method was adopted in states and cities having imperfect registration, in consequence of the impossibility of presenting an accurate showing by the former method.

On the whole, the registration of vital statistics is progressing in the United States, but not as rapidly as might be wished. Considerable impetus has been given to the discussion of the subject, by the frequent presentation of papers at the meetings of the American public health association and the American statistical association. The importance of the subject as a foundation for our accurate knowledge in matters pertaining to public health, can not be overestimated. Those states, in fact, which have made the most commendable progress in preventive medicine are also the states which have brought their systems of registration to the highest degree of perfection.

By far the best general presentation of the vital statistics of the United States is that which may be found in the volumes of the United States census of 1880 and 1890, including the special volumes devoted to the vital statistics of certain large cities. The reports of 5 of the New England states, with those of Michigan and Minnesota, are published in separate volumes, while those of New York, New Jersey, Connecticut, and several other states, are incorporated in the annual reports of the state boards of health. Within the past year much improvement has also taken place in the registration of Indiana, in consequence of the exertions of its state board of health.

Classification. The question of the classification of diseases has assumed increased importance, in recent years, in consequence of the rapid progress of medicine. The system in general use for nearly half a century in the registration states and chief cities of the United states, has been that of Dr Farr, and has served a useful purpose. This system, however, is now shown to be far behind the present demands of medical progress, and improved methods are urgently called for.

The principal substitute for the older systems now offered and also now accepted and adopted by a considerable number

of authorities throughout the world, national, state and municipal, is that of Dr Bertillon of Paris.

This system was brought to public notice in the United States, in a paper by Dr Bertillon, presented at a meeting of the International statistical institute, at the Columbian exposition at Chicago, in August 1893, and was later on the subject of discussion at the meeting of the American public health association, at the same place, in October 1893.

Subsequently, the committee on vital statistics of the same association, after a full discussion of the subject, reported in its favor, and their recommendation was endorsed by the association in October 1898.1 This committee, through the commendable activity of its secretary, Dr Wilbur, has accomplished much toward the introduction of the system in several of the registration states and in some of the larger cities. A very full and complete presentation of the system, with minor details and adaptations to an American population, is printed in the monthly bulletin of vital statistics of Michigan, beginning with February 1898.

RURAL HYGIENE

In the United States, the population occupying the rural districts is still largely in the majority, and probably amounts to nearly 50 millions.

(By the census of 1890 the rural population was estimated at 71% of the whole, or about 44 millions.)

There must necessarily be a large ratio of the population engaged in the pursuits of agriculture, since the broad prairies and other agricultural lands of this large territory furnish food, not only for the domestic population, but also send ample supplies every year to feed the inhabitants of other countries.

The preservation of the health of this portion of the population is a matter of quite as much importance as that which relates to the dwellers in cities; and while it is true that the average length of life of the farmer is greater than

1) See Transactions American public health association, 1898. p. 311.

that of people engaged in other occupations, it might undoubtedly be lengthened by closer attention to sanitary principles. There are few occupations in which hygiene is more neglected. The farmer pleads that he can not afford to take measures for ventilating, warming or draining his house. On the contrary, he can not afford not to take these precautions.

Much improvement has actually taken place in those states and districts where an awakening of the people to the need of better modes of living has been brought about by various means, either through the occurrence of such epidemics as neglect and carelessness often produce, or through active missionary work of a sanitary nature. In the following directions there is room for much improvement in the sanitary conditions of the rural population.

The conditions referred to are: 1) A good location of the home, having a sunny exposure, with dry soil and freedom from dampness. 2) A well-planned house, adapted to the wants of its inmates. 3) Thorough drainage and disposal of the household wastes, so that neither harm, nor annoyance to others can take place. 4) A pure water-supply; this is a point of special importance in the case of dairy farms, since the farmer is then a distributor of food to populations living at a distance, and it oftens happens that a polluted watersupply at the dairy causes an epidemic of disease among the consumers of the milk when this water is used for washing cans and cooling the milk.

Another defect in the hygiene of the rural population of the United States is that of badly selected or badly cooked food. Notwithstanding the great abundance and variety of food, both animal and vegetable, which is produced on the well-tilled farms of New England and on the western prairies and fertile fields of the south, it is undoubtedly true that the food of the farmer is less varied and less wholesome than that of the urban population.

In the more densely settled states it often happens that the

better and the more nutritious products of the farm (eggs, and the products of the dairy) are sent to the markets of the neighboring cities, while the farmer's family is fed on a limited and less nutritious diet. The chief defects of the diet of the rural population may be stated as follows:

Too exclusive use of fried food.

Salt meat, to the exclusion of fresh meat.

Exclusive use of fine wheat flour in the place of the coarser and more wholesome sorts of meal and flour which were largely in use a half century since.

Pork in some form is used as food by a very large part of the population of temperate climates, and when it is the product of healthy animals it is a nutritious and wholesome food for all who are accustomed to a life of toil, and for those who have naturally vigorous constitutions.

Swine, however, are subject to many diseases, some of which, specially those of a parasitic nature, are communicable

to man.

It has been observed that those animals which were fed on the offal and garbage of cities were infected in a much greater degree than those which were fed on wholesome food.

It is only a few months since the writer was called to investigate 2 outbreaks of trichinosis, in which more than 50 persons were taken ill and 5 died. The disease is almost unknown among persons of American birth, since the latter invariably use pork thoroughly cooked, while the eating of raw pork is quite a common practice among those of foreign birth, specially among Germans.

Tape-worm, also, usually has its origin in eating the flesh of swine which has been insufficiently cooked.

The government provides an ample force of inspectors at the principal pork-packing places, for the purpose of securing protection to the consumers of this pork in other countries to which it is exported. But the agriculturist himself, who produces the pork upon his farm, has no protection for his family who may be consumers of the same, except that which

common sense at once suggests-the thorough cooking of the meat. This applies with greater force to those farms which are near great cities, to which the offal of these cities is often hauled for the purpose of being fed to swine. Investigators have shown that this class of animals is much more liable to trichinosis than those which are fed on the healthful food raised upon a farm—meal, grain, potatoes and other vegetable foods.

The proper ventilation of sleeping-rooms is another matter of importance, and one which is usually neglected.

THE CLIMATE OF THE UNITED STATES IN ITS RELATION

TO HEALTH

In a country which extends almost from the tropic of cancer in the south to Point Barrow in northern Alaska, several hundred miles beyond the Arctic circle, and from Eastport, Maine, in longitude 67° west, to the extremity of the Aleutian islands, at a point beyond 160° west, the range in all the factors which make up the somewhat indefinite term "climate" must necessarily be great.

That climate has a decided influence on the health of a given population is a well established fact.

Yellow fever is a disease, for example, which rarely prevails north of latitude 35°, in the United States, and even when it once appears north of 35° it is easily prevented from spreading, but in the gulf states the greatest vigilance on the part of the sanitary authorities is necessary, both to prevent its introduction and to suppress it when once introduced.

Pneumonia, in the United States, appears to destroy more lives in the high and mountainous districts than it does along the low lands of the sea-coast, while the opposite may be said of phthisis, which attacks the dwellers in low and damp districts more severely than those who inhabit the drier tablelands of the interior. Diphtheria is more prevalent in the colder, northern portions of the United States than in the south, and malarial fever is more prevalent in the south and