Part 25

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

_Jurisprudential value of the appointment of Officers of Health._

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In a subsequent communication, he states—

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

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