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

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.

§ 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