HB/2Z3 
 
HB 1323 
 . 14 U6 
 Copy 1 
 
 um'ARTMENT OF COMMERCE AND LABOR 
 
 BUREAU OF THE CENSUS 
 E. DANA DURAND, Director 
 
 EXPLANATORY LIST 
 
 OF 
 
 DIAGRAMS 
 
 RELATING TO 
 
 DEATHS OF INFANTS 
 
 PREPARED FOR THE ANNUAL MEETING 
 AND EXHIBIT OF THE AMERICAN ASSO- 
 CIATION FOR STUDY AND PREVENTION 
 OF INFANT MORTALITY .-. •.• /. v 
 BALTIMORE, NOVEMBER 9 TO 11, iqio 
 
 WASHINGTON 
 
 GOVERNMENT PRINTING OFFICE 
 1910 
 
f^OV 23 1910 
 
8-3175 
 V. S. No. 111. 
 
 
 LETTER OF TRANSMITTAL. 
 
 Department of Commerce and Labor, 
 
 Bureau of t:ie Census, 
 Wa.s/nn<7ton, D. t\, Novemher 7, 1910. 
 
 Sir: The fullest success of the movement for the prevention of 
 infant mortality in this country can only be attained by the aid of 
 complete statistics of infant mortality, and its causes, for the entire 
 United States. 
 
 Registration of births is equally necessary with the registration of 
 deaths. The diagrams will show how woefully the registration of 
 each is neglected. Even so, however, the data presented by the Cen- 
 sus have been largely instrumental in bringing about the movement 
 for saving the lives of infants and children signili/.ed by this meeting 
 of the American Association for Study and Prevention of Infant Mor- 
 tality'. Work for better registration of vital statistics is work for life 
 saving at all ages. 
 
 The diagrams, and this brief explanatory text which incorporates 
 the headings thereof, have been prep.ired under the direction of Dr. 
 Cressy L. Wilbur, chief stitislician for vital statistics. The diagrams 
 were constructed by Miss Alice C. Couffer, assisted by other clerks of 
 the division of vit;il statistics. 
 
 Respectfully submitted. 
 
 Director of the Census. 
 Hon. Charles Nagel, 
 
 Secretary of Commerce and Labor. 
 
 (3) 
 
DESCRIPTIVE LIST OF DIAGRAMS RELATING TO DEATHS 
 
 OF INFANTS. 
 
 PREPARED BY THE BUREAU OF THE CENSUS 
 
 For the Annual Meeting and Exhibit of the American Association for Study and 
 Prevention of Infant Mortality, Baltimore, November 9 to 11, 1910. 
 
 SOURCES AND IMPORTANCE OF VITAL STATISTICS. 
 
 The extent of the efi'ective registration of births and deaths in the 
 United States, its growth during recent years, and the importance of 
 such registration for all sanitary work, and especially for the preven- 
 tion of infant mortality, arc shown by the maps (cartograms) and 
 statements contained in Diagrams Nos. 1 and 2. 
 
 Diagram No. 1. — Map showing Present and Prospective 
 Registration States for Deaths. — Registration cities in nonregis- 
 tration States. Map showing provisional birth registration area. 
 
 Not a single. State, not even a shu/le city, in the entire United States 
 possesses complete registration of hirths. Boston claims to have about 
 the best — only 96 per cent. The most utterly worthless registration of 
 hirths among all the great cities of the entire civilized world may be 
 claimed by the cities of Baltimore, Chicago, and Netv Orleans. Why 
 
 NOT BEGIN REFORM WITH BALTIMORE? 
 
 The Value of Vital Statistics, 
 
 Dr. John N. Hurty, Secretary of the Indiana State Board of Health, 
 says that ^''The accurate collection, tahidation, and analysis of records 
 of births, stillbirths, deaths, marriages, dirorces, and sickness may be 
 said to constitute the bookkeeping of humanity. It is fundamental 
 to the practical application of hygiene, to secure higher efficiency, longer 
 duration of life, and fuller measure of happiness." 
 
 Surg, George B. Young, of the united States Public Health and 
 Marine-Hospital Service, says "Vital statistics are the foundation 
 of scientific public health work, irhich can not begin tnithout access to 
 compilation (f dial .■statistics-/'' (Shall all our American work for the 
 prevention of infant mortality be mere inefiective amateur work 
 because we are not willing to lay a sound basis of vital statistics?) 
 
 Dr. J. H. Mason Knox, Jr., President of the American Association 
 for Study and Prevention of Infant Mortality, says that the origin of 
 this association was due to the examination of the statistics of deaths 
 
 (5) 
 
6 
 
 of infants as presented by the Census Bulletin of Mortalit}'^ Statistics 
 for the registration area of the United States, lloio much more 
 effective in ivspirlng and guiding mnltary effort xoould he relloMe 
 statidics of infantile mortality — which can not Ije ohialned .e'.fcept 
 through state {or city) action — for the entire United States? Why 
 
 NOT BEGIN WITH BALTIMORE? ^ 
 
 What the Census is doing for Better Vital Statistics. 
 
 The United States Bureau of the Census — 
 
 Receives transcripts each year, month by month, from all the States 
 and independent registration cities that possess adequate laws and so 
 enforce them, as to niaJi-e their results of vcdiie'. 
 
 Endeavors, with marked success, to promote the extension of the 
 registration area by the passage, and eiiforceiiieiit, of adequate laws. 
 (See the map at the left of this diagram.) 
 
 Cooperates with the American Public Health Association, the 
 American Medical Association, the American Statistical Association, 
 the American Association for Study and Prevention of Infant Mor- 
 tcdlty, state and count}^ medical societies, state boards of health, com- 
 mittees of state legislatures, the American Federation of Labor, and 
 ever}^ other organization or bod}^ that can be interested in this subject, 
 to the end tJicd tJie United StcUes may attain a coniplete and uniform 
 system (f registration. 
 
 Standardizes methods of collection of data, chiefl}^ by means of 
 the revised United States Standard Certificates of Death and Birth, and 
 cooperative work for uniform methods of administration, uniform tables, 
 and by urging the j^early professional meeting of registration officials 
 in the Section, on Vytcd Statistics of the American Puhllc Health 
 Assoclcdum,. 
 
 Publishes an annual report on mortality statistics each year since 
 1900 (in place of the old decennial report); and for the past two years 
 an annual bulletin of mortality statistics. 
 
 Diagram No. 2. — Increase in the Number of Registration 
 States. Proportion of total population of the United States con- 
 tained in the registration area 1880, 1890, 1900, and 1910. The chief 
 increase of the registration area for deaths lias occurred since the jjer- 
 manent organization of the census,, which peimiits continuous worlx for 
 its eadension. 
 
 WHAT IS INFANTILE MORTALITY? 
 
 The definition of Infantile mortcdity and the movement thereof for 
 those countries for which dffta are available — not for the United States, 
 hecause toe have no adequate registration of hlrths even in the limited 
 ''''registration area'''' for deaths! — are shown in Diagrams Nos. 3 to 5, 
 
Diagram No. 3. — Dkckeask of Infantile Mortality.— /«- 
 fantile mortnlHy is the ratio of deaths of infants under 1 year of 
 age j)<-'>" 1^000 livhig birt/i.s',' foreign countries l)y tive-year periods 
 (1886-1890, 1901-1905). ' No ratex of ivfavtilr wortaUtyare avaUahJe 
 heeause (1) there -w i^o general reghtration of deaths; (£) even for areas 
 with registration of deaths the regls'rafion of births Is incomplete.. 
 
 Diagram No. 4. — Decrkase of Infantile Mortality in Cities. 
 Infantile m'>rtidlty is the ratio of deaths of infants under 1 year of 
 age PER lf)00 living hlrths. Foreign cities hy same Hve-year periods 
 as for foreign countries. Bates of Infantile nt(.rtallty can not be given 
 for American cities on accoant of their d(fectlve registridlon (f births. 
 
 Diagram No. 5.— The Course of Infantile Mortality. 
 A Century of ths History of Infantile Mortality, showing all the Data 
 Available for Various Countries as Compiled by the French 
 Government. The foreign countries are the same as in Diagrams 
 Kos. 3 and 4, the century being by five-3'ear periods from 1801 to 
 1910 for deaths of infant-^ under 1 year of age (stillbirths exchided) 
 per 1,000 living births. [From Statistique Generale de hi France.] 
 
 Tlie era of modurn sanitary civilization may be marked b}' the dates 
 upon which various countries began to record infant mortality. 
 Some countries — China, Turkey, and the United States— even yet 
 possess Ko records of infant mortality. Unless the American 
 people rv(d,'e up, China and Turkey will have satisfactorv data for 
 Infant Mortality long before the United States. Why not begin with 
 Baltim ore ? An d Marylan d f 
 
 BIRTH RATES AND DEATH RATES IN FOREIGN COUNTRIES AND CITIES. 
 
 Infantile mortalit}' tends to diminish more or less in accord with 
 the general tendency to reduction of birth rates and death rates. Of 
 course, the reduction of infantile mortality is in itself an important 
 factor of a diminution in the death rate at all ages, and with a reduced 
 birth rate either the mortality of infants must have decreased to the 
 same or even greater extent or else there would have l)een an increase 
 in the ratio of infantile mortality, Avhich is not the case as shown by 
 the preceding diagrams. The general birth rates and death rates for 
 foreign countries and cities are presented in Diagrams Nos. 6 to 9, which 
 are taken from the International Statistics puI)lishod by the R(^gistrar- 
 General of England and Wales, a copy of whose latest annual report 
 should be in the hands of every serious student of infant moitdity. 
 The omission of the United States from the iutornational data for 
 births is on account of our almost entire lack of effective birth 
 registration. 
 
8 
 
 Diagram No. 6. — Watch the Birth Rate Decrease! There 
 ARE Fewer Deaths of Children Because Fewer Children are Born. 
 This leads, temporaril,y, to a lower general death rate; later, to a higher 
 rate hecause of fewer young jfersons at the most healthy ages. Moral: 
 If fewer babies are born their lives should be more carefully guarded. 
 Number of hirths per 1,000 living jjopulatlon (stillbirths excluded), 
 and per cent decrease for foreign countries by five-year periods. No 
 birth rates are given in the tables of International Statistics for the 
 United States. Why? Are not the births of American babies worthy 
 of registration? Are the births of your children properly registered? 
 Why not? 
 
 Diagram No. 7. — Decrease of the Birth Rate in Cities. Much 
 of the reduction in the number of Deaths of Infants in cities, as for 
 countries as a whole, is due to the diminished birth rate. Hence the 
 necessity for greater saving of the little infant life we are coming to 
 have. ^''An infant saved is worth two infants bornf'' Perhajis. Not 
 even one American city with a birth rate worthy of inclusion in the Inter- 
 Tiational Statistics? Not one single one ! and the accurate registration 
 of births is the absolutely necessary basis of correct data of infant 
 mortality. Why not begin with Baltimore? 
 
 Diagram No. 8. — Decrease of General Death Rate. The 
 *' crude" or "general" death rate- has decreased in most countries 
 having accurate registration during recent j'ears. This decrease is 
 associated with the reduction in infantile mortality. Foreign coun- 
 tries as in preceding diagrams! The "crude" or ordinary death rate 
 (the term does not mean the imperfect or carelessly computed death 
 rate, but is used in contradistinction to a death rate "corrected" for 
 age, sex, or other distribution of population) is the first ready means 
 of comparison for conditions affecting mortality. Human life, on the 
 whole, is becoming safer all over the civilized world ; and for infants 
 as well as for all ages. 
 
 Diagram No. 9. — Decrease of General Death Rate in 
 Cities. The cities of the world share in the general reduction of 
 the death rate, and some, in recent years, have shown heretofore un- 
 exampled low rates. We have reached an era of low mortality; are the 
 babies getting their share? Foreign countries as in preceding diagrams 
 and numbtr of deaths per fOOO living population (stillbirths excluded) 
 by five-year periods, with per cent decrease. 
 
 PROPORTION OF DEATHS OF INFANTS UNDER 1 YEAR AND CHILDREN 
 UNDER 5 YEARS OF AGE TO TOTAL DEATHS. 
 
 As stated on the folloAving diagrams (Nos. 10 and 11), this is a veiy 
 unsatisfactoiy means of studying infant and child mortality, but it is 
 the best we have for some purposes in the almost entire absence of 
 
complete registration of births in the United States. (The onlj' 
 accepted I)asis of comparison is the ratio of d aths of infants under 
 1 year of age to total births; that is, the true infant 'mortality for 
 infants, and a similar ratio is most useful for children under 5 3 ears, 
 although the specific death rate based upon population under 5 years 
 is also of service.) The diagrams at least show what a large propor- 
 tion of total deaths would be affected by efforts for the reduction of 
 infant mortality. 
 
 Diagram No. 10. — Proportion of Deaths of Infants Under One 
 Year and Children XJ^der Five Years of Age to Total Deaths at All 
 Ages, Registration States : 1909. The per cent under 1 year and under 
 5 years is shown for the Registration Area and Registration States, 
 with the proportion of deaths out of ever\^ 100 deaths at all ages, as 
 taken from bulletin of Mortality Statistics, 1909. This is a very 
 unsatisfactory comparison, but no reliable data of infaidde mortality 
 are availaljle because of the lack of accurate registration ofhirths. 
 
 Diagram No. 11. -Proportion of Deaths of Infants Under One 
 Year and Children Under Five Years of Age to Total Dkaths at All 
 Ages, Rsgistratioi Cities : 1999. The same data are shown for Regis- 
 tration Cities, 1909, as in Diagram No. 10 for States. 
 
 LIFE TABLES AND INFANT MORTALITY. 
 
 For the exact study of infant and child mortality, as for any 
 other subject of mortality statistics. Life Tables are most essential. 
 A great diHiculty in the preparation of American Life Tables lies 
 in the worthless registration of births even in that part of the 
 country (.55.3 per cent) now represented in the registration area 
 for deaths. The lirst term of a Life Table is the infant mortality, 
 or the probability of djnng during the year of })ii"th; with this 
 wanting or based upon estimates instead of exact data, all the 
 subseqiient values of life-expectancy are afl'ected. There is as yet 
 no general Life Table for the United States, thjs countr}^ being 
 represented in the collection of national Life Tables published by 
 the German Government only by a table prepared by Dr. Sanuiel 
 W. iVbbott, former secretary of the State Board of Health for 
 Massachusetts. 
 
 It is the task of the Census to prepare, as thoroughly as possible 
 with the inadequate data available, Life Tables based upon the Thir- 
 teenth Census of population. In the meantime much of value maj' be 
 
10 
 
 learned from stud}^ of the foreign Life Tables for (lermany, England 
 and Wales, France, Ital}', and Sweden, the Massachusetts table, and 
 the tentative table for native white males of the registration states as 
 constituted in 1900. The great uniformity of the curves in essential 
 respects and the relative (1) rates of mortality, C^) complete expecta- 
 tion of life, (3) and Lehenskraft, or life power, are given for the whole 
 of life b}^ single years of age, for the first ten j^ears of life, and for 
 the months of the first year of life with as full detail as the data per- 
 mit. The relations of infant mortality to the mortality of other ages 
 can best be appreciated by the study of such diagrams. The dia- 
 gram of specific death rates (No. 20) may be examined in connection. 
 
 Diagram No. 12. — Proeabilitt of Dying in Each Year of 
 Age per 1,000 Entering Upon that Age. Rate of mortality (q^) 
 ^y '^o® in completed years from birth to 100 3'ears, for Germany 
 (1891-1900), England 'and Wales (1891-1900), France (1898-1903), 
 Massachusetts (1893-1S9T), Registi-ation States, Native White (males 
 only, 1900), Italy (1899-1902), and Sweden (1891-1900), for males and 
 females separatelv. /nfant morUdlti/. Note how the death curve 
 resembles an ordinary fishhook (>/). The chief point of this diagram, 
 for the purposes of this meeting, is the barb. Prevention of diarrheal 
 diseases alone irould cut down the rate of Infantile mortality hy one- 
 FOUKTH. It is the object of the American Association for Study 
 AND Prevention of Infant Mortaiiey to cut off the barb of 
 this hook of death. High infant mortalit}^ means weakened child- 
 hood, impaired youth and middle life, and prematurel}^ feeble old age. 
 The point of the barb permits the entrance of poison for the 
 whole of life. The chances of living ought to be greater at birth, 
 NOT LESS, as at present, than at other 'periods of life until extreme 
 
 OLD AGE. 
 
 Diagram No. 13. — Probability of Dying in Each Year of 
 Age per 1,000 Entering Upon that Age. First Ten Years of Life. 
 Data for the same countries as in preceding diagram,. 
 
 Diagram No. 11.— Probability of Dying in Each Month of Age 
 during the First Year of life, and in Each Quarter during tha Second 
 Year, per 1,0C0 Entering Upon Each Month or Quarter. The 
 data are taken from Deutsche Sterletafeln (German Life Tables) for 
 the decade 1891 to 1900, Statlstik des Dexdschen Beichs., Band 200, 
 published in 1910 by the Imperial Statistical Office. Similar tables 
 are given for German states and cities. JVo other country has yet 
 'prepared Life Tahles for infant life in as full detail. 
 
 Diagram No. 15.— Complete Expectation of Life, Average 
 After-Lifetime for Each Age. Years of life expected by age 
 
11 
 
 in completed years from birth to 100 years. The dsita are for the 
 same foreign countries as in previous diagrams. Note horn a Jtigher 
 expectation, at hf'rt/i- -Sweden — correspovds to a higher expectation 
 throughout iiearJy the v'hole of life. Longevity? 77^^^ complete expec- 
 tation of life from a properly constructed life table ix tJic only reliahle 
 weasure of '"''Lovgevlty.^' Average age at death is irortlilcSK for this 
 purpose. The construction o/'life tables for the United States is seri- 
 ously hampered by incomplete registration: of birtlis and deaths. 
 
 DiagTani No. 16.— Expectation oi Life, Average After- 
 Ltfktimk fou Each Age during the First Ten Years of Life. The data 
 and countries are the same as in precedino- diagram covering the tirst 
 ten 3'ears of life. 
 
 Diagram No. 17. — Expectation of I^ife at Each Month of the 
 First Year of Life and Each Quarter of the Second Year of Life, Years of 
 future life expected for each coni pitted month of age for the first year 
 of life and for each completed quarter for the second year of life are 
 shown. Germany is the only country that has yet found it icorth 
 while to measure carefully the exact mortality and life-expectancy of 
 infants during tJie frxt and ><(COnd yearx <flife. 
 
 Diagram No. 18.— Lsbenskraft. Lebenskraft (Life-Power, Life 
 Force, Strength or Life, ''Vitality") is a Term Given Spe- 
 cial Importance in the German Imperial Life Tables, and for 
 Which We Have no Common English P^xpression. It is the 
 relative number of persons who live (liiriiij»' 1 year at each 
 age compared with the number dying* during that year (taken 
 as unity = 1). Lebenskraft per 1,000 by years of age from to 100, 
 etc., the same countries being represented as in preceding diagrams. 
 Lebenskraft is computed in the following way: The Nutnlnir Dying dur- 
 ing any given year of age per 1,000 persons who enter upon that age 
 is taken directlv from the Life Table and is the same thii g as the 
 Prol)(0)iHty of Dying in the year or Rate of Mortality^ which is des- 
 ignated in actuarial notation by the letter q. (See other diagrams.) 
 Therefore Lehenskraft., designated by the Greek letter lamlida (A), 
 
 corresponds to the formula: A = — -• Subtraction of one-lialf year 
 
 is because the number dying during the year at any age (taken as 
 unity = 1) lived, on the average, onl}' one-half of the year of death. 
 [Erom German Imperial Life Tables, published 1910.] 
 
 Diagram No. 19. — Lebenskraft. Lebenskraft or Life-Power for 
 Each of the First Ten Years of Life. (See explanation of term in pre- 
 ceding diagram.) The data are for the same countries as jireviously, 
 and for years of age from to 9. The Lebenskraft is pretty nearly 
 the reciprocal of the Rate (f Mortality at each age. The higher the 
 Rate of Mortalitv the lower the Power of Life, as shown by the 
 
12 
 
 Ratio of the Number Surviving- one 3^ear to the Number Dying during 
 the year at each age. 
 
 Diagram No. 20. — Specific Death Rates. Deaths at Each 
 Age Period per 1,000 Living Population at the Same Age 
 Period. The ages shown are from under 5 years to 75 years and 
 over, and for foreign countries as in preceding diagrams. 
 
 THE CHIEF CAUSES OF DEATH AFFECTING INFANT AND CHILD 
 
 MORTALITY. 
 
 The relative importance of the twenty chief causes of death at each 
 year of life under 5, for the quinquennial period 5 to 9 years, and for 
 the ten decades of human life from birth to the attainment of the age 
 of 100 years, may be seen in Diagrams Nos. 21 and 22, based upon a 
 table in the recently published bulletin of Mortality Statistics, 1909, 
 copies of which are available for distribution at this meeting or may 
 be obtained upon request from the Director of the Census. The two 
 diagrams are strictl}^ comparable, being constructed upon the same 
 scale, and the chief causes of infant and child mortality are well shown. 
 The titles of dissases are those of the International Classification, which 
 has been employed by the Bureau of the Census since 1900. It should 
 be remembered that the surfaces of the circles are proportional to 
 deaths alone, and that the specific d3ath rates at each period in pro- 
 portion to population are not indicated. The death rates would be 
 much higher in the latter years of life, but the relative importance of 
 the causes in each age period would remain unchanged. 
 
 Diagram No. 21. — The Tweaty Most Important Causes of Death 
 at Each Year of A^ge Under 5, and for the Five-Year Period 
 5 to 9, Registration Area of the United States: 1909. Single 
 years of age from 1 to 4, five-j^ear period 5 to 9, with per cent of all 
 known causes at each age, are shown. The Surfaces of the Circles 
 are Proportional to the Total Number of Deaths at Each Age. 
 
 Diagram No. 22. — The Twenty Most Important Causes of Death 
 at Each Decade of Human Life According to the Returns for 
 the Registration Area of the United States: 1909. Per cent of 
 all hiown cause'^ at each age .period. Ten-j^ear age periods are shown 
 from under 10 years to 90 years and over. The Surfaces of the 
 Circles are Proportional to the Total Number of Deaths 
 FROM Known Causes at Each Age Period. (For full data see 
 table on page 21, Bulletin of Mortality Statistics, 1909.) 
 
 Diagram No. 23. — The Three Most Important Causes of Death 
 bURiNG Each Month of the First Year of Life. Computed from Rates 
 OF Infantile Mortality shown in the Registrar-General's 
 
13 
 
 Report FOK England and Wales : 1908. , (Both Sexes.) Infantile mor- 
 tality for each month by agt"^ of infayiU tender 1 year and proportion 
 of deaths to 1^000 births are shown. Eight causes of death (some of 
 them so indefinite as to be worthless for statistical or s mitary purpuses) 
 were responsible, in England., for a.hoat two-thirds of the total infantile 
 mortality. These were Diarrhsal diseases, Premature birth, "Atrophy," 
 "■ Debilitj'," Cono-enital defects, IWninionia,'''' Con ludsioas,'''' Bronchitis^ 
 Whooping cough. Pkeventable. Nonpreventable or indefinite. 
 
 HOW PHYSICIANS REPORT CAUSES OF DEATH OF INFANTS AND 
 
 CHILDREN. 
 
 Diagram No. 24 is the result of a recent compilation prepared with 
 special reference to this meeting of the American Association for Study 
 and Prevention of Infant Mortality for the purpose of showing* the 
 chief terms actually used by physicians in stating the causes of death 
 of infants and children under 5 jears of age, without the customary 
 grouping under the titles of the International Classification. It would 
 be utterly impracticable to attempt to compile separately all the indi- 
 vidual terms employed, some of which are quite worthless as convey- 
 ing an}^ clear idea of the cause of death, or to show the thousands of 
 combinations of terms known as "joint causes." The table, however, 
 includes, in the limited number of causes shown, about two-thirds of 
 the total number of deaths compiled, and indicates that the consolida- 
 tion under the titles of the International Classification does not inter- 
 fere, to any extent, with the satisfactory stud}^ of the causes of infant 
 mo^talit3^ The Census is cooperating with a committee of the Amer- 
 ican Medical Association for an American Nomenclature of Diseases 
 by which physicians may be enabled to report the causes of death of 
 infants and children with greater precision. "Marasmus," for exam- 
 ple, is a worthless return for statistical purposes, and has long been 
 discarded from the best English practice. 
 
 Diagram No. 24. — Most Important Terms Designating Causes 
 of Death Keturned for Children Under 5 Years of Age Based on 
 Special Compilation of Deaths in New York City, Michigan, and 
 Pennsylvania: 1909. [Terms representing less than 1 per cent of total" 
 deaths omitted.] Terms returned singly, in combination, and rejected, 
 with the total number, are shown. The red bars show those returned 
 singly, red and black those in combination, and black those rejected, 
 out of IfiOO deaths from all causes from 10 up to 100. This diagram 
 shows the most important individual terms (not titles of the Interna- 
 tional Classification) as actually used by physicians in reporting deaths 
 
14 
 
 of young children. With two or more causes assigned for the same 
 death, one cause must be preferred in compilation; hence the terms 
 ""rejected" in fav^or of more definite statements. 
 
 Diagrain No. 25. — Most Important Causes of Infant Mor- 
 tality. Actual deaths in the registration area of the United States, 
 1909, from all causes of death respon.sible for as much as 1 death in 
 100 at either the First (0-) or Stcond {!-) years of life. Causes of 
 death by age and number of deaths from 10,000 to 30,000 are shown. 
 The names of all preventable causes of infant mortality (wholly or in 
 large part) are in red. Detailed data and percentages in Census Bul- 
 letin on Mortality Statistics, 1909. 
 
 Diagram No. 26. — The Greatest Foe of Infant Life is Diar- 
 rhea and Enteritis. Over two-thirds of the deaths from this disease are 
 those of hahies under 1 year. The number of deaths during live years 
 by calendar months for the registration area of the Uni,ttd States, 
 1900-190 Jf., is shown. Diarrhea and enteritis (which term includes 
 cholera, infantum, gastroenteritis, milk infection, intestinal toxemia, 
 etc.) is a seasonal disease. That is to say, hot weather permits rapid 
 putrefactive changes in uncooled and filth-infected food, more especi- 
 ally the baby's milk. Breast-fed children largely escape. 
 
 THE MESSAGE OF VITAL STATISTICS TO THE AMERICAN ASSOCIATION 
 FOR STUDY AND PRETENTION OF INFANT MORTALITY. 
 
 Begin the attack upon infant mortality with the prevention of the DIARRHEAL 
 DISEASES OF INFANCY, taking precautions early in tie year, B3F0RE the onset 
 of hot weather, that all food supplies, and especially MILK, that will be used by 
 infants during the approaching hot weather of Jaly and Augist, shall be kept in 
 proper sanitary condition. The same precautions, of course, should be continued as 
 a matter of fixed custom and habit throughout the year, bat the immediate effects 
 of reduced mortality of infant life will be gained by special vigilance B5F0RS the 
 period of maximum mortality from diarrheal diseases, as shown in the preceding 
 diagram. The prevention of these diseases— which are preeminently FILTH DIS- 
 EASES — will wipe out one-fourth of the total number of deaths of babies under 2 
 years of age. 
 
 It will do more than that. Many of the deaths from "convulsions," "marasmus," 
 "congenital debility," and even "premature birth," are in reality due to diarrhea and 
 enteritis. All preventive measures tend to diminish mortality from other causes, some 
 of which may not seem to be closely associated with them. The prevention of all 
 deaths from diarrheal diseases would mean more nearly the reduction of infant mor- 
 tality by one-half than by one-fourth. 
 
 Other causes may be restricted, but it is not worth while to divert our most serious 
 efforts to them UNTIL WE HAVE CONaiTERED DIARRHEA AND ENTERITIS, 
 THE MOST DEADLY ENEMY OF INFANT LIFE. 
 
15 
 
 HOW THE CENSUS IS WORKING FOR BETTER VITAL STATISTICS. 
 
 The Bureau of the Census lias been constantly hiborino", since its 
 peniianent or^anizition in li*02, for better vital statistics, which 
 means, as a vqvv important pirt thereof, statistics of ivfant mor- 
 tality. Some of the means that it employs are shown in Diaoram 
 Mo. 27, and consist of special census pamphlets, annual bulletins, 
 annual reports, the Standard Birth and Death Certiticates, n)aiuuils of 
 the International Classification of Causes of Death (one of which, now 
 in preparation, will be distributed to every physician in the United 
 States about December 1), and Monthly Check Lists designed to secure 
 exact correspondence in the returns as com[)iled by the Census and 
 by state or city offices. 
 
 Diagraiii No. 27. — Some Census Publications and Blanks 
 ON Vital Statistics. Census pamphlets for extension and standardi- 
 zation of vital statistics: 
 
 No. 103. L3g:islativ3 Rsquirsmsnts for Rsglstration of Vital Statistics. 
 No. 101. Practical Rsglstration Msthods. 
 No. 102. R3lation of Physicians to Mortality Statistics. 
 No. lOi. Registration of Births and Dsaths. 
 No. 105. Statistical Traatmant of Causas of Death. 
 No. 106. Extension of the Registration Area for Births and Deaths. 
 
 No. 107. Modes of Statement of Causes of Death and Daratian of Illness upon Csrtiflcates of 
 Death. 
 No. 108. Legal Importance of Registration of Births and Deaths. 
 No. 103. Tuberculosis in the United States. 
 
 \^0t her pamphlets In preparation are: Physlcian''s Pocl'et Reference 
 to the International List of Causes of Death; Practical Conxtruc- 
 tl.on and Administration of a Registration La id for Vital Statis- 
 tics; and Uniform Tables for Vital Statistics and Methods (f Sta- 
 tistical Worl\ for State and City Registration Offices.^ 
 Manual of International Classification, 1902, and translation of 
 Revised International Classification, 1910 {Revised Manual in prepa- 
 ration)'^ Annual Bulletins, 1908 and 1909; Annual Reports, 1900 to 
 1908; Standaid Birth and Death Certificates; State and City Regis- 
 trar's Monthly Check Lists; New Punch Card., with provision for 
 ages of Infants In Days and MontJis (old card gives binder 1 year onl}'). 
 
 Help the iiioveiiient for better vital statistics, anil 
 especially better statistics of infant mortality, in YOUR 
 state and city. 
 
LIBRARY OF CONGRESS 
 
 013 825 425 2