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UNITED STATES STANDARD BIRTH AND DEATH CERTIFICATES.

In order that statistics shall be thoroughly comparable, the primary schedules upon which the data are collected must be uniform. For vital statistics these are the original certificates of birth and of death. A great variety of blanks were used by the various states and cities and in many instances the essential information required for the Federal compilation was either not given or perhaps was given in a form somewhat different from that desired. Despite efforts to secure a greater degree of uniformity, at the time of the Twelfth Census (1900) no two states and but few cities in the country employed precisely the same forms of birth and death certificates.

The committee which formulated the essential principles of the Model Law also drafted a model death certificate, which was adopted at once by the states of Michigan, Indiana, and New York in 1901 and approved by the Bureau of the Census, by which it was at once put into use as the form for transcripts of deaths made in the various state and city offices. It was rapidly accepted by a large number of states and in 1909, after a thorough revision, was adopted by the Section on Vital Statistics of the American Public Health Associa tion at the meeting at Richmond as the Revised United States Standard Certificate of Death, and its use recommended to all American registration offices as a "Rule of Statistical Practice." The form of the blank, which measures 7 by 8 inches, may be seen on page 24 in reduced facsimile.

At the present time (1915) the Standard Certificate of Death has been adopted or approved by nearly all the states, both registration and nonregistration, of the country, representing 92.6 per cent of the population. Exceptions are some of the older registration states— Connecticut, Maine, New Hampshire, and Rhode Island, the District of Columbia, and the nonregistration states of Alabama, New Mexico, and West Virginia. This important object of uniformity in the primary schedule of deaths has thus practically been attained. Provision is made for improvements in the form by means of a regular decennial revision by the Section on Vital Statistics of the American Public Health Association.

An important feature of the standard death certificate consists of the instructions found upon the reverse side. These are designed to promote greater precision in the statement of occupation (and industry) and of cause of death, and may be supplemented by the more detailed directions contained in the Physicians' Pocket Reference to the International List of Causes of Death, published by the Bureau of the Census.

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V. S. No. 98

MARGIN RESERVED FOR BINDING

WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD

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EXACTLY. PHYSICIANS should state

H. B.-Every item of information should be carefully supplied. AGE skucified. Exact statement of OCCUPATION is very CAUSE OF DEATH in plain terms, so that sortineate. PARENTS important. Seo Instructions on back of certificate.

(Informant)

(Address).

15

Filed

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8 OCCUPATION

(a) Trade, profession, or particular kind of work.

(b) General nature of Industry, business, or establishment in which employed (or employer) 9 BIRTHPLACE (State or country)

10 NAME OF FATHER

11 BIRTHPLACE

OF FATHER

(State or country)

12 MAIDEN NAME OF MOTHER

13 BIRTHPLACE

OF MOTHER

(State or country)

14 THE ABOVE IS TRUE TO THE BEST OF MY KNOWLEDGE

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7 AGE

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6 DATE OF BIRTH

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REVISED UNITED STATES STANDARD CERTIFICATE OF DEATH

[Approved by U. 8. Census and American Public Health Association]

Statement of occupation.-Precise statement of occupa tion is very important, so that the relative healthfulness of various pursuits can be known. The question applies to each and every person, irrespective of age. For many occupations a single word or term on the first line will be sufficient, e. g., Farmer or Planter, Physician, Compositor, Architect, Locomotive engineer, Civil engineer, Stationary fireman, etc. But in many cases, especially in industrial employments, it is necessary to know (a) the kind of work and also (b) the nature of the business or industry. and therefore an additional line is provided for the latter statement; it should be used only when needed. As examples: (a) Spinner, (b) Cotton mill; (a) Salesman. (b) Grocery; (a) Foreman, (b) Automobile factory The material worked on may form part of the second statement. Never return "Laborer," "Foreman." "Manager." "Dealer," etc., without more precise specification, as Day laborer, Farm laborer, Laborer-Coal mine, etc. Women at home, who are engaged in the duties of the household only (not paid Housekeepers who receivo a definite salary), may be entered as Housewife, Housework, or At home, and children, not gainfully employed, as At school or At home. Care should be taken to report specifically the occupations of persons engaged in domestic service for wages, as Servant, Cook, Housemaid, etc. If the occupation has been changed or given up on account of the DISEASE CAUSING DEATH, State occupation at beginning of illness. If retired from business, that fact may be indicated thus: Farmer (retired, 6 yrs.). For persons who have no occupation whatever, write None.

Statement of cause of death.-Name, first, the DISEASE CAUSING DEATH (the primary affection with respect to time and causation), using always the same accepted term for the same disease. Examples: Cerebrospinal fever (the only definite synonym is "Epidemic cerebrospinal meningitis"); Diphtheria (avoid use of "Croup"); Typhoid fever

(never report "Typhoid pneumonia"); Lobar pneumonia; Bronchopneumonia ("Pneumonia," unqualified, is indefinite); Tuberculosis of lungs, meninges, peritoneum, etc., Carcinoma, Sarcoma, etc., of (name origin; "Can

cer" is less definite; avoid use of "Tumor" for malignant neoplasms); Measles; Whooping cough; Chronic valvular heart disease; Chronic interstitial nephritis, etc. The contributory (secondary or intercurrent) affection need not be stated unless important. Example: Measles (disease causing death), 29 ds.; Bronchopneumonia (secondary), 10 ds. Never report mere symptoms or terminal conditions, such as "Asthenia," "Anemia" (merely symptomatic), "Atrophy," "Collapse," "Coma," "Convulsions," "Debility" ("Congenital," "Senile," etc.), "Dropsy," "Exhaustion," "Heart failure," "Hemorrhage," "Inanition," "Marasmus," "Old age," "Shock," "Uremia," "Weakness," etc., when a definite disease can be ascertained as the cause. Always qualify all diseases resulting from childbirth or miscarriage, as "PUERPERAL septicemia," "PUERPERAL peritonitis," etc. State cause for which surgical operation was undertaken. For VIOLENT DEATHS State MEANS OF INJURY and qualify as ACCIDENTAL, SUICIDAL, OF HOMICIDAL, or as probably such, if impossible to determine definitely. Examples: Accidental drowning; Struck by railway train-accident; Revolver wound of headhomicide; Poisoned by carbolic acid-probably suicide. The nature of the injury, as fracture of skull, and consequences (e. g., sepsis, tetanus) may be stated under the head of "Contributory." (Recommendations on statement of cause of death approved by Committee on Nomenclature of the American Medical Association.)

NOTE. Individual offices may add to above list of undesirable terms and refuse to accept certificates containing them. Thus the form in use in New York City states: "Certificates will be returned for additional information which give any of the following diseases, without explana tion, as the sole cause of death: Abortion, cellulitis, childbirth, convulsions, hemorrhage, gangrene, gastritis, erysipelas, meningitis, miscarriage, necrosis, peritonitis, phlebitis. pyemla, septicemia, tetanus." But general adoption of the minimura list suggested will work vast improve ment, and its scope can be extended at a later date.

8-834 a

V. &. No. 109

MARGIN RESERVED FOR BINDING certain points may be printed on the back. Size of ceruncate, G¡ x 7 inches.)

WRITE PLAINLY, WITH UNFADING INK-THIS IS A PERMANENT RECORD
N. B.-In case of more than one child at a birth, a SEPARATE RETURN must be made for each, and
the number of each, in order of birth, stated.

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A standard form of birth certificate, with a supplemental blank for porting given names of children not named when the births were gistered, has also come into very general use, states representing 6 per cent of the total population having adopted or approved it. e general extent of uniformity with respect to the use of standard th and death certificates is shown in the cartograms on page 16. The action of the Bureau of the Census in promoting the adoption uniform blanks for registration purposes is a part of its general icy for the standardizing of methods and the securing of compararesults. In this work it has sought the voluntary cooperation of te and city registration officials and has been greatly aided by the mation of the special Section of Vital Statistics of the American blic Health Association, the decisions of which (see Census Bulletin . 108, pp. 37 to 42) are promulgated as "Rules of Statistical Prac" and are generally observed by American registration offices. ey deal with such subjects as the statistical definitions of births, births, and deaths, treatment of premature births, deaths of residents (a question not yet satisfactorily solved), deaths in itutions, methods of testing accuracy of registration, and standard as of tables and blanks, including the standard certificates.

a this connection may be mentioned the agreement of American strars and the active support of the Bureau of the Census in ging about the general adoption and very extensive use of the

International List of Causes of Death, or the International Classification, as it is generally called. The use of a uniform method of classifying causes of death is fundamental in mortality statistics. The Committee on Vital Statistics of the American Public Health Association, which then included the three countries of Canada, Mexico, and the United States, early recommended this reform, and with the cordial approval of registration officials of Argentina, Brazil, Costa Rica, and other countries of South and Central America, proposed the First Decennial Revision of the International Classification, which was accomplished at Paris in 1900. The Bureau of the Census adopted the system for its mortality statistics, beginning with the calendar year 1900, and representatives of the bureau, the American Public Health Association, and the American Medical Association were delegated to attend the Second Decennial Revision called by the French Government and held at Paris in 1909. It may be recalled with pleasure by the members of the present Congress that all the leading countries of the Western Hemisphere North, South, and Central America-united in the adoption of the International Classification of Causes of Death before the date of the first revision in 1900.

THE WORK OF THE FEDERAL AND STATE REGISTRATION SERVICES.

The work of the Federal and state registration services is intimately related. Many state laws have been enacted or amended in accordance with recommendations of the Bureau of the Census, representing the interest of the Federal Government in effective registration, and the value of the transcripts of the original certificates registered under state law largely depends upon the character of the administration of such law by the state and local registration officials. Hence a brief view of the mechanism of registration of births and deaths as conducted under the Model Law and the manner in which the results are utilized by the Census Bureau will be desirable.

1a. BIRTHS: DUTY OF PHYSICIANS AND MIDWIVES.-The physician or midwife who attends a confinement is charged with the duty of filing a complete and correct certificate of birth of the child (separate certificates for twins or other plural births) with the local registrar of the primary registration district in which the birth occurred within a brief period after the birth. The time permitted varies in different states, but is usually 5 days (Michigan, 1915-formerly 10 days; New York, 1914-formerly 3 days, 10 days, 30 days) or 10 days (Model Law, Ohio, Pennsylvania). The certificate must be legibly written in permanent black ink so that it will serve the purpose of a lasting official record. Provision is made for filing a supplemental statement of given name by the parent if the child had not been named at the time the original birth certificate was filed. If there were no attending

physician or midwife, it becomes the duty of the parent, householder, etc., to notify the local registrar, who is charged with the duty of preparing a birth certificate. (Further procedures in birth registration are practically the same as those relating to deaths, so that for the sake of simplicity reference will be made only to the treatment of deaths in the remarks following.)

1b. DEATHS: DUTY OF UNDERTAKERS, INFORMANTS, AND PHYSICIANS.-The sole responsibility for filing a satisfactory certificate of death with the local registrar and obtaining his permit in advance of interment is placed upon the undertaker. It is the duty of the undertaker (or of any person who acts as undertaker in the final disposition of a dead human body) when called upon to take charge of a body to cause to be filled out a proper certificate of death, which shall contain or satisfactorily account for all the items contained upon the form of (standard) death certificate required by law. These itens are of two classes: (1) The personal and statistical particulars and (2) the medical certificate of cause of death. The personal and statistical particulars may be written by the undertaker or preferably by the relative or friend (informant) who actually furnishes the information if literate; the statement must be signed by the informant if able to write. Having obtained the personal particulars in the first column of the standard certificate, duly signed by the informant, the undertaker next presents the certificate to the physician last in attendance, who certifies as to the time of attendance, fact and time of death, and cause of death (and duration) with contributory or secondary cause (and duration), if any. Place of burial and date of burial are entered with the signature and address of the undertaker to make a complete certificate, which he is required to file with the local registrar of the district in which the death occurred in order to obtain a burial or removal permit. This must be done before the body is interred or removed and in all cases within seventy-two hours after death.

Provision is made in various ways for the certificate of cause of death in cases where there is no medical attendant, usually by referring to the health officer or coroner. A valuable provision in the new Illinois law (1915) is that for a temporary certificate to be filed for cases pending" by coroners.

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2. DUTY OF LOCAL REGISTRAR.-Upon the knowledge and interest of the local registrar depend to a very large degree the efficiency of registration and the satisfactory character of the returns. In the average state there should be from 1,000 to 2,000 of these officials (New York, for example, has 1,440), so distributed that there will be no difficulty or hardship with respect to the prompt filing of birth and death certificates. Subregistrars are of service in sparsely settled rural districts. Upon the proper distribution of the local registrars

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