from this paper :
"An oculist, when called on to ascertain damages to the eyes from an injury, frequently meets with other disabilities of the body which occurred at the same time. If he works in connection with other physicians and sur- geons who are to determine damages to other parts of the body, it is highly important that there should be standard methods of procedure which can be applied to every system and or- gan of the body so that each may understand the other and work together to obtain results on a scientific basis. The object of this paper is to promulgate methods by which this may be accomplished in a manner equitable to all concerned.
"The problem is a mixed one, inasmuch as we must have a method for ascertaining the economic value of a person both before and after he has been damaged from injury or disease. All recognize the importance of sci- entific methods for solving this problem, but no one has had the temerity to attempt to overcome the difficulties surrounding it. It occurred to me, however, while I was disabled from an injury, received in 1903, that if, when the eyes were damaged, the remaining earn- ing ability could be determined by a mathe- matical formula, based on the principles em- ployed in the natural sciences in measuring any power, as has been done by Magnus* of Germany, the principle might be utilized for the whole body. I, therefore, spent many of the long weary hours of my disability in think-
* "Visual Economics." by Dr. H. Magnus of Breslau, Germany, translated with additions by Dr. H. V. Würde- mann, Milwaukee, Wis.
ing how this could be accomplished. After I had adapted the principle to the whole body, it seemed so simple that I wondered if some one had not solved the problem in a similar way. On making inquiries in connection with the reprints of my papers among many per- sons 1 have failed to find any one who had solved the problem in this manner.
Professor Seaver, formerly director of the gymnasium of Yale University, replied :
I wish to thank you for a reprint on "Physical Eco- nomics" which strikes me as a very valuable contribution on a subject to which I have given consid- erable thought without being able to arrive at definite conclusions, and so 1 have never published anything. You have hit on a practical method of rating a man's physical utility so far as the physical side of him is concerned, as mental rating is given by intellectual tests, so that we may have a fairly accurate mathematical statement of his probable worth to society.
"In the analysis of a person to determine the elements which are indispensable for his normal earning ability and which may be used as factors to express them in a mathematical formula, we find that the functions of the body in a fairly normal condition are of first im- portance. This constitutes the functional abil- ity of the person and the factor of first im- portance in the formula.
"A person would be of very little use, economically, in the world without having had that training of the mind and body which would fit him to follow some occupation suc- cessfully. This constitutes the technical abil- ity of a person and the second factor in the formula. With the functional and technical ability of the first order, there is another ele- ment of a person of considerable importance, namely, his ability to secure and perform the duties of an occupation successfully. It makes no difference whether his services are ren- dered direct to the general public or through some employer; his success depends on his ability to obtain work and to serve those who employ him. This constitutes the competing ability of a person and the last factor in the formula. Therefore, the three elements of a person which are absolutely indispensable to his normal earning ability are, first, the func- tional ability; second, the technical ability, and, third, the competing ability. This analy- sis of a person includes everything needed in the performance of the duties of any occupa- tion. It may, therefore, be considered com- plete, and, moreover, it is in accordance with the principles employed in the analysis of any physical force by which its efficiency is de- termined. The acceptance of this analysis of a person is of prime importance to an under- standing of the mathematical formula for the
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normal earning ability of the body, because its object is to determine the essential elements which may be used as factors in the formula."
This analysis is compared with the one made to obtain a formula for electricity.
"In a similar manner if we use the first let- ter of the prominent word in the analysis of a person, F == the functional ; T = the technical ; C= the competing, and E = the earning abil- ity of a person ; hence E = FT C, the mathe- matical formula for the normal earning ability of the body.
"These three factors are not of equal value, although the efficiency of each is interdepend- ent on the other, F being first in importance ; T second in importance ; whereas C is least im- portant, because it depends on the other two and the conditions of the labor market. The competing ability is composed of the same ele- ments as F and is modified to a similar but less extent when F is impaired. It is also modified by T and the way employers and the public consider the person, especially when he has been damaged by injury or disease.
"To amplify the formula, F must be re- solved into its component parts by selecting and grouping into the form of units such sys- tems and organs as are so interdependent that each is needed to insure the functions of the other in its particular unit, and these systems and organs taken together form a unit that is absolutely indispensable to the functions of the body. These units are to be regarded as fac- tors of F, which when multiplied together, and by the other two factors of the formula, pro- duce the composite quantity E. As much as possible, systems and organs have been se- lected and grouped together as units in ac- cordance with their development and asso- ciated functions, it being found necessary to have four such units for the whole body, which when designated by the first four let- ters of the alphabet are as follows :
( Osseous, articular, and
a = muscular systems, con- ( sisting of
Circulatory and respi- b ==-
n-
ratory systems, con- ( sisting of
c =
Digestive and genito- urinary systems, con- { sisting of
-
f Cerebro-spinal sys- d = of spinal sense, con- tems, nerves, organs [ sisting of
e, the hones, f, the joints, g, the muscles,
h, vascular system,
i, the blood,
j, the lungs and their accessory organs,
k, the alimentary ca- nal and its acces- sory organs,
1, the skin, m, the kidneys with the genital organs.
n, the brain, its mem- branes, and its nerves,
o, the spinal cord, its memhranes, and its nerves,
p, nerves and organs of special sense.
"Each of these units fulfills the requirements of our definition : it is composed of systems and organs so interdependent that each is needed to insure the functions of the other, and these taken together form a unit that is absolutely indispensable to the functions of the body. This being true, the value of the function of each unit may be obtained by a formula similar to that employed in determin- ing the value of any physical force. In am- plifying F, by resolving it into its component parts, as factors, a, b, c, d, each of these was resolved into its component parts, as fac- tors, and a=efg; b=hij; c=klm; and d=nop.
"Although it is true that scientific standards of measurement of all the parts of the units of the body have not been determined and agreed on, nevertheless it is a self-evident fact that anything that is used must have a value placed upon it, and when this value has been meas- ured, tested, compared, and estimated in a scientific manner, in a large number of normal healthy persons, and an average value ascer- tained, this average value becomes a scientific standard of measurement for that particular part of the unit of the body. It is in this way that all the scientific standards of measure- ment, now employed, have been determined and agreed on, and it is in this way that all the remaining ones must be established. Un- til this work is consummated we shall have to employ such standards as have been agreed on, and by the same methods by which these have been obtained determine values for all the re- maining systems and organs of the units of the body which will eventually be accepted as scientific standards of measurement.
"In ascertaining damages to the body, a physician must first determine what the im- pairment of the function of the unit is, and then, by comparing this with the case record and the scientific standard of measurement for it, give the remaining value in the form of a fraction of the whole unit in the formula. The principles and process then are the same as those employed in determining the efficiency of any physical force. It will be seen that it is the damaged functions that the physician first seeks, and not necessarily the pathology of the damaged unit. The pathology of a disability is necessary only to determine its character, whether transitory or permanent, serious or not, as the case may be, and should not be made the basis to determine the remain- ing earning ability of the body. The earning ability is a composite quantity made up of the physiologic functions of the systems and or-
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gans of the imits of the body, cach of which is interdependent on the other in making man the most wonderful product of nature.
"In youth and the beginning of manliood, we can only rate a person according to his functional and his technical ability, but when that person has a fixed occupation we can, thereby, determine, by our formula, his carn- ing ability and his economic power in the world as accurately as we can that of any physical force. We can determine his niental ability only so far as it is manifested in his vocation and the importance placed on it as evidenced in the remuneration he receives for it. We can not figure on possible prospects of advancement, nor change of occupation. We can only figure on the actual conditions of life as they exist, and when accidents occur, caus- ing damage, on the supposition that tliese con- ditions would continue for a length of time thereafter according to the basis on which the American experience table of mortality has been constructed and on which has been estab- lished life insurance-the first business of the world.
"The value of the functions of the body cannot be determined, for health, like charac- ter, is priceless. Even the possession of health much below any economic value is priceless, and is clung to under all conditions of priva- tion and suffering. This does not affect the purpose of our formula, which represents mathematically the normal earning ability of the body. This has solely to do with the in- dividual's ability to perform certain services and to receive a specific compensation there- for for the remainder of a prospective work- ing life. No life insurance company would consider a risk on a man's life for an amount his business or wealth did not warrant. A can who has no income whatever and could offer no collateral would be refused a loan of money from any person, or bank, and he could not obtain money except by reasons which are foreign to the rules of business. A person with good habits and a steady occupation with a specified income would be able to hire money on that alone, in proportion to his income, other things being equal. The time is coming when the earning ability of man will be rated and will be just as valuable in the labor mar- ket as in the rating of his financial ability to- day in the business marts of the world.
"We will now proceed to illustrate the use of the formula in the case of a young man whose eyes were severely damaged and the right hand badly burned by a current of elec- tricity sufficient to kill two men instantly.
W. O'B., aged 20, mill employee, June 22, 1900, while standing on an Iron platform and handling a portable electric light, received a current of electricity sufficient to throw him down instantly. Two of his fellow work- men who saw him fall quickly went to his aid and, In attempting to pull him away from the platform and the wire of the lamp, which was burning his hand, both were killed instantly.
"Thus every step of the process to deter- mine the economic value of the damage to Mr. O'B. in consequence of the injury he received June 22, 1900, has been taken with a well- defined method of procedure, as that of weigh- ing or measuring of any commodity and then multiplying the quantity by the price per unit of the standard of measurement for that com- modity, in order to obtain its value. The final result then cannot be questioned on the ground of the want of care in obtaining it, it can only be questioned on the ground as to whether the principles on which the methods are based are correct and give results that are right and equitable to all concerned.
"On both of these points we have the high- est authority, for my formula for the normal earning ability of the body is based upon the principles employed in the sciences in deter- mining the value or efficiency of any natural power. It was employed by Magnus in his mathematical formula for the normal carning ability of the eyes. My work has been to adapt these principles to the entire body by selecting and arranging the different systems and or- gans according to their development and as- sociated functions, that all the essential parts of the body may be grouped under four units, which may be used as factors of the functional ability in a practical formula as readily as though the principles were applied to but one organ at a time.
"For the success and approval of this work, I have quoted from one of the many letters which I have received, because Dr. Seaver, as he writes, has spent a large part of his life in studying the body, to develop, measure, and utilize it to the best advantage. He has writ- ten one of the best works on anthropometry and physical examinations in the Englishi language, and therefore his opinion is an au- thority on this subject.
"As to the method of determining the pres- ent economic value of a person, I have quoted from the highest English authority, and there- fore, of the world, because the science of vital statistics owes its existence largely to English writers, the greatest of whom was Dr. Farr.
"One important datum is lacking in the ab- sence of a record of an examination of the eyes before the accident, and, therefore, we are unable to assert positively that the condi- tions of his eyes, as found after the accident,
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was due to the injury, but we are confident that the position taken is fully justified by the history of the case, and the nature of the in- jury.
"If Mr. O'B. had had a record of an ex- amination of his eyes showing that they were normal prior to the accident, all doubt on this point would have been removed. This again shows the necessity of every person having a case record of his physical condition, for no one knows when he may meet with an acci- dent and need it to determine just what the amount of the damage is from a given injury. If the history and examination revealed a sus- picion that a part of a disability existed prior to the accident for which damages are claimed, and this should be, by further evidence in the case, established beyond a reasonable doubt, then the fact must be taken into consideration in determining the amount of the damages due to the accident. To avoid disputes and liti- gations every person should have a carefully made record from repeated examinations of his body.
"This would be of great value to a person, not only in case of injury, but also in the treat- ment of any disease.
"The progress of medicine is towards pre- venting, rather than curing diseases, and in order to make this practice more complete, the time is coming when physicians will be largely occupied in making these examinations and case records, and thereby preventing rather than curing diseases. There is nothing of more importance to be instituted in the science and practice of medicine for its welfare and advancement than the carefully made records of the physical and laboratory examinations of every person. To make them more effective they should be instituted when the child en- ters school, and be repeated at stated times during the whole period of school life. This would necessitate establishing a new officer, the school physician, not an inspector of the schools, but one who would take a child, analyze him, detect all abnormalties and in conjunction with the parents and other physi- cians correct them during school life, and thus have the body improved with the mind, that each may help the other to the fullest devel- opment. From these records data could be obtained which, when applied to the mathe- matical formula for the normal earning ability of the body, and worked out according to the principles on which it is constructed, would give the rating of a child, taking into consid- eration his functional ability on which his technical ability so largely depends, but which
has been heretofore almost entirely neglected in rating him. With this work carried out during school life, it would soon demonstrate its own importance, by making these records of the highest value in the training of the mind and the body, the advancement of the race, for the promotion of health and the pre- vention of disease, and in furnishing data to determine damages to the body from injury or disease by the mathematical formula for the normal earning ability of the body, in a manner equitable to all concerned."
In 1907, when Dr. Holt gave his oration on physical economics at the annual meeting of the Portland Medical Club, Dr. C. R. Burr, the retiring president, gave an address on "Personal Damages Considered from a Med- ical Standpoint." This led to a conference with Dr. Burr, who had written a treatise en- titled "The Worth of Man, Being a Treatise on Personal Damages Considered from a Med- ical Standpoint." As Dr. Burr's work con- tained much that Dr. Holt had planned to in- clude in his own work on "The Physical Economic Value of Man and the Measure of Damages," it led to a union of the two works in one which will be issued in the near future.
The value of this work can hardly be esti- mated at the present time, but that it is des- tined to have a wide use and become a stand- ard wherever and whenever the economic value of man is brought into question and the measurement of damages is sought there can be no doubt. In the paper on the "Economic Value of Man and the Measure of Damages," read before the National Association of United States Pension Examining Surgeons, at Chi- cago, in June, 1908, Dr. Holt gave illustrative cases showing how readily damages to the body may be determined, and also how an equitable pension may be ascertained. He supplied tables, the first of which gives the re- maining earning ability when it is determined that the competing ability is damaged to same degree, or less than the functional ability. The second table gives the remaining earning abil- ity when it is determined that the com- peting ability is damaged to same de- gree, or more than the functional ability. By these two tables the earning ability may be ascertained when it is determined that the competing ability is damaged but slightly or when it is damaged to a degree nearly total, or total. All the computations are made and given for all possible degrees of damage to the body from injury or disease, thus eliminating computations. The third table gives the loss on $1,000, when the com-
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peting ability has been damaged but slightly or to any degree approaching total, and total so that by ascertaining the economic value of a person from the present value of his future income by the evom table (the sixth) and then dividing this value by 1,000 to obtain the number of thousands and parts of a thousand dollars a person is worth, and finally multiply- ing this by that which is found to be the loss on $1,000, in the third and fourth table, we ob- tain the economic loss as readily as we obtain the amount of a town or city tax by knowing the rate on $1,000, and the assessed valuation of the property in thousands and parts of a thousand. Thus while the results are deter- mined by mathematics and with mathematical precision, there are 110 more computations actually used than there are in ascertaining the tax of a person by knowing the rate of taxa- tion per thousand and the number of thou- sands and parts of a thousand dollars a per- son is assessed. Indeed, the process is identi- cal and for this reason should be readily un- derstood by all who own property and pay taxes.
It has been the effort of the officers of the American Medical Association to unite all the different state associations in one compact body, the units of state associations being county societies of each state. Maine was one of the last to come into this arrangement, which it did legally at its annual meeting held at Bangor in June, 1908, by a unanimous vote. By this arrangement the Maine Medical As- sociation is entitled to one delegate to the house of delegates of the American Medical Association and Dr. Holt has the honor of be- ing the first legally qualified delegate to thus represent the Maine Medical Associations.
From the first paper read before the state associations in which Dr. Holt advocated new methods for the treatment of the ear which gave him an international reputation, to his last papers on physical economics and the measure of damages by mathematics which has given him a world-wide reputation, he has been writing papers in which he has advocated new methods of practice which have been ac- cepted and become the common property of the profession.
Few men have won higher distinction in the special departments of ophthalmology and otology. To this reputation he has added that of a philanthropist and as the field of his use- fulness has expanded as a practitioner, he has sought not only to extend to the poor the full benefit of his skill and research, but to advo- cate many advances for the betterment of the
human race. This alone gives him an unique professional standing and would be sufficient to engage the attention of most men. But his great work has been centered in a noble char- ity, the Maine Eye and Ear Infirmary, which stands without a parallel in the history of medicine.
In a recent statement of facts in connection with an appeal for funds by the trustees for renewals and equipment, we note that during the twenty-three years of its existence it has accumulated and either now holds or has dis- bursed $695,585.05; that over thirty thousand persons have been treated at the infirmary ; that the out-patient department has had an attendance of over one hundred eighty thou- sand; that over eight thousand operations have been performed upon the eye and car for the preservation or restoration of sight and hearing. Throughout the reports of the in- firmary we discern unmistakable evidence that Dr. Holt has carried on the major part of this work, for we read in the twenty-first re- port of the trustees that "A carefully tabulated estimate of the number of hours which physi- cians and surgeons have devoted gratuitously to the upbuilding and carrying on of this charity during its existence would be equal to about the services of one professional man for the entire twenty-one years. No reference to the bestowal of time upon this charity would be complete without mentioning the fact, well known to all who are conversant with its affairs, that the Executive Surgeon has de- voted a large part of his time to this charity. It was by his means, zeal, self-sacrifice. devo- tion and executive force that made the In- firmary in the first instance possible, and then brought it to its present high rank of useful- ness. It is therefore but simple justice to re- peat the words of a former President of this Board, that "the Maine Eye and Ear Infirm- ary must remain while it endures a monument to the ability and philanthropy of Erastus Eu- gene Holt.'
Dr. Holt married Mary Brooks Dyer, Octo- ber 9, 1876, and they have six children: Lu- cinda Mary-Belle, who is a graduate of Smith College and of Tufts College Medical School ; Clarence Blake, who has an A. B. from Har- vard University ; Roscoe Thorne, who has an A. B. A. M. LL. B. from Harvard University ; Erastus Eugene Junior, who has an A. B. from Bowdoin College and who is now a senior in the Medical School of Maine; Doro- thy Kent, who is a student in Miss Marshall's School in Philadelphia; and Benjamin Dyer. who is a graduate of the Portland High School and ready to enter college.
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