Our Absurd Vital Statistics
Vital statistics in this country are an infant science. Yet they are the very basis and fundament of any attempt to better the general health. Knowledge of what is killing us before our time is the first step toward saving our lives. The Census Bureau does its best to acquire this essential information. For years Director North has been persistently hammering away at this point. But progress is slow. Only fifteen States, representing 48 per cent. of our population, are comprised in the "registration area"; that is, record all deaths, and forbid burial without a legal permit giving the cause of death and other details. Outside of this little group of States, the decedent may be tucked away informally underground and no one be the wiser for it. This is convenient for the enterprising murderers, and saves trouble for the undertakers. Indeed, so interested are the latter class, that in Iowa they secured the practical repeal of a law which would have brought that State within the area; and in Virginia this year they snowed under a similar bill in the legislature, by a flood of telegrams. Ohio, the third largest State in the Union, keeps no accurate count of the ravages of disease. Probably not more than 60 per cent. of its deaths are reported. Why? Inertia, apparently, on the part of the officials who should take the matter in charge. Governor Harris in his January message made a strong plea for registration, but without result. As for births, there is no such thing as general registration of them. So this matter is neglected, upon which depend such vital factors as school attendance, factory employment, marriage, military duty, and the very franchise which is the basis of citizenship. It is curious to note that Uruguay, in its official tables of comparative statistics, regrets its inability to draw satisfactory conclusions regarding the United States of America, because that nation has not yet attained to any scientific method of treating the subject. Patriotism may wince; but let us not haughtily demand any explanation from our sneering little neighbor. Explanations might be embarrassing. For the taunt is well founded.
DR. JOHN N. HURTY
SECRETARY OF THE BOARD OF HEALTH IN INDIANA, WHICH HAS RECENTLY PASSED A LAW FORBIDDING THE MARRIAGE OF IMBECILES, EPILEPTICS, AND PERSONS SUFFERING FROM CONTAGIOUS DISEASE
Is it strange that, having no basis in national statistics, our local health figures "speak a varied language"? We have no standards even of death on which to base comparisons. But a dead man is a dead man, isn't he, whether in Maine or California? Not necessarily and unqualifiedly. In some Southern cities he may be a "dead colored man," hence thrown out of the figures on the "white death rate" which we are asked to regard as the true indication of health conditions. In New Orleans, until recently, he might be a "death in county hospital," and as such not counted—this to help produce a low death rate. In Salt Lake City he's a "dead stranger," and unpopular on account of raising the total figures for the city. They reckon their total rate there as 16.38, but their home rate or "real" rate as 10.88. That is to say, less than 11 out of every 1,000 residents die in a year. If this be true, the Salt Lake citizens must send their moribund into hasty exile, or give them rough on rats, so that they may not "die in the house." As for the "strangers within our gates" who raise the rate over 50 per cent. by their pernicious activity in perishing, the implication is clear: either Salt Lake City is one of the deadliest places in the world to a stranger, or else the newcomers simply commit suicide in large batches out of a malevolent desire to vitiate the mortality figures. The whole thing is an absurdity; as absurd as the illiterate and fallacious three-page leaflet which constitutes this community's total attempt at an annual health report.
DR. GEORGE W. GOLER
HEALTH OFFICER OF ROCHESTER, NEW YORK, WHO REFUSES CHILDREN CERTIFICATES TO WORK IN FACTORIES, UNLESS THE APPLICANTS ARE IN SOUND PHYSICAL CONDITION
St. Joseph, Missouri, claimed, one year, a rate of 6.5 deaths out of every 1,000 inhabitants. Were this figure authentic, the thriving Missouri city, by the law of probability, should be full of centenarians. It isn't. I essayed to study the local reports, hoping to discover some explanation of the phenomenon, but was politely and regretfully informed that St. Joseph's health authorities issued no annual reports. The natural explanation of the impossibly low rate is that the city is juggling its returns. In the first place, that favorite method of securing a low per capita death rate—estimating a population greatly in advance of its actual numbers—is indicated; since the community has fewer lines of sewers and a smaller area of parks than other cities of the size it claims—two elements which, by the way, would in themselves tend to militate against a low mortality. Perhaps, too, the city has that ingenious way of eliminating one disturbing feature, the deaths under one week or ten days, by regarding them as "still-births." Chicago used to have this habit; also the trick of counting out non-residents, who were so thoughtless as to die in the city. At present, it is counting honestly, I believe. Buffalo used to pad for publication purposes. One year it vaunted itself as the healthiest large city in the country. The boast was made on the original assumption of a population nearly 25,000 in excess of the United States Census figures, to which 20,000 more was added arbitrarily, the given reason being a "general belief" that the city had grown to that extent.
Perhaps as complete returns as any are obtained in Maryland, where the health official, Dr. Price, culls the death notices from 60 papers, checks up the returns from the official registrars, and if any are missing, demands an explanation by mail. It behooves the registrar to present a good excuse. Otherwise he is haled to court and fined. The Board has thus far never failed to secure a conviction.
Now, if the most concrete and easily ascertainable fact in public health statistics, the total of deaths, is often qualified or perverted, it follows that dependent data, such as the assigned causes of death, as required by law, are still more unreliable; so I shall keep as far away from statistics as possible except where some specific condition can be shown by approved figures or by figures so inherently self-disproved that they carry their own refutation.