Those who work in certain lcinds of phos phorus are bound to.suffer injury under any possible precautions, those who put up the frames of steel buildings, who work on tele graph poles and who handle electrified wires are always in danger and those who are grind ers of tools are great sufferers from disease, but their work can be so safeguarded that the danger may be eliminated to a great extent.
Some of the occupations which have a large element of danger, in addition to those which have been mentioned, are those of caisson work ers, in which the workers must sustain a pres sure of five or six atmospheres,miners, molders, and slaters, of workers in iron furnaces, in potteries, in chemicals and metals, in electrical establishments, etc. A very large class of diseases are known as occupational diseases and the publication of statistics upon such subjects is doing much to enlighten the public in regard to the need of drastic legislation and regulation concerning. them.
It would hardly seem necessary to comment upon the influence of density of population upon mortality, so evident is it to anybody who has given it the slightest attention. It is not merely the crowding which induces morbidity and mortality, it is the accompaniments— un sanitary conditions, bad air and what is almost inseparable from thetn, ignorance, immorality, intemperance and poverty.
Causes of Death.— These are usually con sidered from the standpoints of diseases and injurie.s, but there are many deaths which do not seem to be attributable either to disease or injury, as in the case ot those who die in ex treme. old age, without pain, without sickness or injury, with nothing but a sudden stopping of the mac,hinery, like the running down of a clock.
The classification and record of diseases and injuries as causes ot death is very important and is becoming more and more elaborated by boards of health, throughout the country. In preparing statistical tables the causes of death are noted as a ratio of mortality from all causes, or as a definite proportion of the living population.
In census bulletin 109, which has already been referred to, the following rate of mor tality is given, from 20 causes, in the order in which the relative number of deaths occurred: (1) Tuberculosis, (2) Organic Diseases of the Heart, (3) Diarrhom and Enteritis (at all ages), (4) Pneumonia (lobar and tmdefined), (5) Acute Nephritis, (6) Accidents, (7) Can cer and other Malignant Tumors, (8) Cerebral Hmmorrhage, (9) Broncho-pneumonia, (10) Premature Birth, (11) Congenital Debility, (12) Old Age, (13) Typhoid Fever, (14) Bronchitis, (15) Diseases of the Arteries, (16) Diphtheria and Croup, (17) suicide, (18) The Puerperal State, (19) Otner Diseases of the Stomach excepting Cancer, (20) Diabetes. This
table is not very complete, but it may give to the public at large a general idea of the rela tive mortality from these particular causes.
Climate and temperature have much to do with the death rate. Thus it has long been ob served that the lowest mortality is that which occurs in the beautiful month of June, while the highest is in blustering March, when so many people, especially among the aged, are enfeebled as the result of the severities of the winter.
Disease.—An important part of the statis tics of boards of health is the registration of infectious disease, Beginning, as it did years ago, with the registration of smallpox, it was quickly followed by the registration of the diseases which are known as Zymotic, including those which are so common during childhood, measles, mumps, scarlet fever, diphtheria, whooping cough and chicken pox.
The necessity for enforcing the law in re gard to reporting and recording these diseases is quite as great as the necessity for a rigid quarantine. Personal feeling or prejudice should play no part in a matter like this which has so great a bearing upon the health and well-being of the entire community.
Public Health Nursing.— This is an occu pation but recently established. It means that the trained nurse goes into the homes of the poor, the ignorant and the dirty where vital statistics of importance are constantly avail able, and statistics also which have a decided bearing upon the welfare of the entire com munity. It would seem especially desirable that those who are engaged in this work should always have with them blanks for the collec tion of such important data. They could cer tainly gather many important facts which otber wise would be lost, including legitimate and illegitimate births, infectious 'diseases, re movals on account of disease, deaths especially among infants and stillbirths. Both in large and small cities and villages where this service has been established should this plan be car ried out It would be a great assistance to doctors and in many instances would provide the necessary correction for their defective re turns.