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and recording of death certificates and the reporting of contagious diseases."
CHAS. L. MATTFELDT, M.D., Health Officer for Catonsville, Md.
"The proper collection of mortality statistics would necessitate the enactment of a law providing for the issuance of a burial permit for every death occurring within the State. An official could be designated to act in such capacity even in the most sparsely settled portions of our State, and that, too, without cost. If Maryland desires to take rank among the progressive States some action must be taken by the Legislature, such as the enactment of a general burial-permit law."
C. F. GOODELL, M.D., Health Officer for Frederick City, Md.
"The need of a burial-permit section in the Registration Law is very evident."
H. S. WEUSTHOFF, M.D., Health Officer of Havre de Grace, Md.
“One of the most important things to my mind is the need of a burialpermit section in the Registration Law, and it is essential that we get such a provision into the law at the next Legislature. A very necessary detail is a fair compensation of the local registrars for recording certificates. A fee of iwenty cents for each complete record is little enough for the counties and small towns of Maryland.”
A. SHELMAN WARNER, M.D.,
Health Officer for Highlandtown, Md. "Our health ordinance provides that no human body shall be buried without a permit from the town clerk.This and other restrictions connected with the burial and removal of dead bodies has helped to teach the people to be more careful about needless exposure at funerals in case of death from contagious disease. The ordinance was well received, and has rendered valuable assistance to our undertakers and ministers in conducting funerals. A State law, with similar provisions, might well be enacted."
JAMES O. BULLOCK, M.D.,
Health Officer for Lonaconing, Md. Another section of the law which needs amendment is Section 6K. It will be observed that no compensation is provided for the performance of the duties imposed by this act upon local registrars. In older registration States the usual fee for recording a death is twenty cents. This small fee will prove no burden upon any county in the State. Wherever a single registrar makes the records for a population of one hundred thousand or over, it will be wiser to pay a stated salary for the work of the local registrar. For any less number of people it will be more economical to pay a fee of twenty cents for each certificate recorded by the local registrar. The amount of money expended in each county for recording deaths may be estimated by multiplying the estimated population of the county by 36, and striking out the last four figures. Applying this to the population of the State, outside of Baltimore City, it will be found that $2,400 will fully cover the fees for records of death in a year, even if such large towns as Cumberland, Hagerstown and Frederick should pay their registrars by fees. These figures are obtained by assuming the death rate in the counties to be eighteen per thousand persons living. This is a liberal estimate of the death rate, since that for Baltimore City, which should be higher than that of the rest of the State, is about nineteen per thousand. No argument whatever should be needed in favor of so insignificant a tax upon the twenty-three counties of Maryland.
RESULTS OF THE VITAL STATISTICS LAW DURING ONE YEAR.
There are on file at the office of the State Board of Health cards representing 6,721 deaths which occurred between July ist, 1898, and June 30th, 1899. During the same period, certificates of births were received to the number of 5,586. If we subtract from the number of death cards those which have no other basis than a newspaper notice there will remain 5,041, which would give as an apparent ratio of births to deaths five and a half to five. If another correction were made on account of the fact that reports of individual deaths are directly pursued by the State Board of Health, while the reports of births are sent in solely on the volition of the reporter, we shall find that the figures represent a ratio of about eleven to nine. It is not by any means intended to offer such a ratio as the demonstrable ratio of increase of native population. The figures merely indicate a balance in favor of growth. It has always been the experience in early years of registration that far more births than deaths escaped record, and so no doubt it has been in Maryland.
The certificates of birth are roughly divisible on the line of color, but it has been thought better not to enumerate colored and white births separately, since the reports of white births have certainly been a far greater proportion of the births actually occurring
Similarity with respect to deaths, a separate enumeration for each race would give misleading results. Our sources of information are more accurate as to deaths among the upper social classes.
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A diagram is here shown of the deaths for the year ending July ist, 1899, divided according to causes of death. If the column marked "unknown" is disregarded, the diagram shows that the causes of death in this State stand in about the same relation to each other as in the States operating more perfect plans of registration.
The "unknown” column consists almost entirely of deaths for which we have been unable to obtain authenticated certificates. This column represents the deaths of citizens who were of sufficient importance to secure their notice in the newspapers, but whose means of taking off were not harrowing enough to be of news interest. Tne newspapers have enabled us to confer unmerited distinction upon violent death. The accident, suicide and homicide columns occupy higher rank than they should.
The diagram showing deaths by ages shows marked deviations from the ordinarily observed mortality at different periods of life. This diagram is not, however, to be interpreted at all. We have no means of ascertaining the number of persons living at the various ages, and without this factor no safe reasoning can be based upon the deaths charged to each period.
One preventable disease (or class of diseases) is strong enough to thrust itself into prominence in this diagram. Infantile diarrhæa creates the havoc which gives the column of deaths under the age of 2 its gloomy eminence, and perhaps will indicate to thinking men that measures designed to cut down this item of avoidable loss would yield some profit to the State. This diagram is, however, of little interest just now.