DUTIES OF PHYSICIANS AND TOWN CLERKS IN MAKING

RETURNS OF VITAL STATISTICS.

BY H. B. WHITTIER, CITY Clerk, Rutland.

Judging from what I have been able to observe, I should say that the present laws governing the making and recording of vital statistics are adequate for present needs at least, and that the certificates and permits in use are sufficiently comprehensive. Some may think that too many questions are asked, that there is too much "red tape," but any one who has to do with records knows this is not the case. No matter whether the certificates call for much or little information, there will oftentimes be some questions that will not be answered, so that it will be necessary in the future, as it often is at present, to refer for certain information to some other record than that in which it should be found; for instance, to the death certificate for data that should be in the birth certificate, and vice versa. With adequate laws and comprehensive blanks, it is only necessary that those who have to do with the making of and caring for statistics should have a realizing sense of the importance of the work and should exercise due care in doing it. This applies especially to the physician, the health officer and the town clerk, and incidentally to the undertaker, sexton and clergyman.

It is not to be expected that the individual will be interested in this question or will inform himself in relation thereto. It is something that touches him but few times in life, if at all. He possibly may be like the father who came to my office not long ago to make and file the certificate of the birth of his sixteenth child. When asked the name of the attending physician he replied that they dispensed with physicians' services years agodid n't need them. This man knew just what to do to make a proper record of the birth, but where there is one family striving so strenuously for a Roosevelt medal that from sheer force of habit they become familiar with the laws and customs relating to making and filing certificates, there are hundreds of others that furnish few such certificates and have no idea of what should be done with them, while many, in these days of "race suicide," furnish none at all. And in case of death in the family, if the physician does not get the data for the certificate, the undertaker attends to it, thus relieving the family from the necessity of doing anything but answering the necessary questions. So the individual does not need and should not be expected to pay much attention to the question of making and filing certificates.

The physician holds the key to the situation so far as the making and filling of certificates is concerned. If certificates are complete and correct when they leave his hands, and if he files all of them and files them promptly,

he has done his share in making up statistics and is not subject to criticism. Most physicians pay proper attention to filling out certificates and file them quite promptly, but there are some who make them in a slipshod manner, some who file them when it suits their convenience, and some who, I fear, occasionally neglect to file them at all. I reported 236 births to the State Board of Health last year, of which certificates about one third were filed within ten days, the time specified in the law; about forty per cent within two months, and the remainder within from three to ten months. There were, of course, some that were not filed until after the last report for the year had been sent in. The neglect to file certificates within a reasonable time occasionally prevents the clerk from getting the additional information if the certificates are not complete, but the showing for last year was so much better than it often has been that the neglect might be passed by without comment if it was certain that all the births that occurred in the city were reported. The physician who exercises great skill and care in bringing a child into the world and then forgets to report the birth needs to be awakened to a realizing sense of his duty. He cannot have in mind the family and property interests that may sometimes hinge on the ability of the child to prove some fact that should be found in the birth certificate, or he would see to it that the record is made promptly.

In the smaller towns where births and deaths are generally known to everyone, it is possible for the town clerk, if he takes an interest in having his records complete, to look after cases for which certificates are not returned by notifying the parents or by reminding the physicians of their neglect, but in the cities and larger towns this is not possible, and it is quite probable that births occur each year that are not reported.

The law provides for the prosecution of physicians whom you know to be delinquent in filing certificates, but while such delinquency is aggravating and causes a good deal of trouble at present, it is not the greater difficulty. It is the neglect to file certificates at all that is liable to work the most hardship, especially later on. If the parents do not take pains to see that birth certificates are on file-and they should not be expected to do soand the physician neglects to file them, how is the law to reach such a case? No one but the physician knows anything about the matter and he and the parents may be dead before the neglect comes to light, before a copy of the record may be needed.

I am often requested to furnish certified copies of births that occurred in comparatively recent years, of which no record can be found. I have received such requests at least twice during the past year. In one instance the applicant knew the name of the attending physician and I was able to get the date of the birth from him, but no other data; in the other case the parents resided in Rutland but a short time, could not speak English, did not remember the attending physician's name, so I was unable to furnish a copy that was very much needed. I have known physicians to send itemized bills for returning certificates that have never reached my office

and I have traced and caused to be recorded several births in this way. I notice that births, deaths and marriages are published in some of the annual reports I receive from cities in other states, especially from the state of New Hampshire. Town and city reports are widely read. It seems to me that the publication of statistics each year by such towns and cities as publish reports, would tend to bring to light any certificates not previously filed and to correct any errors that might appear in the printed record.

Most physicians would improve their certificates if they would give more attention to the spelling of the names in them. Notwithstanding the fact that phonetic spelling has many adherents and that simplified spelling has the President's indorsement, the names in certificates should be spelled the way the persons themselves spell them. Foreign names are troublesome, especially French names, because they are sometimes returned in French and sometimes in English. It is perplexing for the clerk to receive one return with the French surname and another from the same family with the name as spelled in English, especially if it places them under different letters in the index. If the card system of indexing is used and the clerk knows, for instance, that "Courtemanche" and "Shortsleeves" mean the same person, he can place the cards together under the name he thinks will be most familiar to searchers, but if a book index is used it means double indexing or the index will be misleading to a person who does not know the connection between the two names. Physicians who are in the habit of returning foreign names in the original should also give them in English, especially if the persons are more generally known by their English names. In the index in my office is a French name which appears on sixteen cards and it is spelled eight different ways. This is a sample of the old order of things; we are doing better at present.

There are physicians who return certificates with only the initials of the given names of the parties. Such a return is not a proper one, and if it is a certificate of birth an additional information blank should be sent for the given names in full, even if the certificate is properly filled out, in other respects. And the lead pencil is still in evidence for filling out certificates notwithstanding the warning on the margin of each blank. In giving the birthplace of the father and mother, something that should never be omitted, it should be remembered that the state in which the town is located is, in a way, as important for the record as the town itself and should always be given; otherwise you have to guess whether Pittsfield, for instance, is located in Vermont, Massachusetts, Maine, or some other state.

I also wish to call attention to the difficulty clerks sometimes have in making out the names of diseases in death certificates. If the health officer is a physician and a good penman, he usually makes plain the name of the disease in the burial permit if it is not plainly written in the certificate, but the health officer is not always a physician nor is he always able to improve upon the physician's handwriting, besides, a good many bodies

are taken out of town for burial and for such the clerk has no permit to refer to. In making reports or certified copies the clerk occasionally runs across a cause of death that makes him think that if the disease itself was as puzzling to the physicians as the name of it is to the clerk, it is no wonder that the services of an undertaker were necessary. And yet this disease must be given a name by the clerk, and if the report or certificate is typewritten you can imagine his difficulty.

While I am aware that physicians are usually dependent upon the friends of the deceased or of the newly born child for the greater part of the data for certificates, I am led to believe that they do not always exercise due care in questioning the informants or are not sufficiently insistent upon having all the information possible from them. The item that may seem the least important may be the one most needed for proof some time in the future. Every question is important for statistical purposes and should be answered if possible. I receive on file a good many death certificates which have scarcely any information in the left hand column. I know it is impossible to get more for some of them, but when one of the best known persons in your town or city dies, it seems as if there ought to be someone who could give this information, and that a certificate should not be filed until it is obtained.

One thing more and I will leave the physician. In order that the clerk may carry out the provisions of Act No. 174 of the Laws of 1906, relative to sending certified copies of births, deaths and marriages of non-residents filed in his office, it is necessary that the physician should always give the correct residence of the mother in the birth certificate, and the former or usual residence of the deceased in the death certificate, otherwise this most excellent provision cannot be complied with.

The health officer's connection with the subject in hand consists in making out the burial permits plainly, in insisting that certificates be made as complete as possible, in causing to be corrected any errors he may discover in the death certificates, in making plain the names of diseases if they are not plainly written-which may be easily done if he receives the certificates from the hands of the physicians-and in filing the certificates with the clerk as the law requires. From my observation I should say that the health officer's duties in connection with certificates tend to improve them and make them better adapted to serve their purpose as records. I wish to suggest to the health officers that they discontinue the use of the old style burial permits that do not have the margin for binding, if they have not already done so. Such permits occasionally accompany bodies brought to Rutland for burial. The use of them must be due to neglect, for I am sure the State Board of Health has furnished the new permits to every health officer in the state.

In regard to the duties of town and city clerks, being one of their number and liable to any criticism that may be applied to them, I presume I shall not be able to set forth their shortcomings as effectively as the secre

tary of the State Board of Health might, for no doubt he is troubled more by the clerks not making their semi-annual reports promptly and legibly than the clerks are troubled by the negligence of the physicians.

Much is required of a town clerk. He is expected to be careful and painstaking and should not be trusted with records unless he is so. He should be thoroughly familiar with everything pertaining to the duties of his office, should be competent to make deeds and similar documents and to do other work of a legal character. A clerk should have a legal training in order to fill the office to the satisfaction of everyone, and it is not strange that such as have not had that advantage should sometimes fall short of what is expected of them, but no special training is needed for making reports of births, deaths and marriages to the State Board of Health, and the clerk who fails to make them on time can have no reasonable excuse to offer. He may suspect that physicians are holding back birth certificates and because of this may delay his report until the very limit of the time, but after using his best efforts to get such certificates, when the time comes for completing his report he should send it as the law directs, and not make the secretary's life a burden by delaying his statistical report. If he fails to report promptly, he should not complain if the secretary takes such measures as the law provides for causing him to remember his duties.

Every clerk should realize that in taking charge of the records of his town he becomes the custodian of its most valuable possession. The office of town clerk is one of importance and is worthy the best efforts of any one who accepts it. While it may be accepted primarily for the fees connected with it, the clerk should be willing and expect to do a good deal of work for which he will get no pay, no thanks, even, if he wishes to serve his town in the best possible manner and keep its records to a high degree of efficiency. He should bear in mind that the records of births, deaths and marriages are, comparatively, of as much importance as any records he has to deal with, and that in connection with them delinquencies should be followed up, errors righted and omissions supplied with as much care as he would give to similar work in connection with land records.

It should be taken into consideration that unless the clerk takes a special interest in the subject of vital statistics, his point of view in relation to it is different from that of one who values statistics for statistical purposes, and this may account for any indifference he may seem to show to the necessity of supplying the less important data that may be missing from certificates when filed. Generally speaking, only the leading facts are essential for such copies as the clerk is called upon to make, for usually a copy answers the purpose just as well if the record is not complete as to the minor details as if every question is answered. The value of the less important items, such as the number of child of mother, the birthplace of father, occupation, etc., which are very essential for statistical purposes and which should always be found in the record, is not so apparent to the