At the special meeting of the Metropolitan Counties Branch of the British Medical Association, held last night at the Museum of Practical Geology, Jermyn Street, the subject of an improvement in the present procedure in death-certification and registration came up for discussion. Sir W. Priestley, M.P., president, took the chair.
Sir Henry Thompson moved the following resolution:—“Considering that a Select Committee of the House of Commons has in 1893 made an extended inquiry into the subject of death-certification and registration on the plan now followed in this country, and has reported that it manifestly fails to accomplish the purpose for which it was designed, this meeting is of opinion that Her Majesty’s Government should be respectfully memorialised to bring in a bill as soon as possible to give effect to an improved procedure in general accordance with the suggestions offered in the Committee’s report.” He said that, during the last twenty years or more, circumstances had not unfrequently occurred to attract public attention to the existence of grave defects in the system of death-certification adopted in this country, whether regarded as a safeguard against criminal attempts on life, or as a means of forming trustworthy records of disease for scientific purposes. From the Registrar-General’s report for England and Wales for the year 1892, it was shown that in fifteen thousand cases of death no inquiry had been made as to its cause, and that no certificate had been obtained from any source—a number amounting to nearly three per cent. on the total returned for the year. On the same authority it appeared that in twenty-five thousand more, or four and a half per cent., the cases “were so inadequately certified as not to be classifiable,” making together a class of seven and a half per cent. in which no evidence of any value as to the cause of death existed. After what had already been done in the matter, all that appeared to be necessary at present seemed to him to be that they should forward a memorial to the Home Secretary, with a request that he would consider the important work which had been already done by the Select Committee, and, if he saw fit, take steps to embody their recommendations in an Act of Parliament, for the purpose of giving the country a greatly improved procedure in exchange for that at present employed. Dr. Isambard Owen, in the absence of Dr. Farquharson, M.P., seconded the resolution, and asserted that the State now winked at an exceedingly loose system of death-certification, since under the present procedure it was possible for a medical man to give a death-certificate on a patient whom he might not have seen for an interval of several weeks, and perhaps months. The resolution was supported by Dr. Nelson Hardy, Dr. Alderson, Dr. Hugh Woods, Dr. Sykes, and others, and was unanimously adopted.
A well-known physician in large practice, writing to the author from a Midland town, October 10, 1895, says:—“Medical men, attending patients seriously ill, accept the statement of the friends that the patient died in the night, and give a certificate at once, without any inspection of the body. This is the regular practice.”
INTERMENTS WITHOUT CERTIFICATES.
In Ireland matters are no better, and clergymen and others, with whom the author has been in correspondence, say they are much worse, and the danger of premature burial is, if possible, greater than it is in England. The Rev. W. Walters, writing from Ventry Parsonage, Dingle, Ireland, September 16, 1895, says:—“In Ireland interment usually takes place the day after decease, and no certificate as to the cause of death is ever required. There is no safeguard whatever, and amongst the ignorant poor I fear premature burial is terribly frequent.”
A prominent medical officer of health, having charge of a populous metropolitan parish, wrote to the author, October 8, 1895, in reply to inquiries:—“When a doctor attends a patient in an illness, and the patient dies, he usually accepts the word of the friends as to the facts of death, and if they are poor, or in moderate circumstances, he grants the certificate in the ordinary way. If he is satisfied as to the cause of death he dare not refuse the certificate. You will see by the form I send you that he need not actually satisfy himself that the patient is dead; if he is not satisfied he writes, ‘As I am informed,’ in the space left for the words.... On one occasion I was directed by a lady to drive a very long hat-pin through her heart after death, to ensure that she should not be buried alive. I have given so little attention to the matter that I cannot say if the Continental practice in this respect is better than ours. Signs of decomposition are, I believe, the only ones of any real value. The form of certificate of death referred to is marked, ‘Printed by authority of the Registrar-General,’ and a request marked ‘N.B.’ is to read the suggestions on page ii. In this other form, which is entitled ‘Suggestions to medical practitioners respecting certificates of the cause of death,’ elaborate instructions are set forth under ten separate clauses, with examples showing in what way the death-certificates are to be filled up, but not one word of instruction or caution as to the fact of death—whether it be real or apparent—the absolute signs of death, or the steps to be taken in doubtful cases, or in the various forms of suspended animation, such as coma, trance, catalepsy, etc.”
The Times, January 19, 1878, p. 9, foot of column 6, reports a singular case in point:—
“Premature.—A poor woman lay very ill in her scantily-furnished home in Sheffield. The doctor was sent for, and came. He at once saw that hers was a very grave case, and that she had, as he thought, little chance of recovery, even if she could get the nourishment her illness required. As he was about to leave, the question was put, ‘When should we send for you again, doctor?’ ‘Well,’ was the reply, as he looked at the poor woman and then at her wretched surroundings, ‘I don’t think you need send for me again. She cannot possibly get better; and to save you further trouble I’ll just write you out a certificate for her burial.’ And he did. After the doctor departed the woman—women always were wilful—got better rapidly. She has now completely recovered, and goes about carrying her burial certificate with her.—Sheffield Telegraph.”
WORTHLESS DEATH-CERTIFICATES.
Dr. Charles Cameron, M.P., in moving the introduction of the Disposal of the Dead (Regulation) Bill, in the House of Commons, on April 30, 1884, said:—“A very large number of our population die without any medical attendance at all, or at least without having ever received sufficient medical attention to enable a certificate of the cause of death to be given worth the paper on which it is written. In many of these cases some sort of worthless certificate is procured and presented to the registrar, but many thousands of persons are each year buried in the United Kingdom without even this formality.”