V-A-^'C ■K Auth. ___ c. \ / REPOET ON EEGISTBATION. PRESENTED TO THE AT ITS FOURTH ANNUAL MEETING, HELD IN THE CITY OF BOSTON, JUNE 14, 1860, BY EDWIN M. SNOW, M. D., OF PROVIDENCE, R. I. NATIONAL LIBRARY OF MEDICINE Bethesda, Maryland NOTE. At the Second Annual Session of the Quarantine and Sanitary Convention, held in the City of Baltimore, in April, 1858, the following subject was assigned to the Committee on Internal Hygiene, and subsequently, by the arrangements of the Committee, was specially assigned to me, viz :— "A complete and efficient system of Registration of Births, Marriages and Deaths, with particular reference to cities, and the necessary connection of'such a system with sanitary measures." Circumstances having prevented the completion of my report in season for presentation with that of the Committee at the meeting in New York, in 1859 I was requested by vote of the Convention, to continue the investigation of the subject, and to report at the meeting to be held in Boston, June 14th, 1860 In accordance with this vote, the following Report is respectfully presented. EDWIN M. SNOW. Boston, June 14, 1860. REPORT ON REGISTRATION. The proposition assigned to the Committee is so comprehen- sive in its character, that a full investigation of the subject would require a much more extended report than seems to me to be necessary to subserve the objects and aims of this Conven- tion. Registration is not a new subject;—its general principles are well known, and systems modeled, to a greater or less extent, after that in use in England, have been in operation for many years in some portions of this country. Nor have we been dependent entirely upon foreign writers for our knowledge of the subject. The reports of Drs. John H. Griscom of New York, Edward Jarvis of Massachusetts, and William L. Sutton of Kentucky, to the American Medical Association, have established the general principles of a system of registration as applicable to our institutions. The writings of Dr. Emerson of Philadelphia, and of the late Mr. Lemuel Shattuck of Boston, and the official reports of dif- ferent States and cities by Drs. Josiah Curtis and N. B. Shurtleff of Massachusetts, C. W. Parsons of Rhode Island, Wilson Jewell of Philadelphia, R. W. Gibbes of South Carolina, William L. Sutton of Kentucky, C. L. Allen of Vermont, and others, have done much to spread a knowledge of the subject, and to show the practical operation and importance of Registration. A committee of the " American Association for the advance- ment of Science" has also prepared a report upon Registration, which, when published, will be found to be extremely compre- hensive and valuable. So much having been so ably written upon the subject, it would be a work of supererogation to present, or to attempt to 4 present to this Convention, " a complete system of registration. I shall, therefore, only give a few hints in relation to the prac- tical application of such a system, with particular reference to cities in this country. There are two principal objects of the registration of births, marriages and deaths : The first is to obtain and preserve a complete record of the movement and changes of the population of a place, for the purposes of legal and genealogical investigation. The identifi- cation of the individual for these purposes, in his relations to his family and to the community, must be considered the primary object of registration, and is equally important in the city and in the country. Wherever the rights of property and the social interests of the people are of any consequence, it is certainly necessary that a complete record of the birth, marriage and death of every individual, should be carefully preserved. This important object of registration is very imperfectly understood and but little appreciated, and has been most sadly neglected, in this country. The title of a few feet of land is every where recorded with all the formality necessary for per- manent preservation, while, in most of our States, no record is made of births, marriages, and deaths, either of which events may, at no very remote period, affect the title to vast amounts of property. Indeed, it is not improbable that the titles to property are daily changed by births, marriages and deaths, of which no record is made, more than by deeds which are recorded with so much care. More attention is given in this country to the pedigree of animals than of human beings, and many persons can tell the exact genealogy of a favorite horse for several generations, who do not know the maiden names of their own grandmothers, nor would it be possible for them to ascertain the fact from any legal records. It would probably be impossible for a large portion of the middle-aged men and women in the United States to prove that their own parents were ever married, and that they have any legitimate right to the name they bear. The necessity for such information and proof is daily felt, and its constantly increasing importance furnishes abundant reason for the establishment of an efficient system of registration. The second principal object of 'the registration of births, marriages, and deaths, is to furnish facts for statistical, scientific, medical, and particularly for sanitary inquiries. When we consider the relation of statistical and sanitary investigation to the welfare of the people, and the results of such investigation in the prevention of disease and in adding to the SiS5 5 length of human life, this object of registration appeals directly to the sympathies and interests of the community as well as of individuals, and its importance is apparent to all. This object is particularly important in cities where so many complicated causes are constantly in operation to produce dis- ease and death. In the examination of this subject, I shall proceed to show— First—The kind and extent of the information which it is desirable to obtain by registration, and, Second—The best method of obtaining this information, par^ ticularly in the cities of the United States. I. The kind and extent of the information desired. If we refer to the two objects of registration as already stated, it will be seen that the character of the information required for these objects is entirely different. For genealogical and legal purposes, and to show the personal history of the population, it is necessary that the record should be of such a character that each individual may be identified in his relations to his family. On the other hand, for statistical and sanitary purposes, we care nothing for the identification of indi- viduals ; but wish simply certain facts independent of all relation to individuals. It will readily be seen that it is difficult to fix the limits to the information which may be obtained, and which may prove useful when obtained. It is desirable that the portion of the information which is to be recorded should be such as may be given under suitable heads in a record book of convenient size. These limits will be suf- ficient for recording all that is necessary to accomplish the first object of registration, viz: the identification of individuals ; and will also be sufficient to include some of the most important items of information to be used for statistical and sanitary purposes. For these purposes facts alone are required, some of which it is not necessary should be recorded ; but the facts thus obtained may be used without recording, from the original returns, and their number and character may be changed according to the wants of different communities, and may be limited only by the ability to obtain such as are reliable. Those who have become interested in the study and analysis of such facts will agree with me that there is no danger of obtaining too many of them, or of obtaining such as cannot be used with advantage. Such being the general principles in relation to the informa- tion which it is desirable to obtain by a system of registration, I can better show the particular items by giving a specimen of the blanks which seem to me to be best adapted to obtain returns 6 of births, marriages and deaths in the cities of this country. These blanks are given at the close of this report. Their form is such that, when desirable, additional items may be added with- out interference with those already given. It is believed that all the items given in these blanks are im- portant to be obtained in every city, and perhaps the blanks for returns of births and marriages contain all that are absolutely important. But while every item given in the blanks for returns of deaths is essential in every city, the blanks do not fully meet all the wants of any city. The circumstances, character of the popu- lation, and wants of each community, must be studied, and such additional items of information must be added as each special case may require. These deficiencies will readily suggest them- selves to every Health Officer, and to every one who is acquainted with and interested in sanitary science. In cities where any considerable portion of the population lives in tenement houses, or in cellar tenements, information should be obtained in the returns of deaths by which the mortality of such classes of the population can be shown. In other cities it may be important to show the influence of location, of the character of the soil, of the water in domestic use, and of many other circumstances, upon the mortality of the population. Such items may be introduced, at the discretion of Boards of Health, into the blanks for returns of deaths, and every Regis- tration Law should contain a provision authorizing Boards of Health to require such additional information as they may deem necessary. All our most important information in relation to the causes of mortality is obtained by the division of those who die into classes, and by showing the number who die from each disease in each class. Every item of information, then, which can be obtained in regard to the mortality of any considerable class or division of the population, is of the highest importance. There is one item required in the blank for returns of deaths, given at the close of this report, which I wish to name particu- larly, because of its peculiar interest and value, and because, so far as I am aware, Boston and Providence are the only cities where this information is obtained. I refer to the Parentage of those who die. The information in relation to Parentage is important not only because the facts obtained relate to two classes of the population, which, as classes, are entirely different from each other in their sanitary condition and in all the^ circumstances with which they 7 are surrounded ; but it is also necessary because the division of the population according to nativity or birth-place has no value whatever, and only misleads and deceives the enquirer after truth. And yet the classification according to birth-place alone is given in the mortuary reports of all the cities in this country except the two named above. The following examples will show the value of this distinction. The subject of infantile mortality in our cities is one of the most important that engages the attention of those interested in sanitary science, and the proportion of this mortality to the whole number of deaths, is one of the best tests of the sanitary- condition of a city. Any classification which will serve to show the causes of this mortality is surely worthy of the attention of sanitarians. In the City of Providence, during the year 1859, there were 340 deaths of children under 5 years of age. Taking the class- ification according to nativity, we find that 338 of these children were of American, and 2, only, of foreign birth. But classified according to parentage, 137 were of American, and 203 of for- eign parentage. In the same city, during the same year, there were 75 deaths from the four diseases, cholera infantum, cholera morbus, diar- rhoea and dysentery. Of these 75 persons, 69 were of American and 6 of foreign birth; but according to parentage, 25 were of American and 50 of foreign parentage. Similar results will be found in other cities, so that if we take the classification according to birth-place as given in the reports of nearly all our cities, we find that all the deaths from cholera infantum, nine-tenths of the deaths from diarrhoea and dysentery, and ninety-nine one-hundredths of the deaths under 5 years of age, are among the American population. The mere statement of such facts shows their utter uselessness. I have illustrated this subject more fully on another occasion, and it is not necessary to occupy the attention of the Convention farther with it at this time, except to urge its importance upon those who have the charge of registration, particularly in the larger cities of this country. Such, it seems to me, are the principal points which should guide us, respecting the information which it is desirable to ob- tain by a system of registration. We will now proceed to consider the second division of the subject, in which I propose to give a few considerations in rela- tion to 8 II. The best method of obtaining the information needed in relation to births, marriages and deaths, particularly in cities. 1. In relation to Births. Nearly all the registration laws in this country require parents or physicians, or both, to furnish to the recording officers the information respecting births, and provide penalties for the neg- lect to comply with this requirement. The last registration law in Massachusetts, passed in the autumn of 1859, contains the provision that, " Parents shall give notice to the clerk of their city or town of the births and deaths of their children." I will venture to say that in Massachusetts, not one birth in fifty has ever been, or ever will be recorded, under this provision, and it is evident that those who framed the law placed little dependence upon this section, as they have, in the same law, provided other, and more efficient means for obtaining the infor- mation respecting births. The provision requiring parents to furnish information respect- ing births is entirely useless for several reasons. The services of too great a number of persons are required to obtain the necessary information. One general principle may be stated here, not only in relation to returns of births, but also in relation to all the returns desired in a system of registration : it is, that the duty of obtaining the information and making the returns, should be committed to as few persons as possible. The reasons for this are obvious. The large majority of parents, particularly in cities, have very little knowledge of the law, and take very little interest in it; and if they have a knowledge of the law, very few of them will take the trouble to comply with its requisitions. The provision, in some places, requiring physicians to report the births of children occurring in their practice, is equally inoperative and useless, for obtaining complete and perfect returns. Physicians, as a class, are as ready to do their duty to the public as any other persons ; but among them, as in all other classes, there are not a few individuals, who would refuse to comply with a statute which required considerable trouble, and which they were called upon to obey without remuneration, and with the threat of prosecution in case of non-compliance. The result of such a provision, in a registration law, is, that only a small portion of the physicians will comply with its requisitions. Again, most physicians dislike to make these returns, because, by so doing, they reveal information relating to their practice, which the public has no right to demand. Moreover, if all 1) physicians faithfully comply with the law, we cannot thus obtain full returns of births. A considerable portion of the children, particularly in cities, are born without the attendance of phy- sicians, and the returns of these births must be obtained from the parents, or other parties. The objections to this have already been stated. Again, in the registration of births, it is very important that the names of the children should be recorded. The physician completes his attendance usually within a few days after the birth ; and in most cases before the child is named. It cannot be expected that he will take the trouble to visit the child, per- haps repeatedly, until he can ascertain and report the name. Hence it has been found wherever the experiment has been tried, and will be found in future, that physicians' returns of births are generally deficient in the names of the children, and frequently in other particulars. We, therefore, find in practice, what might be expected in theory, that all laws requiring parents or physicians to make returns of births, utterly fail in obtaining full and correct returns. The only method by which returns of births can be obtained in cities, with any approach to fullness and correctness, is by requiring the recording officer to obtain the information person- ally, or by his agents. The Registration Law upon this subject, in Rhode-Island, is as follows:— " Of Births. Sec. 5. It shall be the duty of the clerk of each of the towns, annually, in the month of January, to collect the facts required by section third of this chapter, in relation to all children born in the town during the year end- ing the thirty-first day of December next preceding, and for each full report of a birth so obtained, the clerk shall receive ten cents to be paid by the town in which the birth is recorded." A separate fee of ten cents each is provided for recording the returns after they are obtained, so that the interest of the clerk coincides with his duty, to obtain as full returns as possible. Self-interest and duty combined, in this as in other cases, are usually sufficient to accomplish the desired results. Under this plan for obtaining returns of births, marshals are employed in Providence, to visit every family in the city, in the months of January and July of each year, and obtain all the necessary information in relation to all the children born during the six months next preceding. These marshals are furnished with the blanks for returns of births which are bound, by the top, in convenient volumes, each containing one hundred blanks. After the blanks are filled, they are cut out, and arranged according to dates before being recorded. It is not difficult to find suitable men in all our cities, who 10 would be willing to obtain the returns in this manner, for the fee which is allowed by the Registration Law of Rhode-Island. With faithful marshals, the only chance for failure to obtain complete returns under this plan, is on account of removals from the city. Among certain classes of the population of all cities, removals are frequent, and some returns are undoubtedly lost in this way; but if the marshals are instructed to obtain returns of the births of all children born during the preceding six months, the number obtained who were born in other places, will, proba- bly, equal the number lost by removal. In some cities, the children who were born in other places, are omitted in the census of births. The object of the registra- tion of births are two : First, To preserve a record of the births of all the inhabitants of the place ; and Second, To obtain the exact number of births in a place for statistical purposes. It seems to me that both these objects will be most nearly accomplished, by including in the returns all the children found who were born during the preceding six months. On account of removals, it is important that the census of births in all cities, should be taken at least twice in each year. Such, in my opinion, is the only feasible plan for obtaining returns of births in the cities of this country, with any approach to completeness. A similar method has been adopted in Boston for some years, and a comparison of the returns of births in that city and in Providence, with those of other cities, furnishes good evidence of the superiority of the plan. 2. In Relation to Marriages. The returns of marriages in all our cities are obtained under the provisions of State laws, and, for obvious reasons, it is not advisable that cities should pass additional laws upon the subject. And yet, the record of marriages is of so great importance, that it may not be improper to give a few observations in relation to the modes of obtaining the returns. When we consider the effect of marriages upon the titles to property, and their importance in tracing the history of families, the indifference in this country to the preservation of the proof of these events, is most remarkable. The tendency, for some years past, of all legislation upon the subject, at least in the Eastern States, has been to remove all impediments to the per- formance of the marriage ceremony. The public notice of the intention of marriage has been generally abolished, and in some States, parties of almost any character, or age, and even of different races, can be united for life, without restriction. The most sacred obligations,—obligations which are not for a day but which can be rightly absolved only by death, are assumed 11 with less form and ceremony, and are made a matter of less im- portance, than the conveyance of a square foot of land. It is certainly reasonable that legislative enactments should place some restriction upon the hasty assumption of such obliga- tions : but, at any rate, if persons will act thus inconsiderately, it is no more than just that the rights of their posterity should be protected by the careful record of their folly. In all portions of this country, so far as I am aware, where any regulations exist upon the subject, it is made the duty of the clergyman, or other person performing the ceremony, to furnish the report of the marriage to the recording officer. In Massa- chusetts and Connecticut, a preliminary record of the intention of marriage must be made; but as this record of intention is no proof of the marriage, and as it does not accomplish the object of a publication of the intention, I can perceive little utility in it. There, as in other States, the return of the marriage necessary for the record, must be obtained from the officiating clergyman. In Rhode-Island, the blanks in the return of a marriage must be filled out and must be signed by the parties, and delivered to the clergyman, before he can perform the ceremony. But we still depend upon the clergyman for the return, and there seems to be no particular benefit in the regulation, except that when the clergyman has the blanks already filled and signed, he may be more inclined to do his duty, and make the return to the recording officer. It also enables us to show what portion of those who enter the married state can write their own names. I am sorry to say, but truth compels me, that very many clergymen do not seem to appreciate the importance of the record of marriages, and are sadly delinquent in the observance of their duty to make the returns. I venture to assert, that, in no city in this country, are complete returns of marriages obtained, without continued and persistent effort on the part of the record- ing officer. The whole system is wrong, and the lamentable results of this relaxation in the laws relating to marriage, and of this neglect in making the necessary record, are every day seen in the in- crease of petitions for divorce, and in the civil and criminal suits at law which are from time to time brought before the community. The remedy for these evils is to give the marriage contract the importance which it deserves, and which the highest interests of the community demand. The best method of accomplishing this object, in my opinion, is, by the adoption of a system some- what similar to that contained in the Code-Civil of France. A formal marriage contract, containing the full description 12 and family history of the parties, should be written, signed, and sealed, before competent witnesses. This contract should be acknowledged by both parties, before the proper officer, and should be placed on record. When this is done, the recording officer should issue his certificate of the fact, and this certificate, and this alone, should authorize the performance of the religious ceremony by any clergyman. But the contract itself, signed, acknowledged, and recorded, should be taken as proof of the marriage, and should constitute the marriage so far as all legal and civil rights are concerned, the performance or omission of the religious ceremony being left to the option of the parties. With these provisions, persons would not rush into the marriage relation so heedlessly as at present; the clandestine marriage of minors would be prevented ; every marriage would be recorded, and the proof of every marriage would be preserved with the same care as that of deeds of land and of other civil transactions. Such, it seems to me, is the most efficient plan for obtaining the information necessary for the record of marriages, and for preserving the proof of these important events. 3. In Relation to Deaths. The information relating to deaths is more intimately con- nected with the objects of this Convention, and is more important to us as students in sanitary science, than that relating to births or marriages. Hence, the best method of obtaining full and complete returns of deaths, especially in cities, is a subject re- quiring the most careful consideration. The radical defect of the different systems adopted for obtain- ing these returns, in most of our cities, is, that they permit the removal and burial of the dead, without requiring sufficient evidence in relation to the cause of death. The death of a human being is always an event of sufficient importance to call for a careful investigation, and the estimate of the value of human life is so low among a portion of the popu- lation of our cities, that a proper regard for the welfare of the community demand that every death should be fully accounted for. The cases are unfortunately not uncommon in many cities in which deaths are caused by violence, and of course require investigation previous to burial; but besides these, there are numerous instances where, though there is no positive suspicion of violence, the death occurs under circumstances that call for an investigation. The safety of the community and a proper regard for the public morals demand that it should be made 13 impossible to bury the dead in such cases until the cause of death is satisfactorily ascertained and all suspicions removed. For these reasons, and also for the purpose of obtaining com- plete returns of deaths for legal and genealogical, and particularly for sanitary, investigation, the rule should be made imperative in all systems of registration in cities, that 1. No dead body of a human being shall be buried, or placed in a tomb, or removed from the city, without a permit from the recording officer. 2. No permit shall be given until full information concerning the deceased, person is furnished, including satisfactory evidence in relation to the cause of death. This plan for obtaining returns of deaths simplifies the whole subject, and renders unnecessary many regulations which are essential under any other plan. The principle that no dead body of a human being shall be disposed of until the cause of death is fully accounted for, will commend itself to the favorable opinion of the community, and a public sentiment will be created which will be an efficient aid in the enforcement of the law, and will insure complete returns of deaths so far as this object can be attained by legislative enactments. Another advantage of this plan is, that the returns of deaths will be made promptly, within a few hours after the death occurs, thus giving the health officer full knowledge, at any time, of the causes of death which are prevalent in the community, and of the locality in which particular diseases exist. This consideration is of great importance at all times, and particularly when an epidemic is present in a city. This plan requires " satisfactory evidence in relation to the cause of death." Such evidence should be the physician's certificate in all cases where a physician was in attendance dur- ing the sickness of the deceased person. This certificate should be required in all cases, without exception, when it is possible to obtain it. In cases of sudden death, when a coroner's inquest is held, the certificate of the coroner should be required as evidence of the cause of death. But in addition to the cases where the physician's or coroner's certificate of the cause of death can be obtained, a considerable number of deaths occur in cities without the attendance of a physician, and without the investigation of a coroner. The purposes of registration and the safety of the community require that better evidence of the cause of death should be obtained, in such cases, than the statements of the friends of the deceased. These statements are never reliable as positive evidence of the cause of death, and besides, if they are received as evidence, an 14 opportunity is afforded for the burial of persons whose deaths occur under circumstances which absolutely demand inves- tigation. ,.„ -, -i • • -u 1J To obviate these objections, well qualified physicians should be appointed in all cities, whose duty it should be to make an examination into the circumstances relating to all deaths which are reported without the certificate of a physician or of a coroner. This officer should visit the body, and make such enquiries as may be necessary to ascertain the cause of death. If the circumstances seem to demand it, he may report the case to a coroner for further investigation ; but in nine cases out of ten, the examination of a qualified physician will be sufficient, and he can give a more satisfactory opinion in relation to the cause of death than it is possible to obtain from a coroner's inquest, as they are conducted in most cases, in our cities. Perhaps it may be best that the examining physician should be clothed with the powers of a coroner, and most certainly all coroners should be physicians ; but the laws relating to the duties of these officers should be such that it shall not be greatly to their pecuniary advantage to hold an inquest, when a personal examination may be entirely sufficient and satisfactory. In small cities, the recording officer, if a physician, as he always should be, may be required to ascertain the cause of death in such cases, by personal investigation ; but in large cities more than one such officer will be necessary. In all cities the burial of the dead and the management of funerals are mostly in the hands of undertakers, and from them the greater portion of the returns of deaths will be received, under the system I have proposed. For the purpose of securing efficiency in the operation of a system of registration in cities, and for the prevention of abuses, no person should be permitted to act as an undertaker without a license first obtained from the Board of Health, and this body should have the power to revoke any license for satisfactory reasons. Though not especially pertinent to this subject, I may be permitted to remark that if gentlemen will make inquiries in their several cities, they will find, in my opinion, that no business needs the regulations and restrictions of law for the prevention of abuses, more than that of undertakers. Such seems to me to be the best plan for obtaining returns of deaths in cities. It is certainly correct in theory, and judging from my own experience in connection with the subject, I am confident that it will be found successful in practice, and will 15 furnish more nearly complete returns, and with less trouble, than can be obtained in any other way. Other methods of obtaining returns of deaths have been adopted in different cities, and the results of their operation are known to those who are acquainted with the subject. I think that such persons will agree with me in saying that they have all failed in obtaining the full benefits of registration. Among these plans is that which has been in operation in the city of Providence, during the last four years. I refer to this particularly, because it has been supposed to be efficient, and because it has been recently adopted, in substance, in one of our largest cities, and has been recommended for adop- tion, by the Board of Health of another city. This plan is, briefly, as follows : 1. Physicians are required to leave a certificate of the cause of death with the undertaker, within forty-eight hours after the death occurs. 2. The undertaker is forbidden to bury, or place in a tomb, or remove the body, until he has received the physician's certificate of the cause of death, or, if this cannot be obtained, a permit from the City Registrar. 3. Persons other than undertakers are required, in all cases, to make a report, and obtain a permit, before they can bury or remove a dead body. 4. Undertakers are required to make returns of deaths to the City Registrar, on Monday of each and every week. It is certainly true that, during the last four years, under this system, we have obtained in Providence, almost without excep- tion, complete returns of all the deaths in the city, together with the physician's certificate of the cause of death in nearly every case in which a physician was in attendance. And yet, in the practical operation of the law, I find difficul- ties and defects, even in the comparatively small city of Provi- dence ;—defects which, in my opinion, would seriously impair its efficiency when applied to larger cities. Some of the objections to this system are the following: 1. The section requiring physicians to leave a certificate of the cause of death with the family of the deceased, or with the undertaker, is not, and never can be enforced. Physicians are generally willing to sign the certificate when it is presented to them for this purpose; but they will not take the trouble to leave it with the family, or with the undertaker. The result is, that the duty of obtaining the certificate devolves wholly upon the undertaker, and as this often requires considerable trouble, it is neglected until after the burial, and without constant and 16 unremitting watchfulness on the part of the recording officer, some certificates will fail to be received. 2. Another and the most radical defect in this system is, that though the law may be rigidly enforced, it is possible, under its provisions, to bury the dead without that investigation which the welfare of the community demands. When a death occurs in which no physician has been in attendance, the evidence in relation to the cause of death is obtained from the undertaker, who receives his information from the friends of the deceased. But though the undertaker may do his duty faithfully, by reporting the case, and obtaining a permit before the burial, he is liable to be deceived by the friends of the deceased, and would certainly be deceived in precisely those cases where there are suspicious circumstances attending the death, and where an investigation is most necessary. A case of this kind occurred a few months since in Providence, in which the undertaker, being deceived by the friends, reported the cause of death as consumption, and received a permit for burial. Subsequent investigation showed it to be a case in which an unmarried woman, in attempting to conceal the birth of a child, lost her own life as well as that of the child. 3. Another objection to this law is, that a weekly return of deaths is not sufficiently frequent to meet the wants of a Health Officer. He should be able to ascertain at all times, what causes of death are in operation in the community, that he may promptly take the necessary measures for their removal. This is especially important in times of epidemics. Without dwelling longer upon the defects of this system, it may be sufficient to say, as the result of four years experience, that its practical operation is not entirely satisfactory, even in a small city, and that the objections to it would, in my opinion, have still greater force in larger cities* That there will be imperfections in the returns, under the system I have proposed, as Avell as under all other systems, is most certain, and the recording officer, if interested in the sub- ject, will have frequent occasion to regret that his wishes are not fully realized, either in the character or extent of the information obtained. The physicians' certificates of the causes of death which are absolutely essential, and should never be omitted in any system of registration, will not always be satisfactory to an intelligent recording officer. If qualified to judge upon the subject, he will, not unfrequently, receive certificates from physicians which he will know cannot be correct, and he will constantly find evidences of haste, carelessness, and even of ignorance, in some physicians, which will seriously impair his confidence in the 17 reliability of human testimony upon this subject. And yet, the certificate of a physician, who has attended a case of fatal sickness, is the best evidence that it is possible to obtain in relation to the cause of death, and should never be omitted in the return. A physician's certificate that the cause of death is unknown, is much more satisfactory than the surmises of other persons. It lias been found in Providence, that the habit of signing the certificates of the causes of death has been an incidental but very great benefit to physicians themselves, by rendering them more careful and exact in their diagnosis of diseases. It may be objected that the plan here recommended of requiring a permit in all cases, previous to burial, will prove burdensome in large cities. To this I should reply, that, if the principle is correct, that the highest interests of the community demand that the death of every individual should be fully ac- counted for, the acknowledgement of this principle implies the necessity for the adoption of sufficient measures for accomplish- ing the object; But I do not anticipate any difficulty upon this point. The cases must be very rare where it is necessary to bury the dead before there is time to obtain a permit, and I should consider the prevention of hasty burials, which are too common in this country, an incidental argument in favor of the plan proposed. But the practicability of this plan has already been tested in the largest city in this country. Through the foresight of the last President of this Convention, an ordinance was adopted in the city of New York, nearly twenty years since, requiring a permit to be obtained in all cases previous to the removal of a dead body from the city. As in consequence of the growth of the city, nearly all the dead are removed to other places for burial, the practical operation of the ordinance in New York, at the present time, is precisely what I have recommended. The plan proposed is also in operation in Buffalo, and perhaps in some other cities. It is a constant source of regret to Health Officers, and to all who are interested, in sanitary science, that we have no registra- tion of cases of sickness as well as of deaths. Only a small portion of the sickness which exists at all times, proves fatal, and we therefore receive no official knowledge of its existence, and vet, the information relating to cases of disease in a com- munity is more important to the Health Officer, with reference to preventive sanitary measures, than that relating to deaths. I do not think, however, that it is advisable to attempt to obtain 3 18 this information in connection with the registration of births, marriages and deaths. The information in relation to cases of sickness in a com- munity must be obtained, if at all, directly from the physicians themselves. The Board of Health, in our cities, usually have, and always should have, the power to call for this information whenever the interests of the public health require it. But, after all, their success in obtaining reports of cases of disease will depend very much upon the interest which physicians can be induced to take in the subject, and it will be difficult to obtain any valuable information, by penal enactments, which cannot better be obtained by appeals to their professional pride in behalf of sanitary science. In the city of Providence, all cases of small pox and varioloid, are promptly reported by physicians, to the Superintendent of Health, and I have no doubt that reports of other diseases could be obtained, if requested. Whatever system of registration may be adopted in a city, its efficiency, and the importance of its results to the community, will depend, to a very great extent, upon the officer who is en- trusted with its management. The Registrar should be a well-qualified physician, familiar with, but not engaged in, the practice of medicine. No one but an intelligent physician can be qualified to perceive and correct the errors and blunders so frequently found in the returns of deaths, and most certainly the analysis of these returns, and the application of the knowledge obtained to the prevention of dis- ease, requires a medical education, and affords an ample and interesting field for the exercise of medical talent. I have thus attempted to state the general principles relating to a system of registration of births, marriages and deaths, with particular reference to cities, and have, designedly, endeavored to show the general principles relating to the subject, rather than to enter into particulars which could have only a? local applica- tion, and which must be changed to meet the peculiar wants laws and customs of different communities. In the Appendix will be found a more specific expression, in the form of an ordinance, of a few of the principal features of the system of registration pro- posed in this report, and also a specimen of the blanks for returns which seem to me to be best adapted to obtain the objects desired. The blank for returns of marriages is given in accordance with the laws of Rhode-Island, as this seemed to me to be more useful, at the present time, than the form of a contract as re- commended in the preceding report, APPENDIX. [The following portions of an ordinance are based upon the supposition that the State Legislature has conferred upon cities the power to make ordinances upon the subject, and that it has also made all necessary laws for the regulation of marriages and for preserving the record of them. The ordaining clause and other particulars must be changed to meet the wants and customs of each city.] AX ORDINANCE in relation to the Registration of Births, Marriages and Deaths. It is ordained by the City Council of the City of as follows : Section 1. A City Registrar shall be appointed by the Board of Health, who shall be a well qualified graduate in medicine, and who shall hold his office for the term of years from the first day of January next after his appointment, unless sooner removed by the Board of Health. Section 2. It shall be the duty of the City Registrar to keep a faithful record of all the births, marriages and deaths in said city, in accordance with the laws of the State, and in accordance with such regu- lations, consistent with such laws, as may be made from time to time by the Board of Health. Section 3. It shall be the duty of the City Registrar, semi-annually in the months of January and July^ to obtain by a census from house to house, and to record, the information required in relation to all the children in the city who have been born during the six months next preceding. Section 4. The City Registrar shall furnish to the Board of Health, at any time, such information as they may require in relation to the returns of deaths, or any other subject connected with the duties of his office. He shall also, annually, in the months of January or February, prepare a report in relation to the births, marriages and deaths in the city, during the year ending with the thirty-first day of December next preceding, with such tables and observations as he may deem important, and as may be required by the Board of Health. Section 5. The Board of Health may appoint a sufficient number of qualified physicians as Assistant Registrars, in each ward of the city, whose duty it shall be, as hereafter provided, to grant permits for the burial of the dead, and to make an examination in cases where no phy- sician's certificate of the cause of death can be obtained. 2U Section G. No person shall bury, or place in a tomb, or remove from the city for burial, or otherwise dispose of the dead body of any human being ^iio shall die in the city, without a permit first had and ob- tained from the City Registrar, or from one of the Assistant Registrars. Section 7. No permit shall be given as provided in Section G, until the Registrar or Assistant Registrar is furnished with the information required for record in relation to the deceased person, so far as the same can be ascertained, together with the attending physician's certificate of the cause of death, whenever it can be obtained, or a coroner's certificate whenever a coroner's inquest has been held. Whenever a permit for burial is applied for iu a case of death without the attendance of a phy-' sician, or if it is impossible to obtain the physician's certificate, it shall be the duty of the Assistant Registrar in the Ward in which the death occurred, to visit and view the body of the deceased person, and to make all necessary enquiries respecting the deal!;, and when he has obtained satisfactory evidence in relation to the cause and circumstances of the death, he shall sign the certificate, and give a permit for burial. If not satisfied in relation to the cause and circumstances of the death, or if, in his opinion, the public good requires it, lie shall report the ease to a cor- oner for investigation. Section 8. Whenever a person shall die in the city under the care of a physician, it shall be the duty of the physician attending in his or her last sickness, to furnish to the undertaker, when requested, a certifi- cate, giving the name of the person, the date of death and the disease or cause of death. Section 9. No person shall carry on the business of an undertaker, nor bury, nor place in a tomb, nor remove from the city for burial, the dead body of any human being, without a license first had and obtained from the. Board of Health, and the Board of Health shall have power to revoke and annul any such license at their discretion. [There are many other items which would be necessary for a complete ordi- nance upon the subject, the precise nature of which would depend upon the local circumstances and wants of each city. Some of these are the follow- ing : the salary or fees of the City Registrar and of the Assistant Registrars, the employment of clerks, provisions for the preservation of the records, penalty on physicians and undertakers, and a statement of the items of information to be obtained. I would also recommend that a small fee be allowed to under- takers for making returns of death.] RET i;rn of a birth CITY OF 1. Date of Birth?...... . . . '1. Name of the Child V...... o. Sex?................ i. Color?............... 5. No. of Child of Mother?. . . . G. Place of Birth, Street and No. 7. Father's Name ?......... S. Father's Age ?.......... !>. Father's Occupation ?...... 10. Father's Birth Place? 11. Mother's Name?......; , 12. Mother's Maiden Name? . . . 13. Mother's Age?.......... 14. Mother's Birth Place ?..... 15. Remarks ?......... . . . .Informant. X. B.—At No 2 give the full name of the child, and be particular to get middle names in full. At No. 4 state whether the child is white, black or mulatto. At No. 5 state whether it is the 1st, 2d 3d, &c, child of the mother. At No. 6 give the street and number if in the city ; the town and State, if elsewhere in the country. At Nos. 8 and 13 give the age at the last birth-day. At Nos. 10 and 14 give the town and State, if in this country. If the child was still-born, or has died since birth, state the facts at No. 15, with any other facts In case of twins or triplets, a separate blank is to be filled for each child. ■>.") RETURN OF A DEATH. CITY OF----- \. Date of Death?...... J'cttuLct^ 10, 1Syi)0. •2. Name in full?.........jCCciii'lsjl JSHclLLcju. ^Lcttcu., 3 Age?.............! 33 Years. £ Months. 1$ Days, 4. ( Place ) Street and" No.?! -W f^ei^cj^-^ft^ei, \ of f o. (Death?) Ward?......$. G. Sex?........... 7. Color?.......... 8. Condition?........ 9. Occupation?....... 10. Where Bora?...... 11. Father's Name? .... 12. Mother's Name ? . . . . 13. Birthplace of Parents? 14. Where Buried?..... JW. _///,—ftVifa afi t&ea^a.c, rzfCaiLs.c.l-s.ze.fi.e.f-, ^r-c.LLLcLtLn.aiL, ^fctrn.es. J3ha.LLcu±. s^aiLL&a. J&clLLcui-. Fa. /fteLcLn-cL. Mo. JIL. gf. flfc.it-n.cin. ^crrLeter-Li.. ^pccrTLtLS J^ictLLcirL, Informant. N. B.—At Nos. 4 and 5, give the place where the person died. At No. 8, state whether married or single, widow or widower. At No. 13, state the country in which each parent was born; PHYSICIAN'S CERTIFICATE. Date of Death? J>cLrLtLct^ 10, 18bO. Name ? ^clllslcl jSfralLan. ^/CLcl^cu.. Disease? 1. Primary. /@an.&LLrn.fi±L.arL. " 2. Secondaiy. ^n.eiLm.an.LCL. Duration of Disease ? 1. J m.an±hs.. 2. b dcu^&. ^cLrrLtLs. ^LLnle.*-, Physician. 1 certify that the above is a true return, to the best of my belief. SpkLLLfi /WcLLLej^, Undertaker. RETURN OF A MARRIAGE. STATE OF EIIODE-ISLAND. fl-WUlLcum. OL( //Las JlcLn&an -if'?- ( LLLcLcrLCP.. 1. Full name of GROOM? 2. Place of Residence ? . . 3. Aire?..... 4. Color?............ 5. Occupation?........ G. Place of Birth ?...... 7. Father's Name?...... 8. Mother's Maiden Name ?. 9. No. of Groom's Marriage ? 10. Full name of BRIDE ? . . (Maiden name if a Widow ?) 11. Place of Residence? . . . . 12. Age ?.............. 13. Color ?............. 14. Place of Birth?....... 15. Father's Name ?....... 16. Mother's Maiden Name ? . 17. No. of Bride's Marriage?. 3Jt.n.ccLt-&, fWlljLtc.. /Wcr-nested, ^/{Lcls.&. ^f'c.&e/Lh. (2j1cLrn.cn. ^f£a.n.&an.. 13L('lu'CCCL ^///-SL$C/L. UIL^CL ^clcu. ^ftcinc. (f.LL^(L jLztcLcu. ^fancs. z?'frr/-iLc..n.Ai, ^ft.ss. 32 jircL^s.. fUfhlta. ■f^f-cjj-Lden.rr. ^/^Lct^tLn ^fcnes. XUhcL'lcl JjfLcu'-m-cn. ^ftLccincL. N. B.—At Nos. 4 and 13, state whether white, black or mulatto. At Nos. 9 and 17, state whether 1st, 2d, 3d, &c, marriage of each. Providence, R. I., Jh,Ln£. 1Mh-> I860. We, the Groom and Bride named in the above certificate, hereby certify that the information given is correct to the best of our knowledge and belief. JWLLLLam. J3L. ^ftcLn&cxn, Groom. (pli^.cL 0L. ^ftc.nr, Bride. Signed in presence of /Jf£.en./-u. JV'cl^s.. and ^yiLcLLLLcLcL JWh-LtLnq.. N. B.—The above blanks must be filled, and the certificate must be signed by both Groom and Bride, and must be given to the person about to solemnize the marriage, before the marriage can be legally solemnized in the State of Rhode-Mand. \4 STATE OF RHODE-ISLAND o/ ///C/ ill litt^H «fetifllt d»/ ypM;,,,, &i. _jsr„,,»,.„ „„,/ v//y, *P*tc*f- ^y/oJtfy H'CiC/ /(//?( (ft f'n (L'/iali >«(/('/ /'// //>(/ 'It-' arr/-t(/ffnrr^ ft'/'ut ft/'.' /«'/'.> /ftc/ J7/ftfo of' ClMff/ts 2/JnJft oi- Tbe City of Provtdence, /ft/, L.- yrMccjj, «= /ft. j?7f<.><„<>■„., fjfLl'-l'I-C t'- /(/it It' 11 l^lf. /^'Illl '' rf' • WITXI-.ssKS TO Till: MARltlAfiK : jftA',o;.y ^. ftft/«/fti>. N. ]j.__The Clergyman, or other person solemnizing the marriage, is ruiuirc.l to sign this certificate, and return it to the Clerk or Registrar of the town or city in which the marriage takes place, on or before the s, end Monday of the month siiccnding the date of the marriage. Tlic laws of Rhode Islam 1 require at least two witnesses to be present at a marriage, in addition to the parties and the clergyman officiating.