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

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

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

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

Perhaps in no manufacturing community is human life, in large
classes of men, so shortened or accompanied with such an amount of
suffering or wretchedness as in this town, in connection with
certain staple manufactures. Were the legislature to interfere and
enforce the correction of the evils, by a system of ventilation,
which is neither difficult nor expensive to put in operation, the
duties of this officer, if directed to the superintendence of this
system, would save numerous lives and prevent an incalculable amount
of misery. At present, in consequence of these evils, a majority of
the artisans is killed off from twenty-five to thirty-five years of
age, and numbers annually leaving widows and children in great
destitution, and, in most cases, dependent on the parish. The evils
are not inseparably connected with the occupation; they admit of
redress. An officer of health, by maintaining the system of
ventilation in efficient operation, would save numerous lives, would
create a better tone of mind among the artisans—for wretchedness is
closely allied with ignorance and immorality—would diminish the high
rate of mortality amongst the young under five years of age—left by
the premature death of the parent unprovided for, and lastly, would
greatly relieve the parish funds. The officer, having the power to
remove at once any case of fever from a densely populated locality,
as well as to enforce measures of prevention, such as the removal of
accumulated filth, stagnant pools of water, or the correction of any
other local circumstances, would perform duties which would redound
considerably to the advantage of the community.

§ 214. In confirmation of the views of the benefits derivable to medical
science from such arrangements as those proposed, § 211, various
instances might be adduced besides the last cited, § 213, and that
already given in the General Report, p. 355, of the discoveries made, on
an examination of 1000 cases, by M. Louis, on the nature of consumption,
now generally recognized as presenting facts at variance with all
ancient and previous modern opinions: but in respect of the views there
stated, as to the great public importance of well-ascertained medical
statistics, I submit the high confirmation derivable from the following
statement contained in the recently published outlines of pathology and
practice of medicine, by Dr. W. Pulteney Alison, fellow and late
president of the College of Physicians at Edinburgh, and professor of
the practice of medicine in the University of Edinburgh:—

“The living body,” he observes, “assumes, in many cases, different kinds
of diseased action, varying remarkably in different periods of life,
without any apparent or known cause; but in the greater number of cases
it is generally believed that certain circumstances in the situation or
condition of patients, before diseases appear, can be assigned with
confidence as their causes. The efficacy of these, however, is seldom
established in any other way than simply by the observation that persons
known to be exposed to their influence become afflicted with certain
diseases in a proportion very much greater than those who are not known
to be so exposed.

“This kind of evidence is in many _individual_ cases very liable to
fallacy, in consequence of the great variety of the circumstances
capable of affecting health, in which individuals are placed, and of the
difficulty of varying these so as to obtain such observations, in the
way of induction or exclusion, as shall be decisive as to the efficacy
of each. Hence the importance of the observations intended to illustrate
this matter being as extensively multiplied as possible; and hence also
the peculiar value, with a view to the investigation of the causes of
diseases, of observations made on large and organized bodies of men, as
in the experience of military and naval practitioners. All the
circumstances of the whole number of men whose diseases are there
observed, are in many respects exactly alike; they are accurately known
to the observer, and are indeed often to a certain degree at his
disposal; they are often suddenly changed, and when changed as to one
portion of the individuals under observation, they are often unchanged
as to another; and therefore the conditions necessary to obtaining an
_experimentum crucis_ as to the efficacy of an alleged cause of disease
are more frequently in the power of such an observer than of one who is
conversant only with civil life.

“But when the necessary precautions as to the multiplication of facts,
and the exclusion of circumstances foreign to the result in question,
are observed, the efficacy of the remote causes of disease may often be
determined _statistically_, and with absolute certainty; and the
knowledge thus acquired as leading directly to the _prevention_ of
disease, is often of the greatest importance, especially with a view to
regulations of medical police. And if the human race be destined, in
future ages, to possess greater wisdom and happiness in this state of
existence than at present, the value of this knowledge may be expected
to increase in the progress of time; because there are many diseases
which the experience of ages has brought only partially within the power
of medicine, but the causes of which are known, and under certain
circumstances may be avoided; and the conditions necessary for avoiding
them are in a great measure in the power of _communities_, though at
present beyond the power of many of the individuals composing these.

“There are, indeed, various cases, of frequent occurrence, in which the
study of the remote causes of disease is as practically important as
anything that can be learnt as to their history, or the effects of
remedies upon them. This is particularly true of epidemic diseases, and
of diseases to which a tendency is given by irremediable constitutional
infirmities.”

Having had the honour to be associated with the late Dr. Cowan of
Glasgow, Dr. Alison, and some other gentlemen, in a committee to
consider of the means of obtaining a system of mortuary registration for
Scotland, and having conversed with many qualified persons who have also
paid much attention to the subject, I may state confidently that the
exposition above given of the advantages derivable to the public service
from the improvement of vital statistics would meet with extensive
concurrence, independently of the very high sanction conferred by any
expression of an opinion on such a subject from Dr. Alison. The towns
where the greatest mortality prevails present precisely the
opportunities so highly appreciated, of observations on large and
organized bodies of men, § 213, often as similar in the chief
circumstances which govern their condition, as the classes presented to
the observation of medical officers in the army or in the navy.

Lord Bacon observes, in his suggestions for an inquiry into the causes
of death—“And this inquiry, we hope, might redound to a general good, if
physicians would but exert themselves and raise their minds above the
sordid considerations of cure; not deriving their honour from the
necessities of mankind, but becoming ministers to the Divine power and
goodness both in prolonging and restoring the life of man; especially as
this may be effected by safe, commodious, and not illiberal means,
though hitherto unattempted. And certainly it would be an earnest of
Divine favour if, whilst we are journeying to the land of promise, our
garments, those frail bodies of ours, were not greatly to wear out in
the wilderness of this world.” It would accord with his great views that
adequate public provision and arrangement should be made to enable
physicians to render the services desired. From the earliest time to the
present, when the subject of sanitary evil and desecration of
grave-yards was brought before the public by the long-continued
exertions of Mr. Walker, members of the medical profession have made the
most strenuous exertions and sacrifices for the attainment of such
objects.

It is submitted that, in whatsoever place a proper system of the
verification and registration of the fact and cause of death has not
been introduced, as in Ireland and Scotland, and in all populous and
increasing districts, that the appointment of an officer of health,
having charge and regulations of all interments, would be the most
economical as well as the most efficient mode of introducing it: in
every place it must be a measure of paramount importance.

§ 215. As an instance of the incompatibility of such duties as those of
the proposed officer of public health, with service in connexion with
any existing local administrative body, it may be mentioned that every
local Board in such a town as Sheffield would comprehend some of the
chief householders, who would most probably be the chief manufacturers
and employers of the class of workmen, and that even the official
connexion would to such minds as the workmen expose him to suspicion,
and diminish his influence, for the effectuation of any voluntary
changes of practice. On other grounds, such as the absence of
qualification in such Boards to give superior directions; and such
grounds as those specified in p. 322 and p. 349 and 350 of the General
Report, it is submitted that the functions of the officer of health
would be the best exercised, independently of any other local
administrative body. He would, in an independent capacity, be the most
powerful auxiliary of any well-intended and zealous administration of
local works, and as his functions must bring him at once to the chief
spots where the consequences of neglects and omissions would be often
manifest in fatal events, he would, as an independent and yet
responsible officer, exercise an extensive influence and an efficient
check on behalf of the public at large.

§ 216. Every efficient measure of improvement of the sanitary condition
of the population, must be in its mere pecuniary results a measure of a
large economy (§ 80). Physicians and medical officers are of opinion
that all the ordinary and extraordinary duties specified, and even more,
may be done by an officer of health with the same average expenditure of
time (taking one case with another), that occurs to a physician in
visiting a patient, examining the case, writing out a prescription and
giving instructions to attendants. I shall be able to show that it may
be accomplished at a charge no greater than that now paid by the
labouring classes to one of their body as a steward or officer of their
burial clubs who is required to inspect and identify the body of a
deceased member.


_Proximate Estimate of the comparative Expense of Interments under
arrangements for National Cemeteries._

Having shown the chief desiderata in respect to the improvement of the
practice of interment, and the means of protecting the public health, I
proceed to submit the substance of the information collected as to the
means of obtaining them.

§ 217. In submitting for consideration a proximate estimate of the
extent to which it is practicable to carry that reduction of the expense
of interments, which is so important to the middle and lower classes,
the expense of interments of gentry and persons of the middle class of
life is taken at double the amount at which persons of great experience
in providing for the interment of large numbers have estimated they may
be executed for without any reduction of the essentials to a decent
solemnity.

§ 218. The estimate takes the existing scale of burial fees of the
parish of St. James, Westminster, as fees to be continued, which would,
if received in a fee fund, not only provide compensation for vested
interests, but go far to provide the expense of new services.

§ 219. To the estimate of the expenses of interment is superadded a fee
to defray the expenses of medical officers of a board of public health.
The reduction of that great source of waste and expense, the payment of
two or three stages of profits, for materials, &c. of funerals (by
placing them under general arrangements), would admit of this charge,
which is really a means to a still greater economy, the economy of
health and life, and consequently of the number of funerals themselves.
Objection to these charges would scarcely have place where the pecuniary
economy is immediate. The medical service proposed may be procured to
the working classes (supposing it were necessary to charge the expense
on the funeral) at all distances, for the same sum as that which they
now pay to the unlearned inspectors, officers of their clubs, for
inspection within short distances, namely, 2_s._ 6_d._ It is declared by
competent witnesses, that a respectable officer of public health, a
physician, performing such services as those described, would be
welcomed in most families on such a charge as 10_s._ 6_d._ for the
middle classes, and 1_l._ 1_s._ for the higher classes, charged as a
part of the reduced funeral expenses.

_Estimated Scale of Charges for Interments in the Metropolis,
inclusive of Compensations; the payment for the purchase of new
Cemeteries; and new Establishment Charges._

────────────────────────┬────────────┬────────────┬────────────
│ │ Proposed │ Scale of
│ │ Charge for │Expense for
│ Existing │ Officer of │Undertaker’s
│Burial Dues.│ Health and │ Materials
│ │Registration│ and
│ │ of Death. │ Services.
│ │ │
────────────────────────┼────────────┼────────────┼────────────
│£. _s._ _d._│£. _s._ _d._│£. _s._ _d._
│ │ │
Gentry {Adults │ 10 10 0│ 1 0 0│ 21 0 0
{Children│ 5 5 0│ 1 0 0│ 3 10 0
│ │ │
1st Class {Adults │ 2 10 0│ 0 10 0│ 10 10 0
Tradesmen {Children│ 1 5 0│ 0 10 0│ 2 10 0
│ │ │
2nd Class }Adults │ 1 12 9│ 0 6 3│ 6 0 0
Tradesmen }Children│ 0 16 9│ 0 6 3│ 1 12 6
(Undescribed) } │ │ │
│ │ │
Artisans {Adults │ 0 15 6│ 0 2 6│ 1 10 0
{Children│ 0 8 9│ 0 2 6│ 0 15 0
│ │ │
Paupers {Adults │ }│ │
{Children│ }│ │
│ │ │
Totals



───────────────────────────────────────────────────────────────
────────────────────────┬───────────────┬────────────┬──────┬──────────
│ │ │Annual│ Total
│ │ Total │Number│estimated
│Charge for New │ estimated │ of │Expense of
│Cemeteries and │ Scale of │Cases │Interments
│Establishments.│ Expense of │ of │ to each
│ │ Burials. │ each │Class per
│ │ │Class.│ annum.
────────────────────────┼───────────────┼────────────┼──────┼──────────
│ £. _s._ _d._ │£. _s._ _d._│ │ £
│ │ │ │
Gentry {Adults │ 6 0 0│ 38 10 0│ 1,724│ 66,374
{Children│ 4 5 0│ 14 0 0│ 529│ 7,406
│ │ │ │
1st Class {Adults │ 3 0 0│ 16 10 0│ 3,979│ 65,655
Tradesmen {Children│ 2 0 0│ 6 5 0│ 3,703│ 23,144
│ │ │ │
2nd Class }Adults │ 1 10 0│ 9 9 0│ 2,996│ 28,312
Tradesmen }Children│ 0 10 0│ 3 5 6│ 2,761│ 9,042
(Undescribed) } │ │ │ │
│ │ │ │
Artisans {Adults │ 0 2 0│ 2 10 0│12,045│ 30,113
{Children│ 0 1 9│ 1 8 0│13,885│ 19,439
│ │ │ │
Paupers {Adults │ │ 0 13 0│ 3,655│ 2,376
{Children│ │ │ │ ——————
│ │ │ │
Totals │ 251,861
│ ———————
Or an annual saving on the estimated total expense of the │
interments and parochial charges for the whole metropolis │ 374,743
───────────────────────────────────────────────────────────────────────

§ 220. In this estimate the expense of the funerals of the classes
“undescribed” in the mortuary registries may be taken as representing
the second or third class of tradesmen. In the estimate of the expense
of funerals of persons of the first class, no account is taken for a
long cavalcade of mourning coaches; but those who are conversant with
the details agree that several may be supplied, with a full retinue of
hired mourners, and the expense be yet kept below one-half the present
amount of charges. A confident opinion is expressed that interments
might be performed, under general arrangements, with all the advantages
specified, and full compensation be given, at a rate of between 5_l._
and 6_l._ each funeral, instead of about 15_l._, the present average.

§ 221. On the eight chief cemeteries opened in the metropolis by private
companies, and comprising about 260 acres, or considerably more than the
space occupied by all the parochial and private burial grounds whatever,
a capital of about 400,000_l._ has been invested. The expenses of
litigation and of procuring Acts of Parliament, and purchasing grounds,
must have been excessively heavy; and it appears probable that, for an
amount not much greater or not exceeding it by more than one-fifth,
superior national cemeteries, with houses of reception and appropriate
chapels, may be formed on the present scale of expenditure of these
companies, and in a style commensurate with what is due to the
metropolis of the empire. If the charge of the purchase of the land and
the structural arrangements be spread over 30 years, and the payment of
the money charged, with interest, on the burials of persons of the
higher and middle classes, the amount might be included in the total
charges for funerals above estimated for the several classes, which
charges, though so much below the amount at present usually paid, are
yet higher than asserted to be necessary by respectable tradesmen, ready
to verify their assertions by sureties to supply the materials and
service of an equal or of a better description for the public than that
which they now obtain. If the charges of the new cemeteries and
establishments at such rates as those suggested were taken as
substitutes for the existing rates of charge for graves, the new rates
would be for the middle and higher classes greatly below the charges
usually found in undertakers’ bills and executors’ accounts. If those
new expenses were levied in the shape of a poll tax, or as burial dues,
a sum of about 5_d._ per head per annum (exclusive of the expense of
collection) would suffice in the metropolis to repay the principal and
interest of purchase-money in 30 years, and also to defray the annual
establishment charges.

§ 222. The establishment charges of the existing eight principal
cemeteries amount, it is stated, to about 7500_l._ per annum. I believe,
that by appropriate arrangements of a public establishment a far more