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

cause of the accident been developed by the inquiry, others of the
family might have suffered in the same way. The other cases, which
had escaped inquiry, have been chiefly those of accident, in which
the death occurred at long periods subsequently, such as five or six
weeks. I have found that it is a common practice to represent
children as “still-born,” who were born alive, it not being
necessary to register still-born children. By passing them off as
still-born, burial is obtained for a smaller fee. But by this means
cases of infanticide might be concealed. The fact of a married woman
having been pregnant, and no proof existing as to the issue may
hereafter be of legal importance. I have heard of many suspected
cases of the wilful neglect of children, on whose deaths sums were
obtainable from different burial societies. I cannot doubt that by
inquiring much infantile death, which occurs from ignorance and
incorrect treatment, would be prevented.

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

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

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

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

In a subsequent communication, he states—

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

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

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