HB 133.2 ■SsBa HB 1323 .S5 B2 Copy 1 A REPORT DEATH-RATE OF EACH SEX IN MICHIGAN, COMPARISON WITH DR. FARR'S LIFE TABLES OF HEALTHY DISTRICTS OF ENGLAND. WITH A STATEMENT CONCERNING INFANT MORTALITY IN MICHIGAN. BY HENRY B. BAKER, M. D., Secretary of the State Board of Health, Xnd Registrar of Vital Statistics in Michigan. \Reprinted from Vol. IJ. Public Health Papers of the American > Public Health Association^ 1876. ;/) CAMBRIDGE: ^rintcD at tfjc 0i\jcr^idc ^u$$. 1876. s A REPORT ON THE DEATH-RATE OF EACH SEX IN MICH- IGAN, AND A COMPARISON WITH DR. FARR'S LIFE TABLES OF HEALTHY DISTRICTS OF ENGLAND. By henry B. baker, M. D., Secretary of the State Board of Health, and Registrar of Vital Statistics of Michigan. KEAD AT THE ANNUAL MEETING IN PHILADELPHIA, NOVEMDER 10, 1S74. In Stating and comparing the total death-rate in Michigan, I do so by means of Life Tables, for the reason that I know of no other method whereby it can be properly stated or compared. VVe may say that the annual mortality is such a specified per cent, of the living inhabitants; but the population of our cities and States is far from a fixed one, and varies in each city. State, or country, and the death-rate depends so much upon the age and sex of the inhabitants that no very useful estimate of the healthful- ness or unhealthfulness of a climate or locality can be formed from such imperfect data. It is requisite, first, to construct a Life Table, or to reduce the statement to one concerning a "fixed population," — that is, a popula- tion such as would be maintained in that locality by a specified, constant, and uniform birth-rate alone, without immigration or emigration. Life Tables for the entire United States, constructed from the United States censuses, are almost necessarily to some extent " evolved from the inner consciousness " of those who construct them. This is so for the reason that it has not been possible to obtain reliable data which would enable one to make the necessary corrections for the omission of deaths in the enumera- tion. That this may not stand simply as an unsupported assertion, I wish to cite a few of the recognized authorities. Referring to this subject, the author of the Life Table in the United States Census volume for i860 re- marks : "Hence to know the true law of mortality, we must either await such progressive registration, or else resort to new methods of analysis and combination of the existing statistics, as here proposed." For the Life Table published in that volume the death-rate appears to have been estab- lished by first increasing the deaths returned by a constant factor, derived from the mind of the statistician, then separately modifying the death-rate of those aged under five years, of those aged 70 to 80 years, and of those aged 80 to 90 years, each by a different factor arrived at by estimates, appar- ently based upon the author's general knowledge of vital statistics. For the Life Table published with the census of 1870, Mr. Elliott in- creased the deaths returned by 41 per cent., this being requisite to make the death-rate equal that in England and Wales. It may be objected that when this is done we do not learn anything concerning the real death-rate in the United States, for we have forced it to appear the same as already found to 2 REPORT ON THE DEATH-RATE be in some other country. Life Tables thus constructed must necessarily be very much like Life Tables in England and Wales. On this point Mr, Elliott remarks ^ that " It is impossible to determine with precision the amount of deficiency in the return of deaths, but from the results herein computed on the assumption of a deficiency of forty-one per cent., it is easy to calculate corresponding values which shall conform to the assumption of any other supposed rate of deficiency." In the Insurance Report of Massachusetts for the year 1868, page 103, Mr. L. W. Meach published a Life Table for males in the United States, " upon the ample basis of thirty years' observations," which probably means that it was formed from the three United States Censuses of 1840, 1850, and i860; but upon what plan the omissions in returns of deaths were estimated is not stated. Other Life Tables may have been published, but all that have come to the writer's notice have been mainly estimates, in the absence of exact evidence on the subject. General Walker, Superintendent of the Ninth United States Census, remarks that " The dimensions attained by the life insurance interest within the past few years make it peculiarly a matter of regret at the present time that the census should not afford the data for determining with absolute precision and certainty the death-rate of the country, whether in the aggregate, or by classes of the population." ^ Inasmuch as no method has yet been found, or at least acted upon, whereby the actual death-rate can be positively ascertained for the United States, or, so far as I know, for any single State, I venture to offer these Life Tables for males and for females in Michigan, as tables based entirely upon evidence of the death-rate in the State, the corrections for omissions in enumerating being made upon a principle which does not appear to have been tried in any other locality. The principle upon which the correction is made may be stated briefly as follows : The number actually omitted be- cause of a delay of a given time, as for instance of one year, is ascertained by comparing the results of two separate enumerations of the deaths in the same locality during the same time, one enumeration being made at one time by one set of officers, the other at a different time by a different set of officers. We thus find the proportion of deaths omitted after the lapse of a given time. It is assumed that the proportional number omitted is in proportion to the length of time which has passed since they occurred, and before their enumeration. It is not possible to say that even if enumerated in the same months in which the deaths occurred none would be forgotten or overlooked ; but for this, no correction has been proposed, and none is here offered. It is not probable that many would be omitted under such circumstances. It is quite probable that some other modification may hereafter be discov- ered to be essential to perfect accuracy, but the writer believes that this method will be found to be adequate to the correction of at least the greater part of the error in the returns of deaths made after the close of the year in which the deaths occurred, as is the case at present in Michigan and in the enumeration for the United States Census. 1 Page 10, Vital Stat. U. S. Census, 1S70. 2 Foot-note on page 9, Vital Stat. U. S. Census, 1S70. OF EACH SEX IN MICHIGAN. 3 The results of this method of correction, which apj^ear in this table for males and females, are based simply upon the evidence collected in one State, and in one year, — that of 1870. In order to render the evidence more reliable, observations must be extended through a long series of years. The death-rate in Michigan, so far as evidenced by the returns, was larger during the year 1870 than it usually is, the increased number of deaths being re- turned as caused by zymotic diseases. There were no very serious epidem- ics of small-pox, cholera, or other contagious diseases, except scarlatina, from which 852 deaths were returned. These tables do not therefore include those chances of death attendant upon serious epidemics. The correction for omissions was made by comparing the returns for the census year as made by the registration officers with those of the census marshals, thus : Deaths by Census. Deaths by Registration. Dec. i86g. Jan. 1870. Dec. iS6g. Jan. 1S70. 801 : 800 : : 836 : X , whence X = 834. The number act- ually returned for January, 1870, by the registration officers was 421; 834 — 42i=:4i3^98.o9 per cent, of the numbers returned. The deaths for De- cember and January were enumerated by the census marshals about five months after they occurred ; the deaths for December were enumerated by the registration ofiicers after about four months, but the deaths for January were not enumerated by the registration officers until after a year and four months. This 98.09 per cent, was therefore added to the deaths for Jan- uary, 1870, as a correction for omissions because of one year's additional time elapsing between the occurrence of the deaths and their enumeration. Upon evidence which seemed to warrant the assumption, it was assumed that if the lapse of one year's time resulted in omissions to such an extent that 98.09 per cent, of the deaths returned should be added to them to make them equal the deaths which would have been returned if enumerated in months of occurrence, then the lapse of one month's time would require the addition of one twelfth of that per cent, and the intermediate months in a corresponding proportion. The methods and results of the corrections will be best explained by means of exhibits A and B, and diagrams 3 and 4, graphically representing the same. REPORT ON THE DEATH-RATE -^ ^t^ C5 :^ f^ ^ '^ I S^ -"is ^^ ^ .fi" ^ 1 1^ ^ ^ ">? «-> •S ?5 <-> 5? C J3 ^ S ^ vAi G ^ ? ^ ^ E^ ^ ^ V ^ c^ i ^ •I" ^ So I i :^ to ^ g "=>' 5 ^^ \ kj 8 .^ ^ !>i V ^ S ^ 53 8 'u <-, S ^ O ^ b!?, < (—1 pq XI ^ i Oo ^ "^ S ■55 •S 1-5 05 -^ ■§ ■^ "n .<-> ^ V ~ >^ ■;2 1 5^ ^ S ^ ^ 0=^ 1 V 1 ^ •^ ^ ►^i C^ ?> "s^ •X3 -C o ^ *± .2 ^ ^ =2 ^ % ° c; '^3 o - T3 § ij Cm O D (« 01 +J. Ti S O a bJO < o o ^ pi >< rt t1 ^-1 hn ^ fTl Q OJ Cl VI OJ ;-! rt cj - pq V, '^ U1 rt tn O ^^ (U 0) .2 DIAGHxUI X?3. Dsai; i^l!i:M§aii durmg year endii^ Jtjuc 11370 a; rs^amed, 's cciTsrwed for Cteky of oneyear, corrected as if emimerxLsd in months "" cccurrsnce sjasJiiied to tmifcrir: p op-jlation, as corrected aad egua.- hzQi to Timfom poptilitios.- md tc months of ^zmfbnn length. TOt CALVERT urn. CO. DETRO Dedcuei ly KB.BakerJlH OF EACH SEX IN MICHIGAN. 6 REPORT ON THE DEATH-RATE The omissions during the year ending Jime i, 1870, appeared to be such that the deaths returned should be multiplied by 1.86 in order to equal the number which was believed to have occurred, but the deaths returned for the year ending December 31, 1870, corrected upon the same principle, it appears should only be multiplied by 1.79 in order to equal the true num- ber. As the system of registration becomes more perfect, it is probable that the amount of the correction may be modified, and a mean of several years would approximate closer to the true statement. These life tables are made by using the decimal 1.86 with which to multiply the deaths returned, that being the first result of a direct comparison and correction in this man- ner. It is possible that it may increase the number of deaths slightly more than should be done. For the year for which the tables are made, deaths were also returned in greater number than for the year preceding or suc- ceeding. On the other hand, no very extraordinary epidemic prevailed. The correction is only claimed to make the deaths equal the number which would have been returned if enumerated in the months when they occurred. In constructing these life tables for Michigan, the population represented by deaths was equalized throughout all ages before computing the death- rate, which was computed for each and every age, in order that if any real " climacteria " exist they might be discovered. Climacteria cannot well be discovered when the death-rate is computed by periods often years. If the death-rate is computed by periods of five years, every alternate period will contain the important even year — such as twenty, thirty, forty, fifty, etc. — and the death-rate for that period will appear too small, because the number of inhabitants stated in the census as living at such ages is always too large. The statement of the age of persons who have died is much more accurate than the statement of the age of the living. By equalizing the population before computing the death-rate, we may avoid equalizing the deaths, and leave them free to exhibit at each and every age any variation which may occur. It may be proper in this connection to call attention to the fact that the life table for females in Michigan, does not show any extraordinary increase of the death-rate of women aged forty to fifty years as compared with the males of the same ages ; on the contrary for about all ages over that of fifty years, the death-rate of males exceeds that of females. It increases some- what rapidly, however, for both sexes, at about that age. The essential columns of these life tables are here presented. OF EACH SEX IN MICHIGAN. Table i. — Exhibiting the essential parts of Life Tables for each sex in Michi- gan, stating, for each age, the Chances of Death for one thousand persons living at that age, the Average Future Duration of Life, the Probable Fiitm-e Duration of Life, and the Probable Age at Death. Age in Deaths to one thou- Mean after Lifetime True Expectation of Years. sand iving. at each Age.i Life (Probable Life). Probable A ge at Death. Males. Females. Males. Females. Males. Females. Males. Females. 1 69. 1 1350 43-79 44.24 53-05 49-52 53.05 49.52 I 56.2 47.8 51.61 50-07 60.48 58.14 6L48 59.14 2 29.8 254 53-65 51-56 61.23 59-93 63.23 61.93 3 22.7 18.8 54-28 51.89 61.24 59-91 64.24 62.91 4 14.0 13-5 54-53 51-87 60.91 59-58 64.91 63.58 5 II.7 ii.S 54-30 51-58 60.24 59-03 65.24 64.03 6 S-5 10.7 53-94 51.19 59-48 58.30 65.48 64.30 7 5-9 7-4 53-39 50-73 58.66 57-56 65.66 64.56 8 6.7 6.6 52-71 50.11 57-78 56-73 65.78 64.73 9 ^1 6.6 52.06 49-44 56.92 55.88 65.92 64.88 lO 5-6. 4-5 51-34 48.76 56.04 55-31 66.04 65.31 II 4.0 4.8 50-63 47-98 55-18 54-17 66.18 65.17 12 5-2 5-3 49-S3 47-21 54-29 53-31 66.29 65.31 13 4.0 6-3 49.09 46.46 53-42 52.46 66.42 65.46 14 4.1 5-6 48.28 45-75 52-52 51-65 66.52 65.65 15 3-9 8.8 47.48 45.01 51-63 50.81 66.63 65.81 i6 4.2 7-5 46.66 44-40 50-73 50.06 66.73 66.06 17 5-7 9.4 45-86 43-73 49-83 49.29 66.83 66.29 i8 4-7 8.7 45.12 43-14 48.98 48.58 66.98 66.58 19 8.8 11.7 44-33 42.52 48.10 47-84 67.10 66.84 20 6.9 8.8 43-72 42.02 47-32 47.16 67.32 67.16 21 10.5 8.4 43-02 41.38 46-49 46.38 67.49 67.38 22 7-3 12.7 42.47 40.73 45-75 45-58 67.75 67.58 23 7.8 8.1 41.78 40.25 44-93 44-89 67.93 67.89 24 6.6 II. 2 41.10 39-57 44.20 44.08 68.20 68.08 25 6.1 9-3 40-37 39.02 43-46 43-32 68.46 68.32 26 69 10.8 39.62 38-38 42.70 42.52 68.70 68.52 27 6.4 II. I 38.89 37-79 41.97 41-75 68.97 68.75 28 6.7 'o-5 38.14 37-21 41.14 40.98 69.14 68.98 29 6-3 8.9 37-39 36.67 40.30 40.29 69.30 69.29 30 5-9 II.4 36.62 36.00 39-45 39-51 69.45 69.51 31 %-^ 9.4 35-S4 35-41 38-59 38.78 69.59 69.78 32 8.9 IS.3 35-06 34-74 37-73 38.00 69.73 70.00 33 7-1 8.4 34-37 34-38 36-94 37-34 69.94 70.34 34 6.2 II. 6 33-61 33-66 36.07 36-50 70.07 70.50 ^1 8.2 15.8 32.82 33-05 35-15 35-70 70.15 70.70 36 6.1 9.1 32-09 32-58 34-27 34-99 70.27 70.99 21 6.3 1 1.4 31.28 Z^-'^l 33-36 34.16 70.36 71.16 3S 10. 13.6 30.48 31-23 32.45 33-38 70.45 71.38 39 6.3 10.5 29.78 30.66 31-59 32-64 70.59 71.64 40 9.2 8.2 28.96 29.98 30-67 31-S3 70.67 71.83 41 6.4 8.1 28.23 29.22 29.80 30-99 70.80 71.99 42 9-3 13-7 27.41 2S.46 2S.89 30.12 70.89 72.12 43 10.8 11.4 26.66 27.84 28.01 29.35 71.01 72.35 44 "•5 10.4 25-95 27.16 27.18 28.53 71.18 72.53 ^^ II. II. 2 25-24 26.44 26.36 27.70 71.36 72.70 46 II.O 6-3 24.52 25-73 25-53 26.88 71.53 72.88 47 S-5 II. 5 23-78 24.89 24.70 25.98 71.70 72.98 48 10.3 14.7 22.98 24.18 23.82 25-15 71.82 73.15 49 12.6 II. 5 23-53 22.98 24.36 71.98 73.36 50 17-5 16.6 21.50 22.80 22.13 23-53 72.13 73.53 51 12.4 9.1 20.87 22.17 21-33 22.76 72.33 73.76 52 18.S 14-5 20.12 21-37 20.47 21.89 72.47 73.89 53 15-3 14.8 19.49 20.68 19.68 21.08 72.68 74,08 1 Average Future Duration of Life, so-called " Expectation of Life." RErORT ON THE DEATH-RATE Table i. — Life Table fo7- Michigcvi, Co?itinned. Age in Years. Deaths to sand : one thou- iving. Mean after Lifetime at each Age.i True Expectation of Life (Probable Life). Probable A ;e at Death. Males. Females. Males. Females. Males. Females. Males. Females. 54 17.8 13.2 18.79 19.98 18.85 20.26 72.85 74.26 55 22.1 17.2 18.12 19.24 18.06 19.42 73.06 74.42 56 19.5 20.5 17-52 18.57 17-37 18.62 73.37 74.62 57 29.2 18.0 16.86 17-95 16.64 17.85 73.64 74.85 5S 25.0 12.3 16.35 17.27 16.04 17.07 74.04 75.07 59 19.2 15.0 15.76 16.48 15-39 16.22 74.39 75.22 60 24.2 20.1 15.06 15-72 14.65 15.41 74.65 75.41 61 24-3 16.7 14.42 15.04 13-97 14.67 74.97 75.67 62 37-9 26.6 13-76 14.28 13.28 13-87 75.28 75.87 63 28.3 28.4 13.29 13.66 12.74 13-15 75.74 76.15 64 33-3 42-5 1266 13.04 12.07 12.42 76.07 76.43 65 47 -o 34-0 1208 12.60 11-39 11.80 76.39 76.80 66 38.3 32-7 11.65 12.03 10.84 11.12 76.84 77.12 67 39-6 40.1 11.09 11.42 10.18 10.46 77.18 77.46 68 24.9 45-9 10.53 10.87 9-51 9.86 77.51 77.86 69 41.7 40.6 9-79 10.37 8.71 9.26 77.71 78.26 70 69-3 S4-0 9.19 9-79 8.04 8-59 78.04 78.59 71 63.8 51-7 8.84 9-32 7.70 8.00 78.70 79.00 72 85-3 60.3 8.41 8.80 7-25 7-44 79.25 79.44 IZ 70.1 67.9 8.15 8-33 6.92 6.92 79.92 79.92 74 71.8 82.3 7.72 7-90 6.48 6.47 80.48 80.47 75 79-7 77-5 7.28 7-57 6.02 6.11 81.02 81.11 76 lOI.O 105.1 6.87 7.16 5-63 5-71 81.63 81.71 77 117.4 96.0 6.58 6.94 5-36 5-51 82.36 82.51 78 105.3 120.7 6.40 6.63 5.16 5.20 83.16 83.20 79 122.6 1 18.3 6.09 6.47 4.S7 5.06 83.87 84.06 80 126.0 1 23. 1 5-87 6.27 4.66 4.89 84.66 84.89 81 129.4 127.9 5-65 6.08 4-44 4.72 85.44 85.72 82 142.8 132-7 5-41 5.89 4-23 4-57 86.23 86.57 83 145.2 137-5 5-23 5-72 4-09 4.42 87.09 87.43 84 157-0 142.3 5-04 5-55 3-93 4.26 87.93 88.26 85 159-1 147.1 4.88 5-39 3.80 4-13 88.80 89.13 86 161. 2 151-9 4.71 5-24 3-64 4.00 89.64 90.00 87 171. 156-7 4.52 5.09 3-46 3-89 90.46 90.87 88 180.8 161. 5 4-35 4-94 3-30 yn 91.30 91.77 89 190.6 166.3 4.21 4-79 3.16 3-65 92.16 92.65 90 197.1 171. 6 4.08 4-65 3-05 3-54 93.05 93.54 91 203-5 177-5 3-96 4-51 2-95 3-42 93.95 94.42 92 210.0 183.4 3-85 4-37 2.86 3-31 94.86 95.31 93 216.S 189.3 3-74 4.24 2.78 3.20 95.78 96.20 94 223.0 195-2 3-63 4.12 2.70 3-09 96.70 97.09 % 229.5 201. 1 3-53 3-99 2.63 2-99 97.63 97.99 96 235-9 207.0 3-43 3-87 2-55 2.91 98.65 , 98.91 97 242.4 212.9 3-34 3-75 2.48 2.84 99.48 99.84 98 248.9 218.8 3-25 3-63 2.40 2.76 100.40 100.76 99 255-4 224.7 3-17 3-50 2.34 2.68 101.34 101.68 100 261.9 230.6 3-09 3-37 2.29 2.61 102.29 102.61 loi 268.3 236.5 3-00 3-23 2.23 2-54 103.23 103.54 102 274.8 242.4 2.91 3.08 2.20 2.49 104.49 104.49 103 281.3 248.3 2.81 2.90 2.07 2-43 105.07 105.43 104 287.8 254-2 2.70 2.69 2.00 2.38 106.00 106.38 105 294-3 260.1 2.62 2-43 2.00 2-33 107.00 107.33 106 300.7 266.0 2.50 2.11 2.00 2.16 108.00 108.16 107 307.2 271.9 2-33 1.67 2.00 1.61 109.00 108.61 108 313-7 514.6 2.08 1.09 2.00 •95 110.00 108 95 109 320.2 757-3 1-75 •75 1.67 .67 110.67 109.67 no 326.7 1 000.0 1-37 •50 ^■Zl •50 111.33 110.50 111 663-3 - .90 1.00 112.00 - 112 1 000.0 ~ -50 — •50 — 112.50 "" * Average Future Duration of Life, so-called " Expectation of Life.' OF EACH SEX IN MICHIGAN. 9 Table 2. — Exhibiting the essential parts of Life Tables, for each Sex, in the Healthy Districts of England, stating the Chances of Death for one thou- sand persons living at each age, the Average Future Duration of Life at every ffth age, the Probable Future Duration of Life at each age, and the Probable Ag;e at Death. As;e in Years. Deaths to sand 1 one thou- ving.i Mean after Lifetime at each age.- True Expectation of Life (Probable Life).i Probable As e at Death.i Males. Females. Males. Females. Males. Females. Males. Females. 1 1 2.8 92.6 48.56 49-45 58-55 59-24 58.55 59.24 I 35-1 31-9 - 62.32 62.26 63.32 63.26 2 21.8 21.7 _ - 62.41 62.34 64.41 64.34 3 15.4 15-3 _ - 62.04 62.02 65.04 65.04 4 12.6 12.5 _ - 61.46 61.48 65.46 65.48 5 10.3 10.3 54-39 53-93 60.80 60.84 65.80 65.84 6 8.3 8.4 60.06 60.13 66.06 66.13 7 6.7 7.0 _ - 59-24 59-36 66.24 66.36 8 5-5 5-9 - - 58.39 58.55 66.39 66.55 9 4.6 5-2 - - 57-51 57.71 66.51 66.71 10 4.0 4-7 51.28 50.88 56.61 56.84 66.61 66.84 II 3-6 4-5 - 55.70 55-97 66.70 66.97 12 3-6 4-5 - - 54-78 55.08 66.78 67.08 13 3-6 4-7 _ - 53.86 54.20 66.86 67.20 14 3-9 5-1 - - 53.05 53.32 67.05 67.32 15 4-3 5-5 47.20 47.04 52.13 52.44 67.13 67.44 16 4-7 6.0 - 51.23 51.58 67.23 67.58 17 5-2 6.5 _ - 50.34 50.72 67.34 67.72 18 5-8 6.9 _ - 49.46 49.88 67.46 67.88 19 6.4 7-4 - - 48.59 49-05 67.59 68.05 20 7.0 7-7 4340 43-50 47-74 48. 2 2 67.74 68.22 21 7-1 7-9 46.89 47.40 67.89 68.40 22 7-3 8.0 - - 46.05 46.57 68.05 68.57 23 7-5 8.1 - - 45.20 45.76 68.20 68.76 24 7.6 8-3 - - 44.36 44.94 68.36 68.94 25 7.8 8.4 39-93 40. 1 S 43.52 44.12 68.52 69.12 26 7.8 8-5 - 42.68 43.30 68.68 69.30 27 7-9 8.6 - - 41.84 42.48 68.84 69.48 28 8.0 8.8 _ - 41.00 41.66 69.00 69.66 29 8.1 8.8 _ - 40.16 40.84 69.16 69.84 30 8.2 8.9 36-45 36-85 39-31 40.02 69.31 70.02 31 8.3 9.0 38-47 39.20 69.47 70.20 32 8.3 9.1 - - 37-63 38.37 69.63 70.37 Zl 8.4 9.2 - - 36.79 37.55 69.79 70.55 34 8.5 9-3 - - 35-94 36.73 69.94 70.73 35 8.7 9.4 32.90 33-46 35.10 35.90 70.10 70.90 36 8.8 9-5 34.25 35.08 70.25 71.08 37 8.9 9-7 - - 33-41 34.25 70.41 71.25 38 9.0 9.8 - - 32.57 33.42 70.57 71.42 39 9.2 9.9 - - 31.72 32.59 70.72 71.59 40 9.6 lO.O 29.29 30.00 31.19 31.77 71.19 71.77 41 9.6 10.2 - - 30.04 30.94 71.04 71.94 42 9.8 10.3 - - 29.20 30.11 71.20 72.11 43 10. 1 10.5 _ - 28.36 29.28 71.36 72.28 44 10.4 10.7 - - 27.52 28.45 71.52 72.45 45 10.8 10.9 25-65 26.46 26.69 27.63 71.69 72.63 46 II. I II. I - 25.86 26.80 71.86 72.80 47 II. 5 11.4 - - 25.03 25.98 72.03 72.98 48 12.0 11.6 - - 24.21 25.15 72.21 73.15 49 12.5 1 1.9 - - 23.39 24-33 72.39 73.33 1 Computed from Dr. Farr's Life Tables. 2 Average Future Duration of Life, so-called " Expectation of Life." Taken from Dr. Farr's Life Tables for Healthy Districts. Quoted from Walford's Insurattce Cyclopisdia. 10 REPORT ON THE DEATH-RATE Table 2. — For Healthy Districts of England, Cojitinued. Age in Deaths to one thou- | Mean after Lifetime True Expectation of Years. sand 1 ving.^ at each age.^ Life (Probable Life).' Probable Ag e at Death.i Males. Females. Males. Females. Males. Females. Males. Females. 50 13.0 12.2 22.03 22.87 22.58 23-51 72.58 73.51 51 13-6 12.5 - - 21.77 22.69 72.77 73.69 52 14.2 12.9 - - 20.96 21.87 72.96 73.87 53 14.9 ^■3 - - 20.16 21.06 73.16 74.06 54 157 13-7 - - 19-37 20.24 73.37 74.24 55 16.5 14. 1 18.45 19.24 18.59 19-43 73.59 74.43 56 17.4 14.2 - - 17.81 18.63 73.81 74,63 57 18.3 16.2 - - 17.04 17.82 74.04 74,82 5S 19.4 18.2 - - 16.28 17.04 74.28 75.04 59 21.4 20.3 - - 15-52 16.27 74.52 75.27 60 237 22.3 15.06 15-69 14.79 15-53 74.79 75,53 61 26.1 24.4 - 14.07 14.81 75.07 75.81 62 28.S 26.5 - - 13-38 14.10 75.38 76.10 63 3I-I 28.8 - - 12.71 13-42 75.71 76.42 64 33-9 31.2 - - 12.06 12.75 76.06 76,75 65 36.8 33-9 12.00 12.5S 11-43 12.10 76.43 77.10 66 44.8 36-7 - - 10.S2 11.47 76.82 77.47 67 43-4 39-7 - - 10.23 10.85 77.23 77.85 68 47.2 43-1 - - 9.66 10.26 77.66 78.26 69 51.2 46.8 - - 9.11 9.68 78.11 78.68 70 55-6 50.8 9-37 9-85 8.58 9.12 78.58 79.12 71 60.4 55-2 - 8.07 8.59 79.07 79.59 72 65-7 60.0 - - 7-59 8.08 79.59 80.08 73 71-3 65.2 - - 7-13 7.59 80.13 80.59 74 77-4 71.0 - - 6.69 7.12 80.69 81.12 75 84.0 77-2 7-15 7-52 6.27 6.67 81.27 81.67 76 91. 1 83-9 5.87 6.25 81.87 82,25 77 98.6 91. 1 - - 5-50 5.84 82.50 82.84 78 106.9 99.0 - - 5-14 5-47 83.14 83.47 79 115-5 107.3 - - 4.81 5.10 83.81 84.10 80 124.9 1 16.2 5-37 5-64 4.50 4-77 84,50 84.77 81 1347 125.8 - 4.20 4.46 85.20 85,46 82 145.2 135-9 - - 3-93 4.16 85.93 86,16 ^3 156.4 146.9 - - 3-68 3.88 86.68 86,88 84 167.9 1 58. 1 - - 3-44 3-63 87.44 87.63 85 180.2 173.0 4.01 4.19 3.21 3-39 88.21 88,39 86 1934 182.9 - 2.99 3.16 88.99 89.16 87 206.5 196.5 - - 2.81 2-95 89.81 89.95 88 220.8 210.0 - - 2.64 2.77 90.64 90.77 89 235-6 224.5 - - 2.48 2-59 91.48 91.59 90 2507 240.3 2.99 3-" 2.32 2.43 92.32 92.43 91 265.6 254.8 - 2.17 2.27 93.17 93.27 92 281.9 272.1 - - 2.01 2.12 94.01 94.12 93 301.2 287.7 - - 1.90 1.97 94.90 94.97 94 314-5 307.7 - - 1.81 1.86 95.81 95.86 95 335-1 321.4 2.25 2.32 1. 71 1.76 96.71 96.76 96 348.8 345-0 1.63 1.66 97.63 97.66 97 369.0 357-1 - - 1.52 1-59 98.52 98,59 98 396.2 375-0 - - 1.42 1.50 99.42 99,50 99 406.2 400.0 - - 1.38 1.41 100.38 100,41 100 421. 1 407.4 1.69 1-75 1.30 1.36 101.30 101.36 lOI 454-5 437-5 - 1. 17 r-25 102.17 102.25 102 500.0 444.4 - - 1.00 1. 17 103.00 103.17 103 333-3 600.0 - - 1.50 •83 104.50 103.83 104 500.0 500.0 - - 1. 00 1. 00 105.00 105.00 105 1 000.0 - - - •50 1.50 105.50 106.50 106 ~ 1 000.0 ~ — •50 — 106.50 1 Computed from Dr. Farr's Life Tables. * Average Future Duration of Life, so-called " Expectation of Life." Taken from Dr. Farr's Life Tables for Healthy Districts. Quoted from Walford's Insurance Cyclopcedia. OF EACH SEX IN MICHIGAN: 1 1 After making the most that could conveniently be made of the evidence to be obtained in Michigan, it became desirable to bring external evidence to bear upon the result. In looking about for some proper standard of comparison, the Life Tables constructed by Dr. Farr for the "healthy dis- tricts" of England have been selected, for several reasons: the two locali- ties are not very dissimilar as regards average temperature, moisture of the atmosphere, etc. ; both are nearly surrounded by water, the inhabitants of the two localities number about the same, and although there are many points of contrast, these " healthy districts " of England bear quite a close relation to Michigan as regards conditions affecting life and health. Finally, it is about the only locality of which I have seen Life Tables which seem worthy of confidence as approximate statements. Life Tables of in- sured persons can be more easily secured ; but comparisons therewith cannot be undertaken here, however interesting they may prove to be. As regards the selection of these " Healthy Districts of England," Dr. Farr says : — " ^Ye have no means of ascertaining what the rate of mortality would be among men living in the most favorable sanitary conditions : otherwise observations for a term of years on a considerable number of such persons would supply a standard rate with which other rates could be compared. In the absence of such a standard, the districts of England in which the mortality rate did not exceed 17 annual deaths in 1,000 living have been selected as the basis of a new Life Table. 1 " For the sake of convenience, these were called ' healthy districts,' consisting of sixty- four, or nearly a tenth part of the total registered districts of England and Wales, and in- habited by nearly a viillion of people. Sixty-three of these districts have been taken as the basis of the new Life Table." '^ It is not claimed that we have gained a knowledge of the rate of mor- tality among persons living under the most favorable sanitary conditions. On this point Dr. Simon, in the First Report to the Privy Council, said : " In conclusion, I beg to observe that even in the very districts to which, provisionally, I refer as standards of health, there are deaths of a prevent- able kind ; not many, indeed, but enough to satisfy your lordships that the healthiness of those districts, as compared with perfection, is but of moder- ate excellence ; and enough to show that, if in those districts the popula- tion had exhausted all known means for removing the causes of disease, their death-rate would have contrasted still more strikingly with that of the unhealthier districts." ^ The results of a comparison of the two Life Tables are best shown by means of diagrams. Diagram No. i exhibits, by numbers down from the top, and stated at left side, the deaths in 1,000 persons of each sex, at each age, in Michigan, and in the " healthy districts " of England. It will be seen that the several lines representing these four classes of persons bear a very 1 William Farr, M. D., F. R. S., Annual Report of Registrar General, 1859, p. 174. Walford's Insuranee Cyclopcedia, vol. ii., p. 538. '^ Dr. Farr, Philosophical Transactions for i860; Assurance Magazine, vol. ix., p. 121 ; Walford's Insurance CyclopcEdia, vol. ii., p. 539. 3 Dr. Simon, in First Report to the Prizy Coicncil, 1S59 ; Walford's Cyclopcedia of Insur- ance, p. 540. 12 REPORT ON THE DEATH-RATE o _ r-( - E - = - - E -\- - - E I ^ ^ = S = = ^ E 7L = "Z — — 1 -k ~~ iZ u: " ~ _ — !— ■• L _ __ ^_ r~!. . I ^ E ifrsi; iij =r — ^rr. ~ Vf. ^rr 37 -I- if ■jz — — — — — — — — ^ — — — ~ -^ = =• =- = ■=^ = = ™ / „^ «^ — - •^' — ~ •» .^ .' t — — — __ .. ^< — ■ ^" / , / * O _ 1 ___ \- ^ __ : - — — — — 1 — — — —5' 7^ = = — — — — — — — ' — — ' — — ■ — — — • _ -h __ _ ^ _ : ~ — — — -t ~~ — — & — — — — — — — — — — — — — — — — — — — — — — — 1 V/ i 1 ,> — ® < i , y - — — ; 1 y ■> ■/' ' / ~ , / - / •• ■/■ ■'/'' : ■. /^ ./I? !in -| — — -'/•■ ^ .'^- /■ ~ — - 4 — — — — _ — — i~ .^ - --| — , o - .•/« 1 — ■ \ ■ - \ • \ •1 — ~ — - 8: 1 f 1 1 1 1 1 . 1 1 1 1 ' 1 1 \ 1 1 • 1 1 1 ■■ 1 .-. 1 i--| : ) ( — .- i.'l \ 1 « : 1 1 ) i 1 1 .'1 ', 1 ■ 1 1 - :l 1 1 — — 1 il 1 1 1 s. - 1 1 I 1 1 1 1 S - 1 ] — 1 1 1 _l 1 ^ 1 1 1 — — — 1 hF — 1 t 1 v;«:-> s ' 1 1 - — uinrr J- 1 _i_j I lOO O .-1 C C 800 400 500 GOO 700 800 900 1000 c< a •S d a il i OF EACH SEX IN MICHIGAN. 13 close resemblance at all ages until that of eighty years is reached, when the lines for England fall below those for Michigan, indicating, according to the data used, a higher death-rate at the older ages in England than in Michigan. The slightly greater death-rate in Michigan of those under one year of age may be explained by the fact that in Michigan still-births are included, but this will not explain the slightly greater death-rate at other ages under five years. Diagram No. 2 exhibits graphically the probable duration of life of males in Michigan ; and, by means of lines marking the upper limit of the probable life of females in Michigan and of males in the " healthy districts " of England, the close correspondence therewith is rendered apparent. At the top of the diagram is also exhibited the limit of " Possible Life." The heavy straight line at the top of the diagram is the limit of possible life of males in Michigan, — at the age of 112 years. The dotted straight line near the top of the diagram is the limit of possible life of females in Mich- igan, — no years. The dashed straight line near the top of the diagram is the limit of the possible life of males in the " healthy districts " of England, — 105 years. A corresponding line showing the limit of possible life for females is not drawn, as it would fall so near the line for males as not to be noticeable, — 106 years. The heavy vertical lines represent the probable life of males in Michigan. The bottoms of these lines begin at each succeeding age, from birth to 112 years. The tops of the lines are opposite the probable age at death, shown in the column on the left. As the dia- gram is drawn to scale, the probable duration of life is shown for each age by the length of the heavy vertical line. The dotted line, running near the tops of the vertical lines, represents the limit of probable life for females in Michigan, and the line of dashes shows the limit of probable life of males in the " healthy districts " of England. The corresponding line for females runs so near to this that it cannot well be drawn. The starting- point for each sex in each country is the same as for the males in Michigan; namel}^, opposite each particular year of age, shown on the left of the dia- gram for every decennial year. One of the objects in view in preparing Diagram No. 2 was to enable those who examine it most easily to appreciate the very great difference between the "Probable Life" and the "Possible Life" at each and every age. This diagram relates to the " Healthy Districts " of England and to the healthful State of Michigan, and it will be seen by the line referring to Michigan, in this diagram, that except for the ages between one and twenty-five years, man does not live out one half of his " possible " time ; and of the males in England only those aged under thirty-six years live out one half their " possible time." The total death-rate appears to be about the same in the two localities. The difference in this statement in the ages, — twenty-five in Michigan and thirty-six years in England, is caused by the shorter possible time in England, the time of which is stated as 105, whereas in Michigan it is believed to be not less than 112 years. H REPORT ON THE DEATH-RATE OF MICHIGAN. o o o o 0> o CO o c- o > 1 t? ; •1 •A 1 ^ : Ui 1 n : Zl V, j _: _: J : -5r 1 (L— _ -of "i :i ^ ■; Zl- -.1 1 : ■|iJ7 :i n 1 1 ■.\_ z < zi -of •~ \\ 1 a 1 -.1 1 ■W 0; tf)i '.1 1 •eJ l_i ': r — i^ u o! Oi -1 : 1 — — 1 1 -ET •• 1 1 ? ^. J-i ' \ r 1 . i _ r> ,Ti' \ \ 1 1 1 O z ini Uli \\ t 1 -1 \ \ 1 1 ' U| •l- " "1"— ■ -• — in y; ^77 : 1 1 r H g Li J <• -hi : 1 1 1 / ^___ .a t ii y J Q in 6 a 5' H 1 1 r — : 1 1 1 ; |_J 1 S j; Hi: J'. E; ui; O' c ^ 1 ! \\ 1 1 ■■i ! „ •-I [fli \rr 1 1 IDj- -u- 1 1 CD 10 O O O O lO r^ CO 03 ■-' INFANT MORTALITY IN MICHIGAN. 1 5 INFANT MORTALITY IN THE STATE OF MICHIGAN. BY H. B. BAKER, M. D. Secretary State Board of Health a7id Superintendent of Vital Statistics of Michigan. READ AT THE ANNUAL MEETING IN BALTIMORE, NOVEMBER II, 1875. These statements are worked out from my " Life Tables " for this State, and are believed to be as near the truth as it is practicable to attain at this time.'^ Quite different statements would appear if there were an attempt to make them from the per cent, of deaths under five to deaths at all ages. Perhaps this might properly be done if the population of the State was a " fixed " population, such as would be maintained by the birth-rate, and con- trolled by the death-rate which prevails in this State, but the actual popula- tion differs from such a " fixed population " by containing a larger propor- tion of children under five years of age. In such a "fixed population," as computed from my Life Tables for this State, the proportion of persons liv- ing aged under five years, to the total number at all ages, is as follows : males, 9.30 ; females, 9.56 per cent. By the census of 1874, it appears that in the actual population the proportion is as follows : males, 13.24; females, 14.05 per cent. The per cent, of deaths under five to total deaths is con- sequently larger than it would be if the population was fixed at that which would be controlled by the death-rate in this State, without modification by immigration or emigration. For the year 1872 the per cent, of deaths of those under one year of age to the total deaths was : males, 25.42 ; females, 23.17; of deaths of those aged under five years to total deaths it was: males, 42.44 ; females, 40.30. " What causes are contributing most to infant mortality ? (7) " — So far as re- lates to causes specified in the returns, they are in the order named. Scarlet Fever, Diarrhoea, Cholera Infantum, Pneumonia, and Dysentery. For the year 1873, the deaths reported from these diseases, of those aged under five years, were for each disease in the order named above: 361, 326, 302, 258, and 252. If the deaths from Diarrhcea, Cholera Infantum, and Dysentery be grouped together, and the deaths from " Bowel Diseases " be added, the aggregate number is indeed large. There is not much difficulty in fixing the actual cause of the excessive mortality from these specified causes among the conditions connected with the hot season of the year. It is also reason- ably certain that the mortality from these causes is greater in cities and vil- lages than in rural districts. I have no hesitation in subscribing to the be- lief that much of this infant mortality could be prevented by thorough and 1 The questions to which tlie writer here attempts to reply were submitted to him by the Secretary of the Public Health Association in the following terms : — " Infant Mortality. — What percentage of all infants born alive in your community sur- vive to their first birth-day.?" {Ans. — I reply that for this State, including still-births, it is : males, 83.09 per cent. ; females, S6.50 per cent. Concerning those born alive, I have made no special computation.) " What per cent, survive to the fifth .? " {Ans. — Including still-births, 73.32 per cent, of the males, and 77.70 per cent, of the females born survive to their fifth birth-day.) 1 6 INFANT MORTALITY IN MICHIGAN. enlightened action by local boards of health in cities and villages. Much more might be prevented if the parents, in all parts of the State, were well informed as to the causes of infant mortality. To collect and disseminate information on such subjects is the function of the State Board of Health. For this work " Vital Statistics " are essential ; and although the system of registration and report of vital statistics is somewhat new in this State, much information of great value has already been collected upon this subject ; and it is hoped that the time is not far distant when the State Board of Health, already established in this State, can disseminate among the people such in- formation on this subject as will tend to lessen the infant mortality in pro- portion as its warnings are heeded by the people. Inflammation of the lungs is one of the prominent causes of infant mortality in this State. As to the actual cause of this disease, if the evidence already collected in the vital statistics of this State shall be verified by further ex- amination, much of the infant mortality from this cause may be prevented by intelligent action of those who may control the condition of the air in dwellings and schools, as regards purity and humidity, but more especially as regards the warmth and humidity of the atmosphere in the sleeping-rooms of the children. The greatest number of deaths from this disease seems to occur in a cold and dry atmosphere. In my first reply to the question " (7)," the deaths from scarlet fever were stated for the year 1873. From this disease, deaths had previously been reported of those aged under five years as follows : in 1869, 163 deaths: in 1870, 531 deaths; in 1871,408 deaths; in 1872,336 deaths. It will be seen that this is one of the important causes of infant mortality in this State. In my opinion a very considerable proportion of the deaths from this cause might be prevented, and will be prevented, as soon as the people will act upon the instructions of the State Board of Health. It will take some time, however, for this influence to permeate the whole people sufficiently to result in uniform, prompt, and efficient action for the accom- plishment of this result. My belief in the preventability of much of the mortality from scarlet fever is based in part upon the belief that the disease is less fatal among persons who have passed the age of five or six years. Unfortunately we have not yet such records of cases of the disease in this State as will enable one to verify or disprove this belief. If it is true, then prompt isolation of first cases, and thorough destruction of the contagium, will result in saving the lives of many, by postponing the time when the dis- ease shall be contracted. But whether the mortality is or is not less after the infantile period, many lives may be saved by the means suggested ; for to some thus shielded in infancy the contagium may never again come in sufficient force to cause the disease. It seems probable that, even with no systematic effort for that purpose, many persons now pass through life with- out ever having the disease. It is the solemn duty of local boards of health to largely increase this number. I regard the great slaughter of the inno- cents in this State, by this disease, as a stinging reproach to the local boards of health for their inefficiency, and a powerful argument for the need of a State Board of Health, charged with the noble duty of educating the people in the way of life. LIBRARY OF CONGRESS 013 738 844 3 HoUinger Corp. pH8.5