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A review of the year and a report as required by law to be made would be incomplete if no notice was taken of the cause or causes that helped or hurt, the defects and omissions in the sanitary machinery of the State that hinder progress, and hold the State in a stationary position as compared with many of her neighbors.

LEGISLATIVE DEFECTS. — The experience of the Board during the legislative session held the present year went far to show that a prime fault and one that operates directly to the disadvantage of the public health interests of the State is the lack of committees on sanitary affairs in both branches of the General Assembly to whom all matters relating to or affecting public health, all bills for the purpose of bettering the sanitary condition of the people, could be referred and given proper consideration ; where the arguments for and against could be heard and duly weighed, and when measures recommended by the Board for adoption as necessary to improve and advance the sanitary condition of the State had been so considered and favorably reported, a wider attention would be thereby commanded with proportionately better chances of useful legislation being secured.

As it now is no such committees exist, sanitary matters are unfortunately or indiscriminately referred, and public health measures of much practical moment are disposed of in rather hap-hazard fashion, or totally lost sight of in legislative haste, confusion or indifference.

An earnest effort was made by the Board at the opening of the last session of the General Assembly to secure an improvement in this respect and appeals were made to the presiding officers of both Houses to provide for the appointment of committees on public health, but no useful result was reached.

No' EFFECTIVE LEGISLATION SECURED. - Partly as a result of this defect, as we think, no effective legislation was enacted during the session for the advancement of sanitary science so far as it relates to the protection of our population against the appearance and spread of domestic or imported diseases ; and it has been practically impossible for the Board to secure observance of the requirements of the organic law in one of its fundamental purposes, namely, reports of deaths and births occurring in the State — annual reports of which are l'equired to be made by county clerks to the Board within ten days after December 31st of each year.

As there is no public health official in each county to see that this law is observed by physicians, and as no penalty attaches to failure on the part of county clerks to perform this duty, it is very generally neglected, to the serious detriment of the public in several important respects.

REMISSNESS OF PHYSICIANS. — Although a fine of ten dollars is provided to be assessed against every physician who fails to make returns to the county clerk within thirty days after their occurrence of all births and deaths in his practice it is very doubtful, indeed, if any considerable number of such reports are made outside of the larger cities ; and, as a State, Missouri is in this way discredited and placed at a material disadvantage in not being able to demonstrate by the actual figures of vital and mortuary statistics the claimed undeniable healthfulness of her climate, topography and geographical situation. Until such figures are available claims of this sort are mere guesswork and idle boasting.

Were such reports correctly made and the data carefully tabulated and returned, as the law directs, it would perhaps appear through a series of years that the claim of uniform general good health in this State as compared with other States presenting the same problems of population, drainage, water supply, etc., would be fairly well sustained.

RELATION OF RETURNS TO U. S. CENSUS. — The omission of returns showing the birth and death rates since the law was passed in 1883 will be particularly felt by sanitarians and public health statisticians in view of the fact of the taking of the census by the United States government next year when such data would have a material value and bearing in showing for that period the vital movement of the State, the natural increase or decrease of population, the parts of the State relatively so affected, the comparative healthfulness of different localities, the types of prevalent endemic diseases, and the occurrence and nature of fatal epidemics ; being informed on these points by the sanitary monitors constituted by such figures, the necessary measures of prevention or correction are readily suggested and applied. PAY FOR RETURNS RECOMMENDED.-In this connection it


be appropriately asked whether it is altogether fair and just for the State to require gratuitous services of physicians in making returns of births and deaths ; these returns are of vital and social moment to the State, they are for the information of the people, and their use is designed for the benefit of all the people by affording indications of weak places in the sanitary situation in the State and pointing out remedies therefor; and the reasonableness of the demand that these services to the public shall be paid for has been recognized by some of the Eastern States where a small fee is allowed for every report made of this kind.

Also it may be asked if it would not be more fair to allow special compensation to county clerks for the work incidental to the keeping of these records and tabulating and making the annual report required by law. Certainly the work would be more cheerfully and in all probability better done if it was paid for; and, therefore, the Board renews the recommendation of former years and asks that the law be amended in this respect.

REPORTS CALLED FOR. — Owing to the fact of the failure of the State in previous years to make suitable provision for the support of the Board these reports from county clerks were not expected or required, but during the present month circulars have been sent to all the counties in the State calling the attention of the clerks to their duty in this respect. The responses received have very generally exhibited a gratifying willingness to do their part, but many naturally ask from what source are they to be paid for the work, or are they expected to do the work for nothing?

They call attention to the very general failure of physicians to report births and deaths, and also ask that the State shall provide the requisite blanks, as many of the county courts refuse to incur this expense.

Why REPORTS SHOULD BE MADE. Every death cccurring in the State, the known cause of which is not certified to by the attending physician as an indispensable preliminary to burial, and made a matter of public record, is a direct temptation to the commission of crime against human life by the opportunity of escaping detection it offers to the evil-disposed ; and who can doubt among the ten thousands of deaths yearly occurring in Missouri that hate, revenge, and other bad passions furnish motives for fatal poisonings that are never brought to light, but which could scarcely escape detection if a public record of all the known facts or suspicious circumstances in connection with every death was kept.

It is for the protection of society in this respect that the State claims the right to require that physicians shall certify to the causes of deaths.

With proper encouragement in the future from the General Assembly it is hoped that the next decade will show a vast improvement over the present one in the collection and recording of this class of statistics.

Poor House POPULATION. — An attempt has been made within the last two months to collect statistics showing the poor house popvlation of the State, the greatest number maintained during the month of December this year, together with information showing how many are sick or insane, how many are physically disabled, the sex of the inmates, and their ages and nationalities so far as knowo.

The preliminary reports relating to this subject received from county clerks show an existing diversity of method in dealing with this class of unfortunates; in the greater number of instances the county provides a farm or poor-house for the keeping of paupers under charge of a superintendent or manager, who is responsible to the county court.

In other counties these unfortunates are farmed out for care and keeping to the lowest bidder.

Some counties maintain a department in the poor house for the care and treatment of insane patients, while others send this class of dependents to the State institutions.

SANITARY ORGANIZATION OF STATE. — The necessity existing for the complete thorough sanitary organization of the State by means of some measure, such as that proposed by the Board and recommended for passage to the last General Assembly, is continually and urgently felt. To be effective this organization must be by counties and towns, and competent men must be secured as health officers with suitable compensation; as, if public health is a desirable thing to have, it is manifest that it cannot be secured without intelligent effort and money must be spent to retain the services of suitable and qualified officials.

COMPENSATION OF HEALTH OFFICERS. — The matter of fairly adjusting the compensation of these officials is one still under discussion, and the pay for such services varies widely, and, therefore, as an attempt to secure a fair and equitable basis for reckoning such compensation, attention is called to the provision embraced in the bill for the creation, etc., of local boards of health and health officers which places such remuneration on a population basis. As a health officer's duties relate primarily to the number of people under his sanitary charge, and to every individual in such population, bis pay should bear some definite relation to this feature of the question.

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