Part 24

§ 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 health, 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 with 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 and 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 9_s._ 6_d._, 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 occasions 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 1_s._ 6_d._ or 2_s._ 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.

In 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 and practically useless remedy by the inspection of an unskilled and unqualified ward inquest (Vide General Sanitary Report, p. 300), the skilled and responsible medical officer, with such summary powers and duties of immediate interference, as were successfully exercised in the case above cited, should be appointed.

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

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

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

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

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

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

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

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

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

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

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

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