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JAMA 100 Years Ago
September 20, 2006


Author Affiliations

JAMA 100 Years Ago Section Editor: Jennifer Reiling, Assistant Editor.

JAMA. 2006;296(11):1414. doi:10.1001/jama.296.11.1414-b

Physicians should appreciate the necessity of designating correctly the cause of death. Science is in no way served when the cause of death, for instance, is entered on the certificate simply as “convulsions,” or “heart failure,” or “pulmonary edema.” The patient may have died immediately or directly in such circumstance, but these unqualified statements give no clue to the disease which was the essential, indirect or underlying cause. In later years relatives are often anxious when they themselves become ill; then, again, it will be found that questions of heredity in disease, very important to be settled, must forever remain obscure. From the legal viewpoint the matter is still more grave. A defective certificate may occasion the patient's family much vexation and at the same time give the authorities unnecessary work in the way of investigation. Occasionally there may be mortification for the physician not altogether undeserved. For example, to designate a death as due simply to meningitis, peritonitis or gastro-enteritis, without qualification, may not satisfy the coroner or medical examiner. The further statement will be necessary whether the disease was idiopathic or the result of a fall, a wound, a “criminal operation” or a poisoning. Here is an example of a death certificate correctly made out, which nevertheless became a “coroner's case:” “Asthenia de senectute; contributing cause, fracture at the neck of the femur.” The fracture was probably sustained in falling out of bed or by slipping on the street, as is usual in such cases. But some one may have pushed or struck the deceased, becoming thus more or less responsible for the death. In any event, whenever an accident has contributed to a death, no matter how remotely, the case is one for investigation. In most communities a letter from a reputable and responsible physician to the authorities, accompanying such death certificates, will obviate official action and spare the family annoyance.

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