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much of the information supplied, and the vague and general indefinite
character of the language in which some of the certificates are couched.
This seems to be unavoidable under the present system, and the
occurrence of such a condition of things has been a subject of much
discussion. The causes are :—
(a) The delivery of the certificate to the immediate relatives
or friends of the deceased.
(b) The registration of death by laymen.
The delivery of the certificate to the relatives of the deceased must
in itself create a difficulty which the medical attendant naturally desires
to avoid, and one can hardly blame him if he endeavours to avoid
putting into writing the fact that the deceased died of alcoholism or
syphilis and then handing the certificate to the deceased's friends, well
knowing that it would doubtless cause them great pain and not unlikely
arouse considerable resentment to himself personally as casting a slur
upon the deceased. The certification of other diseases, such as cancer
or consumption, is sometimes not free from great difficulty for the
same reason. The Registrar of Deaths is not infrequently a layman,
and although it must be admitted that the General Register Office
have drawn up clear rules to guide them, it stands to reason that by
want of medical training such an officer is not always in a position
to decide whether the cause of death is as clearly set out as the
officer responsible for the compilation of statistics would desire. The
remedy for this could be found by extending the system of notification
to causes of death.
It seems to me to be a perfectly logical corollary to our present
system by which births, infectious diseases— including tuberculosis—
are notified. The latter notification takes the form of confidential
certificates to the Medical Officer of Health, and there seems to be no
reason why similar confidential communications to the Medical Officer
of Health should not be enacted and paid for as any other notification
certificate is paid for, and that the Medical Officer of Health should
be empowered to require indefinite certificates to be so amended as
clearly to establish the cause of death. Such a scheme should cause
no dislocation to the present system ; the registration of the fact of
death would still be left with the Registrar, who would register the
death only 011 an order from the Medical Officer of Health or Coroner.