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for physical training may thus far be regarded been termed the bookkeeping of the public as adequate. The chief recommendations of health movement. The importance of havthe Public Health, Hospital, and Budget Com- ing such statistics and of making them as mittee of the Academy of Medicine, based on complete and comprehensive as possible is a study of existing conditions, are the en- so evident that it seems impossible to give largement of the working staff of the Child any reasonable explanation of the fact that Hygiene Division, and a concentration of at the present day such statistics are recorded. responsibility and control in the medical work even partially, for only fifty-five per cent of of the Department of Education. It is pointed the population of the l'nited States. It is out that more thorough physical examinations, equally mortifying to be compelled to confess more frequent inspections, and an extension that the statistics recorded even for this porof the follow-up work, to secure better co- tion of the American people are in great operation from parents and medical prac- part so inaccurate and so incomplete that titioners, are necessary.
In view of the they are of comparatively slight use in furnishprevalence of physical defects, the Com- ing a satisfactory guide to our progress in mittee recommends that there should be one matters of health. While we maintain elabschool nurse to every 2,500 children, and one orate organizations and complete machinery physician to every 7,500.
for collecting and compiling elaborate records Of the necessity, value, and importance of of manufactures, trade, and transportation, medical school inspection, the mere statement in this most vital and important matter we of the extent to which physical and mental remain in the dark ages as compared with defects abound in the schools is sufficient the leading nations of Europe. proof. When over seventy per cent of the In certain sections of the country, particupupils in the schools of a great city are found larly in some of the older States and larger to be in need of treatment, and forty-three cities, very encouraging progress has been per cent are afflicted with communicable dis- made in recent years toward the creation of eases, it is obvious that medical inspection an adequate system of health accounting. and treatment advance to a position of equal Such progress as has been achieved has importance with the mental training for resulted almost entirely from the efforts of which the schools are primarily conducted. medical organizations or of public health But unless this work is so organized and con- officers who themselves are, of course, memducted as to be comprehensive and thorough, bers of the medical profession. To provide much of the effort will be wasted. To secure a comprehensive and widely useful system of a high degree of efficiency it is important vital statistics applicable to the whole country that the public attitude be changed from the and useful for comparative studies, however, present one of general indifference to one of
will require joint, or at least harmonious, active interest and co-operation. Medical in- action on the part of the Federal Government spection of schools is work of the most direct and the States as well as by municipalities. and practical public value. It not only adds to To bring about such a result the backing of the efficiency of those who are preparing to a strong body of enlightened public sentitake up the work of the world, but at the ment is almost essential. Here is another same time it is helping to lighten the load of field, therefore, in which it is important that disease and dependence that oncoming gener- the co-operation and support of the lay pubations otherwise must carry.
lic, whose members will derive the benefit
from the inauguration of an adequate system IMPORTANCE OF ACCURATE VITAL STATISTICS
of vital statistics, shall be given to the medWhile the relation between medical inspec- ical profession, upon whose members will tion of schools and the registration and com- fall most of the work of making such a pilation of vital statistics may not be partic- system effective. ularly close, the two subjects are treated While the health records of New York City together here because both are fields in which are recognized as being more comprehensive the organized efforts of the medical profession than those of most American municipalities, have resulted in such progress as has been they cannot compare in point of completeness made and in which intelligent co-operation on with those of the leading cities of Europe. the part of the public will contribute much to The Paris statistics, for example, contain further progress and greater efficiency. much more detailed information and offer
Vital statistics and demography have aptly more bases for correlation than the New York
tables do. They classify births not only as On all of these subjects certain popular to living and stillborn, and as to sex and the beliefs and opinions are current, but few of ages of the parents, but they specify also the these have been put to a comprehensive duration of marriage; they give the relation statistical test. It would be exceedingly valuof age to fecundity; they report marriages able to have bases for definite conclusions on by conjugal status before marriage and by these and other related subjects. the degree of consanguinity of husband and In 1911 the Health Department of New wife, and they convey a variety of other York City, realizing the deficiencies of its information helpful in charting the great vital statistics, appointed a committee of movement of racial development and the statisticians to advise them in the matter. causes contributing to its progress or deca The committee made a few simple but dence. By contrast with this the vital statis- highly practical recommendations.
They tics report of New York has only two tables suggested that the existing Bureau of Records for births and only one for marriages. Simi be enlarged into a Bureau of Vital Statistics larly, in comparison with London, the New with three subdivisions-one of Records, one York reports are not only less detailed but of Research, and one of Publicity. The inare deficient in descriptive analyses.
creased cost to the city of this reorganization
was computed at only $40,000; but the proINADEQUACY OF AMERICAN STATISTICS
posal was rejected by the Board of Estimate Much valuable information even now exists and Apportionment of the city on the plea of in the offices of departments of health in economy. American cities which is not being utilized, In order to urge upon the city the necesand in hardly any city is any persistent effortsity of appropriating the necessary means for made to interest the public in this subject, the reorganization of the Bureau of Records, which transcends in public importance many and also to impress the medical profession as of the questions on which a vast deal of dis well as the lay public with the importance of cussion is lavished. If an exceptionally high complete and exact, promptly published, vital or low birth rate or death rate is recorded statistics, and their service to science as well for a given period, that fact may receive brief to administration, the Public Health, mention in the newspapers, but beyond this Hospital, and Budget Committee of the New little attention is paid to reports dealing with York Academy of Medicine has prepared a the records of vitality. One reform urgently report on vital statistics and health reports of needed is the preparation of official health New York City. In this report it indorsed publications in such form, and the presenta the recommendations of the Committee of tion of the conclusions and inferences which Advisory Statisticians for a reorganization their figures justify in such a way, as to and enlargement of the present Bureau of appeal to the average reader, for whom they Records ; but it went further, and gave a should be primarily intended.
detailed outline of what, in its judgment, the With very little additional effort in the reports of the Bureau should contain. The compilation of records now collected in many Committee urged the appropriation of the cities, reports could be made to throw much needed funds, and made an appeal to the light upon such vital problems as the relation medical profession for co-operation in the between morbidity and occupation, between prompt and exact recording of births, deaths, the vitality of children and the age and occu and sickness. In spite of all the efforts of the pation of their parents, between the pro- Department of Health, only ninety-five per portion of stillbirths and the employment of cent of births are registered with the Departmothers. The relation of mortality to the ment, while the per cent of reportable cases density of population, the influence of immi- of contagious and communicable diseases is gration upon birth, death, and morbidity very much less. The value of our vital starates, the effect of consanguinity upon the tistics depends, in a large degree, upon the fecundity of marriage, the incidence of dis- good will of our physicians. ease upon the various elements of the popu The Committee has also recommended lation, and the relation between infantile that instruction in the methods and principles diseases and the ages and occupations of of medical and vital statistics be given in the parents, could be shown. Needed illumina- medical colleges, and, following this up, it pretion could be given to important social prob- pared an outline of such a course, with broad lems such as race suicide.
social and administrative bearings, which was
submitted to the Council on Medical Educa- cians are deprived of this important source tion of the American Medical Association. of technical skill and exact knowledge.
While eighty to ninety per cent of the perAUTOPSIES AND PUBLIC HEALTH
sons dying in English, Canadian, German, Closely connected with the problem of and Austrian hospitals come to a necropsy, correct vital statistics is the question of med- the per cent of autopsies in the largest hosical competency. Many death certificates do pitals in this country is about ten, and in not give the true cause of death because of some instances it is considerably less than the carelessness, neglect, or intent of the that. Studies of the number of correct cliniphysician; many, however, and these are cal diagnoses as revealed by autopsies show numerous, are faulty because of the igno- that many important diseases fall below fifty rance of the physician as to the real cause per cent in recognition, and some even below of death. Definite proof in many instances twenty-five per cent. The trustworthiness of can be furnished only by autopsies.
some of our death statistics, under the circumThis brings us to a subject in connection stances, may easily be conjectured. Prowith which it is entirely within the facts to fessor Bashford, director of the Imperial say that the advancement of medical science Cancer Institute in London, asserts that and the promotion of public health is greatly returns from Ceylon with regard to cancer, hampered in the United States by the are more reliable than those of New York ! groundless though understandable prejudice The same is true of other important diseases. of the general public against the extension of There is a general belief, which is supported the privileges of hospitals in the matter of by such statistics as we have, that certain performing autopsies. This prejudice arises diseases, such as cancer, affections of the largely from ignorance of the importance of kidneys, and heart disease, are rapidly inpost-mortem examination and from popular creasing in this country. Whether they actuconfusion of autopsies with anatomical dis ally are increasing at any such rate as seems sections. Unfortunately, there is a continu to be indicated cannot be determined until ous effort on the part of zealous but mis- provision is made for far more ample postguided individuals and organizations to mortem examinations. In view of this fact, increase this prejudice by misrepresentation the Committee has recommended that a camof the facts.
paign of education be undertaken by medical The great value of autopsies, not only to organizations to acquaint the public with the the medical profession but also to the mem dependence of medical progress and educabers of the general public whom that pro tion upon the extension of post-mortem exfession serves, is beyond question. If we aminations in hospitals, that effort be made wish to add to our store of medical knowl to secure legislation similar to that of Euroedge, if we wish to turn out good physicians, pean countries in reference to this subject, if we are to have reliable mortality statistics, and that meanwhile hospital rules be so there must be more post-mortem examina- framed as to facilitate the performance of tions in the hospitals. A comparative study autopsies in cases where they are likely to of this subject which the Public Health, prove of value. By aiding in this movement Hospital, and Budget Committee of the New the public at large will serve its own interests York Academy of Medicine recently pub- by helping to advance the cause of medical lished shows to what extent American physi- progress.
(This article will be followed in the next issue of The Outlook by another
on the same general subject, written by the same authors.)
BY AN AMERICAN RESIDENT
This article comes from a man who has for many years been engaged in business in Mexico. We print it, not because we agree with all its conclusions, but because it gives a first-hand and virid impression of conditions as they appear to an American who knows the country well. Elsewhere we discuss the subject editorially.—THE EDITORS.
HILE the American newspapers tion. An acknowledgment of the Huerta
are daily carrying several columns Government within two or three weeks of its
of matter relating to Mexico, to installation would have been better for all one who has been living in that country the Americans and American interests in Mexico, amazing ignorance and misunderstanding so far as sentiment is concerned; but, as a which exists not only in the mind of the matter of fact, it would not have changed ordinary citizen, but, judging from Washing- things very much. Huerta might have been ton reports, in the Department of State itself, able to get a little more money or he might as to the actual conditions and situation not. Bankers are cautious people, and the there, is astonishing.
nations which have money are holding on to In all previous revolutions in Mexico, with it pretty well for their own use; but even so, the exception of Juarez against Maximilian, it would only have prolonged matters a little. when Juarez was backed by a national senti At the same time Huerta was the only Govment of more or less strength, it has been one ernment there was; he had a Cabinet of the man against another-some one man on the most representative men in Mexico, and the outside trying to oust the man in power. sentimental feeling in Washington regarding But to-day that is not the case. It is not one the death of Madero should not have been man against the Government, but a dozen allowed to interfere with more practical men all working without organization or cohe questions. sion, but more or less to the same end, viz., Our present Administration is rather posithe overthrow of the existing Government. tive on the point that when an American Carranza, a man of considerable ability, con- goes into a foreign country to invest his capitrolling several thousand men, raises the tal and work, he does that at his own riskstandard of constitutionalism. Maytorena in which attitude may or may not be proper ; Sonora cries “ Secession ;” Contreras and but, carrying out that idea to a logical end, it Pesequira, “Restoration and justice;" and should also hold the view that any one taking Zapata, really the only consistent one in the the Presidency of Mexico most assuredly does lot for the last three years, says, “ The cause,” it at his own risk, too. meaning the settlement of the land question. Madero's murder was deplorable, but it is
These various leaders and others men- argued that there was no other course to the tioned, some being men of good ability and successful revolutionists. Madero was an intelligence, are seeking power and control idealist, and more or less of a crank, as we of the country only for their own personal would express it; but there was not a drop interest, but they are holding their men and of cowardly blood in him. He would not gaining recruits daily by an appeal to the sign a resignation, and consequently some socialistic instinct which lies dormant in every one had to sign it for him, and he could not poor and downtrodden man such as the peon be left free to deny his signature! Had he of Mexico.
really resigned, it is said, there is no question To-day the revolution in Mexico is a class that he would have been allowed to leave revolution, not one of individuals or princi- the country. ples, and the absurdity of our Government The condition of the country to-day is hopetrying to “mediate "bespeaks an al nost piti- less. There is hardly any State that is not disful ignorance of conditions.
affected, and the Government controls only the Our Ambassador to Mexico, Mr. Henry territory immediately adjacent to the railway Lane Wilson, has been absolutely right in his as far north from the City of Mexico as Zacaposition and attitude, viz., either acknowledg- tecas. For five months there have been no ment of the Huerta Government or interven trains through from Laredo, Piedras Negras,
or Juarez, or any other border point except, but Gorro, in a last effort, bit the man's for a short time, from Matamoras. North of finger through, if not entirely off ; so the Zacatecas there is not a mine or manufactur- soldier picked up a rock about the size of a ing industry of any kind that is running, and paving-stone, smashed his head in, and broke south of Zacatecas there is nothing doing ten his jaws off—and got the teeth. And these miles away from the railway.
were Federal troops, not bandits. The Government is bankrupt ; the railway Ambassador Wilson is somewhat in error system of some 13,000 kilometers is bank- in characterizing all opponents of the Govrupt, and it will take $20,000,000 to put its ernment in arms as “bandits.” Some of the physical condition back to where it was two leaders are men of more than ordinary intelyears ago. If the truth were known, most ligence, with good ideas as to organization of the banks would be found to be insolvent, and discipline among their men. As an exand thousands of men supposed to be and ample take Natera, the man who took Zacarated as wealthy are pawning their jewelry. tecas. He had a force of 1,000 or 1,200 Take, for instance, the town of Sombrerete, men, poorly armed and equipped and short a place of some 10,000 or 12,000 inhabitants; of ammunition. The Federals had 500 or you cannot buy a spool of thread or a lead 600 men only, but they were well armed and pencil or a yard of cloth in it; even the shelv- equipped, had rapid-fire guns and all advaning in the stores has been gutted; and 3,000 tage in position, but at the end of the second men who might be and should be working day's fighting Natera rushed the town and there are drifting into the revolutionary took it gallantly by assault, the Federals ranks. The miner as a rule is not a natural making their escape as best they could. revolutionist; he prefers to work and take Within twenty minutes after getting conhis chances on stealing a little rich ore to help trol of the city he had the place thoroughly out; but present conditions are forcing him policed, with a man at every corner ordered into rebellion or outlawry, and the longer he to shoot without question any one who showed keeps at that the harder it will be to induce signs of looting or brutality. him to return to legitimate work.
The next morning he called the leading So far as the lives of Americans and other citizens together and told them how much foreigners in Mexico are concerned, they are money he wanted, and that they could form comparatively safe as long as they consent a committee and apportion it as they saw fit. to have their horses and mules, money, and By eight o'clock that evening he had itgeneral supplies taken from them without something over $200,000; but on learning protest; but the slightest resistance outside that the school teachers and lower municipal of talk is a death warrant.
employees had not been paid in some time, Take, for instance, the case of Gorro, a he turned back $35,000 to be used for that Russian by birth and a naturalized American purpose. He also opened all the pawnshops, citizen, an engineer in charge of a mine who letting the people have their pledges back at thought he was there to protect and save his 25 per cent of their original loan. company's property. A bunch of Federal Natera was in Zacatecas some ten days, soldiers came to his property and demanded and there was not a case of drunkenness certain stocks and supplies. In the course among the men, not an instance of ill-treatof the argument a Federal soldier was killed ment of any citizen or looting of any kind. or wounded and Gorro was badly wounded He did take all the arms, ammunition, in both arms and one leg, so that he was uniforms, saddles, and other Government practically helpless ; he succeeded, however, property he could carry, and he did take all in barricading himself and could have held the good horses there were in town irrespecout probably for some little time.
tive of who owned them, but he was very He was growing very weak, however, and civil about it, apologized for the necessity, after a parley, in which they promised to and gave a receipt and left other poor, halfspare his life, he let them in. Now Gorro starved horses in their places. was a man who took great pride in his per When he went away he took about six sonal appearance, had spent large sums on hundred new voluntary recruits with him. his dentist, and had practically a full set of Natera had a staff of about twenty men, solid gold bridge-work. One of the soldiers comprising some of the best telegraphers, took a fancy to the gold teeth, and, putting electricians, and mechanics in Mexico ; and it n finger in his mouth, tried to pull them out, would seem that his conduct in this instance