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diseased infant, and that, in this way you gave the child you vaccinated syphilis or tuberculosis.
In order completely to protect the child from smallpox you ought always to make four insertions at an interval of half an inch from one another; then dress the arm with a pad of boracic wool kept in place by two strips of adhesive plaster.
Public vaccinators are appointed by the local board of guardians. On applying for this post you must furnish a certificate of proficiency in vaccination— the same which you obtained when a student. The appointment must be approved by the Ministry of Health. The payment for each vaccination done at the child's residence must be not less than 2s. 6d., but the guardians may, and ought, to pay a larger fee. For cases of revaccination the same fees are payable.
Notification of Infectious Disease.-Every case of notifiable infectious disease must be certified to the medical officer of health of the district in which the patient is within twenty-four hours of its being diagnosed by the medical attendant. Failure to do so
may incur a penalty of a fine not exceeding 40s. For each notification a fee of 2s. 6d. is paid if it occurs in your private practice, and Is. if it occurs in any public institution or body of which you are medical officer.
As regards compulsory removal to hospital, if you are of opinion that there is a risk to the health of the community through the spread of disease by an infected person remaining at home, then, on the certificate of a medical man, a justice of the peace or a magistrate may order his removal compulsorily to a hospital for the treatment of such cases, even against his own wish or that of his parents or guardians.
Juror's or Witness's Certificate.-A medical certificate may be required by a juror or witness to excuse his attendance because of his illness.
In England a mere written statement containing the person's name, address, occupation and nature of the illness, with your own signature and date, is alone required, provided you are a registered medical practitioner.
In Scotland the certificate takes the form of a sworn statement and must be given on "soul and conscience." (E.g., "I certify on soul and conscience that A. B., 26, New Street, Glasgow, carpenter, is suffering from croupous pneumonia and is unable to attend court.-(Signed) W. D. GILLESPIE, M.D., 26th May, 1921.")
One ought not to grant these certificates without due consideration, as you may be cited to appear in court and may be questioned as to the truth of your certificate. The illness may not be one which need confine the person to bed, but it may in your opinion unfit him to appear in a court of law either to sit on a jury or to give evidence. Thus, he might be in such an excitable or nervous condition as to be unable to concentrate his attention, and your certificate should embody such an explanation.
A certificate in the above form may be granted by you to a person who has been allowed out of prison on bail and through illness is unable to attend court on a certain specified date.
Other Certificates.-There are other certificates which a medical man has to grant, e.g., Factory Acts; children in relation to school attendance; Workmen's Compensation Act, etc., but as a rule these
are in special form or schedule and so require no further consideration.
Every case of industrial poisoning which comes under the notice of the medical practitioner must be notified at once to the Chief Inspector of Factories, Home Office.
Cremation.-By reason of the fact that cremation destroys all evidence which the dead body might have afforded in reference to criminal inquiries, disease or poisoning, it is very necessary to safeguard the State against such contingencies.
Before a body can be cremated two medical certificates of death must be furnished. Each of these contains questions of a very searching character. It is compulsory that each of the certifiers must have seen and examined the dead body.
One of these certificates is granted by the ordinary medical attendant of the deceased (Schedule, Form A). The other may be granted by any one of the following: A registered medical practitioner of not less than five years' standing and who must be appointed by the cremation authority; by a medical officer of health; a surgeon of police; a certifying surgeon under the Factory and Workshops Acts; a medical referee under the Workmen's Compensation Act; or a physician or surgeon in a general hospital containing not less than fifty beds; or on certificate given after post mortem examination of the dead body by an expert in pathology (Schedule, Form D).
These two certificates are then submitted to a medical referee appointed by the cremation authority, and only if he is satisfied does he grant an order for cremation. If he is not satisfied he may
require further information, or he may require a post mortem examination to be made by an expert in pathology. If he has any reason to think that death had resulted from poison, violence, neglect, illegal operation, or if there are any suspicious circumstances whatever, he will not grant an order for cremation unless a coroner's inquest has been held. He may refuse to allow cremation without assigning any reason.
It is unlawful to cremate any unidentified body. The death must also be registered in the usual
MEDICAL SECRECY; MEDICAL RESPONSIBILITY; STREET ACCIDENTS; ADMINISTRATION OF
Medical Secrecy.-It ought to be an invariable rule with you never to discuss with outsiders the illnesses of any of your patients. Not infrequently an acquaintance of one of your patients will accost you with the question "What is wrong with Mr. S.?" You ought not to inform him, because you do not know how this information might be spread abroad nor how it might prejudice your patient. Perhaps the latter might not wish it to be known that he was ill, or he might object to have the nature of his illness revealed, and more especially if he were suffering from a contagious or communicable disease. Put off your interrogator with some general answer, and if he still persists, then point out to him his indiscretion in demanding information from you.
The medical man must remember that on taking his professional qualification to practise he subscribed to the time-honoured oath of Hippocrates, which amongst other rules stated that "Whatever in connection with my professional practice or not in connection with it, I see or hear in the life of men which ought not to be spoken abroad, I will not divulge, as reckoning that all such should be kept secret."