Report on the sanitary conditions of the labouring population of Great Britain. A supplementary report on the results of a special inquiry into the practice of interment in towns. Made at the request of Her Majesty's principal secretary of state for the Home department online

England. The charge for the service and materials of the ninth class, in
which there is the attendance of a vicar and a priest, and of a bass
singer or chorister for the mass, is about 15_s._ of English money. In
the service ordinaire there is less religious service, and that is
performed gratuitously. The only charge made is the price of the coffin,
which is five or seven francs, according to the size: the coffin is
covered by a pall, and carried on a plain hearse, drawn by two black
horses. This funeral is conducted by a superintendent and four
assistants, exclusive of the driver. The following is the scale of
charges, and the numbers interred under each, during two years:—

─────────────────────┬──────┬──────┬──────┬──────┬───────┬──────
│ │ │ │ │ │
│ 1st │ 2nd │ 3rd │ 4th │ 5th │ 6th
│Class.│Class.│Class.│Class.│Class. │Class.
─────────────────────┼──────┼──────┼──────┼──────┼───────┼──────
│ £. │ £. │ £. │ £. │£. _s._│ £.
Religious Funeral │ │ │ │ │ │
Service │ 24│ 19│ 11│ 8│ 5 10│ 2
Anniversary Religious│ │ │ │ │ │
Service │ 26│ 20│ 12│ 9│ 6 0│ 3
Undertaker’s Material│ │ │ │ │ │
and Service │ 95│ 83│ 49│ 23│ 14 10│ 5
─────────────────────┼──────┼──────┼──────┼──────┼───────┼──────
Total Expenses │ 145│ 122│ 72│ 40│ 26 0│ 10
─────────────────────┼──────┼──────┼──────┼──────┼───────┼──────
Number of { 1839│ 23│ 52│ 138│ 256│ 828│ 1,457
Burials { 1841│ 30│ 47│ 188│ 201│ 816│ 1,655
─────────────────────┴──────┴──────┴──────┴──────┴───────┴──────
─────────────────────┬──────┬───────┬──────┬────────┬──────────┬───────
│ │ │ │Total of│ │
│ 7th │ 8th │ 9th │the nine│ Service │General
│Class.│Class. │Class.│Classes.│Ordinaire.│Total.
─────────────────────┼──────┼───────┼──────┼────────┼──────────┼───────
│ £. │£. _s._│ _s._ │ │ │
Religious Funeral │ │ │ │ │ │
Service │ 1│ 0 16│ 11│ │ │
Anniversary Religious│ │ │ │ │ │
Service │ │ │ │ │ │
Undertaker’s Material│ │ │ │ │ │
and Service │ 3│ 1 11│ 4│ │ │
─────────────────────┼──────┼───────┼──────┼────────┼──────────┼───────
Total Expenses │ 4│ 2 7│ 15│ │ │
─────────────────────┼──────┼───────┼──────┼────────┼──────────┼───────
Number of { 1839│ 2,523│ 141│ 530│ 5,958│ 14,087│ 20,045
Burials { 1841│ 2,377│ 78│ 715│ 6,107│ 14,185│ 20,292
─────────────────────┴──────┴───────┴──────┴────────┴──────────┴───────

§ 132. On the number of burials in Paris for 1841, the gross income
would be about 80,000_l._ per annum. Out of this sum the contractor pays
the fixed salaries of the staff of officers, which consists of a chief
inspector of funeral ceremonies, of 27 other directors besides, 78
bearers, one inspector of cemeteries and four keepers; officers chiefly
appointed by the municipality. The total amount of the salaries which he
pays is 5862_l._, English money. He keeps an establishment of 30 hearses
and 76 carriages, with suites of minor attendants properly clothed, and
inters the 7000 of the pauper class gratuitously. The last contractor
paid annually to the municipality 17,000_l._, which sum was chiefly
devoted to ecclesiastical objects. The large profits which he realized
led to considerable competition, and a new contract was recently sealed
for nine years, securing for public purposes an annual income of
28,000_l._

Besides this amount, there is a revenue of about 20,000_l._ per annum
derived by the municipality from the sale of tombs, and from the tax on
interments, which is twenty francs for the interment of every adult, and
ten francs upon children under seven years of age. One-fifth of this
revenue, or about 4000_l._, is devoted to the hospitals.

§ 133. The remains of those who die in the public hospitals in Paris,
and are not claimed by their friends, are, after dissection, merely
enclosed in a coarse cloth and deposited in the ground, without any
funereal rites. This number amounts, as stated, to no less than 7000
annually. The total average deaths in Paris is from 28,000 to 30,000
annually. This, in a population of 900,000, gives about one burial to
every thirty of the population annually, which is nearly as large a
proportion of annual deaths and burials as that in Manchester. The
deaths and burials in the British metropolis (though varying in
different parts, from 1 in 28, as in Whitechapel, to 1 in 56, as in
Hackney, chiefly according to the condition of the locality) average for
the entire population of 1,800,000 inhabitants, one death or burial in
every forty-two of the inhabitants, or one-fourth less of burials than
at Paris in proportion to the population. In Paris the average number of
inhabitants to every house is 36. If the mortality were there in the
proportion of London there would be 7,000 fewer burials yearly. An
assertion may be ventured, that more than this excess of mortality is
ascribable to the still lower sanitary condition of the labouring
population in Paris, which has its concomitant in a still lower moral
condition than yet prevails amongst the population of our large
towns.[26]

§ 134. In Paris the law requires that the dead shall be interred within
twenty-four hours after the decease, but this law may be evaded by
neglect to give notice of the death. The general practice, however,
appears to be, that interments take place within two days.

§ 135. In America, the later regulations manifest the tendency of the
general experience to connect the regulations of interment with the
general regulations for the protection of the public health, and to do
this by single, specially qualified, paid, and responsible officers,
rather than by Boards, or by any unskilled and honorary agency. The
revised statutes of Massachusetts introduce the alternative of the
appointment of a single officer. Every town is empowered to appoint a
Board of Health, “or a health officer:” and the Board so appointed may
appoint “a physician to the Board.” The Board acting by such officer may
destroy, remove, or prevent, as the case may require, all nuisances,
sources of filth, and causes of sickness. “Whenever any such nuisance or
source of filth, or cause of sickness shall be found on private
property, the Board of Health, or health officer, shall order the owner
or occupant thereof at his own expense to remove the same within
twenty-four hours, and if the owner or occupant shall neglect so to do,
he shall forfeit a sum not exceeding one hundred dollars,” c. 21, s. 10.
In cases of the refusal of entry into private property, on complaint to
a magistrate, the magistrate may thereupon issue his warrant, “directed
to the sheriff, or either of his deputies, or to any constable of such
town, commanding them to take sufficient aid, and being accompanied by
two or more members of the said Board of Health, between the hours of
sunset and sunrise, to repair to the place where such nuisance, source
of filth, or cause of sickness complained of may be, and to destroy,
remove, or prevent, the same, under the direction of such members of the
Board of Health.” The cleansing of the streets and houses is in most
cases included in the functions of the Board of Health, or of the health
officer, who regulates the removal of all refuse. Sec. 14, c. 21.

Every householder, when any of his family are taken ill, is required, on
a penalty of one hundred dollars,—and every physician in the like
penalty, on ascertaining that any person whom he visits is infected with
the small-pox, or other disease dangerous to the public health,—to give
immediate notice to the officers of public health, and they may, “unless
the condition of such person is such as not to admit of his removal
without danger of life,” remove him at once to the public hospital,
whatever may be his station in life. Sec. 43 and 44, c. 21.

I have been favoured by Dr. Griscom, the inspector of interments at New
York, with the copy of a report on the sanitary condition of the
population of that city; which points out the great extent of deaths
that are preventible by the adoption of means similar to those
recommended in the General Report for the improvement of the sanitary
condition of the population in Great Britain. This report, revealing
extensive causes of death in New York, of which a large proportion of
the population must have been unaware, may be adduced in proof of the
immense services derivable from such an office, when zealously executed,
in guarding against evils more destructive than wars.[27]

§ 136. In Munich, and in other towns in Germany, the visits and
verification of the fact of death as the warrant for interment, is felt
to be an important public security, and is highly popular; but one cause
of its popularity is the jurisprudential functions of the officer of
health, as means of preventing premature interments, and the escape of
crime; for comparatively little attention appears yet to have been given
to the practical means afforded by the office of tracing out and
removing the causes of disease. The difficulty appears to be in respect
to the jurisprudential functions of the officers of health to satisfy
the public anxiety for the exercise of solemn care in _every_ case of a
multitude, where only one case in that multitude will, on the doctrine
of chances, be a case calling for intervention; and where it is not
provided, as it may and ought to be, that the discovery of that one
shall be a matter of deep personal interest, instead of a mere source of
trouble to the officer himself, his examinations may be expected to
degenerate into a routine in which the intended security will fail in
the less obvious cases.

In later times very comprehensive regulations as to the sites and
management of cemeteries, and the service of officers of health, who
have charge of the cemeteries, have been adopted throughout the Austrian
dominions, and it is stated that they work very satisfactorily. On the
occasion of every death by accident or violence, or of suspicion, a
close inquiry as to the causes is made by the town physician. In Vienna
a strict inquiry is made into every such death by the following
officers, who all attend for that purpose;—namely, the town physician,
the surgeon in chief, the professor of pathological anatomy, a lawyer,
and in some cases, when analyses are required, a chemist. The results of
their examinations are set forth in a “protocol,” a carefully prepared
document, “_bien motivé_,” which sometimes takes two or three days in
drawing up. The effect of this inquiry is the prevention, to a great
extent, of crimes of violence, and the production of public confidence.
It is stated to be highly popular.

§ 137. In Paris some cases have of late occurred, which have created
much public uneasiness by the evidence they afforded of the defective
organization of the service of the officers of health, and occasioned it
recently to undergo an examination with the view to the adoption of
better securities. It appears that, from a very early period, to satisfy
the public solicitude, the law required the fact of the reality of a
death to be verified by the personal visit and inspection of the Maire
of the district of the city where the death had taken place.
Subsequently, the Maires were allowed to delegate this duty to officers
of their own nomination, persons qualified for the duties by a medical
education, and who were called _Officiers de Santé_. But the
appointments thus made by the Maires did not give public satisfaction;
and in the year 1806 it was required that the persons appointed as
“officiers de santé” by the Maires, should be chosen by them from
amongst the doctors in medicine and surgery who were attached to the
public hospitals. They appear, however, to have been mostly chosen
without reference to public qualifications, from their own medical
friends in private practice. This arrangement of appointing persons in
private practice appears to have prevailed in other countries, and to
have frustrated much of the benefits otherwise derivable from the
institution. Thirty-five of these private practitioners are now
appointed to perform the duty. Reports have gained ground that from
negligent discharge of the duty, persons had even been buried alive, and
that the verification had been given in cases of murder. On a recent
commission of inquiry, the celebrated surgeon, M. Orfila, thus speaks of
the necessity of the verification of the fact of the decease.

“It is possible to be interred alive! Interments may take place
after murder, committed with the knife or by means of poison,
without a suspicion being created that the death has been occasioned
by violence. Ignorance or malevolence may attribute to crime deaths
that have occurred from natural causes!”

After referring to ancient cases in which evidence was recorded of
parties having been buried alive, he adduces the following recent
instances of parties having been interred without due verification of
the cause of death by the _Officier de Santé_:—

“We all know the case of the death of the grocer in the Rue de la
Paix, who died of poison by arsenic. The interment took place after
the verification of the death. In about a month afterwards I was
called upon to examine the body as to the poison. Although the
putrefaction of the corpse of the person who was of a very full
habit had been much advanced, I was enabled to discover the presence
of the arsenic by which the crime had been perpetrated.

“The widow Danzelle, of the Rue Beauregard, was found dead in her
bed on the 1st of January, 1826. The certificate of the decease was
given in due form to the relations to authorise the interment. In
that certificate, given to M. le Commissaire de Police, the medical
practitioner declared, ‘the death has taken place, and it appears
that it has been occasioned by a commotion of the brain with
hæmorrhage.’ ‘The deceased’ added he, ‘lived alone; she was found
dead in her chamber, where she appeared to have fallen down.’ The
municipal authorities caused the interment to be adjourned, and
required a new examination of the body in the presence of the
Commissioner of Police, assisted by two doctors in medicine. The
result of the examination was, ‘that Madame the widow Danzelle had
fallen under the blows of an assassin; the corpse bore five recent
wounds in the neck, made with a cutting instrument, and the carotid
artery had been divided.’

“In the month of July, a child of Dame Revel, Rue de Seine Saint
Germain, died very suddenly. The authorities being informed that the
child had been the subject of much ill-treatment on the part of the
parents, ordered an inquiry and _une expertise medico-legale_. The
examination of the body showed that the rumours as to the barbarous
conduct of Dame Revel, the mother, were but too well-founded. Dr.
Olivier testified to the fact, that the body bore twenty-seven
recent contusions on the body and members, and a fracture of nearly
five inches in extent, which almost entirely broke through one of
the bones of the cranium.

“The death of this poor child, which was three years and three
months old, awakened suspicions which had arisen on the death of its
eldest brother, of eight years of age, which had been interred on
the 28th of February preceding. The body was disinterred, and Dr.
Olivier, to whom this second examination was confided,
notwithstanding the length of time that had occurred since the
death, found traces of numerous contusions on the body and members,
and a wound above the right ear, with a fracture and disjunction of
the bones of the cranium.”

And notwithstanding in this, as in the other case, the interment was
effected without observations.[28]

After giving instances where the innocent were justified or suspicions
were allayed by post mortem examinations, which proved that deaths
suspected to have been from murder had occurred from natural causes, M.
Orfila concludes by stating:—

“I do not believe that it often happens that persons are interred
alive in Paris, though I must admit that such events may take place;
but I am convinced that the earth has covered and continues to cover
crimes without any suspicion being raised in respect to them.”

§ 138. Another report imputes the neglects of the “officiers de santé,”
to the forgetfulness of duties, the force of habit or routine, the
results of age and infirmities; and the chief remedy recommended, and
now apparently in course of adoption in Paris, is the erection on the
unsubstantial foundation of service by a number of private
practitioners, of two additional stages as securities, namely, of three
paid medical officers, who are to devote their time to the
superintendence of the performance of the public duties by the private
practitioners, and, secondly, a certain number of high honorary
officers, who are to superintend both classes of paid officers. This is
an example of one of those superficial alterations, in which, from want
of firmness on the part of the legislature to compensate fairly and
amply the interests which it is obviously necessary to disturb, and from
not duly regarding and estimating the immense amount of pain and public
evil which requires measures of alleviation of corresponding extent and
efficiency; consequently from allowing that amount of pain and mortality
to weigh as dust against local patronage and latent sinister
interests,—that evil is only masked, and more widely and deeply spread
by the intended remedy. Of a certainty the attention of every private
practitioner, as he gains practice, whilst acting as a public officer,
must every hour of the day be _from_ his public duties, and _with_ the
means of adding to his emoluments. That the least possible time may be
taken from them, the public duties are slurred over, conclusions are
snapped from the readiest superficial incidents; extensive and
removable, but latent causes of evil, the development of which would
require sustained and laborious examination, are perpetuated, by being
stamped authoritatively as “accidental” or arbitrarily classed under
some general term assigning the evils as the results of some inscrutable
cause. The three superior paid inspectors will not long be able to
stimulate the thirty-five private practitioners to a close attention to
their public duties against their paramount and ever-pressing interests,
or will soon tire of doing so. The service will become one of mere
routine and of short and easy acquiescence in all except the most
extraordinary cases which present an appearance of danger to the officer
himself if he overlook them. Under such arrangements, the functions of
the office degenerates into a highly prejudicial form, protracting the
evil, by creating an impression from the fact of the existence of the
office, that all has been done in the way of prevention or remedy that
can be done by such an officer. The admixture of private practice with
important public duties in such cases, is attended with further evil in
depriving the public of much volunteer service from the whole class of
private practitioners, for many who would give information to advance
science, or to aid the public service, can scarcely be expected to give
cordial aid that may add to the credit and promote the interests of a
rival. To the people themselves such services, from a locally connected
private practitioner, are generally less acceptable than those of an
independent and responsible public officer. The official service must,
in time, fail to inspire confidence, for it must fail to elicit evidence
to justify public confidence. The additional expense of the three
additional officers will only have created an additional interest, in
slurring over cases that may have been overlooked by the other class of
officers, involving blame for remissness to the superior officers. When
exposures do take place, these two classes of officers will only add to
the means of perplexing public attention, and of dividing and weakening
responsibility. If less than half the number of officers, devoting their
whole time to the service, would be sufficient (as will be shown they
would), for the efficient discharge of these highly important duties in
London, less than one-third of the number would suffice in Paris.

§ 139. Except in the regulation of the expenses of the funerals, there
appears to be nothing in the practice of interments in Paris, that
deserves to be considered with a view to imitation. Indeed, the whole
arrangements there are now under revision, and exertions are being made
for their improvement. The little account that appears to have been at
any time made of the feelings of the labouring classes, and the burial
after dissection, of the poor dying in hospitals, without funereal
rites, the almost total omission of any marks of sympathy or respect
towards their remains,—cannot but have a most demoralizing effect on the
survivors. The mode in which the evil of the retention of the corpse
amidst the living is provided for by the law, which requires that
interments shall take place within twenty-four hours after notice, must
frequently oppress the feelings of the dying and of survivors, and
harass them with alarms which the medical inspection provided, as we
have seen, § 137, is not of a character to allay. The intermediate stage
of removal provided at Franckfort and other German towns; the retention
of the corpse in a separate room warmed and ventilated, and watched at
all hours, and lighted during the night; the regular medical attendance
and inspection, and other cares bestowed until there are unequivocal
signs of dissolution, and the minds of all classes are satisfied,
appears to be a superior arrangement, salutary in its effect and
principle.[29] Beyond these benevolent arrangements may be commended the
acts of real good will and charity by which the feelings of the
labouring classes are consulted and satisfied by community of sepulture,
and the benevolent care and spirit of good will in which it appears to
be maintained.


_Experience in respect to the sites of Places of Burial, and sanitary
precautions necessary in respect to them._