Report of the Registrar of Vital Statistics. M. O. HECKARD, M. D., REGISTRAR. Two important and valuable advances-steps toward which were first taken by HEALTH COMMISSIONER Dr. REYNOLDS have been made in the Bureau of Vital Statistics under the present administration of the HEALTH DEPARTMENT: First, in the form of the "Report of Death," by which the attending physician is relieved of all responsibility and labor connected with such report, except that involved in a statement of his knowledge and belief as to the immediate and contributing cause or causes of death. For this purpose the ASSISTANT COMMISSIONER prepared the subjoined form of report and secured its approval by the State Board of Health, thereby, among other things, relieving the physician from the necessity of making duplicate reports: [New Form of Report of Death.] REFER TO BACK OF REPORT FOR INSTRUCTIONS. REPORT OF DEATH. Authorized by the State Board of Health, Sec. 4, 5, State Board of Health PHYSICIAN'S CERTIFICATE OF CAUSE OF DEATH. I HEREBY CERTIFY, That, to the best of my knowledge and belief, the cause of the death of the above named and described deceased was as hereunder written: SINCE the Undertaker is necessarily obliged to consult the survivors. and in order to relieve the Physician of this task, the information required for filling out the REPORT OF DEATH will be obtained from the head of the family or other responsible friend, by the Undertaker; while the Physician's function may be limited to certifying as to the CAUSE OF DEATH. It is optional with the Physician whether he first makes out the CERTIFICATE and leaves it with the family for the Undertaker, or whether he requires the filled-out REPORT to be brought to him for his CERTIFICATE. To provide for the former purpose, books of REPORT blanks may be obtained by the Physician from the Registrar of Vital Statistics, Room 4, City Hall. The stubs or counterfoils of these blanks will be found useful in preserving records of CERTIFICATES issued. A folder, “Concerning the Physician's Certificate of Cause of Death," and a Classified List of such causes, is also furnished for the use of the Physician. The substance of this folder is also printed on the inside of the cover of the book of REPORT blanks. TO THE UNDERTAKER. The information required in the REPORT OF DEATH should be written clearly in the numbered spaces, as follows: 1. Full name of deceased. If an infant not named, write in: Child of. and give name of parents. 2. Male or Female and Color or Race, if other than White. 3. Name of Country where the deceased was born. If in the United States, give name of State or Territory. 4. Age in years, months and days. 5. Years of residence in Illinois. 6. Day, month and hour-a. m. or p. m.-of death. 7. Strike out the two words not required in this entry, and write in the Occupation of the deceased. 8. Write in the exact locality of death-number and name of Street, Avenue, Boulevard, etc., and number of Ward. If the death occurred in a Hospital or other Public Institution, or if the deceased was a nou-resident. the last previous residence should be stated. 9. Name of Cemetery; or if for burial beyond the city limits the name of the city, town or other locality of the place of burial. 10. Full name, address and license number of Undertaker, and date of Report. The folder referred to in the above, Concerning the Physician's Certificate of Cause of Death," is as follows: DEPARTMENT OF HEALTH: CITY OF CHICAGO. BUREAU OF VITAL STATISTICS: DEATHS. CONCERNING THE PHYSICIAN'S CERTIFICATE OF CAUSE OF DEATH. EVERY physician under whose supervision a death occurs is required by State Law to report the same to the County Clerk, within thirty days after its occurrence, together with a CERTIFICATE OF THE CAUSE OF DEATH and such correlative facts as the STATE BOARD OF HEALTH may require.— Revised Statutes of Illinois; Chap. 126b. Every physician who has attended in the City of Chicago any person during a last illness, or who has been present by request at the death of any person in said city, is required by City Ordinance to present to the DEPARTMENT OF HEALTH a written statement, by him signed, of the cause of such death, specifying the date, hour, place and street number of the place of such death; if from a contagious or infectious disease such report is to be made within twenty-four hours after death; if from any other cause, within thirty-six hours after death.-Laws and Ordinances, City of Chicago; Sec. 2030, 2050, 2051. IN order to relieve the members of the medical profession of Chicago of the often unpleasant task of ascertaining the social and family data required by the form of report heretofore in use-as well as to obviate the necessity of the duplicate reports prescribed by the foregoing Statutes and City Ordinances-a special form of report has been prepared and adopted by the DEPARTMENT, with the concurrence and approval of the State Board of Health, which has authority in such matters under the Statutes. This form is so arranged that the Physician need furnish only the strictly professional information concerning the Cause of Death-all else will be obtained by the undertaker, who will fill in the social and family data, etc., and, after procuring the Physician's certificate, will return the completed report to the Registrar of Vital Statistics as the basis for the burial permit. This return to the Registrar will discharge the Physician's duty under the city ordinances above cited; and when the report is forwarded by the Registrar to the County Clerk the statutory requirement will be fulfilled. For the further convenience of the Physician, as well as to secure a more approximate uniformity of classification and nomenclature in the certificate of the cause of death, the subjoined classified list of causes has been prepared and is furnished for the desk of the practitioner. |