VITAL STATISTICS.

BY EDWARD R. CLARK, M. D.

In my judgment the importance of vital statistics can hardly be overestimated. Somehow since my earliest recollection I have had a lurking idea that the registration of vital statistics was of more than passing importance. In this state the first law that amounted to anything in the way of registration was enacted about one year before I was born.

For some years previous, and altogether for about twenty years, my father was clerk of school district number nine in Peacham, Vt., and as I grew older I well remember with what care he collected the statistics of his territory and returned them to the town clerk, as then required by law. I remember well, also, of asking him what was the use of all that fuss, and he took great care to explain to me his conception of the why and the wherefore. I am pleased to say that in later times my experience has fully justified all that he said and more.

The vital statistics of our state for fifty years, incomplete and faulty as they were in many instances, have shown us that our fathers did wisely and perhaps more wisely than they knew. It was the best the times afforded, and if nothing else has been done it has served to show what may be accomplished under a better system.

Whether our present system is the best that can be devised time alone can tell. Certainly, so far as I can find, nothing has yet appeared which offers anything better.

Men in general may be divided into two classes-those who do and those who do not.

Those who do not are often in the majority. Those who do, almost always have some idea, and often a clear one, of the duties they owe to their neighbors and the community as a whole. Physicians and health officers are no exception to the general rule.

In times past many physicians have made only the most perfunctory returns, doing as little as they possibly could to comply with the law of 1896, in re the registration of vital statistics that came under their notice, oftentimes going so far as to tell people that this matter of the death certificate, the birth certificate and the burial permit were simply all a piece of tommyrot; so much so that people, otherwise well informed, readily believed it was so, until the matter was fully explained to them.

No one is infallible, not even myself, as I have had abundant reason to know or find out in the last few years, and especially during the last year. It was a case where I thought I had taken a good deal of care to have the cause of death properly inscribed, but in due course of time. there came a letter from the secretary of the State Board asking what kind of a pelvic

abscess it was. In my simplicity I had thought pelvic abscess covered the ground. But to get a little more definitely to our subject.

The importance of vital statistics may be considered under three heads:

I. Their value to the health official and preventive medicine.
II. Their value to the community in general.

III. Their value to the individual seeking to establish his family history or to locate his dead.

As to the first of these I need say little or nothing. The second is so correlated to the first that its importance must be apparent to any one who has any idea of the growing needs of our more complex modern ways of living. As to the third, its importance has been brought to me again and again, and I wonder who in this assemblage has not at one time or another had his attention called to the importance of this third proposition: house where I now live; my own family. And this brings us to what seems to me to be a proposition of exceeding importance. Statistics to be of any great value must be

First: Exact.

Second: Complete.

Third: Written in a plain hand with unfading ink.

Fourth: Uniform in construction, for convenience in transmission and preservation.

In my judgment it is of a great deal of importance in a given case, that in making up the returns called for on a given registration blank, that they shall be exact, i.e. that for instance in case of the birth certificate the facts stated should be absolutely correct. Namely, the date of birth, sex, nationality, etc., but also to my mind the birthplace of the parents, and by place of birth of parents I do not believe we should be satisfied with saying that the father or mother was born in Germany, Ireland, or Holland, New York or Nevada. But the exact township, city or parish should be sought for and recorded; for it often happens that parents die before children are old enough to learn from their parents any of the circumstances of their early lives, and you and I do not know how important it may be to some one, at some time, to have a public record of the facts in the case.

Another thing that to my mind is of exceeding importance and pertains to exactness, is to see to it that proper names are spelled out in full. It is not enough to say on the birth certificate that the father's name is E. W. Jackson or J. P. Miller. It should be Eugene Watson Jackson or John Prentiss Miller. For it has not infrequently happened in the same town were several men of the same surname with identical initial letter or letters. For instance, when I was a boy, in the neighboring town of R— were seven men by the name of William G―, and only one of them had a middle letter or name. They were known as follows: Postle Will, Red House Will, Swamp Will, Turkey Will, Tooth Will, Thumb Will, and the seventh I cannot now recall.

Now further to identify the parents is the age of the father and mother, and who will say that that is unimportant?

Now all that has been said concerning the birth certificate can be said of the death certificate. Name of the deceased, age; name and place of birth of parents. Don't be content with saying that the deceased was born in New Hampshire or Massachusetts, or that his parents were, but tell the town. Sometimes it can not be readily found, but usually a little care and inquiry will bring the desired information. The other day there was sent to me a death certificate where names of father and mother and birthplace were marked "don't know," when there were at least four persons within forty rods of the physician's office who could have supplied the necessary information, and who did supply it to me afterward and I placed it on the record.

It is a question in my mind if the health officer should not refuse to issue a burial permit on a death certificate thus issued, especially when it is plain that the actual information could be so easily obtained. But there is another matter which it seems to me would many times tend to exactness. Often in his work the physician finds some persons whose known relatives have all passed over the River, and who it appears is approaching his last long journey. Now in such a case it has seemed to me wise to inquire of such an one and record his family history. In several cases the whole personal and family history of the deceased would have been blank had not such inquiry been made. Thus far I find that in speaking of exactness I have trespassed on the division of the complete.

There is yet one thing having to do with the death certificate, and that is the cause of death. A few years ago a health officer, now deceased, showed me a death certificate in which the cause of death was given something as follows: A certain blood dyscrasia developing fever and causing death. Now this was a puerperal case, and the young mother died on the tenth day. In another case in which a physician had been discharged and another one employed in a pneumonia case, the death certificate read: Pneumonia, contributory cause-been in the care of another doctor; was called only two days before her death. Now in the first instance what could you or I or any registration official make out of such a statement of cause of death? Or in the latter what earthly or heavenly thing could a registration official or any one make of it?

The handwriting on the registration blank is not usually "a thing of beauty and a joy forever," but what a joy it is to find a death certificate that is written neatly and in a hand as plain as copperplate. I wish that every physician in this state could see their death certificates as they are seen by the health officer or other registration official. As I see some of the certificates that come to me I wonder what some one who in after years may be pawing over these records will think of the medical profession if we are to be judged by the neatness and care with which our records are made out. A few years ago I had occasion to look over some records in a town

in the northern part of this state, and what a joy it was, for every thing to the last detail was as exact and plain as copperplate.

My office is next door to our town clerk. I am ashamed for the medical profession for the frequency with which he calls me to decipher some hieroglyphics of my neighboring medical men.

In the fourth place, in re uniformity of construction. Is there any necessity for saying anything? Certainly not, for anyone who has thought of the matter at all.

There is one thing in our state to which I would call attention, and that is in relation to penal statistics.

DISCUSSION.

Mr. C. E. Allen.

I certainly did not expect to be called upon to say a word. I am not a member of the meeting, but I am very much interested in the subject of vital statistics.

I have had some experience, however, with this subject. Perhaps some of the members present may recall two quite lengthy papers which I submitted to two of your health officers' meetings. The subject of vital statistics is an exceedingly important one. We all know that statistics are facts classified and vital statistics are those that concern humanity as a whole. The importance of a careful systematic collection of facts relating to vital statistics, therefore, is unquestioned. These facts are entirely useless, and worse than useless, because they would be misleading, if they are not properly, carefully and reliably prepared. Ten years ago when I was clerk of this city and my attention was called to the matter of vital statistics, with a request that I should prepare a paper on the subject, I was chagrined, I was disappointed to find existing such a condition as I did. The printed tables were very unreliable. In one year I found a mistake of sixty-eight thousand deaths. You would hardly believe it. In another year I found a mistake of nearly one thousand births. You would hardly believe that. In those days the matter of sex was not recorded as it should have been and there was a discrepancy which would call the attention of any one who took the advantage of the opportunity to look over these tables to errors somewhere. If they had the time, they could dig them out, of course. However, very few of us have this time. Since then the advance in the subject of vital statistics has been very great in this state. The registration laws have been made not only to be what they ought to be, but they have been made to conform to the suggestions of the best judges upon the subject. The association on public health in Washington prepared blanks and asked the different states to pass laws to see that these blanks were filled out correctly, properly and fully. What is the result? Look into the last report of the State Board of Health of this state. The improvement is very great. The results of the information given there can be relied upon. Before they could not be. One little matter has been suggested by the paper which was read

this evening and by one or two of the speakers, viz. that it is not the fault of the law, nor the fault of the blank, but the fault of the individual who fills out the blanks and sends them to the State Board of Health. If a physician has not the time to write medical words and terms so that his writing can be read, I might almost say that he had better not write at all, because the Board of Health depends upon his report, and the aggregate of these reports is the general report of the State Board of Health and that is what the public, what the state of Vermont, and what the people of the state want. Not only the people of this state, but if these laws and these blanks are uniform throughout the entire United States (as they will be now) the different boards of health will have something which can be used for general comparison. We will have something that will tell us what we want to know. I am very grateful personally to the State Board of Health for the labor, the enormous labor they have performed in bringing the whole subject to its present condition and all it is necessary now for us to do is perhaps by some future legislation to make amendments in some trivial respects and carry out the law as it stands upon our statute books to-day. Then we will have something upon which we can rely; something that will instruct; something that will answer the questions which so many in these times are asking, and thus secure the success of the work of public hygiene upon which the welfare of the community so largely depends.

George R. Hall.

I only want to emphasize one thing and that is with regard to the death certificates which come to me as health officer. Sometimes I have to turn to a medical work to get the name of the disease, as the writing is not legible. A good many times it would need the services of a Philadelphia lawyer to read some of the writing. I think in some cases, the doctors might write a little better if they saw fit. I think it would be well to call their attention to it, so that whenever they have occasion to fill out these certificates, they may take at least time enough to write plainly so that others may read what they have written. Before I can issue a burial permit I must have the cause of death, and it takes me considerable time to look up some medical work in order to ascertain what is written.

Dr. Henry D. Holton.

During the last six months the returns of the deaths have come in on the blanks from the town clerks, which were copied by the town clerks as accurately as they could. The physicians should remember that town clerks are not medical men and do not understand medical terms, and it is often difficult for them to tell what is written. Some very interesting causes of death have been noted in those certificates. We wrote over four hundred letters to the physicians whose names were given as reporting to the town clerk, to get the cause of death. There were a great many causes given as cancer. What can I do with that? How can I classify it? I have to send