True, the facts I have thus briefly brought under notice may be explained—and they certainly need explanation; for as they baldly appear in the returns of mortality they would seem to indicate an indifference to life which is not only shocking, but may be in some degree the cause of that terrible infantile mortality which all thinking persons deplore. I will only add that it is notorious that medical men are constantly called in to see children sick beyond the hope of recovery, in order that no fuss may arise after death—the death certificate being all-sufficient. No doubt in many cases, where the diagnosis is quite clear, the certificate is given, although the practitioner may be conscious of the neglect of the parents in applying for assistance when “too late;” and, I dare say, that in some at least of the cases which come before the Coroner the inquest has been brought about by the judicious refusal of medical men to give certificates under such circumstances. I venture to think, however, that a certificate should not be given in any such case, and that not only should an inquest be held, but that the mere fact of the responsible person in charge of the infant having failed to obtain that medical advice and assistance which the poor may have for the asking, should be regarded as establishing a prima facie charge of neglect, for which he or she should appear and answer at another tribunal in the absence of exculpatory evidence.
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.
METEOROLOGY.
The mean temperature of the air at Greenwich during the registration year was 49.4° F., the average of 35 years being 49.3°. The averages of the four quarters were 41.6°, 53.5°, 60.6°, and 41.8°. The hottest week was that which ended on the 11th of July, mean temperature 66.8°; and the coldest week was that ended on the 2nd of January, 1875, mean temperature 28.8°. The highest reading of the thermometer was on the 9th of July, 92.0°, and the lowest on the first day of the current year 18.2°. The dryness of the atmosphere (i.e., the difference between the dew point temperature and air temperature) was 5.6 (average in 30 years 5.5.) The rainfall was 24.1 inches.
VACCINATION.
I am indebted to Mr. Shattock, the energetic Vaccination Officer, for the interesting particulars contained in Table IX, (Appendix), on the important subject of Vaccination. From it we learn that during the year 4,357 births were returned to him by the sub-district registrars, and that the successful vaccinations numbered 3,588. Twenty-three infants were certified as insusceptible of successful vaccination; in 74 cases the postponement of vaccination was sanctioned by medical certificate on account of the state of health, &c.; 27 children were removed to other districts, the vaccination officer of each district being duly apprized of such removal; 9 cases were still under proceedings (at the date of the report), by summons or otherwise; while 464 children died unvaccinated. The cases unaccounted for—either through the removal of the children to places unknown, or which cannot be reached, and cases not having been found—amounted in all to only 172, or a fraction below 4 per cent. of the total births—a result that must be considered very satisfactory, highly creditable to the vaccination officer, and, I would add, to the Board of Guardians; while I can hardly believe it has been surpassed in any other district of the Metropolis.
The Guardians have lately (August, 1875) prosecuted successfully a non-qualified practitioner for signing Vaccination Certificates. A penalty of Ten pounds was inflicted; the offence with which the defendant was charged being that of “falsely pretending to be registered” under the Medical Act, none but registered practitioners being qualified to sign Vaccination Certificates.
SANITARY WORK.
Table 6 (Appendix) contains a summary of the principal items of sanitary work accomplished during the Vestry year ended 25th March, 1875. The number of complaints received and entered in the complaint book was 1,482; viz., 820 in the North, and 662 in the South Sanitary District. Seven thousand two hundred and eighty-six houses were inspected—viz., 3,229 in the North, and 4,057 in the South district, besides mews, of which there are about 140 in the parish. The number of sanitary notices served for the amendment of houses, premises, &c., was 1,438, viz., 756 in the North and 682 in the South: 1,477 houses and premises were cleansed, &c.: 68 were disinfected after infectious diseases. The drains of 442 houses were cleansed and repaired; and trapped and ventilated in 341 other cases: 463 privies and water-closets were repaired and supplied with water; and 6 new water-closets were provided: 31 new dust-bins were erected, and 41 old ones covered, repaired, &c.: 8 water-cisterns were constructed, and 75 cleansed, covered and repaired—a very inadequate number it would seem, so far as regards cleansing, only that in a great number of cases this operation—so commonly neglected—was directed and carried out without formal notice: 115 accumulations of dung, stagnant water, animal and other refuse were removed, and in 58 cases animals improperly kept, or kept in unfit localities (swine especially), were removed.