Part 4

Falls 7 Barns 1 Drowned 4 Suffocation 16 Cut throat 2 Pistol shot 2 Hanging 2 Run over by railway train 1 Wilful Murder 4 “Accident,” “Violence” 2 Total 41

With respect to the accidental or violent deaths it may be remarked that the 16 from suffocation were of infants and due to “accident.” One of the newly born infants was found in a box and another up a chimney; these being, as were some of the others, the children of single women. On four newly-born children the verdict of “murder” was found. In one case there had been “exposure,” in a second the child was found dead, and in the other cases the verdict was simply “wilful murder.” Of the four drowning cases one was suicidal. By hanging, cut-throat, and pistol-shot all the deaths recorded (two from each cause), were suicidal, making a total of seven suicidal deaths during the year. The remaining deaths by violence were accidentally caused.

Having carefully analysed the facts relating to these deaths as they appear in the weekly returns of mortality, I submit the results, which are, I think, worthy of attention. Of course the primary cause of an inquest being held is the absence of a medical certificate showing the cause of death. The reasons why certificates are not forthcoming, and therefore why inquests become necessary, may be inferred from certain particulars which appear in the returns, and may be summed up as follows:—

Sudden Death 99 Found dead in bed (22) or otherwise (26) 48 Accident 3 Violence 15 Doubtful (none of the above reasons stated) 7 Total 172

It is to the deaths from disease that I would draw particular attention, the bare facts appearing to point to a large amount of neglect of the sick, which, without explanation, would seem to border on the criminal. Fatal visceral diseases, it need hardly be said, present symptoms which the most ignorant cannot altogether overlook—fever, pain, exhaustion, &c.; and each disease has a more or less prolonged course, varying with the importance of the organ affected, and with the amount of care bestowed on the sufferer. It is not credible that any medical man would be unable to diagnose the existence of such a disease, _e.g._ as pneumonia, or would refuse to certify the cause of death of a patient who had died under his care. We are driven to the conclusion, therefore, that, in a great number of cases of disease, many of the victims being infants, no effort is made to obtain medical advice for the sufferers, and hence, when death ensues, an inquest becomes necessary, as there is no medical certificate to show the cause of death. A post-mortem examination is made, and then it becomes known that death was caused by a disease that might have been cured, and that certainly must have had a well-defined and often a lengthened course. Passing over such maladies as apoplexy and heart disease, it is only necessary to mention, in support of this view, such diseases as pneumonia, &c. (30 deaths); brain diseases (15); convulsions—a symptom rather than a disease (8); scrofula (5); syphilis (2); diarrhœa, diphtheria, &c. The question then arises, in connection with such cases as these, whether it is sufficient to record the cause of death? whether, in fact, some one should not be made responsible for the neglect to provide medical advice for a child who ultimately dies “suddenly” or is “found dead” as a consequence of an attack of pneumonia, that may have extended over one, two, or three weeks, or even a longer time? Not many weeks before this present writing one of the “Peculiar People” was found guilty of manslaughter, having neglected to provide medical attendance for his child, who died of pneumonia, although it was admitted that every care, otherwise, had been bestowed on the patient; and, notwithstanding the well-known fact that with such care a very large proportion of the cases, especially if one lung only is affected, will recover. It need scarcely be added that the parents’ neglect had its origin in conscientious motives, however mistaken and absurd. Can such a plea be made in all or many of the cases to which I have here alluded: and should negligent parents escape without punishment—without censure even?

True, the facts I have thus briefly brought under notice may be explained—and they certainly need explanation; for as they baldly appear in the returns of mortality they would seem to indicate an indifference to life which is not only shocking, but may be in some degree the cause of that terrible infantile mortality which all thinking persons deplore. I will only add that it is notorious that medical men are constantly called in to see children sick beyond the hope of recovery, in order that no fuss may arise after death—the death certificate being all-sufficient. No doubt in many cases, where the diagnosis is quite clear, the certificate is given, although the practitioner may be conscious of the neglect of the parents in applying for assistance when “too late;” and, I dare say, that in some at least of the cases which come before the Coroner the inquest has been brought about by the judicious refusal of medical men to give certificates under such circumstances. I venture to think, however, that a certificate should not be given in any such case, and that not only should an inquest be held, but that the mere fact of the responsible person in charge of the infant having failed to obtain that medical advice and assistance which the poor may have for the asking, should be regarded as establishing a _prima facie_ charge of neglect, for which he or she should appear and answer at another tribunal in the absence of exculpatory evidence.

DEATHS “NOT CERTIFIED.”

The number of deaths “not certified,” that is, of persons who were attended in their last illness by non-qualified practitioners—generally professing to hold unregisterable foreign degrees, often obtained by purchase, _in absentia_, was 33. The numbers in the two previous years were 30 and 21. In my annual report for 1872 I mentioned that I had some time previously called the attention of the Registrar-General to the desirability of an addition to the form of certificate of death provided for the use of medical men, whereby it would be made clear whether the subscriber was or was not duly qualified, _i.e._, registered. The Registrar-General approved the suggestion, and his attention having, at my instance, been again directed to the subject by the Society of Medical Officers of Health last year, he has, in the new form of certificate brought into use at the commencement of the current year, added a line immediately below the place for signature on which the subscriber is required to enter his “registered qualification.” It is not probable that any unregistered practitioner would venture to use the certificate, should he inadvertently become possessed of it, as might happen through the almost unavoidable ignorance in which the sub-district registrars are left, from the want of an official list of registered practitioners. Not long ago I ventured to direct the attention of the Registrar-General and the Registrar to the General Medical Council to the importance of these officers being supplied with the Medical Register, issued annually by the Council; but these gentlemen, while appreciating the suggestion, were unable to hold out any hope that it would or could be carried into effect, inasmuch as the Government are unwilling to incur the necessary expense, and as the Register is too inaccurate to be implicitly relied on in doubtful cases. But now that medical men are required, under a penalty for neglect, to give certificates of the cause of death, some means ought to be found of restricting the use of them in any form, to registered practitioners. The sub-district Registrars do not knowingly accept a certificate from a non-qualified practitioner, but in some cases where a medical title is used by a stranger, “invalid” certificates obtain currency. In all other irregular cases the registrar returns the death as “not certified,” making use, nevertheless, of the information as to the cause of death contained in the certificate! If it were made an offence at law for any unregistered practitioner to give a certificate of death, the difficulty would probably be met. At present I do not know what course would be best to adopt, unless to hold inquests on the bodies of all persons who die under the treatment of non-qualified practitioners. This course was adopted in some cases in the northern part of the parish last year, and it led, in at least one instance, to the unsatisfactory, not to say discreditable result, of the Philadelphian M.D. who attended a sick child, calling in a registered practitioner at the last gasp, so that he might certify to the cause of death. An inquest, however, was held on the body, and the death was found to be due to quite a different disease to that entered in the certificate. I may add that the Board of Guardians, laudably anxious to put a stop to the scandal, took proceedings at the Hammersmith Police Court against an unregistered practitioner for signing a vaccination certificate, and thus “falsely pretending to be registered.” The case was dismissed, however, and no further steps have been taken in the matter. But something should be done for the protection of the poor, who are almost exclusively the patients of the unqualified man, being unable to realize the distinction; and action is rendered the more necessary by the fact that children—infants of tender age—are most commonly the victims of the practice. Thus, of the 33 cases of uncertified deaths referred to, 25 were children, of whom 18 were less than one year old. The causes of death returned included such diseases as typhus fever, scarlet fever, measles, diarrhœa, inflammation of the lungs and of the brain, and scrofulous maladies.

METEOROLOGY.

The mean temperature of the air at Greenwich during the registration year was 49.4° F., the average of 35 years being 49.3°. The averages of the four quarters were 41.6°, 53.5°, 60.6°, and 41.8°. The hottest week was that which ended on the 11th of July, mean temperature 66.8°; and the coldest week was that ended on the 2nd of January, 1875, mean temperature 28.8°. The highest reading of the thermometer was on the 9th of July, 92.0°, and the lowest on the first day of the current year 18.2°. The dryness of the atmosphere (_i.e._, the difference between the dew point temperature and air temperature) was 5.6 (average in 30 years 5.5.) The rainfall was 24.1 inches.

VACCINATION.

I am indebted to Mr. Shattock, the energetic Vaccination Officer, for the interesting particulars contained in Table IX, (Appendix), on the important subject of Vaccination. From it we learn that during the year 4,357 births were returned to him by the sub-district registrars, and that the successful vaccinations numbered 3,588. Twenty-three infants were certified as insusceptible of successful vaccination; in 74 cases the postponement of vaccination was sanctioned by medical certificate on account of the state of health, &c.; 27 children were removed to other districts, the vaccination officer of each district being duly apprized of such removal; 9 cases were still under proceedings (at the date of the report), by summons or otherwise; while 464 children died unvaccinated. The cases unaccounted for—either through the removal of the children to places unknown, or which cannot be reached, and cases not having been found—amounted in all to only 172, or a fraction below 4 per cent. of the total births—a result that must be considered very satisfactory, highly creditable to the vaccination officer, and, I would add, to the Board of Guardians; while I can hardly believe it has been surpassed in any other district of the Metropolis.

The Guardians have lately (August, 1875) prosecuted successfully a non-qualified practitioner for signing Vaccination Certificates. A penalty of Ten pounds was inflicted; the offence with which the defendant was charged being that of “falsely pretending to be registered” under the Medical Act, none but registered practitioners being qualified to sign Vaccination Certificates.

SANITARY WORK.

Table 6 (Appendix) contains a summary of the principal items of sanitary work accomplished during the Vestry year ended 25th March, 1875. The number of complaints received and entered in the complaint book was 1,482; viz., 820 in the North, and 662 in the South Sanitary District. Seven thousand two hundred and eighty-six houses were inspected—viz., 3,229 in the North, and 4,057 in the South district, besides mews, of which there are about 140 in the parish. The number of sanitary notices served for the amendment of houses, premises, &c., was 1,438, viz., 756 in the North and 682 in the South: 1,477 houses and premises were cleansed, &c.: 68 were disinfected after infectious diseases. The drains of 442 houses were cleansed and repaired; and trapped and ventilated in 341 other cases: 463 privies and water-closets were repaired and supplied with water; and 6 new water-closets were provided: 31 new dust-bins were erected, and 41 old ones covered, repaired, &c.: 8 water-cisterns were constructed, and 75 cleansed, covered and repaired—a very inadequate number it would seem, so far as regards cleansing, only that in a great number of cases this operation—so commonly neglected—was directed and carried out without formal notice: 115 accumulations of dung, stagnant water, animal and other refuse were removed, and in 58 cases animals improperly kept, or kept in unfit localities (swine especially), were removed.

The number of inspections in each district, and in each period of four weeks, covered by my monthly reports, may be seen, in Table 6A. Legal proceedings were had recourse to in 100 cases, viz., 82 in the North, and 18 in the South district, and generally with a successful result. A few of the cases deserve special notice.

And first I will mention the subject of boiling food for pigs. A greater nuisance than this is, it would be difficult to imagine in a parish like Kensington. The effluvia given off from the boiling of a quantity of animal and vegetable refuse, collected from the wash-tubs, and often in a semi-putrid state before cooking, is sickening and offensive to the last degree. It constitutes by far the greater part of the nuisance arising from the keeping of swine in an improper locality; and the efforts persistently made during the last four years to improve the condition of the Potteries have been sadly marred by the continuance of the process of food collection and preparation, which still goes on to some extent, although nearly all the swine have been removed. As no means were ever adopted to prevent the escape into the air of the noxious effluvia resulting from the cooking, we resolved to attack the nuisance under the 27th section of the Nuisances Removal Act, which enacts, in effect, that

“If any building, or place for boiling offal . . . or used for any trade, business, &c., causing effluvia, be at any time certified to the local authority by any Medical Officer to be a nuisance or injurious to the health of the inhabitants of the neighbourhood, and that the person carrying on such business shall not have used the best practicable means for abating such nuisance, or preventing or counteracting such effluvia, the person so offending shall, upon a summary conviction for such offence, forfeit and pay a sum of not more than Five Pounds nor less than Forty Shillings, and upon a second conviction for such offence the sum of Ten Pounds, and for each subsequent conviction a sum double the amount of the penalty imposed for the last preceding conviction, but the highest amount of such penalty shall not in any case exceed the sum of Two Hundred Pounds.”

Several prosecutions were undertaken successfully—fines varying from Forty Shillings to Five Pounds (including costs) being inflicted. The steps already taken will, it is hoped, prove sufficient, and render unnecessary any further appeal to the law, especially as a notice of your Vestry’s intention to proceed against offenders in every case has been widely distributed in the Potteries.

Twenty-four convictions were obtained against old offenders for keeping swine in an improper locality, and Mr. Bridge, one of the magistrates at the Hammersmith police-court, announced his intention of throwing on the defendants in any future cases that might be brought before him, the onus of proving that the pigs were not on the premises on days intervening between the days for which the defendants might be summoned for the offence of keeping pigs in a place under the ban of a “prohibitory order,” the penalty for this offence being Ten Shillings a day. Hitherto we have been required to prove the presence of swine on each day, so that, for example, to obtain in one week penalties to the amount of three pounds, it was necessary to visit the prohibited premises every day in the week. But if Mr. Bridge should feel justified in carrying out his views, it would only be necessary to visit the premises on Monday and Saturday to obtain the same amount of penalties which would be imposed, unless the defendant should be able to prove that the pigs were not on the premises on the intervening days, viz., Tuesday, Wednesday, Thursday, and Friday.

The proprietor of a licensed slaughter-house in the Potteries, Notting-hill, was fined in the sum of Ten pounds and costs for having on the premises the carcase of a cow, diseased and unfit for human food. The cow had been brought dead from another place, and after seizure it was stated that the carcase was not intended for food. But it was dressed in the usual way, and the meat having been condemned by Mr. Ingham, proceedings were taken before Mr. Bridge, with the result above stated, the magistrate ruling that the fact of the carcase being in the slaughterhouse was sufficient evidence of the intention to pass it off as food for man. The cow, it may be added, having died, or been killed, at a licensed cow-shed in the same locality, I pointed out to the licensee the great impropriety of his proceedings, and the risk he would run of losing his license, to say nothing of other consequences, on a repetition of his indiscretion. Subsequently, I received notice from the proprietor of a licensed slaughter-house that the carcase of another cow that had been killed in the last stage of the “lung disease” (pleuro-pneumonia) was awaiting my opinion of the fitness, or otherwise, of the meat for human food. I condemned the meat, which was removed to a knacker’s yard. No proceedings were taken in this case, but I cautioned the licensee not to admit diseased animals—living or dead—on his premises at any future time. Some time after the occurrence of this case I learnt, to my great surprise, that the instructions issued by the Metropolitan Board of Works, to the district veterinary cattle inspectors under the provisions of the Contagious Diseases (Animals) Act authorised the removal of diseased cows from cowsheds to a licensed slaughter-house for the purpose of being killed; or if killed at the shed, of being dressed, there to await the _fiat_ of the inspector as to the fitness, or otherwise, of the meat for human food. This instruction seems to be at variance with the slaughter-house bye-laws, to say nothing on the question of the propriety of using for food the flesh of diseased animals. In the provinces it is the practice, I believe, to destroy and bury animals affected with pleuro-pneumonia; and I am under the impression that heavy fines have been inflicted on persons for selling or exposing for sale the flesh of such animals. In London cowkeepers are required, under a penalty for neglect, to give notice to the Metropolitan Board of Works of the occurrence of cases of pleuro-pneumonia; and they are entitled to compensation from the Board to the extent of a moiety of the value of any animals that may be killed with a view of “stamping out” the disease. It follows that the larger the amount realized by the sale of the carcase, for whatever purpose, whether for the food of man or of cats, the less is the amount payable to the owner in the way of compensation.

The proprietor of the slaughter-house in the Potteries first referred to above, was fined Five pounds and costs for allowing a large accumulation of putrid blood, &c., to remain on the premises after his attention had been repeatedly called to the necessity of properly storing and regularly removing all such matters before they became offensive.

A seizure of meat unfit for human food was made at Norfolk Terrace—at a mis-called “co-operative” store—and the defendant was fined Twenty pounds and costs.

A person who had formerly kept a licensed cow-shed was fined Forty shillings and costs for keeping cows for dairy purposes without a license.

A somewhat serious nuisance having been complained of, arising at an iron foundry at Notting Hill, from the escape of noxious fumes and grit from the low but capacious chimney above the melting furnaces, I gave a certificate to the effect necessary to found legal proceedings, which, however, were not had recourse to, the proprietors of the foundry having expressed their willingness to adopt any measures I might advise, with a view to remove the cause of complaint. They have done this by carrying up the shaft some 20 feet, and by the interposition of diaphragms to intercept the fine grit carried up by the draught; and I hope that in the result these measures will be found adequate for the purpose.

LICENSED SLAUGHTER HOUSES.

The licensed slaughter-houses—49 in number—viz., 28 in the North Sanitary District, and 21 in the South, have been duly inspected. In my last annual report I gave some account of the Slaughter Houses (Metropolis) Act, 1874, under which the Metropolitan Board of Works, as the “local authority,” were empowered to frame bye-laws, for regulating the conduct of the business of a slaughterer of cattle, and the structure of the premises in which the business is carried on. As it was impossible to get the bye-laws framed and confirmed by the Local Government Board previous to the annual licensing day in the month of October (as a matter of fact they were not confirmed until the 27th of May in the present year), your Vestry, on the recommendation of the Sanitary Committee, unanimously resolved that certain conditions were essential in order to fit a slaughter-house for the business, and decided to oppose the renewal of licenses in every case that did not come up to the standard. The conditions were as follows:

1. A slaughter-house should have an independent entrance, so that the cattle may not have to pass through the house or shop; and it should be at a reasonable distance from other buildings, particularly inhabited houses.

2. It should be open to the roof; or, at least, should have no inhabited rooms over it.

3. It should be well ventilated and properly lighted, so that the slaughtering may be done, as it always should be, with closed doors.

4. It should have walls and floor of smooth and impervious materials—the flooring being laid on concrete.

5. It should be well drained, with stone ware pipes, and the drains should be permanently trapped.