CRESSY L. WILBUR, M. D. 101 



than to others, and they should be the last to resist in any way 

 the enforcement of these laws. Hence the attitude of physicians 

 who refuse to make returns of births or who demand the pay- 

 ment of a small fee by the State cannot be commended." 



And in a later comment (October 8) : 



''The value of such data is recognized in all civilized communi- 

 ties. The carelessness of Americans regarding birth and death 

 records is looked on with astonishment by our European neigh- 

 bors. Cattle, dogs and horses are carefully registered. The 

 birth of even an Angora kitten is considered worthy of record, 

 yet we have practically no birth records (of complete and sat- 

 isfactory character) while, in nearly half of the United States, 

 human beings die and are buried without any record being made 

 of the fact. The properly educated physician recognizes the 

 importance of (birth and) death certificates and furnishes them 

 without compensation, not as a privilege, but as one of his 

 duties to the State." 



The registration area for deaths has rapidly extended in 

 recent years, as indicated in the table on page 7 of the bulletin 

 on Mortality Statistics, 1909, and in the maps exhibited before 

 this Association. Soon we shall have no State of which it 

 may be said, as Dr. E. C. Levy, Chief Health Officer of the 

 city of Richmond, said of the "Mother of the Presidents" before 

 the Virginia Funeral Directors' Association, May 21, 1908: 



"You would see what an awful light that State is put in 

 that buries its dead people (Virginians^ with no more ceremony 

 than it buries its dead dogs, and you would take a view of this 

 thing which would make you dissatisfied until Virginia was in 

 the list of registration States." 



But in the registration of births the country is even more 

 backward. Only a very few States have even approximately 

 complete registration of births (90 per cent, or 1 birth omitted 

 for every 10 that occur). A' tentative list might include the 

 New England States, Pennsylvania, Michigan, and the District 

 of Columbia. Even the District of Columbia, whose laws are 

 made by the direct action of Congress and which is identical 

 with the city of Washington, does not register all its births! Nor 

 are physicians frequently prosecuted for violations of the law. 

 In fact the only State in the Union in which, now or at any 

 former time, a determined effort has been made to thoroughly 

 enforce the registration of births, as the law provides and with 

 prosecution and infliction of the penalty of the law in delinquent 

 cases, is the commonwealth of Pennsylvania. The work of 

 enforcement of the law, an absolutely essential part of an 

 effective administration of any system of birth registration, is 



