Fifth. Ignorance and disregard of the laws of health are responsible for a large proportion of this excessive mortality.

SOCIAL AND PHYSICAL PROGRESS.1

The study of vital statistics is one of the most important subjects that can engage the attention. The death rate, taken in connection with the birth rate, determines the natural increase or decrease of population, the growth or decline of a people, and the strength of nations. Dr. William Farr, late registrar-general of births, deaths, and marriages in England, states the whole matter in the following language: "There is a relation betwixt death, health, and energy of body and mind. There is a relation betwixt death, birth, and marriage. There is a relation betwixt death and national primacy; numbers turn the tide in the struggle of population, and the most mortal die out. There is a relation betwixt the forms of death and moral excellence or infamy.'

It has been known for a number of years to health officers and students of vital statistics that the death rate of the colored people was larger than that of the white people; that the colored people were dying in larger numbers in proportion to the colored population than the white people were in proportion to the white population. Of late years these facts have become known to most intelligent persons, and great interest attaches to the degree of the excess of the colored death rate and to the causes of it.

This paper will deal with the vital statistics of the cities of Atlanta, Ga.; Baltimore, Md.; Charleston, S. C.; Memphis, Tenn., and Richmond, Va. Each of these cities contains a large colored population, surrounded by social, economic, and moral conditions such as exist in other cities where colored people are congregated in considerable numbers, if Philadelphia is excepted. The cities selected are therefore thoroughly representative for the purpose in hand, and the conditions found to prevail in them may be fairly presumed to prevail in the other cities having a large population of colored people.

The average annual death rate per 1,000 of the living population in these five cities for the fifteen years from 1881 to 1895 was 20.74 for the whites and 36.13 for the colored, showing a percentage of excess for the colored of 73.8.

The average annual death rate per 1,000 by race for each of the five cities under consideration for the past fourteen or fifteen years is as follows:

An inspection of the table just given shows that the highest death rate among the colored is in Charleston (which is also true as to the whites) and that the lowest death rate among the colored is in Memphis, the lowest among the whites being in Atlanta. Comparing the white and colored death rates, it is to be seen that the greatest excess of colored over white is in Charleston, where it reaches 90 per cent, the excess in Atlanta being 87.6 per cent and that in Richmond 83.4 per cent. The least excess is found in Memphis, which is 51.3 per cent, Baltimore having 58.1 per cent. These figures seem to justify the conclusion that the worst physical conditions among the colored people are to be found in Charleston, Atlanta, and Richmond and the best in Memphis and Baltimore.

Having found the average death rates of the two races in these five cities for the past fourteen or fifteen years, and having compared them with each other and drawn a conclusion as to the relative physical conditions of the colored populations in the cities under consideration, it will conduce to a better understanding and a fuller knowledge of these conditions to divide the fourteen or fifteen years which this investigation covers into three periods as nearly equal as possible. By pursuing this method we shall be able, in a measure, to decide whether the physical condition of the colored people is better or worse in 1894 or 1895 than in 1880 or 1881.

1 By Mr. L. M. Hershaw (1886), Washington, D. C.

The tabular statement contains, in addition to the average annual death rate, the percentage of the excess of the colored death rate. Lest the percentages of excess mislead somebody, it is necessary to explain that, in comparing the three periods they merely show whether or not the colored death rate has decreased as rapidly as the white death rate, and not the actual increase or decrease of the colored death rate. To illustrate: Comparing the second and third periods in Richmond, it is to be seen that the percentage of excess for the second period is 81.7 per cent and for the third period 89 5 per cent. Without looking at the matter carefully the conclusion is likely to be drawn that the colored death rate is greater for the third period than for the second, when, as a matter of fact, it is less, the rates being 38.83 for the second and 34.91 for the third.

An inspection of the above table shows that there has been a constant decrease in the colored death rate from period to period in Atlanta, Memphis, and Richmond. In Atlanta the colored death rate for the first period is 37.96, for the second 33.41, and for the third 32.76; in Memphis 43.01 for the first period, 29.35 for the second, and 21.11 for the third and in Richmond 40.34 for the first period, 38.83 for the second, and 34.91 for the third. While Baltimore and Charleston do not show the constant decrease from period to period noted in the other cities, they do show a lower death rate for the third period than for the first, the death rates in Baltimore being 36.15 for the first period, 30.52 for the second, and 31.47 for the third, and those in Charleston 44.68 for the first period, 46.74 for the second, and 41.43 for the third. Memphis shows the greatest improvement, the average death rate at the end of the third period being 50.9 per cent lower than at the end of the first, and Charleston shows the least improvement-6 per cent. In Atlanta the improvement is 13.9 per cent, in Richmond 13.4 per cent, and in Baltimore 12.9 per cent.

Of the five cities with which this paper deals but two have a registration of births-Baltimore and Charleston. Richmond had such a registration, but it was discontinued some years ago. The registrations of Baltimore and Charleston are admittedly incomplete. No view of the vital statistics of a community is complete without a knowledge of its birth rate. The birth rate is closely related to the death rate. The natural increase of population depends upon the excess of the birth rate over the death rate. It would be highly interesting to know what the birth rate of the colored population in the five cities under consideration is. Is it as great as the death rate? Is it greater than the death rate? These questions can not be answered satisfactorily because the health reports do not supply the information. The United States census of 1890 gives the colored birth rate of the United States as 29.07 per 1,000, but owing to the incompleteness of the records of births by the municipal and State authorities, these figures are not reliable and are probably much too small. Four European countries have birth rates which exceed the colored death rate in the cities that we have under consideration. In view of the well-known fecundity of the negro race, it is fair to inter that his birth rate is certainly as high as that of the Italian, the German, the Austrian, or the Hungarian. If this is so, then the death rate in these cities has not reached the point where population begins to decrease. It is well-nigh useless to pursue this branch of the subject further, because of the lack of data.

Having established the fact that the average colored death rate for the past fourteen or fifteen years in the five cities is 73.8 per cent in excess of the white death rate in the same cities for the same period, and having shown, by dividing these years into three equal periods and comparing the rates of previous with succeeding periods, that the colored death rate shows an improvement over fifteen years ago, it remains to set forth the causes of this excessive mortality.

The principal causes of the excessive mortality of the colored people are the same in all the cities, therefore it will serve our purpose to know the average death rate of the three cities, Charleston, Memphis, and Richmond, combined, for a period of

1 The death rate is generally expressed in terms of 1,000. The phrase "rate of 38.83" means that there were thirty-eight and eighty-three one-hundredths deaths per 1,000 of population. For brevity, the words " per thousand "are omitted.

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fifteen years for certain classes of diseases, and to give in full the same facts concerning Atlanta. The table which follows shows for Charleston, Memphis, and Richmond, combined, the average death rate per 10,000 by specified causes for a period of fifteen years, from 1881 to 1895:

It is to be seen from the table above that for all classes of diseases the colored death rate exceeds the white. The greatest excess is found under scrofula and syphilis, where it is 482.7 per cent in excess of the white death rate. The next greatest excess is due to infantile diseases-cholera infantum, convulsions, and stillborn-the excess being 165.1 per cent. The third greatest excess is due to pulmonary diseases, and is seen to be 130.4 per cent. We see also that the least disparity between the white and the colored death rate is found under the group of diseases most affected by environment, including typhoid and malarial fevers and diphtheria, where the excess is only 30 per cent. As to syphilis and scrofula, it is to be observed that the number of deaths is small. The white death rate during fifteen years in Charleston, Memphis, and Richmond has been less than 1 per 10,000 of the population, while the colored was somewhat less than 5. The per cent of the excess of the colored over the white is, however, startling, and furnishes much food for reflection as to the morals of the colored people.

The two principal causes of the excessive mortality of the colored people are pulmonary diseases-consumption and pneumonia-and infant mortality. The exces sive prevalence of consumption and pneumonia among colored people is brought out very plainly in the foregoing table, where the excess in these cities is shown to be 130.4 per cent.

The following table, containing the total average annual number of deaths and the average annual number of deaths of children under 5 years of age, with distinction of race, will serve to show the extent of the infant mortality among colored people:

There is an enormous waste of child life among both races, not only in the cities under consideration, but in all cities. But from the data at hand the conclusion is justified that the mortality among colored children is not alarmingly in excess of the mortality among white children, unless it be for children under 2 years of age. The figures which we have presented on this subject show that the mortality among children of both races has decreased constantly since 1881 in Atlanta, Charleston, and Memphis.

Of the diseases which are excessively prevalent among colored people the most important, and the one which should be the occasion of the greatest alarm, is consumption. We have seen already that consumption and pneumonia are among the causes of excessive mortality of the colored people, the excess per cent of Charleston, Memphis, and Richmond being 130.4.

The table following shows the rate per 10,000 of deaths from consumption in all the cities investigated:

It is to be seen that in all of the cities the death rate for consumption is high among the colored people, the lowest rate being 34.74 per 10,000, in Richmond, and the highest 72.20, in Charleston. The greatest disparity between the white and the colored death rate for this cause is also in Charleston, where the excess per cent of the colored is as high as 239.5. The important fact must not be lost sight of that the death rate from this cause has constantly decreased in all the cities except Charleston, and in Charleston the death rate for the period 1890-1894 is lower than for the period 1881-1884. There is reason, however, for great concern and anxiety as to the excessive prevalence of this disease among the colored people. Unless checked and reduced to a normal state, it may in the course of years be a deciding factor in the ultimate fate of the race. The prevalence of tubercular and scrofulous diseasesconsumption, scrofula, syphilis, and leprosy-has caused the weaker races of the earth to succumb before the rising tide of the Christian civilization. The Carib of the West Indies, the noble red man of these shores, the natives of the Sandwich Islands, and the aborigines of Australia and New Zealand have all disappeared or been greatly reduced in numbers as the result of the ravages of these diseases. It should be an object of first importance, then, to get control of these diseases before they reach the point where control is impossible.

It will be of interest to know somewhat in detail the physical condition of the population in Atlanta for the fourteen years from 1882 to 1895, and the tables which follow set forth quite fully this fact.

It is seen that the death rate of the colored population, though greatly in excess of that of the white, has constantly decreased, the average death rate per 1,000 for the first period being 37.96, for the second 33.41, and for the third 32.76. Relatively, as compared with the whites, the death rate of the colored shows much improvement. Though the percentage of excess of colored for the third period is greater than that for the second, the percentage for both of these periods shows a marked decrease from that of the first period.

The following tables show for three periods, 1882 to 1885, 1886 to 1890, and 1891 to 1895, the average annual death rate per 10,000, Atlanta, Ga., by specified causes:

CONSUMPTION AND PNEUMONIA.

1882-1885 1886-1890 1891-1895

1886-1899 1891-1895

1882-1885

1886--1890

1891-1895

1882-1885 1886-1890

1891-1895

TYPHOID, SCARLET, AND MALARIAL FEVERS, AND DIPHTHERIA.

It is observed that in all these groups of causes the colored death rate has decreased from period to period, except for consumption and pneumonia, where the death rate for the period 1891-1895 is greater than for the period 1886-1890, though slightly less than for the period 1882-1885.

The statistics presented in the various tables which this paper contains, viewed candidly and dispassionately, show results favorable to the physical improvement of the colored race. If the mortality rate had remained stationary for a period of fifteen years, it would have been a lasting evidence of the physical strength and endurance of the race. But we have shown that the rate has decreased in that period, and that, too, as is well known, in the face of hard, exacting, and oppressive social and economic conditions. When all of the facts in the colored man's case are taken into consideration, the wonder is, not that the death rate is as high as it is, but that it is not even higher. The history of weak and inferior races shows that they begin to decrease in number after one generation's contact with Anglo-Saxon civilization. The native population of the Sandwich Islands a hundred years ago was estimated to be 100,000. The latest census taken on the islands shows the native population to be 35,000. We do not witness this decay and decrease in numbers in the colored race anywhere in the Western Hemisphere.

In studying any phase of negro life in the United States, the fact must be kept