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having more or less perfect registration, indicates that the mortality from this cause
is somewhat higher in the western states than in tlie eastern states at present; that,
moreover, a constant diminution in the typhoid fever death-rate has taken place
in the latter during the last fifteen years, while that of the western states has
remained substantially constant. Typhoid fever may be expected to be less readily
restricted by the temporary measures of isolation and disinfection employed during
the actual prevalence of the disease, and more dependent upon permanent sanitary
improvements affecting the water supply and drainage of communities, than the
other infectious diseases commonly dealt with by boards of health.

The geographi<?al distribution of typhoid fever In Michigan was studied in the
last Registration Report (page 1(>8) and illustrated by a tinted map for the five-year
period 1888-92. The high degree of prevalence In the counties of the Upper Penin-
sula is well shown, and examination of Tables 91 and 92 indicates that the mor-
tality from this disease still remains high in the northern part of the State.

* See di»«ram on page 297, Michigan State Board of Health Report for 1894.



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292 VITAL STATISTICS OP MICHIGAN, 1891.



GLANDERS.

(20) oundera Only four deaths have been recorded

from this disease In Michigan since the establishment of registration. None
occurred in the present year. There Is, Indeed, occasionally some doubt about the
deaths reported as due to **glanders," since the term may be Intended for "gan-
ders," the latter expression, or the more definite one "yaller ganders," being a
common form of report by the supervisors for "jaundice."

MEASLES AND GERMAN MEASLES.

(21) M«uuieg 84 The measlcs curve is subject to violent

fluctuations, as may be seen in Diagram II, and the year 1894 was a year of dimin-
ished prevalence. The death-rate, 3.8 per 100,000 population, was nearly as low
as that for 1892, which was 3.3 per 100,000, and was only surpassed by three pre-
vious years, 1874, 1878 and 1885. It is probable that restrictive measures are not
so thoroughly carried out in the case of this disease as with other diseases danger-
ous to the public health on account of the general belief In its slight importance.

(22) o«rmaii mMMies 2 German measles or rdtheln is of little

Importance as a cause of death. It Is included in the list of dangerous communi-
cable diseases chiefly from the liability of scarlet fever to be mistaken for it, with
which disease it has a closer relationship than with measles proper. No deaths
appear to have been recorded from this cause prior to 1892, although it is not un-
likely that an occasional one has been Included among deaths from measles.

"EPIDEMIC" OF SMALL-POX IN MICHIGAN. 1894.

(23) Small-pox 85 Small-pox was unusually prevalent and

fatal in Michigan during the year 1894, the reported deaths exceeding those of any
previous year of registration since 1882. The death-rate was 3.8 per 100,000
inhabitants. It will be observed that in this year of unusual mortality from this
dreaded disease, the deaths reported exceeded by only one the deaths reported
from measles, which latter disease, as stated above, was unusually mild in 1894.
Thanks to Sir Edward Jenner, this once awful scourge of the human race has
become a disease of very little importance, so far as its effect upon the general
death-rate Is concerned. There is always the possibility, however, of its estab-
lishment as a local epidemic among an unvaccinated population, whose brutal
Ignorance, as in the case of the Milwaukee small-pox riots during this year, may
impede its restriction by the health service.

In Diagram II small-pox is seen to have caused a much smaller amount of mor-
tality than any other of the Infectious diseases represented for the past 12 years,
while its maxima, in 1872, 1877, 1881-82 and 1894, approximate only to those of
measles and whooping-cough, being much less than the death-rates shown for
scarlet fever, typhoid fever and diphtheria. It Is true, nevertheless, that no disease
strikes such terror into the community nor causes such active measures of restric-
tion to be employed.

<24) Chioken-pox 4 This disease has not yet been oflicially

included in the list of dangerous communicable diseases, although it is probable
that this will be done. While unimportant in itself, it is exceedingly liable to be
confused with small-pox, especially at the beginning of an epidemic of the latter,
and hence its public health importance.



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DISEASES OP THE BOWELS. 293



WHOOPING-COUGH.

(25) whoopiny-oough 158 A slight increase is noted in the preva-
lence of this disease as compared with the preceding year. The mortality for
previous years of registration may be conveniently examined in Table 88 and
Diagram II, from which it appears that the course of this disease has been very
uniform in recent years, although showing some decrease since the earlier years
of registration. It now causes usually a less number of deaths than measles each
year, while from 1869 to 1880 it caused a somewhat larger number on the average.
Considering its" importance as a cause of death, much less serious effort has been
expended upon Its restriction than upon some other infectious diseases.

DISEASES NOT CLASSED (AT PRESENT) AS DANGEROUS COMMUNICABLE

DISEASES.

Many diseases In the following list, e, g., cholera infantum and pneumonia, are
known to be caused by one or more species of bacteria, and will undoubtedly be
added in time to the list of oflacially defined ^'dangerous communicable diseases."
Like the preceding group of dangerous communicable diseases, the arrangement is
In general an alphabetical one, which has been so far departed from, however, as
to admit of the formation of several groups of diseases classified in relation to
the part of the body or special organs affected. Thus under Brain diseases. Bowel
diseases, and corresponding titles, all of the maladies causing diseased conditions
of the brain and nervous system, alimentary canal, or other specified organs, are
roughly grouped. It must be remembered that infectious diseases, although gen-
erally limited to or chiefly affecting some special organ, are elsewhere studied,
and also that the titles "cancer" and "tumor" (line numbers 45 and 46) contain
deaths from affections of various organs which have not been distributed in
accordance with their anatomical seat. For the latter, see Table 98, which specifies
the parts of the body affected by neoplastic growths.

DISEASES OF THE BLADDER.

(26) Bladder dUeoMt^ 4S CJombiued with diseases of the kidneys

(27) CalciUus 13 (line numbers 58 to 60), the total number

(28) Cystitis 25 of deaths due to disorders of the urinary

(29) Bladder disease, etc 5 apparatus may be ascertained. Diabetes

Is separately stated (line number 49), but may be included for comparison with
statistics which embrace this title under diseases of the kidneys. Calculus and
cystitis were separately stated in the old classification employed in these reports,
but all other diseases of the bladder were placed under "kidney disease, etc."

DISEASES OF THE BOWELS.

{^) BovseldiaeauM 2,060 This is a very important group of

(81) Inflammation of bowels 396 causes of death in the consideration of

(32) Diarrhea 234 the sanitarian, from the fact that so

(88) Cholera infantum 891 large a proportion of the cases is from

(84) Dysentery 100 preventable causes, and occurs in infants

(85) Peritonitis 102 and children. Referring to Table 84, in

(36) Bowel disease, ete 837 which for the first time In these reports

the separate ages at death under 5 years of age are stated, we observe that of the



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294 VITAL STATISTICS OP MICHIGAN. 1894.

2,060 deaths from intestinal disorders that occurred in Mictiigan during tlie jear
1894, no less than 1,043, or 50.6 per cent, was of infants under 1 year of age; 1,411
of the deaths were of children under 5 years of age, representing a i)ercentage of
68.5. Certainly the great majority of these early deaths from Intestinal disorders
are due to easily recognized and remedlc-d dietary errors.

Some of the cases of inflammation of the bowels, and many of those included
in "bowol diseases, etc..'* arc diarrheal in character. The nature of the returns
does not permit of any very exact distinctions being made between those included
under different titles. Thus, of the 234 casc^ of death from diarrhea, no less than
179 were originally sp<>cifle<i as "summer complaint," a recognized synonym for
cholera Infantum, while, on the contrary, many cases of ordinary diarrhea in
infants were returned as "cholera infantum.'* These diseases are best studied in
the aggregate, and according to their age incidence. Many of the deaths reported
as due to **convul8ions** are really the effects of intestinal diseases, although nearly
every system of statistical nosology follows the old plan of Dr. Farr, and includes
such deaths under diseases of the nervous system. The defects in the method of
collection of statistics of deaths in Michigan preclude any attempt at a systematic
comparison of mortality from this class of diseases and weather conditions by
months or other subdivisions of the year, although their relations are undoubtedly'
very intimate. Certain diseases now included in the group, including many of
those under diarrhea, dysentery, peritonitis and cholera infantum, are due to one
or more micro-organisms, and hence have claims to be included in the specific
infectious diseases.

DISEASES OF THE BRAIN AND NERVOUS SYSTEM.

(37) Brain di§ease$ J,82<j The number of deaths reported from

(88) Apoplexy 283 various affections of the brain and cen-

(89) Concestion of brain 81 tral nervous system exceeded that re-

(40) Inflammation of brain 302 corded for any previous year of regis-

(41) Epilepsy 49 tratlon, although the death-rate from

(42) Meningitis 181 this group of causes of deaths, allow-

(43) Paralysis. 707 ance being made for increase of popula-

(44) Brain disease, etc 226 tion, has been several times exceeded.

The increase over the previous year appears to be mostly from apoplexy and
paralysis. As shown in Table 87, the death-rate from diseases of the nervous
system has pretty steadily increased during each of the five-year periods, with
the exception of the first one, 1870-74, which was marked by an epidemic of cere-
bro-spinal meningitis. The prevalence of epidemic influenza in this State during
recent years and its depressing effects upon the inhabitants of advanced ages,
have probably tended to increase the deaths of this group.

CANCERS AND TUMORS.

(45) Cancer 677 Following Dr. Billings's example in the

(48) Tnmor 149 Mortality Statistics of the U. S. Census,

deaths from cancers and tumors are studied together. There is much confusion
of the two terms in their ordinary use. Pathologically, all cancers are tumors,
but not all tumors are cancers; in common language, the term "tumor" appears
to be restricted to non-malignant growths, or to malignant growths concealed
from observation, such as cancer of the stomach. In Table 88 and Diagram II
the course of cancer in Michigan may be examined for each year of registration,



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CANCBR3 AND TUMORS.



295



Table 98.— Dea<^ returned from cancer in Michigan for the year 1894, and for
the twenty-two years, 1S72-93 ineluHvCy specifying the part of the body affected.



Cancer of —


Tear 1804.


Twenty-two years,


1872-93.




Total.


Males.


Females.
408


ToUl.


Males.


Females.


All organs


877
1


269


7,866


3,374


4,492






•Abdomen _ ...


1










Arm - -_.._-.




6

1
23

4

153

4
452


3
1

20
4

60
3
24


8


Back










Bladder


1
1

19

1

25
1


1

1

4




8


Bone






Bowels -

Brain


15

1

25
1


98
1


Breatt




428


Ohest






Ea?!::::::::::::::::::::::::::::.:




3

17

226

4

1
4

5

35
7
2
4

10
21

4

19

89
36
3

I
2

3


2

8
166

4


1


Eye


1
8


1

1




9


^^"s::::::::"...:::::.


1


60


Foot




Oall bladder








1


'Gioin








3

4

21

2

1
4

7
14

4
100

8

60
27
3


1


Hand








1


Head








14


^eart..


1




1


5


HiD

uip....- ............ -....-...-..




1












Kidney


1

2
2
14

1

2
2


1
2
2
7




3


Leg -




7


Lip .






Life::::::::::::::::::::::;:::::::


7
1

1
1


92


LnngB - - .— -


U


Month


1
1


29


Neck


9


Nose .




Omentom








1


Oraries










2


^BaonhamiB


1

1
1


1
1
1




1


2


Mate :






Pancreas




5

1

35

2
13
1
5
1,988

102

1
3
28

1

4,048

1

801


8

1

20

2
2


2


Pyloms








8


4


4


15


Shoulder




Side

Spleen..


2


1


i


a

1


Spine - - -








2
1,170

61
i
3

17


3


Stomach


181
10


97

7


84

3


818


Throat


41


KSh .....:::.




Testtci^


1
3


1
2






Tongne - ..


1


11


Tonsils


1


Unspecified part


848


125


223


1,538


2,510


Urethra . . .


1


Utems — .


88




38




301











NoTB— Deaths retomed from '* tomor" in Michigan, 1894. There were 149 deaths. 40 males and 109
females, thns returned, many of which were probably deaths from cancer. Their distribution, by sex
And organs affected, was as follows : Abdomen, 3 f<>male8 ; bowels, 2 males, 1 female ; brain, 4 males, 5
females; breaat, 1 female; face, 1 male; hip, 1 male; leg, 1 female; lungs, 1 male; kidneys, 1 female;
neck, 1 male, 2 females ; ovary, 15 females; rectum, 1 male ; side, 3 males ; stomach, 5 males, 12 females;
. throat, 3 males ; uterus, 8 females ; unspecified, 18 males, 65 females.



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296 VITAL STATISTICS OF MICHIGAN, 1894.

and its constant and regular increase in importance as a cause ot death will be
noted. The sinuous regularity of the curre and the absence of the fluctuations
characteristic of the infectious diseases represented, are especially characteristic.

An increase in the mortality from cancer is generally indicated for recent years,
not only in the Michigan reports, but in those of other states and countries. It has
been claimed that the large increase in the mortality from cancer is more appar-
ent than real, and is due chiefly to more accurate diagnosis of cancers of inaccess-
ible parts of the body.

In Table 98, on the preceding page, may be seen the distribution of deaths from
cancers and tumors, by sex and according to the parts of the body affected, for the
year 1894, and also, for cancers only, for the period of twenty-two years, 1872-93.
Of the whole number of deaths reported from cancer In the 22 years, 42.9 per cent
were males and 57.1 per cent females. Excluding from the total number of deaths
of males all cases in which the organ affected was unspecified, we hare 1,836
cases, of which 1,170 or 63.7 per cent were deaths from cancer of the stomach.
Among females, the ratio of deaths from cancer of the stomach was less, being
41,8 per cent; 428 deaths, or 21.6 per cent were from cancer of the breast, and 301
deaths, or 15.2 per cent were from cancer of the uterus.



DEATHS CAUSED BY CHILDBIRTH.

(47) Childbirtii ^ 218 Besides the deaths returned under this

head, there were 33 deaths from puerperal fever not included here, but classed
under dangerous communicable diseases (line number 15). The deaths resulting
from childbirth have remained very uniform for the years given in Table 86>
showing, as there has been a large Increase in population In that time, that the
death-rate has constantly diminished.

DEATHS FROM "CONVULSIONS."

(48) CoDTulsionA 412 This Is an Indefinite term, merely ex-
pressive of the symptoms in deaths from certain causes. When specified as epi-
leptic, puerperal or uremic, they are classified elsewhere. Nearly eight-tenths
(76.7 per cent) of the total number were deaths of children under five years of age.

Dr. Parr's original nosological classification of causes of deaths, which has
served as a basis of most later ones, classified convulsions under the head of
diseases of the nervous system, guided, evidently, by the obvious agency of the
nervous system in convulsive attacks. Probably the great majority of fatal cases
of "convulsions," especially In infants and young children, are not primarily of
nervous origin, but are the effects of diseases of the digestive organs. After
citing a careful analysis of 281 reported deaths from "convulsions" in Dresden
during the period of July 11 to September 25, 1886, of which number actual
disease of the nervous system caused only 36 deaths, while cholera Infantum
and diarrhea caused seven-eighths of the whole number, Dr. Vaughan concludes
that "These figures will probably hold good for the United States, and we are
justified, I think, in claiming that more than 90 per cent of the deaths reported
as due to convulsions are really due to digestive disturbances."*



^ Infantile Mortality ; Its Canaation and its Restriction, by Victor C. Vanghan, M. D., Ph. D., Joar.
Amer. Med. Assn., Yof. 14, p. 182.



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DISEASES OP THE HEART. 29T



DIABETES.

(49) Diabetes _ 106 Deaths thus returned have usually

been considered to be from diabetes mellltus, although rarely so specified. A
marked increase is apparent in deaths recorded from diabetes for 1893 and 1894
as compared with any of the previous years shown in Table 86.

DEATHS PROM "DROPSY."

(50) Dropsy 400 This is another Indefinite return of

cause of death which would be practically eliminated from registration reports
under an efficient system of registration. In all cases of "dropsy," the disease
responsible for that condition should be stated, whether cardiac, renal or other.
Were the statements of causes of death based upon physicians' certificates, there
would be hope for improvement in this respect, but under the present registra-
tion law these indefinite returns will continue to constitute a large percentage of
total deaths.

-FEVER" (UNSPECIFIED FORM) AND MALARIAL. FEVER.

(51) Fever 75 The deaths returned simply as due to

"fever" may have been caused by typhoid fever, malarial fever, or by any disease
attended with a noticeable rise of temperature, such as pneumonia, or the exan-
themata. Puerperal fever and septicemia after traumatism may not unfrequently
be here included. The return has little interest or importance from its indefinite
character, except as it may indicate a possible margin of correction of typhoid
fever or other definitely specified fevers.

(52) Malarial fever 91 This Is the smallest number of deaths-

ever returned from this cause in Michigan, as shown by Table 86. Malarial dis-
eases have steadily diminished during the entire period of registration.

DISEASES OF THE HEART AND CIRCJULATORY SYSTEM.

(53) Heart diseases U891 Very few of the deaths returned frou>

(54) Pericarditis 88 diseases of the heart specify the exact

(55) Heart disease, etc 898 form of the malady, so that the 898-

(56) "Heart failure" 405 deaths from heart disease were practi-
cally all returned in this indefinite form. This number does not include the 405
deaths from "heart failure," which have been separately compiled since 1891. For
preceding years, as shown in Table 86, these deaths were included in heart dis-
ease. They are generally equivalent to deaths with cause unspecified,— so
returned either through ignorance or carelessness,— and probably imply no actual
heart disease. For this reason the statistics of heart disease at present are not
comparable with those of years antedating the common use of this pernicious term.

Taking the returns at their face value, however, it is shown in Table 87 that the
mortality from heart diseases has more than doubled in Michigan since the early
periods of registration. The last few years have given an unusually high mor-
tality from these causes. This increased death-rate from diseases of the circula-
tory system may be due in part to the increase in average age of the inhabitants
of the State, and the high fatality of the years 1890-94 may come largely as a
result of the epidemic of infiuenza.
38



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VITAIi STATISTICS OP MICHIGAN. 1894.



EPIDEMIC INFLUENZA, OR 'LA GRIPPE."

(54) Influanza 402 Influenza continued to be reported dur-
ing the year, although with diminifihed intensity as compared with the years
immediately preceding. The first three months of the year contributed 1S2 out
of the total number of deaths, 402, that occurred during the year. This was evi-
dently a continuation of the attaolc that 1>egan abruptly in December, 1893, with
252 deaths.

In Michigan there is an undoubted tendency, owing to the manner of collecting
the data, for many deaths to be ascribed to "la grippe" that would be referred to
other causes were the statements as to cause of death derived from death certi-
ficates issued by physicians. Every disease whose onset is attended with acute
catarrhal symptoms is liliely to be so returned, no matter what organs were ulti-
mately Involved, and many consumptives, whose deaths would have undoubtedly
occurred during the past few years in the natural course of that disease, have been
returned as dying from influenza, a cause that merely accelerated death. All of
these considerations must be taken into account in studying the reported mortality
in Michigan from epidemic influenza, and especially in comparing the mortality
In this State with that of other states and countries having more accurate systems
of registration. The following table exhibits the deaths reported for each month
of the past five years from this disease:

Deathi in Michigan from influenzi (^' la grippe *^)^ by months, according to the

retumefor the yeare 1889-94.





Total
for
year.


Months.


Yean.


Jin.


FiBb.


Mar.


Apr.


Hay.


June.


July.


Aqc.


sepc.


Oct.


Not.


Dec.


Dnk,


1880


176
1,064
1,076
907
555
402


30
174
110
351
43
82


28
210

83
200

41

45


17
154
96
90
28
55


11
133
249
58
26
30


6
79
110
35
33
23


7

60
62
24
20
15


2
44

48
18
14
14


2
53
31
10
15
20


4

36
48
17
20
18


8
46
37
19
24
26


19
37
88

30
39
28


41

56
160

28
252

37


1


1800


2


1801


4


1892




1808




1804









The importance of accurately distinguishing in the certificate of death the pri-
mary and secondary causes is now well understood, and in the case of a disease
like influenza that destroys in so many ways, through its association with various
complications and sequelae, such information is absolutely essential. The forms of
death certificates in use in the State of New Yorlt provide for the return of the
immediate and remote causes of death, and the bill presented to the last legis-
lature in the interest of an improved system of registration in Michigan had
this provision. As an illustration of the valuable information collected by means
of such a form of returns, and as giving, moreover, interesting details concerning
the incidence of Influenza in a European country during the same epidemic as
that to which the Michigan statistics relate, the following data are presented,
derived from the Statistical Year Boolv of Switzerland, 1895, p. 270. In the orig-
inal table full particulars are given with respect to ages and sex of det^edents:



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INFLUENZA..



299



Deaths in Switzerland directly and indirectly from influenza daring the yeare 1889-90

to 1894.



Causes of death.



TOTAL DEATHS DIRECTLY OB INDIRECTLY
PROM INFLUENZA



I. iNFIiUBNZA ALONE

II. Influenza with Complications.



IV.



a) Of respiratory organs.
,6) Of circulatory system.

c) Of nervous system

d) Of digestiTe organs...

e) Of urogenital system..

Of other organs

Of several organs.



III. Diseases following Influenza (SEguEL£).



(a) Of respiratory organs.
(6) Of circolatory system..

(c) Of nervous system

Of digestive organs .



(e) Of urogenital system..



Of other organs .
Influenza and Concomitant Diseases..



a) Of respiratory organs.
' Of circulatory system.,

Of nervous system

Of digestive organs ....

Of urogenital system..

Of other organs

g) Of several organs



1894.



2,275



452

h28a

1,031
115
78
24
14
11
15

ft4

54
9
5



Online LibraryMichigan Dept. of StateAnnual report relating to the registry and return of births, marriages and ... → online text (page 35 of 46)