DEPARTMENT OF VITAL STATISTICS.

GEORGE D. LESLIE, STATISTICIAN.

TUBERCULOSIS IN CALIFORNIA.

The State. Tuberculosis is the principal cause of death in California, being the cause of about one-seventh of all deaths. Of 31,095 deaths reported to the State Bureau of Vital Statistics for 1907, 4,607, or 14.8 per cent, were from tuberculosis, and of 29,303 deaths reported for 1906, 4,437, or 15.1 per cent, were also from the "great white plague." The totals for diseases of the circulatory system were only 4,362 and 3,766 for 1907 and 1906, respectively; for diseases of the respiratory system, 3,588 and 3,187; for diseases of the nervous system, 3,060 and 2,763; and for diseases of the digestive system, 2,775 and 2,678.

From tuberculosis of the lungs there were 4,040 deaths in 1907, as compared with 3,861 in 1906, while from tuberculosis of other organs there were 567 deaths in 1907 against 576 in 1906.* Of each 1,000 deaths in California in 1907, 129.9 were from tuberculosis of the lungs and 18.2 from tuberculosis of other organs, or 148.1 from tuberculosis of all forms. In 1906 the proportions were 131.7 for tuberculosis of the lungs and 19.7 for tuberculosis of other organs, or 151.4 for all forms.

For an estimated State population of 2,001,193 in 1907 the death rate per 100,000 inhabitants is 201.9 for tuberculosis of the lungs and 28.3 for tuberculosis of other organs, or altogether 230.2 for all forms of tuberculosis. Similarly, for an estimated population of 1,882,846 in 1906 the death rate per 100,000 is 205.1 for pulmonary tuberculosis and 30.6 for other forms, or 235.7 for all kinds. In short, the tuberculosis death rate per 100,000 was no less than 230.2 for 1907 and 235.7 for 1906.

The general death rate per 1,000 population was 15.5 for California in 1907 and 15.6 in 1906, the rates being swollen greatly by deaths from tuberculosis. It will be shown that many deaths from tuberculosis in California occur among persons of short residence in the State, who evidently came here when too far gone with the disease to be cured. It is also quite likely that many other cases arising here are directly due to this imported infection.

The distribution of deaths from tuberculosis other than pulmonary was as follows:

Geographic Divisions.-Southern California is an especially popular resort for consumptives, and here over one-fifth of all deaths are due to tuberculosis. The following table shows the number and per cent of deaths from tuberculosis for the several geographic divisions of the State in both 1907 and 1906:

Number and Per Cent of Deaths from Tuberculosis, for Geographic Divisions:
1907 and 1906.

This table shows that in Southern California in 1907, 20.1 per cent of all deaths were from tuberculosis, and in 1906 no less than 21.6 per cent. For Los Angeles County the per cents were 20.3 for 1907 and 21.2 for 1906, while for the other counties south of Tehachapi the per cents were respectively 19.8 and 22.2.

North of Tehachapi only one-eighth of the deaths are due to tubercu losis, the per cents for Northern and Central California together being 12.6 for 1907 and 12.7 for 1906. The per cents for 1907 and 1906, respectively, were 13.0 and 12.8 for Central California and 11.0 and 12.1 for Northern California, the prevalence of tuberculosis decreasing more and more toward the north. The per cent was below the State average each year for every main and minor geographie division north of Tehachapi, being lowest of all for the interior counties of Northern California, 9.8 in 1907 and 11.3 in 1906.

The per cents are somewhat less for the metropolitan area comprising San Francisco and the other bay counties, 12.5 in 1907 and 11.7 in 1906, than for the rural counties north of Tehachapi, 12.7 and 13.8, respectively. In the city and county of San Francisco the per cent of deaths from tuberculosis was only 12.2 for 1907 and 11.3 for 1906.

Length of Residence. The heavy mortality from tuberculosis in

California is due largely to the immigration of people so badly afflicted

with this disease that they can not recover, even under the most favor-

able climatic conditions, though they may lengthen their lives somewhat

by coming to this land of sunshine. For it appears that many who died

of tuberculosis in California had been residents of the Golden State

for only a short time. This is shown for the several geographic divisions

in 1907 and 1906 in the following table, giving numbers and per cents

by length of residence:

Deaths from Tuberculosis Classified by Length of Residence in California, with

Per Cents, for Geographic Divisions: 1907 and 1906.

It appears from the table that the per cent of tuberculosis victims in California who were natives of the State, having been here for life, was only 28.6 for 1907 and 28.9 for 1906. The per cent born elsewhere, but who were residents of 10 years' standing, was 25.7 for 1907 and 26.6 for 1906, while the per cents for those who had lived in California only from 1 to 9 years were 22.4 and 20.7 for 1907 and 1906, respectively. In 1907, 9.9 per cent and in 1906 no less than 12.5 per cent of all the deaths from tuberculosis were of persons who had been in the State less than a year. The length of residence was unknown for 13.4 per cent of the tuberculosis victims in 1907 and for 11.3 per cent in 1906. The per cent for natives of the State was 38.1 for Central California each year, and for Northern California 35.9 in 1907 and 37.6 in 1906. The per cents were respectively 37.7 and 38.0 for the counties north of Tehachapi against only 14.8 and 14.9 for those to the south. The per cent of tuberculosis victims born in the State was 39.4 for the metropolitan area in 1907 and 39.3 in 1906, as compared with, respectively, 36.1 and 36.8 for the rural counties north of Tehachapi.

The deaths from tuberculosis among residents of 10 years' standing were 34.1 and 33.3 per cent for Northern California and 29.9 and 30.7 for Central California in 1907 and 1906, respectively. For Northern and Central California together the per cents were 30.5 and 31.1 against only 18.4 and 19.7 for Southern California. North of Tehachapi the per cents were respectively 30.2 and 31.0 for the metropolitan area, as compared with 30.9 and 31.2 for the rural counties.

In 1907 altogether 32.3 per cent of the deaths occurred among residents of less than 10 years' standing, 22.4 per cent having lived here from 1 to 9 years and 9.9 per cent under 1 year. Similarly, in 1906, 20.7 per cent had been here from 1 to 9 years and 12.5 per cent under 1 year, or altogether 33.2 per cent had resided in California less than 10 years. The per cents for residents of less than 10 years' standing are above the State averages only for Southern California, 56.4 in 1907 and 58.9 in 1906. The per cents were 57.2 and 61.2 for Los Angeles and 54.6 and 54.1 for the other counties south of Tehachapi in 1907 and 1906, respectively. On the other hand, the corresponding per cents were only 16.4 and 16.6 for the counties north of Tehachapi, being 17.2 and 16.9 for Central California, and 11.8 and 14.8 for Northern California. The per cent of deaths among persons who had lived in California less than 10 years was 15.2 for the metropolitan area in 1907 and 14.3 in 1906, as compared with, respectively, 17.5 and 18.7 for the rural counties. north of Tehachapi.

It seems, therefore, that in Southern California, where over one-fifth. of all deaths are from tuberculosis, that nearly three-fifths of these deaths occur among persons who had been in the State less than 10 years. In fact, about one-fifth of all the tuberculosis victims south of Tehachapi had resided in California less than a year, the per cent being 18.4 for 1907 and 25.4 for 1906. The per cents were 17.7 and 24.6 for Los Angeles and 20.2 and 26.9 for the other counties in 1907 and 1906, respectively.

Southern California.-Moreover, many who died of tuberculosis in Southern California had lived in the State only a few months. This is shown clearly in the following table giving numbers and per cents by length of residence in months for Southern California in 1907 and 1906:

Deaths from Tuberculosis Classified by Length of Residence (in Months), with Per Cents, for Southern California: 1907 and 1906.

The table shows that of all who died of tuberculosis in Southern California in 1907, 2.4 per cent had been in the State less than a month, altogether 7.7 per cent less than three months, and altogether 12.7 per cent less than six months. In 1906 3.4 per cent had lived here under a month, altogether 9.1 per cent under three months, and altogether 16.0 per cent under six months. Of all the tuberculosis victims in Los Angeles in 1907 12.2 per cent, and in 1906 15.1 per cent, had resided in California less than half a year. The corresponding per cents for the other counties south of Tehachapi are 14.0 for 1907 and 17.8 for 1906.

Conclusion. These figures give only a minimum statement of the extent to which the general death rate of California is swollen by the deaths of persons who were stricken with tuberculosis elsewhere, and who simply came here in the hope of recovering, or with the expectation of at least lengthening their lives in the glorious climate of the Golden State. The statistics cover only the deaths that occur among these recent residents, in many cases quite soon after their arrival in this land of sunshine. No data are available to tell what proportion of deaths from tuberculosis among native Californians and old-time residents are directly due to imported infection by the presence here of sick people from other places. It is quite evident, however, that the death rate of California is swollen somewhat by the unhealthfulness, not of this State, but of other states, being increased, in fact, by the wide fame of California as a curative health resort. For the principal cause of death the State is one which finds most of its victims among newcomers seeking restored health and finding longer, happier life in the balmy atmosphere of California.