Vital statistics are usually assumed to cover only the number of births and deaths occurring in a given territory within a given time, a subject not attractive to the general reader, but this address will be devoted more particularly to the objects for which and the agencies by which such statistics are assembled, which is far more important and interesting, especially as it includes the social questions they resolve for us. “It is sometimes said figures rule the world; but this at least is true, that they show how it is ruled.” To this saying of a wise man may be added that they also show how it might be or should be ruled; they best illustrate “philosophy teaching by example,” because most precise and definite in form of presentation. They are of most use when applied to the most important interests of mankind, and have no higher function than in bearing their part in safeguarding the nation’s health.
For its vital statistics the Federal Census Bureau has always had to depend on data collected by local agencies, and of the imperfection of those agencies, and especially the large territory for which there were none—no attempt to keep the official record of births and deaths, it has loudly complained. Notwithstanding the commendable efforts that have been made throughout the country to supply deficiencies by State legislation, so much remains yet to be done that a census report, as late as 1907, showed less than half the population of the country, and only a third of the States in number, within the registration area. But the movement has been forward, and it is gratifying to note that the most significant step in advance was made by Pennsylvania, in a law creating a state department of health and fixing its duties in 1905. Until then that commonwealth was said to have “the poorest registration of any of the Eastern States,” though its first law for the purpose had been passed fifty-four years earlier; but “it had in 1906, the first year of the operation of the new law, an effective registration of births and deaths practically as complete as that of any registration State in the country, and far superior to the majority.” The best point about the law of 1905, and its most significant difference from that of 1851, is that it is executed. Obedience is no longer optional, but compulsory. Authority under it is centralized in the hands of the Governor, Attorney-General and Commissioner of Health, and practically for most purposes in those of the Commissioner.
The total appropriations for work under this department since 1905 have been $9,286,080. The number employed by its various divisions is 3,625. Of this number there are 1,170, nearly one-third of the total force, who are local registrars in the vital statistics service.
With what is so large a force to occupy itself? The 1,170 registrars receive all birth and death certificates and issue all burial permits (to which registration is a prerequisite), and the bureau has also charge of marriage certificates, filed with it by the clerks of county courts. The medical inspection division establish quarantine under direction of the county inspectors, see to placarding houses and disinfecting them after cases of communicable disease, guard against the sale of milk from premises where any such diseases are found, and represent the department in co-operation with local health boards. Supervision of the medical inspection of schools forms also an important part of the duty of these officers, some 300,000 children having been examined during the past school year. At the free tuberculosis dispensaries, with which the department has provided the large centers of population, the indigent receive free medical advice and necessary supplies. The commissioner has supervision, by the act creating the health department, of all systems of public water supply and of public or private sewage disposal. Detailed plans must be filed with the department, and no new construction can be done until the Governor, the Attorney-General and the Commissioner have approved the plans. The biological products division distributes, through 656 stations in all parts of the commonwealth, free antitoxin to the poor. The stations are located as impartially as practicable.
What has been accomplished by all this equipment, discharging all these functions, cannot be completely told; a few figures may be given, with a result here and there, and the rest left to estimate of probability. For example, the statement that 6,724 patients were admitted to the Mont Alto Sanatorium in the four years 1907–1911 certainly indicates the magnitude of the problem, and the importance of giving it the best attention we can. It is perhaps a little more significant that 58,004 patients have been treated in the department’s tuberculosis dispensaries since they were organized. The activity of the sanitary engineering division is clearly shown in its recorded count that up to June, 1912, 40,447 private sources of stream pollution had been abated on notice from the department. One hundred and eleven modern sewage-disposal plants have been built or are in process of building, 306 municipal and private sewer systems are under construction in accordance with plans approved by the health department. Ninety-seven modern water filtration plants have been or soon will be constructed under State approval. It is worth while to connect with this fact another even more gratifying: the death rate from typhoid fever in Pennsylvania, which was, in 1906, 565 per million inhabitants, had fallen to 206 per million in 1911. As a final instance, the death rate from diphtheria, a little over 42 per cent. in untreated cases, has been reduced in the average of the 35,111 cases treated with antitoxin between 1905 and December, 1911, to 8.07 per cent., or less than one-fifth. Further, a certain district having been set apart for the trial of 5,000 units, instead of the usual 3,000, as an initial dose of diphtheria antitoxin, the death rate in that district has now shown a reduction to 4.22 per cent.
This story is not told for the mere satisfaction of praising our Keystone State or its faithful and capable public officers, though for that, too, it affords opportunity. Its function is to point a moral, to indicate a course of treatment of the subjects of vital statistics and public health, which, as Pennsylvania’s experience leads me to believe, may well be applied to a wider field than Pennsylvania. It is not by accident that the association of statistics of births and deaths and marriages, with a State office for the promotion of public health, has come into favor at the same time in so many parts of the country. The force of example is something, to be sure, as is also the circumstance that a physician is usually at hand, when a birth or death occurs, that he is apt to know what there is to tell about the occurrence, that he is apt to know how to report, and that the State health office is one to which a physician might naturally address himself. But more important than these considerations is the value of birth and death records in the conservation of the people’s health. From the greater or lesser number they show the favorable or adverse effects of accompanying conditions can be judged, and a conclusion reached as to how such conditions should be regulated. Nor could any condition be more important to regulate than those affecting health. The people’s health is its most precious asset. Dr. Wiley says he “would rather be a strong, vigorous man without a dollar than a sickly millionaire,” and thus indicates the pecuniary value of health to an individual. Multiplying that value by the number of the population, the amount becomes fairly appalling.
We have a department of agriculture expending vast sums—nearly fifty millions in the last decade—in improving the soil, improving the growth of vegetation, improving the health of animals, and no department to do anything to improve human health. We spend $700,000,000 a year for past and imagined future wars, and pay no attention to the 700,000 calculated above—a larger number dying every year, unnecessarily from disease, than bullets have slain since the continent was discovered. As we are reminded by Dr. Dixon, our Pennsylvania health commissioner, we are spending millions a year for the protection of our forests and water supply and other natural resources, but it is no credit to our intelligence that while guarding these material interests we allow man himself, without whom all else is worthless, to remain unguarded.
Yet it is a mistake to say that we do and have done nothing; what has been done is greatly to the credit of mankind, only it has not been enough. Jenner’s discovery and his application of it has left no excuse for smallpox anywhere. The president of the board of health in Mexico assured me that compulsory vaccination had freed his city of smallpox; and the Japanese health authorities, since their enforcement of compulsory vaccination, have ceased altogether to look upon the presence of smallpox as a source of danger. It is no longer a scourge in the Philippines and Cuba. Similar to the work of Lister in antiseptic surgery is that of Pasteur and Koch in various germ-diseases, of King and Carroll and Lazier in mosquito-transmission of infection. With the elimination of the Stegomyia mosquito, yellow fever is no longer dreaded; Havana and the gulf ports are as safe as anywhere; and the construction of the Panama Canal has become possible—as, but for the discoveries by Carroll and Lazier (or their rediscovery of Dr. King’s discovery) it never could have been.
From the brilliant successes attained in the directions just indicated, we seem to see that the most important thing for us is to know; we are to find our safety in knowledge. When we know that malaria is inoculated by the bite of the mosquito Anopheles, and yellow fever by the mosquito Stegomyia, that typhoid fever is fed to us, in a large proportion of cases, from the feet of the house-fly, that the fearful bubonic plague is inoculated by the bite of a flea infesting the rat, we have already traveled more than half way to deliverance. We can drive off the mosquito, or, by oiling the puddles, prevent her from hatching; we can “swat the fly,” or abate the manure-heaps and other filth from which it draws its unblest being; and, if we can not catch the flea, we can make war upon its host, the rat. If, as is computed, within the last 2,000 years 2,000,000,000 people have fallen victims to the bubonic plague, it is enough to justify wholesale enlistments in a grand rat-hunt.
Half a century ago people were afraid of night air, and closed their windows at night. It is hard to guess how many lives might have been saved by opening those windows. We are told that the average duration of human life has doubled in the last 200 years. Whatever gain there has been is due, more than anything else, to more knowledge.