Mixed Race Studies

The United States Census in Its Relations to Sanitation

Public Health Paper Report
Volume 15 (1889)
pages 43-46

John S. Billings, Surgeon, U.S.A. (1838-1913)

I have several times inflicted upon this patient and long-suffering Association papers relating to statistical matters and methods, which, it must be confessed, were better fitted to serve for occasional reference than to occupy any of the scanty time available for listening at our annual meetings. To-day, however, I have a very short discourse on the same subject which I want you to listen to, because, if the suggestions in it have any value, some of them should be acted on before the paper will probably appear in the volume of our proceedings.

Theoretically, we all agree that vital statistics are the foundation of public medicine, but, practically, I suppose that the majority of sanitarians and physicians think that they are not essential to the work of a health officer or board of health, although they may be desirable; that the main objects in sanitary work are to see that the water-supply is pure; that garbage and excreta are promptly removed or destroyed; that no filth is allowed to accumulate in the vicinity of habitations; that contagious diseases are controlled by isolation and disinfection; that plenty of fresh air be provided in schools, churches, etc.; and that all this can and should be done whether death-rates are known or not.

This is not my own view, because my observation of the progress of public health work in this and other countries for the last twenty years leads me to believe that this progress, in any locality, for any considerable length of time, depends upon the completeness of its vital statistics and the use that is made of them; because upon such completeness and use depend mainly the amount and regularity of appropriations from state or municipal funds for the payment of the expenses needed to secure the objects of the health department. Occasionally it is possible to get up a cholera, or yellow-fever, or small-pox, or typhoid fever scare, and to then get a little money for sewerage, or for street and alley cleaning; but these spasmodic reforms do not last long, and in most cases do not amount to much. You have got to produce constant, undeniable evidence that the work is needed, and is useful, evidence that will convince the press and the majority of the community; and this evidence must be mainly death-rates, to which should be added all the sickness rates that can be obtained…

…In investigating the details of the records of deaths kept in different cities, I have noted deficiencies in a few of them to which I wish to call the attention of all who have to do with the registration of vital statistics.

First. All deaths occurring in hospitals should be charged to the ward or district of the city from which the patient was taken to hospital, when this can be ascertained. Otherwise the death-rate in the ward in which the hospital is located will be too high, and in the other districts it will be too low.

Second. The birthplace of the parents of the decedent should be reported. We want to know the race of the decedent, whether he was Irish, German, Italian, or American, and to give merely his own birthplace is not sufficient.

Third. It is very desirable that in all cases of deaths of colored persons it should be stated whether the decedent was black or of mixed blood, such as mulatto or quadroon.

One of the most important questions in the vital and social statistics of this country relates to the fertility, longevity, and liability to certain diseases of those partly of negro and partly of white blood, and the only way to obtain data on this subject is through the registration of vital statistics.

Under the provisions of the law providing for the census, the living colored population is to be enumerated with distinction as to whether each person is black, mulatto, quadroon, or octoroon; and we need the same distinctions for all colored persons dying during the census year, to enable us to calculate comparative death-rates. Wherever there is a fairly accurate registration of deaths, which now exists in several states and in over one hundred cities, the next census will afford the means of calculating death-rates with distinctions of color, sex, and age, which will furniish important indications for sanitary work. For all cities of io,ooo inhabitants and upward, it is proposed to collect as complete information as possible with regard to altitude, climate, water-supply, density of population, sewerage, proportion of sewered and non-sewered areas, and other points bearing on the healthfulness of the place, which will permit of interesting comparisons with the death-rates.

Read the entire paper here.