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present conditions it is not possible to get even approximately
correct death-returns. Under the best conditions it is not possible
to get exact returns. It has been computed that even with full
post-mortem examination, the cause of death can be accurately
given in about 85 to 90 per cent, of the cases, but that under
present conditions the exact cause of death is not given in more
than about one-half of the deaths. There are many reasons for
this want of accuracy, but I need only point out one of them. I
refer to the suspicion with which the. doctors look upon the
present method of death certification.
The Act of 1926 made it possible to obtain a death certificate
slightly less inaccurate and evasive than was obtainable before
its passage, and that is all that can be said about it. In practice
it has made hardly any difference, apart from the ordering of a
post-mortem examination without an inquest and the registration
of still-births. The alteration of the law so that the certificate
is sent direct to the registrar instead of being given to the
relatives of the deceased looked on the surface as though it would
allow the practitioner to state what he knew to be true without
the risk of offence to the bereaved; in practice it does nothing of
the kind. The signing of the death certificate and sending in a
separate envelope to the local registrar and the filling up of the
separate slip for relatives to be handed to the registrar is the
greatest farce which can be imagined. Although it keeps the
original certificate from the relatives, they can obtain copies and
for many purposes must obtain a copy, and they can compel the
registrar to furnish them with a copy. It is obvious that in spite
of the elaborate precautions the death certificate is by no means
private. The copies are used mainly for insurance purposes, and
solely in the interest of the insurance companies. There are many
reasons why insurance companies should not obtain a copy of the
death certificate. It should suffice that companies are informed
that a certain person had died on a certain date. If any further
information be required, this should be obtained from the doctor
in attendance. If we want reliable death-returns, the first essential
should be an assurance to the doctor that the death certificate
is a strictly confidential one. An opportunity offered itself when
the Local Government Act, 1929 abolished the Boards of
Guardians to bring about an effective reform, but it was missed
and the vital statistics will still continue in the same unsatisfactory
condition. The death certificate should be treated in the same
confidential manner as a tuberculosis notification, and under the
present condition this cannot be done.
Deaths in Public Institutions.
Of the total number of deaths, 329 occurred in Public
Institutions and 14 in Nursing Homes. It has been pointed out
in previous reports that there is an increasing tendency to remove
the patient to an institution whenever an illness occurs in a