DR. CHARLES V. CHAPIN
SUPERINTENDENT OF HEALTH IN PROVIDENCE, RHODE ISLAND, ONE OF THE CITIES WHICH HAS BEEN FOREMOST IN PROSECUTING PHYSICIANS FOR FAILURE TO GIVE NOTICE OF INFECTIOUS DISEASE
Finally, there are the city bureaus, with powers vested, as a rule, in a medical man designated as "health officer," "agent," or "superintendent." What Massachusetts is to the State boards, New York City is to the local boards, but with even greater powers. Under the charter it has full power to make a sanitary code. Matters ranging from flat wheels on the Metropolitan Street Railway Company's antiquated cars, to soft coal smoke belched forth from factory chimneys, are subject to control by the New York City Department of Health. The Essex Street resident who keeps a pig in the cellar, and the Riverside Drive house-holder who pounds his piano at 1 a.m. to the detriment of his neighbor's slumber, are alike amenable to the metropolis' hired doctors.
The province of the city, State, and Federal health organization is broad. "Control over all matters affecting the public health" is a comprehensive term. "All the powers not already given to the school committees," observed a Massachusetts judge, "are now ceded to the Boards of Health." In theory, then, almost unlimited powers are vested in the authorities. But how carefully they must be exercised in order not to excite public jealousy and suspicion, every city health official well knows. More serious than interference and opposition, however, is the lack of any general equipment. At the very outset the loosely allied army of the public health finds itself lacking in the primal weapon of the campaign; comprehensive vital statistics.
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.