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17
reasons for the necessity of reform are (1) The unsatisfactory state
of the law as it affects the registration of uncertified deaths; (2) The
unsatisfactory state of the present method of certification.
Referring to the former, it appears that in some districts of
London the average percentage of uncertified deaths is as high as
3.5 or 4 per cent. The average for London as a whole for each year
from 1896 to 1900 has been 0.6 per cent. In our opinion "in no case
should a death be registered without the production of a certificate
signed either by a registered medical practitioner, or by a Coroner,
after satisfactory inquiries by the medical investigator or after
inquest." Taking England and Wales as a whole, it appears from
a Special Report of the Registrar-General in 1897 that in 4 percent,
of the total inquests no definite cause of death was entered in the
Coroner's certificate. Further, as matters now stand, when there
is no medical certificate of the cause of death, the Registrar makes
inquiries of the relatives of the deceased person, and, if he is satisfied
with their explanation of the cause of death, enters it according to
their statements, adding that the death is "not medically certified."
As the Registrar is not usually a medical man, and therefore cannot
possess the knowledge required for efficient judgment, it is clear
that the system is open to abuse.
Referring to the second point, namely, the unsatisfactory state
of the present method of certification, it may be remarked that it
is of vital importance to the public health that death certification
should be an exact record of the cause of death. Under the present
arrangements, securing this desideratum is not facilitated for
various reasons into which it is impossible to enter fully here.
Hence the Vestry held that medical certificates should be forwarded
direct to the Registrar, and not delivered to the relatives of the
deceased; that the fact of death should be certified by the medical
man; and, thirdly, that qualified medical investigators should
be appointed to inquire into all uncertified deaths, make
post-mortem examinations when required, and report to the
Coroner.
B