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22
Death Registration and Vital Statistics.
It may almost be said that the foundation of efficient public health
work rests upon the accuracy of death registration. To secure that
accuracy we are dependent upon the general practitioner, who, as a rule,
expends a great deal of care upon the certificate of death, which is the
initial step in the process of registration, in spite of the fact that he
receives no payment for the performance of what is a most important
duty on behalf of the State. Indeed, it is common knowledge among
medical officers of health that a death certificate is often much more
carefully filled in than a certificate notifying a case of infectious disease,
although for the latter he receives a statutory fee. A study of the
earliest records of death registration in this country is of considerable
interest, not to say wonderment. The cause of death not infrequently
found is dropsy, cough, tumour, atrophy and various other symptoms,
and some years ago one very conscientious practitioner gave the
cause of death as primary, syphilis, secondary, the act of God. A great
deal of progress has been made in the accuracy of death registration
since those early days, but there is still much room for improvement,
and medical officers of health at any rate will welcome reforms in the
administration of the national statistics of life and death. The first of
these reforms might be with advantage the institution of a confidential
system of death certification under which system the medical practitioner
might transmit the death certificate to the registrar direct in a sealed
envelope, and such certificate should be looked upon as a confidential
document, subject to the discretion of the Registrar-General. To quote
the system of death registration as carried out in Switzerland:-The
practitioner is furnished by the civil authorities with a form, the upper
part of which is detachable, and contains only the name of the deceased
and a series number. This part is torn off and placed in a distinctive
envelope by the practitioner in attendance, and must be delivered to the
local registrar within forty-eight hours. The rest of the serially
numbered form contains spaces for the details of the cause of death, with
a space wherein the practitioner can note the sanitary and social
conditions of the dwelling of the deceased. This part is placed in a
separate coloured envelope and sent with the other to the local registrar,
who, however, forwards this second one unopened to the Central Health
Statistical Bureau. The practitioner is remunerated for his certification.
Sir Victor Horsley, who has devoted much thought to the question
of vital statistics generally, urges that the office of Registrar-General be
completely reconstituted as a sub-office of a ministry of public health.