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rules, but unfortunately there is laxity in the completion of the
certificates and the various causes are entered in the wrong order,
with resulting misleading allocation. Then so much depends on
the whim of the certifying practitioner. An aged person dies
after being bedridden for a short time; there is some hypostatic
congestion of the lungs and the heart has the usual degenerative
changes. One doctor would be content with "senility" as a
cause of death, another will blame the "bronchitis" as the cause,
while a third will attribute it to the "myocardial degeneration,"
and, according to the words used, the death would be classified
to groups 32, 20 or 16 of the short list of causes of death. Another
reason that deductions will be fallacious is that such vastly different
conditions are grouped under the one heading. The significance
of a death from heart disease varies greatly according to the age
of the patient. Excluding those in the early days of life which
are alleged congenital abnormalities of the heart, heart disease
in early life is mostly due to acute rheumatism. Later on are
manifest the effects of a specific disease, viz., syphilis, and certain
secondary changes consequent on degenerative changes in the
arterial system, and lastly in the aged there is the myocardial
degeneration, part and parcel of the wearing out of the body.
These are the main aetiological factors—a disease associated
probably in some way with nutrition and surroundings and calling
for action by Local Authorities for early diagnosis and treatment ;
a disease preventable and curable; changes taking place largely
through faulty personal hygiene, apart from those causes due to
hereditary influence; and what might almost be termed physiological
wearing out. Another instance is group 15, referred to as cerebral
haemorrhage, apoplexy, etc.—but including conditions which
cause similar signs but are of so very different origin as cerebral
haemorrhage, cerebral embolism, cerebral thrombosis and cerebral
softening.
For tabulated list of causes of death, see end.