Such a water (III.) may have been polluted at some remote time in its history, or may be simply filtered sewage. The constituents are entirely harmless, and if one can be assured that the filtration will remain effective, or that no new unfiltered contamination can become mixed with it, there is no reason for abandoning such a supply. The surroundings of such waters should be thoroughly examined and the water itself subjected to frequent analysis. The filtered water from a badly polluted river supply will show these characteristics. Much of our ground water is really a polluted surface water, filtered through the soil, and in such cases will prevent these characteristics. We can control artificial filtration, but unfortunately we have no control over ground conditions, and filtration is apt to be imperfect at times. A water polluted in the past and still receiving fresh polluted material will have the following characteristics :

Such a water is always dangerous, for any water receiving unfiltered fresh sewage may contain the living germs of typhoid at some time. The elements of pollution may be present in such concentration as to alter the physical character of the water, but much less often there is nothing in its odor, color or taste to indicate anything abnormal. Such waters may be regarded as unquestionable in character by the user, while others having taste and odor due to the presence of perfectly harmless microscopic plants of the algae group will immediately cause alarm.

In this state, with its innumerable hills and mountains whose sides are covered with streams of pure water, removed above all possibility of contamination from human habitations, it would seem that no one need suffer for lack of it. Yet it is a fact that a large proportion of our population is using polluted water-water from wells dug near out-buildings and draining

a soil reeking with the filth of years. Most of these old wells should be abandoned and replaced by spring supplies. Not until this is done will we see our rural typhoid rate of thirty-one per one hundred thousand-the highest in New England-drop to a reasonable rate.

THE LOCAL REGISTRAR OF VITAL STATISTICS.

BY CRESSEY L. WILBUR, M. D., CHIEF STATISTICIAN, BUREAU OF THE CENSUS, WASHINGTON, D. C.

The local registrar of vital statistics is the king-pin without which the whole system of registration breaks down. We may enact that all deaths shall be registered immediately after their occurrence, that standard certificates of death shall be employed, and that no bodies of decedents shall be interred or removed without the sanction of a burial or removal permit; we may give all manner of general authority to the central registration office of the state,-unless there is included in the law the absolutely essential requirement that there shall be a sufficient number of local registrars, conveniently located, each of whom is responsible for the complete registration of the births and deaths in his district, and alert and vigilant to see that every single one, of all of the births and deaths that occur in his jurisdiction, is properly registered as required by the law, we shall have a more or less defective registration, and in consequence imperfect legal records and uncertain vital statistics.

The official registration of births and deaths is a matter of comparatively recent origin as conducted on the scale of a national or state administration. The first modern registration system was that of England, established in 1837. "The days of a man are three score years and ten,” and an infant born in England and registered as a birth during the first year of national registration and as a death during the current year would merely have accomplished the scriptural duration of life. In such a lifetime the official registration of vital statistics has spread over the entire civilized worldexcept the United States. The importance to the individual and to the community of authentic records of births and deaths is everywhere practically recognized except in this country. But there is hope that the United States has begun to enter upon an era of greater appreciation of the necessity of the registration of vital statistics, and that in time we shall be prepared to take a more fitting place among the progressive nations of the earth in this respect.

Vermont has reason to be proud of its history as a registration state. Beginning in 1857, only twenty years later than the establishment of the

English system, we have now arrived at the semi-centennial of the collection of vital statistics in this state. It is one of the four states now included in the registration area of the United States whose reports run back to a period before the Civil War. The others are Massachusetts, Connecticut and Rhode Island.

I shall not undertake to consider the character of the Vermont reports or the nature of the early law, subjects which were reviewed in an interesting paper on the "Importance of More Full and Correct Returns of Vital Statistics," read by Mr. Charles E. Allen before the School for Health Officers in 1900. The general course of registration may be compared with that of the adjacent state of Massachusetts. It is certain that in the earlier years of registration in both states there was a considerable degree of incompleteness in the returns. Just how complete they are to-day we do not definitely know, except that, in a general way, the registration of births is admittedly less accurate than the registration of deaths.

It is a curious thing, in studying the official vital statistics of the United States in comparison with those of foreign countries, that we should be forced continually to make these damaging admissions relative to the completeness of our figures. When a law is enacted abroad providing for the compulsory registration of all births and deaths in a country, there is a presumption that it will be enforced, and that all births and deaths occurring among the inhabitants of the same will be duly recorded. With us the presumption would seem to be the other way. It appears to be largely a matter of personal convenience to the individuals and officials concerned as to whether the law shall be complied with or not. Nearly every state in the union has passed laws, and some of them have passed many laws, requiring the registration of vital statistics, but at the present time less than a score of them are included in the "registration area" from which transcripts are received by the Bureau of the Census, and these transcripts relate to deaths alone, and the standard of admission is only 90 per cent of complete registration! There is not a single state at present that possesses a complete registration of births, and probably not a single city of any considerable size in this country.

Is it not beginning to be time for us to leave off this slipshod, negligent, amateurish manner of administration of important public affairs-important equally to the state and to the individuals affected-and attempt a more thorough enforcement of registration laws? In a letter to the governor of Maryland, Prof. William H. Welch, president of the state board of health, says :—

Few if any American states have brought their mortality registration up to a satisfactory degree of efficiency in the past five years. Maryland would probably be admitted at this time to the class of "registration states," according to the United States Census standards. That is to say, Maryland's mortality lacks no more than 10 per cent of completeness. But I beg your Excellency to consider that this is the root and foundation of our sanitary institutions, and that anything short of numerical completeness is not to be

tolerated in our statement of losses by death. No argument is needed on this point; it is the business of the state to discover where this 10 per cent shortage occurs, and to compel its detailed statement. . . . . Nine tenths of the people of Maryland now know the value of the systematic registration of deaths, and should no longer wait upon the 10 per cent who consider such information to be of little or no utility. The motive in those localities is to save a petty part of a petty expense. It is possible for the authorities to comply formally with the law, without exercising any real supervision over current mortality, so that but a fraction of the true mortality may be recorded, while the authorities cannot be charged with a specific misfeasance.

Should we not hold such language in regard to the registration of births as well as of deaths? There is increasing interest in this subject, and promising efforts are now being made in various parts of the country to secure better registration of births. Complete success will depend chiefly upon the efficiency of the local registrar, and while there is some difference in the exact method of registration, he should be held responsible for the absolute completeness of returns from his district as he is in England, according to the instructions of the Registrar-General:

It is the duty of every registrar to register promptly the birth of every child born alive, and every death which occurs, within his district; and he is required by statute to inform himself carefully thereof.

It is left to his discretion to employ such means of informing himself thereof as may appear to him best; but he must employ some means, and must not neglect inquiry, in the hope that, without exertion on his part, information will be voluntarily tendered.

He should apply to those persons who, from their occupations, are most likely to have immediate knowledge of any birth or death within his district, such as medical practitioners, midwives, nurses, and undertakers; and he should also systematically consult the announcements of births and deaths in the local newspapers. On learning of the occurrence of a birth or death he should at once make a memorandum thereof, and take such steps as may be expedient for effecting the registration.

The law in Vermont makes it the duty of the physician or midwife, if one be present, otherwise the head of the family in which a birth occurs, to file a certificate of birth with the town clerk within ten days thereafter. This he records, and twice a year, in the months of February and August, transmits a certified copy to the secretary of the State Board of Health. The town clerk is the local registrar, so far as births are concerned, and is, or should be, responsible for the proper registration of all births in his

town.

For deaths, however, there would seem to be a divided responsibility. No dead body can be interred or removed from the town in which the death occurred without a permit, based upon a certificate of death issued by the attending physician, which permit is made out by the health officer, deputy health officer, or, only in case of their absence, by the town clerk. The town clerk receives the original certificates of death from the health officer or deputy, and also the permits from the sextons, during the first

week of the following month, records them, and transmits certified copies to the central registration office at the same time that he reports the births. He does not, however, have the opportunity of examining the certificates prior to the granting of the permits, and so cannot be held directly responsible for any imperfections or omissions of data. On the other hand, the health officer or his deputy does not record the deaths or report them to the state registrar, nor would his attention, perhaps, be called to the corrections necessary to secure perfect returns. It would appear that possibly in this way there may be opportunity for the occurrence of an unusually large number of omissions in certain classes of data.

As the law stands in Vermont at present, there should be the fullest coöperation between the town clerk, who may be taken as the local registrar of record, the health officer or deputy health officer, who acts as local registrar for the granting of permits, and the secretary of the State Board of Health, who is the state registrar for the reception, examination and compilation of returns. (The duplication of the Vermont system extends to the central office, since the returns are transmitted by the secretary of the State Board of Health to the secretary of state for permanent preservation and indexing, the latter being thus the state registrar for this purpose as originally provided in 1856.) If a record of death were carefully examined by all of the officials into whose hands it passes, namely, (1) health officer, (2) town clerk, (3) secretary of the State Board of Health, and (4) secretary of state, it would seem that any errors or imperfections might be very thoroughly winnowed out by undergoing so many inspections. The very complication of the system, however, renders it difficult to locate responsibility for omissions. The original certificates of death do not go to the central office, but "certified copies," not, however, in the same form or containing all of the information of the originals, represent them. It is evident that in the process of copying, especially in copying the medical terms used on the original certificates, many errors may be introduced. In some cases such errors are readily corrected, as in the instance of "information of the brain" instead of inflammation of the brain mentioned by Dr. Holton at a former session of this school. In others, and especially when terms regarded by the town clerk as illegible or unimportant are omitted or altered, serious imperfections may result.

In undertaking to obtain the correction of an imperfect return, one, for example, in which the age of decedent or cause of death was omitted, the central registration office cannot know whether the town clerk or the health officer was responsible for the error. Of course the health officer should not accept an imperfect certificate of death, but if he does and files it with the town clerk, I do not see that the town clerk is under any obligation to secure the missing information. It would be desirable, indeed, that the town clerk should at once call the attention of the health officer to any omissions, so that the items could be secured and properly entered before the copies are sent to the state registrar. This is one of the most serious