REVIEW OF PUBLIC HEALTH WORK IN INDIANA. 229 



sand of population. We observe here only a very slight improvement in 

 vital statistic reports between the years 1881 and 1896. If we were to go 

 deeper into the analysis of this matter, we would find that, upon the subjects 

 pertaining to vital statistics, it was possible to obtain only about one-third 

 of the real number. 



The health law which was passed in 1891, and is but a modification of the 

 law of 1881, says. Section 10, "It shall be the duty of all physicians and ac- 

 coucheurs in this State, to report to the Secretary of the Board of Health of 

 the town, city or county, in which they may occur, all births and deaths 

 which may occur under their supervision, with a certificate of the cause of 

 death, and such correlative facts as may be required in the blank forms fur- 

 nished, as provided in this act. When any birth or death may occur, with 

 no physician or accoucheur in attendance, then such birth or death shall be 

 reported by the household where, or under whose observations, such birth 

 or death may occur, ^vith the cause of death, if such be known." 



It may seem strange that under this very positive law, so unmistakable in 

 its language, that it was impossible with the most strenous exertions to collect 

 anything like correct vital statistics in the State of Indiana. 



A slight effort, however, to collect the vital statistics of the State, dis- 

 closed where the trouble lies. In the first place, the State health law made the 

 county commissioners, the councils of cities and the town trustees of towns, 

 boards of health ex-officio. It further required that these boards of health 

 should appoint a secretary, who shall be health officer and serve one year 

 from the first of January next ensuing, the compensation of said health 

 officer to be determined by the appointing authority. It is obvious that an 

 officer whose tenure is but one year can not become proficient in his work. 

 It was found to actually be the case that new health officers enter upon the 

 duties of their office with nothing like a good understanding of what these 

 duties were. It was usual for practitioners desiring this place to bid for it. 

 If the preceding officer has received a compensation of $100.00 per year, 

 numerous applicants would appear who would offer to do it for varying 

 amounts, less than what had been previously paid. 



As the appointing power was composed of citizens who had never given 

 a single thought to the subject of hygiene, and who, consequently, did not 

 appreciate its importance, this matter of lowness of bid for the position is a 

 great hindrance. It therefore not infrequently happened that the men who 

 were not actuated by high motives and who were not moved by the forces 

 which make medicine, scientific and honorable, found positions in the health 

 service. Despite however, the demoralizing conditions which were bred by 

 the law, there were in the health service a large number of the noblest prac- 

 titioners of the State. These were the ones who collected and presented the 

 most accurate and reliable reports. From the other class, it was frequent to 

 hear the argument, when pressed to put forth greater efforts to do good work, 

 that the pay does not warrant them in doing more than they have done. 



