The human equation
Economic historian Robert Fogel sees a new species of human evolution in records detailing the chronic illnesses of Civil War veterans.
When he was six years old, Robert Fogel—Nobel laureate, Chicago professor, and pioneering economic historian—came down with chickenpox. It was 1932. He left school feeling sick, and his mother summoned a doctor. “Two hours later,” Fogel recalls, “the New York City Department of Health slapped a sticker on the door to our house: ‘No one may leave or enter this apartment until this sticker is taken down.’” Fogel’s older brother, not yet home from school, and his father, still at work, bunked in a neighborhood boarding house for two weeks. Each day his father would place a basket of groceries on the Fogel family stoop, then ring the doorbell and walk away. “And that’s how we were fed,” he says. “It was very traumatic.”
Two decades later, Fogel’s son Michael, then six or eight, came home with chickenpox. Still in New York and anticipating a similar tribulation, Fogel called the pediatrician. “He said, ‘Good! This is a very good year for chickenpox; it’s very mild.’” Within days Fogel’s son returned to school, covered in spots. “So an entirely different environment,” Fogel says. Once a frequently fatal disease and a public-health menace, chickenpox had become, by the mid-1950s, an inconvenience. “The same was true of mumps and measles,” Fogel says. “They were all transformed,” even before the widespread use of antibiotics and vaccines. “The question is: what happened?”
The answer, he has concluded after decades of research, is that the pathogens didn’t get transformed; the people did. “Over the past 300 years”—and particularly during the 20th century—“human biology has changed,” Fogel says. People in the industrialized world are taller, heavier, stronger. They’re more resistant to disease and more likely to overcome it when they do get sick. They live longer, their lives less fraught with chronic ailments. “We’re just not falling apart like we used to,” says Fogel, who has taught at Chicago since 1964, minus a six-year hiatus at Harvard. “Even our internal organs are stronger and better formed.” Along with coauthor Dora Costa, PhD’93, Fogel has dubbed this process of improvement “technophysio evolution.” The phenomenon, he insists, is “not only unique to humankind, but unique among the 7,000 or so generations of human beings who have inhabited the earth.”
Fogel, the GSB’s Charles R. Walgreen distinguished service professor of American institutions, talks easily about biology, medicine, or almost any subject. Mention poetry and he’ll quote a few lines from A. E. Houseman’s A Shropshire Lad. Then he might ruminate briefly on the history of soap, adding that as a boy he sculpted figurines from blocks of soap. In his teens Fogel planned a career in theoretical physical chemistry—his father thought electrical engineering sounded more practical—and he graduated in 1944 from Manhattan’s Stuyvesant High School, one of three New York public academies specializing in science and math. During his first year at Cornell, though, it was modern European history that kindled his imagination. In 1946, as postwar euphoria gave way to fear of a second Great Depression, his attention turned to economics. He graduated in 1948, a history major with an econ minor. Twelve years later he had a master’s degree in economics from Columbia University, and three years after that, a Johns Hopkins doctorate in economic history.
“Naive belief,” he says, led him, by then a husband and father, to graduate school in 1956. Fogel thought studying history and economics would quickly reveal the “fundamental forces” shaping eons of technological and institutional change. That knowledge, he reasoned, would point the way toward economic stability and equality, both in this country and elsewhere.
Not so easy. At Columbia he discovered that economic history’s understanding of the “large processes” was fragmentary. So he narrowed his inquiry: how much do historians really know, he wondered, about the role of the factory system in 19th-century economic change? To what extent did innovations like steel mills and railroads actually drive economic growth?
Increasingly, he called upon quantitative evidence—hard numbers—to help uncover the answers, upending cherished assumptions along the way. His master’s thesis, which later grew into a doctoral dissertation and the subject of his second book, tested the notion, he says, that railroads constituted “the greatest technological innovation of the 19th century, the engine that pushed forward the whole of the American economy.” Initially expecting to find numbers to bolster that consensus, Fogel uncovered the opposite. In Railroads and American Economic Growth: Essays in Economic History (Johns Hopkins Press, 1963), he used data on 19th-century agricultural commodities, transport costs, land value, and canal usage to dismantle what he called the “axiom of indispensability.” Even if the first rail had never been laid, he argued, the per capita income that America reached on New Year’s Day 1890, about the time the United States became the world’s largest economy, would have been delayed by only about three months.
In 1967—after the dust cleared and other scholars, often to their surprise, confirmed the basic findings of Railroads—Fogel embarked on what became a controversial study of American slavery. Unearthing thousands of plantation records, probate documents, and slave-ship manifests, he and coauthor Stanley Engerman, a University of Rochester economic historian and former doctoral classmate, published Time on the Cross: The Economics of American Negro Slavery (Little, Brown and Company, 1974). The book portrayed antebellum slavery as a lucrative, robust, and rational economic system, not the moribund institution historians traditionally perceived. Between 1840 and 1860 the South’s economy outpaced the rest of the country’s, Fogel and Engerman reported, and the demand for slaves was rising in urban areas nationwide. Slave agriculture, meanwhile, was 35 percent more efficient than Northern family farming. Materially, if not psychologically, slaves lived healthier and longer lives than urban industrial laborers. Over a lifetime a typical slave field hand might receive back as much as 90 percent of the income he produced as food, clothing, housing, and medical care. However morally reprehensible it was, slavery proved, they said, an economically efficient market solution.
Condemnation of Time on the Cross was immediate, relentless, and withering. In the New York Review of Books, historian Thomas Haskell advised consigning the book to “the outermost ring of the scholar’s hell, obscurity.” Economists Paul David and Peter Temin declared it “simply shot through with egregious errors” and with four other scholars produced a 400-page volume to “refute its every word.” Fogel and Engerman were called careless, clueless, mendacious. They were accused of being Confederate apologists. The rancor and cries of racism bothered Fogel (whose wife, Enid, is black), but, he says, he meant to pick a fight. “We wanted to show traditional historians that they could ignore quantitative evidence only at their peril”: the data offered a different view of slavery than the one scholars were used to seeing.
In the end, Time on the Cross weathered the critical storm, emerging with its conclusions largely intact. In 1989 Fogel reexamined and expounded on the economics of enslavement in Without Consent or Contract: the Rise and Fall of American Slavery (W. W. Norton), following it up in 1992 with three volumes of supporting evidence, statistical methods, and technical papers. The next year he won a Nobel Prize in economics. Presenting the award, Swedish Academy of Sciences professor Lennart Jorberg credited Fogel and fellow prizewinner Douglass North with revitalizing economic history with their use of quantitative methods. Fogel’s work, Jorberg said, had helped make the field “more stringent and more theoretically aware.” Fogel offers a plainer assessment. “We’re mainly empiricists,” he says. “We’re just looking for evidence.” Where it leads, they follow.
Fifteen years ago the evidence led Fogel and Dora Costa to the theory of technophysio evolution. The term implies no genetic shift—“that takes a while,” says Costa, now an MIT economist—but argues that changes to the human form accumulate, generation upon generation. People owe their rising physiological fortunes, Fogel and Costa say, to increasingly salubrious surroundings: labor-easing technologies, better medical care and public health, proper nutrition, greater wealth, cleaner cities, and sanitary water supplies. “Chicago exported a lot of typhoid down to St. Louis during the early 1900s,” Fogel says, by dumping wastewater into the Illinois River. “And flies—when I was growing up, you always shared your breakfast with flies.” Hanging from the kitchen ceiling, his mother’s flypaper was constantly covered with bugs. “Now if we get a fly in this house, it’s an emergency.”
Fogel, along with Chicago-educated colleagues—many of whom, like Costa, are his former students—have unearthed mounting evidence for physiological change. They’ve traced the shifting trajectory of aging and disease in dozens of working papers and journal articles. In 2004 Fogel published The Escape from Hunger and Premature Death, 1700–2100: Europe, America and the Third World (Cambridge University Press), a study that draws on data from the U.S., Britain, France, Norway, the Netherlands, Ghana, and India to assemble a picture of humanity’s changing biology. Since 1700, he wrote, Westerners, liberated from centuries of malnutrition, have more than doubled their average longevity and increased their average body size by more than 50 percent. In 1790 French men in their 30s weighed about 110 pounds; today they weigh closer to 170. Between the third quarter of the 18th century and the third quarter of the 20th, Norwegian men added five-and-a-half inches to their average height. American men added about two inches. As their economies grow, developing countries are starting to see similar gains. In India, life expectancy at birth rose from 29 to 60 between 1930 and 1990.
Some of the most dramatic evidence for technophysio evolution has arisen from a research project examining the health records of roughly 45,000 Union Army veterans, including 6,187 black soldiers. Directed by Fogel and involving dozens of researchers, the Union Army Study compares the Civil War generation, the first to turn 65 during the 20th century, with those who followed. Concentrating on health problems whose diagnoses have remained relatively unchanged, such as back pain, arthritis, and heart disease, Fogel and his colleagues have reconstructed veterans’ entire lives using a staggering assemblage of documents, most housed at the National Archives in Washington, D.C. Military records yielded information not only on recruits’ rank, regiment, and term of service, but also age, weight, height, birthplace, nationality, and physical condition upon enlistment. If a soldier had ever deserted or become a prisoner of war, the military records said so. Daily muster rolls indicated who had been sick or wounded and for how long, while hospital registers recorded the details of their ailments. Pension records and census manuscripts offered family histories and data about soldiers’ income and employment before and after the war, plus their wives, children, and hometowns.
Perhaps most valuable were the surgeon’s certificates. Upon filing their first pension claim—and for every few years thereafter—veterans were examined by doctors who detailed the particularities of their condition, from height and resting heart rate to hardened arteries or crippling arthritis. The typical pensioner, Fogel says, entered the system at age 50 and died about 24 years later. Through these late 19th- and early 20th-century documents, he and his colleagues have watched the veterans age and deteriorate, their health growing ever more frail until surgeon’s certificates yield to death certificates. (Although no comparable medical record exists for women of the Civil War generation, pension documents offer some information on veterans’ widows and dependents, as do census records and death certificates.) In a 2003 essay on the Union Army Study’s origins, Brigham Young University economist Larry Wimmer, AM’62, PhD’68, a former Fogel student and an early collaborator, argued that together with pension records, the surgeon’s certificates “provide us with an important benchmark on infectious and chronic diseases before our modern understanding of germ theory, before widespread public-health programs, and before the introduction of modern interventions such as antibiotics.”
Benchmark or not, the Union Army Study took years to get off the ground. The idea emerged in 1972, when Fogel and Engerman, in their hunt for slave-price figures, stumbled across the Family History Library, an enormous repository of genealogical records maintained by the Mormon Church in Salt Lake City. Thinking he could use height measurements to study 19th-century nutrition, Fogel began looking for similar data sources. By the late 1970s that search led him to Civil War recruiting rolls. A hunch told him he was standing at the foot of a mountain.
Others weren’t so sure. The National Institutes of Health turned down Fogel’s first grant application in 1986. “They said the research couldn’t be done,” he says. “A lot of people thought the data just wouldn’t be there,” and even if it did exist, it would be impossible to translate into usable statistics. Undeterred, he and his colleagues slogged through files at the National Archives, using money from Chicago, BYU, and the National Bureau for Economic Research to collect and collate data from a sample of 2,400 veterans. The task took four years. “It was not like falling off a log—that was hard work,” Fogel says. In 1991 the NIH approved Fogel’s grant application, which launched a 15-year process of collecting and standardizing the records so they could be used.
Over the past two decades the study has yielded some unexpected results. Foremost, perhaps, was the discovery of how sick Americans were, and from how early on. Nearly everyone in the Civil War generation endured painful, debilitating ailments for the better part of their lives. Even so, 65 percent of men between 18 and 25 volunteered for the Union Army. A quarter of those volunteers were sent home because of physical disabilities: hernias, arthritis, tuberculosis, cardiovascular disease, blindness. Teenagers didn’t escape illness either. One-sixth of Union recruits aged 16 to 19 were rejected because of infirmity. “These men were much sicker,” Costa says, “than anything we’d imagined.”
Their health only worsened with age. By 1910, 68 percent of veterans 65 or older suffered from musculoskeletal disorders such as arthritis, and 76 percent had heart disease. For World War II veterans of the same age, those figures were 48 and 39 percent. One in two Union Army veterans ages 60 to 74 endured back problems, compared to 30 percent of men the same age in 1994.
The findings challenge a long-held consensus that chronic disease grew more severe throughout the 20th century as medical advances began keeping the debilitated alive for longer. “Before we started, it was very common to believe that in earlier decades, infectious disease killed off the ‘weak sisters,’ the people who were constitutionally unsound,” Fogel says, “and that those who survived to 65 were fairly robust.” On the contrary, his research has revealed that by their mid- to late 60s, Union Army veterans had an average of 6.2 chronic conditions. For 65-year-old white men today, that figure is less than two. Meanwhile, the few Union pensioners who reached their 80s, Fogel says, were putting up with eight or nine chronic complaints. He wonders: “Why do they stay alive with so many different organ failures” and without the benefit of modern surgical and pharmaceutical advances? “That’s one of our puzzles now.”
Another puzzle has been figuring out what made 19th-century Americans so sick so young. Why are there such gaping disparities between those who fought the Civil War and those who fought the Great War or World War II? The answers, Fogel and Costa say, seem to lie in early life. Of the children born between 1835 and 1845, nearly a quarter died in infancy, and another 15 percent perished before they turned 15. Those who survived to adulthood, says Fogel, endured persistent malnutrition. Inferring body-mass index from height and weight measures, he argues that one in six young adults was dangerously underweight by modern standards of proper health. Owing in part, perhaps, to undernourishment, children and adolescents often suffered acute infection: typhoid or tuberculosis, measles or rheumatic fever. “Malaria was all over the South, and by the 1850s it was endemic as far north as Wisconsin,” Fogel says. “These kinds of stresses take a toll; they have a long reach.” Similarly, poor nutrition, which often began in the wombs of underfed mothers, stunted growth and led to lifelong problems. Early-life diseases predisposed people to chronic illness.
Work compounded the hardship. “This was a world where manual labor was the norm, and it was unmechanized labor,” Costa says. On average, Americans worked about 78 hours per week, from dawn to dusk Monday through Friday and half a day on Saturday. “The farmers were particularly striking,” Costa says. As young men they enjoyed the best health, having escaped exposure to many of the worst diseases that plagued urban dwellers. “But once they reach older ages, they’re falling apart.” People in cities, meanwhile, often didn’t reach older ages at all. In large metropolises like Boston, New York, and Philadelphia, life expectancy at birth in 1830 was 24 years—“ten years less,” Fogel says, “than that of Southern slaves.”
The Union Army data has proven a rich quarry. Over the past 15 years Fogel and his colleagues have used it to examine labor markets, marital felicity, and postwar migration. They’ve zeroed in on specific maladies like hernias, diarrhea, and cardiovascular disease. Now Costa is at work on a book about social capital, how companionship and camaraderie kept Union soldiers from deserting despite the demands of self-preservation, or kept them alive in prisoner-of-war camps where depression and disease killed so many. “We’ve been focused on how health measures add to human capital,” Fogel says. With an eye toward the implications for medical care, public health, and Social Security, “we’re trying to figure out: can we forecast what’s going to happen to specific chronic illnesses 50 or 75 years down the road?”
Economist Lorens Helmchen, PhD’04, who began analyzing Union Army veterans’ health records in 1999 and researched the changing prevalence and severity of musculoskeletal disorders and heart disease, calls Fogel’s focus on the distant horizon fascinating and unusual. “He’s not talking about the next business cycle, or the next several business cycles,” says Helmchen, now at the University of Illinois at Chicago. “He’s talking about the next 50 or 100 years.” Fogel’s “passion for the facts, for finding out where the data hide,” Helmchen says, is infectious and inspiring. “I met with him every two weeks, and he couldn’t wait to get the results of what I’d been doing. He’d interpret them right away.”
Last November Fogel turned 80. His life bears out the sweeping progress his research chronicles. When he was ten, Fogel’s parents took out a life-insurance policy in his name. Two years later a cousin died of rheumatic fever. She was 11 years old. “Polio was still a tragedy then” too, says Fogel, who as a grown man became an early beneficiary of antibiotics when he contracted pneumonia in 1950. His life expectancy at birth was less than 60; for newborns today it is almost 80. “My oldest granddaughter was born in 1981,” he says. “According to my forecasts, she has a 50-50 chance of living to be 100 years old.”
Fogel still can’t pinpoint the reasons why. Despite all he’s learned, he says, technophysio evolution doesn’t yet offer a full answer. “We’ve seen these gains in health and longevity, but what percentage is due to improvements in public health?” Fogel asks. “Or medical care, nutrition, income? What about socioeconomic factors: how much of the health improvement has come from bringing up the people living in the worst conditions?” Half a century after he enrolled in graduate school, Fogel is still dissecting the fundamental forces. “That’s my project.”