county. I believe a burial permit section in the registration law would have a good effect in securing death reports throughout the county and smaller towns.

"A fair compensation ought to be allowed local registrars for work of recording the certificates. It is only a simple business question as to how much it should be."

W. H. RAVENSCRAFT, M.D.,

County Health Officer for Garrett County.

"In reference to the "vital statistics" law, it is impossible to get anything like a full return.

"I think a registry law requiring a burial permit from the health officer of the city or county, to be given upon receipt of a certificate from the doctor attending the case; the undertaker to give the blank to the family to be filled by the doctor, and then taken to the party designated by the health officer and a burial permit obtained, the undertaker inclosing them to the health officer. This would at least give full returns of deaths."

THOMAS B. OWINGS, M.D., Health Officer for Howard County.

"The establishment of a bureau of vital statistics, with branches in the counties, has not during the past year resulted as I hoped. The value of vital statistics is unquestioned. That they should be full and complete is necessary to get them so requires more stringent laws.

"A committee (I am a member) was appointed at the last meeting of the Maryland Public Health Association to urge the passage of a law by the Legislature at its next session, requiring the possession of a burial permit issued by the Secretary of the local Board of Health before a deceased person can be buried, and making it unlawful to fail to comply. This would compel the doctors to at once report the death to the Secretary, also would make the undertaker unable to carry out his work without such a certificate. Such a law would entail a greater amount of clerical work on your Secretary, but would surely accomplish its purpose. This is no new thing, as all the cities have such a law."

W. FRANK HINES, M.D.,

Health Officer for Kent County.

"There is but one way to insure immediate registration, and that is to forbid any disposition of a dead body until a proper record is returned. The burial permit is the key to prompt registration, and without it no vital statistics law can be economically operated.' I sincerely hope that the next Legislature will make such provisions in an amended law.

"Another important detail is the fair compensation of local registrars for the work of recording the certificates. I think a fee of fifteen cents for each complete record made is little enough remuneration."

E. E. STONESTREET, M.D., Health Officer for Montgomery County.

"While a majority of the physicians of the county have manifested a willingness to comply with the vital statistics law, I still have abundant reason to regret, and even to complain, of an incompleteness along this line that must render our statistics unreliable, if not actually misleading: yet I am gratified to note some improvement touching this important matter within the past year.

"Why could not one element at least of the defect be remedied at the coming session of the Legislature? What would better accomplish this

than a section requiring a burial permit? This would insure fuller and more prompt reports. This feature of the law might be very properly corrected, as well as the inadequate compensation received by a local health officer throughout the State."

JAMES BORDLEY, M.D.,

Health Officer for Queen Anne's County.

"The undertaker should not be allowed to bury any body unless he has a death certificate, properly made out by the attending physician, and that would compel some member of the family to go to the physician's office and get the certificate before burial would be possible."

L. B. JOHNSON, M.D.,

Health Officer for St. Mary's County.

"In my opinion the State should either improve the law requiring the registration of births and deaths or abandon it. The operation of the law reveals two classes of physicians-one yielding acquiescence to the request of the State for information which shall furnish an accurate birth and death rate, as well as establish the comparative prevalence of fatal diseases; the other, ignoring the law and withholding information absolutely essential to the construction of vital statistics, which shall truthfully represent conditions in Maryland, and as contemplated by the law. The failure of these delinquents nullifies the faithful work of others, and renders the returns of little or no value."

J. McP. SCOTT, M.D., Health Officer for Washington County.

"There is urgent necessity for a burial-permit section to the Registration Law. We hope for a favorable consideration of this matter at the ensuing Legislature."

CHAS. P. JONES, M.D.,

Health Officer for Worcester County.

"Perhaps the best way to obtain full and prompt reports of deaths (the need of which I would particularly emphasize) would be the incorporation of burial-permit section in the Registration Law.”

WM. S. WELCH, M.D., Health Officer for Annapolis, Md.

"The system of reporting and recording deaths and infectious diseases is working to our complete satisfaction. The burial permit contributes largely to the completeness of the death returns; in fact, we might say it is the key to the whole matter. Our local ordinance forbids the burial or removal of a body without a permit, and the result is such that we would recommend its adoption throughout the State."

H. S. HEDGES, M.D.,

Health Officer for Brunswick, Md.

"To obtain a complete record, no body should be removed from the location where death took place without a permit from the local health officer or registrar, and I sincerely hope that such a provision will be added to the present vital statistics law. If such a law is enacted at our next Legislature it will be of great benefit both in accurate collection

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 twenty 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.