the policemen-was the omnipresent sign "Registrar of births and deaths."

*

The territory of the whole island is divided into small registration districts and a small fee, from 9 pence to 1 shilling, is paid by the Government, I understand, for each registration of the registrar.

One view of the uses of birth registration.-The late Dr. Frank W. Reilly has epitomized some of the uses of birth registration as follows:

There is hardly a relation in life from the cradle to the grave in which such a record may not prove to be of the greatest value. For example, in the matter of descent; in the relations of wards and guardians; in the disabilities of minors; in the administration of estates; the settlement of insurance and pensions; the requirements of foreign countries in matters of residence, marriage, and legacies; in marriage in our own country; in voting and in jury and militia service; in the right to admission and practice in the professions and many public offices; in the enforcement of laws relating to education and to child labor, as well as to various matters in the criminal code— the irresponsibility of children under 10 for crime or misdemeanor, the determination of the "age of consent," etc.

Physicians and others wishing a more detailed study of the subject of vital statistics as a whole will find this material in a recent pamphlet written by Dr. John W. Trask, Assistant Surgeon General of the United States Public Health Service, and issued by the Public Health Service.

PRESENT STATUS OF BIRTH REGISTRATION.

In view of the uses to which birth registration can be put in preserving the lives and rights of children, the following statements are submitted as to the present status of birth registration in the United States. It will be seen that certain States need new laws, others need important amendments, and all Sates need increased public interest in order that the enforcement of the laws may be secured.

Although we have no complete records for the United States as a whole, there are certain States and cities in which the facts are carefully recorded; the New England States, Pennsylvania, and Michigan being the eight States which the United States Bureau of the Census includes in its provisional birth-registration area. To this list of States are added two cities, New York City and Washington, D. C. That any one of these units secures absolutely perfect registration is not claimed. The secretary of the Commonwealth of Massachusetts, in his 1910 report on "Births, marriages, and deaths in Massachusetts," said:

Again, I wish to mention that the number of births reported in the State does not include all the births that take place, as a great many physicians neglect entirely to report the births at which they are present.

The National Government can and does tell us exactly how great is the accession to our population each year by immigration, or intake from foreign lands. At each port of landing immigration inspectors record each arrival and tell us his or her nationality, age,

sex, destination, and how much money each one brings. But the National Government can not go into the States and cities and establish registration offices and tell us how many children enter each State by birth. This work must be done by each State separately. We have no national bookkeeping to account for the ebb and flow of human life as an asset and a liability of our civic organism. We have no national records to give our sanitarians and students a basis for their preventive studies. Congress by resolution1 has urged the States to enact and enforce suitable registration legislation. The State governments must now act. By uniform laws well enforced the States acting together can give the United States a system of vital statistics, and in no other way can this be secured.

It is fair to say that there is a steadily increasing sense of the value of vital statistics, and that the number of States with good laws increases yearly. At the present time, as shown on the map on the front page of this bulletin, good birth registration laws have been enacted in 32 States and the District of Columbia, although their enforcement does not yet meet the census requirements. These States are:

In the following States either new laws or important amendments

By using an estimate founded on the number of babies under 1 year of age reported at the last census, April 15, 1910, added to the number of babies who died in the same year, and comparing with this estimate the number of births which were actually registered, figures may be obtained which indicate roughly the efficiency of the birth registration in the different States. The following table shows these figures.

1 February 11, 1903.

ESTIMATED NUMBER OF BIRTHS IN VARIOUS STATES COMPARED WITH REGISTERED

1 For those States which do not have adequate records of deaths the number of babies who died in the first year of life is estimated on the very conservative basis of 10 per cent of the population under one. 2 Registration law passed since Jan. 1, 1910.

3 Inclusion or exclusion of stillbirths uncertain.

4 No figures available.

5 Includes stillbirths.

6 Returns for year ending June 30, 1911, rates based on a population (as of Jan. 1) of 210,194.

It must be borne in mind that this table is based on estimates,1 and perhaps no better indication of the need of an accurate, uniform system could be made than that displayed by this table, which seems to show that Massachusetts has registered 105.7 per cent of her babies, while the secretary of the Commonwealth of Massachusetts, in his 1910 report on "Births, marriages, and deaths in Massachusetts,"

says:

Again, I wish to mention that the number of births reported in the State does not include all the births that take place, as a great many physicians neglect entirely to report the births at which they are present.

It may interest readers of this bulletin to make a personal inquiry as to the recording of their own births or those of their children. It is probable that a large proportion of parents will not find their own and their children's birthdays entered on the public records. The county clerk in many States is the official who keeps these records. The most effective law, as will be shown later, does not, according to experience, depend upon county clerks, but upon local registrars with small districts, where accuracy is secured by neighborhood knowledge.

METHODS OF SECURING BIRTH REGISTRATION.

A joint committee, on which are represented the American Medical Association, the American Public Health Association, the American Bar Association, the Bureau of the Census, and the Children's Bureau, has given this matter much study in the past 10 years and has drafted a model State law for the registration of births and deaths. Certain provisions of this law are so fundamental that it is extremely doubtful whether a State law not containing them can be successful-certainly those State laws which have proved most effective do include them.

This model law creates the office of a State registrar of vital statistics, under the State board of health, and upon this officer it places squarely the responsibility of securing registration of all births and deaths. The law divides the State into small primary registration districts. Each city, each incorporated town, and each township constitutes a separate registration district, and when these are too large to be covered conveniently by the local registrar, subregistrars may be appointed by the State board.

It provides compensation to local registrars at the rate of 25 cents for each birth or death certificate issued; and in case no birth or death occurs in a given month, 25 cents for a report of that fact.

1 The estimate quoted-the number of infants under 1 year of age on a given date added to the number of infants who died in the same year-affords the only comprehensive basis upon which to compute the approximate number of births. It is generally recognized, however, that the census figure for the number of infants under 1 year on a given date is too small, owing to the tendency on the part of mothers to give a child's age as 1 year when the child has not yet completed 12 months of life. The census understatement results in an estimate smaller than the number of births which must have taken place and tends to make out a better case for the States than, with the present prevailing registration, is deserved.

The responsibility of reporting births to the registrar is placed upon the doctors and midwives or other persons in attendance at the birth. The law provides that they may be prosecuted for failing to perform this duty. The parents of every child should specifically ascertain that the birth of the infant has been duly registered.

It proves in practice impossible to secure satisfactory registration of births through the machinery of the county government. A county is too large an area to be covered by a single registration official. Too frequently the county officials are made a step between the local registrar and the State registrar, thus preventing the effective supervision of the whole work by the State official who is responsible for the efficiency of the entire system.

The superiority of the model law is not all that it has to commend it to us. It offers the way for uniformity among the States, and statistics collected under this law and tabulated by the United States Census Bureau will give us what we can secure in no other way. Copies of the law may be obtained upon application to the Census Bureau, and it is advisable, before introducing this bill in any legislature, that it be carefully redrafted by a competent lawyer and submitted to the Census Bureau for criticism.

The growing interest in birth registration is shown by the rapid advance made by the States in passing registration laws. In almost every State listed as needing amendment there is an active movement on foot to secure such changes, and with the public interest felt by groups of citizens and public authorities interested in babywelfare work, compulsory education, and the abolition of child labor, it is safe to predict that not many years will elapse before the United States will have birth records which can be compared with those of other civilized nations.