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children are notified under the name of the mother, unless the father acknowledges the paternity.

Dead Born. You must exercise great care in giving these certificates if you have not been present at the birth. It is almost better not to give such a death certificate, but write and intimate the fact to the medical officer of health and give your own opinion. The midwife or the person present at the birth can make the declaration that the child was born dead.

Registration of Births.-Every birth must be registered in England and Wales within forty-two days of its occurrence, and in Scotland within twenty-one days, by either of the parents, the householder or any person present at the birth.

Certificates of Death.-No certificate of death should ever be granted by a medical man unless he has first seen and examined the dead body. This is absolutely necessary if you have not seen the deceased for some time previous to his death. Crimes have remained undetected by carelessness in granting certificates of death. In one case a woman obtained twenty-four death certificates from different practitioners on the life of a single infant, who had suffered from bronchitis and who had died from it according to her statement. In each case she drew funeral insurance money, though actually the child was still alive. In another case a young woman who lived with her father in the country became engaged to a profligate young man. The father suffered from asthma, and it was the daughter's frequent habit to go to the doctor for medicine for her parent. She appeared one day at



the doctor's house, stating that her father had had a very severe attack and had died. She asked for and got the certificate of death. Had it not been that the undertaker, while placing the body in the coffin, noticed that there were severe injuries to deceased's head, the murderer, who was the girl's fiancé, might have escaped punishment.

In filling up the death certificate great care should be exercised, and in stating the name of the disease the designation given in the volume "The Nomenclature of Diseases" of the Royal College of Physicians should be employed. A summary of these designations is found at the beginning of each book of death certificate forms, which is obtainable at the office of any registrar of births, marriages and deaths.

One should be very careful not to confuse the secondary with the primary cause of death. The primary is the one of most value, as under its heading the death is entered and so is used for statistical purposes. Thus, ascites is not a disease but a consequence of some other disease, e.g., malignant disease of the liver; again, syncope is rarely the actual cause of death in a case of phthisis pulmonalis. Mention only the important secondary cause of death; thus, in a child dying from bronchopneumonia in the course of measles, the latter is the primary and the former the secondary cause. Employ definite terms for each disease and never vague names as diarrhoea, dropsy, cachexia.

The medical attendant must furnish the certificate of death to the registrar within five days in England and Wales and within seven days in Scotland under

a penalty of £2. The certificate must give the true cause of death, or otherwise the medical man may render himself liable to penalties for giving a false certificate. In one case the certificate stated that death had resulted from appendicitis, peritonitis and syncope, while really the woman had succumbed to the results of an illegal operation. The medical man who signed it was fined £10, with £10 costs, for making a false declaration. He might have been sent to prison for seven years.

The bodies of still-born children who have reached the twenty-eighth week of utero-gestation cannot be buried without a medical certificate as to the cause of death.

The medical man must never give more than one certificate of death, as fraudulent use has been made of the duplicate.

Under no circumstances ought he to sign blank certificates of death, with the intention that his assistant, partner or locum tenens may fill them up. Grave irregularities have occurred by reason of this having been done; especially has this occurred in the case of insured infants and young children.

In cases of sudden death, if the medical attendant knew that the deceased suffered from some grave malady (e.g., aortic heart disease), and if he has no doubt as to the actual cause of death, he may grant a certificate, even though he may not have seen the deceased for a week or two previous to his death. It is advisable, however, to inform the coroner of this by call or telephone message, as it is his duty to make inquiry into every case of sudden death. In Scotland, of course, this is not applicable, though the registrar

ought to be informed of the facts. If the interval has been long between your having seen the deceased and his sudden death (e.g., four to eight weeks), you must inform the coroner for the district in which the death took place, as you ought not to grant a certificate of death. He may grant a certificate and burial order without holding an inquest.

In cases of death after a long illness, where perhaps you have not seen the deceased for some time, it is better to withhold your certificate. If you have no doubt whatever as to the cause of death, you should call on the registrar or write to him, fully explaining the case. In this way you transfer responsibility from yourself to the registrar. If the latter is not satisfied, he may refer the case to the coroner, or procurator-fiscal in Scotland, but if satisfied he himself may grant a burial order.

If in any particular case you are not convinced as to the cause of death, you may refuse to give a certificate. Your grounds, however, must be reasonable. You cannot refuse to give a certificate of death because your last account for professional services has not been paid, or because you may have quarrelled with a relative of the deceased, or because of any such trivial reason.

In a case of sudden, violent or unexpected death, or if the death has occurred under what you consider suspicious circumstances, you must inform the coroner, or in Scotland the procurator-fiscal or, failing him, the surgeon of police.

You may, however, shift the responsibility by giving a certificate stating that death has been caused directly or indirectly by violence, or that it

has been sudden or that you cannot state the true cause of death. In such a case it is the duty of the registrar to report the death immediately to one of the above officials. This, however, is by no means the proper course for a medical man to follow.

The registrar may receive no medical certificate of death, as the deceased may not have been attended by a medical practitioner. The registrar may be satisfied with the explanation of the qualified informer and may grant an order for burial. If he is not satisfied, however, as to the cause of death, he must communicate with one of the above officials.

It is the duty of the medical practitioner to report to the coroner or his officer every case of very sudden death, the cause of which is not obvious. Every case of death from accident must also be reported to the coroner; even such a slight accident as that of an old person falling out of bed and fracturing the neck of the femur, where death ensues soon afterwards. Of course, every case of death following an assault, or which has resulted from criminal negligence, must be reported to the coroner or procurator-fiscal.

Every death must be registered by the nearest relative present at the death or during the last illness of the deceased. In the absence of these any witness of the death, or the occupier of the house, or any relative living nearest to the deceased must register the death. These are known as " qualified


The certificate of death is usually obtained by one of the above from the medical attendant and handed to the registrar at the time of registering

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