Death Certification in United Kingdom

Death Certification and Crematory: History

The crematory council turned their attention to the need for a national system of death certification, to be enforced by law as an essential and much-needed reform in connexion with cremation. On the 6th of January 1893 the duke Death certification. of Westminster introduced a deputation to the secretary of state for the home department, Mr Asquith, and the president of the Cremation Society opened the case, showing that no less than 7% of the burials in England took place without any certificate, while in some districts it was far greater. In consequence of this the home secretary appointed a select committee of the House of Commons, which was presided over by Sir Walter Foster, of the Local Government Board, to “inquire into the sufficiency of the existing law as to the disposal of the dead … and especially for detecting the causes of death due to poison, violence, and criminal neglect.” After a prolonged inquiry and careful consideration of the evidence, a full report and conclusions drawn therefrom were unanimously agreed to, and published as a blue-book in the autumn of 1893.8

The following conclusions are quoted from this volume:—Page iii. “So far as affording a record of the true cause of death and the detection of it in cases where death may have been due to violence, poison, or where criminal neglect is concerned, the class of certified deaths leaves much to be desired.” Page iv. Certification is extremely important as a deterrent of crime, and numerous proofs are given at length in support of the statement…. “Contrast this class with that of uncertified deaths, when the result is such as to force upon your Committee the conviction that vastly more deaths occur annually from foul play and criminal neglect than the law recognizes.” Page vii. Great uncertainty in resorting to the coroner’s court, and want of system in connexion with the practice of it, are affirmed to exist. Page x. It is stated that the opportunity for perpetrating crime is great in the considerable class of uncertified cases … “in short, the existing procedure plays into the hands of the criminal classes.” “Your Committee are much impressed with the serious possibilities implied in a system which permits death and burial to take place without the production of satisfactory medical evidence of the cause of death.” Page xii. “Your Committee have arrived at the conclusion that the appointment of medical officials, who should investigate all cases of death which are not certified by a medical practitioner in attendance, is a proposal which deserves their support.”

In considering cremation, the committee reported as follows:—Page xxii. “Your Committee are of opinion that there is only one question in connexion with this method of disposing of a dead body to which it is necessary for them to refer. That question is the supposed danger to the community arising from the fact that with the destruction of the body the possibility of obtaining evidence of the cause of death by post-mortem examination also disappears.” The mode of proceeding adopted by the Cremation Society of England having been described, “your Committee are of opinion that with the precautions adopted in connexion with cremation, as carried out by the Cremation Society, there is little probability that cases of crime would escape detection, but inasmuch as these precautions are purely voluntary, your Committee consider that in the interests of public safety such regulations should be enforced by law.”

The Cremation Society felt that this report much strengthened the case for legislation amending the law of death certification. In August 1894 the president of the society laid the results of the select committee before the British Medical Association at Bristol, and a unanimous vote was obtained in favour of the suggestions made by it. In November a second deputation waited on Mr Asquith, in which the president of the society begged him to carry out the system recommended. The home secretary replied that the business belonged to the department of the Local Government Board, and that it was already dealing with the question and bringing it to a satisfactory solution. Soon afterwards, however, the government changed, other questions became pressing and further consideration of the subject was postponed.

With reference to the recommendations of the select committee before mentioned, the regulations necessary for registration of death and the disposal of the dead may be outlined as follows:

• That no body should be buried, cremated, or otherwise disposed of without a medical certificate of death signed, after personal knowledge and observation, or by information obtained after investigation made by a qualified medical officer appointed for the purpose.
• A qualified medical man should be appointed as official certifier in every parish, or district of neighbouring parishes, his duty being to inquire into all cases of death and report the cause in writing, together with such other details as may be deemed necessary. This would naturally fall within the duties of the medical officer of health for the district, and registration should be made at his office.
• If the circumstances of death obviously demand a coroner’s inquest, the case should be transferred to his court and the cause determined, with or without autopsy. If there appears to be no ground for holding an inquest, and autopsy be necessary to the furnishing of a certificate, the official certifier should make it, and state the result in his report.
• No person or company should be henceforth permitted to construct or use an apparatus for cremating human bodies without license from the Local Government Board or other authority.
• No crematory should be so employed unless the site, construction, and system of management have been approved after survey by an officer appointed by government for the purpose. But the licence to construct or use a crematory should not be withheld if guarantees are given that the conditions required are or will be complied with. All such crematories to be subject at all times to inspection by an officer appointed by the government.
• The burning of a human body, otherwise than in an officially recognized crematory, should be illegal, and punishable by penalty.
• No human body should be cremated unless the official examiner added the words “Cremation permitted.” This he should be bound to do if, after due inquiry, he can certify that the deceased has died from natural causes, and not from ill-treatment, poison or violence.

The Cremation Act 1902 (2 Ed. VII. ch. 8), and the regulations9 made thereunder by the home secretary, have since given legislative effect to some of the foregoing recommendations and have laid down a code of laws applicable and binding where cremation is resorted to. But the amendments in the law of death certification generally, so long pressed for by the Cremation Society of England and recommended by the select committee, are none the less necessary.

Undoubtedly in populous communities and in crowded districts the burial of dead bodies is liable to be a source of danger to the living. As early as 1840 a commission had been appointed, including some of the earliest authorities on sanitary science,—namely, Drs Southwood Smith, Chadwick, Milroy, Sutherland, Waller Lewis and others,—to conduct a searching inquiry into the state of the burial-grounds of London and large provincial towns. By the report10 the existence of such a danger was strikingly demonstrated, and intramural interments were in consequence made illegal. The advocates of burial then declared that interment in certain light soils would safely and efficiently decompose the putrefying elements which begin to be developed the moment death takes place, and which rapidly become dangerous to the living, still more so in the case of deaths from contagious disease. But these light dry soils and elevated spots are precisely those best adapted for human habitation; to say nothing of their value for food-production. Granted the efficiency of such burial, it only effects in the course of a few years what exposure to a high temperature accomplishes with absolute safety in an hour.

In a densely populated country the struggle between the claims of the dead and the living to occupy the choicest sites becomes a serious matter. All decaying animal remains give off effluvia—gases—which are transferred through the medium of the atmosphere to become converted into vegetable growth of some kind—trees, crops, garden produce, grass, &c. Every plant absorbs these gases by its leaves, each one of which is provided with hundreds of stomata—open mouths—by which they fix or utilize the carbon to form woody fibre, and give off free oxygen to the atmosphere. Thus it is that the air we breathe is kept pure by the constant interaction between the animal and vegetable kingdoms. It may be taken as certain that the gaseous products arising from a cremated body—amounting, although invisible, to no less than 97% of its weight, 3% only remaining as solids, in the form of a pure white ash—become 406 in the course of a few hours integral and active elements in some form of vegetable life. The result of this reasoning has been that, by slow degrees, crematoria have been constructed at many of the populous cities in Great Britain and abroad (see Statistics below).

The subject of employing cremation for the bodies of those who die of contagious disease is a most important one. Sir H. Thompson advocated this course in a paper read before the International Congress of Hygiene held in London in 1891; and a resolution strongly approving the practice was carried unanimously at a large meeting of experts and medical officers of health. Such diseases are small-pox, scarlet fever, diphtheria, consumption, malignant cholera, enteric, relapsing and puerperal fevers, the annual number of deaths from which in the United Kingdom is upwards of 80,000. Complete disinfection takes place by means of the high temperature to which the body is exposed. At the present day it is compulsory to report any case in the foregoing list, whenever it occurs, to the medical officer of health for the district; and it is customary to disinfect the rooms themselves, as well as the clothes and furniture used by the patient if the case be fatal; but the body, which is the source and origin of the evil, and is itself loaded with the germs of a specific poison, is left to the chances which attach to its preservation in that condition, when buried in a fit or unfit soil or situation.

The process of preparing a body for cremation requires a brief notice. The plan generally adopted is to place it (in the usual shroud) in a light pine shell, discarding all heavy oak or other coffin, and to introduce it into the furnace in that manner. Thus there is no handling or exposure of the body after it reaches the crematorium. The type of furnace in general use is on the reverberatory principle, the body being consumed in a separate chamber heated to over 2000° Fahr. by a coke fire. In a few instances a furnace burning ordinary illuminating gas instead of coke is in use.

Source: Encyclopedia Britannica (1911)