CERTIFICATION OF CAUSES OF DEATH.

98 Any legal pressure to b put upon the certifier ought to symptoms showed themselves on January 2nd, 1872, and Mr. Young, a gentleman practising in the neighbourhood, be opposed by the whole profession. I have repeatedly was hurriedly summoned in my absence, and we afterwards urged that it is the duty of the State to provide a skilled met in consultation. On the 4th of January Sir Wm. Fergusson met me in the case, and entirely concurred with the treatment adopted. From this date to the 21st January the symptoms, although variable, were, on the whole, more favourable, and Mr. Biller wished to be removed to Brighton for change of air. I could not approve of this course, and suggested that Mr. Erichsen should see him again with me. We ac-cordingly met on the 24th, when we found that our patient had been seized in the night with epileptiform fits and violent tetanic convulsions. Mr. Young had been sent for, and had witnessed the attack, which lasted more than two hours. This gentleman met Mr. Erichsen and myself at the consultation, and has kindly seen my patient frequently for me since. Mr. Biller rallied, and although his progress towards improvement was slow, he was well enough to be removed to Brighton, and I accompanied him there I placed him on the 4th of March in an invalid carriage. under the care of my friend, Mr. Richard Rugg, who saw the patient daily until his removal to Worthing, about the middle of April. I may here remark that during his stay at Brighton Mr. Biller was enabled to get about a little on crutches, and went out once in a carriage and wheel chair. At Worthing our patient was still able to move about slowly on his crutches, and progressed favourably to a certain degree; but on the afternoon of April 22nd he was again seized with a similar epileptiform attack of even a more alarming character. Mr. Harris, surgeon, of Worthing, was called in, and continued in attendance until Mr. Biller was removed to London, on May 1st. I myself met Mr. Harris twice in consultation. Thus it will be seen that this gentleman was visited and professionally attended by five well-known medical men besides myself, including the eminent surgeons, Sir Wm. Fergusson and Professor Erichsen, from the time of the accident to the period of the visit of the five medical witnesses on the part of the railway company. These gentlemen arrived on Tuesday, June 24th, one week before the trial took place, and visited Mr. Biller, in the presence of Mr. Young and myself. The patient, who had not left his bed since the 28th of April, was violently excited, weeping, and almost delirious. He was not able to be examined by either witness, and the entire length of the visit did not exceed fifteen minutes in duration. This was the only opportunity which the medical witnesses of the company had of forming their diagnosis, and upon this one visit they did not hesitate to express their judgment thus hastily and imperfectly arrived at in direct opposition to that of men who had been constantly in attendance upon the case. Sir Wm. Fergusson, Mr. Erichsen, Mr. Young, and myself met at Mr. Biller’s the day after this visit, and unanimously concurred in the opinion we gave in court at the trial. I am, Sir, your obedient servant, DAy-GOSS. SAMUEL SAMUEL DAY-GOSS. Kennington-park-road, July 16th, 1872.

officer of health to make the necessary examination, and the certificate in every death, the cause of which, for any reason, may be uncertified. I am, Sir, yours, &c., HENRY W. RUMSEY. Cheltenham, July 15th, 1872.

give

.

To the Editor

of

THE LANCET.

SiR,-You invite the opinion of the profession upon that clause of the Government Bill for amending the Registration Acts now before the House of Lords, which will make, should it pass, the furnishing of certificates of death by medical men compulsory. The furnishing of these certificates by medical men is the exercise of their private calling-the means by which they live-and to compel them to do this without remuneration is manifestly most unjust, and will not, I hope, be allowed to become law without a decided protest from the whole of the profession. The extremely handsome manner in which the great bulk of the profession has furnished these certificates for years, voluntarily and gratuitously, deserves some better recognition at the hands of the Government than that proposed in the new Bill.

Yours Leeds, July 16th, 1872.

faithfully, PHILIP FOSTER.

-

To the Editor

of THE LANCET. of certificates of death, on which you invite comments from the profession, I would ask your permission to make a few remarks. I suppose it is granted that some efficient registration of deaths is most desirable, and it is equally evident that no one is so able to certify as the doctor. We are all agreed that the present form of certificate requires modifying. I think it advisable that the certifier should always see the corpse, and that the certificate should also be required for the burial of stillborn infants. The advantages to be gained by insisting upon these points are evident ; surely, therefore, if the medical attendant is required to call to see the corpse, and then give a certificate, he should be paid for so doing, and any Bill upon the subject ought to provide for such payment. I am, Sir, yours faithfully, JAMES CHEESE, L.R.C.P.L., &c. &C. Newport, Mon., July 13th, 1872.

SiR,-Upon

the

subject

ON THE DANGER OF WOUNDS PRODUCED BY GALVANISED IRON IMPLEMENTS. To the Editor of THE LANCET. SIR,-Permit me to make a few remarks as to the dangerous consequences which may

ensue

from

a

poisoned

CERTIFICATION OF CAUSES OF DEATH. wound, which appears to be readily produced by a 11 galTo the Editor of THE LANCET. vanised iron" implement, and which I think is well illusSIR,-In answer to your appeal to your readers for their trated by the following case :H. G-, aged fifty years, who, previous to the accident opinions respecting the compulsory certification of causes of death, proposed in the Bill now before the House of which resulted in his death, had enjoyed good health, rean injury from a 11 galvanised iron" anchor to the Lords, I beg to repeat the strong objection which I have ceived hand, which, at the time, he considered of so right always felt, and frequently expressed in my publications, a character, and for a few days gave him so little trifling incon-

to any such compulsion. The chief value of the certificates at present arises from their being voluntary. An arbitrary system of coercion has doubtless a tendency to impair the testimony of unwilling certifiers, and to H mingle errors among the facts spontaneously supplied by enlightened and accurate observers." If a man is forced to say something the chances .are that he may say anything. With reference to the Scotch compulsory system, an eminent member of the Glasgow Medical Association, six years ago, said publicly that " the returns (of causes of mortality) issued from the Registrar-General’s office for .cotland were not worth the paper on which they were printed, and that no medical man acquainted with the facts pdaoed the least reliance on them.",

venience, that it

not till matters assumed a serious I saw him on May 10th and found his right hand and arm most extensively swollen and in a suppurating condition; a few days later an abscess formed in the neighbourhood of the left elbow-joint, was

aspect that he sought medical advice.

the legs showed signs of inflammation, particularly observable on the inner side of the left thigh. Large quantities of pus escaped through incisions made in the arm. The constitutional symptoms of pyaemia were well marked; the patient, though apparently rallying for a day or two, became rapidly worse, and died on May 27th. That the above case of "pysemio poisoning " was attributable to the peculiar nature of the metallic substance producing the injury I think there can be little doubt, for since this case was brought to my notice I have it on good