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111
been duly attended in their last illness by a registered practitioner.
I am of opinion that when death ensues in the case of
persons attended by unregistered practitioners an inquiry should
be made, for the fear of inquisition would tend to limit illicit
practice, which, as a very general rule, must be to the public
detriment.
The subject of uncertified deaths has engaged the attention
of the Society of Medical Officers of Health on more than one
occasion, and some years ago this Society passed the following
resolution, viz.:—
"That all cases of uncertified deaths should be reported by the local
registrar of births and deaths to the Coroner, who should, when
there is no prima facie ground for holding an inquest, direct such
cases to be investigated by a registered medical practitioner."
It had been suggested that the duty of making the proposed
investigation should devolve on the Medical Officer of Health as
a part of his ordinary work, but the Society did not approve
this view, the adoption of which would impose on the Medical
Officer an onerous and responsible duty, seeing that "uncertified
"deaths include all "inquest cases" as well as those
deaths described as "not certified."
Of all the unsatisfactory arrangements connected with uncertified
deaths, it was felt that the least defensible is that which
makes the Coroner's Officer de facto judge, in a doubtful
case, whether an inquest should be held, and the Society, at
my instance, adopted the following resolution bearing on the
subject:—
"That the present system of investigation of deaths referred to a
Coroner, viz., by an officer having no special qualifications for the
discharge of the duty, is unsatisfactory."
It follows as a corollary to this proposition that the firstinstance
inquiry should be made by an expert,