Note The above is in addition to the educational work done by the hospital doctors and nurses and which is reported on table of yearly transactions.

JOHN MCMULLEN, M. D., Surgeon U. S. Public Health Service.

VITAL STATISTICS REPORT

January 1 to December 31, 1916

BY HAROLD B. WOOD, M. D., Dr. P. H.
Assistant Commissioner.

Developments in the work of the registration of births and deaths during the year constitute:

1. The adoption of the United States Standard certificates for births and deaths. The blank certificates were first distributed in December, 1916.

2. The adoption of the International classification for recording the causes of death.

3. Obtaining from one-half of the counties monthly reports of the reported births and deaths, by the receipt of the original certificates. These certificates are counted, checked, numbered and filed in the office, to be card-indexed later.

4. A very marked improvement in the character and completeness of the reports of births and deaths.

The model law for the registration of births and deaths was introduced in the legislature, was passed by the Senate, but failed of passage in the House.

The estimated population for West Virginia for 1916 is 1,387,038.
The death rate is unknown.

Reported deaths in 1916 totaled 9,157.

The birth rate is unknown.

Reported births in 1916 totaled 26,781.

The death rate of West Virginia or of any section of West Virginia, except of Wheeling, is unknown and cannot be computed with any degree of accuracy. The registration of deaths in West Virginia is so notoriously inaccurate and incomplete, except in Wheeling, that any estimation of a death rate would be merely a guess. Death and birth rates are, therefore, omitted from any vital statistics reports of West Virginia until the passage of a satisfactory law makes the computation of death rates possible.

Wheeling has been included in the list of registration citles for deaths for a number of years.

Parkersburg has a satisfactory registration law and is obtaining nearly complete registration of deaths. Charleston requires the issuance of burial permits. The Department has been unable to learn of the adoption and enforcement of a satisfactory vital statistics law in any other city of the state.

West Virginia is laboring and suffering under an antiquated system of defective registration laws. The law (Sec. 5383, chap. 150, Code of W. Va.) provides that births and deaths shall be reported within thirty

days to the clerk of the county court, this duty devolving upon physicians, midwives, undertakers and county assessors. Each person making a report of a birth or death is legally entitled to a fee of twentyfive cents. The clerk of the county court is required to record the repcrted births and deaths, even if reported in duplicate, and to submit a report on births and deaths to the State Department of Health on or before September 1st. The county clerks who submitted their reports on time were of the following counties: Boone, Fayette, Gilmer, Grant, Greenbrier, Hancock, Harrison, Jefferson, Kanawha, Lewis, Logan, McDowell, Marion, Mason, Mercer, Morgan, Pendleton, Randolph, Ritchie, Summers, Tucker, Tyler, Upshur, Wayne, Webster and Wirt counties. No reports of births and deaths were received from Berkeley, Pocahontas or Wood counties, and no reports of the marriages were received from Logan and Pocahontas counties, and no report of the ages of married persons in Doddridge county was received in time to include in this report.

Marriage records are kept by the clerks of the county courts who receive reports, grant licenses for a fee of $1.00, and who are required to submit a copy of the records to the State Department of Health on or before March 1st. In 1917 this legal requirement of reporting on time by the county clerks was followed by the clerks of Cabell, Clay, Fayette, Hardy, Jackson, Kanawha, Marion, Mercer, Mineral, Nicholas, Ohio, Pendleton, Randolph, Ritchie, Summers, Taylor, Tucker and Wayne counties.

Divorce records are not reported nor available to the department. Transportation permits are issued only by the State board of embalmers, but used permits are returned by the Baltimore and Ohio railroad to the State Department of Health.

The deaths registration was checked in five localities by comparing recent burials, as shown by cemetery headstones, with county records. Of those searched only 46 per cent had been recorded. In another town of 40 burials, only 17 had been registered. There is ample proof of the very great incompleteness of the death registration in West Virginia. It is fallacious to suppose that with the present laws complete registration can be obtained. The first essential for obtaining reliable and complete records of death is the requirement of burial permits. They are not required at present in West Virginia, one of the few backward states in the entire Union in this particular.

A further check was obtained upon the inaccuracy of the death registration by sending return postal cards to all of the 269 undertakers listed in the state directory. Burial permits are, unfortunately, not required by law in West Virginia. Many interments are known to be made in home-made coffins. In many other instances the families purchase caskets from country stores which are supplied by the manufacturers. The proportion of the actual burials attended by undertakers cannot accurately be estimated. Of the 269 undertakers interviewed, 5 reported going out of business. The other replies were as follows:

Number of undertakers in state.....

Number of undertakers giving information.

Number of burials they attended during 1916..

Number of caskets sold to families having no undertaker.

Number of transportations of persons dying in state..
Number of dead bodies handled by these undertakers.

Total number of deaths reported to Department..

Probable completeness of death registration...

264

85

3216

1048

569

4833

9157

...60%

Circular letters were sent to all hospitals and state institutions. These replied as follows:

Total number deaths in 12 hospitals during 1916, 483.

Total number deaths in 5 state institutions, 233.

The state maintains three hospitals for the treatment of miners, at Welch, McKenzie and Fairmont. Their deaths were included in the total deaths at the other hospitals.

Number of births in 12 hospitals, 277.

Number of births in 5 state institutions, 12.

Some hospitals and institutions admitted never having made birth or death reports before this year, when they were convinced of the necessity of registration.

These tabulations are shown, not only to indicate the advance which was gained during the past year, but to reveal the distribution of responsibility of the recording and the utter absurdity of imagining that records can have much value when made upon hearsay rather than upon evidence. Thirty per cent of the birth records of 1916 were made by persons who were not present at the event and, therefore, cannot swear to the facts in the case; also, 53 per cent of the death certificates of 1916 were signed and registered by persons who have neither the training nor the ability to declare the actual cause of death. For this reason very little value is placed upon the tabulations herewith presented. In 1915 there were found 248 duplications and 5 triplications among the 9443 death records, the diagnosis of the undertaker and assessor usually being at great variance from that of the attending physician. It is evident that the citizens

of West Virginia are not getting the legal protection they need. It is imperative for the state legislature to pass the Model registering law. Many requests are received for certified copies of birth or death records to be used for legal purposes, to claim legacies, to obtain insurance or to prove parentage, yet, on account of the defective registration, but few requests can be granted.

PERCENTAGE OF THE REPORTS WHICH WERE MADE BY PHYSICIANS