Writing out in correct lists all the groups of phenomena that make up the term disease, we will find that they invariably come from without. From my point of view all the groups of diseases are in truth accidents; exposure to some influence or influences that pervert function or create new motion. I must first refer to the cause to which at various times has been ascribed the responsibility for this excessive mortality, viz.: that innate vital weakness exists in the colored population of this country as a result of amalgamation. On this theory the black race when mixed with the Caucasian is the only one which produces with the latter a progeny of weakened innate vitality. I have never seen this statement supported by any trustworthy knowledge or information. On the other hand it has always been accompanied by the most absurd arguments which invariably tend to expose the mind of the writer as being prejudiced to the intermingling and the intermarriage between the two races. It is among the possibilities that physiological peculiarities account for dispositions to disease belonging to typical classes of the human family. No one has as yet been able to determine what those peculiarities are. Whether they are primitively impressed on a race, or are acquired is a question that can be answered only when the exact relationships of diseases to race are discovered. My own view is, that acquired and transmitted qualities and specific existing social peculiarities are sufficient agencies for the production of all the known variations of vitality belonging to peculiar races.
I am now thoroughly convinced that the causes of this great mortality of the colored people of the cities of the South are poverty, prejudice, and ignorance. For obvious reasons I will submit them in the following arrangement:
1. POVERTY:
a. Contagious Diseases (close contact).—Diphtheria, scarlet fever, small-pox, tuberculosis, syphilis, etc.
b. Unsanitary Nuisances (11,705 abated in the District of Columbia for year ending June 30, 1900).—Filthy alleys, cellars, bad drainage, garbage, filthy gutters, hog pens, filthy houses, filthy lots, stagnant water, filthy privies, leaky roofs, sewers, filthy yards, filthy streets, wells, etc.
c. Unsanitary Homes.—Only those houses that are refused or abandoned by the white people are offered to the colored people for dwellings.
d. Impure Food.—The large quantity annually condemned in the District of Columbia is an indication of that to which the poor is subjected.
e. Impure Air.—Bad design and construction (small rooms) and unhealthy location.
f. Impure Water.—Unhealthy sources, cheap, shallow and unhealthy wells, etc.
g. Infantile Mortality.—Unusually large from poverty alone.