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tion, it would follow that the only "uncertified" deaths were
those in which the return states there was " no medical attendant,"
viz., 9, or less than 5 per 1000. But including all cases the
percentage of uncertified deaths to total deaths was a trifle under
1.5, a proportion not widely differing from the average in all
London, but much lower than in some parts of the country, where
it ranges as high as 10 per cent. Now, as certificates of death are
rarely refused by medical men who have been in attendance, and
as it is scarcely probable that so large a proportion of cases of
fatal illness receive no medical attendance, it is reasonable to
conclude that a large number of persons are attended in their last
illness by unqualified practitioners who certify. The cause of
death may be given upon such certificate, but the death is nevertheless
returned as " not certified." With a view to put some check
upon unqualified practice, and to enable the public to discriminate
between qualified and unqualified medical men, I called the
attention of the Registrar-General to the desirability of a slight
alteration in the form of death certificate, consisting in the
addition of the words " Duly Registered Medical Practitioner "
under the place for signature. As unqualified men use these
certificate forms (which are intended solely for the use of
qualified practitioners), it is not to be wondered at if many people
are misled into the belief that they are duly qualified. But if
the proposed addition were made, an unqualified practitioner would
be placed in a dilemma, for either he would erase the words
proposed to be added, and so reveal his true status; or by leaving
them in he would subject himself to the penal 39th clause of the
Medical Act. The Registrar-General was good enough to approve
the suggestion, which will, I hope, be carried into effect before
long. At present the giving of certificates of death by medical
men is a voluntary act, almost universally adopted by the profession,
on public and scientific grounds. But quite recently a
Bill has passed the House of Lords, and is likely to become law
during the present Session,* one object of which is to compel
medical men to give a certificate, showing the apparent cause of
death of all persons attended by them in their last illness. Such
a practice will no doubt be useful, but the manner in which it is
proposed to be carried out, is a somewhat ungracious return for
the gratuitous and voluntary services of the profession during
many years.
Table A (appendix) contains the causes of death, arranged
in quarterly groups. From these it appears that the winter
quarters were not su fatal as usual, the deaths being fewer in
excess over those in the summer quarters than we ordinarily
anticipate. This was due to the exceptionally mild weather,
particularly in the fourth quarter of the year, during which actually
* The Bill was subsequently withdrawn, owing to the impossibility of getting it
through the lower House on account of the lateness of the session.