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.