WHY BIRTHS AND DEATHS SHOULD BE REGISTERED. JNO. EMERSON MONGER, M. D., State Registrar of Vital Statistics. The necessity of death and birth registration is so obvious to one engaged in the work that it is extremely hard to write on the subject. It is almost like urging that smallpox or any contagious disease should be reported. The contra side of the argument contains so little of merit, and the positive side so much, that one wonders why it is so hard to get some men to attend to this duty. Since my connection with the State Bureau I have found that most of the men who are dilatory in this plain duty in these matters are careless because they do not realize its importance. Our death registration is very well taken care of by the provision in the law compelling the undertaker to secure a death certificate before he can secure a burial permit. But even with this proviso occasionally we are compelled to prosecute some individual for evading the law by burying a body before securing a proper permit. This law should be, and is, drastically enforced, because any let-up in its enforcement might give a criminally inclined individual a chance to smother up a crime, or improperly take care of a contagious case. On the side of death registration I believe we have one of the best enforced laws in the country. In birth registration we are not so forunate. The United States Census Bureau requires that 90 per cent of the births be reported before our data will receive the attention of the Bureau. It is figured that statistics based on less than 90 per cent are valueless. Ohio, unfortunately, is slightly below this minimum requirement, and we are making every effort to bring it up to the Census Bureau standards. Dr. William H. Davis, of the United States Bureau of Vital Statistics, informs me that during the month of October, a test of this state will be conducted. We can only raise our standard by awakening our profession to its short-comings. We believe that the profession in Ohio is not less patriotic than that in other states, and from our experience in this bureau we know that the vast majority of our doctors are conscientiously trying to fulfill their duty toward their patients by making prompt reports of births and deaths. There is, however, a small minority who do not make these efforts, and it is this small minority that keeps our state out of the Federal Registration Area. As rapidly as our inspecting force can secure evidence we are prosecuting these dilatory doctors. Some trouble has developed from a misunderstanding of the law, or rather of a supreme court decision given in January, 1912. In this case a part of the law was declared unconstitutional. The legislature in session in 1913 corrected this defect by passing a law that conforms with the suggestion made by the supreme court. Unfortunately wide * Read before Section on Hygiene and Sanitary Science, Ohio State Medical Association, Springfield, Ohio, May 14, 1917. publicity that implied that the whole law was defective was given to this early defect, and very little to the fact that the legislature later passed a court-proof law. In investigating complaints I find that in most instances the doctors who are not making reports are under the impression that the law is defective and that they are not compelled to report. I wish to emphasize the fact that we have no fear of the outcome of cases now, as this law was drawn in conformity with the decision of the supreme court.. In the matter of prosecution I wish to say that there has been no duty in my life so repugnant to me as haling a brother physician into court; but I promised the leaders of the profession, and the officers of this Association who endorsed me for the position, that I would enforce the law and try to make Ohio a Registration State, and I intend to enforce this law without fear or favor. Registration is valuable. It is one of the duties the state owes its new-born, and we do not intend to allow the carelessness of a few to invalidate the conscientious work of the majority. I believe that over 90 per cent of our physicians are careful to make reports, and it is ridiculous that a small minority should render useless their work. I have no patience with the individual who is lacking in patriotism, and who is so careless of the welfare of his patients, that because he believes he should be paid to make the report he refuses or neglects to make it. Whether a man should be paid or not paid is a question that I am not here to discuss. The present law makes no provision for payment, but does provide that reports must be made. We intend to see that they are made, or prosecute the negligent. When a physician accepts an obstetrical case there are certain things that are implied. The patient expects us to use all precautions, including many things which are not mentioned, such as asepsis and due care to avoid trouble in every way, and it is also implied by this acceptance that we take care of the report. It is much the same thing to not make a report as if an attorney in our employ in an important case would fail to make an entry in the case that might invalidate our whole cause. When we employ an attorney we expect him to use every honorable means to bring our case to a successful termination, and if he fails because of neglect we hold him responsible. The family expects us in the same manner to give them every service. That birth registration is important is proven daily in our bureau dozens of time. In considering its importance I will discuss it under three heads: first, its value to the State; second its value to the physician; and third its value to the individual. Its Value to the State. A state to properly care for its wards must know who and where they are, and how many there are. The trend of modern legislation. is toward paternalism, and as our national and state life becomes more complex legislation will become more paternalistic. Industrial educational, military and social conditions are assuming a position undreamed of a generation back, and to properly care for its people a state must be able to take stock of its population. In the application of its laws it is essential that it must know their ages, as there are certain limitations for crimes at certain ages. It must know the number of children it must educate. It must know accurate ages for graduation from school, for the entrance into certain trades. In fact there is no relationship of a state to its wards that the first question, and often the determining one, is not the age of the individual. The only legal way to establish this is in the records in the care of the state. A very interesting thing to me since my connection with this. bureau has been the rivalry that exists between the various city health organizations. Cities are as jealous of their birth and mortality statistics as is a star ball player of his batting average, and they are bending every effort to make a good showing for their cities. A city is oftentimes very seriously affected by a high death rate, and much made of a low rate. The development of many of our southern cities and states has received a great impetus from the proven fact that their death rates have been exaggerated. Its Value to Physicians. It has been said, and I believe it is to be so, that the science of medicine is founded on vital statistics. It is an unquestioned fact that the science in which this section is most intimately interested - that of preventive medicine - owes most of its progress to vital statistics. The great campaigns for the control and prevention of certain diseases. which, after all, have been the really worth while things of modern civilization-owe much to the checks and balances the statisticians have produced. One can talk convincingly where definite figures can be produced, and our campaigns against typhoid, malaria, yellow fever, tuberculosis, and infant mortality, owe much of their success to the fact that we could convince the laity and thereby interest them in our propaganda. Again, many things which have been falsely proclaimed as the omega of treatment of a particular disease are found fallacious under the cold analysis of statistics. There are a certain few fallacies in our statistics, and always will be. These are due to imperfections of medical science and deficiencies of a few of our profession. But happily these causes are being lessened, and the few that creep in do not injure the value of the whole. Where large numbers of the human family are accounted for it is almost uncanny the way events transpire, and the certainty of their occurrence. For example: We can say there will be so many suicides in 1917 from hanging; so many perforations in typhoid, with little fear that our statements will be far out of the way. An error in a hundred events might change our conclusions, but when dealing with hundreds of thousands its effect is negligible. From this you can see the importance of securing all the data. To make our statistics reliable we must be able to register practically every event. Lay organizations, such as labor unions, civic bodies of various kinds, federations of women's clubs, and our churches, are showing an increasing interest in this work, and I believe our medical organizations should be the leaders and not the laggards. After all vital statistics are of more importance to the medical man than to any other class, and our attitude toward the subject should not be other than friendly. Its Value to the Individual. This third reason for registration is probably the most important in that its value is to the individual citizen. The registration of deaths is imperative for the settlements of estates, life insurance, annuities. damage cases, etc. The registration of births is one of prime importance to the individual. There is no relationship in life when the failure to produce a birth certificate may not seriously incommode the individual, and birth registration is particularly important for the poor. Their places of habitation are more or less temporary, and in after life if the necessity to establish the exact age arises it is often times difficult or impossible for them to establish by acceptable affidavit their age and nativity. A very tragic example of this occurred at the outbreak of the war. Some twenty-five years ago a young man was born in an Ohio city. After his birth his parents, who were Austrians, moved away and shortly thereafter died. This boy was raised in an institution and at the outbreak of the war happened to be in a belligerent country. He was impressed in a regiment and naturally protested that he was an American citizen. He was allowed to make an effort to prove his assertion, but as no record either official or by affidavit could be produced, we can only assume that he, an American citizen, was compelled to serve as a soldier in a foreign country, because of our then inadequate birth registration. Had this birth been registered there would have been no difficulty in establishing his claim. Because of many newly made laws the necessity of birth registration is being brought home to us. The child labor, inheritance, pensions laws and especially widow pensions laws where ages of dependent children must be known, criminal responsibility of the young, school admission and graduation, the practice of certain professions, the engagement in certain trades, voting, the limitation of guardianship, civil service requirements, "age of consent" for females, military service, and many other reasons with which I will not tire you, all point to its importance. There never was a time in our national existence when the importance of birth registration was pointed out so clearly as at present. The necessity of those of military age to produce accurate. record is imperative, and there will be much confusion in the enforcement of our universal military training law because we have no accurate record for men of the required age. It is a patriotic duty to report births, and the great crisis through which we are passing only emphasizes its importance. In the final analysis of the causes of the war it is possible that the historian will record as one of its causes the rapid decrease of the birth rate of certain of the belligerent nations. |