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95
Convulsions; Mesenteric disease; and Wasting. The deceased
were children, aged one day; twenty-eight days; four months;
and two years respectively.
The attention of the Metropolitan Sanitary Authorities
was called, in 1887, to the subject of uncertified deaths, by the
Vestry of St. James, "Westminster, that body being of opinion
that "no death should be registered unless the cause thereof is
certified either by a qualified medical practitioner, or by the
Medical Officer of Health for the District, or by the Coroner
upon inquisition." If it were meant that the Medical Officer of
Health should, as a part of his duty in that capacity, inquire
into and, if practicable, certify the cause of death, I for one
should respectfully prefer not to come under any such obligation.
It was stated that "at present three to four per cent, of
the total deaths are not certified at all." The proportion of uncertified
deaths has steadily declined from 4.7 in 1879 to 2.9 in
1889. The percentage varies within wide limits. In 1889 it
was 1.1 per cent, in London; 0.16 in Kensington; ranging
upwards to nearly 7.0 in Wales, where probably certification is
often impracticable, because, by reason of the inaccessibility of the
place of death, or remoteness from a doctor's residence, medical
attendance cannot be obtained. In such cases, which probably
constitute a large proportion of the total number of uncertified
deaths, the suggested duty would be altogether impossible of
performance by the Medical Officer of Health. It would take
up too much space to deal exhaustively with the subject, but
I may further remark, speaking now from my experience in
this Parish, that, practically, all of the uncertified deaths are
referred to the Coroner, and registration takes place only after
the Coroner's decision that inquisition is unnecessary. The
preliminary inquiry by the Coroner's officer is not satisfactory;
and it is probable that in many cases in which inquisition is
now made, inquiry by an expert—e.g., a Medical Officer of
Health—would save the time of Coroner and jury, and some
expense to the rates, if his decision that inquest was