Tuesday, October 18, 2005

Not Exactly An Ozzie and Harriett Crime Rate

Newspapers around the country reported yesterday that 2004's murder rate was the lowest since 1965. Major violent and property crimes also fell a little over 2% last year. So are we back to the good old days before exploding illegitimacy rates and a deteriorating culture sent violent crimes skyrocketing? Not exactly.

One-hundred years ago the homicide rate was less than 25% of the 2004 rate of 5.5 per 100,000 people. The murder rate climbed steeply to nearly 10 per 100,000 in the mid-1930s and then fell below 5 for most of the 50s and early 60s. But that doesn't tell the whole story.

As Lt. Col. Dave Grossman pointed out in his book On Killing, the aggravated assault rate serves as a close proxy statistic for attempted murders. And the aggravated assault rate has increased dramatically since the 1950s even if the murder rate has not. Criminologist Anthony Harris estimates today's homicide rate would triple if medical and rescue technologies had not improved since the 50s.

Grossman was kind enough to email me an excerpt from his new book On Combat when I asked him for more detailed source citations for his writing on this topic. He argues that in comparing today's homicide rate with the 1930s and before we ought to multiple today's rate by ten for a true comparison:

Since 1957, the U.S. per capita aggravated assault rate (which is, essentially, the rate of attempted murder) has gone up nearly five-fold, while the per capita murder rate has less than doubled. The reason for this disparity is the vast progress in medical technology since 1957, to include everything from mouth-to-mouth resuscitation, to the national 911 emergency telephone system, to medical technology advances. Otherwise, murder would be going up at the same rate as attempted murder.

In 2002, Anthony Harris and a team of scholars from the University of Massachusetts and Harvard, published a landmark study in the journal, Homicide Studies, which concluded that medical technology advances since 1970 have prevented approximately three out of four murders. That is, if we had 1970s level medical technology, the murder rate would be three or four times higher than it is today.

Furthermore, it has been noted that a hypothetical wound that nine out of ten times would have killed a soldier in World War II, would have been survived nine out of ten times by U.S. soldiers in Vietnam. This is due to the great leaps in battlefield evacuation and medical care technology between 1940 and 1970--and we have made even greater progress in the years since. Thus, it is probably a conservative statement to say that if today we had 1930s level evacuation notification and medical technology (no automobiles and telephones for most people, and no antibiotics), then we would have ten times the murder rate we currently do. That is, attempts to inflict bodily harm upon one another would result in death ten times more often.

Consider, for instance, some of the quantum leaps in medical technology across the years. Just a century ago, any puncture of the abdomen, skull or lungs created a high probability of death, as did any significant loss of blood (no transfusions) or most large wounds (no antibiotics or antiseptics), or most wounds requiring significant surgery (no anesthetics, resulting in death from surgery shock). Also, consider the increasing impact of police methodology and technology--fingerprints, communications, DNA matching, video surveillance, and others--in apprehending killers, preventing second offenses, and deterring crime.

Each of these technological developments, in their place and time, should have negated the effects of weapons evolution and saved the lives of victims of violence. When assessing violent crime across any length of time, we should ask what proportion of trauma patients survive today, and what proportion of those would have died if they had 1940-level technology (no penicillin), 1930-level technology (no antibiotics), 1870-level technology (no antiseptics), 1840-level technology (no anesthetics), or 1600-level technology (no doctors, no anatomy).

The medical technology continues to move forward, saving ever more lives every year. In an article entitled “New Battlefield techniques,” NY Times reporter Gina Kolata interviewed Dr. Paul K. Carlton Jr., the recently retired surgeon general of the Air Force. He told of field surgeons who carry everything needed in a backpack, including “sonogram machines the size of cassette recorders, and devices the size of a PDA that can do a complete laboratory analysis on a drop of blood.”
Dr. Carlton used the U.S. invasion of Afghanistan as an example of what is now possible.
Of 250 seriously injured patients, only one died. "It was the lowest died-of-wounds rate in the history of war," he said. One man suffered a catastrophic wound to his rectum, prostate, anus and bladder. The ghastly injury plunged him into shock immediately, but one of the backpack surgical teams got to him right away and did a damage control surgery. Then, he was put on an airplane equipped as a critical care unit and flown a few thousand miles to another hospital for another surgery to stabilize him. Then he was flown to Germany for reconstructive surgery. "He's home with his family now," Dr. Carlton said. In any other war, he added, "he would have been dead."
A little over a year later, in the invasion of Iraq, new bandages with a powerful clotting agent that can stop arterial bleeding were introduced, providing yet another major leap forward in lifesaving medical technology. That same technology is also holding down the murder rate back home.

Landmarks in the Evolution of Medical Lifesaving
  • c.1690: French army institutes first scientific, systematic approach to surgery
  • c.1840: Introduction of anesthesia overcomes surgical shock
  • c.1840: Introduction in Hungary of washing hands and instruments in chlorinated lime solution reduces mortality due to “childbed fever” from 9.9% to .85%
  • c.1860: Introduction by Lister of carbolic acid as germicide reduced mortality rate after major operations from 45% to 15%
  • c.1880: Widespread acceptance and adaptation of germicides
  • c.1930: Sulfa drugs
  • c.1940: Penicillin discovered
  • c.1945: Penicillin in general use, and ever-increasing explosion of antibiotics thereafter
  • c.1960: Penicillin synthesized on a large scale
  • c.1970: CPR introduced on wide scale
  • c.1990: 911 centralized emergency response systems introduced in U.S. on wide scale
  • c.2002: Harris, et al., landmark study by U.Mass and Harvard, published in the journal Homicide Studies concludes that med tech advances since 1970 have prevented approximately three-out-of-four murders

No comments: