TABLE IV.-RANK OF THE SEVERAL SPECIFIED OCCUPATIONS AS DETERMINED BY THE RATIO OF MARRIED MALES IN 1900 TO HUSBANDS DIVORCED FROM 1887 TO

1906 INCLUSIVE.

RANK OF THE SPECIFIED OCCUPATION IN THE ORDER OF THE INCREASING RATIO OF MARRIED MALES (1900) TO HUSBANDS DIVORCED (1887 TO 1906).*

BETTER STATISTICS OF INDUSTRIAL MORTALITY FOR THE UNITED STATES.

BY CRESSY L. WILBUR.

From the leading editorial in the Journal of the American Medical Association for Jan. 9, 1909, on "Industrial Hygiene: A Neglected Field," I quoted the following extract as the basis of an appeal* to the medical profession of the United States to co-operate in securing the more definite statement of specific occupation and industry of decedents as reported upon certificates of death:

When we turn to our own country, the contrast is striking. We have statistics as to the mortality rate in the different trades, but almost nothing as to the far more important feature, the morbidity rate. In the case of women wage-earners the uselessness of this one-sided information is strikingly shown, for according to the federal statistics women factory workers have a lower death-rate than any other class of society, the truth being, of course, that few women die as factory workers. When death comes, most of them have passed into the class of housewives. Nor do the mortality statistics give really accurate information, because the classification of the trades is not sufficiently discriminating. Thus the men who work at the metalpolishing wheels are listed together with the men in other branches of the metal trades, and therefore the federal figures do not show the enormous death-rate from pulmonary disease among these men which is revealed by an examination of the records of the Metal Polishers' Union. In the older countries not only the death-rate, but the injury to health caused by the trades, is made the special object of study and of government control; and here we American physicians fall far behind our European contemporaries. The physicians of Germany, France, Great Britain, and Switzerland have grown alert to the close connection between occupation and disease.

The mortality of occupations is one of the most difficult problems of vital statistics, especially in the United States where

*Letter in Journal of the American Medical Association, Feb. 6, 1909.

only a little over one-half of the population possesses fairly complete registration of deaths at all. The accuracy of figures showing occupational mortality from various causes of death depends upon the completeness and precision of several factors. These are: (1) the correct statement of occupation and age in the enumeration of population by the census; (2) the correct statement of occupation and age of decedents upon certificates of death; and (3) the precise statement of cause of death by the attending physician, health officer, or coroner upon the medical certificate. It is especially important that the mode of statement of occupation and the correct statement of age shall harmonize upon the population schedules and the transcripts of deaths, as otherwise the ratios of occupational mortality which are based upon the comparison of these two sets of returns will be to some extent unsatisfactory.

Much attention is being given to the subject of occupation by the division of population of the census in connection with the preparations for the taking of the Thirteenth Census in 1910. The Census Bill, now in conference, provides for the statement, after "occupation," of "whether or not employer or employee," and it is contemplated to ask the further question of "by whom employed," so that by reference to a list of industrial establishments, it is hoped, the precise nature of the industry as well as the specific character of the occupation of the individual can be established. Furthermore, an analytical study is now being made of the extremely numerous terms returned at the Twelfth Census for the designation of occupations, so that for the first time in this country the material will be available for a thorough classification of occupations. On the basis of this information and of previous experience precise instructions will be formulated for the enumerators of population at the approaching census, and it seems likely that the data relating to the occupations of the inhabitants of the United States who are enumerated in 1910 will be more valuable than ever before collected.

Efforts are likewise being made to secure better reporting of occupations in the mortality returns. At the initial meeting of the Section on Vital Statistics of the American Public Health

Association at Atlantic City, 1907, I submitted, for consideration by the organized registration officials of the country, certain propositions which were printed in the Quarterly Publications of the American Statistical Association for December, 1907, so that they were brought very widely to the attention of statisticians and students of social data, and were also referred in due course to a special Committee on Occupations, of which Mr. Frederick L. Hoffman was chairman. At the second annual meeting of the Section, held at Winnipeg, August, 1908, two of the propositions were adopted, and have now become accepted rules of practice of the registration officials of the United States:

STATEMENT OF OCCUPATION.

Rule No. 1.-An attempt should be made to secure not only the kind of occupation (e.g., laborer), but also the kind of industry (e.g., pottery).

Rule No. 2.-Occupations should be stated for all decedents over ten years of age (and for decedents under ten years of age if employed in a mill, factory, or in any gainful occupation).

The other propositions are still under consideration by the committee, which will report upon them at the meeting to be held at Richmond, Va., during the present year. At the same time a revised form of the “Standard Certificate of Death" will be adopted, of which the improved statement of occupation will form a part, so that we shall be able to begin the use of the new blank on Jan. 1, 1910, and thus obtain better returns of occupations for the census year. The exact form in which the question is to be asked is still under consideration, that suggested above being only a tentative arrangement designed to elicit discussion. Having agreed upon a standard certificate of death with satisfactory provision for the statement of occupation, then it will be possible for the Bureau of the Census to prepare instructions for the reporting of occupations that will be entirely consistent with the instructions given to enumerators for the return of occupations on the population schedule, and, with the co-operation of the state and city registration services, these instructions can be brought to the attention of every

physician, undertaker, and local registrar in the United States who has to make out the original reports.

Physicians do not, as a rule, in the United States certify to the occupation of the decedent. This information is more usually given by the informant, who may be some relative or friend of the deceased, or by the undertaker. But physicians do occasionally fill out this part of the certificate, and they might readily note, when the certificate is presented for statement of the cause of death, whether the occupation is properly stated or not. In fact, it might be possible to provide for an indorsement by the medical attendant of the statement of occupation, with the addition of such details as may be necessary for proper classification. He could call special attention to the effects of former occupations as determining the cause of death.

But it is doubtful, to my mind, whether physicians as a whole would respond to any great extent to such an opportunity for obtaining additional and very important data on the effects of employment. I am afraid that they would be apt to consider even the simplest addition to the present form of question as unduly complicated and as savoring too much of "red tape" and inquisitiveness into personal particulars. If the physicians would not approve of the attempt to secure more definite and exhaustive information, it is not likely that the other classes of informants, who may not understand the practical uses of the data, will be likely to yield better results. I should therefore be very glad to learn the personal views of as many physicians as possible in all parts of the country with respect to the suggestions made for obtaining a better statement of occupation upon the certificate of death, and to know how fully the medical profession is disposed to co-operate therefor.

What physicians can readily do, without question, is to furnish more precise statements of cause of death, and to use only the accepted medical terms to describe well-known diseases, taking special pains to note that diseases or injuries due to occupations are definitely indicated. Thus "lead poisoning (house painter)" would clearly show that it was not a case of accidental acute poisoning from some salt of lead, but that it