REGISTRATION.

The Necessity and Advantages of a Registration of the Vital Statistics of Wisconsin.

BY JOSEPH HOBBINS, M. D., OF MADISON,

MEMBER OF

THE ROYAL COLLEGE OF SURGEONS, AND FELLOW OF THE GEOLOGICAL SOCIETY, LONDON.

REGISTRATION.

This paper, intended for the general reader, has for its object-to show the necessity and advantages of a registration of the vital statistics of Wisconsin; what we are doing to obtain such a system; what ought to be done to make it operative, and who are to do the work.

If it be true, as Locke says, that "the end of government is the good of mankind," then, the protection of the health and life of its people is the first duty of a government.

In order, however, to effectually legislate for the protection and preservation of the public health, the well being and longevity of its subjects, the government of necessity must know not only by figures, the birth and death rate of the governed, but the agencies which conduce to the production of those figures. Hence the necessity for the adoption of a system of registration, a system in operation in every other civilized nation, and in many of the more intelligent States of this country.

It may be well to premise that this practice of registration is not a thing of to-day, that it has nothing in its character that is either novel or theoretical. It has existed, with the greatest practical benefit, in Geneva, Switzerland, since 1549. It was introduced into New England as early as 1639, an act being passed in Massachusetts, ordering "that the days of every marriage, birth, and death of every person within the jurisdiction" of that State should be recorded.

The health of its subjects and the average duration of their lives. is to every government a matter of the highest consideration. And to be indifferent to, or ignorant of the laws which affect human existence, would be to make the legislator responsible for the ravages of every preventable epidemic invasion. But how shall the legislator or government of our State be able to act intelligently or effectually in relation to public health? In no other way, we reiterate, is it possible than by an adequate knowledge of our vital statistics, to be derived through registration, by which not only are the causes of disease and death ascertained, but the proportion of the death-rate to the population, and to the occupation of those who died-knowledge of no secondary importance. In no other way than by carrying out this system of registry can we fully know-that which concerns us so much to know-what parts of our State are best adapted to health, or most provocative of disease, or the parts best calculated to ameliorate certain classes of disease. We do know that some places and circumstances are more fatal to children, some to adults, and some to the aged, than others. In one locality one class of disease, and in a different one another class prevail. So much is known of all the States, but

even with the aid of the sanitary maps of the United States census, or those of Walker's Atlas, nor, indeed, with the aid of the vital statistics there given can we derive any positive information on these points applicable to this State, anything that is not of an exceptional character. "Local influences differ much in different places and seasons. But what those influences are, or wherein they differ, we are not informed. We only know it by partial investigation and vague report. We have not sufficient data for definite plans of action," says one of the ablest writers on this subject.

It is these data that we need. For it is data of this description which tell us in the most indisputable manner where we may locate to live, and again, where may locate to die. The value, the necessity of this knowledge is easily illustrated. We learn from English registration that "while a child has a chance of living 45 years in Surry, it has a chance of living only 25 in Liverpool.' In a registration report of Massachusetts we find that "in the county of Suffolk the average of life is 20 years. In the county of Hampshire it is 40 years-so also in Duke county, 40 years." The round numbers only are given, discarding fractions. Do not facts like these, facts officially given, ascertained only by registration, conclusively show the necessity for a system of registry and at the same time answer the question-What is the good of registration? If, as before indicated, you want to move into a State, or any part of a State in safety to your health, or for the purpose of seeking relief from disease, or from some peculiar physical condition, it is just this system of registry with its life line that would and should govern you in your choice of locality. If this life line showed to you that the average of life was only, as officially reported some years ago, 27 years in Boston, Massachusetts; only 34 years for the whole population of Massachusetts; 27 years for London, and only 20 years for Liverpool, England; while it was 40 years in Geneva, Switzerland, and 41 years for the people of Plymouth, Massachusetts, and doubtless over 40 years for this State of Wisconsin, then indeed should you be converted to a belief in the necessity for and advantages of statistical information and in our system of State registration.

For other reasons yet is the carrying out of our law of registry necessary. We quote from the report of the Commissioner of Insurance of Wisconsin, June 1, 1876: "The total number of life policies issued in the State during the year 1875, was 3,179; amount insured, $4.530,752; amount of premiums paid, $1,340,766. The number of life policies in force at the close of the year was 23,343; amount insured, $35,479,291. The foregoing exhibit does not inIclude the policies issued by the Railway Passengers' Assurance Company and the Hartford Accident Insurance Company."

The people of Wisconsin, then, are directly interested in life insurance to the enormous amount of $35,479,291!!! Upon what basis do they invest their money? Upon the American table of mortality, of which Prof. C. F. McCay, of Baltimore, says in the report of the National Insurance Convention of October, 1871:

"The world is in profound ignorance as to every element on which the table was based, and how it was constructed." Mr. Clarke, of Massachusetts, saying in the same report, "We want a table of mortality which will be acceptable to the companies in all the States.' And the report of a like convention for May, 1871, has this language: "The mortality experience of different companies varies now from various circumstances, and will continue to do so in the future, rendering it necessary to collect data from many institutions and sources, and also such as will cover a sufficient period of time before an accurate table of mortality can be constituted.'

The American table, as its compiler, Mr. Homans, says, was constructed in 1859 from the experience of one company, the Mutual Life." But highly commended as it is by foreign and home actuaries and companies, no one accepts it as being correct, and undoubtedly, even proximately, it is most incorrect, applying probably very much better to eastern States and to like populous and manufacturing countries than to western or agricultural States.

And herein lies the point. How far is a mortuary table that is applicable to England and to the eastern States for life insurance purposes applicable to Wisconsin? Now, casting aside for the moment all data with regard to this point, for all the data are comparatively worthless, (the United States census itself admitting that there must be 41 per cent. more mortality than the assistant marshals report) let us fall back upon the experience and knowledge at our command

Having practised as a physician a sufficient length of time in England, in Massachusetts and in Wisconsin, to enable us to judge if not accurately, at least fairly, of their comparative mortality, we feel, that from the the recent and excellent origin of our people, being composed as they are of the bone and sinew of Europe and of the East, of the most adventurous, hence physically calculated to live; from their occupation, being chiefly that of agriculture:* from the cheapness and abundance of good food; from the general good habits consequent upon the general striving for a home, a farm and independence; from our latitude; from our elevation; from our easy drainage, east, west, north and south; from our soil; from the marked salubrity of our climate; from our comparative freedom from malarial diseases; from the strikingly and peculiar mild type of all our epidemics, mild, especially as compared with that of England or Massachusetts;*and last, though not least, from raising-through our common school education-an intelligent generation; we repeat, that from a due consideration of each and all of these life elements, we feel that we can earnestly affirm that the average of human life in Wisconsin is much greater than in England, or in the Eastern States. Consequently we should be benefited in this one item of insurance to the extent of a saving probably of 25 per cent. on our premiums, in having a mortuary table of our own.

In Dorchester, Massachusetts, the poor average 27 years, and the prosperous farmers 45 years of life. The same rate applies to England.

The severity of epidemics is governed by the insalubrity of the locality, or is "according to a compliance with, or disobedience of the principles of health."