Chapter XII: Appendix: Page (11)

This occurred seven years since, and on a very recent inquiry made at this same house, it was stated that comparative cleanliness having been maintained, no fever had since broken out, no more such deaths have been occasioned, no more burthens had been cast upon the poor’s rates from this house. The law already authorizes the house to be condemned, and its use arrested, when it is in a condition to endanger life by falling; if it be deemed that the principle should be applied to all manifest causes of disease or death, or danger to life, then, instead of the remote and practically useless remedy by the inspection of an unskilled and unqualified ward inquest (Vide General Sanitary Report, p. 300), the skilled and responsible medical officer, with such summary powers and duties of immediate interference, as were successfully exercised in the case above cited, should be appointed.

§ 197. It is proper to observe, that it occurs not unfrequently that such scenes arise from negligences and dilapidations of a succession of bad tenants, of which the chief landlord is himself unaware: but whether aware of it or not, the prompt intervention of an officer of health in such cases would not be without its compensation to the owner. A bricklayer, who himself owned some small houses occupied by artisans, which he had himself built, was asked in the course of another inquiry:—

In what periods do you collect the rents?—Some monthly; about
one-third monthly; the rest we collect quarterly.

What may be your losses on the collections?—They will average,
perhaps, about one-fifth; we lose rather the most on the quarterly
tenements.

What are the chief causes of your losses from this class of
tenants?—Loss of work first; then sickness and death; then frauds.

Are the frauds considerable?—Not so much as the inabilities to pay.
I find the working classes, if they have means, as willing to pay
and as honourable as any other class. Within the last 18 months
there have been a great many people out of work; at other times
there is as much loss to the landlord from sickness as from any
other cause. Three out of five of the losses of rent that I now
have, are losses from the sickness of the tenants, who are working
men.

When children are sick, there is of course no immediate interruption
to the payment of rent?—Very seldom.

What sort of sicknesses are they from which the interruption to work
and to the payment of rent occurs?—Fevers, nervous disorders, and
sickness that debilitates them.

Then anything which promotes the health of the tenants will tend to
prevent losses of rent to the owners of the lower class of
houses?—Yes, I have decidedly found that rent is the best got from
healthy houses.

In some of the cellar dwellings in Manchester the losses of rent, chiefly from sickness, amounted to 20 per cent.

§ 198. In all cases of deaths from epidemic diseases, one of the first duties of the officer of health would be to inquire whether there were any other persons in the house attacked with disease, and examine them. In all such cases as those cited, §§ 26, 27, 28, 29, 30, 31, he should have adequate power, which, that it may be efficient must be summary, to take measures to protect the parties affected and others, by ordering their immediate removal to fever wards. It is only in a deplorable state of ignorance of the nature of the evils which depress such districts that there could be any hesitation in granting such powers from the fear of abuse; the most serious legislative difficulty would be to ensure their constant and efficient application. Mr. S. Holmes, the builder of the Stockport viaduct, and formerly an active member of the Liverpool town council, gives the following illustration of the extreme miseries witnessed in that town, and it is certainly not an exaggerated description of the scenes to which the officer of health must at the commencement of his duties be frequently carried on the occurrence of deaths.

The melancholy facts elicited by the corporation clearly show that
Liverpool contains a multitude of inhabited cellars, close and damp,
with no drain nor any convenience, and these pest-houses are
constantly filled with fever. Some time ago I visited a poor woman
in distress, the wife of a labouring man. She had been confined only
a few days, and herself and infant were lying on straw in a vault
through the outer cellar, with a clay floor, impervious to water.
There was no light nor ventilation in it, and the air was dreadful.
I had to walk on bricks across the floor to reach her bed-side, as
the floor itself was flooded with stagnant water. This is by no
means an extraordinary case, for I have witnessed scenes equally
wretched; and it is only necessary to go into Crosby-street,
Freemasons’-row, and many cross streets out of Vauxhall-road, to
find hordes of poor creatures living in cellars, which are almost as
bad and offensive as charnel-houses. In Freemasons’-row, about two
years ago, a court of houses, the floors of which were below the
public street, and the area of the whole court, was a floating mass
of putrified animal and vegetable matter, so dreadfully offensive
that I was obliged to make a precipitate retreat. Yet the whole of
the houses were inhabited!

§ 199. In cases of epidemics the saving of life by the prompt intervention of an officer of health, on the occurrence of the first death, and the immediate removal of the survivors affected, would be very considerable. In cases of fever, on the removal of patients to the fever hospital, they are often received in a state of violent delirium, or in a state of coma succeeding to violent delirium. After they have been washed in a bath, and placed in a clean bed, in the spacious and well-ventilated ward of the hospital, in a few hours, often before the visit of the physician, the violent delirium has subsided, or the state of coma having passed away consciousness has returned. Although in a great majority of cases the patients are only sent to the hospital in the last stage of disease, this mere change in the locality and external circumstances of the sufferers diminishes the proportion of deaths from one in five to one in seven. Supposing the cases occurred in equal numbers daily, the functions of registration in the metropolis would carry the officers of health to upwards of 20 cases per diem of deaths from epidemic disease, for the most part in the most wretched districts.

§ 200. The principle of this part of the proposed arrangement is in necessitating visits of inspection, and thence necessitating the initiation of measures of relief where there has hitherto been, and whence it may safely be said there will be, no complaint or initiation of measures of relief by the sufferers themselves. It is observed by Dr. Southwood Smith, in confirmation of the observations made on the demoralizing effects of the physical evils which depress the bodily condition of large classes that, as they have not the bodily vigour, so they have not the intelligence of a healthy class. One of the most melancholy proofs of this, he observes, is, that they make no effort to get into happier circumstances; their dulness and apathy indicate an equal degree of mental as of physical paralysis. And this has struck other observers who have had opportunities of becoming acquainted with the real state of these people. “The following statement impressed my mind the more, because it recalled to my recollection vividly similar cases witnessed by myself. ‘In the year 1836,’ says one of the medical officers of the West Derby Union, ‘I attended a family of thirteen, twelve of whom had typhus fever,—without a bed in the cellar, without straw or timber shavings—frequent substitutes. They lay on the floor, and so crowded that I could scarcely pass between them. In another house I attended fourteen patients: there were only two beds in the house. All the patients lay on the boards, and during their illness never had their clothes off. I met with many cases in similar conditions; yet amidst the greatest destitution and want of domestic comfort, _I have never heard, during the course of twelve years’ practice, a complaint of inconvenient accommodation_.’ Now this want of complaint, under such circumstances, appears to me to constitute a very melancholy part of this condition. It shows that physical wretchedness has done its worst on the human sufferer, for it has destroyed his mind. The wretchedness being greater than humanity can bear, annihilates the mental faculties—the faculties distinctive of the human being. There is a kind of satisfaction in the thought, for it sets a limit to the capacity of suffering which would otherwise be without bound.”

§ 201. In respect to any such services proposed, involving inquiry on the spot, an objection is apt to be suggested, that the exercise of such functions would be unpopular and objected to. By the sufferers it certainly would not, § 122. With portions of the population, in such a deplorable state of ignorance as that manifested, even in this country, at the time of the invasion of the cholera, when they imbibed the notion that the wells had been poisoned by the medical men, the creation of any monstrous impressions by others must be admitted to be possible; but the existence of that notion would have been no justification for closing the hospitals, for staying the work of beneficence, and suspending the performance of medical duties. Such an objection, however, implies a very large misconception as to the _general_ state of intelligence of the working classes. There is, on this point, as regards the metropolis, the direct and decisive evidence of experience. In consequence of the difficulty of dealing satisfactorily with common hearsay evidence, some of the local registrars have, with praiseworthy care, proceeded to verify the facts of the death by inquiries made at the house where it took place, which inquiries are strictly supererogatory. The following evidence, though in part substantially a repetition of scenes already described, is here adduced less for the descriptions of places visited than as showing the manner in which these officers were received.

Mr. James Murray, the registrar of births, deaths, and marriages for the Hackney Road district of Bethnal Green, having stated that sometimes he made inquiries on the spot for the registration of deaths, speaking of the poorer population of that district, states that they have usually only a single room, and that “they never speak of occupying the same house, but the ‘same room.’”

In what proportion of cases do the bodies of those persons remain in
the room in which the persons live and sleep?—It would depend upon
the part of the district, for part of the higher district is highly
respectable. In that district nine-tenths of them have only a single
room, and no opportunity of placing the body elsewhere.

In nine-tenths of the cases the body remains in the same room?—It
must be so, they have no other room.

In a coffin?—Yes; I have seen it so repeatedly.

Is the retention of the body injurious?—I think so.

When you go to register the deaths is it deemed an intrusion, or are
you received with civility?—I am always received with civility in
all cases.

It is not considered an intrusion?—Not at all. I myself have rather
cultivated the good feeling and opinion of the working classes; they
know me exceedingly well, and I have never met with any instance of
incivility among them.

Mr. John Johnson, the registrar of one part of the Shoreditch district, was asked—

Of the labouring classes, what proportion of the families have more
than two rooms?—I cannot say the number; but there is a vast number
who occupy one room, and some occupy two rooms; some occupy a
kitchen and one room, or a little parlour and kitchen, and some two
rooms up-stairs, some one room; perhaps if they have two rooms
up-stairs they have a family in each.

Do you find, on visiting those places, upon the occurrence of a
death, that the dead body is retained in the living and sleeping
room?—Frequently we find it so.

And the family are eating and pursuing the ordinary offices of life
in the room where the body lies?—Yes.

Have you found the body retained for a long time?—No, they do not
usually keep it longer than five or six days; but I have known
instances where the body has been kept two and three weeks.

But in that time does it not acquire a putrid smell?—Yes, and in
rooms where I have gone to register births I have found the effluvia
so bad that I have been obliged to go out of the house without
effecting the register.

It had an effect upon your health for the time being?—Yes.

When you go to register deaths at the houses of the labouring
classes, are you on the whole well received?—Generally very well;
they consider we pay them a compliment by calling upon them.

They do not deem your registration or inquiry an intrusion?—Not at
all.

Mr. W. H. Wheatley, the registrar for the Old Church district of Lambeth, was asked—

You think it necessary, in order to ascertain the causes of death
with correctness, to go to the spot and ascertain the fact on the
spot?—Yes: I get much more correct information in that way than from
parties calling upon me.

If you were to remain at your desk, without local inquiry, do you
conceive your registration would be at all correct, or would it not
be widely different from the fact?—I do not think it would be
correct. I think in every case of death the registrar ought to go to
the house, not only for the purpose of registering the death, but
that there ought to be some means of ascertaining from what cause
the party died; that the body ought to be seen by the registrar, or
some authorized person, or that it should be compulsory to produce a
medical certificate, certifying the precise cause of death. The
searchers, who were two women, appointed in open vestry, under an
old Act of Parliament, to call and investigate every case of death
that occurred, and to examine the body and see that the party had
come fairly by his or her death, have been done away with since the
passing of the Registration Act, and there is now no means of
ascertaining how the party has met with his death.

Can you state to the Commissioners instances of error which you have
obviated or prevented by going and inquiring upon the spot, that
would have occurred by your not going?—I cannot mention individual
cases; but it has come under my knowledge that parties have called
upon me to register a death, and when I have asked the cause they
have said, “I do not exactly know what it was, I believe it was a
fever, or something of that kind.” I have said, “I must trouble you
to get me a medical certificate, or I will call at the house.” I
have gone to the house, and found it widely different in many cases
from the statement they gave to me, from error on their parts.

Are you satisfied from the experience of your office, though it has
been short, that there can be no correct registration without
examination on the spot, and a sight of the body?—I think so; it
would entail upon the registrars a very arduous and a very
unpleasant office, but that the registration would be more perfect,
and it would be a check upon crime, I have very little doubt.

Do you find any obstruction given on the part of the poorer classes
to your going to the spot and making inquiries?—Not the slightest.
My opinion is that the poorer classes pay more attention to the
registration than the middling classes.

Have you met with any manifestation of prejudice or bad feeling from
the poorer classes?—No, not the slightest, but really a wish that
the registration should be effective.

They do not view the registrar as an intrusive officer?—Not in the
least.

In the worst conditioned places the only persons who are seen as public officers are policemen and the rate-collectors or the tax-gatherers. When commissioners of inquiry have been seen taking notes in them, the popular impression was that they were tax-gatherers, an impression which it required some trouble to remove. In a little time the officer of health would be most popular and would exercise extensive and beneficial influence. The practical evidence of the registrars was of an uniform tenor, establishing, as far as actual experience may establish, not only the acceptability of the more elevated and extensive service proposed, but that it must develope most important civil as well as medical facts, the correct knowledge of which is necessary for the relief of the most afflicted portions of the population.

_Jurisprudential value of the appointment of Officers of Health._

§ 202. In the lamentable state of the population, which in England and Wales produces annually upwards of 700 committals to prison for crimes of passion, and of these 450 for murder, manslaughter, and attempts upon life, it may scarcely be deemed necessary to adduce many particular examples of the importance of the extraordinary jurisprudential services and securities for life to the community obtainable by the exercise in all cases of the ordinary functions of the verification, as far as may be, of the fact as well as the cause of death. On examining the grounds of the fears of life and suspicions of the poorer classes, inhabiting the worst conditioned districts, it is evident that obstructions to crime, or safeguards, which are carefully preserved in the well regulated communities (marked by security of life and the rarity of crimes of violence) are here absent, and that wide openings are left for the escape of the darkest crimes. Had there been an officer of public health, and a verification of the cause of death by him on inspection, as at Geneva, Munich, or other towns on the continent, and inquiry for registration of the causes of death, it is probable that, with the certainty of such inspection, the murders of the children at Stockport or at Little Bolton would not have been attempted; or, if perpetrated, they might have been detected in the first case. The whole class of murders verified on examination after disinterment may be cited as coming within the same category. The crime of burking, which appears to have originated in Scotland, and was extended to England, could scarcely have been attempted systematically, except under the temptation of the absence of such a security; and with such service as that proposed, it is highly improbable that it could have been carried on to the extent there is reason to believe it was.

On this point Mr. Corder, the superintendent registrar of the Strand Union, gives important testimony.

From your knowledge of the actual state of much of the population in
the worst part of the metropolis, derived from your experience in
the several local offices you have held, and especially your
experience as a superintendent registrar, do you believe that the
inspection of the body to verify the fact of death, and, as far as
inspection and inquiry on the spot may do so, to determine the cause
of death, would be important securities not merely for the truth of
the registration, but valuable securities for life itself?—Most
certainly I do. Had there been such an inspection and verification
prior to the year 1831, the horrible system of destroying human
beings for the purpose of selling their bodies could not have been
carried on to the extent to which I know it existed at that period.
Being then the vestry clerk of St. Paul, Covent Garden, the officers
of which were bound over to prosecute Bishop, Williams, and May, for
the murder of the Italian boy, the duty of conducting the
prosecution entirely devolved upon me. In the course of my
inquiries, I elicited beyond all doubt that the practice of burking,
as it was then called, had prevailed to a considerable extent in the
metropolis.

Would inspection, do you conceive, and proper inquiry as to the
cause of death, have prevented such murders?—Most effectually so, I
conceive. I may mention that they took out the teeth of the younger
subjects, and sold them to the dentists. The Italian boy, it would
have been seen, had no teeth; the teeth had been punched out in such
a manner as to have been remarkable.

Though the motives to such dreadful practices are removed under the
securities for the public safety imposed in connexion with the
Anatomy Act, yet in cases of other attempts against life, do you
consider that the requiring a certificate of the fact of death,
verified on inspection before burial, would interpose useful
practical obstacles for the prevention of murder, and the protection
of life?—Most assuredly.

Mr. Partridge, the surgeon of King’s College, at whose instance the murderers were taken into custody, in the cases referred to, expresses a similar opinion as to the importance of the proposed verification of the fact and cause of death by a proper officer.

§ 203. It may here be stated that only a small proportion of the local registrars are either medical officers or members of the medical profession; but the short experience of those registrars who have those qualifications has elicited abundant indications of the extent to which proper securities are wanting for the protection of life in this country. Nearly all who have for any length of time exercised their functions have had occasion to arrest cases of _primâ facie_ suspicion on the way to interment that had escaped the only existing security and initiative to investigation, the suspicion of neighbours and popular rumour. Mr. Abraham, surgeon and registrar of deaths in the City of London Union, was asked on this subject—

You are Registrar of Deaths in the City of London Union. Since you
have been Registrar, have you had occasion to send notice to the
coroner of cases where the causes of death stated appeared
suspicious?—Yes, in about half-a-dozen cases. One was of an old
gentleman occupying apartments in Bell Alley. His servant went out
to market, and on her return, in less than an hour, found him dead
on the bed, with his legs lying over the side of it. He had been
ailing some time, and was seized occasionally with difficulty of
breathing, but able to get up, and when she left him she did not
perceive anything unusual in his appearance. I went to the house
myself, and made inquiries into the cause of death; and although I
did not discover anything to lead to the suspicion of his having
died from poison or other unfair means, I considered it involved in
obscurity, and referred the case to the coroner for investigation.
Another case was of a traveller who was found dead in his bed at an
inn. The body was removed to a distance of forty miles before a
certificate to authorize the burial was applied for. His usual
medical attendant certified to his having been for several years the
subject of aortic aneurism, which was the probable cause of his
sudden death, although the evidence was imperfect and
unsatisfactory, and could not be otherwise without an examination of
the body, and I therefore refused to register it without notice from
the coroner.

A third case occurred a few days ago. A medical certificate was
presented to me of the death of a man from disease of the heart and
aneurism of the aorta. He was driven in a cab to the door of a
medical practitioner in this neighbourhood, and was found dead. He
might have died from poison, and, without the questions put on the
occasion of registering the cause of death, the case might have
passed without notice. There was not in this case, as in others, any
evidence to show that death was occasioned by unfair means, but the
causes were obscure and unsatisfactory, and I felt it to be my duty
to have them investigated by the coroner.

But for anything known, you may have passed cases of
murder?—Certainly; and there is at present no security against such
cases. The personal inspection of the deceased would undoubtedly act
as a great security.

Mr. P. H. Holland, surgeon, registrar for Chorlton-on-Medlock:—

My district is of the better description, inhabited either by the
higher classes or by respectable working men, in which cases of
deaths from crime are not very likely to occur; yet suspicious cases
have from time to time happened (say six or eight annually in my
district), to which I have thought it necessary to call the
attention of the coroner. In one case, for example, a father, a
labouring man, came to me to report the death of his infant child,
stating the cause to be sickness and purging; there was then no
cholera prevalent, and the rapidity of the disease was unusually
great. My suspicion was excited as to the cause of the death, of
which the father could give no clear account, and I sent word to the
coroner that I thought the case was one which required inquiry. An
inquest was held, and it turned out that the child had taken
arsenic. The jury were of opinion that the death was entirely
accidental,—that there had been no criminal intention. Had not the
cause of the accident been developed by the inquiry, others of the
family might have suffered in the same way. The other cases, which
had escaped inquiry, have been chiefly those of accident, in which
the death occurred at long periods subsequently, such as five or six
weeks. I have found that it is a common practice to represent
children as “still-born,” who were born alive, it not being
necessary to register still-born children. By passing them off as
still-born, burial is obtained for a smaller fee. But by this means
cases of infanticide might be concealed. The fact of a married woman
having been pregnant, and no proof existing as to the issue may
hereafter be of legal importance. I have heard of many suspected
cases of the wilful neglect of children, on whose deaths sums were
obtainable from different burial societies. I cannot doubt that by
inquiring much infantile death, which occurs from ignorance and
incorrect treatment, would be prevented.

Inspection on the spot would, I consider, operate much more
powerfully in prevention than in detection of crime. It would also
occasion the stoppage of many existing but unsuspected causes of
death. I have had reason to believe in the existence of a large
amount of the preventible causes of death, with respect to which I
have had no means of inquiry.

I was, during four years, apothecary to the Chorlton-on-Medlock
Dispensary, during which time cases of sickness occurring in houses
unfit for healthful habitation were constantly coming under my
observation; many particular localities, affording far more than
their due proportion of disease, owing to imperfect drainage and
ventilation. Any one who had gone to inspect the body on the
occurrence of death in those places, with powers to enforce sanitary
measures, such as the removal of the survivors, the drainage and
cleansing and ventilation of the premises, would, undoubtedly, have
had the means of preventing much mortality.

§ 204. Mr. Leigh, the surgeon, whose testimony has already been cited, acts as one of the registrars of Manchester, and adverts to one source of mortality amongst infants which appears to be widely extended in the town districts. It is a practice with mothers who go to work to leave their children in the care of the cheapest nurses, who commonly neglect the infants, and have recourse to Dalby’s Carminative in large quantities to quiet them. It is his opinion that a large number of them fall a sacrifice to this and other improper modes of treatment. For example, says Mr. Leigh,

There is one evil of the extent of whose existence I had no
conception, till I had for some time held the office of registrar.
In decrying this, I would beg distinctly to disavow any private
professional feeling. I allude to the great number of cases in which
either no medical treatment at all, or what is nearly as bad,
improper medical treatment, had been resorted to. I think, in nearly
one-fourth of the deaths of infants reported to me, on inquiry I
find that the little patients had been attended by incompetent and
unqualified practitioners, chiefly retail druggists. Cases of croup
and inflammation of the lungs which are eminently benefited by
medical treatment, and in which prompt and decisive measures often
preserve life, are treated by them, and I have reason to know by
inquiry into the details of the cases that bleedings, calomel, and
the remedies absolutely requisite in such cases are never, or very
rarely, employed, whereas, under proper medical treatment, most of
such cases would recover. Under these circumstances, these men
themselves become fertile sources of mortality to the young.

In a subsequent communication, he states—

I find that in the month of January just passed I registered the
deaths of 33 children under 4 years of age, of these 9 were attended
by druggists; I believe all by one who has received no medical
education: this is at the rate of 108 per annum. Three of the
children had no assistance at all, making 12 out of 33 that might
possibly have been saved. This number 33, however, is below the
average of the year, for in the three months preceding there died in
the district, of children under 4 years, 133, or 44 per month; and
during the quarter ending 30th September, 1842, 169, or 56 per
month; and the general number of those having no attendance, or
being attended by druggists, is fully one-third, so that 100 per
annum is much below the truth. I some time ago requested Mr. Bennet,
the registrar for the Ancoats district, to make similar notes on the
cases reported to him, and on inquiry from him I have reason to
believe that the evil exists to as great an extent in his district
as in mine.

I find that in most of the cases no efficient medical treatment was
adopted. Cases of pneumonia are seldom or never bled, or proper
remedies applied: the disease is probably not recognized, and if it
were, the treatment and extent to which it should be pursued is not
known to the parties prescribing.

A similar practice appears to be prevalent also in the mining districts of Staffordshire and Shropshire. (Vide Reports of the Sub-Commissioners for inquiring into employment in Mines, vol. I., pp. 22, 23; articles 182–6; and pp. 38, 39; pp. 305 to 315, and the recent report respecting the employment of children at Nottingham.) In the course of some recent inquiries by Dr. Lyon Playfair he found the increasing sale of opium in the manufacturing towns was ascribable to the increasing use of it in the form of carminative, or as it was named “quietness” for children, and that the consumption of opium by adults had diminished. On inquiring from the druggists who sold the opium what was the cause of the diminished consumption by the adults, the uniform answer was, the “distress of the times,” which compelled them to dispense with luxuries. He however ascertained clearly that from this terrible practice great numbers of children perish, sometimes suddenly from an overdose, but more commonly slowly, painfully, and insidiously. He was struck, however, with the fact of the increased proportions and rapidity of the births in the places where this infantile mortality was prevalent. It was remarked by the people themselves. So that there was no diminution of the numbers of children, but a woeful diminution of their strength and a proportionate increase of their burdensomeness. Those who escaped with life, became pale and sickly children, and it was very long before they overcame the effects arising from the pernicious practice; if indeed they ever did do so.[41]

The most serious consequences, arise from the omission of proper administrative securities for the safety of life in Scotland. On these Dr. Scott Alison states:—

In Scotland there is full opportunity for the perpetration of murder
and burial without investigation by any responsible officer. There
is no coroner and no inquest. I have known cases of the occurrence
of deaths from culpable negligence, to say the least of it, which
required public proceedings to be taken, but where interment took
place without the slightest notice. I had myself a young man of
about 20 years of age under treatment who, in my opinion, died from
culpable maltreatment whilst in prison. He had in a drunken frolic
committed an assault, and was imprisoned in a damp cold cell without
a fire. He certainly died of disease which was very likely to be
produced by the cold which he then endured, and to which he ascribed
it. Before his imprisonment he was a remarkably strong, fine healthy
man. No inquiry was made or thought of in the case. I have known
several cases, and they were not uncommon. I remember two, within
two or three days, of children having been overlaid and killed by
their parents when in a state of drunkenness. They were buried
without any notice being taken of the circumstance by any party,
though if punishment were not inflicted upon them public notice
would have been of importance for the sake of the morals of the
population.

I have known deaths of grown up people from burning when in a state
of intoxication, and deaths from intoxication take place without
inquiry; also deaths from accidents, such as falling into coal pits,
deaths from machinery, as to which in many cases no public inquiry
whatsoever was ever made. I have known cases of children burned to
death who were left without any care. It was a common case in
Tranent for persons to drink for a wager who would drink most. I
know of the case of three tradesmen who drank for a wager; two of
them died within a few days, and the widow of one of them committed
suicide shortly afterwards; and I was informed that they were all
buried without any notice being taken of the fact. There is
certainly a facility for the perpetration of murder in Scotland from
the absence of securities, and for protection of life against
culpable negligence. The visits of an officer of public health would
be of very great utility.

Mr. William Chambers observes:—

It seems to me not a little surprising that in Scotland, which is
signalized for its general intelligence, love of order, and I may
add really beneficent laws, the country should be so far behind in
everything connected with vital statistics. I have already noticed
that it possesses no coroner’s inquest. This is a positive disgrace.
Deaths are continually occurring from violence, but of which not the
slightest notice is taken by procurators fiscal, magistrates, or
police; indeed, these functionaries seldom interfere except when a
positive complaint is lodged. Some time ago, the medical gentleman
who attends my family, mentioned to me incidentally that that
morning he had been called to look at, and if possible recover, a
lady who had been found hanging in her bed-room. His efforts were
ineffectual; the lady was stone dead; and it was announced by her
relatives that she had died suddenly. In the usual course of things,
she was buried. Now, in this case, not the slightest inquiry was
made by any public officer, and whether it was a death from suicide
or from murder nobody can tell. The procurator fiscal, whose duty it
is to take cognizance of such deaths, is, of course, not to blame,
for he has not the faculty of omniscience.

The preventive and detective functions of the officer of health would be the more efficient from the exercise of any such functions being incidental to ordinary functions of acknowledged every day importance, which must lead his visits and inspection to be regarded as _primâ facie_ services of beneficence and kindness to all who surround the deceased. The comparative inefficiency of officers whose functions are principally judiciary is well exemplified in some remarks made by Mr. Hill Burton, Advocate, in a communication on the subject of interments in Scotland.

A prominent defect (as he observes) in the means of inquiry into the
causes of death in Scotland consists in the circumstance that before
any investigation can be entered on there must be ostensible reasons
for presuming the existence of violence and crime. On the occasion
of a death having occurred in circumstances out of the ordinary
course, the only person authorized to make any inquiry as to its
cause is the officer whose proper and ostensible duty it is to
prosecute to conviction. It hence arises that the simple institution
of an inquiry is almost equivalent to a charge of crime, and that
the proper officer, knowing the serious position in which he places
those concerned, by taking any steps, is very reluctant to move,
until the public voice has pretty unequivocally shown him that the
matter comes within his province as a public prosecutor. There is no
family in Scotland that would not at present feel a demand by a
Procurator Fiscal, or by any individual to inspect a body within
their house, as very nearly equivalent to a charge of murder; and I
should think it is of very rare occurrence, that any such inspection
takes place, in a private house, unless when a prosecution has been
decided on.

The absence of any machinery, through which an inquiry can be calmly
and impartially made into the cause of death, without in itself
implying suspicion of crime, is frequently illustrated in the
creation of excitement and alarm in the public mind, which the
authorities cannot find a suitable means of allaying. I remember
some years ago being present at a trial for murder, which, as it
involved no point in law, has unfortunately not been reported. It
was a trial undertaken by the Crown for the mere purpose of
justifying an innocent man. Two butchers were returning tipsy from a
fair; some words arose between them, and soon after, one of them was
found stabbed to the heart by one of the set of knives which both
carried. On investigation, it appeared that the deceased had fallen
on his side, from the effects of drunkenness, and that one of the
knives which hung at his side, dropping perpendicularly with its
heavy handle to the ground, pierced through his ribs to his heart as
he fell. It was impossible, however, to satisfy the public that such
was the case. The feeling of the neighbourhood ran high, and the
Crown was induced, out of humanity, or from a desire to preserve the
public peace, to concede the formality of a trial. I know it to be
of the most frequent occurrence, especially in the north of
Scotland, that suspicions which must be destructive to the peace of
mind of those who are the objects of them, take wing through
society, and can never be set effectually at rest.

§ 205. Mr. W. Dyce Guthrie, after reciting several cases of strong suspicion which came under his observation whilst acting as a medical practitioner in Scotland concludes by observing—

Whether on an inquest before a coroner the real truth would have
been elicited I cannot determine, but I think there can be but one
opinion as to the propriety of having all obstacles removed which
may presently stand in the way of arriving at the truth of all
circumstances connected with sudden and suspicious deaths. Were it
necessary, I could cite many instances of sudden deaths attended by
circumstances of such a nature as not only rendered an investigation
highly proper in a legal point of view, but necessary in charity to
those individuals whose characters were tarnished by the cruelly
unjust insinuations of some black-hearted enemies. The business not
having been thoroughly probed at the time of its occurrence leaves
great latitude for the villanous conjectures of parties whose
interest it may be to damage others in the estimation of the public.

§ 206. Besides supplying the defect of administrative arrangements in respect to the cases of suspicion which at present escape inquiry, the proposed appointment of officers of health presents as a further incidental advantage the means of abating an evil which has been the subject of much complaint, namely, the grievous pain inflicted on the relations and survivors, and the expense to the public by the holding of inquests, which the subsequent evidence and the terms of the verdicts have shown to have been unnecessary. In the metropolis, and in many extensive districts inquests are chiefly moved on the representations of common parish beadles, or by common parish constables, to whom the inquest is usually a source of emolument. This will be admitted to be one of the least secure and satisfactory agencies in towns that could well be employed for so important a purpose. I have been informed of instances where they have been paid to avoid the annoyance of inquests in cases where from sudden but natural deaths, as from apoplexy, inquests might have been held, and that there is reason to believe that such payments have not been unfrequent. Such agency cannot be said to be a secure one either as to integrity or discretion.

§ 207. I am informed by Mr. Payne, the coroner for the city of London, that he has in some cases felt it to be his duty to send a confidential person to make inquiries for him, before he would act on the ordinary sources of information in holding inquests. I have also been informed that other coroners adopt the same laudable practice, and frequently incur the trouble and expense of previous inquiries by more trustworthy persons, in cases where the alleged cause of death is not manifest. The appointment of medical officers of health might be made without the exercise of any new or anomalous powers to relieve the coroners from such necessity, and at the same time give the public cause to be better satisfied that no really suspicious cases were shrouded and concealed, and that none escaped from inadvertence.[42] I believe that on the uses to be derived from the appointment of the officers in question most coroners would concur in the opinions expressed in the following answer received from Mr. Payne.

In reply to your inquiry (respecting the Medical Registrars of
Deaths giving notice to the Coroner of such deaths as may appear to
them to inquire to be investigated by him), I beg to say that I have
long felt there has been something wanting in the machinery by which
inquiries into deaths are, or ought to be regulated.

In cases of death from external violence, where the injury is
apparent, the constable of the district is fully aware of the
necessity of applying to the coroner; but in cases of sudden or
other deaths where there is no cause apparent to a common observer,
there is a necessity for some qualified person forming a judgment as
to the expediency of a judicial inquiry into the cause of death, and
I know of none so well qualified to form such a judgment as a member
of the medical profession. The office of _searcher_, when properly
carried out, was useful as far as it could be in the hands of old
women, but that could only apply to cases in which external violence
was apparent to the view on searching the body. I believe, however,
that the office has now ceased to exist, and the present mode of
registering deaths does not supply any means of detecting unnatural
or violent deaths. I am therefore quite of opinion that a Medical
Registrar (chosen for his ability and _discretion_) who would not
unnecessarily annoy the feelings of private families, and yet make
himself acquainted with the death by personal knowledge, would be a
valuable addition to the present mode of ascertaining and
registering deaths.

_Advantages to Science from the Improvement of the Mortuary
Registration._

§ 208. Extending the view from the private and public immediate and extraordinary necessities which may be met by a staff of well qualified public officers, exercising the duties and powers proposed, to the ordinary but higher public wants, it will be found they may in that position obtain in years, or even in months, indications of the certain means of prevention of disease, for which the medical experience of ages has supplied no means of cure, and only doubtful means of alleviation.

§ 209. There is not one medical man who has acted as a registrar of deaths who has been consulted on this subject, who does not state as a result of his short experience under the registration of the fact of deaths, and even of the distant and imperfect statements of the causes of death, that it has given them such a knowledge as no private practice could give of the effect of habits of life and of locality in producing disease.

§ 210. As a practical instance of the immediate advantages of placing the business of registration under the guidance of medical knowledge, may be cited the following from the statement of Mr. Jones, a medical officer, who acts as registrar of the Strand Union. Speaking of the working of the registration, he says—

I find that neither my experience as a medical officer, for many
years in the parish, nor my experience as a private practitioner,
give me the same extended view of the causes of death as the
mortuary registration. It brings to my knowledge cases which I could
not know as a private practitioner: for example, as to the
occurrence of small-pox or epidemics. In such instances, it is of
use to me, as it sometimes enables me to go to places where I
believe children have not been vaccinated, and suggest to the family
the necessity of vaccination as a measure of prevention. When I have
received information of one or two cases of small-pox, I have looked
to the register of births, and sent to other people to warn them of
the necessity of vaccination.

§ 211. On the advantages which inquiries for the registration of death would give, the concurrent opinions of several eminent medical men may be expressed in the terms used by Dr. Calvert Holland, of Sheffield, who observes that, “From an inquiry on the spot concerning the train of symptoms preceding death, the general examination of the body, or from conversation with the medical attendant, the cause of death, with few exceptions, would probably be assigned with as much accuracy as by any plan that can possibly be devised. We should hail such an appointment as one of great value. Even in those instances in which it is difficult, from the obscurity or undefined character of the symptoms, to say precisely what is the cause of death, the inquiry would tend to dissipate the doubts or obscurity in which it might be involved. The duties of the officer, if he possessed first-rate professional abilities, would give to him a power of analyzing symptoms, of tracing cause and effect, which few practitioners possess or can acquire in a long life of professional exertions. Were the causes of death analyzed and recorded by one having no other duties, and fitted by his accomplishments to undertake the task, the medical and statistical inquirer would possess a body of information on the influence of general local circumstances as well as on particular agents in connexion with manufactures, the just value of which it is not possible to appreciate.”

§ 212. For the promotion of the new science of prevention, and the knowledge of causes necessary to it, a primary requisite is to bring large classes of cases as may be duly observed, under the eye of one observer. It would be a practicable arrangement, on the receipt of the notices of deaths, to direct the visits of one officer chiefly to cases of the same class, for the purpose of collecting information as to the common causes or antecedents. The amount of remuneration included in the estimate hereafter given might be made the means of obtaining additional time and services for carrying the inspections of the officers of health still further into the circumstances of the living; as in cases of consumption or fever, where numbers came from the same place of work or occupation, to visit and ascertain whether there was any overcrowding or any latent cause of disease.

§ 213. In an important paper which Dr. Calvert Holland has written “On the Diseases of the Lungs from mechanical causes,” he gives an account of the physical and moral condition of the cutlers’ dry grinders of Sheffield, whose case may be cited not only as further exemplifying the large evils, § 200, which, in the absence of protective public arrangements, will pass without complaint from the _immediate_ sufferers, but as showing the advantages derivable from any arrangements which bring large classes of cases within one intelligent view, _i. e._ before an officer of health, in presenting clearly common causes of evil, and in suggesting means of prevention, which in single cases or smaller groups of cases might not have challenged attention or justified any confident conclusions as to the remedies available.

It is known that the steel and stone dust arising in the processes of grinding cutlery, is peculiarly injurious to the class of workpeople engaged in it, and that those who continue at the work are generally cut off before they are thirty-five or forty-five years of age. Formerly the same workmen completed several processes in the making of knives, of which processes grinding was only one. At that time the “grinders’ disease” was very little known, and the men lived to about the average age, and were considered the most respectable class of the Sheffield workmen. As the manufacture advanced the labour became subdivided, and one class of workmen were wholly occupied with the destructive process of grinding. Whether their numbers were kept down by the excessive mortality, or a monopoly were maintained by the destructive effects of the process, wages were so high as to allow them to play during a part of the week. Then arose that avidity for immediate and reckless enjoyment, common to all uneducated minds under the perception of a transient existence. When trade was good they would only work a part of the week; they spent the remainder in the riot and the dissipation characteristic of soldiers after a siege. Many of them each kept a hound, and had it trained by a master of the hunt, and their several hounds formed a pack with which they hunted lawlessly, and poached over any grounds within their reach. The grinders pack is still kept up amongst them. They became reckless in their marriages. “The more destructive the branch of work,” says Dr. Holland, “the more ignorant, reckless, and dissipated are the workmen, and the effects may be traced in the tendency to marry, and generally at exceedingly early ages.” He further observes of one class of them, that amongst them “nature appears not only precocious but extremely fruitful.” Their short and improvident career is attended by a proportionately large amount of premature and wretched widowhood and destitute orphanage.

This one class of cases was brought fortuitously under the observation of Dr. Holland, and he has done what a competent officer of health could scarcely have omitted to attempt to do,—to devise means of prevention and reclaim their execution.

One benevolent inventor proposed the adoption of a magnetic guard, or mouth-piece, the efficiency of which consisted in the attraction of the metallic particles evolved in the process of grinding. But the dust to which the grinder was exposed consisted of the gritty particles of the stone as well as of the metallic particles of the instruments ground, and if the invention had been adopted, it would still have left the men exposed to the gritty particles. It was not, however, adopted, nor does it appear that any efficient preventive would be voluntarily adopted by these reckless men. Dr. Holland invented another mode, which acts independently of the men, and which is very simple, and, it is confidently stated, that after a trial of some years, it has proved equal to the complete correction of the evil. It consists of an arrangement by which a current of air, directed over the work, carries from the workman clear out of the apartment all the gritty as well as all the metallic particles. The expense of the apparatus would scarcely exceed the proportion of a sovereign to each grinder. But it is not adopted; and Dr. Holland is in the position of an officer of health, on behalf of mothers and children, to reclaim authoritative intervention and the interests of society to arrest the suicidal and demoralizing waste of life. Having consulted his experience on the advantages of such an office as that in question to the working classes, he speaks in strong and confident terms of the benefits to be derived from it:—