Edwin Chadwick.

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

. (page 27 of 27)
Online LibraryEdwin ChadwickReport 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 text (page 27 of 27)
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efficient service might be obtained for national cemeteries for the same
money. Assuming that the greatest solemnity and the highest cathedral
service is due to funerals, four full choirs of 20 choristers and four
organists to lead them might be obtained for less than 10,000_l._ per
annum for four national cemeteries to meet the wishes of those who
desire a service of the highest solemnity. The lowest aggregate charge
for the separate establishments of parochial and suburban burial
grounds, if only on the scale of that of St. Martin’s-in-the-Fields,
must be at the least 25,000_l._, and would probably extend to 30,000_l._
or 40,000_l._ per annum. Such an amount in connexion with national
cemeteries would suffice to maintain, in addition to the superior
religious establishments above described, a superior description of
intermediate houses of reception for the dead, with houses and offices
for the residence of the officers of public health in care of them: it
would beyond that suffice to provide the means for accommodation, on a
large scale, for the reception and treatment of all persons labouring
under infectious diseases. It might also suffice for the establishment
of public baths, in which the metropolis is also deficient.

§ 223. The number of the officers of health requisite for the due
execution of the service could only be determined by experience; but,
judging from analogous experience, a much smaller staff than on the
first view might be expected would suffice for the performance of all
the duties specified, if their whole time were devoted to them. Medical
officers of dispensaries, within their districts, visit, examine, and
treat twenty or thirty cases per diem; physicians in full practice, and
driving to distant parts of the town, on the average (which includes
cases of short visits of a few minutes and cases where a long attendance
would be required), visit about three cases in the hour. This appears to
be the best analogous experience. On this experience, and considering
that it would be good economy to provide each officer with a one-horse
vehicle, he may be expected to visit fifteen cases a-day, one day with
the other, out of the daily number of deaths. The two public medical
departments, the navy and the army, have rendered the highest, if not
the only, public service in the prevention of disease—the navy medical
department especially; which service it has been enabled to achieve from
having the subjects of its care under the most complete control. The
scale of remuneration to these officers, who, whatever diploma they may
possess, are required to undergo, and do undergo, a special
re-examination, is taken for estimating the expense. There are various
grounds that, at all events at the outset, and for their superior
responsibility, this class of officers should be selected. The proposed
staff would be as follows:—

Per Annum.
£. _s._ _d._
An inspector of public health, of the rank of an
inspector-general of hospitals in the army, or of 657 0 0
fleets in the navy, at full pay of 1_l._ 16_s._ per
diem, at the rate given after ten years’ service

A deputy inspector-general, at the rate of the army 438 0 0
full pay of 1_l._ 4_s._ per diem

Eight inspectors of public health, of the rank of staff
surgeon, at the rate of the army full pay of 19_s._ 2,774 0 0
per diem

Two supernumeraries, of the pay of regimental surgeons, 547 10 0
at the rate of the army pay of 15_s._ per diem

Ten single horse vehicles, and ten drivers, at 1_l._ 1,638 0 0
1_s._ per week, total 3_l._ 3_s._ per week each
————— —— —
Total 6,054 10 0
————— —— —

Ten officers, visiting fifteen cases per diem, would suffice to take
order such as described, for the burial of 45,000 persons. They will
also be enabled in upwards of 8,000 cases to direct measures for the
protection of the survivors and their neighbours from the spread of
contagious disease. Supposing that each class of deaths occurred daily,
with the same regularity that they occur yearly, the distribution of the
duties of verification and examination may be seen from the following
table, made from the Registrar-General’s returns.

│ ║ Liver- │ Man- │ Leeds
│Metropolis Pop. 1,870,727 ║ pool │chester │ Pop.
│ ║ Pop. │ Pop. │168,627
│ ║223,045 │192,408 │
│ Daily │ │ ║ Weekly │ │
│ Number │ Daily │ ║ Number │ Weekly │ Weekly
│ of │Number │ Total ║ of │ Number │ Number
│ Deaths │ of │ Number ║ Deaths │ of │ of
│ of │Deaths │ Daily. ║ in │ Deaths │ Deaths
│Children│ of │ ║ Liver- │in Man- │ in
│ under │Adults.│ ║ pool. │chester.│ Leeds.
│ 15. │ │ ║ │ │
Epidemic, │ │ │ ║ │ │
Endemic, and │ 18│ 4–2/10│ 22–2/10║ 52–6/10│ 34–8/10│ 20–3/10
Contagious │ │ │ ║ │ │
Diseases │ │ │ ║ │ │
Sporadic │ │ │ ║ │ │
Diseases:— │ │ │ ║ │ │
Nervous Disease │ 14–6/10│ 6–6/10│ 21–2/10║ 28–7/10│ 18│ 15–6/10
Diseases of the │ │ │ ║ │ │
Respiratory │ 13–2/10│25–6/10│ 38–6/10║ 46–8/10│ 34–6/10│ 24
Organs │ │ │ ║ │ │
Diseases of the │ │ │ ║ │ │
Organs of │ │ 2–4/10│ 2–7/10║ 1–8/10│ 1–1/10│ 8/10
Circulation │ │ │ ║ │ │
Diseases of the │ │ │ ║ │ │
Digestive │ 5–5/10│ 3–8/10│ 9–3/10║ 10–5/10│ 9–5/10│ 6–1/10
Organs │ │ │ ║ │ │
Other Sporadic │ 5–4/10│12–7/10│ 18–1/10║ 13–5/10│ 16│ 10–2/10
Diseases │ │ │ ║ │ │
Old Age │ │ 9–4/10│ 9–4/10║ 5–1/10│ 5–7/10│ 5–6/10
Violent Deaths │ 1│ 2–4/10│ 3–4/10║ 3–8/10│ 4–9/10│ 2–7/10
Causes not │ 2/10│ 3/10│ 5/10║ │ │ 1
specified │ │ │ ║ │ │
Total │ 58–1/10│67–2/10│ ║162–8/10│124–8/10│ 86–3/10
Total Deaths │ │ │ 125–4/10║ 23–2/10│ 17–8/10│ 12–3/10
Daily │ │ │ ║ │ │

NOTE.—The data upon which this Table is calculated are taken from
the Registrar-General’s Fourth Annual Report—the Metropolis, p. 330;
Liverpool, p. 281; Manchester, p. 281; Leeds, p. 283. The Metropolis
is calculated on the average of the years 1840 and 1841, the other
places on the year 1840.

§ 224. The total number of funerals and deaths requiring verification
daily would be—for Birmingham about 12, for Nottingham 5, for Leicester
3, for Derby 3. From the data above given it will be seen at how small
an expenditure of time a well directed force for the prevention as well
as the alleviation of misery—vast interests of the population, that are
now neglected—may be placed, under responsible superintendence, and on
the most sordid views of economy of money, immense savings, under proper
regulations, be made. In Liverpool alone, in the business of cure or
alleviation there are now engaged 50 physicians, and 250 surgeons,
apothecaries, and druggists, and not one responsible public officer to
investigate the causes of disease with a view to prevention. Nor has the
city of London, with a population of 125,000, one such officer, though
it has an expenditure of 72,000_l._ per annum in hospitals and endowed
medical charities alone, for the alleviation of disease.

§ 225. There is much experience to establish the conclusion that very
special qualifications are requisite for the performance of the duties
of an officer of the public health. The only safe proof of the
possession of such qualifications is the fact of a person having
investigated successfully some scientific question on the prevention of
disease to a practical end, by which the main qualification, the habit
of practical investigation, and zeal and ability for the service of
prevention may be placed beyond doubt. It would be no imputation on the
merits of a general medical practitioner that he was found unsuited to
the performance of the duties devolving on an officer of public health.
The working of the Parisian administrative arrangements shows the injury
done to the public service by the difficulty of retrieving any mistaken
appointment, and suggests the desirableness of an arrangement to
facilitate changes of the officers of health even where there is the
security of a previous special examination as to the qualifications for
the office. Cases would occur where officers would themselves choose to
withdraw from such a service, for which they felt unsuited, if they
might retire without imputation and without any severe sacrifice. If,
therefore, officers of health were chosen from amongst those who had
long served with honour in the army or navy medical department, the
advantage would be gained of a facility of retirement being given to the
officer of health (an office, indeed, which would often be trying to the
constitution), and without loss of rank or of the means of livelihood.

§ 226. The arrangements for the performance of the funereal rites in
public cemeteries would, of course, fall to the proper ecclesiastical
authority. The architectural arrangements, and the decoration of the
cemeteries, may claim the highest aid that art can give to the
production of solemn religious impressions. Public monuments and works
of art have of late been extensively thrown open to the population, and
there is evidence that this course of proceeding has been productive of
beneficial effects on those of the lower classes who have had
opportunities of viewing such monuments during their holidays. But the
place of burial is the object to which the views of almost every
individual of that class, as well as of others, is ever most intently
directed. All the structural and decorative arrangements of the national
cemetery should, therefore, be made by the highest talent that can be
procured, with the purpose of interesting the feelings, under the
conviction that in rendering attractive that place we are preparing
_the_ picture which is most frequently present to the minds of the
poorest, in the hours of mental and bodily infirmity, and the last
picture on earth presented to his contemplation before dissolution.

§ 227. It will have been seen that if the tendency of the public mind be
followed out by the economical regulation of funeral expenses, and if
the public be protected from the extortions of undertakers, considerable
reductions of expense may be effected, and munificent provision may yet
be made for permanent decorations.

These reductions would, also, under practicable regulations of the mode
and practice of interment, admit of full and liberal compensation to all
legal and proper interests affected by the proposed change of the
practice, and to whom Parliament might determine that compensation
should be awarded.

§ 228. In the case of the ministers of the Established Church in large
towns, the surplice fees, including the burial dues, are to be
considered as the

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Online LibraryEdwin ChadwickReport 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 text (page 27 of 27)