For the purposes of "further inquiry," some circular letters . had to be devised. The newspaper notices are found to contain most frequently the name of the clergyman officiating at the funeral, less frequently the name of the undertaker, and sometimes the name of the attending physician. We accordingly use a formal letter addressed to undertakers, another addressed to clergymen, and another addressed to physicians. Each of these letters has a device for numbering, that addressed to undertakers being marked U. I., No.-, printed on yellow paper; that to clergymen being marked C. I., No.-, on blue paper; that to physicians P. I., No.-, on white paper. copying ink. Thus it is possible to bring together all the papers All are printed with relating to a given case with relatively little trouble. The purpose of these special inquiry letters is, of course, to reach at last. the attending physician, and to obtain from him a proper death certificate.

Every certificate, from whatever source, must be scrutinized in every item which it contains. Those who certify frequently omit such important matters as the date of death, the age, sex or color of the decedent, or else make a statement concerning the cause of death so confusing that a classification of the card is impossible. These matters must become subjects of special inquiry, and it is impossible to devise any formal letter which would apply to any considerable number of these questions. We usually send a letter of inquiry concerning these missing items. and enclose a postal card already written, except as to the one or two essential words. last been obtained, the office record now completed, or the original When all the necessary information has at certificate in the handwriting of the attending physician, as the case may be, is put into another drawer marked "Finished Inquiry." The cards containing the information on which the pursuit of the legal record was based are all preserved in a third drawer. Meanwhile, the properly returned certificates are tabulated on the mortality sheets, and then permanently filed alphabetically and by counties. All the cards in the "Finished Inquiry" drawer are kept until another monthly return is made, when, if no duplication of records is found, they are tabulated and filed. The "Further Inquiry" cards represent the certificates of death which have been most expensive to collect. It has several times happened that our tracers have brought us in four or five certificates of the same death at a cost of sixteen cents or more in postage. Nevertheless, this plan has a very good effect in impressing upon persons whose duty it is to certify, the fact that neglect of this duty is not likely to pass unnoticed.

After we have exhausted all the means above described in an effort to obtain physicians' certificates, we have a large number of cards on hand which contain no information beyond that which was contained in the newspaper notices. These have not cost

much to obtain, but they are worthless for all purposes, save mere enumeration. A glance at the chart, which shows the comparative importance of the causes of death, will demonstrate the commanding importance of the column marked "Unknown." This column represents the greater part of those deaths which are reported to us by the newspapers of the State, and shows also what a large part of the work properly belonging to local registrars is done in the office of the State Registrar. Besides the reports represented by this column, the newspaper contributions have swelled the other columns by as many notices as contained either a statement of the cause of death, or some item of information upon which we could press further inquiry till an authoritative certificate was obtained.

It will thus appear that of all the records of death filed in the central office of the State Registrar, quite one-half were begun and completed in the central office, without the aid of a local registrar. If our returns for the period are taken to represent fifty-five per cent. of the actual mortality of the State, it will be seen that of every one hundred deaths occurring seventytwo were unnoticed in the locality where they happened. This poor showing is not due to general neglect of the law, but to particular indifference in certain sections of the State, ascribable partly to the carelessness of the local officers, partly to hostility of boards of county commissioners, and wherever poor results are apparent, to want of popular enlightenment on the subject. In some portions of the State the local returns have been really far worse than our figures show. Thus the showing made by Carroll County, poor as it is, owes next to nothing to the local registrar. Nearly all of the returns we possess were obtained without the aid of that functionary. The returns from Baltimore County would have been worse than those of Carroll but for the fact that so many bodies from that county are carried through Baltimore City to the places of interment. The Health Department of Baltimore City has made prompt returns of all such death certificates. The returns from Baltimore County owe nothing to the local officers except Dr. C. L. Mattfeldt, who has made almost complete returns from Catonsville and vicinity. The physicians of Baltimore County are as ready and willing to perform their duties as those in Baltimore City, and the Baltimore County Commissioners have needed nothing more than that the importance of this work should be put fairly before them. In these two counties, Baltimore and Carroll, the known character and abilities of the recently appointed local health officers* will bring about substantial improvement in this and other directions.

Allegany County owes nothing to Cumberland. In Cumberland the passing citizen receives no notice save from the press.

*Dr. Stevenson, of Sherwood, and Dr. Foutz, of Westminster.

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 official 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 18981899 copies of records for the following purposes:

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.......
Pension claims..

Other uses. ...

1,329

1,389

4,712

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