Section on Vital Statistics
ADDRESS OF THE CHAIRMAN, J.N. HURTY, M.D. (1908)
Secretary State Board of Health of Indiana.
(dowaload the entire document .pdf)
To Dr. Cressy L. Wilbur is due quite all of the credit for the organization of this section. That the section was needed, that it has a good work to do, appears upon the surface. The resolution leading to the organization of the section was written by Dr. Wilbur and presented by myself at the meeting in Mexico City in 1906. The question had been informally discussed, and the authorization for organization was passed without dissent. As all here know, the final forming of the section was accomplished at the annual meeting of the Association at Atlantic City in June, 1907. In anticipation of successful consummation, Dr. Wilbur aroused the interest and secured the attendance of a number of earnest workers in vital statistics, and, .in addition, arranged an excellent program. Certainly no greater success ever attended a like effort, and this much of history is given, for possibly it may have future usefulness.
THE WORK AHEAD. What shall this section do? A work must be done, something must be accomplished, a structure must be built. The importance of collecting accurate vital statistics and drawing from them the lesson they contain, need hardly be discussed; but it seems not inappropriate to note that the life history of population is of great importance, and that vital statistics comprises the analysis and synthesis of the said life history. For a civilized people to have accurate knowledge of their wealth, to know the amount and value of the crops of the land, to know fiscal relations and facts, are not of more importance to them than to know about themselves.
Being born is both a serious and a joyous matter; and it is stupid, indeed, for any civilized State not to have accurate records of all births; and, as for records of diseases and deaths, the importance of collecting, tabulating and analyzing them should be understood by even a wayfaring man, though he be a fool. Yet, what has been done in the matter by the free and independent and civilized States of North America?
THE SITUATION. The situation is not discouraging, nor is it flattering. Free schools exist in every State, orderly government prevails, the courts everywhere are pure, literature, art and science flourish, and honor and righteousness control; yet, at this time, only fifteen States comprise the registration area, and their registration is not what it should be for deaths; and as for births registration is woefully deficient. The vital statistics of the National Government, as collected decenially, are a failure, and the method is abandoned. It is, indeed, humiliating to acknowledge that not a State in the Union knows with the accuracy it should know, its birth and death rate. We have fuller and more accurate knowledge of the number of sheep, mules, chickens and hogs, and of the number of deaths caused among them by disease, than we have of ourselves. A great National Bureau, supported by millions of dollars, exists to study and to stay disease among the lower animals and the plants; but the like for the human family has not yet appeared.
As vital statistics are the measure and the compass of hygiene and sanitary science, and as health is the basis of all wealth and power, it seems strange, indeed, that we practical Americans have not long since grasped the situation and acted upon it; however, the indications are favorable. As was shown by Dr. Wilbur in his address at Atlantic City last year, not one of the States having accurate systems of registration has discontinued since 1904. In 1901 Illinois slid backward, and Iowa in 1904 did likewise by repealing their laws; both, seemingly, not being mentally ready for the bath and the clean clothes.
Other favorable conditions are the, excellent work of the American Statistical Association, the action of the American Medical Association, the organization of this section, and the general interest which is certainly rising.
The anti-tuberculosis movement, which .is engaging the attention of the public, as well as the interest which is quite everywhere being manifested in public health work, are also encouraging factors; for how is it possible for the people to become interested in public health work, and not finally see clearly the necessity of the State collecting accurate vital statistics? This is possibly the principal reason why the cause, of vital statistics has advanced more rapidly in cities than in the States. Inasmuch as, disease prevention work is more advanced in the centers of population.
A certain class of physicians greatly obstruct the collection of accurate records in Indiana, and possibly, a like class in non-registration States constitute a block of progress. We find in Indiana that this class cannot be induced to take an interest in the' work which so greatly concerns the science of medicine, the family and the State. The members are not always ignorant, but generally are. These men require continuous watching to secure from them the data which the law commands they shall supply. But more than this the educated and strong members of the class tell their patients that State records of deaths, births and disease constitute an invasion of family privacy. To nullify this pernicious and hateful influence is very difficult. Henry Ward Beecher once said: "The church had many strong enemies within her walls." It may also be truly' said that the cause of registration would have advanced further and would have advanced more rapidly had not opposition existed within the medical profession.
The frequent changes in health boards on account of politics, is another cause of delay. Any and all doctors are hygienists, is the belief of the appointing powers, whose great aim is to advance their individual cause; however, this fault is disappearing, and finally, when health officers enjoy permanence in office and there is reasonable anticipation of the privilege of working in a good and interesting cause, then there will be no lack of understanding nor lack of enthusiasm, as now exists in certain quarters.
THE OUTLOOK. The outlook, I feel sure, is promising. Anyhow, there is no reason for discouragement or impatience. We do not desire revolution, for the results of evolution are more permanent. Time is required for education and evolution, but their results are lasting.
A twinkle of encouragement appears in a recent work undertaken by the International Association for Labor Legislation. This organization is trying to collect data concerning the relation of occupation to cause of death. The data is wanted principally for selfish purposes; but its need brings the importance of vital statistics forcibly to the attention of a class whose help will prove highly valuable. One Indianapolis paper became interested in occupational causes of death on account of the circular letter of the association just named and, upon finding that the State Board of Health could not furnish the data desired because of lack of funds to collect the same, gave a strong editorial upon the importance of vital statistics; and now we are trying to arouse all labor associations, and they are becoming interested and active. It is thus progress is made, and I have no doubt we will be able at the next session of our legislature to secure a better appropriation for statistical work.
The Indiana Board of Health began January 1, 1908, to collect birth records. Our law is not all it should be, but it Is capable of doing passable work; its greatest defect being a clause allowing twenty days in which to report. And this clause was insisted upon by a medical member of the legislature at the time the law was passed. Had we had laymen only to deal with the defect would not exist. In the first month of our work the number of births collected checked fairly with our calculations as to what the birth rate should be and very soon two difficulties in the way of accuracy appeared. The first was the old difficulty met with in collecting death records, namely, the doctors. The second was the lack of understanding and interest of parents. As to the delinquent doctors, I fear it will be more difficult to educate them and secure their cooperation than it will be to secure the attention and cooperation of the laity. In the first six months of this year we sent the following letter to every mother whose child was not named in the certificate:
"We have received at this office for legal record the birth certificate of your baby. Please fill out the inclosed blank where child's name is called for and return to us in the stamped and addressed envelope, and please correct any errors, either of dates or spelling of the names.
"This legal record of the birth and name of your child is of great importance to you, to your child and to the State. The record is frequently needed by those who least expect it. Some day it may be required in court to prove your child's parentage, or to prove inheritance of property, or to prove, right to insurance or pension, or to prove legitimacy. Every mother should demand that her child's birth be legally recorded as the law commands; and also demand that the physician or midwife carefully look after the matter, for their duties are not fulfilled and they should not be paid for their services until they make the report required by law. Women will do wisely to discuss with each other the importance to themselves and to their children of legal records of births and deaths.
"If at any time the State Board of Health, can help you, please write to us. Thanking you for your kind reply, and wishing you all happiness, etc."
Despite the requirement that omitted names should be supplied on supplemental blanks by the physicians or midwives attending the births, still every month we had over 2,000 birth certificates without names. Our letter to mothers usually brought the names, but for lack of funds we have been compelled to discontinue the plans, and now our collection of births languishes. Our letter also served the purpose of educating the people in the importance of collecting vital statistics, and certainly had a good effect, as is proven by letters from the people in response. Our regret at being compelled to stop the good work on account of lack of funds is, of course, considerable; but that defect will be remedied in another year if the M.D. members of the legislature do not too strongly oppose.
Perhaps the most important work before us is the adoption of rules of statistical practice. This will, doubtless, be done with wisdom, and then comes the practical working of them, a matter which will be attended with difficulties; but no difficulties shall be allowed to discourage.
There must be full consideration of rules. We must do our work well and thoroughly. First, comes statistical definitions of deaths, stillbirths and births. Second, requirements of registration of deaths and births. Third, methods of testing accuracy. Fourth, adoption of uniform age
periods in death statistics. Fifth, statement of cause of death. Sixth, occupation. Seventh, the adoption of standard tables and uniform methods of analysis.
ACTION. We now are in action. Not until the last year, marked by the organization of this section, has anything been done with vital statistics in this association but talk. We shall now proceed with intelligent and persistent energy. Mere talk about the importance of vital statistics shall cease. When Demosthenes was asked the first element of successful oratory he said, "Action." When asked the second he again said, "Action" and the third and all other requirements were stated to be "Action." "The Section on Vital Statistics of the American Health Association is now in action. Let the battle proceed.