Chapter XX: Section V: The Regulations with regard to the House for the reception (1)

of the Dead._

The following are the regulations regarding the use of the house for the reception and care of the dead, which are here made known for every one’s observance.

(1.) The object of this institution is—

_a._ To give perfect security against the danger of premature
interment.

_b._ To offer a respectable place for the reception of the dead, in
order to remove the corpse from the confined dwellings of the
survivors.

(2.) The use of the reception-house is quite voluntary, yet, in case the physician may consider it necessary for the safety of the survivors that the dead be removed, a notification to this effect must be forwarded to the younger burgermeister to obtain the necessary order.

(3.) Even, in case the house of reception is not used, the dead cannot be interred until after the lapse of three nights, without the proper certificate of the physician that the signs of decomposition have commenced. In order to prevent the indecency which has formerly occurred, of preparing too early the certificate of the death, the physician shall in future sign a preliminary announcement of the occurrence of death, for the sake of the previous arrangements necessary for an interment, but the certificate of death is only to be prepared when the corpse shows unequivocal signs of decomposition having commenced. For the dead which it is wished to place in the house of reception, the physician prepares a certificate of removal. This certificate of removal can only be given after the lapse of the different periods, of six hours; in sudden death, of twelve hours; and in other cases, twenty-four hours.

In case of the thermometer being below 10 degrees of Reaumur, (30 Fahrenheit), removal can only take place when there are unequivocal signs of death, and under the certificate of death from the physician.

(4.) The custody and treatment of the dead in the house of reception is the same for all ranks and conditions.

(5.) The superintendence of the house of reception is conferred upon the Inspector of the Church Yard. He must possess the requisite medical and surgical knowledge, and must be examined by the Sanitary Board with regard to his qualification for the office, and must be instructed according to their direction.

(6.) The guardians of the dead are under the control of the inspector, and must receive a special instruction with regard to their duties.

(7.) The dead which are placed in the house of reception must not be interred until unequivocal signs of decomposition have appeared.

The inspector determines the time of interment.

(8.) The dead, on arrival at the house of reception, are immediately placed in separate rooms, which are built for that purpose, and which are numbered, and there receive all the proper means of security.

(9.) In the house of reception, there are besides these rooms two other chambers; one is used as the animating chamber, the other, as a bath room.

The kitchen, which is also near at hand, is used to furnish hot water, or whatever may be required.

(10.) In case a body gives signs of re-animation, it must be brought immediately into the chamber used for that purpose, when all the means will be applied by the inspector, according to the instructions he has received.

(11.) This chamber, in which there is a bed, must always be carefully locked, in order that it may never be used for any other purpose. The inspector alone has possession of the key of this chamber.

(12.) There must be in this chamber every necessary provision of medicines, and of means of resuscitation and proper ventilation of the air, according to the instruction of the Sanitary Board, and all these arrangements must be kept in most perfect order by the inspector.

(13.) If any particular case occurs in the house of reception, the Sanitary Board must immediately have information of it, and the Board must from time to time examine into the state of the house.

(14.) Permission to friends and relatives to enter the rooms of the dead is not granted unconditionally, on account of considerations of health, but it depends upon the consent of the inspector. Entrance into the waiting hall, from which the rooms in which the dead are deposited range, is at all times allowed to the relatives of the dead.

(15.) A register is kept in the house of reception, in which is entered the rank and name of the dead, the age, the last disease, the day and hour of the death, the placing in the house of reception, and the time of interment, and the name of the last physician. Every registration is signed by the inspector.

(16.) No payment is made for reception and guarding of the dead in the house of reception, nor for the services of the inspector or nurses, nor for the heating of the chambers. These expenses are defrayed from the Interment Fund.

(17.) The inspector and nurses are strictly forbidden to allow any persons to visit them in the buildings of the burial ground.

(18.) When the inspector has been examined by the Sanitary Board, as to his special qualifications, and has passed, the oath is administered to him by the younger burgermeister.

_Instructions to the Inspector in regard to the House of Reception._

(1.) The inspector must be examined as to his medical and surgical knowledge, by the Sanitary Board, and as to his treatment of suspended animation, in which he is specially instructed by the Sanitary Board, and is then sworn in by the younger burgermeister.

(2.) The inspector has to instruct his assistants, and must see that his instructions are strictly followed.

(3.) He must answer for all that is out of order in the house of reception.

(4.) As long as there are corpses in the house, the inspector must not leave his house.

(5.) He has to keep a register, in a form which is prescribed, and must punctually and clearly fill up all the heads of the form.

(6.) As soon as a corpse is brought to the house, the inspector must determine in which of the rooms it is to be placed, and order all the necessary arrangements and means of security, and the attendance of guardians, and must not leave the dead until everything has been arranged for its proper protection and care.

(7.) The Cemetery Inspector must superintend the attendants night and day.

(8.) No corpse can be interred until unequivocal signs of decomposition have appeared. On this matter the inspector has to act according to the instructions of the Sanitary Board.

(9.) Should the case arise, that the dead sets in motion the alarum, or that the nurses perceive a slight colour in the cheek, or a slight breathing, or a movement in the eye-lid, the inspector must immediately arrange that the body be brought into the fresh air of the re-animating chamber, which is properly warmed, and he will there adopt all the other means, on which he has received instructions from the Sanitary Board.

(10.) When these signs of life have appeared, the inspector must immediately give information of the circumstance by a messenger to the physician who last attended the person, in order that a notification of the same may be made to the _Physikat_.

The tidings of the re-animation shall be conveyed to the house of mourning by the physician alone, and then only when there is no longer any doubt of the resuscitation.

(11.) One of the first essentials in the house is cleanliness. The Cemetery Inspector has therefore strictly to watch that everything which belongs to the house is kept most perfectly clean by the nurses.

In order to preserve the purity of the air, he must see that the arrangements for ventilation are kept in perfect order.

(12.) He must also see that the rooms are properly warmed during the cold weather.

(13.) The Cemetery Inspector is not specially paid for his services in the house of reception, but has a house free, besides the salary determined by the Cemetery Commission, and printed in the salary table.

_Instructions in respect to the Watchers or Nurses._

(1.) The nurses, amongst which the sextons may be sometimes employed, are named and appointed by the Church and Cemetery Commission, on good behaviour.

(2.) They are under the superintendence of the Cemetery Inspector, and must obey his orders with the greatest exactitude and alacrity.

(3.) As soon as a corpse is brought to the house the nurses must convey it immediately into the room pointed out by the inspector, and afterwards do all that is required of them by him.

(4.) They must be instructed in all their duties by the inspector.

(5.) He, whose week it is to watch in the warder’s chamber, must never leave the chamber when there are corpses in the rooms, on pain of instant dismissal; but if anything requires him to leave the chamber, he must first summon with a bell, one of the other nurses to take his place.

(6.) The nurses must keep everything in the house in the greatest cleanliness. Any one who has frequently to be reminded of his duties through carelessness shall be dismissed from the situation.

(7.) If roughness be shown by a nurse to the dead, he must be punished with instant dismissal, and a notification of the same must be given by the Church and Cemetery Commission to the police, in order that proper inquiry and punishment be given.

(8.) In case the alarum is set in motion, or any other sign of life is perceived, the nurse must immediately inform the Inspector, and quietly and gently fulfil all his directions.

(9.) The nurses are forbidden to use tobacco in the house.

(10.) They are forbidden to receive any visits in the house, and more especially to allow any person to come during the night into the ward-chamber.

(11.) There shall be in the warder’s chamber a clock, which, by a certain mechanism, can tell when, and how long a nurse may have slept during the night. Frequent negligence of this kind will be punished by dismissal.

No. 2.
REGULATIONS FOR THE EXAMINATION AND CARE OF THE DEAD, AND FOR RELIEVING
THE APPREHENSIONS OF PREMATURE INTERMENTS, PROVIDED AT MUNICH.

_Regulations for the Examination of the Dead._

Whereas it is of importance to all men to be perfectly assured that the beings who were dear to them in life are not torn from them so long as any, the remotest, hope exists of preserving them; so is death less dreadful in its shape when one is convinced of its actual occurrence, and no longer a danger exists of being buried alive.

In order to afford this satisfaction to mankind, and to preclude the possibility of any one being considered as dead who is not actually so; that the spread of infectious disorders be avoided as much as possible; that the quackeries so highly injurious to health may be suppressed; that murders committed by secret violence may be discovered, and the perpetrators delivered over to the hands of justice, is the imperative duty of every wise government; and in order to accomplish these objects, every one of which is of infinite importance, recourse must be had to the Safety Police as the most efficient means, by a strict medical examination into the deaths occurring, and a conformable view of the body.

In consideration of which, the orders already existing on this subject will undergo a strict examination, and, with the august consent of the government of the Isar-Circle, the following general regulations have been fixed upon:—

1. An examination of all dead bodies, at two different times, and this without exception to rank, is henceforth to take place in the metropolitan city of Munich, and the suburbs belonging thereto.

2. The first examination is to be held immediately after death has taken place, and the second shortly before the interment.

3. At the public hospitals, both examinations are intrusted to the acting physician, who has however strictly to observe those regulations relating to the certificates for the examination of the dead.

4. The first examination is to take place at the very spot where death has taken place, or where any dead body may be discovered, by the sworn surgeon of the district: the second examination, however, by the surgeon appointed by and belonging to the Police Establishment.

5. The city of Munich, with the suburbs, are to be divided into Eight Districts; for each of these districts a separate surgeon is hereby appointed, viz.:—

[Here follow the eight districts, with the names and residences of the Surgeons appointed for each district.]

6. As soon as a death takes place, immediate notice must be given by the Soul-nuns, Midwife, &c., &c., or by any such person charged with the arrangements for the burial. This said notice must state the street, the number of the house, and of the floor where the dead body is lying; whereupon the said surgeon has immediately to go there, and conduct the investigation according to his instructions.

7. Previous to this, and before the first examination has taken place, it is neither permitted to undress nor to clean the dead body: nor is the body allowed (in cases of natural death) to be carried out of that room where death has taken place, or to be removed from the spot; and it is not even permitted to remove the cushions from under the head of the dead body. Every violation of this decree will be punished with a fine of from 5 to 15 florins, or with imprisonment from one to three days.

8. Those regulations issued by the examining surgeon respecting the treatment of the dead body, or which relate to the clothes and other objects of the deceased, must be strictly obeyed.

9. After the examining surgeon has convinced himself that every hope of re-animation has disappeared, he fills up the certificate of examination according to his instructions; but be it observed at the same time, that if a medical man has attended the deceased, such is bound to enter in the said certificate the description of the disease, and to certify it by his signature.

10. If the dead body remains in the dwelling-house until the burial takes place, the second examination by the surgeon from the Police must be held there; and for this reason the certificate must be forwarded into his hands as soon as possible.

11. But if the dead body after the first examination has been removed to the house for the reception of the dead, in order to remain there, this said certificate should previously, or at the delivery, be taken to the Inspector of his Institution, in order that no obstacle may arise to its reception.

12. The utmost cleanliness and greatest order is to prevail in this said house for the reception of the dead, where the dead bodies removed there are to be placed under a perpetual and proper watch; and the Police Surgeon is bound to call at the Institution twice every day, namely, in the morning and in the evening, to institute a very minute examination of the dead bodies there; and in case of any signs of re-animation, to render speedy and the most serviceable assistance.

13. If the medical man who conducts the second examination perceives those signs in a corpse which do not leave any doubt whatsoever that a death has taken place, he then enters the verification in the certificate, which thereupon is taken to the Directory of Police, who then grant the permission for the interment.

14. Without such a legal certificate permitting it, no body is allowed to be buried; and that Priest or Clergyman who will assist at any burial without having seen this certificate forfeits a sum from 15 to 30 florins.

15. Proper arrangements have been made that the Printed Forms for the decreed Certificates may always be obtained at the Directory of Police, and will be delivered gratis to the officiating medical men of the Public Hospitals, as well as to the Examining Surgeons; a receipt however must be given for them.

16. All those persons nominated for the execution of these measures, as the Soul-nuns, Midwives, attendants at the house for the reception of the dead; the Inspector of such House, the Examining Surgeons, the Surgeons of the Police, &c., &c., will be supplied with the printed regulations, as well as the most minute instructions, for which purpose they will be sworn, and be ever subject to a rigorous inspection.

_Munich, Nov. 20, 1821._

[The regulations which follow this are chiefly as to the different
prices of different degrees of the religious service.]

_Regulations for the Guards or Watchers at the House for the reception
of the Dead near the Burial Ground at Munich, with reference to the
Inspection of Dead Bodies._

1. There must be at least two health-worthy and active men, as trusty as possible, appointed as Body Watchers, and specially sworn in by the Police.

2. When a body is intended to be placed in the house for the reception of the dead, it must be previously notified to the Inspector of the same, and the before-mentioned “Examination Ticket,” or a special official order, be delivered over to him.

3. It is forbidden to the Body Watchers to place any body there without the previous knowledge and concurrence of the Inspector.

4. Should no obstacle arise, the corpse is then received by the Body Watchers, and deposited in the place appropriated to it.

5. The cover of the coffin must then be immediately withdrawn, the face of the deceased uncovered, and the hands and feet disengaged from the bandages attached to them.

6. The place where the bodies are watched must be kept warm day and night, and lighted during the night without interruption.

7. Great cleanliness is to be observed, and a supply of pure air to be kept up.

8. The Watchers must constantly remain in the watch-room, and frequently by day and night enter the room for the reception of the dead, in order carefully to observe the bodies lying there.

9. The Police Surgeons will particularly instruct the Body Watchers as to what signs or appearances they are especially to observe, and how they are to act with regard to them. On this point they are to take the greatest care.

10. Should any sign or appearances which may betoken re-animation proceed from any body, it must be immediately brought into the watch-room with every care and precaution, and placed on the bed provided with mattrasses and blankets for that purpose.

11. On such an event occurring, not only the Inspector must be informed of it, but the Police Surgeon must be called in without a moment’s delay.

12. As to the treatment of the body until the arrival of the Surgeon, the Inspector and Body Watchers are informed by the Police Surgeon. In all cases must warm water be prepared, and the safety apparatus arranged.

13. The body, thus awakened from its sleep, must be treated with extreme care, and everything must be avoided likely to create any strong impression on it.

14. No coffin wherein a body is placed must be closed, nor must any preparation for the burial take place, until the distinct permission from the Police Surgeon is issued.

15. The entrance into the room for the reception of the dead is allowed to every one under proper restrictions, care being taken that the quiet and good order there are not disturbed.

16. Any Body Watcher who shall be convicted of any neglect in the performance of his duties, will be punished with a proportional fine and imprisonment, and dismissed on a repetition of the offence.

_Munich, Nov. 20, 1821. Royal Police Direction._

_Regulations for the Proceedings at the Second Examination of the
Corpses by the proper nominated Surgeon of the Police._

1. The second examination of the deceased must be performed by the appointed Police Surgeon, who must, however, take particular pains to satisfy himself that the first examination has been duly executed, that the certificates were properly drawn up, that the Soul-nuns have fulfilled their various duties, and that both the Inspector, as well as the appointed Watchmen belonging to the house for the reception of the dead, have duly discharged the duties with which they are intrusted, and that, moreover, nothing has been undertaken or omitted that should not be in accordance with the various intents and purposes of the decreed examination of the bodies.

2. This said Surgeon must be supplied with a copy of all the regulations relating to the examination of the bodies, as well as copies of all such regulations for the guidance of all others charged with the performance of any of these duties.

3. If the Surgeon who is appointed by the Police feels convinced that by one person or other any act has been performed contrary to the prescribed duties, or that any negligence in the execution of the service exists, he must, on pain of personal responsibility, give immediate notice to the Police.

4. The same (the Police Surgeon) is bound to issue proper instructions, more particularly to the Soul-nuns, to the Inspector of the house for the reception of the dead, and to the Watchers and attendants of the said institution, as well as to all individuals assisting at any of the examinations; which said instructions relate to the method of proceeding, and treatment of the dead bodies, especially in such a case where re-animation might again take place, and repeated caution must be given on this subject.

5. The second examination with which he is charged must either be undertaken in that house where death has taken place, or in the house for the reception of the dead. In the first case, when, for instance, the deceased is kept at the house where death has taken place until the final interment, the Police Surgeon must receive the necessary information through the medium of the examining ticket, which has been issued and signed by the medical man of the district, and which ticket must be forwarded to him, either through the Soul-nun, or through any such person charged to attend the deceased.

6. The stated sickness, or the manner how death ensued, as also the time in which deceased is to be buried; all of which, having been entered on the ticket, must serve him for guidance whether the second examination must be more or less accelerated. In all cases, however, such must be undertaken as timely as possible, so that generally interment may take place after 48 hours.

7. He has, accordingly, to go to that place stated in the certificate of examination, examine the corpse with due minuteness, and, in case the burial may be proceeded with, he has to state it in the certificate; such is then to be forwarded to the Royal Police, where the permission for interment is granted.

8. If it is intended to remove the body to the house for the reception of the dead, such may take place without any hesitation after the proceedings of the first examination; and in this case the Police Surgeon must find both the body and certificate at that place.

9. The Police Surgeon is bound to attend twice every day at the house for the reception of the dead of the burial-ground, viz., every morning from 9 to 10 o’clock, and in the afternoon from 3 to 4 o’clock. On his arrival, such dead bodies, with their certificates, which have been examined, must be shown to him; he examines them, and signs those certificates which do not admit of any delay; which certificates are afterwards forwarded to the Royal Police authorities, in order to procure the certificate of permission for the burial.

10. Of all such dead bodies having undergone the second examination by the Police Surgeon, and which have been considered by him proper for burial, minute lists must be kept by him containing the consecutive numbers, as well as the statement of that day on which the interment has been ordered, and all such observations which have been entered in the certificate of examination.

11. Such corpses which from the manner of their death are subject to any judicial examination or dissection, will, after their previous dissection, be received by the proper judicial authorities, and the interment is to take place according to the existing orders.

12. Should information be forwarded to the Police Surgeon that signs of re-animation have been observed in any body, it is to be his first and most sacred duty to attend instantly at the place and spot, in order to conduct all attempts at restoration, and to issue orders about the mode of treatment of the re-animated body.

13. Attending minutely to his duties, it is certain that he may perceive divers symptoms which are not only important to him as Examining Surgeon, but also as surgeon to the Police; he has therefore to attend minutely to such observations, and, together with his own, communicate such to his superior authorities.

14. In case the Police Surgeon should be prevented, either by indisposition, absence, or any other cause, from conducting the examinations with which he is intrusted, he is forthwith to give immediate notice to the Royal Police, in order to provide for a proper substitute, whom he may himself propose.

15. It is fully expected from the Surgeon of the Police, that, impressed with the importance of the business he is charged with, he will do all in his power to attain the manifold important objects belonging to it. Any negligence of which he may be guilty will be rigorously punished, and on a repetition of the offence he will be discharged.

_Royal Police Direction, Munich._

_Instructions to the Soul-Nuns as to their Duties in regard to the
Inspection of the Dead._

(1.) As soon as a person is dead, or appears to be so, the nurse or sister of charity in attendance is immediately to give information of the same to the medical man appointed to the district.

(2.) For this purpose she obtains the _form of notification_ for conducting the inspection of the dead, which contains the divisions of the districts of inspection, and the names of the physicians appointed to each district.

(3.) In order that the physician may inspect _immediately, and without the slightest delay_, the case of death in his district, the name of the street, the number and floor of the house in which the death occurs is to be given with exactness, so that he may not in any way be hindered in going to the place and making the earliest possible inspection.

(4.) Before this inspection has taken place, it is expressly forbidden to undress the corpse, or wash it, or, if the death is a natural one, to remove it from the bed or room in which the death took place, or even to take away or alter the position of the pillow.

(5.) Any disobedience to this law will be punished by a fine of from 5 to 15 florins, or by a three days’ imprisonment.

(6.) The physician will make a note of all the circumstances of the first inspection, according to his instructions. If he should consider that particular arrangements are necessary, they are to be adopted immediately.

(7.) His note of remarks shall be left at the house, in the charge of the soul-nun, and through them the signature of the physicians attending the person who had died, if such there has been, shall be procured.

(8.) If the dead is retained at the house till the time of interment, the note of inspection must be directly handed over to the public surgeon, in order that he may make the second inspection, and determine further what is necessary with regard to the interment.

(9.) If after a certain length of time he sees no reason to postpone the interment, he will make a note to that effect and give it to the police direction, and from them is procured the sanction for the interment.

This sanction will be given in to the clergyman’s office belonging to the district, and thence handed over to the officer who has the care of the house for the reception of the dead previous to interment. Without this sanction no corpse can be interred.

(10.) The corpse must be retained until interment in an apartment where there is fresh and pure air. The coffin must not be closed, nor the face covered till after the second inspection, and the hands and feet must not be bound.

If any signs of life should be observed, the district physician is immediately to be called.

(11.) If the corpse is conveyed into the house for the reception of the dead, the second inspection must be made there. The district physician’s note of inspection is to be given to the officer of the house for the reception of the dead at the time, or before the corpse being brought there, and that officer is to hand over the note to the public surgeon. Without this note of inspection, no corpse can be received into the house for the reception of the dead.

(12.) The soul-nuns, or midwives, or whoever is intrusted with this office, must wait for the second inspection, and for the time when the public surgeon shall pronounce that the interment is necessary. For this purpose the surgeon will make the requisite certificate, which must then be given to the proper officer, who immediately gives the sanction for the interment.

(13.) As the second inspection in the house for the reception of the dead must take place, according to the regulations, in the morning between 9 and 10, and in the afternoon between 3 and 4, the sanction for interment may be procured between 11 and 12 in the morning, and 4 and 5 in the afternoon.

No. 3.
DEFECTIVE ARRANGEMENTS FOR THE VERIFICATION OF THE CAUSES OF DEATH.

_Thomas Abraham_, Esq., Surgeon.

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 to 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.

In the course of your practice, have you had occasion to believe that evil is produced by the retention of the corpse?—Yes; I can give an instance of a man, his wife, and six children, living in one room, in Draper’s Buildings. The mother and all the children successively fell ill of typhus fever: the mother died; the body remained in the room. I wished it to be removed the next day, and I also wished the children to be removed, being afraid that the fever would extend. The children were apparently well at the time of the death of the mother. The recommendation was not attended to: the body was kept five days in the only room which this family of eight had to live and sleep in. The eldest daughter was attacked about a week after the mother had been removed, and, after three days’ illness, that daughter died. The corpse of this child was only kept three days, as we determined that it should positively be removed. In about nine days after the death of the girl, the youngest child was attacked, and it died in about nine days. Then the second one was taken: he lay twenty-three days, and died. Then another boy died. The two other children recovered.

By the immediate removal of the corpse, and the use of proper preventive means, how many deaths do you believe might have been prevented?—I think it probable that the one took it from the other, and that if the corpse of the first had been removed the rest would have escaped; although I, of course, admit that the same cause which produced the disease of the mother might also have produced it in the children. I believe that, in cases of typhus, scarlatina, and other infectious diseases, it frequently happens that the living are attacked by the same disease from the retention of the body.

Have you had occasion to observe the effects of cesspools in your district?—Yes, and that they are very injurious to the health. In the states of the weather when offensive emanations arise from the cesspools and drains, I have often heard people complain of headache, giddiness, nausea, languor, and an indisposition for exertion of any kind; and I have known a walk or a ride in the open air to remove those symptoms, but in an hour or two after their return home they have found themselves as bad as before. Their sleep brings them little or no refreshment; in truth, they have inhaled, during the whole of the night, the noxious atmosphere, which is very depressing, and will fully account for their rising, as they often say, as tired as when they went to bed. As an example, I may mention the case of a compositor, residing in Draper’s Buildings—a narrow, confined, and filthy place, where there was always a disgusting stench in every house. He was the subject of disordered stomach and liver, which might have been induced by his night-work and intemperance: the stinking hole in which he resided contributed its share towards it, without doubt. This man remained at home for a week, when he was getting better, but had scarcely any appetite. I advised him to walk in Finsbury Circus two or three times a-day, as long as he could without fatigue; and on several occasions, when he returned to his dinner, he said, “Now, if I had had my dinner in Finsbury Circus I could have eaten a hearty one, but now I do not seem to care anything about it.” I believe that if I had entered that man’s house with a good appetite for a dinner, and had remained there for an hour, that I should have cared no more about eating than he did,—which I attribute to the nauseating and depressing effects of the effluvia from the cesspools, drains, and general filthiness of the place.

Are you aware whether this state of things arose from the cesspools or the state of the sewers?—I conceive the worst have been cesspools; but the drains, if they open, are just as bad. I was called upon to visit a patient living in a court in Whitecross Street, ill of typhus fever; in the centre of it was a gully-hole, which was untrapped and smelt horribly. The fever went through the whole of that court. I gave it as my opinion at the time, that the case I visited was occasioned by the gully-hole, and that the fever would go through the court, which it did.

Have you perceived the present state of the drains in the city of London?—At times they smell very strongly, which scarcely any one can fail to notice; but I have heard country-people complain of them at times when they have not attracted any particular notice from me.

Are you aware that decomposing matter is allowed to accumulate in them?—Yes; very recently they took up the refuse in our street, Old Broad Street; it smelt very badly, and it was black and horribly filthy.

How long before had the sewer been cleansed?—I do not know. I do not remember its having been cleansed, before the last September, since I have been there, which is about nine years.

Do you remember to have perceived the smell from the sewers before the last September?—Yes; there is a gully-hole near my own house from which there was constantly an offensive smell: it was much worse after a thaw in winter, or a shower of rain in summer. A neighbour living two doors from me being more annoyed by it than I, made great efforts, and at length succeeded in getting it trapped; and I have not since perceived any smell from it, though I observe it now in other places. The gully-holes are trapped now in most of the respectable streets, but in the bye and poor streets they are not trapped.

From the evidence which has come before you, have you any doubt that the existing state of sewers in the City are the latent cause of much disease and death?—I have not the least doubt of it in the world.—A great deal of active disease, which creeps on gradually and insidiously, may be traced to that cause.

In the poorer districts, in what state is the surface-cleansing of the streets?—Even the best streets are very badly cleansed, but in the poorer streets of the city the cleansing is very bad indeed—horribly bad! Take Duke’s Place, for example; you will see cabbage-stalks and rotten oranges that have been thrown away, and they often remain there for several days. We do not get our streets swept oftener than once a-week.

If there were a perfect system of drainage and cleansing in the city, do you think that the health and the duration of life of the inhabitants would be extended?—I think there would be a considerable extension.

What is the physical condition of the children born in London of parents who are natives of the rural districts, as compared with the physical condition of children who are born in the country of parents of the same class?—The children born and bred up in London are more frequently of small stature and have slender limbs, are deficient in stamina and powers of endurance, are of irritable frames and prone to inflammatory attack, than children born and bred up in the country. An impure atmosphere is immeasurably more injurious to children than adults. Children also suffer more from want of opportunities of exercise in the open air. The beneficial effects of pure air and exercise on children who have been born and pent up in London are most marked: a weakly child, and which, if kept in London, would perhaps always continue weakly, would most likely become strong and healthy if sent into the country. I cannot doubt that children born of healthy parents, and bred up in the country, would be more robust and stronger than children born of the same class of parents and bred up in London, and that this difference may be justly ascribable to atmospheric influence.

When children are weakly, what is the effect on the temper and character?—The temper and character of weakly children are generally found to correspond with, and are most probably derived from, the character of their constitution: their temper is quick and irritable, their passions ardent, their perception keen, and their imagination predominant over their judgment.

You are speaking, of course, of the general characteristics of individuals as specimens of the population brought up under such circumstances?—Yes, of persons coming under my own observation.

Have you, as Registrar of Deaths, noticed the larger proportion of infant mortality in the city?—There is, I conceive, all over the kingdom, a large proportion of infant deaths; but I have no doubt that a considerable proportion of the excess of infant deaths in London is ascribable to atmospheric influences.

It appears, from the Mortuary Registration, that of deaths in the city of London, about one-half are deaths of children under ten years of age; whilst in a rural district, take the county of Hereford for example, only one-third of the deaths are deaths of children.

Do you conceive it probable that this different rate of infant mortality is to be traced chiefly to the difference of the atmospheric influence, the average age of all of the labouring classes being, in Herefordshire, 39 years, whilst in the City of London the average age of the deaths of all the labouring classes is only 22 years?—I am decidedly of opinion that a greater proportion of the excess of infant mortality in London, and the reduced duration of life, are ascribable to atmospheric impurity.

If all cesspools were removed, and water-closets substituted; if water were introduced into the houses of the poorest classes; if the sewers were regularly flushed weekly, or oftener, so as to prevent accumulations of deposit and the escape of miasma, such as you have described; if the carriage and foot pavements were more frequently and completely cleansed; if these several public duties were performed with practicable efficiency, can you express a confident opinion that decrease and premature deaths would be considerably diminished?—I am quite confident that the adoption of such measures would not only diminish disease of every kind, but greatly improve the moral as well as the physical condition of the inhabitants.

No. 4.
THE PROPORTIONS OF DEATHS AND FUNERALS PREVENTIBLE BY SANITARY MEANS.

_Henry Blenkarne_, Esq., South West District Surgeon of the City of
London Union.

Have you in your district perceived any effects resulting from interments in the parochial burying places?—I have no cognizance of any bad effects resulting from those interments. The first twenty years of my life I lived close to a burial-ground, and never was aware or heard of any prejudicial consequences arising. I may observe, however, that when a relation of mine has attended the church she has been enabled to perceive whenever a vault underneath the church has been opened. She has said, “I feel they have opened a vault;” and on inquiry it has turned out to have been so.

Have you observed any evil effects following the practice of the long retention of the corpse in the house amidst the living?—Yes, I have observed effects follow, but I cannot say produced by them, though they were perhaps increased by them. In those cases which I have had where there has been a succession of cases of fever in the same family, after a death it has generally occurred that the parties affected have complained two or three days before that they felt very unwell. Generally this has been the case. I have, in such instances, ordered them medicine immediately. Since the Union has been established we have immediately removed all fever cases to the Fever Hospital.

The retention of the corpse amidst the living, under such circumstances, must aggravate the mortality, must it not?—There cannot be a moment’s doubt about it.

What, from the observations in your district, has been the actual state of the sewerage, and cleansing dependent upon it, as the cleansing of the cesspools?—There has been great improvement in the city of London by the improvement of the sewerage, in so far as it has removed the cesspools. When you went into a respectable house formerly, you could, in the city, tell the state of the weather by the smell from the cesspools. Where water-closets are substituted, the health of the inhabitants has undoubtedly been improved. In the poorer neighbourhoods, where they have still cesspools, they are still very bad. I constantly tell them, if you get rid of that nasty cesspool you’ll get well and keep well; it is of no use my giving you physic until that is done. Where there have been deposits accumulating in the sewers, and the drains have been choked up, the effect has been just the same as if there had been cesspools.

You are aware that in respect to sewerage it is the practice to allow deposits to accumulate in the sewers, and then, when the private drains are stopped up, to open the sewer and get out the deposit by means of buckets, and remove it in carts?—Yes, I am.

Have you seen any illness result from this practice?—I cannot state a case, though I have no doubt of its highly injurious effects; but can decidedly speak to illness arising from the accumulations. The illness is just the same as from cesspools: a low depressing nervous fever, most like that which is described to be the form of the jungle fever. In November or December last, they were taking up the deposits from the sewers near Broken Wharf, in Upper Thames-street: the stench from it was quite sufficient to have produced any fever: it was not within my district, and I do not know what were the effects. Fortunately there was clear weather, and the wind blew towards the river.

Have you any doubt that the removal of such refuse, as well as the accumulation, must be attended with danger to life?—Yes; if any person in a state of mental or bodily depression were exposed to such an influence, it would produce low fever; it would be dangerous in proportion as it was stagnant.

In passing through the city, have you been assailed with smells from gully-holes?—Only yesterday, in passing through the city, the smells from many of the gully-holes were very offensive; and several medical friends agree with me in attributing extremely prejudicial consequences as arising from this cause.

The following case is related on the authority of Dr. Good, as having occurred within the city of London, and is mentioned by Mr. Fuller, in a letter from a surgeon who has paid great attention to the influence of sewerage, and who adduces the facts of the case in evidence that typhus may be produced by the miasma from sewers:—“Soon after the closing of the Parliamentary Committee, I learned, from the late Dr. Hope, the particulars of a case which, to my mind, has completely proved the production of typhus fever from it, and was so much in the character of an _experimentum crucis_, that I did not consider it necessary to prosecute the inquiry any further. The case is as follows:—“A family in the city of London, who had occupied the same house for many years, enjoying a good state of health, had a nursery-maid seized with typhus fever; the young woman was removed from the house and another substituted in her place. In a short time the new nurse-maid was attacked with typhus fever, and was also sent away. A few weeks after one of the children was seized with the same fever: an inquiry was now instituted by the medical man in attendance, in order to ascertain, if possible, the cause of this frequent recurrence of typhus fever, when the following facts were brought to light:—The nursery was situated on the upper floor but one of the house, and about a fortnight or three weeks before the first case of fever occurred, a sink was placed in the corner of the nursery for the purpose of saving the labour of the servants; this was found to communicate with the common sewer, and to be quite open, or untrapped; they ordered it immediately to be effectually trapped, and then no other case of fever occurred, although it continued to be occupied as before; and, when I learned the case, more than a twelvemonth had passed.””

Have you met with cases analogous to the one here stated?—I have met with several such cases. I know of an instance where a room in an old house had an offensive stench, and the health of the person living in it was always bad. A stench was perceived in the room, which it was guessed might arise from the decay of dead rats in the wainscot. The party went to much expense to pull down the wainscot, when it was found that there was an opening which communicated with the cesspool below. The hole was properly cemented and stopped up, and the room has since that time become quite habitable and healthy; and where I have directed the cesspools to be emptied, as the predisposing cause, the general result has been that the sick have immediately got well. From my knowledge of the local causes I can predicate, with certainty, what will be the general effect on the health in the case of removal of the parties.

Besides the houses of the labouring classes, are there many houses of the middling classes in your district in the city of London that are provided with cesspools?—Many houses that I go into are provided with cesspools. I mentioned the other day to a lady that I should never be enabled to keep her well so long as there was a cesspool in the house; I told her that the expense of continued medical attendance would pay for a communication with the common sewer and better cleansing.

Are you aware that a new practice has arisen of preventing the accumulation of deposits in the sewers, by flushes of water, which remove all deposits weekly, and so far prevent the year’s accumulation and corruption of deposits in the sewers. If this system were enforced in the city, have you any doubt as to the extensive prevention of disease and mortality which would be thereby effected amongst all classes?—Certainly it would be a great boon, in a sanitary point of view, to the population of the city of London. I am so much convinced of this, that in my own house I put a stick under the handle of the water-closet, so as to have a continued flow or flush of water for some length of time; this I do to remove any accidental accumulation. Of course the flushing of the common sewers would have the same effects.

Besides the accumulations in the sewers, is there at this time no decomposing refuse from the defective cleansing of the courts and bye-streets, and poorer districts?—Yes; in the poorer districts there is accumulation. In one court, for example, called Harrow-court, Thames-street, where there is almost always low fever, there is always dirt and filth, and I am constantly exhorting the people to remove the filth; but the great difficulty with the poor people is commonly how to get the water. There is a court in Cornhill which a man was cleansing the other day by applying a hose to the water-cock (which is used in case of fire), in order to cleanse the pavement. An officer belonging to the water company coming by, said, “If I see you doing that again, I shall indict you.”

Are you aware that the streets are swept oftener than weekly in the city of London?—My impression is—not oftener.

It has been proposed that water should be laid on, and kept at high pressure in the streets, so as to enable the courts and alleys, the foot and the carriage pavements, to be washed daily by means of a hose attached to the water-pipes. This, which has been proposed for protection against fire, as well as for cleansing the streets more completely, has, I am informed, been done in Philadelphia. If the system were carried out in the city of London, what do you conceive would be the effect on the health of the population in the poorer districts?—I should certainly say that it would tend greatly to prolong life amongst the population.