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Statement showing deaths and death rates among children under 1 year of age in the
District of Columbia during the calendar year 1907.
a Estimated births, recorded and unrecorded, is the sum of children under 1 year old living in April, 1907, as determined by the police census, plus the number of children under 1 year of age dying in the District during 1907, as shown by the mortality records. They were as follows: White, 4,742; colored, 2,641; all, 7.383.
As was pointed out in a previous report of this department, the prevention of preventable deaths can not be accomplished by the mere compilation of such data as are embodied in the foregoing table and in other tables printed in this report. The very first step toward prvention is the analysis of such numerical data with reference to all of the facts out of which such data arise-duration of illness, feeding prior to and during the attack, character of housing, promptness of summoning medical aid, weather conditions, and the many other factors that go to make the difference between life and death. Only by such a method will it be possible to determine the causes that are most potent in producing such unnecessary mortality in this District. After such causes are known, it will be necessary, if they are to be removed, to have the active cooperation of those having the care of the infants. And this can be obtained only by a systematically conducted campaign of education. Both the ascertaining of the causes of such mortality and the conducting of such a campaign of education require more men and money than are now at the command of the health department, and therefore can not be undertaken.
In the absence of any means for investigating through its own employees the circumstances causing preventable infantile mortality, and because of the inability of the health department to take direct action toward the removal of such causes as are removable, except such action as the department is taking toward the improvement of the milk supply and of the general sanitary condition of the District, the health officer on April 17, 1908, requested the Instructive Visiting Nurse Society to cooperate with the department in an effort to teach mothers of newly born children how to care for them. It was
a See Report of Health Officer, 1905-6, p. 7.
believed to be the duty of the attending physician, whenever present at a confinement, to instruct the mother fully as to her duties with respect to her child. The efforts of the department and of the society named were limited, therefore, to the instruction of the mothers of children born without medical attendance—that is, of children born under the care of midwives. Whenever, since June 13, 1908, a birth has been reported by a midwife, the case has been referred for appropriate action to one of the trained nurses in the service of the society. It has been the duty of the nurse to whom any such case has been referred to call upon the mother from time to time during the infancy of the child and to advise her with respect to its care and, when necessary, to obtain for the mother or the child, from available charitable agencies, such assistance as may be needed. This work was begun, however, too late during the year covered by this report to permit the inclusion in the report of any statement as to the amount of work done and results obtained.
MORTALITY BY RACE.
The influence of the colored population of the District on its general death rate is about as bad as usual. The colored population in 1907 made up 29.2 per cent of the population, but contributed 42.79 per cent of all deaths. The colored death rate was 28.22; the white was 15.55. That a relatively high mortality among colored people, as compared with whites, is not peculiar to the District of Columbia is shown by the following table. This fact, and the fact that so large a part of the population of the District of Columbia is colored, should be borne in mind whenever a comparison between the general death rates for the District of Columbia and of any other community is undertaken. And if the comparison is to be made between special death rates, it must be remembered that in many instances the ratio between the colored and the white death rates is even higher, as has been repeatedly pointed out in these reports. a Comparative annual death rates per 1,000 inhabitants of white and colored races and total
in certain American cities for the year 1907, compiled from “ Mortality Statistics, 1907," of the Report of the Bureau of the Census.
1.64 Louisiana, New OrCalifornia, Fresno. 24.4 25.0
20.1 Delaware, Wilming
19.4 25. 6
14.8 District of Columbia,
21.9 Jacksonville. 25. 9 29.7 1.15 Hagerstown.
18.3 Key West.. 20.5 25. 2
1. 25 Missouri, Kansas City 16.7 Georgia:
New Jersey: Savannah. 17.9 30.0 1.68 Atlantic City
16.9 Atlanta.. 21.2 29.9
1.41 Long Branch. 22.0 Indiana:
North Carolina: Evansville. 12.3 16.0 1. 30 Raleigh..
27.3 Jefferson ville. 15.9 18.5
1. 16 Wilmington
19.8 Kansas, Leavenworth 13.4 20.8
1.55 Oregon, Portland. 17.6 Kentucky:
13.4 a See p. 241; see also Report of the Health Officer, 1905-6, p. 20.
Comparative annual death rates per 1,000 inhabitants of white and colored races and total
in certain American cities for the year 1907, etc.-Continued.
NOTE.-The discrepancy between the death rates for the District of Columbia given in this table and those published elsewhere in this report is due to the fact that the former are based upon the population of the District as estimated in the Census Office and the latter are based upon the actual population as enumerated by the police.
Doubtless excessive mortality among our colored people is due in part to bad food, bad clothing, bad housing, ignorance, and poverty, and to that extent it may be said to be preventable. But apparently it is due in part to present racial unfitness for the life to which they are now subjected, and in so far as that is true no improvement can be expected until nature by her processes of evolution has produced a more resistant generation of colored people.
MORTALITY WITH REFERENCE TO PLACE.
Elsewhere in this report appear a table and a map showing the relative mortality in different sections of the District. Until recently it has been impossible to make any definite statement of this kind, and it is possible now only because of the taking of annual police censuses during recent years. When the health department has been provided with a force that will permit it to analyze the figures that are thus accumulating, it will be able, it is hoped, to determine better what, if anything, can be done to diminish the death rates in those particular localities where they are relatively high, and thus to reduce the death rate for the District as a whole. Until such a determina
a tion has been made, however, it will be impossible to apply remedial measures in the most direct and effective manner, or, in fact, even to tell what measures, if any, are practicable.
In addition to the study of the mortality of the District with respect to more or less arbitrarily fixed vital statistic sections, the department has compiled as usual figures to show the relative mortality for our street and alley populations. The table on the following page shows some of the results.
a See page 311.
Comparison of death rates for white and for colored people living in alley and in street
dwellings in the District of Columbia, during the calendar year 1907.
NOTE.-Alley population in 1905 was, white, 1,739; colored, 16,659; in 1906 was, white, 2,155; colored, 15,652; in 1907 was, white, 1,475; colored, 14,864. Street population in 1905 was, white, 225,689; colored, 79,036; in 1906 was, white, 229,262; colored, 79,366; in 1907 was, white, 231,928; colored, 81,324.
The following table shows the variations between alley and street death rates for each race for each of several of the more important preventable diseases. In view of the comparatively small alley population of white people, the figures pertaining to it are more likely to fluctuate from merely accidental circumstances, and consequently are a more unsatisfactory basis from which to draw conclusions, than are the figures pertaining to colored people.
Statement showing comparative racial death rates for alleys and for streets for certain
diseases, during the calendar year 1907.
With the passage on May 13, 1908, of an act to provide for the registration of all cases of tuberculosis in the District of Columbia, the last of all of the communicable diseases ordinarily of importance to this community, except pneumonia, malarial fever, and venereal diseases, has been brought within the purview of the contagious disease service. They will be considered, therefore, when considering the work of that service.
In one form or another pneumonia continues to be one of the most important factors in our mortality records, ranking second to but one disease, tuberculosis. It killed 539 people in 1907. The death rate for the white race was 99.0 per 100,000, for the colored 320.2, and for
a See p. 35.
the entire population 163.5. The germ that causes pneumonia is so widely spread that it is almost impossible to avoid it, and the development of the disease seems to depend rather upon the physical condition of the individual in whom the germ finds lodgment than upon the bare presence of the germ itself. Given a good vigorous body, and the germ will not develop so as to cause disease.
But given a body whose vital forces are either permanently or temporarily below par, and in event of infection disease readily develops. If, therefore, his financial circumstances permit, the individual can do much to protect himself and those dependent upon him, but the Government, beyond teaching him how to accomplish this result, can, toward the prevention of pneumonia, accomplish but little.
The number of deaths due to malarial fever is not large-only 9 for the entire population during the entire year--and would not deserve comment were it not for the relation of this disease to the mosquito, and for the amount of sickness that nine fatal cases represent; for in the comparatively mild form in which malarial fevers now usually occur in this District, many cases must have occurred in order to bring about even 9 deaths. The reclamation of the Anacostia marshes may be expected to diminish the prevalence of this disease, but such work must be supplemented by the careful abatement of all accumulations of standing water on private land, and to accomplish this end an increase in the inspection force of the health department is necessary.
DEATHS FROM VIOLENCE.
The total number of deaths from violence during 1907 was 348. Of these, 72 were due to suicide. If these be deducted, and 1 death due to judicial execution, the remainder may be said to be due directly to carelessness, ignorance, and crime. In a civilized community this represents a heavy tóll to pay during a single year to such causes. Fatal cases of violence are investigated by the coroner and such action taken in each individual case as the circumstances warrant. The many cases of injury, however, that fall short of producing fatal results either go uninvestigated or else are investigated only by the police officer on whose beat they occur, in a more or less perfunctory way. Certainly it would seem that if a case of violence resulting fatally must be investigated by a specially qualified officer, a case proving almost fatal, and in which a fatal result is perhaps averted only by reason of prompt and skillful surgical aid, should be likewise investigated. And if that is true the same principle might well apply to all cases of violence whatsoever.
The systematic investigation of all injuries due to violence, instead of merely the fatal injuries, would lead sooner to the discovery of the particular causes of accidents and to the discovery and application of preventive measures, by legislation if necessary. The investigation of all injuries would result, too, in the investigation before the death of the victim, of injuries that ultimately prove fatal, a method more favorable to the obtaining of satisfactory results than is the present post-mortem inquiry. And even though investigation might lead in the individual case to no further official action in that one case, yet it would spread upon the record facts that might be of value when