adequate for the purpose, or it has been made without method or judgment. Such places are the harvest-fields of death, and, as might be expected, children are especially the victims. What is true of air is measurably true of light. There may be life, indeed, in the absence of light; but it will be a weak and puny one. In the dwellings alluded to, that which causes a pollution of the air, at the same time shuts out the light. It is something more than instinct that leads one to select a residence accessible to the rays of the sun, and to make a sitting-room of that situated on the sunny side of the house. Apartments unvisited by the sun should be avoided as pestilential. In such places physical degeneracy inevitably ensues—an inability to resist disease. Here epidemics of all characters find ready entrance, and prove the most fatal. Every human being brought forth or nurtured in the midst of such surroundings can scarcely be free from physical disorganization, and thus they invite the attacks of death in its multiform shapes. The result may be slowly reached, but it is certain. The case is no less sad because the victims appear insensible to their condition. Perhaps stern necessity, if a glimmer of the truth should chance to dawn on their apprehensions, would not allow of escape. Necessity is a hard taskmaster, and, in a hand-to-hand conflict with self-interest, the chance is that there will be a surrender at discretion. The foregoing remarks suggest what may be some of the causes of the present mortality of the city of Boston. Investigation may demonstrate the existence of other causes; but it will hardly fail to show that the matters alluded to do not have some bearing on the subject. CERTIFICATES OF DEATH. Prior to 1860, physicians were not required to certify to the cause of death. Returns were made by undertakers and others, who reported the diseases as they received them, sometimes undoubtedly from the most unreliable sources. Returns thus made, it is evident, were deserving of but little credit. In the year above-named, the Registration Act was amended by the Legislature, so that physicians were thereafter required to certify to the cause of death in all cases under their charge. This provision of the law has been complied with in all instances where physicians were in attendance at the time of death. In cases where there was no medical attendance, a city ordinance requires the City Physician to view the body before burial, and, from the information he may obtain, certify to the cause of death to the best of his knowledge and belief. Of course this return is not considered to be absolutely correct; indeed, it may be far otherwise; but it is fair to presume, that in many cases, from inquiries that he may make, he may be able to specify the probable cause of death. While a certificate of this character may be of no great statistical value, certainly one giving the cause of death as unknown would be worth no more. Besides, such post-mortem visitations would be likely to prevent the concealment of crime. It may be interesting to some to learn to what extent the registered causes of death may be regarded as correct. This information can be easily imparted. There are, as may be supposed, a large number in every year who die without any medical attendance whatever. Others, considereded incurable, are found to have relinquished treatment for a longer or shorter period before death. This fact is of frequent occurrence in all cities, as may be readily seen. No laws or ordinances can improve such a condition. If people will choose to die without medical attendance, there is no help for it, nor for the uncertainty that may exist as to the cause of death. It is in such instances, mainly, that the services of the City Physician are called into requisition. In the past year these cases make about 3.80 per cent. of the whole number of certified causes. In a large portion of the in 4 stances here alluded to, that official was probably correct in his returns. But for the purpose of ascertaining what proportion of the returns possess any value the instances on which the above percentage is rated will be classed as "unknown,' and therefore worthless. By reference to Table XI. it can be easily ascertained which of the reported causes of death possess any value. Those of a doubtful character are similarly designated in all mortality reports, and there is no ground for believing that they will ever be reported otherwise. For instance, the deaths reported from "convulsions" make 2.35 per cent. of the whole mortality; "debility," 2.38 per cent., and "marasmus," 3.37 per cent. These comprise nearly all that can be regarded valueless as statistical facts. The rest were certified to by regular physicians, and are entitled to the same credit that other physicians are entitled to in other cities. It will thus be seen that about 12 per cent. of the registered causes of death are of an uncertain character. There can be no more doubt of the accuracy of the remaining 88 per cent. than of the same proportion of all other mortality reports. Physicians certify in all cases, and, so far as can be known, they are all deserving of like credit. ९९ It may not be improper to say here, that the reported causes of death do not in all cases appear in Table XI. as they are entered on the records. For instance, deaths from meningitis" appear under the head of "diseases of the brain; " "carditis," "pericarditis," etc., as "diseases of the heart." And so in reference to other specified causes. Therefore, so far as accuracy and the statistical value that may belong to the registered causes of death are concerned, it is not too much to say that Boston will compare favorably with any other city. Respectfully submitted, N. A. APOLLONIO. CITY REGISTRAR'S OFFICE, May 18, 1874. |