Commonwealth of "Virginia STATE HOARD OF HEALTH Bl'UBAU OF STATISTIC* ENNION G. WILLIAMS, M. D., Commissioner and State Registrar. W. A. PLECKER, M. D., Assistant State Registrar KldlMONI) Dec. 1913. jocal Registrars, Virginia. Gentlemen:- We approach now oir second yearTs ending, since we began work, Tune 14, 1912.* With what unusual success, you will find related in the Annual Report, the Nov. 1913 Bulletin, and in the fact that we have been accepted by the U. S. Bureau of the Census as a registration state for deaths, for the first full .7ear, 1913. For this happy result, we thank the 95 out of every 100 of our Local Registrars who have entered into this work with the zeal of men /ho know no such word as fail. We hope the otlu-r 5% 7/ill either catch the same spirit for 1924, or by resigning, make way for helpers, who will really aid in our deter- ni.nation to make Virginia the Model Registration State of the South. The U. S. Census Bureau will soon accept Birth Registration also for states that are efficient. Shall Virginia enter with the first? If you say y-s, then go afier the 60,000 births that will occur in 1914, instead of 'he 50,000 which we got the first year. That means for every man to get one-fiftn more’ than before. If necessary, make miserable the life cf the lazy midwife, and the "Don’t Care" Doctor Watch for the one out of ten death certificates lost, because peonle buy coffins and have no undertaker. TAKE HEED TO THE FOLLOWING. 1. Do your best to get every omitted death and birth since June 14, 1912, in your December report, Jan. 10th. but keep after them later if they escape you. See that the Overseer of the Peer does not fail to report pauper deaths and births, and that all convict deaths are reported. 2. Then by Jen. 15th file your 1913 books with the County Clerk, send us his receipt, and get your pay. 3. Do not copy a Jan. 1914 certificate in your 1913 books. We will net let it pass. You will get no pay for it in either year. 4. We want the CORRECT NAME and ADDRESS of every midwife and coffin dealer, or maker, not already sent us. 5. We want corrections to the Doctors’ list, whenever changes require it. 6. Before filing your books with the clerk, remove all unused blanks for regular use, by lifting the ends of the staple fastenings from the back,when the blanks will come off without tearing. You can also secure blanks from last year’s books, now with the clerk. 7. When you mail the clerk’s receipt, or preferably sooner, ask on the enclosed requisition blank, Form 38, for books and supplies as needed, stating exactly what is on hendd- You will receive no blanks, books or envelopes for 1914 fill this is done. Wishing you a- Merry Christbaaa and Happy New Year, I am in the work with you to win. Most sincerely yours, W. A. Plecker,M. D. State Registrar 7) S .Hi i i / VjROilJA Tho legitimate fi Id and litres of preventive medioine,**em faults alisoot llmltle&e • As one portion i cultivated and lianafloial iXCiilH n begin to bo apparent,other associated,or now brumes begin to open up and clamor for attention. The duties In connection with tho administration of tho Virginia lureau of Vital ftatiatioa.have impressed upon m« *h» greatness of the task which county,city,ytato i nd national departments of health hart before thorn. o cannot study tbs baneful effects of alcoholism,venereal dice* sf and gastronomic excesses,without realizing that the teaching of moral and aolf-aontrol is distinctively a of the health depart- ment* Ae could do no better in our attempts to impress the individual responsibility of every one to observe strictly the principles of in infootlous end contagious disenses,thorn to teach t ob the truth and the very words of the divines ,wito tXjL&uxiy tUj- OtA^tZt^eiA it*, up so - \U>t the sixth commandment " requires all lawful endeavors to preserve our own life end the lives of others". To those ho are not familiar with the possibilities of a careful ' subject. study of vital statistics,it seems a dry and uninteresting dtdiyx Those who know that it 19 the bed-rock foundation upon which all preventive medicine is based,see In it the opportunity for making fint-hond investigation of the greatest value. hlle the statistics scoured during the firjt year's operation of the Virginia law,i re too incomplete to draw fine and accurate Conclu- sions,yet many valuable lessons may be If mod from them by patient investigation. These we hope to t.’evoloi .point by* point in tho future, as our time ;.nd means permit* \ One condition alone, I wiah to consider briefly at this time,both from ita importance *cind from the foot that it ia one of the most apparent of the many problaray which fuec the JDcpartoont of Health, the modi or. 1 pro- fession,and the state • It is that nearly nr ignite one-half of the child-births in Virginia are attended by laidwives. The serlou: phase of the question ia.thnt theca women .unuflly negroes are the moat ignorant and dirty to be found* TJp to f 6 or 30 years ago when antiseptic,and later aseptic methods, became me ml amongst the modlo* 1 profession,this situation might L ve been tolerated. "Tot only t at,but under oertain oontUtions.it might hare been encouraged. This ia mode clearer by reference to the great discovery made by eiaoelwoiea in the Vienna Hying in Foopital.in 1847. Thor© ha found t at whllo the mortality from puerperal septicemia \,va e ooasivo in the pr otioe of phyeioi&na and etudente, vho went directly from the dlouooting recta .hniland from ])andling septic patients to the lying-in wards, where vaginal evaluations were freely made /ith unoleaneed hands; the patients in the oare of vrtio made no exwai nations, fa red far better. Xou ore all familiar vdth the greet improvement he wrought ,by simply requiring the hands of examiners to be wsehed in a solution of chloride of lime. Tho midv/ives did not know,and knew that they did not know. Tho physicians did not know.and did not know that they did not know. Today the physiolam knows,and knows that he knows. The midwife still does not know,but believes that she knows. The presumption of these ignorant creatures is simply appalling, v/ithout the slightest idea as to the cause or prevention of septic fever,they freely thrust into 4 he vagina of their patient,their fingers unwashed and with their xmll-tips oi‘ the color ouggeatlve of mourning* The sad feature of the case la.that that suggestion of mourning, proves too often the actual for It .in tljat unsuspecting house- hold. If the patient escapee septic infection.she le liable to be left a o ripple .with undiscovered and &S3i$9S&tii unrepaired team. .any of them hare discovarad that ergot la carried by phyalolana In their obstetrical boge.and used under oortain conditions* They too procure ergot,and with a chow of doing something to help the labor along,give It in larro doses during labor. You know the serious results likely to follow to the mother,*nd the fatal re suite to the child* They stand aghaat in the presence of hemorrhage or eel*u&jia, which with proper management before and during labor*perhaps would not hare occurrad. faulty positions are not recognised,and a physician »UMaonued,till the patient la moribund. Without the slightest Idea of What Is possible or what Is Impossible I hare known of one of theta in her frantic ottempts to deliver a transverse child, equally tear Its arm off* Of courts# a double funeral followed* A study as county reglstr&r.whon the question was asked as to preset* tation,revealed the fact that midwives lose twice rs many infonts In breech presentations,as physicians.because they do not know that raiding tho body of *be child will hasten the delivery of the after-coming head and prevent the asphyxiation resulting from delay* If the child does not seem to breathe.it Is wrapped in an old skirt the and laid aside with/exclamation ‘Mead’'.without he slighteat attempt at resuscitation. If the mothor and child a>ia tho critic* 1 period of aotu. 1 labor. 4 other dangers &wj it them. Dirty ruga ora thru-st under and around the mother.inviting later infection* Abraded nipples raooivo no attention.till breast ibaoead is the roBUlt • A distended bladder remains unrelieved* Dirty dreading of the umbilical oord leads up to the ohild'a death from obHOesa or "fits"* A cursory examination of our certificates of death reveals a shook* ing internal and infant B4ortftlity9from these onuses* lie 109 dent ha actually rsportod the fir t year from puer oral sen- tioonia constitutes wo beliove but a small part of the reality* other® ore oonoo&led under the expression "no doctor". , Vffc have not yet reached the point whore all suck cases receive investigation as t ey should* e beliove also that many ot er icptlo deaths are concealed under the ur certtin tonus,Gloria .typoid frfver9 pneumonia ‘ o* The actual mortality statistics take no eooount of the long seeks of uioknesjBfand the death of the ohlld from look of a mother’s care,while she hovers between life and death* It is needless to consume time by depleting more fully these scones, only too familiar to all of yon. I hope to iuake a more complete study of this whole subject9if the data la sufficiently ooeumte to justify it getting forth on actual compar- ison of he work of physician and midwife* Itactically all physician* make vaginal examinations9some mldwlvee do not* Some physicians are clean9eom arc not* ho knows therefore what tho result will bo 7 We simply seek truth* ■V# do not know how large a part of the medical profession Is living up to he knowledge that vc possess. If however,actual investigation proves that we are correct In our ourmlaes.gXJtg and tho midwife la shown beyond question to be a a our o a of and death,then the state cannot rofrain from stopping In end protecting hsr citizens* Tho responsibility of proving tho actual fecta,rests upon the fureau of Vital statistics.of the Department of health* The secondary responsibility of proclaiming to the public the danger may be prevented .likewi jo rests upon the ealth *partti*nt« / 1 believe finally that If the situation is found to be a serious one, a remedy oan be v/orked out* To this ond I am here to make an appeal to the medical profession the to stand shoulder t.o shoulder shoulder *.ith/ ealth Department ,1a ito work,and especially to rid during the year 1914 in securing f3tatlatics of births and deathsgthat *411 roach our office accurately, proiaptly*end completely* I particularly appeal to you to report tho causes of death accurately, Do not doooive yourself and us into believing that a death from puerperal infection,i a due to malaria .typhoid .or pneumonia. If the death is the result of alcoholism.or venereal disease.let it show in the certificate.and do not state simply some end result* H Keep by you for ready reference .the excellent little :*hysieian« pooket Reference" out t0 611 phyaioions by the T7.9* Bureau 6 t 1 g by complete hKMilf sympathy and harmony between the profession and the Eeulth .that the highest results will bo achievedtund the greatest good accomplished for both,for the 3tate*and for the people The T&KJflt proposed is to odueat* the publlo as to the danper from dirty and neglectful methods. Teach them also that the laborer is worthy of his hire,and that they cannot expect ekilliUl,pains-taking service for the rldloulou*ly low fees that pro rail in oomo localities in Virginia* There are places whore the regular obstetrics 1 fee in 6.CO* There will remain after all la accomplished that cam be,still n»nyf particularly of the colored people,vbo cannot aeoure a phyaieli n* For those,the mldvife .Till remain aa e nooeasity. Therefore a ho mist be taught severe 1 fundamentals . iMteee ares 1. lover nx\ke a Vaginal examination* S* hovor administer any drug orator oil. 3* Call in a physician os soon as any thing mutual Is d^scovered. 4* Aid in the quick delivery of the after-coming head,by mining tho body of the child by the feet* 5* Before handling the patient,cleanse the hands with soap end warm water .using preferably on antiseptic soap,and use more cleanly methods with the patient and surroundings* In addition to the education of the and the publlo,the physician himself must be inspired with an sense of res- ponsibility in promptly responding to calls for aid dX women in dis- tress ,regardless of financial reword. In other words to practice the law of lore laid down by the great Teaohor* Se believe that all of these things con best be brought bout, by the department of Health,ohiofly through bulletin*fand ot r , dues tie* it al &enns available already. a boliovo that this is legitimate helth work, end that the Bureau of Vital Stetietioa ia the souroe from whioh thia labor should reoeiva its initiative* P. S. Begin on Jan. 1st to number all certificates, starting with No.l in registered number space. See Sec. 18 of the law. We will be glad to have you send us names as indicated below. Yours very truly, W. A. Plecker, M. D. Asst. State Reg. State Board of Health The following persons, both white and colored, it is believed will read and appreciate the Monthly Bulletins of the Virginia Health Department, if placed on the mailing list:- CORRECT NAME. POST OFFICE. COUNTY. OCCUPATION COLOR.