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The town has good sanitary laws, but no discoverable administration. Returns from Frostburg and Lonaconing are complete.
Dorchester enjoys the distinction of making the very scantiest returns among all the twenty-three counties in Maryland. The bad eminence of Dorchester is due to the want of burial ordinances in the thriving city of Cambridge, and there is little reason to hope for early improvement along this line of sanitary work
The best registration area is found in Cecil County, where all the necessary influences for good sanitary work are found, an intelligent population, a thoughtful, progressive Board of County Commissioners, an earnest and effective local officer.
Calvert County ranks as the next best registration area, and its registration for the present year promises to be more nearly complete than that for the year under consideration. Since Calvert is one of the very sparsely populated counties, the attention paid to registration of births and deaths must, in a great measure, be due to the local registrar's ability to secure and maintain the co-operation of the medical profession.
As a collection of public documents, about half the records on file are of value. Those which are well enough authenticated to be presented in a court of justice as evidence of any of the facts alleged in a death certificate, are of course the records bearing the signature of an attending physician. Half of the records on file would mean about thirty per cent. of all the records obtainable under a good system of registration. As a source of information for the purposes of a private citizen, our registration has therefore attained no more than one-third of a normal efficiency.
It may fairly be doubted whether these fragmentary results are worth the time and labor they have cost. Very probably much of the time spent upon these records by the State Registrar might have been more profitably employed in other official work. If a question concerning the continuance of this system of registration is admitted, it must be upon the ground that part of the cost is avoidable, and not on the ground that the results, even as they stand, are unprofitable. The information received has been fully worth the money it has cost, and if such information could not be more cheaply obtained, the necessary price should be paid rather than abandon the work.
But the laborious and relatively unproductive methods now employed are wholly unnecessary. Ninety-five per cent. of all the deaths happening in the State of Maryland can and should be collected and filed as permanent records, with no greater expenditure of State funds, and with no more cost in labor than has attended the registration work of the past year. To this end it is only necessary to modify the present law in such a manner as to secure good local registration.
The key to complete registration of deaths is the burial permit. Since all men are everywhere agreed that a dead human body must be disposed of promptly and in some decent way, it is only necessary to attach a legal formality to the act of burial in order to obtain a record of the death at or very near the time of its occurrence. Registration of deaths is not now, and has never at any time or place, been successful without a burial permit. Eighty per cent. of all the deaths occurring in the State of Maryland happen within ten minutes easy transit of a local registrar. A burial permit law applying only to incorporated towns of one thousand or more inhabitants would insure the registration of ninety per cent. of the deaths which annually occur.
For the purposes of the State Board of Health statistics based upon ninety per cent. of the total mortality would be exceedingly useful. Indeed, the remaining ten per cent. might at no great risk be neglected. But the State Board of Health does not wish these records solely for its own purposes. It cannot be too much insisted upon that these records have great and growing value, and that they are of use in a great variety of ways in the conservation of private, as well as public interests, Wherever they have long been established, as in New England and most of the Middle States, in Michigan, in most European countries, they are a source of valuable information, constantly consulted by private citizens, public officials and professional men of all classes. It is not alone the statistical facts which are of use, but the mine of personal information contained in these easily accessible records is of even greater immediate value. It falls well within the limits of probable truth to say that in Maryland every year quite three thousand citizens are forced, in guarding their own private interests, to employ some clumsy and expensive substitute for purposes which these records would serve both conveniently and effectively. A good authority has said that more pension claims fail of successful prosecution through want of proofs of death or relationship than for any other cause. If many just claims fail of right adjudication from this cause it is more than probable that as many fraudulent claims are successfully imposed upon the Government by testimony which authoritative officiąl records would at once disprove.
It must be clear that the material interest which every citizen of Maryland has in a correct system of registration of births and deaths is far greater than the value which the sanitary authorities of the State set upon the records. The sanitarians are besieging the Legislature for vital statistics, which are to them the balance sheets showing what head, if any, they make against disease and death. The people need for their own and different purposes the records upon which these statistics are based.
The State cannot, therefore, neglect the ten per cent. of deaths which occur outside of incorporated towns and cities, and must for equal justice to all her citizens make record of at least the two most important events in the history of every individual.
To illustrate the value of these records, aside from their hygienic uses, I offer some figures obtained from some of the important cities operating registration offices:
In Boston no accurate account is kept by years, but the clerk of the Registry Department says that in 1898 about 5,200 copies of records were called for.
Washington, D. C., has records covering a very few years; yet the citizens asked for and obtained in the fiscal year 1898– 1899 copies of records for the following purposes: Insurance claims .....
........ 143 Pension claims..........
274 Evidence in court and otherwise.........
92 To be sent to foreign countries .................... 18
Total. ................................... ......... 527 St. Louis has had a registry department for only a short time. Copies of records were asked for in 1898 to the number of 880; copies of birth certificates, 64; of death certificates, 816.
In New Orleans in 1898, 887 copies of vital statistics records were asked for by citizens.
In Philadelphia, during the same year, 7,430 copies of records were asked for: Insurance claims.......
....... 1,329 Pension claims..........
1,389 Other uses. ..... The Registrar of Vital Statistics of Chicago replied to our inquiry that in 1898 no record was kept of the number of copies of record asked for. The uses to which they were put were insurance claims, pension claims, evidence in court, to be sent abroad, and in settlement of estates. The vital statistics of Chicago are not of many years' standing. About four years ago more than a thousand copies of these records were asked for by citizens. .
In New York, in 1898, the total number of copies of records of births and deaths obtained by the citizens was 18,735. No account was kept of the purposes for which these transcripts were used. Including the marriage records there were 21,124 searches made.
These figures certainly show that official records, such as we desire to make primarily for their use in sanitary work, have a different and perhaps an equal value for the private purposes of
citizens. It is evident that if the records of New York were destroyed, the sense of personal loss would touch more than 20,000 persons within a year, and would affect an equal number of citizens in each of many succeeding years.
The bill, which was originally offered at the last Legislature, contained the following two sections, which are not found in the law,
Section 6 B in the original bill was as follows:
“Each local registrar shall have power to appoint competent persons, to the number of not more than one for each election district in the registrar's jurisdiction, to act as sub-registrars. Such appointments shall be made so as to suit the convenience of each locality, shall be certified in writing, and shall be recorded in the office of the State Registrar. Such sub-registrars shall be duly sworn to the faithful performance of their duties, and their term of office shall not extend beyond the term of office of the appointing registrar. Each sub-registrar shall be authorized to make all such records and to issue all such certificates and permits as are made and issued by the local registrar, and shall, in the first five days of each month, send to the local registrar the originals of all certificates, records and permits remaining in his possession on the last day of the preceding month.”.
Section 6 E of the original bill provided that:
“No interment of any dead body of any human being, or disposition thereof in any tomb, vault or cemetery, nor any embalming process, or injection of any preservative substance, shall be made without a permit as aforesaid from the registrar or sub-registrar of the district where said person died, or otherwise than in accordance with such permit. The application for a burial or removal permit, together with the statement of facts required therein, shall be signed by a relative, friend, householder, manager of the institution upon whose premises the death occurred, or by any competent person acquainted with the facts. The certificate of death shall be signed by the physician last in attendance upon the deceased person, (or by the health officer or coroner, in case of death without medical attendance or of sudden or violent death). It shall be the duty of the undertaker or other person in charge of the burial or removal of the body of any deceased person whose death occurs in any registration district of the State, to obtain the application for burial or removal permit, with the certificate of death, file the same with the registrar in whose district the death occurred, and obtain the proper burial or removal permit based thereon from the registrar prior to the burial or removal of the corpse, and it is hereby made the duty of the attending physician, in attendance upon any person who shall die, to leave with the family or at the home of the deceased, a certificate setting forth the cause of such death, which certificate shall, by the said family or friends of the deceased, be given to the undertaker, in order that he may obtain from the registrar the proper burial or removal permit. And it shall be the express duty of the registrar to see that the law governing the issue of burial aud removal permits is strictly complied with, that all personal and statistical information, required on the blank applications, is fully supplied, so far as it is possible to obtain the same with reasonable effort, and that a clear and distinct statement of the cause of death, so far as known, is made by the certifying physician. In case of doubt in regard to the return of a cause of death, or if a vague or ambiguous statement is made under that head, the registrar, before granting a permit, shall immediately refer the application to the health officer or coroner, who shall investigate and report the facts over his official signature; provided, that in case of an investigacion of an unsatisfactory return, the registrar may issue, in his discretion, when it shall appear that death resulted from natural causes and not from unlawful means, a temporary permit allowing burial or removal, which temporary permit shall be cancelled by regular permit issued in due form upon the completion of the proper return; and provided, further, that in case of death from any contagious or infectious disease, said certificate shall be made and forwarded immediately."
For Section 6 B, the following was substituted and became a law:
SEC. 6 B. All physicians shall be sub-registrars of vital statistics, and shall be authorized and required to make all such records and certificates as are made and issued by the local registrar, and shall in the first five days of each month send to the local registrar all certificates and records made during the month next preceding.
This makes all physicians State officials, imposing upon them duties which they do not desire and cannot be made to perform. Section 6 B, as it originally stood, would have secured the attention to this important business of a small number of competent men who, taking up the work after formal qualification, could have been held responsible for the mortality returns of their districts.
It would be quite practicable to give this duty of registration in small rural districts to justices of the peace, and so avoid the multiplication of officers. The justices are at least as well qualified for this small clerical work as for coroner's duty.
Section 6 E contained no provision which will not eventually become the law of the State. Objection was made to the stringency of the regulations imposed upon undertakers. Indeed, it is quite customary in Baltimore City for undertakers to complete all the work of preparing a body for burial before seeing the certificate of death or applying for a permit to bury. The Legislature did not seem to be impressed with the view that under such circumstances neither the manner of death, nor even the fact of death is known to the undertaker upon any other authority than his own observation and the representation of the friends who are unknown to the undertaker. Under such circumstances murder may have been committed, and the crime may be effectually concealed by the undertaker. Instances in which murder by poison has been done, and conviction of the criminal rendered difficult or impossible by prompt embalming, are quite numerous. How many cases of the same sort have been successfully and completely concealed can only be conjectured.
In the rejected section (6 E) the householder or nearest friend was required to state certain of the essential facts concerning the deceased person. This is right, because such facts should be certified by the person to whom the facts are personally known,