REPORT OF THE PERMANENT SECRETARY. To the State Board of Health: GENTLEMEN: In presenting this, the biennial report of the State Board of Health, your Secretary has to regret its many imperfections in matters appertaining to the vital statistics of the State. This is owing to many causes beyond the control of your executive officer, the most potent one being the impossibility, under the existing law, of collecting trustworthy records. This we may hope to correct in time, as public interest in sanitary matters increases. But during the long continued illness and subsequent death of your late efficient Secretary, Dr. Hatch, the imperfection of the law manifested itself in the most striking manner. As you are aware, it is the duty of the County Recorders to transmit to the Secretary of the Board of Health a copy of all the births, deaths, and marriages in their respective counties, but as this was not possible for them, from the fact that no person, with few exceptions, ever registered births or deaths in their offices, the Secretary of the Board of Health was obliged to collect these statistics from voluntary contributors. In the midst of this occupation disease was silently making its inroads upon the health of Dr. Hatch, and the work he was doing become onerous. Sickness is at all times a disqualifying agent in the transaction of business which requires constant vigilance and attention to sustain the interest of voluntary contributors to a work which is appreciated by few, and almost thankless. How much more so when that sickness of months was accompanied by extreme debility and ever-increasing prostration, rendering each act performed a sacrifice of strength and a quicker movement toward eternity. Under such a trial we cannot wonder that the records of the year 1884 are imperfect. Those of the earlier part of that year were lost, mislaid, or never recorded, and those of the latter half of. the year-which I was fortunate enough to secure-were so few and imperfect as to give a very uncertain estimate of the mortality of those months. At the period of Dr. Hatch's death, the machinery of the Board had become disarranged, the intelligent hand that had hitherto guided its working had ceased to labor, his last biennial report had been made, to him time was no more, and all registration had come to an end. The loss this Board had sustained in the demise of its distinguished Secretary was quickly followed by the no less severe misfortune in the sudden death of its venerable President, Dr. Henry Gibbons-a man whom the Board held in highest reverence and esteem, whose prudent counsels and clear foresight enabled it to meet emergencies with judicial wisdom. At this time the Board had still to meet another loss in the resignation of Dr. Chester Rowell, who by having accepted a Federal position thereby became disqualified from holding a State office. The Board was now bereft of three of its most valued officers, all men of experience as sanitarians and thoroughly imbued with the importance of the work in which they had been engaged. Under these circumstances it became necessary for the con tinued efficiency of the Board, that the vacancies should be promptly filled. accordingly, his Excellency Governor Stoneman appointed Doctor James Simpson and Dr. R. Beverly Cole, of San Francisco, and Dr. G. G. Tyrrell, of Sacramento, to occupy the seats made vacant by death and resignation. After the reorganization of the Board, the election of Dr. H. S. Örme as President, and the selection of myself as Secretary, it became evident upon looking into the affairs of the Board that the material which might have been utilized in continuing the work of my predecessor was in such a disjointed condition, and the records of the office so scattered, that but very littic of it was available. The correspondents of the Board being unknown it was a matter of impossibility to obtain a renewal of their reports: therefore your Secretary, in order to ascertain certain facts connected with the welfare of the Board. issued the following circular to every county in the State, and to the more prominent medical men residing therein, in the hope that a complete list might be obtained of those willing to cooperate with the Board in its desire to possess the fullest information possible of the sanitary condition of the State; and, also, to learn to what extent the requirements of the law governing Boards of Health had been observed: OFFICE OF THE CALIFORNIA STATE BOARD OF HEALTH, SACRAMENTO, December 8, 1884. ) Owing to the long continued illness of Dr. F. W. Hatch, late Secretary of the California State Board of Health, the mortuary returns from the different localities in the State to the Board of Health have not been as complete as they ought to be, and as required by the provisions in the Political Code designed for that purpose. In order to perfect these returns and establish permanent communication throughout the State between the differen counties and the State Board of Health, whereby vital statistics may be collected and utilized for the advancement of sanitary science and the general welfare of the community. I wili esteem it a special favor if you will answer at your earliest convenience and as Tully as possible the following questions: 1. Has a Board of Health been established in your city (or town)? Ans. 2. Is the Board organized under Chapter II, Article V, Section 3061 of the Political Code, approved March 19, 1878, or under the provisions of the city (or town) charter? 3. How is the Board constituted? Ans. Are meetings of the Board regularly held? Ans. - If so, how often? Ans. 6. Have health ordinances been adopted, and are they enforced, looking to the improvement or preservation of the sanitary condition of your city (or town)-such as the cleansing of privies, vaults, and other foul places? Ans. 7. Have reports been made by your Board of Health to the State Board, as required by Section 3061 of the State law, of deaths and epidemic, contagious, or infectious diseases? Has your Board of Health adopted any ordinance requiring a certificate of death to be thed, and a burial permit to be obtained, before the interment of a deceased person shall be allowed? Or is there any such ordinance now in force in your city (or town)? If not, what means have you of ascertaining death, or causes of death, in the community? 1 no such Board has been established, or Health Officer or Sanitary Inspector appointed will you, upon the receipt of proper blanks furnished for that purpose, ascerthe number of deaths and causes thereof in your city, town, or vicinity, and transit the same monthly to the Secretary of the State Board of Health, in Sacramento? Al Wil you notify the Secretary of the State Board of Health of any epidemic, infectious or contagious disease in your city, town, or vicinity, that direct investigation may be made into its cause, advice given, or, if possible, remedies suggested to mitigate or arrest the advance of the disease? Ans. What is the present estimated population of your city (or town)? Ans. Respectfully submitted for the State Board of Health. G. G. TYRRELL, M.D., Permanent Secretary. To this circular over a hundred replies were received, which demonstrated the fact that in but few instances had the law, requiring incorporated cities and towns to establish local Boards of Health, been observed, and in still fewer instances had a Health Officer been appointed in lieu thereof. Another fact was ascertained by this circular, which has an important bearing upon the mortuary statistics of the State, and that is that in eight only of those cities or towns having organized Boards of Health is a permit required for the burial of a deceased person. In every other city, town, or village heard from, no permission from any regularly constituted authority was required to inter a dead body, neither was the cause of death required to be ascertained, If, however, the undertaker kept a list of those he interred, he generally inquired of the physician the cause of death, and recorded it. This was, however, entirely voluntary on the part of both undertaker and physician, no law existing on our statute books requiring a permit for burial, except by local ordinance in incorporated cities. Another fact was elicited in the replies to this circular, and that was the general desire of the medical profession on this coast to aid and assist the State Board of Health in the promotion of sanitary measures, and in the collection of mortuary statistics. Among the whole number of medical men from whom replies were received, there was but one who refused to correspond with the Board except he was compensated for the trouble; and one who refused upon the ground that the sooner an epidemic destroyed the inhabitants of the town in which he lived the better; and lest the conveyance of the information of an outbreak of epidemic disease might mar that result, he declined to notify the Board if such should occur. With these two exceptions a most cheerful compliance with the desire of the Board for information was promised and expressed. Accordingly, I supplied some hundred and twenty-four gentlemen with postal cards, for deaths and prevailing diseases, from whom I receive reports every month. An attempt was made to obtain a complete list of all the deaths occurring in each county, by applying to the County Recorders, who, according to law, are required to transmit to the Secretary of the State Board of Health a trimonthly statement of all the births, marriages, and deaths registered in their office. It was soon ascertained that while the Recorders were willing to do their duty in the premises, they had no records to transmit, and in some counties not a single death had been recorded for years. The Legislature of 1884 being now in session, your Secretary, in hope of having this gross violation of a plain provision of the law rectified, prepared the following amendment to the law relating to the registry of births, marriages, and deaths, and expected that if he succeeded in having it placed upon the statute book a record of births, marriages, and deaths would be a possibility, and by a little attention might be made a probability or a decided success: AN ACT TO AMEND SECTIONS THREE THOUSAND AND SEVENTY-SEVEN, THREE THOUSAND AND SEVENTY-EIGHT, AND THREE THOUSAND AND EIGHTY-TWO OF AN ACT ENTITLED "AN ACT TO ESTABLISH A POLITICAL CODE," APPROVED MARCH TWELFTH, EIGHTEEN HUNDRED AND SEVENTY-TWO, RELATIVE TO THE "REGISTRY OF BIRTHS, MARRIAGES, AND DEATHS." The People of the State of California, represented in Senate and Assembly, do enact as follows: SECTION 1. Section three thousand and seventy-seven of said Act to establish a Political Code is amended so as to read as follows: 3077. All persons registering marriages, births, or deaths, must, at the close of every month, file with the County Recorder a certified copy of their register. All such certificates must specify, as near as may be ascertained, the name in full, age, occupation, terni of residence in the city or county, birthplace, condition, whether single or married, widow or widower, sex, race, color, last place of residence, and cause of death of all decedents; and of births, the sex and color of the child, and name and nationality of its parents. Any person so registering in accordance with this section, and filing the same with the County Recorder, who shall give a certificate of the same, which shall be sufficient eviden of the duty having been performed, shall, upon presentation of the Recorder's certificate to the Board of Supervisors, be entitled to a compensation of twenty-five cents, to be allowed by the Board of supervisors, and paid out of the General Fund of the county, for each and every birth, marriage, or death so recorded. Nke 2. Bertion three thousand and seventy-eight of said Act to establish a Political Code is amended so as to read as follows: 3078. If, at any birth, no physician or midwife attends, the parents must make the report, and shall be entitled to the same compensation as other persons performing like Service in the manner prescribed in section three thousand and seventy-seven. Nee, B. Hection three thousand and eighty-two of said Act to establish a Political Code is amended so as to read as follows: 3082. Any person, on whom a cury is imposed by this chapter, who fails, neglects, or refuses to perform the same as herein required, is liable to a penalty of fifty dollars for pach and every offense, to be recovered by the District Attorney of the proper county for the use of the General Fund of such county, when notified by the Secretary of the State Hourd of Health that such reports have failed, or were neglected to be returned to his vffice by the County Recorder, or when notified by the County Recorder that such returns have not been filed with him, or when he has reason to believe that any births, marriages, or deaths have not been returned as required by this Act. Mp 4. This Art goes into effect immediately. As will be seen, the amendments consist in Nrat-Having every person registering births, marriages, and deaths file monthly a certified copy of their register. Neconully-In paying for each birth. death, or marriage so recorded the sum of twenty-five cents, which is a small pittance, but still enough to insure performance of the duty. Thirdly-For a failure to perform this duty, it shall devolve upon the Secretary of the State Board of Health to notify the District Attorney to commonde suit against the County Recorder. if he is derelict: and it shall be the duty of the County Recorder to notify the District Attorney to prosecute those whose duty it is to register births, marriages, and deaths, if they fail to do a within the time stipulated. This bill was introduced by Dr. Saxe, Senafor from Santa Clara, through whom it was thought it could be enacted into law, as of the greatest importance to the sanitary interest of the State, and also as one of vital interest to the welfare of the community, as without a perfect record of the births, marriages, and deaths it will be impossible to show the effect of our climate in reference to the causes which abridge or prolong life, or to ascertain the amount of sickness, or mortality, or the parative prevalence in certain localities of endemic disease: as we know that local influences differ much in various places, and certain seaau, some are comparatively healthy and some extremely unhealthy. By a general, full, and accurate registration these and numberless other facts might be definitely ascertained to the great benefit of the community and the lessening of our mortality list. Another point of vast importance is that as our State increases her population, so is the greater necessity of having a record of vital statistics, which for their accuracy may be relied in establishing the right to or the just distribution of property. Cases have happened in this State where persons have failed in securing their lawful title to property because of the impossibility of supplying the missi link in the chain of evidence which accurate registration would infalliBly have supplied. An accurate registration of vital statistics would also wilve many questions regarding the social condition of communities and he progressive change in the habits and practices of peoples. The value the accumulated and systematized facts so obtained would in business lating to life insurance and annuity companies be invaluable, and as a Means of detecting crime a proper registration of every death occurring in he Mate would obviate or unmask many a foul murder, whether at the ands of the abortionist, the quack, or the willful murderer. The almost iversal practice now in vogue in this State of allowing the burial of the dead without let or hindrance, is simply offering an inducement to crime, and should not longer be permitted to exist without correction. It is of paramount importance then to every well ordered Government "to establish such a system of registration of all vital statistics of any importance as shall enable it, both for the present and the future, to know its own life history and the influences that are molding it for better or for worse as the years pass by." With these objects in view the present law was sought to be amended. I regret, however, to say that the bill for this purpose never got beyond its first reading, although favorably reported for passage by the Judiciary Committee, more energy being required to pass any such salutary measure, in which no monetary issue was involved, than the introducer of the bill was able to give it. About this time a bill was introduced by Senator G. Whitney, which read as follows: Whenever, by existing law or by ordinance of any incorporated city, or city and county, or by ordinance or resolution of the Board of Supervisors of any county, a permit is required from a Board of Health, Health Officer, or other authorized officer or person, before depositing burial in any cemetery of any human body, such permit shall not be granted without the production and filing with such Board of Health, Health Officer, or other authorized officer or person, a certificate signed by a physician or a Coroner, or two reputable citizens, setting forth as near as possible the name, age, color, sex, place of birth, occupation, date, locality, and cause of death of the deceased. And no certificate shall be received upon which to grant such permit unless signed by a physician, Coroner, or two reputable citizens, registered as such under his proper signature at the office of such Board of Health, Health Officer, or other authorized officer or person. This bill before its passage I sought to have amended, by inserting a clause requiring that no person or persons shall inter in any city, or city and county, or in any county in this State, any human body, without first having obtained a permit from some authorized officer or person. This amendment likewise met with disaster, as the author of the bill feared that the insertion of this clause would cause some controversy over his measure, which he sought to avoid, as its passage was desired in the particular interest of the City of Oakland, which he represented. Foiled in this endeavor, I thought that I possibly might be able to get a bill passed amending the Code, making it incumbent upon the Board of Supervisors of each county to appoint a Health Officer for every unincorporated city, town, or village, of five hundred or over inhabitants. The Act was as follows: AN ACT TO AMEND SECTION THREE THOUSAND AND SIXTY-TWO OF AN ACT ENTITLED AN ACT TO ESTABLISH A POLITICAL CODE, RELATING TO BOARDS OF HEALTH. SECTION 1. Section three thousand and sixty-two of the Political Code is amended so as to read as follows: 3062. The Board of Supervisors of each county must appoint in each unincorporated city or town of five hundred or more inhabitants, a Health Officer, with all the duties and powers of the Board of Health and Health Officer, as specified in this article and in the two preceding articles. SEC. 2. This Act shall take effect immediately. This bill was also intrusted to Senator Saxe; was referred to the Judiciary Committee, and reported favorably. It reached its first reading, but further than this the introducer of the bill failed to push it. It was now very evident that nothing could be done in the way of amending our laws in regard to the registration of births, marriages, and deaths during the session of the Legislature of 1885. The further attempt was therefore reluctantly abandoned. I thought, however, that although I had failed in getting such ame |