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89
due to Poison, Violence, or Criminal Neglect.” The
reference appears, therefore, to have been limited to
the legal aspect only, but the recommendations, if
carried out, would in all probability have a considerable
effect on the accuracy of certification from a
medical and statistical point of view. In dealing
with the compiling of vital statistics, much difficulty
has been experienced, from the fact that on some
certificates the causes of death are stated in such an
order that it is impossible to say what was the
“efficient” cause, i.e., the cause which immediately
led to death; in others they are in an order which
a knowledge of pathology enables one to say is
wrong; and in other certificates the most important
cause is omitted. As an example of the last may
be quoted a certificate which stated that the death
was due to “post-pharyngeal abscess,” in which
case there was reason to believe that the death was
due to diphtheria. The truth of that belief was
proved after correspondence. Another source of
error lies in the practice which some medical men
make of not stating that death was due to causes to
which disgrace is attached, such as intemperance,
venereal diseases, &c., but of stating the sequelae
only. If then all these inaccuracies are liable to,
and do occur in the certificates, what is the reliance
to be placed on the statistics compiled from them?
or on the deductions drawn from the statistics?
If recommendations 4 and 5 were carried out,