DEATHS “NOT CERTIFIED.”
The number of deaths “not certified,” that is, of persons who were attended in their last illness by non-qualified practitioners—generally professing to hold unregisterable foreign degrees, often obtained by purchase, in absentia, was 33. The numbers in the two previous years were 30 and 21. In my annual report for 1872 I mentioned that I had some time previously called the attention of the Registrar-General to the desirability of an addition to the form of certificate of death provided for the use of medical men, whereby it would be made clear whether the subscriber was or was not duly qualified, i.e., registered. The Registrar-General approved the suggestion, and his attention having, at my instance, been again directed to the subject by the Society of Medical Officers of Health last year, he has, in the new form of certificate brought into use at the commencement of the current year, added a line immediately below the place for signature on which the subscriber is required to enter his “registered qualification.” It is not probable that any unregistered practitioner would venture to use the certificate, should he inadvertently become possessed of it, as might happen through the almost unavoidable ignorance in which the sub-district registrars are left, from the want of an official list of registered practitioners. Not long ago I ventured to direct the attention of the Registrar-General and the Registrar to the General Medical Council to the importance of these officers being supplied with the Medical Register, issued annually by the Council; but these gentlemen, while appreciating the suggestion, were unable to hold out any hope that it would or could be carried into effect, inasmuch as the Government are unwilling to incur the necessary expense, and as the Register is too inaccurate to be implicitly relied on in doubtful cases. But now that medical men are required, under a penalty for neglect, to give certificates of the cause of death, some means ought to be found of restricting the use of them in any form, to registered practitioners. The sub-district Registrars do not knowingly accept a certificate from a non-qualified practitioner, but in some cases where a medical title is used by a stranger, “invalid” certificates obtain currency. In all other irregular cases the registrar returns the death as “not certified,” making use, nevertheless, of the information as to the cause of death contained in the certificate! If it were made an offence at law for any unregistered practitioner to give a certificate of death, the difficulty would probably be met. At present I do not know what course would be best to adopt, unless to hold inquests on the bodies of all persons who die under the treatment of non-qualified practitioners. This course was adopted in some cases in the northern part of the parish last year, and it led, in at least one instance, to the unsatisfactory, not to say discreditable result, of the Philadelphian M.D. who attended a sick child, calling in a registered practitioner at the last gasp, so that he might certify to the cause of death. An inquest, however, was held on the body, and the death was found to be due to quite a different disease to that entered in the certificate. I may add that the Board of Guardians, laudably anxious to put a stop to the scandal, took proceedings at the Hammersmith Police Court against an unregistered practitioner for signing a vaccination certificate, and thus “falsely pretending to be registered.” The case was dismissed, however, and no further steps have been taken in the matter. But something should be done for the protection of the poor, who are almost exclusively the patients of the unqualified man, being unable to realize the distinction; and action is rendered the more necessary by the fact that children—infants of tender age—are most commonly the victims of the practice. Thus, of the 33 cases of uncertified deaths referred to, 25 were children, of whom 18 were less than one year old. The causes of death returned included such diseases as typhus fever, scarlet fever, measles, diarrhœa, inflammation of the lungs and of the brain, and scrofulous maladies.