Part 26

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

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

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

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

Mr. William Chambers observes:—

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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