HARl'.RR: DIPHTHERIA IN KANSAS. 35 



the period as a whole, to warrant the conclusion that there has 

 been a diminution of infectious diseases, or an improvement in 

 sanitation in the state. In view of the general uncertainty of our 

 statistics it is impossible to tell whether a low death rate recorded 

 for a certain year indicates unusual good health on the part of the 

 people, or an unusual neglect to report on the part of physicians 

 and health officers; and the table is of value only if we assume that 

 the amount of neglect is proportionally about the same every year. 

 From the figures in this table the average annual death rate in 

 Kansas during the twelve years from diphtheria alone was 1.17 per 

 10,000 people of all ages. If we had a complete record of deaths 

 we would probably find this far beneath the actual rate. The 

 United States Census Report gives 385 as the number of deaths in 

 Kansas from diphtheria during the year ending March 31, 1890, 

 while in the State Board Reports we find only 324 given for 1889 

 and iSgo combined. 



An attempt to gain accurate information in regard to any disease 

 in this state impresses strongly on one the need of better vital sta- 

 tistics. Many diseases are known to be to a great extent prevent- 

 able, and in an intelligent attempt to control any disease it is 

 important to know its previous history in the state, its strongholds 

 and the conditions which surround them and the effect of varying 

 seasons on its prevalence. Knowledge of the history of a disease 

 in a state is as important for its prevention as the history of a 

 disease in an individual is for its cure. The state of Michigan 

 publishes each year, for every county in the state, the number of 

 localities attacked by diphtheria, the number of cases, the number of 

 deaths and the death rate, besides data showing the points of origin 

 of epidemics and the direction of spread, while in Kansas we hardly 

 know whether the disease is increasing or not in the state as a 

 whole. In our agricultural reports we have statistics showing the 

 number of dogs in the state and the number of sheep killed an- 

 nually by dogs and wolves, yet we have no vital statistics from 

 which we can learn with any accuracy how many children yearly 

 die from diphtheria. The entire blame for this state of affairs can- 

 not be laid on the health ofificers of the state and counties; it is 

 only when the funds needed for their work are given them, and 

 when they receive the aid of all physicians and the moral support 

 of the people in enforcing the law, that we may hope for material 

 improvement in this important work. 



I wish to thank Dr. H. Z. Gill, secretary of the state board of 

 health, and the county and city health officers of this and other 

 states for valuable assistance in the preparation of this paper. 



