INTERMENTS IN TOWNS. (continued 6)

Here lie I beside the door,

Here lie I because I am poor;

Further in the more they pay,

Here lie I as well as they.

But it may be a question whether the very numbers of funerals, which must take place for a large town, with the extent of the burial places, may not be made a source of solemnity and impressiveness, which may in some degree compensate for the individual and immediate interest excited by a funeral in a small parish. That which at present, when left to a single harassed and exhausted clergyman, and one sexton, and a few wretched assistants, can hardly avoid the appearance of hurry and confusion, might be so regulated as to impose, from the very gathering of such masses of mortality, bequeathed together to their common earth, not (let me be understood) in one vault or pit, but each apart in his decent grave. The vast extent of cemetery which would be required for London (suppose six or eight for the whole metropolis and its suburbs), if properly kept, and with such architectural decorations, and the grand and solemn shade of trees appropriate to the character of the ground, could scarcely fail to impress the reflective mind, and even to awe the more thoughtless. Our national character, and our more sober religion, will preserve us, probably, from the affectations and fantastic fineries of the Père la Chaise ground at Paris. From some of the German cemeteries we may learn much as to regulation, and the proper character to be maintained in a cemetery of the dead.

National sepulture is a part, and a most important part of national religion; of all the beautiful services of our Church, none is more beautiful (I might wish, perhaps, two expressions altered) than our service for burial. I could have wished that the Church had taken the initiative in this great question. I trust that she will act, if the State can be prevailed upon to move, in perfect harmony with the general feeling on the subject. It is fortunate, that in the Bishop of London we have not merely a person of liberal mind, and practical views, but one who brings the experience of the parish priest of a large London living to his Episcopal authority and influence.

One further practical suggestion occurs to me as likely most materially to diminish the expenditure of funerals of all classes, and therefore to render any great scheme more feasible. A funeral procession through the streets of a great and busy town can scarcely be made impressive. Not even the hearse, in its gorgeous gloom, with all the pomp of heraldry, and followed by the carriages of half the nobility of the land, will arrest for an 153instant the noise and confusion of our streets, or awaken any deeper impression with the mass than idle curiosity. While the poor man, borne on the shoulders of men as poor as himself, is jostled off the pavement; the mourners, at some crossing, are either in danger of being run over or separated from the body; in the throng of passers no sign of reverence, no stirring of conscious mortality in the heart. Besides this, if, as must be the case, the cemeteries are at some distance, often a considerable distance, from the homes of the deceased, to those who are real mourners nothing can be more painful or distressing than this long, wearisome, never-ending—perhaps often interrupted—march; while those who attend out of compliment to the deceased while away the time in idle gossip in the mourning coach, to which perhaps they endeavour to give—but, if their feelings are not really moved, endeavour in vain to give—a serious turn. Abandon, then, this painful and ineffective part of the ceremony; let the dead be conveyed with decency, but with more expedition, under trustworthy care, to the cemetery; there form the procession, there assemble the friends and relatives; concentrate the whole effect on the actual service, and do not allow the mind to be disturbed and distracted by the previous mechanical arrangements, and the extreme wearisome length of that which, if not irreverent and distressing, cannot, from the circumstances, be otherwise than painfully tedious.

It may be worth observing that, in London, even the passing bell seems almost lost in the din and confusion. This is the case even in the old churches, which retain their deep, full, and sonorous bells. The quick shrill gingle, or the feeble tone of those which are placed in the chapels of the more recent burial-grounds, instead of deepening to my ear, are utterly discordant with the solemnity of the service. In the country nothing can be finer than the tolling from some old grey church tower—

Over some wide watered shore,

Swinging slow with solemn roar.

What would be the effect of a bell as large as St. Paul’s, heard at stated times, or in the event of the funeral of some really distinguished persons, from the distant cemetery?

§ 178. The formation of national cemeteries would give the means of more special and appropriate service for the interment of the dead than it is now possible to provide by small parochial establishments. In the more populous parishes, the service is unavoidably hurried. In all, the feelings of survivors require the most full, respectful, and impressive service. In many of the rural districts, the friends and fellow-workmen of the deceased accompany the remains to the grave, and one object of subscriptions to burial and general benefit clubs is to secure the advantages of arrangements for the attendance of fellow-workmen, who are members of the same club. When a waterman dies, to whom his brethren would pay respect, the body is conveyed by them in an eight-oared cutter, to the churchyard by the water-side. On their return, the seat which the deceased would have occupied is left vacant, and his oar, tied with a piece of crape, is placed across the boat. One of the most popular and impressive of funeral ceremonies is that on the interment of a private soldier. When a private of the metropolitan police dies, a number of members of the force, and a superior officer, attend his funeral in their uniforms. It is not unfrequent when a member has been invalided and left the force, that he will make it a dying request that his funeral 154may be attended by the officer and men with whom he served. This request is generally complied with. Old soldiers who have been invalided frequently make it a dying request to the commanders of the regiments in which they have served that they may be buried as if they had died in the service; and unless there be an exception to the respectability of their conduct, the honour and consolation is bestowed.

§ 179. In Scotland, it is a subject of intense desire on the part of the labouring classes to gain the attendance of some person of higher condition at their funerals. When an aged and exemplary member of a congregation dies, it is not unfrequent that the minister’s eldest son will pay respect, by acting as one of the bearers of the corpse. In many of the rural districts in England, the persons composing the procession will sing hymns. In the churches, anthems are still sung, and funeral discourses given in the manner described by the Rev. Dr. Russell, the rector of Bishopsgate.

When I was a boy (says the reverend gentleman), nothing was more common, in the parish of which my father was rector, than for the body to be brought into church before the commencement of the evening service on Sundays. The psalms and lessons appointed for the burial service were read instead of the psalms and the second lesson of the evening. At the time of singing, a portion of those psalms which have reference to the shortness of life was sung; and sometimes an ambitious choir would attempt a hymn—‘Vital spark of heavenly flame,’ or the like. Since I have been in orders, I have myself occasionally, in the country, buried persons with a similar service. Sometimes funeral sermons were preached.

§ 180. The natives of the provinces, when they attend the remains of their friends to the grave in London, frequently express a wish to have anthems or such solemnities as those to which they have been accustomed.^[38]

§ 181. The formation of national cemeteries would enable the ecclesiastical authorities to provide means for complying with the desire thus expressed. Under general arrangements, with reduced expenses, it will be seen that ample pecuniary provision for it may be made to give to the funerals of the many the most impressive 155solemnity. On this subject, the Rev. Mr. Stone, rector of Spitalfields, observes—

Should the legislature determine upon removing the burial of the dead from populous places, it would get rid of these mischiefs; and should it adopt a national system of burial instead of the highly objectionable parochial system sketched out in Mr. Mackinnon’s Bill, it might do much more—it might greatly add to the solemnity of our burial obsequies, and so make them at once more impressive and more attractive. This might be done by concentration; instead of the parochial clergyman, hurried to the performance of this affecting service, when his time, attention, and sympathies are engaged by other duties, summoned desultorily to it, and often compelled to repeat it over and over again at the same grave, just as the interest or the convenience of undertakers, the caprice, the bigotry, or the carousals of mourners may choose to prescribe, let ministers appointed to officiate in national cemeteries perform the service over great numbers at once, and at two or three stated hours in every day. But the performance of the burial service over great numbers at the same time would add incalculably to its solemnity. In the present state of things, simultaneous interments are supposed, as they certainly are primarily intended, merely to save the time and labour of the clergy; and they may sometimes be hurried through in a manner so careless, slovenly, and unfeeling, as not even the necessities of the clergy can excuse. But it is quite a confusion of ideas to suppose that the practice itself is slovenly and unfeeling. On the contrary, I find it more impressive in its effect upon myself; and I think it must prove so to others. Two or three coffins, placed with their sable draperies in the body of the church, are in themselves an awful spectacle; and the attendant mourners, occupying the surrounding pews clothed in the same livery of death, form a congregation at once appropriate, and large enough to give effect to a religious service. By their numbers, too, they operate against the intrusion of idle gossips and inquisitive gazers, and, associated as they are with each other in a bereavement of the same kind, they are thus brought into a contact calculated to kindle emotions of social sympathy and religious sensibility. Assembled in the burial ground round the same grave, or disposed in groups by the side of graves within a reasonable distance of each other, they form a picture of the same affecting and impressive character. If the sympathy of a public assembly is perceptible or intense in proportion to the numbers that compose it, this aggregation of burials need only be limited by the effective power of the human voice.

Judging from an experiment of my own, I think that these salutary effects would be heightened to a thrilling degree by music. And from the practice of the highest civil and ecclesiastical authorities, I presume that the introduction of music into the burial office is not inconsistent with the rubric. At a burial already alluded to, I acceded to a special request by allowing the introduction of some organ-music; and, having no rubrical directions on the point, I selected two parts of the service as those in which music seemed to me to be most admissible, and most likely to prove impressive. After the officiating minister has preceded the corpse from the entrance of the church and read the introductory sentences, there is an interval, during which he ascends the desk, the mourners take their places in the pews assigned to them, and the corpse is deposited in the body of the church; and there is a still longer interval, during which the melancholy procession leaves the church for the burial ground. I found that both these intervals, which are unavoidably disturbed by somewhat bustling and noisy arrangements, were most usefully and effectively filled up by the introduction of music. The subjoined scheme of the music performed at royal burials will prove that I was not mistaken in supposing music consistent with the rubric, nor much so in selecting those 156parts of the service, at which I prescribed its introduction. It will also serve to show to what an extent music might be made to give effect and attractiveness to a national burial of the dead.

Parts of the Service. Musical Composer.

“I am the resurrection,” &c. Sung Croft.

“I know that my Redeemer liveth,” &c. Ditto Croft.

“We brought nothing into this world,” &c. Ditto Croft.

The Psalms are chanted Chant in G minor Purcell.

After the lesson, and before the removal of the corpse from its station in the choir, an anthem is introduced ad libitum.

“Man that is born of a woman,” &c. Sung Croft.

“In the midst of life,” &c. Ditto Croft.

“Yet, O Lord God, most holy,” &c. Ditto Croft.

“Thou knowest, Lord, the secrets,” &c. Ditto Purcell.

“I heard a voice from heaven,” &c. Ditto Croft.

Immediately before the Collect, “O merciful God,” or sometimes, though very seldom, before “the grace of our Lord Jesus Christ,” an anthem is introduced ad libitum.

At the close of the service, while the mourners are moving off, the Dead March in Saul is played on the organ.

The anthems usually selected are two of the following:—

“When the ear heard,” &c. Handel.

“I have set God always before me,” &c. Blake.

“The souls of the righteous,” &c. Dupuis.

“Hear my prayer,” &c. Kent.

On the burial of esteemed members of the cathedral choirs, the other choristers have sung the highest and most solemn of the church music.

§ 182. Where the circumstances described, in respect to the Protestant population, have prevented compliance with the popular desire for hymns or anthems to be sung or sermons to be spoken at the burial at the parochial churches in London, interment has been purchased for the express purpose of obtaining them at the trading burial grounds. And yet it may be submitted that the desire is consistent with the earliest recognized practice for all classes,^[39] and that a system of national cemeteries would in proportion 157to the numbers interred in them, furnish valuable cases as examples for its beneficial exercise, and must, to a great extent, prevent the misapplication of the service to such cases as have apparently caused it to fall in public esteem.

“The honour,” says Hooker, “generally due unto all men maketh a decent interring of them to be convenient, even for very humanity’s sake. And therefore so much as is mentioned in the burial of the widow’s son, the carrying him forth upon a bier and accompanying him to the earth, hath been used even amongst infidels, all men accounting it a very extreme destitution not to have at least this honour due to them.” * * * * “Let any man of reasonable judgment examine whether it be more convenient for a company of men, as it were, in a dumb show to bring a corpse to a place of burial, there to leave it, covered with earth, and so end, or else to have the exsequies devoutly performed with solemn recitals of such lectures, psalms, and prayers, as are purposely framed for the stirring up of men’s minds into a careful consideration of their estate both here and hereafter.

“In regard to the quality of men, it hath been judged fit to commend them unto the world at their death amongst the heathen in funeral orations; amongst the Jews in sacred poems; and why not in funeral sermons amongst Christians? Us it sufficeth that the known benefit hereof doth countervail millions of such inconveniences as are therein surmised, although they were not surmised only, but found therein.” * * * “The care no doubt of the living, both to live and die well, must needs be somewhat increased when they know that their departure shall not be folded up in silence, but the ears of many be made acquainted with it. The sound of these things do not so pass the ears of them that are most loose and dissolute in life, but it causeth them one time or other to wish, ‘Oh that I might die the death of the righteous, and that my end might be like his.’ Thus much peculiar good there doth grow at those times by speech concerning the dead; besides the benefit of public instruction common unto funeral with other sermons.”—Hooker, Ecclesiastical Polity, b. v. ch. lxxv.

“When thou hast wept awhile,” says Jeremy Taylor, in his Holy Dying, “compose the body to burial; which, that it be done gravely, decently, and charitably, we have the example of all nations to engage us, and of all ages of the world to warrant; so that it is against common honesty and public fame and reputation not to do this office.”—“The church, in her funerals of the dead, used to 158sing psalms and to give thanks for the redemption and delivery of the soul from the evil and dangers of mortality.”—“Solemn and appointed mournings are good expressions of our dearness to the departed soul, and of his worth and our value of him, and it hath its praise in nature, and in manners, and in public customs; but the praise of it is not in the gospel, that is, it hath no direct and proper uses in religion; for if the dead did die in the Lord, then there is joy to him, and it is an ill expression of our affection and our charity to weep uncomfortably at a change that hath carried my friend to the state of a huge felicity.”—“Something is to be given to custom, something to fame, to nature and to civilities, and to the honour of deceased friends; for that man is esteemed to die miserable for whom no friend or relation sheds a tear, or pays a solemn sigh. I desire to die a dry death, but am not very desirous to have a dry funeral; some flowers sprinkled on my grave would do well and comely; and a soft shower, to turn those flowers into a springing memory or a fair rehearsal, that I may not go forth of my doors, as my servants carry the entrails of beasts.” * * * *

“Concerning doing honour to the dead the consideration is not long. Anciently the friends of the dead used to make their funeral oration, and what they spake of greater commendation was pardoned on the accounts of friendship; but when Christianity seized on the possession of the world, this charge was devolved on priests and bishops, and they first kept the custom of the world and adorned it with the piety of truth and of religion; but they also ordered it that it should not be cheap; for they made funeral sermons only at the death of princes, or of such holy persons ‘who shall judge the angels.’ The custom descended, and in the channels mingled with the veins of earth, through which it passed; and now-a-days, men that die are commended at a price, and the measure of their legacy is the degree of their virtue. But these things ought not so to be; the reward of the greatest virtue ought not to be prostitute to the doles of common persons, but preserved like laurels and coronets to remark and encourage the noblest things. Persons of an ordinary life should neither be praised publicly, nor reproached in private; for it is an offence and charge of humanity to speak no evil of the dead, which I suppose, is meant concerning things not public and evident; but then neither should our charity to them teach us to tell a lie, or to make a great flame from a heap of rushes and mushrooms, and make orations crammed with the narrative of little observances, and acts of civil, necessary, and eternal religion. But that which is most considerable is, that we should do something for the dead, something that is real and of proper advantage. That we perform their will, the laws oblige us, and will see to it; but that we do all those parts of personal duty which our dead left unperformed, and to which the laws do not oblige us, 159is an act of great charity and perfect kindness.”—“Besides this, let us right their causes and assert their honour:” * * “and certainly it is the noblest thing in the world to do an act of kindness to him whom we shall never see, but yet hath deserved it of us, and to whom we would do it if he were present; and unless we do so, our charity is mercenary, and our friendships are direct merchandise, and our gifts are brocage: but what we do to the dead, or to the living for their sakes, is gratitude, and virtue for virtue’s sake, and the noblest portion of humanity.”

Necessity and nature of the superior agency requisite for private and public protection in respect to interments.

§ 183. Having given a view of the evils arising from the existing practice in respect to interments in towns, and an outline of what appears to be justly desired as necessary objects to supply the wants of the population, I now beg leave to submit for consideration the information collected as to the practical means of obtaining them.

§ 184. The most pressing of the evils being physical or sanitary evils, the first means of amendment required is the appointment and arrangement of the qualifications, powers, and duties and responsibilities of an officer of health, to whom the requisite changes of practice may be most safely confided.

The functions of such an officer, as marked out by the evidence of existing necessities, may be divided into the ordinary and the extraordinary. The immediate necessities are those which arise from the want of a trustworthy person who maybe looked up to for counsel and direction to survivors in the event of a death, §§ 121, 122, 123, 124, and guide a change of the practice of interment. It is only by an arrangement that will carry a man of education, a responsible officer, to the house of even the poorest person in the community, just at the time when a competent and trustworthy person is most needed to give advice, that the effect of ignorant or interested suggestions may be prevented, and the beneficent intentions of the legislature, or the salutary nature of any public arrangement for the general advantage can be made known with certainty.

§ 185. The ordinary service of such an officer would consist of the verification of the fact and cause of death, and its due civic registration. From the exercise of these duties would follow the extraordinary duties of directing measures of immediate precaution and prevention, which it is to be feared whatsoever general sanitary measures might be adopted would, at the outset, and for too long a period, constitute ordinary and every-day duties. Out of the ordinary duties of the officer of health, would arise extraordinary jurisprudential duties of protecting the interests of the community in cases of deaths which have occurred under circumstances of suspicion or of manifest criminality.

160§ 186. Assuming the necessity of the establishment of adequate national cemeteries at proper sites, it is proposed that a body of officers properly qualified by service, as in the example § 185, should have charge of the material arrangements, and take the place of the churchwardens and overseers in respect to all places of burial, and be responsible for the control of the servants of the establishment, and shall, moreover, be enabled to regulate and contract for supplies, at reduced prices, of materials and service of the nature of those now supplied by the undertaker. §§ 150, 153, 154, 155.

§ 187. In order that the officer of public health may be brought to the spot, it is proposed that the last medical attendant on the deceased should, on a small payment, be required to give immediate notice of the death, in a form to be specified, or in case there happened to be no medical attendant, it should then be incumbent on the occupier of the house, or the person having charge of the body, to give the required notice.

Before particularising the course of practice of such an officer, it appears requisite to state other grounds on which intervention appears requisite for the verification of the fact of death, and the mode of death, by the inspection of the body previously to interment.

§ 188. It is admitted that some additional arrangements are yet wanting for the complete attainment of the proper civic and technical purposes of registration:—as depositaries of pre-appointed evidence of the fact of death, to determine questions of private rights:—as depositaries of evidence for purposes of medical science and public health, to show the extent and prevalence of common causes of disease incident to different occupations and different localities—and of the data for tables of insurance, as well as for the recovery of sums assured, where the proof of age is not admitted in the policy. Any one who is unknown to the local registrar may go and register as a fact his own death, of which a certified copy of the registry will, according to the 38th clause of the Act, be evidence in a court of law. Cases of the registration of false statements have already been detected; some have been made with the view to successions and to the obtainment of property. False registrations have been made amongst the labouring classes as to the place of death, to gain interments in distant parishes at cheaper rates. Fictitious deaths have been registered to defraud burial societies, and the registrar’s certificate of such deaths have got in use by vagrants as a means of obtaining alms. In Manchester a woman having obtained and used one certificate of a fictitious death, soon after obtained another similar certificate, and in order to deter parties from visiting the house, she got the cause of death registered as “malignant fever.”

§ 189. On the continent, wherever the mortuary registers are well kept, and arrangements are made for the protection of the public 161health, the fact and time of death, and the identity of the deceased, is verified on the spot, by inspection of the body by a competent responsible officer of public health. Vide instance and effects at Geneva, stated in the General Sanitary Report, p. 174.

§ 190. It is proposed that the verification of the fact of death, and ascertaining its cause, by inquiry on the spot, should be confided to the officer proposed to be appointed as an officer of public health. The present local registrars might act as auxiliaries; the proposed appointment would be an additional security for the accuracy of the mortuary registration, and would improve that branch of the local machinery for registration.

Postponing the consideration of other collateral grounds for the appointment of a district officer of health, and to illustrate more clearly the course of alteration of the practice of interments, we will suppose the physician or officer of health brought by the proper notice to the habitation where the body lies in the presence of the survivors.

§ 191. In visiting the habitations of the labouring classes, he would be more careful to denote his office, profession, and condition, by his dress, and in his address, even than with other classes. On his arrival at the place of abode of a person of the working class, he would, after announcing his office and duty, inspect the body, and then require the name, age, occupation, and circumstances of the death of the deceased, enter them, and take the attestations of witnesses present. If the death occurred from any ordinary cause, he would, nevertheless, speak of the expediency of the early removal of the body to the chapel or house of reception, where it would be placed under proper care until the appointed time of the attendance of the relations and friends at the interment. The exercise of a summary power of removal in the case of rapid decomposition of the corpse, or in case of deaths from epidemic disease, for the protection of the living, is frequently suggested and claimed by neighbours. On inquiry in Manchester as to the periods during which the bodies of persons dying in the poorest districts were retained in the rooms where they died, the superintendent-registrar, Mr. Gardiner, observed, “they are not retained so long in these districts, because the houses to which the rooms belong are generally inhabited by several families, and those other families feel the inconvenience of the retention of the body amongst them, and they press for an early interment.” With females or survivors who cannot endure to part with the remains, the exercise of a friendly will would sometimes be necessary, and if properly exercised would generally be effectual. The name of an officer of public health would carry with it very general voluntary obedience to whatever he recommended, and in a majority of cases the prostrate survivors would be glad that he should order everything, and would feel it a relief if he were to do so. He would be prepared with a tariff of the prices of burial, and 162with instructions as to the regulations adopted for the public convenience, and for the more respectful performance of the ceremony of interment, and should be empowered and required, on the assent or application of the parties, to carry them out completely, as he might do with very little inconvenience or expenditure of time. He might be empowered to take such a course as this. Speaking to the widow or survivor of the lowest class, he might say—

“The inspectors of public health have been empowered to regulate the practice and the charges for interment, and to contract for and on behalf of the public to ensure the means of burial in a proper and respectful manner for the highest, as well as for the most humble classes. Formerly, the charge for the funeral of a person of the condition in life of your husband was four or five pounds, but by the new regulations, an equally respectable interment is secured to you for little more than half the amount. You are, nevertheless, at liberty to obtain the means of burial from any private undertaker. You may also, if you prefer it, have burial in any private cemetery, or elsewhere.”

§ 192. It is anticipated that, except on private canvass, and that only for a time, interment under the auspices of a public officer would be preferred in the great majority of cases, if the business were conducted with moderate care, in a manner really satisfactory, and if the minor but really important conveniences of all classes were duly consulted. For example, one frequent cause of the delay of interments amongst the poorer classes in crowded districts, is the delay of notification of deaths to distant relatives and friends, whose attendance may be required. More than one-half of the poor cannot write, and many of all classes who can write are unable to collect their thoughts even for a simple announcement of the event. The poorer classes generally get some one to write for them; and the regular payment for each letter is fourpence and a glass of liquor, or sixpence, exclusive of paper and postage. In the charges for funerals of the labouring classes in Scotland, five shillings is set down as the item of expense of letters of notification of the death of an artisan, and fifteen shillings for the notifications of the deaths of persons of the middle ranks of life. Under practicable regulations, such notifications might be prepared in a manner suitable to persons of every condition, at the rate of threepence per letter, or at one-half the ordinary rate of payment, paper, and envelope, and postage stamp included. The service might be rendered at an expense of a few minutes’ time to the officer in taking down a list of the names and addresses of the persons to be sent to. This list he would on his return to his office, hand to a clerk, by whom they would be immediately prepared and despatched in proper and well considered form. The Inspector might, therefore, add—

“If you will give me the names and addresses of those relatives 163and friends who may be desired to attend the funeral, I will cause notice of the time and places of attendance to be sent to them. Amongst the highest classes it is now the practice to diminish the number of followers to the grave, and to commit that duty only to a few; and it is desirable, for the sake of preventing unnecessary expense, that too many should not be invited. All the friends of the deceased who attend at the national cemetery will have an opportunity of joining in with the procession. Besides, the requests to attend, I can also, if you wish it, and will give me the names and addresses, cause notifications of the fact of the death to be sent to any persons in any part of the country.”

In the cases of illness amongst the survivors, or of a death from epidemic disease, indicating an infected atmosphere, he might add—

“For the protection of your own health, and the health of your children and of your neighbours, it is requisite that the body be immediately removed to a place where it will be kept under the care of a physician, and inspected until the appointed time of interment, when it will be received by the friends and relations who attend.”

§ 193. It is considered that, in general, this course would be complied with, but it is considered by physicians, that if it were found necessary in the first instance, in the case of the poorest and most ignorant and highly-excitable people, to concede the point, the officer might give directions to have the body enclosed with cloth of a material to resist the immediate escape of effluvia, and to be closed down, which might be done at a few shillings extra expense. Mr. R. Baker, the surgeon, who has paid great attention to the means for the improvement of the sanitary condition of the population at Leeds, observes—

I believe that where persons die of epidemic diseases, there is not much regard paid to the necessity of early interment. There is what is called the making up of the body, which is often done very early after death, and even in some cases of supposed contagion, before it is absolutely necessary. But an application is used in coffins of those whose friends can afford it which deserves naming, because it is at once safe and economical, and renders any sanitary precautions unnecessary, where there is a desire from any requisite family arrangements to keep the body; it is to place the body in a deal shell, and then to place this shell within the coffin, between which and the shell are affixed at the sides and bottom, a few pieces of circular wood about the thickness of two crown pieces, here and there, to keep the shell and coffin apart, forming a considerable interstice, which is filled in with boiling pitch. The lid of the shell is then laid on, having a glass over the face, and over this is poured more pitch till the shell is incased in a pitch coffin between the wooden ones. The cost of this process, which is next to that of embalming, is about 9s. 6d., and is easily paid out of the seven or ten pounds which the club supplies. I would only add that this experiment deserves well of every one’s consideration, being far superior to lead, and equally useful, in all ordinary interments, and admirable for the purpose of avoiding contagion, while it admits the opportunity of keeping the body for any arrangement that is required to be made. If this plan could be enforced upon all 164occasions where death had occurred from contagious disease, I look upon it, that a great benefit would be conferred upon the community.

§ 194. In the cases where decomposition, as sometimes occurs, commences even before death and proceeds with extreme rapidity after it, even an immediate removal is not effected without producing depressing effects on the bearers; and when there is an in-door church service, in some districts in the metropolis, it is not unfrequently necessary to have the body left at the church door, on account of the extremely offensive smell which escapes from the coffin. These coffins are generally constructed without knowledge, or care, or adaptation to the circumstances of the remains, or to any sanitary service. Mr. W. Dyce Guthrie, surgeon, who has paid much attention to some of the structural means for the protection of the public health, specifies various modes in which the evils arising before interment, as well as after, may be prevented, at a cost so inconsiderable as not to be sensibly felt, even by the poorest classes, and yet be as efficient as the most expensive arrangements now in use. For example: “Coffins may,” he says, “be rendered perfectly impervious to the escape of all morbific matter, at an expense not exceeding 1s. 6d. or 2s. each, by coating the interior over with a cement composed of lime, sand, and oil, which soon sets and becomes almost as hard and resisting as stone. Pitch, applied hot, would answer the same purpose as the compound I have mentioned, but it would be more expensive.” In the cases of such rapid decomposition as bursts leaden coffins, or renders “tapping” necessary, he recommends the application, at a few shillings expense, of safety-tubes to the foot of the coffin, so as to secure and carry away into a chimney flue, or a current created by a chauffer, the mephitic matter. These are adduced as instances of the detailed appliances of which the officer of health would judge in each case on the spot and suggest to the survivors, and if necessary write directions, or a prescription, for their appliance.

§ 195. A cause of the delay of interments might, it is stated, be diminished by arrangements, under which coffins of every size being kept prepared, one might be brought to the house, with the name of the deceased, and his obituary duly inscribed on a plate, in about one-third the time that is now usually employed for the purpose. By this service, the rapid progress of decomposition, and the escape of noxious effluvia would be arrested.

§ 196. Before leaving the abode of the deceased, the officer of health would, in the case of death from diseases likely to have been originated or precipitated by local causes, inspect the premises, inquire closely as to the antecedent circumstances of the decease; and note directions to be given in respect to the premises to officers having charge of drainage or sewerage, or public works, for cleansing and lime-washing the premises, at the charge of the owner, before renewed occupation.

165In respect to the poorest classes, those who stand the most in need of protection: the measure of prohibiting burial, except on a verification of the fact and cause of death, by a certificate granted on the sight and identification of the body at the place where the death occurred, has its chief importance as being the means of carrying a person of education into places rarely, if ever entered, by them, except by accident. The functions of the officer of health when there are marked out by instances of acts done by force of humanity and charity, which as yet have no authority in law, or in administrative provision. For example, in the following instance, of a house owned by a landlord of the lowest class.

Shepherd’s-court consists of about six houses. It was notorious that fever had prevailed to a great extent in this court; in the house in question, several cases of fever had occurred in succession. The house is small, contains four rooms,—two on the ground-floor and two above; each of these rooms was let out to a separate family. On the present occasion, in one of the rooms on the ground-floor there were four persons ill of fever; in the other room, on the same floor, there were, at the same time, three persons ill of fever; and in one of the upper rooms there were also at the same time three persons ill of fever; in the fourth room no one was ill at that time. It appeared that different families had in succession occupied these rooms, and become affected with fever; on the occasion in question, all the sick were removed as soon as possible by the interference of the parish officers. An order was made by the board of guardians to take the case before the magistrates at Worship-street. The magistrates at first refused to interfere, but the medical officer stated that several cases of fever had occurred in succession in this particular house; that one set of people had gone in, become ill with fever, and were removed; that another set of people had gone in, and been in like manner attacked with fever; that this had occurred several times, and that it was positively known that this house had been affected with fever for upwards of six weeks before the present application was made. On hearing this, the magistrate sent for the owner of the house, and remonstrated with him for allowing different sets of people to occupy the rooms without previously cleansing and whitewashing them; telling him that he was committing a serious offence in allowing the nuisance to continue. The magistrate further gave the house in charge to the medical officer, authorizing him to see all the rooms properly fumigated, and otherwise thoroughly cleansed; and said that, if any persons entered the house before the medical officer said that the place was fit to be inhabited, they would send an officer to turn them out, or place an officer at the door to prevent their entrance. The landlord became frightened, and allowed the house to be whitewashed, fumigated, and thoroughly cleansed. Since this was done the rooms have been occupied by a fresh set of people; but no case of fever has occurred.^[40]

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 166and 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 167must 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; 168their 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.

169Mr. 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 170your 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, 171and 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.

172Though 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 173personal 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,

174There 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, 175and 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 176laws, 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 177ran 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 178or 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 179placing 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 180officers 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 181by 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:—