There has been a considerable prevalence of diphtheria for the year; 543 cases having been reported from 138 towns. Unfortunately, this disease is often difficult of recognition, especially in the early stages; and the seeds of an epidemic may be widely disseminated before danger is known to exist. But besides this there is still too much carelessness in known cases of the disease. The prohibition of public funerals for its victims is not thoroughly enforced, there is still need of public education in its regard. Here, at least, ignorance is liable to prove something very different from bliss.

There does not seem to have been a great prevalence of scarlet fever during the year-there having been reported to us 236 cases from 82 towns. In this disease, as in measles, while cases occur every year, its epidemic prevalence is more or less periodical, as new crops of children grow up who have not already experienced an attack. The scarlet fever poison is so tenacious of life, and clings with such tenacity to articles of clothing, etc., that have become its habitat, that there are probably at all times, in nearly all communities, abundance of germs ready to develop whenever they can find an unexhausted soil. This is shown by the frequent appearance of sporadic cases, whose origin cannot be traced, while it is not to be doubted that each received its poison, directly or indirectly, from a preceding case of the same disease.

The occurrence of cases of typhoid fever is more of an opprobrium to a state or community than that of the diseases already mentioned. While diphtheria and scarlet fever are eminently contagious from person to person, typhoid fever probably never exhibits this quality, but is purely an infectious disease, the poison developing outside of the body from which it is excreted mainly in the intestinal discharges, and being received into a new host through the medium of the food and drink, especially the latter. We call its existence opprobrious, because the means of destroying this poison, and thereby preventing its development and the infection of others, is so well understood and so easily carried out.

To what extent the water supplies of our State may be infected by the typhoid fever germ, it is impossible to tell. Chemical analysis will give little light upon the subject; for if a stream or river has received the dejections from a case of typhoid, it cannot be considered, at any lower point, a safe source of water supply. However pure the water may be chemically, there is no certainty that it does not contain the specific cause of this disease.

Two hundred three towns have reported 566 cases of typhoid fever during the year. It will be seen that it was much more generally prevalent over the State than either of the diseases previously mentioned. The most extensive outbreak was in Bangor and Brewer, both taking their water supply from the Penobscot river. And first it is worthy of note that in the towns upon the Penobscot above Bangor, there were reported 53 cases of typhoid fever for the year against 15 in 1888, or three and one-half times as many in 1889. Almost the same ratio is preserved in Bangor-which had 51 cases in 1888 and 160 (with 40 deaths) in 1889-and in Brewer-with 8 cases in 1888 and 32 in 1889. It seems apparent that there was some common cause for the great prevalence of typhoid along the Penobscot. These figures furnish food for thought, but do not present the data upon which to build final conclusions. At the top of page 123 of this report, will be found the opinion of the Secretary of the local board of Orrington in regard to the cause of four of their

cases.

Any statistics that we may be able to collect in regard to the health of the State, under present conditions, and any deductions we may draw from them, are of very slight value. We lack a substratum of positive facts on which to found scientific conclusions that are something beyond mere theories, in regard to our sanitary condition. With a view to this end, we purpose to perform one of the duties incumbent upon us by virtue of the act establishing this Board, by suggesting to the legislature the enactment of a law for

THE REGISTRATION OF VITAL STATISTICS.

Any proposal to establish and maintain, by law, a system of collecting and utilizing vital statistics, requires that claims for the need of such system must rest upon some evidence of material benefit to the community at large in its well-being and varying interests. It is pertinent to the subject under consideration to define the object of vital statistics. Nothing can do this more clearly and concisely, than the words of Dr. John S. Billings, United States army, a recognized authority as a statistician, which affirm that "the object of vital statistics is to classify and arrange the facts relating to the quantity and character of human life under different circumstances, for the purpose of determining the effect upon it of each of these circumstances taken singly or of two or more acting together."

The Secretary and members of this Board are in almost daily receipt of communications from various official and private sources, both within and without our own State, seeking the information which such a system would afford; but with annoyance and mortification it is necessary to explain that the information cannot be furnished; and there is left the unpleasant reflection that Maine, with one of the best sanitary codes given to any State Board of Health to administer, is yet almost alone in failing to supplement the value and usefulness of such sanitary laws by an efficient system of registration of vital statistics. Apart from the general advantage of such system and the question of State pride, there is the fact, that the demand for its establishment is wide spread and constantly reiterated by a large and intelligent class of our citizens, for all kinds of purposes. Inquiries for this class of information come from professional men, manufacturers, corporations, libraries and literary societies, the various departments of municipal administrations and from officials of all kinds. Inability on the part of the Board to comply with these requests becomes a serious impediment to the accomplishment of what, it is convinced, is not the least important of its functions, and must be a serious reflection upon its efficiency in comparison with the state boards of other states.

In the January number of the Sanitary Inspector for 1889, some reasons for such legislative action as would establish a system of registration within our State were stated as follows:

"1st. It forms the basis of all sanitary work. In England their improved system of registration of births, marriages and deaths was begun in 1837, and since then it has served as a guide to indicate the places where there has been the greatest need of taking measures to improve the public health. If, in a given town it is found that the death rate from typhoid fever, consumption, diarrhoeal diseases of children, or other diseases is higher than it ought to be, the local government board institutes an inquiry into the causes of the prevailing high rate of mortality. As the result of these inquiries local boards have been led in many of the towns to take measures which have reduced the death rate in a marked degree. Massachusetts has had its system of registration of vital statistics for many years and finds its records of the greatest value in determining general and local rates of mortality, or whether a given disease is less or more prevalent than formerly.

2nd. To prevent the concealment of crime. The indispensable provision of modern registration laws which requires a certificate from friends or the attending physician of the cause of death, and a burial permit, is an assurance of safety in this direction.

3d. To ensure the means of proof of personal identity and of right to property. One senator in our legislature of 1887 told the writer that it cost him fifty dollars to look up the proof of the date The applicants for pensions in Massachusetts are furnished by the Commonwealth with the means of substantiating their just claims which our State does not accord its citizens.

4th. To ensure the means of the proof of age with reference to the prevention of election and other frauds.

5th. To assist the State in arriving at correct conclusions with regard to measures of internal economy, taxation, employment and

commerce.

6th. To furnish a record which is always available in tracing the genealogy of persons or families.

Maine stands alone among the New England States in having no system of registration of vital statistics, and consequently is like a ship at sea without a compass as regards her knowledge of where she stands in the health scale. We think we have good reasons for surmising that there is no State in the Union with a lower general death rate. If this is true, the proof of the fact would be worth something. If, on the contrary, the local death rates in some of our towns were making the general death rate higher than it ought to be, the knowledge of that fact would aid in inducing them to improve their condition."

The value of a Bureau of Vital Statistics to our State Genealogical and Historical Societies in the prosecution of work, the results of which continually reflect credit upon themselves and honor upon the State, is almost self evident.

Careful inquiry among all the classes of people likely to be affected has elicited the information that although differences of opinion may exist as to the most feasible methods of securing such statistics, there is great unanimity of opinion as to the need and advantage of the information to be derived after the statistics are secured and utiliz d.

The city clerk of the largest municipality in the State, himself an accurate, careful and painstaking observer and member of the local health board, expresses himself substantially to the effect that:

The collection of vital statistics as it appears from the standpoint of a municipal officer and secretary of a local board of health, is an entirely practical one. "The constant inquiries at my office for the date of the birth of some individual, either to show his right to be registered as a voter, or to become a member of fire or police departments; or to establish a claim in a pension case, or in a claim to succession of property, shows the need of a registry even for those purposes alone. But outside of those considerations, are those of the growth of a community and the relative increase of population from this increment. But the present method of collecting these statistics by yearly canvass of the assessors as in Portland is entirely inadequate.

"Families are constantly changing their location and intervals of a year disclose many removals from the city of families, the births in which fail to be taken. Then our assistant assessors are too much occupied in the other part of their inquiries, as to taxable property, number of polls, etc. In this city the number of births reported by the assessors averaged about 400, but since my employment of a special canvasser I have obtained, on an average, about 800 names yearly. If a canvass is to be made for births, it should be made, at least, semi-yearly; but in my opinion the law should require some more accurate method to secure the return, weekly or monthly of births, perhaps through the coöperation of those in attendance. There is very little dependence to be made upon the birthdays as at present reported, and I fail largely to get any births of children who have died under the age of one year. In marriages I am more fortunate; for the most part both magistrates and ministers return the marriages which they solemnize, within the month; but there is a class of marriages which are seldom returned—those which are contracted by parties who leave the State for that purpose, mostly to escape the absurd delay of five days, in the issuing of a marriage license, required by our laws. There is a penalty of ten dollars attached to this violation of the law, in omission to return the marriage, but I have never known a prosecution to be made.

"A return of the cause of death should always be made by the attending physician before a burial permit is granted. I think that I get a return of every death in the city, but it is only by the most careful watchfulness that the uudertakers who return the deaths do not, now and then, drop one out. When the return was made by the assessors as required by law, it was simply worthless; the returns