Scottish Government

Interim Guidelines for Smallpox Response and Management in Scotland in the Post-Eradication era

Appendix 18: post-mortem and disposal of dead

Post-mortem

1. If the diagnosis is confirmed (see definition of confirmed cases in Section V), then normally there will be no need ace for a post-mortem examination to be performed.

Disposal of the deceased

Statutory powers

1. The Public Health (Scotland) Act 1897 , provides legal powers to control the movement of a body of someone who has died from smallpox.

2. Under Section 63, if a person dies in hospital, the designated medical officer or any registered medical practitioner can certify that the body should not be removed from the hospital except for burial or cremation.

3. Under Section 69, if the designated medical officer or qualified medical practitioner certifies that retention of a body in a building would endanger the health of the inmates, a JP can order that the body be removed from any building to a mortuary and then buried or cremated within a specified time, or direct that the body be immediately buried , without removal to a mortuary , if necessary.

4. Under section 69(2), unless friends or relatives of the deceased have buried the body within the time which has been specified by the Sheriff or Justice, the local authority are under a duty to do so. Separately, under section 50 of the National Assistance Act 1948 , the Local Authority is required to bury or cremate the deceased if it appears to them that "no suitable arrangements for the disposal of the body have been or are being made otherwise than by the authority." However subsection (3) of that section forbids the Local Authority from cremating the body when they have reason to believe that this would be contrary to the wishes of the deceased - possibly including religious views. Local authorities also have a power to bury or cremate a body of a deceased person who was immediately prior to his death in their care or receiving assistance from them under section 28 of the Social Work (Scotladn) Act 1968.

5. The Cremation (Scotland) Regulations 1935, allows for cremation of the body of someone who has died from smallpox. Regulation 15 states that where "in the case of any person dying of plague, yellow fever or cholera , anthrax , or smallpox , the medical Referee, if satisfied as to the cause of death , may dispense with any of the requirements of Regulations 4,5,6,7,8 and 12 These regulations may also be temporarily suspended or modified in any district during an epidemic or for other sufficient reason by an order of theScottish Ministers. "

Responsibility

1. The local authority would assume responsibility for the disposal of smallpox victims and together with the undertakers would act upon advice from the local CCDC. Cremation the preferred option and the advantage of cremation over burial will have to be explained to relatives as is soon as possible.

Encoffining

1. Before removal from deathbed the body should be enshrouded by double bagging in impervious plastic bags. Encoffining should only be carried out by vaccinated personnel wearing appropriate personal protective equipment - gloves, gown, apron, mask, headgear, eye protection and rubber overshoes.

2. Disposable coffins should be used that are consumed by the cremation process. Coffins should be sealed with the lid secured and the outside of the coffin washed down with phenolic disinfectant.

Cremation

1. It is possible to arrange for cremations to take place without the production of forms B and C to the Medical Referee. An order under Regulation 15 of the Cremation (Scotland ) Regulations 1935 can be granted by the Scottish Ministers to suspend or modify the regulations in a district whilst an epidemic of smallpox prevails. Under this order, which is valid for a specified period, a certificate from the CCDC stating that the person died from smallpox is sufficient evidence. The CCDC can be informed by telephone, by the medical officer in charge of the care, and no documents need leave the hospital premises.

2. If large number bodies require cremation, it may be preferable to cremate them at night, when cremation facilities can be dedicated for this purpose, and bodies can be disposed of quickly.