RECOMMENDATIONS FOR CHANGES AND IMPROVEMENTS UNDER A 6-YEAR PROGRAM, 1938 TO 1944 It is recommended 1. That the present budget be increased sufficiently during the next 6 years to secure adequate protection against the spread of the disease by infected individuals, and for individual patients adequate treatment, skilled medical care, and some degree of privacy. 2. That the policy for the development of adequate treatment facilities be made the subject of a conference in which the local organizations, medical profession, medical schools, local hospitals, research and philanthropic societies are given a voice with that of the local health authorities. 3. That in supplementing the present treatment facilities, consideration be given to the subsidization of existing centrally located polyclinics which are willing to meet the minimum standards of efficiency in conformity with the policy of the District Health Department and the Public Health Service. (a) That it be stipulated that these subsidized polyclinics, when necessary, shall admit patients with gonorrhea and syphilis for in-patient care in their institutions. (b) That provision be made for reimbursing physicians operating these subsidized polyclinics. 4. That hospital beds for patients with syphilis and gonorrhea be made available at the municipal hospital. 5. That the health department make available to the private physician, on request, free diagnostic service, free antisyphilitic drugs for those private patients who are, or may become, a danger to the health of the community, and the services of specially trained social-service workers or nurses for the purpose of finding contacts and returning lapsed patients to the private physician for treatment. 6. That provision be made to continue a more intensive education of the public, the patient, and the physician through the instrumentalities of the press, radio, exhibits, motion pictures, lectures, and postgraduate courses. 7. That in 1944 the results of this program be evaluated to determine its effectiveness by means of a resurvey of all medical sources of treatment in the District. VITAL STATISTICS By Dr. HALBERT L. DUNN, Chief Statistician for Vital Statistics, and Dr. JOHN COLLINSON, Assistant Chief Statistician for Vital Statistics, Bureau of the Census RECOMMENDATIONS The following recommendations are made for the bureau of vital statistics in the District of Columbia : 1. A well-trained statistician having considerable experience in public health practice should be employed to operate under the direction of the District health officer, and advise in all statistical work throughout the health department. He should be supplied with such assistance and mechanical equipment as are necessary to render the services required. The organization of the District of Columbia Health Department is such that great benefit would result if a central statistical agency could be established within the department. Such an agency could correlate the statistical activities of all bureaus within that department. This would include particularly the statistical work of the bureau of vital statistics, communicable diseases, maternal and child hygiene, and work relating to the records of hospitals under the control of the health department. It would also assure an extension of administrative control and marked advance along scientific lines. The establishment of such a correlating agency would in no way interfere with the present personnel and organization of any bureau in the health department. 2. A new vital statistics law should be enacted for the registration of births, deaths, stillbirths, marriages, and divorces. Responsibility for the administration of this law should rest upon the Commissioners of the District of Columbia. Following the recommendations of a Model Vital Statistics Law, which the Bureau of the Census is now submitting to the several States, the powers of the Commissioners of the District would be enlarged, and it would be made possible to meet, by rules and regulations, the constantly changing needs of vital statistics procedure. The model draft referred to will be in final form within the very near future. 3. The present bureau of vital statistics should be expanded to include sufficient personnel to relieve the chief of routine work in order that he may devote more time to the study of matters relating to administration and statistical analysis. The bureau should be reorganized to make available more clerical time for statistical and other special work. 4. More space is needed for the accommodation of clerks and for the storage of records. Adequate mechanical equipment should be made available to the bureau of vital statistics. 5. Funds should be appropriated for travel and training of personnel, especially the chief of the bureau, so that he may keep abreast of the changes and advances in statistical and registration procedures. 6. Allowance should be made in the printing fund for publication of more detailed tables and analysis of data on vital statistics. These should include tabulations of data by census tracts and by place of residence. In 1927 a report entitled "Public Health Administration in the District of Columbia" was prepared by Dr. Paul Preble, Surgeon, United States Public Health Service, in collaboration with others of that Service. This report includes an account of the organization and work of the bureau of vital statistics prepared by Dr. Edgar Sydenstricker, statistician. It also contains details of the budget, recommendations for changes in the organization, and a 5year plan of development. The following report relates the findings of a resurvey of the bureau of vital statistics. It compares present conditions with those existing in 1927, and recommends certain changes. VITAL STATISTICS LAWS AND REGULATIONS In the District of Columbia the reporting of births was first authorized in 1871, and records are on file beginning with that year. The reporting of deaths was authorized in 1874, but records have been filed since 1855. The vital statistics laws have been repeatedly revised and expanded. The present law is to be found scattered throughout the 337 pages of the volume entitled "Laws and Regulations Relating to Public Health in the District of Columbia. In force July 1, 1930." In general, these laws and regulations include all of the requirements of the Model Law approved by the United States Bureau of the Census in 1907. They require the appointment of a registrar of vital statistics, the reporting of births, deaths, and stillbirths to the District of Columbia Department of Health, and prescribe the information to be contained in the records. They authorize the department to issue permits for the interment, disinterment, and removal of the dead. They regulate the disposal of dead bodies, including the creation of an Anatomical Board for control and disposition of dead bodies to schools, and they authorize the erection and operation of a crematorium. They provide for the issuance of copies of individual records or of the facts thereon stated, and for the tabulation and publication of statistical data. Penalties are provided for noncompliance with the law. Following is a list of references to the laws and regulations relating to vital statistics in the District of Columbia, in force on July 1, 1930. Laws and regulations relating to vital statistics in the District of Columbia1 Page Section, resolution Subject 6 8.. 28-30 1-11... 67 1 and 2.. 72, 73 12, 13, and 14. Resolution legalizing the health ordinances and regulations for the District of Columbia relating to registration of births, deaths, marriages, interment, disinterment, removal of dead. Regulations to secure a full and correct record of vital statistics, including the registration of marriages, births, and deaths, the interment, disinterment and removal of the dead in the District of Columbia, as amended by act of Jan. 25, 1898, and by Commissioners' order of Jan. 8, 1902. An act authorizing the Commissioners of the District of Columbia to charge a fee for the issuance of transcripts for the records of the health department. An act to prevent the spread of contagious diseases in the District of Columbia, section relating to disposal of body of person who has died of any contagious disease. 1 Citations are to "Laws and Regulations Relating to Public Health in the District of Columbia. In force July 1, 1930." Laws and regulations relating to vital statistics in the District of Subject Relating to cemeteries and the disposal of dead bodies. An act for the promotion of anatomical science and to prevent the desecration of graves in the District of Columbia. An act to provide for the establishment of a public crematorium in the District of Columbia, and for other purposes. An act to provide for the better registration of births in the District of Colum- Regulations for the prevention of the spread of communicable diseases relat- Health officer to transfer marriage records in health department to the clerk FUNCTIONS OF THE BUREAU OF VITAL STATISTICS The functions of the bureau of vital statistics are divisible into three groups: (1) The collection, registration, and preservation of birth, stillbirth, and death certificates; (2) the issuance of statements regarding facts stated thereon; and (3) the tabulation and analysis of natality and mortality data, their compilation and publication. LEGAL REPORTING AGENTS Births and stillbirths.—Births are reported by physician or midwife in attendance at time of birth and by parents in the absence of either a physician or midwife. Deaths.-Deaths are reported by physician or coroner. OFFICE PROCEDURES: BIRTH CERTIFICATES Receipt of certificates.—All birth certificates are received through the mail and over the counter. Each one is stamped with time of receipt by means of an automatic time punch clock. They are then separated into two groups according to year of birth: (1) Current group-births occurring in the current year; and (2) delayed group-births which occurred prior to current year. Numbering of certificates.-After the certificates have been tabulated, the number on the last certificate of the day's returns is noted on the tabulation sheet and the sequence is resumed on the following day. The certificates are numbered by hand operation of a numbering machine. The record numbers are consecutive and continuous since August 1, 1874. The last record number issued on December 31, 1937, was 410,341. Prior to August 1, 1874, registration was voluntary and extended back to 1871. Those certificates belonging to the delayed group (birth which occurred prior to current year) receive a current record number which, however, is followed by the capital letter "D," indicating that it is a delayed certificate. Indexing Delayed certificates.-Delayed certificates are indexed in the ledger volume as of date of birth and not date of registration (i. e., birth which occurred in 1920 but registered in 1938 would be indexed under 1920). General. The birth ledger volume is large enough to permit from 2 to 211⁄2 years' entries to be made. It always remains in the permit room. To facilitate searching, the ledger consists of 3 letter subdivisions under each of the 27 primary alphabetical guide tabs. The birth certificates are sent to the permit room every evening where they are indexed in the ledger volume by the permit clerk on duty. When the original certificate is indexed, it is checked in ink. Procedure in making entry.-The surname, given names of both parents, and the record number are entered in their respective columns in black ink. The given name of child, if known, sex, color, and birth date of child are entered in red ink on the line immediately below the surname. Tabulation.-Certificates for the current year are totaled and tabulated on a summary sheet by hand. Items tabulated are color, sex, and total; born in hospital and home, by color; legitimacy and illegitimacy, by color; delivered by physicians and midwives, by color; twins, by color; and nonresidents by color and sex. Triplets are entered on the margin because of relative infrequency of occurrence. Reviewing and checking of certificates.-The reviewing and checking of certificates and tabulation are done simultaneously. Each |