State Boards of H ealth, 
THEIR OBJECT AND USE, ETC 
EXTRACTS, SHOWING THE 
VIEWS OF PRACTICAL WORKERUNOTW SANITARIANS. 
ISSUED BY 
INDIANA STATE BOARD OF HEALTH. 
THAD. M. STEVENS, M. D., 
Secretary and Executive Officer. 
INDIANAPOLIS: 
\VM. 15. BURFOHD, PRINTER, LITHOGRAPHER ANI) BIN DEI!. 
1882. State Boards of Health, 
♦ K 
THEIR OBJECT AND USE, ETC. 
EXTRACTS, SHOWING THE 
VIEWS OF PRACTICAL WORKERS AND EMINENT SANITARIANS. 
ISSUED BY ORDER OP THE 
INDIANA STATE BOARD OF HEALTH. 
THAD. M. STEVENS, M. D., 
Secretary and Executive Officer. 
INDIANAPOLIS: 
W.M. 15. 13UHKORO, PRINTER, LITHOGRAPHER AND BINDER. 
1882. OPINIONS OF SANITARIANS. 
The first State Board of Health in the United States was that 
of Massachusetts, established in 1:SG9. Since that date, twenty- 
six States have established health organizations. By an act, ap- 
proved March 7,1881, a State Board was established in Indiana, 
and since that date, there has been fully organized in every 
county of the State, except one, a County Health Board; also, 
city and town boards in each incorporated city and town of 
the State. 
Such organization necessarily entails some expense, and 
places upon physicians and others certain duties, for the per- 
formance of which they do not receive what would appear to 
be adequate pay. 
It is the duty of those engaged in such work, or taking an 
interest therein, to inform those who seek information relative 
to the value of such work, and to show the need and good 
policy of keeping up the added expense to the State and in- 
creased labor that devolves upon the physicians and others. 
We here present the views of many who have for years been 
engaged in such work, and give, also, the recorded result, so 
that all may easily judge of its value and need. 
The introduction of any new system is generally met with 
more or less opposition, and it was not to be expected that the 
establishment of a State Board of Health would be an excep- 
tion. It is gratifying to know that this opposition has been 
less than was anticipated. The cause of opposition may be 
said to be founded on a misapprehension or ignorance of the 
object of the law and the aims of the Board. 
It may be well to state that the chief aim of the law is, first, 
to collect facts and then to disseminate correct sanitary infor- 4 
mation among the people. Whatever tends to increase the 
knowledge of the medical profession, tends to increase the 
safety and health of the people. It is due the medical profes- 
sion to say that its members have generally been eager to seek 
all information that promises any beneficial knowledge, and the 
sanitary and vital facts, gathered by the State and local Boards, 
will furnish data from which we shall be able to arrive at cor- 
rect conclusions, as to the causes and means of prevention of 
many diseases. 
The graveyards of the State are full of those who have fallen 
victims to their own lack of knowledge, or their own careless- 
ness. It is within the bounds of truth to say that two-thirds 
of the children that die annually, in Indianapolis or other cities 
of the State, might have been rescued from death, had their 
parents possessed the information which should be within the 
reach of all. Xot. by means of any “Domestic Medicine,” or 
“Every Man His Own Physician” book, but by well authenti- 
cated and practical facts, placed before the people in a reliable 
shape, so that they should be warned as to the dangers that 
can be avoided, as the red flag, warns of small-pox or the 
signal light, of the locomotive. Such disseminated intelligence 
would furnish the means of avoiding the danger. 
Take that disease so common among children, viz : Whooping 
cough—parents look upon it as one of the necessary ills that 
must fall upon all children, and regard it as being without 
danger to the child, and in many cases hail its appearance with 
a kind of semi-delight. It is true, there is comparatively little 
danger in the disease, if proper care is taken of the child, and 
this care must be exercised the parents, and not by the 
medical attendant, if there be one. The truth must be made 
known to the people. Scarlet fever is justly regarded with 
dread, yet whooping cough has annually, in Indiana, carried to 
the grave more victims than scarlet fever, and while the Board 
has at present no means of knowing the exact facts in every 
case, yet the information it has, justifies it in saying that in 
nearly all cases of death from whooping cough during the past 
nine months, the fact that death ensued was due to want ot 
proper care of the child by its parent or nurse, especially at a 
time when the patient is supposed to be convalescent. 
Diphtheria is another of those diseases that has caused fearful 5 
ravages among children. Statistics,gathered by the Board, show 
that certain diseases are prevalent with this class of the popula- 
tion. This is not always from anything in their occupation or 
surroundings. The causes for the frequency of death must often 
be sought for elsewhere. A study of the tables compiled by the 
State Board, that will appear in the annual report, will show 
that bronchitis and pneumonia are particularly noticeable for the 
fatal ending in cases -of children, and this frequently is, in a 
large degree, due to a want of proper preventive measures. 
Farmers and their families will, in winter, attend gatherings 
of various kinds in small and ill-ventilated school houses or 
churches; stoves are made red hot, and, from the steaming at- 
mosphere, they go forth into the chilling air—ride home through 
the cold without properly protecting themselves. 
In the city, those who attend such assemblages go, at least, 
provided with wraps to protect themselves against such sudden 
changes, and the result is, they are less liable to those forms of 
disease. 
It is safe to say that one hundred persons are annually killed 
upon and by railroads of the State, and that, of the whole num- 
ber, less than a score are employes of the railroad, while the 
other persons are those who have no business in the place where 
they meet their death. It is only bringing such facts to the 
minds of the people that they can be made to realize their 
danger. They hear of isolated cases of railroad injuries, but 
it is the figures in the aggregate that impress them. 
In accidents, of one kind and another, fully five hundred 
persons, annually, in Indiana, meet their death, and, in nine 
cases out of ten, carelessness somewhere is the cause. 
It may be asked, why the State should engage in the work? 
The State is directly interested in the life and health of every 
citizen. The longer lived and healthier its citizens, the stronger 
and wealthier the State becomes. 
As to vaccination, the policy of compulsory vaccination has 
been very much questioned, and the silly objection that such a 
system interferes with the rights of the citizen, has been made. 
Every citizen owes some obligation to the community where he 
lives, and while he may have an abstract right to deal with his 
own life, he has no right to endanger the life or health of an- 
other. 6 
Vaccination is not alone to preserve one from the disease, 
hut also to prevent him from aiding in its dissemination among 
his fellows. 
The prevention of disease is the accumulation of wealth both 
to the individual and the State. The knowledge how to prevent, 
is based upon vital and sanitary statistics. 
The diseases that are of the most importance in a sanitary 
point of view belong to the class Zymotic (ferments). We may 
mention, as prominent among these, the following, viz: Small- 
pox, diphtheria, scarlet fever, chicken-pox, whooping cough, 
typhoid and typhus fever, puerperal fever, croup, cerebro-spinal 
meningitis and cholera, dysentery, consumption and acute lung 
affections might be added. 
Now let us see what some of the most eminent and practical 
sanitarians say as to the influence upon human health and com- 
fort the work of State and local health organizations exert, and 
as to the value of vital and sanitary statistics. We give the 
following extracts: 
Public Economy of Sanitary Measures. 
We are fast coming to understand, that the prevention of dis- 
ease means wealth and prosperity, and that, aside from those 
high and sacred considerations which move the heart of man 
to alleviate the sufferings and obstruct the evils that afflict his 
fellow-man, there is a sharp pecuniary side to your efforts, 
which, as true citizens of Chicago, we are not at liberty to 
overlook. 
I read in one of your interesting reports that the small-pox 
scourge of 1871-72, cost the city of Philadelphia over twenty- 
one million dollars. The facts given, I think, warrant the 
conclusion. This was manifested in diminished travel and 
shrunken commerce. Nor is this all; for it appears that this 
great sum might have been saved, to say nothing of the lives 
lost and the suffering endured. We rejoice this year in a most 
bountiful crop; but there are other sources of wealth, quite as 
visible and more certain than corn and wheat, that do not 
attract our attention. 
Our city has been in commotion for thirty days about the 
truly serious loss of four or five million dollars by our savings 7 
banks, but we probably annually lose a much greater sum in, 
and indifference to, sanitary means, and without excitement 
and almost without protest. 
There is not within the limits of Chicago a business unin- 
jured, a palatial residence or a cottage, the value of which is 
not diminished by the pestilent odors that sweep over the city. 
Yet men, busy with their own affairs, who pass for sagacious, 
far-seeing men, act as though it were no concern of theirs—no 
concern of theirs as to the drainage of houses two blocks away; 
no concern of theirs whether the air, common to all, becomes 
polluted; but typhoid and scarlet fever among their loved ones 
at home utter a mournful denial of these assertions. And thus 
you will prove that the widest traffic, the most permanent pros- 
perity, and the largest security for the home are founded on 
the truth that man is his brother’s keeper. 
Wirt Dexter, Esq. 
A. P. II. A. Report, Vol. IV. 
Possible Future Achievements in Hygiene. 
Let us now inquire what are some of the possible achieve- 
ments of hygienic science and art in the future,, and the best 
means for their accomplishment. 
One of the most promising tields of labor for the hygienist 
is, it seems to me, in the still further prevention of sickness 
and deaths from miasmatic causes. 
Referring to our vital statistics for 1871, we learn that the 
probable number of deaths in the State, as corrected by the 
compiler, was 18,094, and that of these 4,832, or about 27 per 
cent,., were believed to have been caused by miasmatic diseases. 
Certainly this number should be largely increased, for there 
were reported as deaths from pneumonia, 482; or, when “cor- 
rected” by multiplying by 1.86, 800. Of these we may add to 
our former number of deaths from miasmatic causes at least 
500, as surely-due to miasmatic causes as any others, and we 
have our list swelled to 5,332 from these causes in a single year. 
As many persons can better appreciate the loss to the State 
by preventable deaths when the value of the years of “effective 8 
life” lost by them is put into dollars and cents, let us, for a 
moment try, approximately, to estimate the real money loss to 
the State by these miasmatic causes. 
The last sickness of the 5,332 persons who die from these 
causes, including loss of time, must have cost on an average $50 
for each person, and the funeral expenses must have been, on 
an average, $25 for each one, giving a cost—actually a loss— 
to the State of $399,900. 
xN'off, as these causes of death are accounted by all hygienists 
as preventable, it is safe to say that a large number of these 
persons died prematurely. Let us suppose, then, that these 
persons died sooner than they otherwise would by an average 
of ten years, and that one-half of those years thus lost might 
be said to be years of “ effective life.” 
The State then loses, annually, 26,660 years of “ effective life,” 
which can not be estimated at less than $150 per year, giving a 
money loss of $3,999,000. 
English observers and statisticians have estimated that for 
every death two persons are constantly sick. 
Thus for every death from the same causes under considera- 
tion, it is probable there are two years of sickness from the 
same causes in other persons in this State, or 10,664 years of 
sickness from nyasmatic. causes in the year 1871. Counting 
one-half of these yeftrs of sickness as in the “effective period” 
of life, we have their money' value, $150 per year, $799,800, 
which is really, so much loss to the State. 
Nor is this all; for the cost of these 10,664 years of sickness, 
in medical attendance, nursing and loss of time of parents and 
friends can not be estimated at less than an average of $200 per 
year, thus entailing another loss to the State of $2,132,800. 
Here, then, is the approximate money loss to the State from 
these preventable causes of sickness and death : 
Sickness and funeral expenses of those dead from 
these causes, 5,332 $399,900 
Loss of effective years of labor by these premature 
deaths, 26,660 3,999,000 
Loss of effective years of labor from sickness of 
others, 5,332 years 799,800 
Loss in cost of 10,664 years of sickness 2,132,800 
Total loss to the State $7,331,500 9 
That probably one-half of all this loss may be saved to the 
State is, I think, apparent from the following and other con- 
siderations: 
Dr. Edward Jarvis, in a paper contributed to the State Board 
of Health of Massachusetts, on “Political Economy of Health,” 
very concisely remarks that “the effective power of a nation is 
in the number of its people in sustaining period” (i. e., between 
the ages of twenty and seventy), “and in the proportion these 
bear to the dependent classes.” 
“Collective personal gain is-public gain, and aggregate per- 
sonal loss is, to the same extent, the suffering of the com- 
munity,” 
“ The State thus has an interest not only in the prosperity, but 
also in the health and strength and effective power of each one 
•of its members.’' 
Whatever has, in the history of the race, and especially in 
the history of civilization, intended to add to the efficient power 
of individuals of the various nations, is really embraced in 
hygienic science and art. Their’s are the better adaptations 
of means, circumstances, and habits, by which man’s life has 
been expanded and his strength increased; their’s the various 
improvements in agriculture, in vegetable and animal life, by 
which man has obtained better and more constant food; their’s, 
too, the wonderful and manifold improvements in the arts, by 
which man is better clothed and housed. 
The gradual increase in the length of human life since the 
commencement of the Christian era, is the result, and really 
marks the progress of the benignant rule of the goddess Hygea. 
In the third century, the average duration of life among the 
most favored classes in ancient Rome was thirty years. In the 
present century, the average longevity of persons of the same 
•class is fifty years, or an increase since the third century of 67 
per cent. There can, I think, be no doubt that in the lower 
classes the increased longevity is still more striking. 
II. 0. Hitchcock, M. D. 
Michigan Report, 1876. 10 
Responsibility of Boards of Health. 
While the responsibilities of Boards of Health in cities and 
villages are proportionately greater than in the townships, yet 
the importance of organization and careful attention to the 
sanitary conditions of the town must not be underrated. Epi- 
demics sometimes sweep through a farming community, which 
might easily have been prevented by prompt action on the part 
of the Board of Health, had immediate notice of the tirst case 
been given to them. Nuisances in the shape of stagnant pools 
of water or undrained marshes often exist in the township, 
which are fruitful sources of disease to the inhabitants, and 
should be abated in the manner provided by law. All Boards 
of Health should, therefore, ascertain whether any cause of dis- 
ease exists within their jurisdiction, and if there is reason to 
apprehend that any source of sickness may possibly arise from 
the action or neglect of any person, the Board should establish 
such regulations, and take such measures as they may think 
necessary to prevent the same. 
Hon. Leroy Parker. 
Michigan Report, 1879. 
The statute now gives the State Board of Health only direct- 
ory or advisory power. Practical experience has demonstrated 
the necessity for giving the rules and orders of the State Board 
mandatory power, with statutory force and effect. 
Contingencies have arisen, and will arise, where local influ- 
ences prevent the operation of the health laws for the protec- 
tion of the people. Authority should rest somewhere in such 
cases, to secure to communities the full benefit of the law, and 
no where could it be vested with more impartial judgment than 
with the State Board of Health, composed, as it is, of repre- 
sentatives from different parts of the State. 
Emergencies often exist requiring prompt and immediate ac- 
tion to protect the public health. Boards of Health should, 
therefore, have the power to restrain persons from maintaining 
a nuisance until a hearing can be had before a court. Such is 
the law in Massachusetts, and the Supreme Court of that State 
has confirmed the action of Boards of Health under the statute 
granting such powers. 
Iowa Report, 1881. 11 
Work of Health Boards. 
As regards villages, the case is worse than in cities. Out of 
152 incorporated villages, an annual report for the year ending 
September 30, 1874, has been received from only nine clerks. 
There seems to be a greater degree of indifference to all laws 
and measures for promoting the public health in villages, than 
in either cities or townships; and this is particularly unfortu- 
nate, because it is in just such places that so much can be done 
in the way of preventing sickness and death. It is in villages 
that water supply is peculiarly liable to be contaminated, and 
the inhabitants to be decimated in consequence, though such 
diseases as diarrhea, dysentery and typhoid fever. It is in vil- 
lages that the ordinary contagious diseases spread with such 
facility and rapidity, through the free communication of chil- 
dren. It is in villages that that fearful disease, cerebro-spinal 
meningitis, or spotted fever, most frequently causes the greatest 
destruction of life. If every village had an actual and active 
Board of Health, how much might be done to search out and 
remove some of these causes of sickness and death which now 
strike down hundreds from the village population of this State 
in every year. 
It is possible that some part of this apparent indifference 
really comes from comparative ignorance of the subject, both 
as regards the possibility of preventing sickness and death 
through sanitary work, and of the duties of village councils as 
local Boards of Health. In fact, it is not reasonable to expect 
that members of village councils, elected to perform the various 
duties of the office, should always be fully acquainted with the 
latest teachings of sanitary science. 
Michigan Report, 1874. 
Vital Statistics. 
The comparative success which has attended the efforts to 
secure these returns of vital statistics, is shown by their steady 
increase, while the per capita expenditure is not as great as 
when there was no attempt at classification or study. It is 
only as to the returns of births that our methods do not seem 
to be perfected. So far as vital study is concerned, we are able 12 
from those obtained, and from the deaths under one year of 
age, to compute allowances. But it would he better if the re- 
turns themselves were more complete. As it is, they are several 
thousand in advance of those under the last system, besides 
being accompanied with details of value in vital study. Until 
our governing authorities, and especially those of our cities, 
come to know that proper sanitary care and policy requires that 
the number of young children be known, in order to limit and 
protect from disease, they will be insensibly contributing to 
the general death rate. 
We find in the State no tendency to resist a law which has 
its foundations in a decent care of human life. It is not of- 
ficious for the State, in the case of a marriage, to claim that it 
have the recorded evidence thereof, with such appended facts 
as, in the judgment of those who have made the civic care of 
population a study, are deemed desirable. As to births, the 
trouble arises from negligence and delay rather than from intent. 
Some at first were disposed to question the right which a State 
lias to enforce a duty without compensation. This duty has 
been imposed by a law on the statute book for thirty years, and 
the principle is acknowledged in many cases, where lawyers, 
who are apt to protect their own legal rights, are required to 
perform services for which no direct pay is provided. It would 
be easy to show that incidental benefits accrue to medical men 
from all laws that look to this kind of guardianship over such 
vital conditions of population, as they bear relation to. 
As to deaths, the common sentiment is that the death and 
the cause of death of every person should be authenticated. 
In most of the returns of death there is evident carefulness 
of diagnosis, or a note showing some doubt or complication 
which is recognized. We invite the attention of all students 
of statistics to the data already on hand, as showing how in- 
formatory these records are, if, for instance, any one physician 
is disposed to abound in “general debility,” “cancer of liver,” 
“pyaemia or septicaemia” (without locality,) “congestive or 
gastric liver” or other doubtful term, the return itself comes to 
be eliminated and either is dropped from the vital tabulation 
or looses its significance in the multitude of numbers. 
E. M*. Hunt, M. D. 
New Jersey Report, 1:81. 13 
Until accurate registration of vital statistics is thoroughly 
carried out by each State, it obviously will be impossible to 
have an efficient system of State Preventive Medicine. What 
wre have said of the States may be applied to the United States. 
1 cite the following fact as illustrative of these remarks: I 
was desirous of learning whether vTe had proof from reliable 
statistics that a man lives longer now than he did a century 
ago. This is believed to be true, if we may judge from past 
hi story, wherefrom it seems that the duration of life has been 
steadily augmenting with advancing civilization. To get ac- 
curate data, I consulted some noted experts in the community, 
but I have not been able to get satisfactory replies. Not one 
of them could refer me to printed vital statistics proving the 
fact for these United States. 
Public Hygiene by Henry L. Bowditch. 
The Registration of Vital Statistics in the United States. 
Abstract of a Paper Read before the General Session of the American Social Science 
Association, by Dr. Elisha Harris. 
The census enumeration of the population ought to be abso- 
lutely accurate and complete; but the method of enumeration 
is so essentially faulty, that, as respects the poll of the living 
inhabitants, even the total columns are equivocal, while all the 
distributive grouping is untrustworthy. The essential vicious- 
ness of each successive census will remain unremedied until 
the methods of enumeration are made exact; until all the facts 
relating to births, marriages and deaths, and the causes of death, 
are currently registered as public records in every county and 
State. Vital statistics comprise the account current of the 
State with the lives of the inhabitants. The registration of 
these statistics is a duty rendered to the State, and is to be 
maintained by ways and means which the State alone can pro- 
vide. But wherever a State has so provided the methods and 
means for the performance of the duties of vital registration, 
the people must comply with alacrity to the requirements of 
the registry law’s. Birth records should be so complete as to 
establish and perpetuate the identity of individuals, and such 
other facts should be secured in respect to*both the child and 14 
its parents as the law may require. Vital statisticians are al- 
ready fully agreed on the elements of good birth records. The 
claim, both of the State and the infant, as to the record of its 
birth, is imperative, and allows no optional delay beyond the 
reasonable time necessary for certifying and filling the record 
for public registration. Claiming such a right, the State can 
not do less than define the duties and obligations it imposes on 
the several persons interested, who can not justifiably postpone 
the certification of a detailed and complete record. In cases of 
illegitimate children, as much information as possible should, be ob- 
tained, particularly as to the occupation and nationality of each 
parent. Such records, made with faithfulness, will subserve the 
interest of statistical and biographical science. Faithful regis- 
tration of still-births should be secured by judiciously regulating official 
returns and the suitable interment of the remains. The interests of 
morality, as well as of science, demand this record. All records of 
marriage should be registered as soon as 'verified. The law sub- 
mitted is in harmony with the statutes of Massachusetts, Con- 
necticut, Rhode Island and Illinois. Amendments of existing 
statutes may be readily effected in the States wliieh need mere- 
ly to give harmony and efficiency to existing laws, while in 
States which have only cumbrous and inefficient statutes relat- 
ing to marriage registration, the adoption of an entirely new 
system, under new laws, will be more practicable than amend- 
ments. The epitomized anthropological history of a life, a 
faithful certificate concerning time, place and social condi- 
tions of each death scene, and medical facts in regard to 
causes of death will ever impart to records all the real import- 
ance which family, State and officers of health will justly claim. 
All events and causes of mortality should he followed back un- 
til the question may be answered, “How may human life hence- 
forth be guarded against the causes of sickness, injury, and 
premature death ?” 
As it is the chief object of this report to suggest the argu- 
ments and plans by which uniformity and completeness should 
be given to the registration of vital statistics, we shall proceed 
directly to this purpose in all we submit in regard to records 
and registration. Certain essential conditions should be kept 
in view in devising the plan of the greatest practical utility 
and completeness in the records. These may be enumerated 15 
as a complete registration of birth in every community; com- 
plete registration of marriage, the records of which shall be 
comprehensive. This branch of registry provides a basis of 
correct information concerning the foundation of families. 
The statute should provide for thorough and scientific verifi- 
cation of violent and unknown causes and circumstances of 
death, and effectual provision for specially verifying the fact, 
and the attendant circumstances of deaths. The entire matter 
of records and registration of mortality should be placed under 
the supervision of expert sanitary officers or boards of health. 
Extract from Proceedings of a Conference of Vital 
Statisticians, 1880. 
Dr. Thompson, President State Board of Health of Kentucky, 
says: “We have had but little experience in Kentucky, except 
in a few localities, in gathering these statistics. I am very 
conlident that the large cities of the West, including Cincin- 
nati, St. Louis, Louisville and Chicago, do not obtain perfect 
returns, much less States at large. It is impossible to give 
anything approximating a correct death list except through 
physicians. And yet some physicians think you are inquiring 
into their private affairs when you require that they shall state 
the causes of death of their patients.. The parents and guard- 
ians also think the causes of death of friends concern only 
themselves. In Kentucky we are endeavoring to compel the 
physicians to make the certificate under oath. It would take 
years to educate the public to make these returns, but we can 
educate the physicians much sooner, and I think that the whole 
duty must be put upon them. It is true that it is for the bene- 
fit of the people, but it is also for the information of the profes- 
sion, and hence, in my opinion, no dead body should be buried 
without the certificate of the physician. It is perfectly clear to 
me that in the rural districts it will be impossible ever to gain 
anything that will be satisfactory, except through the pro- 
fession.” 
Dr. Lindsley, Health Officer, New Haven, Conn.: The law al- 
lowed every town to elect a Registrar, but in failure of such 
election the Town Clerk was to be Registrar. Wherever he 16 
was Registrar, very little interest was taken in the matter of 
these certificates, and frequently he would make collections of 
them but once a year. But where a Registrar was elected, 
he took a personal interest in it, and the collections and records 
were far more accurate than otherwise. At the present time 
we have a law by which, in all the cities of the State, a burial 
permit is required. That has been since the organization of 
the State Board of Health, two years ago. I believe that it 
has operated so far very well, and the records numerically are 
almost perfect. I know that it is so in Hew Haven. I do not 
know of a single instance where a body has been buried with- 
out a permit. 1 believe that the physicians are the proper par- 
ties to look after these matters, and that we can educate the 
profession to the practice of giving them. 
Dr. Clemann: We have an undertaker’s certificate and also 
a physician’s certificate on the same blank. I think in Phila- 
delphia the undertakers are registered, and an inspector is de- 
tailed for the purpose of going around among them at certain 
times to see that they are attending to their duties in returning 
these certificates. The certificate from the cemetery is entirely 
a different thing. It is not on the same blank. If it is found 
that those certificates do not coincide, the matter would be in- 
quired into, and if anything is wrong, a fine of $25 will be im- 
posed all around. One has been enforced within a month- 
The certificate is returned by the undertaker. 
Dr Thompson: In Kentucky, there are no registrars, but we 
have City Clerks, and it is a finable offence for the undertakers 
to bury any one without authority from the city to dig the grave. 
The City Clerk can not give the authority until he receives the 
certificate of the physician. The family have to get that from 
the doctor. It is generally made the duty of the head of the 
family to carry that certificate to the physician wherever his 
place of business is, and I understand it works well. 
Dr. Rauch, Secretary State Board of Health, of Illinois: There 
is no trouble in Illinois; hut the undertakers are not the par- 
ties who are made to make the returns. The medical men are 
the parties responsible. The certificates are, as a general rule, 
brought to the office of registration by undertakers, who are 
punishable by fine, as are cemetery keepers and physicians, for 
neglect of duty. With regard to the persons who should make 17 
these returns, I would ask the question: Ought not this re- 
sponsibility to be divided? In Illinois, the duty rests entirely 
on the medical men. Recently the question of fee has been 
raised. Before that was raised there was no trouble at all. I 
think it is the duty of the medical men to make these returns. 
They can do it better than any one else. It does not require a 
great deal of time and trouble to obtain what is required. 
, Dr. Thompson: We have no difficulty in Kentucky in get- 
ting all the information in regard to the certiticate. The pen- 
alty imposed on the sexton of the cemetery takes the difficulty 
entirely off our hands. They are not allowed to bury any body 
without a permit from the Health Department, and the Health 
Department will not grant certificates unless they are signed 
according to the ordinance. 
Dr. Ames, of Massachusetts : The bulk of the discussion seems 
to be upon the registration of cities, as might naturally be sup- 
posed. But there is a broad field in the country districts. The 
trouble with the country districts' is that they arc sparsely settled, and, 
a physician is called over a large territory, and unless he attends 
to the certificate at the moment of death he may not be able to 
attend to it for some time afterward. 
If there could be some one to vise the return of the house- 
holder, who makes the primary return ; if some officer of the 
town could vise it—and I believe something of that kind might 
be done—registration laws might be passed so as to secure every- 
where completeness of the return, where now no law could be 
passed. And I commend that feature of it to the attention of 
the committee, as one which must everywhere be met, and one 
which ought to be met intelligently, and at the same time re- 
gistration be effected. 
Dr. White, of New Orleans: These duties in Hew Orleans 
are managed as follows: The Board of Health passed an ordi- 
nance stating that no body shall be buried in any part of the 
city, or removed from the city, without a permit from that 
office. That permit is based on the certificate of a physician. 
It is considered the business of the family to furnish the cer- 
tificate, but the doctor signs it. There is no difficulty of the 
working of that matter in Hew Orleans. Ho dead body can 
be removed from the city without a permit from the Board of 
Health, and a fine can be levied on the railroads for carrying 
2—Bd. H. 18 
out bodies without permits. The charge for the burial permit 
is, I think, fifty cents. The money for these permits goes into 
the treasury of the Board of Health. 
Vital Statistics, by J. 1). Plunket, M. D. 
Thus far, the State Board of Health has organized and set 
in motion the system of registration and vital statistics, and if 
this system seems to be complicated, it is because numerous 
laws relating to the matter—and all in operation—have to be 
co-ordinated as to secure the action of local authorities as well 
as insure an efficient supervision and complete records at the 
State Bureau of Registry. 
By this ceaseless survey, description, comparison and map- 
ping of the courses of disease, and the varying rates and causes 
of mortality in more than a thousand registration districts, the 
whole State will derive practical results far more useful than 
any merely numeral summaries that would only record the 
total losses by death, and the gains by birth, and the establish- 
ment of families by marriage. The purpose to render this 
branch of work directly tributary to public interests is well 
formed and now seems attainable. The State Board of Health 
has recognized the practical relations of this branch of its 
work, as defined by a sanitary statesman of England, who has 
emphasized his estimation of it by saying : “ Considered phys- 
ically, the main object of correct civil registration of births, 
deaths and .marriages, is to aid in disclosing the causes of dis- 
eases. Considered legally, the object is to provide the means 
of tracing descent and proving personal identity. And con- 
sidered politically, it is to assist the government in arriving at 
correct conclusions in regard to measures of internal economy, 
etc.” Completeness, accuracy, and the requisite attestation of 
such records should be fully attained under the system of vital 
statistics in the State of Hew York. 
• E. Harris, M. I). 
New York Reports, 1880. 19 
Work op Health Boards. 
For several years I have been comparing the results of the 
work of municipal Health Officers, as contrasted with that of 
municipal Boards of Health, both in this country and Europe. 
I find that, in the great majority of cases, the single officer 
succeeds better than the Board. Where the Health Officer sys- 
tem fails it is often because the officer attempts to continue to 
practice his profession and perform his sanitary duties. It is 
not desirable that a Health Officer should be a practitioner of 
medicine; for, if he is, he can hardly avoid the distrust and 
dislike of his fellow-physicians, if he does his duty; nor can 
he be expected to be as severe on the nuisances of his wealthy 
and influential patients as on those of others. 
J. S. Billings, M. D. 
A. P. H. A., Vol. VI. 
Sanitation. 
“One of the first great objects of sanitary organization,” to 
use the language of a distinguished sanitarian, “is to watch the 
death rate; to watch it not only over a city or parish, but in 
detail; to watch it from month to month, and even from week 
to week; to watch it as affected by different diseases, and par- 
ticularly what are termed epidemic diseases, and such diseases 
as we believe to be, in a great degree, preventable; and this 
done, to make known the results from time to time to those 
who are chiefly concerned in sanitary evils, so as effectually to 
bring home to the cfwellers in darkness, ignorance and disease, 
the immense significance of the facts taught by these figures.” 
At the beginning of the fourth century, Paris is said to have 
“lost her population at the rate of 50 in every 1,000 annually, 
and notwithstanding the great increase of her population up 
to the time of the late war, her death rate was then only about 
28 in 1,000. At the close of the sixteenth century, the aver- 
age duration of life was about twenty-one years; in 1883 it was 
forty-five years and five months.” 
Under the influence of improved sanitary measures, wher- 20 
ever they have been strictly enforced and intelligently con- 
ducted, the results* though far from what it is yet hoped to at- 
tain, are even more gratifying. In England, after the adoption 
of measures for the improvement of cities, “in nineteen towns 
the annual mortality, which had been 28 in 1,000 for years pre- 
vious to the improvement, to 21 in 1,000.” 
In Liverpool, the rate of mortality was reduced from 88.4 in 
1,000 to 26 in 1,000. In five towns, according to Latham on 
Sanitary Engineering, “ the saving of life * * * averaged 
25 per cent.; while in the two diseases, typhoid fever and con- 
sumption, the average reduction was 55 and 25 per cent., re- 
spectively.” 
It is further shown by Dr. Geo. Buchanan that, by the intro- 
duction of sewerage, drainage, and water supply into twenty- 
five cities and towns, possessing an aggregate population of 
593,786, “ the average of the death rate per 10,000 for the 
different places, had decreased as follows: From all causes 
from 247.55 to 219.87; from typhoid fever, from 13.34 to 7.8; 
from diarrhea, from 8.45 to 7.66; from pulmonary consump- 
tion, from 33.44 to 27.3; among infants under one year, from 
55.65 to 50.”’ 
One additional example, drawn from the sanitary records of 
England, where hygienic measures for the prevention, of dis- 
ease have been longest and most efficiently pursued, may be de- 
duced from the testimony of Dr. Buchanan in the ninth report 
to the Privy Council, showing that in twenty-five towns where 
a system of sewerage had been introduced, in nine of these 
the number of deaths was diminished over 50 per cent., and 
in ten others from 33 to 50 per cent., the average reduction be- 
ing about 45 per cent. 
Even i» the United States, where sanitary supervision has 
been only partly and recently introduced, during the last twenty 
years, up to and including 1870, the percentage of deaths to the 
population had decreased from 1.39 in 1,000 to 1.28 in 1,000. 
According to Dr. Henry B. Baker, the efficient Superintendent 
of Vital Statistics of Michigan, the death rate in that State had 
been decreased at each census. In 1850 it was 1.14; in 1860, 
.99; in 1876, .94 per cent., effecting a saving, in a single year, 
of 2,317 lives, and, if we regard its financial aspect, a total of 
$1,899,940. 21 
St. Louis, from one of the most unhealthy, has been raised 
to one of the healthiest cities of the United States; and such 
has been the gratifying result of the general attention paid to 
the improvement of cities, and the removal or destruction ot 
the recognized causes of disease, that it has been laid down as 
a rule, that any excess over 14 deaths in 1,000 of population, 
is unnecessary, and the result of known hygienic laws. That 
such result can be attained is a legitimate conclusion from what 
has already been achieved, as in St. Louis, just mentioned, 
where the death rate for 1875 was only 14.46 per 1,000. 
Another £ict encouraging to those engaged in the work of 
sanitary reform is that so forcibly alluded to by Dorman B. 
Eaton, LL. D., in a discourse delivered in 1875, that as the 
Health of communities increases, crime diminishes. In Glas- 
gow, while the death rate fell, between 1869 and 1873, from 34 
in 1,000 to 29.09 per 1,000, the whole number of crimes were 
reduced from 10,899 to 7,876; 1867 to 1873, of thefts alone 
there was a reduction of from 1,192 to 264. 
These facts are rapidly forcing themselves upon the observa- 
tion of the public. They have attracted the attention of Legisr 
latures and State authorities everywhere, and their legitimate 
result has been the creation of State Boards of Health in nearly 
one-third of the States of the Union. 
F. M. Hatch, M. D., Sec’y. 
Report of State Board of Health of California, 1877. 
Vaccination. 
As a rule, one successful vaccination in childhood protects 
until about fourteen or sixteen years of age. If, however, there 
he epidemics of small-pox near, or the danger of exposure great, 
the process may be repeated oftener, as there can no harm re- 
sult, as no effect will be produced if the person be already pro- 
tected by the previous operation. One trial, however, in face 
of danger, is not conclusive, and care should be taken that the 
operation be thoroughly performed. 
In England, the small-pox death rate has decreased one-half 
since the introduction of compulsory vaccination. In many 22 
cities where periodical inspection of all the schools, and house 
to house visitation, with free, though not compulsory, vaccina- 
tion takes place, often the disease is hardly known unless im- 
ported, and then never becomes extensively prevalent, but is at 
once stamped out. 
The number of persons efficiently vaccinated or successfully 
revaccinated, that are attacked even during an epidemic, is very 
small; and where the* vaccination has been imperfect the dis- 
ease is usually greatly modified in severity. 
When successful vaccination and revaccination has been done, 
the proportion of deaths to attacks is but part 
of- that in unvaccinated persons. By universal revaccination, 
small-pox has been stamped out of the army and navy. Ex- 
perience here shows that one successful revaccination in an 
adult is sufficient. (England). 
Connecticut Report, 1879. , 
IIow to Reduce the Death Rate. 
There are reported in the vital statistics for 1871, 75 deaths 
as having occurred from small-pox; or, when “corrected” by 
multiplying by 1.86, 189 deaths. 
Compulsory vaccination, carefully carried out by faithful and 
vigilant local Boards of Health in every city, village, and 
township of the State, together with more complete isolation 
of every case of variola and varioloid, under the present sta- 
tutes of the State on this subject, would, without doubt, reduce 
the mortality from this cause to a very small per cent, of what 
it now is. 
Can any one doubt that the same may be true in respect to 
the 696 (or, as corrected, 1,294) cases of death from scarlatina? 
It seems a late day to point out the danger of its contagion, 
and the absolute necessity of complete isolation for the preven- 
tion of the spread of this disease so fearfully fatal among chil- 
dren. There has grown up a feeling in the public mind as 
productive of evil as it is devoid of truth, that scarlatina is one of 
the inevitable children’s diseases, and, although often extreme- 
ly dangerous to life, it must be submitted to, and, on the whole, 
the sooner the children have the disease the better. 23 
If the same care of isolation, too, were used in cases of 
measles, diphtheria and whooping cough, the fatality from 
these diseases would be largely reduced. And what is true of 
these last named diseases is, for far stronger reasons, true of 
typhus and typhoid fevers. Let all public and private nuis- 
ances be abated, and all private and public rooms be well*ven- 
tilated, and we shall have recorded hut very few original cases 
of typhus or typhoid fevers; and let these few be strictly and 
completely isolated, and no other would follow. 
II. (). Hitchcock, M. D. 
Michigan Report, 1876. 
I.—Small-pox a Preventable Disease. 
It has long been known that small-pox can be prevented or 
modified by vaccination. It is now believed that a wide-spread 
epidemic of the disease can be attributed only to an equally 
wide-spread ignorance or willfulness concerning small-pox and 
its prevention by vaccination. £7o intelligent person need have 
small-pox. 
II.—Why Vaccinate? 
Because unmodified small-pox is so deadly a disease, and so 
often disfigures and enfeebles those who recover, and because 
by traveling or by travelers, by articles received in the mail or 
from stores or shops, or in various other ways, any one at any 
time may, without knowing it, be exposed to small-pox, it be- 
comes important, so far as possible without injury to health, to 
render every person incapable of taking the disease. This may 
be done so perfectly by vaccination and revaccination with 
genuine bovine vaccine virus, that no question of ordinary ex- 
pense or trouble should be allowed for a day to prevent the 
careful vaccination of every man, woman, and child in Michi- 
gan, and the revaccination of every one who has not been vac- 
cinated within five years. It is well established that those who 
have been properly vaccinated are far less likely to take small- 
pox if exposed to it, and that the very few who have been pro- 24 
perly vaccinated, and have small-pox, have it in a much milder 
form and are much less disfigured by it than those who have 
not been thus vaccinated. 
In Sweden the average number of deaths in each year from 
small-pox per one million inhabitants was : 
Befitre the introduction of vaccination (1774-1801) 1,973 
During the period of optional vaccination (1802-1816) 479 
During the period of obligatory vaccination (1817-1877).... 189 
Vaccination was introduced in England near the beginning 
of the present century, and since 1853 compulsory vaccination 
has been attempted. In England the number of deaths in each 
year from small-pox per one million inhabitants was: 
At the close of the last century...*... 3,000 
From 1841 to 1853 (average) 304 
From 1854 to 1863 (average) .' 171 
In the Bavarian army revaccination has been compulsory 
since 1843. From that date till 1857 not even a single case of 
unmodified small-pox occurred, nor a single death from small- 
pox. 
. During forty-two years of duty, Dr. Marson, physician of 
the London Small-pox Hospital, has never observed a single 
case of small-pox in the officers and employes of the hospital, 
who are revaccinated when they enter the service, and who 
are constantly exposed to the infection. 
“Out of more than 10,000 children vaccinated at Brussels 
with animal lymph, from 1865 to 1870, and who went through 
the terrible epidemic of small-pox which, in 1870 and 1871, 
frightened the world, not a single one was, to my knowledge, 
reported as being attacked by the disease. The same immu- 
nity was shared by those, a much larger number, whom I had 
revaccinated, and who, at the same time, were living in epi- 
demic centers.”—Dr. Wcuiemont, of Brussels, in North Carolina 
Medical Journal, January, 1880, Vol. V., p. 2. 
III.—Who Should be Vaccinated. 
Everybody, old and young, for his own interest, and that he 
may not become a breeding place for the distribution of small- 
pox to others, should seek that protection from small-pox 
which is afforded by vaccination alone. 25 
IV.—Who Should not be Vaccinated. 
Unless exposure to small-pox is believed to have taken place, 
nr likely to take place, teething children, pregnant women, 
persons suffering with measles, scarlet fever, erysipelas, or 
susceptible to and recently exposed to one of these diseases, 
persons suffering with skin disease or eruption, and in general, 
feeble persons not in good health, should not be vaccinated. 
In all cases in which there is any doubt as to the propriety of 
vaccinating or postponing vaccination, the judgment of a good 
physician should he taken. The restriction as to vaccinating 
teething children, makes it important that children should he 
vaccinated before the teething process has begun, because small- 
pox is very much more dangerous than vaccination. Small-pox 
is exceedingly dangerous to pregnant women. 
Reasons for preferring bovine virus to humanized virus may 
he given as follows(1) By the use of the bovine virus there 
is secured a more perfect or typical development of the vaccine 
disease; and hence, it may fairly be inferred, a greater protec- 
tion against small-pox. (2) With the bovine virus and with a 
clean lancet, and with clean surroundings, there is no danger 
of communicating syphilis. (3) The bovine virus is far more 
effective than the humanized virus in revaccination; and where 
the humanized virus fails, and the boviue virus works, it is 
probable that there was susceptibility to small-pox which the 
humanized virus did not remove, but which has been removed 
by the bovine virus. (4) Greater care can be taken in the prop- 
agation of bovine virus, a greater supply can be always at 
command, and always, but especially in time of urgent danger 
from small-pox, people can have a better guarantee that they 
are vaccinated with genuine and pure vaccine virus. 
3fichigan Report, 1881. 
Conditions of Good Sanitary Administration. 
But the arguments that sickness and death, as they occur, are 
providentially inevitable, and that pestilence and famine are 
pre-ordained messengers of God’s wisdom and wrath, before 
which we must dismiss our reason—that our precautions against 26 
them are vain floatings of our wisdom in the face of Divine 
Providence—are so nearly monopolized by illiterate grandma- 
mas and superannuated bigots, as to be elements of precaution 
hardly worthy of notice in our sanitary condition on earth. 
Though Dr. Lyon Playfair, now a professor at Edinburgh, 
says that in his day Scotch professors dared not preach' such 
heretical doctfines, and it is not very long since an English 
company was refused the liberty of deepening the channel of 
the Guadalquiver, because, it was argued, that if God had in- 
tended the river to be navigated, He would have made it navi- 
gable. 
It is, I think, safe to say that London and Paris lost more 
lives needlessly, both by the plague and by the cholera, in ten 
weeks, than either of them have so lost during the last twenty 
years. Bordeaux, then one of the filthiest towns in Europe, 
lost 18,000 out of 40,00 of its people in a few weeks. The 
plague remained longest in Naples, which was perhaps the 
worst ventilated atid worst drained of the large cities of Eu- 
rope. 
There is nothing better settled in regard to life and health 
than that such diseases as cholera, yellow fever, small-pox, ty- 
phus and typhoid fever, can be in great measure kept away by 
good sanitary administration, the cost and loss of which is in- 
finitesimal compared with what these diseases would cause. 
They have been, by such means, so far kept out of New York, 
that for ten years they have caused less aggregate loss and cost, 
I presume, than either the toothache or the mumps. Cholera 
came five times to English ports in 1873, and twenty-eight died 
of it on one foreign ship in London, and yet such were the pre- 
cautions that not a single Englishman took the disease. In 
the city of Bombay, with its population of 650,000, made up 
of all the races of Europe and Asia, and situated in a region 
where plagues and leprosies and choleras, have through all his- 
toric time reaped their greatest harvests of death; where, in 
1820, 150,000 persons died from one of these scourges in a few 
weeks, and the average death-rate had always been alarmingly 
high; in such a city, within a few years, good sanitary admin- 
istration, introduced from England, has, by enforcing drainage, 
ventilation, adequate air-space, by having good water and 
wholesome food and general cleanliness, accomplished results 27 
which are marvelous. The death-rate of Bombay, in 1873— 
only about an average year—was only slightly over 24 to a 
thousand of its people; and Dr. Harris says its death-rate in 
1874, was 23.9 to the thousand, being a lower rate than that of 
Vienna, or Berlin, or New York, or Baltimore, or Richmond. 
Analogous results have been secured in Calcutta and Hong 
Kong. 
Professor Lyon Playfair says the death-rate of London from 
1660 to 1679, was not less than 80 out of every thousand each 
year. About the latter date better sanitary precaution began 
to be applied in that city, and especially since 1848, they have 
been largely and continually improved. Much the same has 
been the sanitary history of Paris. The wonderful results are 
that tli ese two largest are among the healthiest, and the very 
cleanest of the great cities of the world. If New York, or 
Philadelphia, or Chicago, or St. Louis, or Cincinnati, or Balti- 
more, was as cleanly and well paved as either Paris or London, 
the ratio of crime, poverty, death, and taxes, would go down, 
their pride, population, and productive industry, would go up, 
and reupblican institutions would be crowned with a new 
honor. The average death-rate of Loudon for the past ten 
years has been only 24 to the thousand annually. In 1874, 
with its 3,400,700 people, the death-rate was only 22.04 to the 
thousand. The average death-rate of all England, for the ten 
years last past, has been 22.04 to her thousand, which is prob- 
ably lower than in this country; so that good sanitary admin- 
istration has brought down the death-rate of the two largest 
cities in the world, and the largest city.of India, nearly to that 
of the general death-rate of two of the most healthy countries 
of the globe peopled by the most vigorous and enlightened 
of the race of men. 
Taking the records of 1873, and rejecting fractions, the 
death-rates per thousand of population per year in some of the 
principal European and American cities were as follows: Lon- 
don, 22, and New York, 29; Liverpool, 25, and Philadelphia, 
19 ; Glasgow, 28, and Richmond, 33; Edinburgh, 21, and Balti- 
more, 24; Berlin, 27, and Cincinnati, 22; Birmingham, 25, and 
Savannah, 43; Dresden, 34, and New Orleans, 37; Munich, 45, 
and Valparaiso (a very unclean city), 64. It will be observed 
that the average death-rate in American cities is higher than 28 
in England, though, perhaps, not higher than in German cities, 
where public health in cities has, until very recently, been neg- 
lected. 
Our city death-rate among children under one year of age 
is much higher than in English cities. 
The high relative death-rates of Munich and Dresden, have 
caused measures to be taken on a large scale for improving 
their drainage, water supply, and ventilation; and very soon 
we may be sure the rate will go down. The comparative low 
rate of Liverpool has been secured by the most vigorous 
administration, which within a few years has produced results 
which every observing traveler has noticed. 
Interesting results of sanitary administration in smaller 
-cities and villages might be drawn indefinitely from Eng- 
lish experience, and it is in that country that such administra- 
tion has been carried forward with the most thoroughness. I 
give these examples from the report of the medical officer to 
Parliament, made in 1867, relating to villages of from 5,000 to 
2,000 inhabitants. It comprises the health statistics for ten 
years before the sanitary reform, with those of the ten years fol- 
lowing them. 
In Cardiff, where typhoid fever and diarrhceal diseases had 
prevailed, the former subsided in the ratio of 17 to 10, and 
the latter in that of 17 to 4; while the aggregate death-rate ot 
the place fell 35 per cent. In Salisbury the death-rate fell 20 
percent, and typhoid ferver and diarrhoea subsided in the rates 
of 14 to 4. Consumption subsided in Salisbury, 49 per cent.; 
in Ely, 47 percent.; in Rugby, 43 per cent.; in Bouberg, 41 
percent.; in Worthing, 36 percent.; in Newcastle, 32 percent. 
If anybody consoles himself with the thought that we need 
no such work in this country, let him read the first report (made 
in 1873) of the State Board of Health of Minnesota—that fresh 
young paradise of health to which so many go to be cured. In 
that report we are told that, in 1871, forty per cent, of all 
deaths in the State occurred among children not over one year 
of age; that more deaths are attributed to typhoid fever than 
to any other disease; that 3,000 persons are (constantly, as I 
understand) sick of that long-lingering, exhausting complaint; 
that the average age of those thus carried away is twenty-five 
years; that there is the least of such sickness in two larger 29 
cities where there is most cleanliness; and the chief cause of 
this disease the report declares to he “filth which accumulates 
about us, contaminating the air we breathe and the water we 
drink; that there is in most of the large towns a criminal want 
of attention to the construction of sewers and the removal of 
the contents of privies.” Now, Minnesota i3 not, relatively, 
an unhealthy State, nor conspicuously in such sad sanitary con- 
dition. But what shall we say of a people, with such a record, 
which refuses to vote more than $250 per year to its Board of 
Health; or of Virginia, refusing to vote a dollar for its State 
Board of Health, while seeking immigrants from England in 
presence of a death-rate in Richmond a*third higher than that 
of London in 1873, and higher than that of Bombay in 1874! 
And such facts as to the death-rate of young children under one 
year of age lose none of their painful interest when we read in 
the English medical report of 1873, that in about one-seventh 
part of England the death-rate among children is only from 
eight to twelve per cent, of the entire deaths, and that in no 
district is that ratio higher than thirty per cent.; that is less than 
one-half that of Minnesota. 
As we leave this part of the subject, let us remember that a 
small reduction of a death-rate means a large reduction of dis- 
abling sickness — exemption from pain and anxiety in cases 
innumerable, and the. value of which no money can measure— 
and an improved physical tone and capacity for study, work and 
happiness equally incommensurable. 
Dr. Playfair says, if England could be relieved of 125,000 
needless deaths, annually, she would also be relieved of 4,200,000 
cases of sickness; but he does not tell us of how many hun- 
dreds of millions of indigestions and headaches. Many strik- 
ing illustrations of the truths herein set forth might be drawn 
from the sanitary administration of this country, but the limits 
of this paper forbid, and my selections might awaken jealousy. 
The beniticent results attained in the city of New York, how- 
ever, are conspicuous. Beginning in 1866, when political doc- 
tors and ignorant and mercenary partisans were the health 
officers, the good work of sanitary reform, then placed and since 
continued in the hands of men of benevolence, science and 
wisdom, has produced fruits in the presence of which a great 
metropolis and a whole nation may well be proud and take 30 
courage. Contagions and epidemics have been disarmed and 
averted; noxious occupations and deadly nuisances without 
number, besides more than two hundred slaughter-houses, have 
been removed. Cellars, garrets and tenement houses, more fatal 
than a decree of Herod to infantile life, have, on a vast scale, 
been cleansed and ventilated; and the rate of mortality, the 
security and the general comforts, especially of humble life, 
have been increased; the best registry of vital statistics in this 
country has been established, and last, but not least, an appre- 
ciative and inspiring public sentiment, which welcomes good 
sanitary administration as a public blessing, and has extended 
over the Union, has been there developed. 
Dorman B. Eaton, LL. D. 
A. P. H. Ass. Reports, Vol. II. 
Homes for the People. 
In the year 1857, the annual death-rate for the rural districts 
of England and Wales was 17 per 1,000 of the population, the 
aggregate 9,750,000 people distributed over 350,000,000 acres, 
giving nearly 36 acres to each person; during the same year 
the mortality in towns and cities among a population aggregat- 
ing 8,250,000, located on lands amounting in all to 2,150,009 
acres, or rather less than 4 persons to one acre, was 25 per 1,000, 
or, on the total number from overcrowding, alone, an aggre- 
gate of 68,000 preventable deaths per annum. The same law 
of an increasing death-rate resultant from overcrowding was 
illustrated during the cholera year, 1854, in the same countries. 
There were 134 districts in which the population averaged 915 
persons to the square mile; 404 districts in which the density 
of the population was only 225 to the square mile, and 85 dis- 
tricts in which there were only 122 persons to the square mile. 
The death-rate from cholera was nil in the 85 districts sparsely 
peopled, 7 in the 10,000 where the population was 225 to the 
square mile, and more than nine times that number, or 65 in 
10,000, in the more densely peopled districts. The bearing of 
such figures can hardly be questioned. 
We do not, from these startling results, arrive at the conclu- 
sion that city life is per se destructive to vitality. There are 31 
already abundant statistics to render any such idea impossible 
for the well-informed mind, and whenever the tables of mor- 
talities for cities shall be compiled on plans adapted to show 
the health and life rates obtaining in different localities more 
and less favored by position, by construction, and ventilation of 
buildings, by area of breathing room, by efficient sewerage 
and by meteorological conditions, we shall find a much more 
effective reply to such a conclusion. 
Some of the best results' recorded as to vitality are found in 
towns, and may be- illustrated by a few figures submitted to 
the Social Science Association by Mr. Michael, the Mayor of 
Swansea, Wales. That gentleman caused the vital statistics 
of Swansea to be divided according to the respective densities 
of population, and he found the A division, resident in super- 
ior houses apart from each other or standing on their own 
grounds, subject to a mortality of only 11 in the 1,000 per an- 
num, while the C division suffered a mortality of 36, or nearly 
3$ times the minimum, and the intermediate density lost 20 in 
the 1,000, or 9 more than the A division. 
It is claimed by some writers that the human race would be 
extinguished in less than two centuries if confined to large 
cities; but, manifestly, that would depend upon the conditions 
by which they were surrounded, as the Swansea A division 
compares favorably with suburban vitality, and there is no 
reason known among men why every man, woman and child 
should not have a never-failing supply of pure air. 
London shows an aggregate of 10,000 deaths per annum in 
excess of births, but there are parts of London that are as fa- 
vorable to longevity as those occupied by the A division at 
Swansea; and in the worst cities, hygienically considered, 
length of life is found dependent upon individual action in a 
very great degree. For very many centuries the Jews were 
systematically persecuted by governments, and people all over 
Europe, condemned to live in particular quarters in all the 
principal cities, and robbed without scruple by the ruling class, 
if they were so ill-advised as to make a show of comfort or 
wealth. Under such, and manifold other disadvantages, they 
adhered more or less strictly to the rules of life with reference 
to personal purification laid down for them of old time, and we 
find them leading the whole human race to-day in the essen- 32 
tials of vitality. Prussian statistics show that the mortality per 
year among 100,000 Jews is less by 800 than the deaths in the 
same time among the same number of Christians ; the numbers 
being 2,161 Jews to 2,961 Christians; and in every particular 
the chosen people manifest greater powers of endurance. A 
few results obtained from 100,000 on each side, will show how 
complete and advantageous is the contrast favoring the Jews. 
There were among the Christians 143 still-births; among the 
Jews, 89; a difference of 54 to our disadvantage. It might be 
supposed that the decreased number of still-births would be off- 
set by a larger average of weakness in the offspring of Israel, 
but precisely the reverse is the fact, as only 453 children of that 
race die under one year, while 697, or more than 50 per cent, 
above the Jewish average, die in the first year out of the aggre- 
gate of Christian births. In the four years next ensuing, 386 
Jewish children die, the offspring of Christians, already much 
smaller in number, still heading the death-rate by nearly 25 per 
cent., the number being 477. From five years old to fourteen, 
151 children of the Jewish children fall out of the ranks, and 
one-third more, or 202 Christian children die. From that age 
until twenty-five, the Jews lose 125, the Christians 155. 
During the twenty years ending at forty-five, there is a loss 
among the Jews of 231, and among the Christians of 334, or 
103 in excess. So marked was the exemption of the Jews from 
the plagues that decimated all nations during the middle ages, 
that they were charged with having poisoned wells and springs, 
and only active interference on the part of the authorities pre- 
vented a general massacre of the cleanliest people on the con- 
tinent. 
These illustrations show the potency of their modes of life in 
warding oft" maladies, as well as sustain the proposition that 
men may make city life conduce to comfort and longevity by 
wisely controlling circumstances. Men need not fall victims to 
epidemics, although surrounded b}T evil conditions, unless they 
allow their physical systems to become weakened and their 
minds to sink into demoralization. 
Town life is not necessarily more brief nor less healthful than 
life in the country. The conditions of longevity can be filled 
in one location as well as the other. 
Wisconsin Report. 33 
The first annual report of the Indiana State Board of 
Health will shortly he issued. The statistical portion of that 
report will embrace returns of births, marriages, deaths, and 
diseases dangerous to public health, as received from Health 
Officers up to September 30,1882. We give here the following 
extract from the forthcoming report: 
There is an opinion held by many that, while sanitary rules 
are needed to be enforced in cities, and for this purpose City 
Boards of Health are needed, or are at least allowable, in the 
country there is no necessity for any such rules or organizations. 
In the country it is held that the air is pure, and the water 
uncontaminated, that the ill effects of over-crowding are not 
known, and that preventable sickness is comparatively un- 
known outside of the crowded cities. 
if we attempt to reason with those holding such views, we 
are met with a general denial, and the advancement of certain 
ideas derived from the poetical view of the case, the “tangled 
wildwood,”'the “ nectar that Jupiter sips,” and the “free and 
pure country air,” is quoted as proof of the fact that the coun- 
try keeps itself pure, and that such condition is sustained by 
the unaided laws of nature. Man is not called upon, while in 
the country, to exert any care as regards his surroundings; to 
be in the country is to be where health abounds, etc. 
Certainly, this view is all wrong. While the curses accom- 
panying over-crowding are found in cities, still, as in other 
cases, such ills have compensating blessings. Men are found in 
such places exerting themselves, and providing means for the 
removal of that which would cause sickness, and finally drive 
them from that location, and in consequence of such care the 
centers of population are often less afflicted with preventable 
forms of disease than are the rural districts, for in the latter, a 
“ trust in Providence ” system prevails—an apathy born of 
ignorance and sloth, and kept up by false teaching and penu- 
riousness, permits that which destroys to remain, and prevents 
the needed protective influences from being exerted. 
To sustain our position we refer to the accompanying tables: 
3—Bd. H. 34 
TABLE X—Causes of Death. 
Ten Causes of Death by Counties, the Total Deaths from all Causes, with the Per Cent, to the Total Mortality 
in each County. 
Whole State* 
Adams 
Allen 
Bartholomew 
Benton \ 
Blackford 
Boone 
Brown 
Carroll 
Casst 
Clarke 
Clay 
Clinton 
Crawford 
Daviess . . . 
Dearborn 
Decatur 
DeKalb 
Delaware 
Dubois 
Elkhart 
COUNTIES. 
1,909,916 
15,385 
54,763 
22,777 
11,108 
8,020 
25,922 
10,264 
18,345 
27,611 
28,610 
25,854 
23,472 
12,356 
21,552 
26,671 
19,798 
20,225 
22,920 
15,992 
33,545 
Population, 1880. 
*-*>-*>-* MM tO* M- M- M CO 
05 »—* CO C5 tC >—»C- 05 C5 . CO C7- tC CO 05 <X tO 
x cn 4- 05 >-* co> co -j f oi co m-*ccmoo o 
Total Deaths from All 
Causes. 
m- • ««•••• ►-‘•os to■ 8 
Small-pox. 
Ten Causes of Death. 
tsO• >—► l—■ >—• to-*' cot-* * • OS CO »• »w 2 
Diphtheria. 
• • C7t 
I-*' • ti . co • i—*• - i—. 3 
Scarlet Fever. 
* t5 4k ' 
' ’ ' to' " ' 4- •'••►-. 2 
Whooping Cough. 
4*. 
O i—* CO CO X* X CO CD * MOOCH* 
Typhoid Fever. 
fcO-*lC7*H-»* 4^tO* 
' •' to-r i 
Cerebro-Spinal 
Meningitis. 
CXOOClC S£o5X4»- m2* tO CH m* § 
Pneumonia. 
OiOtMMM 4*- 4*-1 t—to 4^.' 4*- tO ‘ * tOCHCHCH to 
Bronchitis. 
CO 
ooosocosS 77-J to coin g- 
Consumption. 
• * . eg 
W-ICOtCO X* MMM H-»* CO © 
Casualty.! 
&2gE2& 2SKSs2 8- gSSS SEgglS 2 
Total Deaths from these 
Causes. 
Sfe£s88 £8282 8'. 888 28fe8o 8 
&2&g8 2- £*£& 88388 fe 
Per Cent, of Total Mor- 
tality. 35 
Fayette 
Floyd 
11,394 
24,590 
20,228 
84 
161 
3 
1 
4 
.... 
1 
'Si 
1 
2 
4 
6 
6 
8 
5 
•1 
14 
22 
9 
4 
11 
9 
33 
57 
40 
39.28 
34.75 
44.44 
Fountain 
90 
4 
1 
' ■ V 
Franklin 
20,092 
67 
3 
1 
3 
2 
1 
6 
2 
13 
2 
33 
49.25 
Fulton 
14,301 
64 
4 
2 
4 
1 
7 
3 
6 
27 
42.18 
Gibson 
22,742 
23,618 
150 
1 
. . . . 
16 
5 
ii 
15 
6 
54 
36.00 
Grant 
94 
1 
1 
6 
7 
15 
1 
8 
2 
41 
43.61 
Greene 
22,996 
24,801 
177 
3 
4 
5 
21 
3 
21 
57 
32.20 
Hamilton 
148 
3 
1 
10 
1 
16 
15 
5 
51 
34.45 
Hancock 
17,123 
68 
2 
3 
1 
9 
7 
1 
23 
33.82 
Harrison 
21,326 
126 
5 
4 
18 
4 
17 
3 
51 
40.47 
Hendricks 
22,981 
180 
3 
4 
2 
10 
20 
1 
23 
1 
64 
35.55 
Henry 
24,016 
141 
1 
7 
5 
1 
13 
1 
17 
5 
50 
35.46 
Howard 
19.584 
136 
1 
4 
2 
8 
10 
10 
4 
39 
28.67 
Huntington 
21,805 
87 
2 
6 
2 
11 
1 
9 
31 
35.63 
J aekson 
23,050 
125 
1 
1 
3 
5 
11 
1 
16 
7 
45 
36.00 
Jasper 
9,464 
40 
1 
1 
3 
1 
4 
10 
25.00 
Jay 
19,282 
70 
2 
2 
2 
3 
5 
7 
5 
3 
29 
41.42 
Jefferson 
25,997 
16,453 
84 
1 
1 
6 
4 
20 
5 
37 
44.04 
Jennings 
90 
1 
3 
1 
10 
2 
5 
13 
35 
38.88 
Johnson 
19,537 
170 
1 
3 
6 
3 
18 
1 
26 
7 
38.23 
Knox 
26,324 
116 
3 
8 
11 
10 
6 
38 
Kosciusko 
26,494 
92 
2 
4 
6 
1 
6 
2 
21 
22.82 
Lagrange 
15,630 
80 
4 
1 
2 
1 
8 
1 
7 
2 
26 
32.50 
Lake 
15,091 
92 
2 
10 
1 
3 
1 
7 
1 
4 
4 
33 
35.86 
Laporte 
30,985 
199 
8 
9 
2 
1 
4 
2 
12 
3 
18 
8 
67 
33.66 
Lawrence 
18,543 
66 
2 
2 
6 
13 
5 
20 
42,42 
Madison 
27,527 
168 
1 
1 
8 
4 
15 
1 
20 
8 
58 
34.52 
Marion 
102,782 
1,263 
11 
12 
3 
10 
59 
19 
72 
35 
190 
44 
455 
36.02 
Marshall 
23,414 
94 
n 
1 
8 
9 
29 
30.85 
Martin 
13,475 
57 
2 
2 
2 
10 
1 
6 
1 
24 
42.10 
Miami 
24,083 
134 
4 
6 
14 
7 
11 
4 
46 
34.32 
Monroe 
15,875 
94 
4 
4 
1 
19 
3 
31 
32.97 
Montgomery 
272316 
150 
1 
1 
1 
3 
10 
2 
17 
2 
37 
24.66 
Morgan 
18,900 
123 
4 
9 
1 
7 
1 
10 
32 
26.01 
Newton 
8,167 
44 
1 
2 
1 
1 
5 
4 
3 
17 
38.63 
Noble 
22,956 
109 
5 
1 
1 
4 
2 
8 
2 
15 
1 
39 
35.77 
Ohio 
5,563 
* 33 
2 
1 
1 
6 
3 
13 
39.39 
Orange 
14,363 
77 
3 
7 
3 
5 
18 
1 
37 
48.05 
Owen 
15,901 
69 
1 
2 
1 
7 
12 
3 
26 
37.68 
Parke 
19,460 
94 
7 
1 
1 
7 
1 
17 
1 
3 
45 
47.87 
Perry 
16.997 
65 
1 
4 
16 
2 
3 
3 
29 
44.61 36 
- 
Ten Causes of Death. 
1 
•a 
p 
£ 
i 
f 
U 
3 
•3'S 
£ 
1 
3 
o 
H 
COUNTIES. 
o 
o 
*■5 
CO 
9 
p. 
o 
PH 
Total Deaths 
Causes. 
1 
a 
in 
.1 
rO 
P< 
5 
Scarlet Fever 
£ 
bfi 
.5 • 
p. 
§ 
$ 
Typhoid Fev< 
Cerebro-Spin 
Menin 
Pneumonia. 
Bronchitis. 
Consumption 
Casualty.! 
Total Deaths 
Causes. 
Per Cent, to 
tality. 
Pike 
16,383 
63 
1 
2 
7 
7 
1 
18 
28.57 
Porterf 
17,227 
Posey 
20,857 
144 
7 
5 
12 
2 
16 
5 
47 
32.63 
Pulaski 
9.851 
25 
l 
1 
1 
4 
1 
3 
11 
44 .a 
Putnam 
22,501 
143 
2 
7 
11 
3 
11 
2 
26 
3 
65 
45.43 
Itandolph 
26,435 
128 
i 
2 
i 
7 
1 
16 
1 
12 
7 
48 
38.28 
Ripley 
Rush 
21.627 
117 
2 
5 
3 
16 
1 
15 
3 
45 
38.40 
19,938 
139 
i 
1 
8 
6 
9 
13 
5 
43 
30.9: 
Scott 
8,343 
17 
3 
1 
2 
2 
8 
47.05 
Shelby 
25,257 
118 
2 
7 
1 
9 
3 
23 
3 
48 
40.68 
Spencer 
Starke| 
22,122 
5,105 
192 
1 
i 
18 
10 
32 
1 
20 
3 
86 
44.78 
Steuben 
14,645 
73 
3 
5 
8 
1 
11 
28 
38.35 
St. Joseph 
33,178 
122 
1 
2 
2 
3 
4 
10 
1 
13 
1 
37 
30.32 
Sullivan 
20,336 
125 
2 
7 
9 
11 
8 
4 
41 
32.80 
Switzerland 
13,3136 
50 
1 
11 
o 
14 
28.00 
Tippecanoe 
35,966 
206 
1 
4 
6 
2 
13 
2 
29 
7 
64 
31.04 
Tipton 
14,467 
95 
1 
2 
10 
2 
7 
9 
2 
33 
34.7: 
7,673 
42,193 
17 
600 
3 
2 
2 
1 
1 
70 
9 
52 9- 
Vanderburgh 
23 
5 
8 
15 
13 
49 
11 
28 
222 
37.00 
Vermillion 
12,025 
54 
4 
12 
1 
3 
2 
22 
40.74 
Vigo 
45.658 
365 
2 
4 
i 
3 
13 
5 
30 
5 
51 
ii 
125 
.34.24 
Warren 
25,241 
95 
7 
21 
3 
8 
2 
41 
43.15 
Wabash 
11.497 
75 1 . . . . 
1 
3 
1 
3 
1 
15 
4 
7 
3 
38 
50.6 
Warrick 
20,162 
83 1! . . . . 
1 
2 
3 
4 
17 
4 
3 
41 
49.3i 
Ten Causes of Death by Counties—Continued. 37 
_ 18.955 | 
85 ' 
10 
1 
1 
4 
12 
2 
7 
1 i 
38 
44.70 
Wayne 
* 38,613 
301 
T 
1 
9 
10 
5 
23 
3 
45 
13 ! 
116 
38,53 
Wei 1st 
18,442 S ■ 
23 
36.50 
13,795 
63 
3 
1 
.... 
1 
11 
4 
Whitley 
16,941 
120 i 
1 i 
9 
.... 
1 
2 
18 
3 
6 
2 1 
42 
35.00 
* Excluding Cass, Porter, Starke and Wells counties, which made no report, 
t Made no reports. 
t Homicides and suicides not included in this table. 38 
Table X gives by State, and eaeli county, total deaths from 
all causes. The deaths from each of the ten causes in each 
county. Also the per cent, of the mortality from each cause 
of death, to the total mortality in the several counties. 
All such causes of death are in a great degree preventable. 
A study of the tables will, we think, show that these prevent- 
able diseases exist in a greater degree in the rural districts and 
scattered population than in those counties where the popula- 
tion is more concentrated; whereas, with proper attention and 
such care as Boards of Health exert, both by mandatory en- 
forcement of proper rules and educational functions. 
Scarcely any deaths should occur in these counties from the 
causes mentioned. 
In this table there is included in the estimate of total mor- 
tality from all causes, 710 still-births. The estimated per cent, 
of mortality for the State from the ten specified causes to the 
total mortality is exclusive of Porter, Cass, Wells and Starke 
counties, the Health Officers of those counties having made 
no report. 
We find the mortality from those ten causes to be 4,149— 
nearly one-half of the total deaths in the State, if we exclude 
still-births. This is a bad showing, even if we estimate that 
one-half of such deaths might be prevented. We also find 
that the death-rate for these ten causes to the total mortality 
in nine counties having the most concentrated population is 
below 40 per cent., while in twenty-nine counties, altogether 
agricultural, with population less concentrated, the death-rate 
exceeds 40 per cent. Such fact ought at once to settle the ques- 
tion as to the need of some means being used in the rural dis- 
tricts to prevent deaths from such preventable causes. If we 
consider separately each of these ten causes of death, we fin4 
that in the counties given to agriculture, and where the popu-. 
lation is most scattered, the death-rate from nearly all these 
preventable causes exceed that which is found to exist in coun- 
ties with population more concentrated. 
The per cent, of deaths from Diphtheria in seven counties of 
scattered population, designated as («*,) average 6.53 per cent.; 
in seven counties of concentrated population, designated as (5), 
it averaged 1.57 per cent. Deaths from whooping cough in 
seven counties (a) averages 3.59, in seven counties (6) 1.41. ERRATA. 
On page 33, lines 11, 12 and 13, should read as follows: 
“ Both by mandatory enforcement of proper rules and edu- 
cational functions, scarcely any deaths should occur in these 
counties from the causes mentioned.” 39 
Deaths from scarlet fever in seven counties (a) averaged 4.46 
per cent.; in seven counties (6) 1.41 per cent. 
Deaths from typhoid fever in seven counties (a) 3.20 per 
cent.; in seven counties (6) 3.20 per cent. Deaths from spot- 
ted fever in seven counties (a) average 4.11 per cent.; in seven 
counties (b) 1.71. Deaths from pneumonia and bronchitis 
(acute lung affections) in seven counties (a), 25.60 per cent.; in 
seven counties (6), 7.66 per cent. Deaths from consumption in 
seven counties (a) average 17.74 per cent.; in seven counties (b) 
12.21 per cent. Deaths from casualties in seven counties (a) 
average 7.09; in seven counties (6), 4.75 per cent. 
*If we examine table XII that gives deaths by occupation, we 
find that, as reported, about one-half of the deaths from these 
ten causes occurred among those we must class as farmers. In 
this classification we must place one-half of those returned as 
laborers, housekeepers, housewives, domestics, and those placed 
as not reported. 
Out of the 228 deaths from casualties, 80 were classed as 
farmers; of the 840 deaths from pneumonia and bronchitis, 439 
were of the class farmers; of the 340 deaths from typhoid 
fever, 169 were farmers. .Of deaths by consumption, 334 were 
of the farmer class. This cause of death showed its greatest 
effect upon the female portion of the population, 810 females 
dying, to 531 males. 
*In table XI is given the deaths from each of the ten causes, 
by ages, and the total number of deaths from each cause. We 
notice that 404 deaths occurred from these ten causes during 
the first year of life, a greater number than occurred in any 
other* year. This preponderance in number is chiefly due to 
an increase of deaths from whooping cough, spinal meningi- 
tis, pneumonia and bronchitis. Dividing the ages into periods 
of ten years, we find the greatest mortality in the first period 
—1,100; the next greatest number of deaths is between the 
ages of 25 and 30—833. 
Xo death from whooping cough occurs after the age of 18; 
5 deaths from scarlet fever, 8 from diphtheria, and 39 from 
small-pox occurred after that age, while 107 deaths from whoop- 
ing cough, 64 from scarlet fever, 153 from diphtheria, and 47 
from small-pox occurred before the age of 18. Of the 480 
*Table omitted here. 40 
deaths from typhoid fever, the majority occurred between the 
ages of ten and 30; from this cause the deaths of males and 
females are about equal in number. Of deaths from spotted 
fever, there were 239; a majority (135) occurred before the age 
of 10 years. More deaths occurred from consumption than 
from any other of the ten causes (1,341), and next to this, 
pneumonia (1,094). Pneumonia and bronchitis, combined, 
show 1,286 deaths. 
Of bronchitis, a majority of deaths (105) occurred before the 
age of five years. The greatest age at which death occurred 
was 107 years. Two returns at this age, one a male, the cause 
of death not being old age, but pneumonia, and one a female, 
death from old age. There have been 102 deaths returned and 
no ages given. Ago is an important item in these statistics, 
and should be returned in all cases. Deaths from early old 
age generally have some additional reason for their appearance, 
and care should be taken in returning facts in such cases. 
Deaths of those under five years of age number 21.19 per 
cent, of the whole. 
It can not fail to strike the attention tlfcit more deaths occur 
from whooping cough than from scarlet fever. This is thought 
to be rather a harmless disease, at least considered inevitable, 
and the sooner the child has it the better, no care is taken of the 
sufferer, acute disease of the lungs follows, and death is often 
the result. The people need to be educated upon this subject, 
and taught that proper care by parents and nurses will prevent 
a large proportion of deaths from this cause.