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 investigation 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,

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 admonition, 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 tomb, 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.,
Health Officer for Carroll County.

"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 unfor

tunate.

"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