It will be no better. It is obvious that the insane patients require a very different management from the other inmates of the farm. Their care is a special one, the necessities of which he cannot conceive nor has he the ability to meet.

The medical attendance will no doubt be furnished by the county doctor, whoever he may chance to be, who is generally inexperienced in the care of the insane. It is no exaggeration to say that the best medical practitioner in the State, I care not from what school nor from how many he may have diplomas, is unfit to direct the management of the insane if he is inexperienced in that line.

But how does the county secure the services of a physician? It is done in almost all cases by a system of bidding which awards the contract to the one who places the lowest estimate upon the value of his services. As a medical practitioner he may be competent or he may not be. He contracts to do the work very much below the usual rates for such services, and furnishes his own medicines and appliances. It is unreasonable to suppose that he will give his first and best care to these patients when his private patrons pay him regular fees. When he is busy with private cases, or is out of town on a trip, the poor patients are often placed in the care of a medical student; the private cases, however, are attended by a brother practitioner.

Every now and then we read of some unfortunate poor patient dying as the result of improper medical attention, or for the lack of any. This condition will of course continue so long as the system of bidding is continued. Out of humanity to the poor the system should be abolished. Cheap pay rarely furnishes anything more than cheap services. When we consider that these insane patients, who have been enjoying the best of care in our State institutions under the charge of such experts as Doctors Gilman, Hill and Hoyt, with the most competent assistants, are to be placed under the espionage of an inexperienced poor-farm overseer and county doctor, is it not time to raise a protest against the further establishment of county insane asylums?

In removing the harmless incurables from the State institutions many patients will be found who are capable, under their existing surroundings, of a good degree of self-control. They now live in the best wards of the asylums, where their presence is a positive benefit to the more recent and acute

cases. They are quiet, orderly, and industrious and daily manifest their enjoyment of life in a manner that tends to allay suspicion and dispel discontent from the disturbed minds of their associates. Many of these patients when removed from their present supporting influences lose their self-control and become a menace to their associates, or else lapse into a deplorable dementia. To force such a result upon any of

these unfortunates is a crime.

There is little doubt but that Polk county will experience the same results from its institution that Linn county has from theirs.

The asylum is located at the poor farm, five or six miles from Des Moines, where the nearest physician resides. The Cedar Rapids Times recently said that poor farms are practically poor houses and ought to be called by that name. It declares that the worst mistake that Linn county ever made was when it put twenty thousand dollars into a county insane asylum. It is located five miles from Marion, where the nearest physician resides, and a large number of insane people are kept in it and given poor care and attention.

Not long ago the Ft. Dodge Messenger agitated the question in Webster county. It recommended the building of a county asylum and explained in detail how much such a move would save the county. Other counties will also want the same thing. It is to be hoped the experiments in this line already made will be sufficient to convince the people that it is a certain step backward in the care of the insane, and its extension should not be further recommended.

The State of Iowa cannot afford to save money at the expense of this unfortunate class.

VITAL STATISTICS.

As suggested in the last biennial report, the Twenty-Sixth General Assembly made a radical change in the manner of collecting and making the returns of births and deaths.

Instead of requiring these returns to be made by physicians and midwives to the clerk of the district court they are collected by the assessors.

of the Code:

The following is the exact language

SECTION 2566. It shall be the duty of all assessors, at the time of making assessment, to obtain and report to the clerk of the district court, upon blanks adopted by the State Board of Health and furnished by the county auditor, such registration of births and deaths as occur within their respective districts for the year ending December 31st immediately preceding.

SECTION 2567. The clerk of the court in each county shall keep a book in which shall be recorded all marriages occurring within the county, together with such data respecting the same as shall be required by the State Board of Health, and shall report to the Secretary of the State Board of Health on or before the first day of June in each year such data respecting such marriages for the year ending December 31st immediately preceding. The clerk of the district court of each county shall keep a book in which shall be recorded all births and deaths occurring within the county as shown by the returns filed in his office by the assessor, as provided in section twenty-five hundred and sixty-six; and on or before the first day of June in each year shall furnish to the Secretary of the State Board of Health a report of such births and deaths.

In accordance with the provisions of these sections the State Board of Health, at the annual meeting held May 5, 1897, adopted the forms for records of births and deaths as shown on page sixty-six of this report.

Time will demonstrate whether the change has been a wise one. If the assessors are faithful in collecting, recording, and returning these data the record will be more correct numerically than under the former law. Even in this particular, however, there will necessarily be many defects as to the births and deaths having occurred during the year, because of changes of residence, especially because of removals from the State. The report however, ought to show the exact number at the time when the assessment was made.

From a professional standpoint and as a basis for sanitary conclusions however, the death reports must always be unreliable because of the inaccuracy with which the causes of death—the names of the diseases-must of necessity be stated.

No argument is needed to demonstrate the advantages of reliable vital statistics. They constitute the basis for practical sanitary investigation; and for the application of proper restrictive and preventive measures. If such statistics showed an undue mortality from any special disease throughout the entire State or in any particular locality, intelligent inquiry could be made as to the cause and the proper remedies could be applied intelligently. After the application of these restrictive measures subsequent statistics from the same localities would demonstrate the efficiency of the methods employed.

In a few years there might thus be demonstrated the particular localities in the State where certain diseases have been, or are, most prevalent, and the type of the disease, whether malignant and fatal in character, or whether mild.

Again, statistics showing accurately, or even approximately the marriages, births and deaths occurring in the State furnish comparisons between the number of births and deaths, and data respecting the number of births to each marriage, that are not only interesting and suggestive, but important.

Michigan has recently enacted a law respecting a registration of deaths that went into effect August 29, 1897. The features embraced in this law have been held and expressed by the writer hereof for some years, viz: That no one should be interred within the State without a proper certificate, showing name, age, cause of death, etc. The practical operation of the law thus far as shown by the first Bulletin issued is highly satisfactory. It shows returns from over two million sixty-one thousand six hundred and sixteen of the total population of the State, leaving less than seven per cent of the State unreported. The following sections are from the Michigan law referred to: SECTION 1. The People of the State of Michigan enact, That the body of no person whose death occurs in the State shall be interred, deposited in a vault or tomb or otherwise disposed of, or removed from the township, village or city in which the death occurred, until a permit for burial or removal shall have been properly issued by the clerk of the township, village or city in which the death occurs, who shall be the registrar of deaths: Provided, That in cities that have, or shall institute, a system of immediate registration of deaths by the Board of Health, the health officer or Secretary of the Board of Health shall act as registrar of deaths under this act, in lieu of the city clerk, and shall in all respects conform to its provisions.

SEC. 2. Whenever any person shall die, the undertaker, householder, relative, friend, manager of institution, sexton or other person superintending the burial of said deceased person, shall cause a certificate of death to be filled out with all of the personal and family particulars required in section three of this act, and attested by the signature of a relative or some competent person acquainted with the facts. The physician who attended the deceased person during his last illness, shall fill out the medical certificate of cause of death, which death certificate shall be delivered to the registrar within the time designated, if any, by the local board of health. In case of death without the attendance of a physician, or if it shall appear probable that the deceased person came to his death by unlawful or suspicious means, then the registrar shall refer the certificate to the health officer or coroner for immediate investigation and report prior to issuing the permit: Provided, That when the health officer is not a physician, and only in such case, the registrar is authorized to insert the facts relating to

the cause of death from statements of relatives or other competent testimony. Upon the presentation of a certificate of death properly filled out and signed, the registrar shall issue a permit for the burial or removal of the body and shall immediately record the death in the register of deaths, numbering all certificates consecutively in the order in which they are received, beginning with No. 1, for the first death that occurs in each year. In deaths from dangerous communicable diseases, burial or removal permits shall be granted by the registrar only in accordance with the rules of the local board of health and of the State Board of Health relating thereto. These certificates of death are sent by the registrars or clerks directly to the Secretary of State, and are in the following form:

Parent of....children, of whom... .are living. Birthplace (State or country)

MEDICAL CERTIFICATE OF CAUSE OF DEATH.

I hereby certify that I attended deceased from..

that I last saw h

alive on.......

.189... to..

189...

.......189..., that he died on... ............189... about......o'clock, ...M., and that to the best of my knowledge and belief the CASE

......