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rather than by a person who must give these statements at second hand.
Objection was also made to the very express injunction upon the local registrar to collect all the essential facts before issuing a permit, and to issue no permit upon vague or ambiguous statements, allowing him in certain cases only the discretion of a temporary permit, pending the completion of the regular certificate. These requirements do not seem rigorous. They are details which the faithful officer will attend to without special admoni. tion, but if the law does not insist upon this scrupulousness, careless or unsuspecting health officers may unwittingly contribute to a great deal of dangerous petty crime, and to some crime of great gravity. Still, since this rejected section of the bill was distinctly more rigorous than the present local law for Baltimore City, it is not surprising that it was looked upon unfavorably. These provisions are, however, a part of the law of the best registration States. If it had been passed as it stood, one item of some importance in connection with the certification of deaths would still have been lacking. I mean the verification of deaths.
In this Staate, out of every ten deaths certified to by a physician in private practice, not more than one is certified upon the positive personal knowledge of the physician that death has, indeed, occurred. The physician usually believes that death has taken place, because death was expected, and he certifies upon information from some member of the family, or perhaps upon the information of a messenger who never saw either the person said to be dead, nor the physician to whom the message is delivered. In such cases, those who send such a message are usually reporting, to the best of their inexpert knowledge, that the event expected has come to pass. It is hardly safe to accept in all cases such statements as the basis for the disposal of a body that possibly may not be dead. It is, of course, extremely unlikely that innocent error will ever arise from failure of the physician to verify the death before making a certificate. But the ready acceptance by physicians of such information and their habit of immediately certifying, whether the alleged event was expected or unexpected, may undoubtedly open the way for gigantic fraud, and American life insurance companies have recognized the danger of such conspiracies.
While these rejected provisions of the bill proposed at the last Legislature are desirable, they are not all indispensable, and might have been lost without great regret, if it had been possible to save that one provision which is indispensable. The present law would become effective if the following were added to Section 6 E of the Act:
“No interment of any dead body of any human being, or disposition thereof in any tomh, vault or cemetery, shall be made without a permit
from the registrar or sub-registrar of the district where said person died, or otherwise than in accordance with such permit. 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 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.”
This brief and simple amendment to the law will insure the collection of correct records of deaths in ninety-five per cent. of all instances.
The testimony of local health officers, found in later pages, is repeated here in connection with this subject.
“I find that I have registered 357 births and 128 deaths, hardly half of the number of each that have occurred.
"I think that there should be a burial permit section inserted in the Registration Law, making it imperative that the certificate pass at once under the scrutiny of an official before the body can be interred."
C. H. Brace, M.D., Health Officer for Allegany County.
“The correct estimating of the relations between births and deaths, or, in other words, the relative increase or decrease in the population of the county depends upon the completeness of these records.
"In order that these records may be complete, I suggest that the next Legislature be asked to add a section to the law providing for a burial permit, and make it unlawful to bury a body without a permit from the health officer of the county. This system is in use in Baltimore City, where all burial permits are issued by the Health Commissioner."
H. BURTON STEVENSON, M.D., Health Officer for Baltimore County.
“I am in favor of passing a law requiring all doctors to give a burial permit throughout the State.
"I also am in favor of all births being required reported under penalty of the law.
“I also think all health officers should be paid at least twenty-five cents for recording births and deaths.”
John SwOPE MATTHIAS, M.D.,
“The majority of the physicians report births and deaths promptly but much value is detracted from this good work by the derelicts who send in late and incomplete reports. The above statistical report of deaths is not full. We have endeavored to make it so by letter and personal solicitation, but it is impossible for one health officer in a county to get a full report without the cheerful co-operation of the physicians.
"A burial permit should be required in all cases of interment. It should be issued upon the presentation of a proper certificate upon which the physician should write in the cause of death, after the other data are collected by the family or the undertaker."
HOWARD BRATTON, M.D., Health Officer for Cecil County.
“I have forwarded to you all the death and birth cards I have received from physicians in the county, and very few physicians pay any attention to this law. I think a very wise plan would be to have an officer to whom persons should be compelled to apply before burying their dead. I know of persons having been buried in this county with highly contagious diseases, and the same was never reported to the health officer and no attention was paid to the matter whatever. People innocently went to the funeral without knowing the danger they were running in doing so."
C. L. CECIL, M.D., Health Officer for Charles County.
“It is my opinion that the reporting of births and deaths should be made compulsory and paid for by the State. If, as is justly claimed, vital statistics is of such great importance and value to the State, why not have a general State law, uniformly fixing the salaries of health officers in the counties, according to the size and population of the same, and paid for by the State? Now the health officers, who are expected to go from one part of the counties to the other, depend upon the various Boards of County Commissioners, who, in many cases, know nothing and care less about health officers.”
GEO. P. JONES, M.D., Health Officer for Dorchester County.
"Owing to the unsatisfactory registration of births and deaths in Frederick County, I regret exceedingly my inability to make out a statistical report that would prove of any practical value to your Honorable Board. Since a current account of deaths, with special references to causes, is a matter in which all sanitarians are deeply interested, this is most unfortunate.
"That you are entirely familiar with the defects in the Registration Law as it now stands, and that you will call special attention to the same in your report I have not the slightest doubt, since your experience must have convinced you that without a burial-permit section added to the present law it will remain practically valueless. To be effective, said permit must be made a necessary preliminary to the disposal of the dead body. Such permits would naturally be made out at the time and place of death in the presence of the family, who could give any information desired. It would rapidly follow the event, its importance would be more fully recognized and its "prompt return greatly facilitated-all of which are essential. It is simply the key to the situation in the rational solution of the whole question. Returns to be of any practical value must be prompt, full and accurate.
“One other cause of the failure in the registration is the lack of adequate compensation. The State is fully able to pay for all services faithfully performed by her citizens. You cannot expect efficient service without adequate compensation. There should be a uniform fee commensurate with the intelligence required, as well as the actual labor performed. It is unreasonable to expect the Registrar of Births and Deaths to perform his duties gratuitously, and as I plainly stated in my report to the County Board, I seriously question the legality of the Act which would compel them to do so."
DAVID M. DeVILBISS, M.D., Health Officer for Frederick County.
"So far as vital statistics are concerned, I have sent to you, from time to time during the year, all that have been reported to me. I am aware that the reported births and deaths fall far short of the total in the
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 com pel 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 with bolding 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 th location where death took place without a permit from the local he officer or registrar, and I sincerely hope that such a provision will added to the present vital statistics law. If such a law is enacted at.... next Legislature it will be of great benefit both in accurate collecti