of the Dead._
The following are the regulations regarding the use of the house for the
reception and care of the dead, which are here made known for every
one’s observance.
(1.) The object of this institution is—
_a._ To give perfect security against the danger of premature
interment.
_b._ To offer a respectable place for the reception of the dead, in
order to remove the corpse from the confined dwellings of the
survivors.
(2.) The use of the reception-house is quite voluntary, yet, in case the
physician may consider it necessary for the safety of the survivors that
the dead be removed, a notification to this effect must be forwarded to
the younger burgermeister to obtain the necessary order.
(3.) Even, in case the house of reception is not used, the dead cannot
be interred until after the lapse of three nights, without the proper
certificate of the physician that the signs of decomposition have
commenced. In order to prevent the indecency which has formerly
occurred, of preparing too early the certificate of the death, the
physician shall in future sign a preliminary announcement of the
occurrence of death, for the sake of the previous arrangements necessary
for an interment, but the certificate of death is only to be prepared
when the corpse shows unequivocal signs of decomposition having
commenced. For the dead which it is wished to place in the house of
reception, the physician prepares a certificate of removal. This
certificate of removal can only be given after the lapse of the
different periods, of six hours; in sudden death, of twelve hours; and
in other cases, twenty-four hours.
In case of the thermometer being below 10 degrees of Reaumur, (30
Fahrenheit), removal can only take place when there are unequivocal
signs of death, and under the certificate of death from the physician.
(4.) The custody and treatment of the dead in the house of reception is
the same for all ranks and conditions.
(5.) The superintendence of the house of reception is conferred upon the
Inspector of the Church Yard. He must possess the requisite medical and
surgical knowledge, and must be examined by the Sanitary Board with
regard to his qualification for the office, and must be instructed
according to their direction.
(6.) The guardians of the dead are under the control of the inspector,
and must receive a special instruction with regard to their duties.
(7.) The dead which are placed in the house of reception must not be
interred until unequivocal signs of decomposition have appeared.
The inspector determines the time of interment.
(8.) The dead, on arrival at the house of reception, are immediately
placed in separate rooms, which are built for that purpose, and which
are numbered, and there receive all the proper means of security.
(9.) In the house of reception, there are besides these rooms two other
chambers; one is used as the animating chamber, the other, as a bath
room.
The kitchen, which is also near at hand, is used to furnish hot water,
or whatever may be required.
(10.) In case a body gives signs of re-animation, it must be brought
immediately into the chamber used for that purpose, when all the means
will be applied by the inspector, according to the instructions he has
received.
(11.) This chamber, in which there is a bed, must always be carefully
locked, in order that it may never be used for any other purpose. The
inspector alone has possession of the key of this chamber.
(12.) There must be in this chamber every necessary provision of
medicines, and of means of resuscitation and proper ventilation of the
air, according to the instruction of the Sanitary Board, and all these
arrangements must be kept in most perfect order by the inspector.
(13.) If any particular case occurs in the house of reception, the
Sanitary Board must immediately have information of it, and the Board
must from time to time examine into the state of the house.
(14.) Permission to friends and relatives to enter the rooms of the dead
is not granted unconditionally, on account of considerations of health,
but it depends upon the consent of the inspector. Entrance into the
waiting hall, from which the rooms in which the dead are deposited
range, is at all times allowed to the relatives of the dead.
(15.) A register is kept in the house of reception, in which is entered
the rank and name of the dead, the age, the last disease, the day and
hour of the death, the placing in the house of reception, and the time
of interment, and the name of the last physician. Every registration is
signed by the inspector.
(16.) No payment is made for reception and guarding of the dead in the
house of reception, nor for the services of the inspector or nurses, nor
for the heating of the chambers. These expenses are defrayed from the
Interment Fund.
(17.) The inspector and nurses are strictly forbidden to allow any
persons to visit them in the buildings of the burial ground.
(18.) When the inspector has been examined by the Sanitary Board, as to
his special qualifications, and has passed, the oath is administered to
him by the younger burgermeister.
_Instructions to the Inspector in regard to the House of Reception._
(1.) The inspector must be examined as to his medical and surgical
knowledge, by the Sanitary Board, and as to his treatment of suspended
animation, in which he is specially instructed by the Sanitary Board,
and is then sworn in by the younger burgermeister.
(2.) The inspector has to instruct his assistants, and must see that his
instructions are strictly followed.
(3.) He must answer for all that is out of order in the house of
reception.
(4.) As long as there are corpses in the house, the inspector must not
leave his house.
(5.) He has to keep a register, in a form which is prescribed, and must
punctually and clearly fill up all the heads of the form.
(6.) As soon as a corpse is brought to the house, the inspector must
determine in which of the rooms it is to be placed, and order all the
necessary arrangements and means of security, and the attendance of
guardians, and must not leave the dead until everything has been
arranged for its proper protection and care.
(7.) The Cemetery Inspector must superintend the attendants night and
day.
(8.) No corpse can be interred until unequivocal signs of decomposition
have appeared. On this matter the inspector has to act according to the
instructions of the Sanitary Board.
(9.) Should the case arise, that the dead sets in motion the alarum, or
that the nurses perceive a slight colour in the cheek, or a slight
breathing, or a movement in the eye-lid, the inspector must immediately
arrange that the body be brought into the fresh air of the re-animating
chamber, which is properly warmed, and he will there adopt all the other
means, on which he has received instructions from the Sanitary Board.
(10.) When these signs of life have appeared, the inspector must
immediately give information of the circumstance by a messenger to the
physician who last attended the person, in order that a notification of
the same may be made to the _Physikat_.
The tidings of the re-animation shall be conveyed to the house of
mourning by the physician alone, and then only when there is no longer
any doubt of the resuscitation.
(11.) One of the first essentials in the house is cleanliness. The
Cemetery Inspector has therefore strictly to watch that everything which
belongs to the house is kept most perfectly clean by the nurses.
In order to preserve the purity of the air, he must see that the
arrangements for ventilation are kept in perfect order.
(12.) He must also see that the rooms are properly warmed during the
cold weather.
(13.) The Cemetery Inspector is not specially paid for his services in
the house of reception, but has a house free, besides the salary
determined by the Cemetery Commission, and printed in the salary table.
_Instructions in respect to the Watchers or Nurses._
(1.) The nurses, amongst which the sextons may be sometimes employed,
are named and appointed by the Church and Cemetery Commission, on good
behaviour.
(2.) They are under the superintendence of the Cemetery Inspector, and
must obey his orders with the greatest exactitude and alacrity.
(3.) As soon as a corpse is brought to the house the nurses must convey
it immediately into the room pointed out by the inspector, and
afterwards do all that is required of them by him.
(4.) They must be instructed in all their duties by the inspector.
(5.) He, whose week it is to watch in the warder’s chamber, must never
leave the chamber when there are corpses in the rooms, on pain of
instant dismissal; but if anything requires him to leave the chamber, he
must first summon with a bell, one of the other nurses to take his
place.
(6.) The nurses must keep everything in the house in the greatest
cleanliness. Any one who has frequently to be reminded of his duties
through carelessness shall be dismissed from the situation.
(7.) If roughness be shown by a nurse to the dead, he must be punished
with instant dismissal, and a notification of the same must be given by
the Church and Cemetery Commission to the police, in order that proper
inquiry and punishment be given.
(8.) In case the alarum is set in motion, or any other sign of life is
perceived, the nurse must immediately inform the Inspector, and quietly
and gently fulfil all his directions.
(9.) The nurses are forbidden to use tobacco in the house.
(10.) They are forbidden to receive any visits in the house, and more
especially to allow any person to come during the night into the
ward-chamber.
(11.) There shall be in the warder’s chamber a clock, which, by a
certain mechanism, can tell when, and how long a nurse may have slept
during the night. Frequent negligence of this kind will be punished by
dismissal.
[Illustration: FRONT ELEVATION OF THE ENTRANCE, AND THE BUILDINGS
ATTACHED TO THE ENTRANCE, OF THE CHRISTIAN CEMETERY AT
FRANCKFORT-ON-THE-MAINE.]
[Illustration: GROUND PLAN OF THE ENTRANCE OF THE INSTITUTION FOR THE
RECEPTION AND CARE OF THE DEAD, ATTACHED TO THE CEMETERY.]
[Illustration: TRANSVERSE SECTION OF THE PROBATIONARY HOUSE OF RECEPTION
AND CARE OF THE DEAD PREVIOUS TO INTERMENT AT THE CEMETERY.]
[Illustration: LONGITUDINAL SECTION OF THE PROBATIONARY HOUSE OF
RECEPTION AND CARE OF THE DEAD PREVIOUS TO INTERMENT AT THE CEMETERY.]
No. 2.
REGULATIONS FOR THE EXAMINATION AND CARE OF THE DEAD, AND FOR RELIEVING
THE APPREHENSIONS OF PREMATURE INTERMENTS, PROVIDED AT MUNICH.
_Regulations for the Examination of the Dead._
Whereas it is of importance to all men to be perfectly assured that the
beings who were dear to them in life are not torn from them so long as
any, the remotest, hope exists of preserving them; so is death less
dreadful in its shape when one is convinced of its actual occurrence,
and no longer a danger exists of being buried alive.
In order to afford this satisfaction to mankind, and to preclude the
possibility of any one being considered as dead who is not actually so;
that the spread of infectious disorders be avoided as much as possible;
that the quackeries so highly injurious to health may be suppressed;
that murders committed by secret violence may be discovered, and the
perpetrators delivered over to the hands of justice, is the imperative
duty of every wise government; and in order to accomplish these objects,
every one of which is of infinite importance, recourse must be had to
the Safety Police as the most efficient means, by a strict medical
examination into the deaths occurring, and a conformable view of the
body.
In consideration of which, the orders already existing on this subject
will undergo a strict examination, and, with the august consent of the
government of the Isar-Circle, the following general regulations have
been fixed upon:—
1. An examination of all dead bodies, at two different times, and this
without exception to rank, is henceforth to take place in the
metropolitan city of Munich, and the suburbs belonging thereto.
2. The first examination is to be held immediately after death has taken
place, and the second shortly before the interment.
3. At the public hospitals, both examinations are intrusted to the
acting physician, who has however strictly to observe those regulations
relating to the certificates for the examination of the dead.
4. The first examination is to take place at the very spot where death
has taken place, or where any dead body may be discovered, by the sworn
surgeon of the district: the second examination, however, by the surgeon
appointed by and belonging to the Police Establishment.
5. The city of Munich, with the suburbs, are to be divided into Eight
Districts; for each of these districts a separate surgeon is hereby
appointed, viz.:—
[Here follow the eight districts, with the names and residences of the
Surgeons appointed for each district.]
6. As soon as a death takes place, immediate notice must be given by the
Soul-nuns, Midwife, &c., &c., or by any such person charged with the
arrangements for the burial. This said notice must state the street, the
number of the house, and of the floor where the dead body is lying;
whereupon the said surgeon has immediately to go there, and conduct the
investigation according to his instructions.
7. Previous to this, and before the first examination has taken place,
it is neither permitted to undress nor to clean the dead body: nor is
the body allowed (in cases of natural death) to be carried out of that
room where death has taken place, or to be removed from the spot; and it
is not even permitted to remove the cushions from under the head of the
dead body. Every violation of this decree will be punished with a fine
of from 5 to 15 florins, or with imprisonment from one to three days.
8. Those regulations issued by the examining surgeon respecting the
treatment of the dead body, or which relate to the clothes and other
objects of the deceased, must be strictly obeyed.
9. After the examining surgeon has convinced himself that every hope of
re-animation has disappeared, he fills up the certificate of examination
according to his instructions; but be it observed at the same time, that
if a medical man has attended the deceased, such is bound to enter in
the said certificate the description of the disease, and to certify it
by his signature.
10. If the dead body remains in the dwelling-house until the burial
takes place, the second examination by the surgeon from the Police must
be held there; and for this reason the certificate must be forwarded
into his hands as soon as possible.
11. But if the dead body after the first examination has been removed to
the house for the reception of the dead, in order to remain there, this
said certificate should previously, or at the delivery, be taken to the
Inspector of his Institution, in order that no obstacle may arise to its
reception.
12. The utmost cleanliness and greatest order is to prevail in this said
house for the reception of the dead, where the dead bodies removed there
are to be placed under a perpetual and proper watch; and the Police
Surgeon is bound to call at the Institution twice every day, namely, in
the morning and in the evening, to institute a very minute examination
of the dead bodies there; and in case of any signs of re-animation, to
render speedy and the most serviceable assistance.
13. If the medical man who conducts the second examination perceives
those signs in a corpse which do not leave any doubt whatsoever that a
death has taken place, he then enters the verification in the
certificate, which thereupon is taken to the Directory of Police, who
then grant the permission for the interment.
14. Without such a legal certificate permitting it, no body is allowed
to be buried; and that Priest or Clergyman who will assist at any burial
without having seen this certificate forfeits a sum from 15 to 30
florins.
15. Proper arrangements have been made that the Printed Forms for the
decreed Certificates may always be obtained at the Directory of Police,
and will be delivered gratis to the officiating medical men of the
Public Hospitals, as well as to the Examining Surgeons; a receipt
however must be given for them.
16. All those persons nominated for the execution of these measures, as
the Soul-nuns, Midwives, attendants at the house for the reception of
the dead; the Inspector of such House, the Examining Surgeons, the
Surgeons of the Police, &c., &c., will be supplied with the printed
regulations, as well as the most minute instructions, for which purpose
they will be sworn, and be ever subject to a rigorous inspection.
_Munich, Nov. 20, 1821._
[The regulations which follow this are chiefly as to the different
prices of different degrees of the religious service.]
_Regulations for the Guards or Watchers at the House for the reception
of the Dead near the Burial Ground at Munich, with reference to the
Inspection of Dead Bodies._
1. There must be at least two health-worthy and active men, as trusty as
possible, appointed as Body Watchers, and specially sworn in by the
Police.
2. When a body is intended to be placed in the house for the reception
of the dead, it must be previously notified to the Inspector of the
same, and the before-mentioned “Examination Ticket,” or a special
official order, be delivered over to him.
3. It is forbidden to the Body Watchers to place any body there without
the previous knowledge and concurrence of the Inspector.
4. Should no obstacle arise, the corpse is then received by the Body
Watchers, and deposited in the place appropriated to it.
5. The cover of the coffin must then be immediately withdrawn, the face
of the deceased uncovered, and the hands and feet disengaged from the
bandages attached to them.
6. The place where the bodies are watched must be kept warm day and
night, and lighted during the night without interruption.
7. Great cleanliness is to be observed, and a supply of pure air to be
kept up.
8. The Watchers must constantly remain in the watch-room, and frequently
by day and night enter the room for the reception of the dead, in order
carefully to observe the bodies lying there.
9. The Police Surgeons will particularly instruct the Body Watchers as
to what signs or appearances they are especially to observe, and how
they are to act with regard to them. On this point they are to take the
greatest care.
10. Should any sign or appearances which may betoken re-animation
proceed from any body, it must be immediately brought into the
watch-room with every care and precaution, and placed on the bed
provided with mattrasses and blankets for that purpose.
11. On such an event occurring, not only the Inspector must be informed
of it, but the Police Surgeon must be called in without a moment’s
delay.
12. As to the treatment of the body until the arrival of the Surgeon,
the Inspector and Body Watchers are informed by the Police Surgeon. In
all cases must warm water be prepared, and the safety apparatus
arranged.
13. The body, thus awakened from its sleep, must be treated with extreme
care, and everything must be avoided likely to create any strong
impression on it.
14. No coffin wherein a body is placed must be closed, nor must any
preparation for the burial take place, until the distinct permission
from the Police Surgeon is issued.
15. The entrance into the room for the reception of the dead is allowed
to every one under proper restrictions, care being taken that the quiet
and good order there are not disturbed.
16. Any Body Watcher who shall be convicted of any neglect in the
performance of his duties, will be punished with a proportional fine and
imprisonment, and dismissed on a repetition of the offence.
_Munich, Nov. 20, 1821. Royal Police Direction._
_Regulations for the Proceedings at the Second Examination of the
Corpses by the proper nominated Surgeon of the Police._
1. The second examination of the deceased must be performed by the
appointed Police Surgeon, who must, however, take particular pains to
satisfy himself that the first examination has been duly executed, that
the certificates were properly drawn up, that the Soul-nuns have
fulfilled their various duties, and that both the Inspector, as well as
the appointed Watchmen belonging to the house for the reception of the
dead, have duly discharged the duties with which they are intrusted, and
that, moreover, nothing has been undertaken or omitted that should not
be in accordance with the various intents and purposes of the decreed
examination of the bodies.
2. This said Surgeon must be supplied with a copy of all the regulations
relating to the examination of the bodies, as well as copies of all such
regulations for the guidance of all others charged with the performance
of any of these duties.
3. If the Surgeon who is appointed by the Police feels convinced that by
one person or other any act has been performed contrary to the
prescribed duties, or that any negligence in the execution of the
service exists, he must, on pain of personal responsibility, give
immediate notice to the Police.
4. The same (the Police Surgeon) is bound to issue proper instructions,
more particularly to the Soul-nuns, to the Inspector of the house for
the reception of the dead, and to the Watchers and attendants of the
said institution, as well as to all individuals assisting at any of the
examinations; which said instructions relate to the method of
proceeding, and treatment of the dead bodies, especially in such a case
where re-animation might again take place, and repeated caution must be
given on this subject.
5. The second examination with which he is charged must either be
undertaken in that house where death has taken place, or in the house
for the reception of the dead. In the first case, when, for instance,
the deceased is kept at the house where death has taken place until the
final interment, the Police Surgeon must receive the necessary
information through the medium of the examining ticket, which has been
issued and signed by the medical man of the district, and which ticket
must be forwarded to him, either through the Soul-nun, or through any
such person charged to attend the deceased.
6. The stated sickness, or the manner how death ensued, as also the time
in which deceased is to be buried; all of which, having been entered on
the ticket, must serve him for guidance whether the second examination
must be more or less accelerated. In all cases, however, such must be
undertaken as timely as possible, so that generally interment may take
place after 48 hours.
7. He has, accordingly, to go to that place stated in the certificate of
examination, examine the corpse with due minuteness, and, in case the
burial may be proceeded with, he has to state it in the certificate;
such is then to be forwarded to the Royal Police, where the permission
for interment is granted.
8. If it is intended to remove the body to the house for the reception
of the dead, such may take place without any hesitation after the
proceedings of the first examination; and in this case the Police
Surgeon must find both the body and certificate at that place.
9. The Police Surgeon is bound to attend twice every day at the house
for the reception of the dead of the burial-ground, viz., every morning
from 9 to 10 o’clock, and in the afternoon from 3 to 4 o’clock. On his
arrival, such dead bodies, with their certificates, which have been
examined, must be shown to him; he examines them, and signs those
certificates which do not admit of any delay; which certificates are
afterwards forwarded to the Royal Police authorities, in order to
procure the certificate of permission for the burial.
10. Of all such dead bodies having undergone the second examination by
the Police Surgeon, and which have been considered by him proper for
burial, minute lists must be kept by him containing the consecutive
numbers, as well as the statement of that day on which the interment has
been ordered, and all such observations which have been entered in the
certificate of examination.
11. Such corpses which from the manner of their death are subject to any
judicial examination or dissection, will, after their previous
dissection, be received by the proper judicial authorities, and the
interment is to take place according to the existing orders.
12. Should information be forwarded to the Police Surgeon that signs of
re-animation have been observed in any body, it is to be his first and
most sacred duty to attend instantly at the place and spot, in order to
conduct all attempts at restoration, and to issue orders about the mode
of treatment of the re-animated body.
13. Attending minutely to his duties, it is certain that he may perceive
divers symptoms which are not only important to him as Examining
Surgeon, but also as surgeon to the Police; he has therefore to attend
minutely to such observations, and, together with his own, communicate
such to his superior authorities.
14. In case the Police Surgeon should be prevented, either by
indisposition, absence, or any other cause, from conducting the
examinations with which he is intrusted, he is forthwith to give
immediate notice to the Royal Police, in order to provide for a proper
substitute, whom he may himself propose.
15. It is fully expected from the Surgeon of the Police, that, impressed
with the importance of the business he is charged with, he will do all
in his power to attain the manifold important objects belonging to it.
Any negligence of which he may be guilty will be rigorously punished,
and on a repetition of the offence he will be discharged.
_Royal Police Direction, Munich._
_Instructions to the Soul-Nuns as to their Duties in regard to the
Inspection of the Dead._
(1.) As soon as a person is dead, or appears to be so, the nurse or
sister of charity in attendance is immediately to give information of
the same to the medical man appointed to the district.
(2.) For this purpose she obtains the _form of notification_ for
conducting the inspection of the dead, which contains the divisions of
the districts of inspection, and the names of the physicians appointed
to each district.
(3.) In order that the physician may inspect _immediately, and without
the slightest delay_, the case of death in his district, the name of the
street, the number and floor of the house in which the death occurs is
to be given with exactness, so that he may not in any way be hindered in
going to the place and making the earliest possible inspection.
(4.) Before this inspection has taken place, it is expressly forbidden
to undress the corpse, or wash it, or, if the death is a natural one, to
remove it from the bed or room in which the death took place, or even to
take away or alter the position of the pillow.
(5.) Any disobedience to this law will be punished by a fine of from 5
to 15 florins, or by a three days’ imprisonment.
(6.) The physician will make a note of all the circumstances of the
first inspection, according to his instructions. If he should consider
that particular arrangements are necessary, they are to be adopted
immediately.
(7.) His note of remarks shall be left at the house, in the charge of
the soul-nun, and through them the signature of the physicians attending
the person who had died, if such there has been, shall be procured.
(8.) If the dead is retained at the house till the time of interment,
the note of inspection must be directly handed over to the public
surgeon, in order that he may make the second inspection, and determine
further what is necessary with regard to the interment.
(9.) If after a certain length of time he sees no reason to postpone the
interment, he will make a note to that effect and give it to the police
direction, and from them is procured the sanction for the interment.
This sanction will be given in to the clergyman’s office belonging to
the district, and thence handed over to the officer who has the care of
the house for the reception of the dead previous to interment. Without
this sanction no corpse can be interred.
(10.) The corpse must be retained until interment in an apartment where
there is fresh and pure air. The coffin must not be closed, nor the face
covered till after the second inspection, and the hands and feet must
not be bound.
If any signs of life should be observed, the district physician is
immediately to be called.
(11.) If the corpse is conveyed into the house for the reception of the
dead, the second inspection must be made there. The district physician’s
note of inspection is to be given to the officer of the house for the
reception of the dead at the time, or before the corpse being brought
there, and that officer is to hand over the note to the public surgeon.
Without this note of inspection, no corpse can be received into the
house for the reception of the dead.
(12.) The soul-nuns, or midwives, or whoever is intrusted with this
office, must wait for the second inspection, and for the time when the
public surgeon shall pronounce that the interment is necessary. For this
purpose the surgeon will make the requisite certificate, which must then
be given to the proper officer, who immediately gives the sanction for
the interment.
(13.) As the second inspection in the house for the reception of the
dead must take place, according to the regulations, in the morning
between 9 and 10, and in the afternoon between 3 and 4, the sanction for
interment may be procured between 11 and 12 in the morning, and 4 and 5
in the afternoon.
No. 3.
DEFECTIVE ARRANGEMENTS FOR THE VERIFICATION OF THE CAUSES OF DEATH.
_Thomas Abraham_, Esq., Surgeon.
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 to 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.
In the course of your practice, have you had occasion to believe that
evil is produced by the retention of the corpse?—Yes; I can give an
instance of a man, his wife, and six children, living in one room, in
Draper’s Buildings. The mother and all the children successively fell
ill of typhus fever: the mother died; the body remained in the room. I
wished it to be removed the next day, and I also wished the children to
be removed, being afraid that the fever would extend. The children were
apparently well at the time of the death of the mother. The
recommendation was not attended to: the body was kept five days in the
only room which this family of eight had to live and sleep in. The
eldest daughter was attacked about a week after the mother had been
removed, and, after three days’ illness, that daughter died. The corpse
of this child was only kept three days, as we determined that it should
positively be removed. In about nine days after the death of the girl,
the youngest child was attacked, and it died in about nine days. Then
the second one was taken: he lay twenty-three days, and died. Then
another boy died. The two other children recovered.
By the immediate removal of the corpse, and the use of proper preventive
means, how many deaths do you believe might have been prevented?—I think
it probable that the one took it from the other, and that if the corpse
of the first had been removed the rest would have escaped; although I,
of course, admit that the same cause which produced the disease of the
mother might also have produced it in the children. I believe that, in
cases of typhus, scarlatina, and other infectious diseases, it
frequently happens that the living are attacked by the same disease from
the retention of the body.
Have you had occasion to observe the effects of cesspools in your
district?—Yes, and that they are very injurious to the health. In the
states of the weather when offensive emanations arise from the cesspools
and drains, I have often heard people complain of headache, giddiness,
nausea, languor, and an indisposition for exertion of any kind; and I
have known a walk or a ride in the open air to remove those symptoms,
but in an hour or two after their return home they have found themselves
as bad as before. Their sleep brings them little or no refreshment; in
truth, they have inhaled, during the whole of the night, the noxious
atmosphere, which is very depressing, and will fully account for their
rising, as they often say, as tired as when they went to bed. As an
example, I may mention the case of a compositor, residing in Draper’s
Buildings—a narrow, confined, and filthy place, where there was always a
disgusting stench in every house. He was the subject of disordered
stomach and liver, which might have been induced by his night-work and
intemperance: the stinking hole in which he resided contributed its
share towards it, without doubt. This man remained at home for a week,
when he was getting better, but had scarcely any appetite. I advised him
to walk in Finsbury Circus two or three times a-day, as long as he could
without fatigue; and on several occasions, when he returned to his
dinner, he said, “Now, if I had had my dinner in Finsbury Circus I could
have eaten a hearty one, but now I do not seem to care anything about
it.” I believe that if I had entered that man’s house with a good
appetite for a dinner, and had remained there for an hour, that I should
have cared no more about eating than he did,—which I attribute to the
nauseating and depressing effects of the effluvia from the cesspools,
drains, and general filthiness of the place.
Are you aware whether this state of things arose from the cesspools or
the state of the sewers?—I conceive the worst have been cesspools; but
the drains, if they open, are just as bad. I was called upon to visit a
patient living in a court in Whitecross Street, ill of typhus fever; in
the centre of it was a gully-hole, which was untrapped and smelt
horribly. The fever went through the whole of that court. I gave it as
my opinion at the time, that the case I visited was occasioned by the
gully-hole, and that the fever would go through the court, which it did.
Have you perceived the present state of the drains in the city of
London?—At times they smell very strongly, which scarcely any one can
fail to notice; but I have heard country-people complain of them at
times when they have not attracted any particular notice from me.
Are you aware that decomposing matter is allowed to accumulate in
them?—Yes; very recently they took up the refuse in our street, Old
Broad Street; it smelt very badly, and it was black and horribly filthy.
How long before had the sewer been cleansed?—I do not know. I do not
remember its having been cleansed, before the last September, since I
have been there, which is about nine years.
Do you remember to have perceived the smell from the sewers before the
last September?—Yes; there is a gully-hole near my own house from which
there was constantly an offensive smell: it was much worse after a thaw
in winter, or a shower of rain in summer. A neighbour living two doors
from me being more annoyed by it than I, made great efforts, and at
length succeeded in getting it trapped; and I have not since perceived
any smell from it, though I observe it now in other places. The
gully-holes are trapped now in most of the respectable streets, but in
the bye and poor streets they are not trapped.
From the evidence which has come before you, have you any doubt that the
existing state of sewers in the City are the latent cause of much
disease and death?—I have not the least doubt of it in the world.—A
great deal of active disease, which creeps on gradually and insidiously,
may be traced to that cause.
In the poorer districts, in what state is the surface-cleansing of the
streets?—Even the best streets are very badly cleansed, but in the
poorer streets of the city the cleansing is very bad indeed—horribly
bad! Take Duke’s Place, for example; you will see cabbage-stalks and
rotten oranges that have been thrown away, and they often remain there
for several days. We do not get our streets swept oftener than once
a-week.
If there were a perfect system of drainage and cleansing in the city, do
you think that the health and the duration of life of the inhabitants
would be extended?—I think there would be a considerable extension.
What is the physical condition of the children born in London of parents
who are natives of the rural districts, as compared with the physical
condition of children who are born in the country of parents of the same
class?—The children born and bred up in London are more frequently of
small stature and have slender limbs, are deficient in stamina and
powers of endurance, are of irritable frames and prone to inflammatory
attack, than children born and bred up in the country. An impure
atmosphere is immeasurably more injurious to children than adults.
Children also suffer more from want of opportunities of exercise in the
open air. The beneficial effects of pure air and exercise on children
who have been born and pent up in London are most marked: a weakly
child, and which, if kept in London, would perhaps always continue
weakly, would most likely become strong and healthy if sent into the
country. I cannot doubt that children born of healthy parents, and bred
up in the country, would be more robust and stronger than children born
of the same class of parents and bred up in London, and that this
difference may be justly ascribable to atmospheric influence.
When children are weakly, what is the effect on the temper and
character?—The temper and character of weakly children are generally
found to correspond with, and are most probably derived from, the
character of their constitution: their temper is quick and irritable,
their passions ardent, their perception keen, and their imagination
predominant over their judgment.
You are speaking, of course, of the general characteristics of
individuals as specimens of the population brought up under such
circumstances?—Yes, of persons coming under my own observation.
Have you, as Registrar of Deaths, noticed the larger proportion of
infant mortality in the city?—There is, I conceive, all over the
kingdom, a large proportion of infant deaths; but I have no doubt that a
considerable proportion of the excess of infant deaths in London is
ascribable to atmospheric influences.
It appears, from the Mortuary Registration, that of deaths in the city
of London, about one-half are deaths of children under ten years of age;
whilst in a rural district, take the county of Hereford for example,
only one-third of the deaths are deaths of children.
Do you conceive it probable that this different rate of infant mortality
is to be traced chiefly to the difference of the atmospheric influence,
the average age of all of the labouring classes being, in Herefordshire,
39 years, whilst in the City of London the average age of the deaths of
all the labouring classes is only 22 years?—I am decidedly of opinion
that a greater proportion of the excess of infant mortality in London,
and the reduced duration of life, are ascribable to atmospheric
impurity.
If all cesspools were removed, and water-closets substituted; if water
were introduced into the houses of the poorest classes; if the sewers
were regularly flushed weekly, or oftener, so as to prevent
accumulations of deposit and the escape of miasma, such as you have
described; if the carriage and foot pavements were more frequently and
completely cleansed; if these several public duties were performed with
practicable efficiency, can you express a confident opinion that
decrease and premature deaths would be considerably diminished?—I am
quite confident that the adoption of such measures would not only
diminish disease of every kind, but greatly improve the moral as well as
the physical condition of the inhabitants.
No. 4.
THE PROPORTIONS OF DEATHS AND FUNERALS PREVENTIBLE BY SANITARY MEANS.
_Henry Blenkarne_, Esq., South West District Surgeon of the City of
London Union.
Have you in your district perceived any effects resulting from
interments in the parochial burying places?—I have no cognizance of any
bad effects resulting from those interments. The first twenty years of
my life I lived close to a burial-ground, and never was aware or heard
of any prejudicial consequences arising. I may observe, however, that
when a relation of mine has attended the church she has been enabled to
perceive whenever a vault underneath the church has been opened. She has
said, “I feel they have opened a vault;” and on inquiry it has turned
out to have been so.
Have you observed any evil effects following the practice of the long
retention of the corpse in the house amidst the living?—Yes, I have
observed effects follow, but I cannot say produced by them, though they
were perhaps increased by them. In those cases which I have had where
there has been a succession of cases of fever in the same family, after
a death it has generally occurred that the parties affected have
complained two or three days before that they felt very unwell.
Generally this has been the case. I have, in such instances, ordered
them medicine immediately. Since the Union has been established we have
immediately removed all fever cases to the Fever Hospital.
The retention of the corpse amidst the living, under such circumstances,
must aggravate the mortality, must it not?—There cannot be a moment’s
doubt about it.
What, from the observations in your district, has been the actual state
of the sewerage, and cleansing dependent upon it, as the cleansing of
the cesspools?—There has been great improvement in the city of London by
the improvement of the sewerage, in so far as it has removed the
cesspools. When you went into a respectable house formerly, you could,
in the city, tell the state of the weather by the smell from the
cesspools. Where water-closets are substituted, the health of the
inhabitants has undoubtedly been improved. In the poorer neighbourhoods,
where they have still cesspools, they are still very bad. I constantly
tell them, if you get rid of that nasty cesspool you’ll get well and
keep well; it is of no use my giving you physic until that is done.
Where there have been deposits accumulating in the sewers, and the
drains have been choked up, the effect has been just the same as if
there had been cesspools.
You are aware that in respect to sewerage it is the practice to allow
deposits to accumulate in the sewers, and then, when the private drains
are stopped up, to open the sewer and get out the deposit by means of
buckets, and remove it in carts?—Yes, I am.
Have you seen any illness result from this practice?—I cannot state a
case, though I have no doubt of its highly injurious effects; but can
decidedly speak to illness arising from the accumulations. The illness
is just the same as from cesspools: a low depressing nervous fever, most
like that which is described to be the form of the jungle fever. In
November or December last, they were taking up the deposits from the
sewers near Broken Wharf, in Upper Thames-street: the stench from it was
quite sufficient to have produced any fever: it was not within my
district, and I do not know what were the effects. Fortunately there was
clear weather, and the wind blew towards the river.
Have you any doubt that the removal of such refuse, as well as the
accumulation, must be attended with danger to life?—Yes; if any person
in a state of mental or bodily depression were exposed to such an
influence, it would produce low fever; it would be dangerous in
proportion as it was stagnant.
In passing through the city, have you been assailed with smells from
gully-holes?—Only yesterday, in passing through the city, the smells
from many of the gully-holes were very offensive; and several medical
friends agree with me in attributing extremely prejudicial consequences
as arising from this cause.
The following case is related on the authority of Dr. Good, as having
occurred within the city of London, and is mentioned by Mr. Fuller, in a
letter from a surgeon who has paid great attention to the influence of
sewerage, and who adduces the facts of the case in evidence that typhus
may be produced by the miasma from sewers:—“Soon after the closing of
the Parliamentary Committee, I learned, from the late Dr. Hope, the
particulars of a case which, to my mind, has completely proved the
production of typhus fever from it, and was so much in the character of
an _experimentum crucis_, that I did not consider it necessary to
prosecute the inquiry any further. The case is as follows:—“A family in
the city of London, who had occupied the same house for many years,
enjoying a good state of health, had a nursery-maid seized with typhus
fever; the young woman was removed from the house and another
substituted in her place. In a short time the new nurse-maid was
attacked with typhus fever, and was also sent away. A few weeks after
one of the children was seized with the same fever: an inquiry was now
instituted by the medical man in attendance, in order to ascertain, if
possible, the cause of this frequent recurrence of typhus fever, when
the following facts were brought to light:—The nursery was situated on
the upper floor but one of the house, and about a fortnight or three
weeks before the first case of fever occurred, a sink was placed in the
corner of the nursery for the purpose of saving the labour of the
servants; this was found to communicate with the common sewer, and to be
quite open, or untrapped; they ordered it immediately to be effectually
trapped, and then no other case of fever occurred, although it continued
to be occupied as before; and, when I learned the case, more than a
twelvemonth had passed.””
Have you met with cases analogous to the one here stated?—I have met
with several such cases. I know of an instance where a room in an old
house had an offensive stench, and the health of the person living in it
was always bad. A stench was perceived in the room, which it was guessed
might arise from the decay of dead rats in the wainscot. The party went
to much expense to pull down the wainscot, when it was found that there
was an opening which communicated with the cesspool below. The hole was
properly cemented and stopped up, and the room has since that time
become quite habitable and healthy; and where I have directed the
cesspools to be emptied, as the predisposing cause, the general result
has been that the sick have immediately got well. From my knowledge of
the local causes I can predicate, with certainty, what will be the
general effect on the health in the case of removal of the parties.
Besides the houses of the labouring classes, are there many houses of
the middling classes in your district in the city of London that are
provided with cesspools?—Many houses that I go into are provided with
cesspools. I mentioned the other day to a lady that I should never be
enabled to keep her well so long as there was a cesspool in the house; I
told her that the expense of continued medical attendance would pay for
a communication with the common sewer and better cleansing.
Are you aware that a new practice has arisen of preventing the
accumulation of deposits in the sewers, by flushes of water, which
remove all deposits weekly, and so far prevent the year’s accumulation
and corruption of deposits in the sewers. If this system were enforced
in the city, have you any doubt as to the extensive prevention of
disease and mortality which would be thereby effected amongst all
classes?—Certainly it would be a great boon, in a sanitary point of
view, to the population of the city of London. I am so much convinced of
this, that in my own house I put a stick under the handle of the
water-closet, so as to have a continued flow or flush of water for some
length of time; this I do to remove any accidental accumulation. Of
course the flushing of the common sewers would have the same effects.
Besides the accumulations in the sewers, is there at this time no
decomposing refuse from the defective cleansing of the courts and
bye-streets, and poorer districts?—Yes; in the poorer districts there is
accumulation. In one court, for example, called Harrow-court,
Thames-street, where there is almost always low fever, there is always
dirt and filth, and I am constantly exhorting the people to remove the
filth; but the great difficulty with the poor people is commonly how to
get the water. There is a court in Cornhill which a man was cleansing
the other day by applying a hose to the water-cock (which is used in
case of fire), in order to cleanse the pavement. An officer belonging to
the water company coming by, said, “If I see you doing that again, I
shall indict you.”
Are you aware that the streets are swept oftener than weekly in the city
of London?—My impression is—not oftener.
It has been proposed that water should be laid on, and kept at high
pressure in the streets, so as to enable the courts and alleys, the foot
and the carriage pavements, to be washed daily by means of a hose
attached to the water-pipes. This, which has been proposed for
protection against fire, as well as for cleansing the streets more
completely, has, I am informed, been done in Philadelphia. If the system
were carried out in the city of London, what do you conceive would be
the effect on the health of the population in the poorer districts?—I
should certainly say that it would tend greatly to prolong life amongst
the population.
From the mortuary registries it appears that the average duration of
life among the professional persons and gentry in the city of London,
who live in better cleansed and ventilated houses, and better cleansed
streets, is, on the average of the whole class, about 43 years, and 6
per cent. of the deaths are deaths from epidemic disease; whilst among
the labouring classes the proportion of deaths from epidemic disease is
19 per cent., and the average age of all who die is only 22 years. With
such sanitary regulations as are under the public control of the public
authorities, to what extent do you think it probable the duration of
life amongst the labouring classes may be extended?—So far as I can
judge, without examination of the particular cases, I should say that
the average might be extended one-half at the least.
The majority of the cases of epidemic diseases may decidedly be ascribed
to the want of cleanliness and ventilation. On looking over the mortuary
registry of the deaths occurring in Upper Thames-street and the district
attached to it, I find the causes of death most frequently registered
are “low fever,” “low fever,” occurring one after the other. This
recurrence of low fever corresponds with my experience of sickness,
which so often assumes the character of low typhoid nervous depression.
The medicine I use in the greatest quantity is ammonia, as an active
diffusive stimulus. For all classes this medicine is in constant use. In
damp weather we have always much increase of this illness: the dampness
produces a depression which lays them open to the atmospheric poison.
Have you had instances where better cleansing has taken place and
illness diminished?—Yes; for example, in Ireland-yard, containing a
large number of families of coal-heavers and others, a place which I
never was out of from continued illnesses: the yard has been much better
cleansed, the houses put in better order, and now there is very little
illness there. I know for a fact, that in the neighbourhood of
London-wall, where recently great improvements have taken place in the
sewerage and ventilation, disease has greatly diminished, especially
_low fever_. Formerly they had a sewer which used to be stopped up and
overflowed; they have had of late a new sewer, which now works better;
they have no stink or stench in the kitchens, as formerly, and they have
nothing of the same kind of disease going on there that they used to
have before.
Are the houses in Ireland-yard occupied by the same inhabitants?—Just by
the same class. The habits of coal-heavers are reputed to be none of the
best in respect to general cleanliness or temperance.
Have you observed any alteration in their habits?—Not in the least.
Have you observed what is the personal condition of the natives of
London?—The real cockney is generally of stunted growth.
Have you observed whether the children born in London of parents who
have come from the rural districts are as tall or as strong as the
parents?—Generally shorter children, though some of them are as tall,
but all are of comparatively weakly constitutions; they are particularly
predisposed to strumous disease. I have been so impressed with the
effect of children living in a London atmosphere, that I have been
anxious to send them out of it when possible.
Does not defective cleansing, as causing atmospheric impurity, not only
tend to produce disease and shorten the duration of life, but depress
the physical condition of the population?—Decidedly.
No. 5.
_Dr. Wray_, Medical Officer of the West London Union.
You have read what is stated by Mr. Blencarne, and by Mr. Abrahams—do
you generally agree with them as to the effects of defective cleansing,
on the condition of the population?—I agree with the whole of what they
state; it perfectly accords with my own experience, which has been about
25 years in this district. I have during that time observed a great
falling off in the condition of the children; they are stunted, squalid,
poor-looking things, and there is a great deal of deformity amongst
them.
Have you observed moral effects attendant on the physical
depression?—Yes; I have observed a great deal in our neighbourhood. I
think the females of the poorer classes who are not strong for work, are
more apt to take to courses of livelihood other than by work;—that very
many of them go upon the town.
No. 6.
_Mr. Thomas Porter_, Surgeon to the St. Botolph’s Bishopsgate District.
Have you observed any emanations from the sewers in your district?—In
Liverpool-street there is now a cleansing of the sewers by opening the
top, taking the soil out, and carting it away.
What is the effect of this process?—It vitiates the atmosphere to a
considerable extent.
Have you observed any effects from it?—I have often found headache to
result from it to myself, and parties have complained to me of the same
effects.
What is the state of the drainage?—There are some districts, such as
Halfmoon-street, which are imperfectly drained, where the cesspools are
suffered to overflow and run along the kennels at the sides
of the street, causing fœtid and deleterious exhalations;
in this street and the alleys opening into it, especially
Thompson’s-court, Thompson’-rents, Baker’s-court, Providence-place, and
Campions-buildings, fever prevails nearly the whole year round. It also
prevails very much in Bligh’s-buildings, Lamb-alley, Dunning’s-alley,
Sweet Apple-court, Montague-court, Artillery-lane, Rose-alley, and
Catherine-wheel-alley. These places, all of which are badly drained and
not regularly cleansed, are seldom without fever for any length of time.
In these places are there any water-closets?—No; they have nothing but
common necessaries, which are usually allowed to run over before they
are emptied, and it is impossible to enter the tenements without being
assailed by the disagreeable and unhealthy effluvia thence arising.
Have they water laid on in the rooms of the several tenements?—Seldom in
the rooms; generally in some place in the court to which they all go.
Many have not that even, and they resort to the common street pumps. I
do not remember an instance where water is properly laid on in any house
of the labouring classes.
What rents are paid for houses in this condition?—Rent for one room is
from 1_s._ 6_d._ to 4_s._ 6_d._ per week. The rents are very high in
proportion to the size and accommodation of the rooms.
You say you have observed emanations from the sewers within your
district?—Yes; they are frequently very offensive in moist warm weather.
You may, indeed, almost tell the condition of the weather from the
smells from the public sewers. Recently in returning from Islington
along the City-road from the Canal bridge to Finsbury-square, and along
Sun-street, I noticed in passing near the gratings, as every person must
have noticed, a peculiarly offensive effluvium.
Within the city itself have you perceived the same effluvium on passing
the gratings of the sewers?—Frequently; it is so general that no
particular place is distinguished by being free from it.
Suppose a tradesman or a merchant returning from Change in a state of
depression from anxiety passing through a street, exposed to a
succession of smells and breathing the effluvium from such sewers; what
is likely to be the effect upon him?—A low nervous fever, with
considerable gastric derangement. The greater part of fever cases which
I have to treat are of this description.
Is that with every class of persons?—Yes, with every rank of life. They
are mostly of the low or typhoid type, and do not bear depletion. In my
ordinary course of treatment I generally begin by emptying the stomach
and bowels, and by lowering the diet. I then use a moderately
stimulating treatment with a perfect absence of solid food.
Is gross feeding or excess very common amongst the people of your
district?—Not very common. Excess from drinking is more frequent than
excess from eating.
In what proportion will there be of excess from eating or drinking in
such cases?—Amongst the labouring classes perhaps there may be one case
in ten from excess of drinking, and one case in thirty from excess of
eating.
If these excesses had taken place in a purer atmosphere, do you conceive
the results in disease would have followed?—In most instances the system
in a pure atmosphere would have thrown off the inconvenience without
fever.
Then excess or depression both predispose to the attacks of disease from
atmospheric impurity, and especially to the direct influence of the
effluvium in question?—Yes, certainly; excess of watching, want of rest,
mental anxiety, every depressing cause predisposes to an attack.
Besides the defects in respect to the cleansing of the cesspools and the
drains, are there not defects in respect to other portions of cleansing,
such as dust-bins neglected?—Yes, in those places there is no person to
regulate or to see that done which ought to be done; consequently the
dustmen and scavengers duty is much neglected, and places are filled
with decomposing remains, which remain there two or three weeks in
summer and much longer in winter. The carelessness of the people
themselves as to cleanliness is also deplorable, as it operates very
injuriously on their health and comfort; the floors of their rooms, the
passages, stairs, and landings are often suffered to remain unwashed for
weeks and months, and the walls and ceilings are seldom cleansed or
whitened, so that what with filthiness of one kind or other they present
an appearance of wretchedness beyond all description.
What is the condition of the children born or kept in courts or places
of the condition you describe, with badly cleansed drains, with privies,
and without water or conveniences for cleansing introduced into their
habitations?—The children are, for the most part, of delicate or weak
frame, and subject to struma. The health of children depends partly
whether they were born in such places or not, whether their parents on
each side are Londoners, as there appears to be a gradual decline in
physical power by a long continuance in a vitiated atmosphere, which
passes from parent to progeny, and partly also in a family where one
part of the children have been born and brought up in the country and
the other in town; those born in the country, and not coming into London
until they are five years of age, will have comparatively strong frames,
and will resist such influences, whilst those born in town will be
comparatively of delicate frame, weakly and strumous, liable to
glandular disease, and diseased affections of the joints and the spine.
Generally they are shorter in stature, sometimes they are taller, but
then they are slender and very delicate, in which case they are likely
to have bending of the limbs.
What is the condition of females born under such circumstances?—I have
observed that the females are less depressed than the males, and are
reared with less difficulty.
Why is this so?—I have not been able to determine. It may be that the
male requires more extensive and powerful exercise, and that in pure
air, than the female, and consequently that the female suffers less from
the want of it.
What are the moral characteristics of the population brought up under
these depressing physical circumstances?—They have decided unwillingness
to labour. They are not so strenuous as the more healthy people from the
country. They are more apt to resort to subterfuge to gain their ends
without labour. Light employments they do not object to, and do
comparatively well in. But it is difficult to keep a native of London,
either male or female to heavy work; they will avoid it if they can. The
cause is in most cases physical from the deficiency of ability to
labour. The greatest part of them are mentally irritable and impatient
under moral restraint.
Is any similar difference marked on the condition of the children of
tradespeople between those children of tradespeople brought up in London
and those born in the country?—Yes, there is a similar difference
perceptible, but less in degree. Amongst tradesmen, too, it is the
extensive practice of the parents to send their children out of town to
school or on visits, which may powerfully affect them beneficially. In
the tradesman’s family they have better sleeping rooms, and greater
cleanliness in person, and in bed and body linen, and also a better
regulated dietary.
What is the effect of such atmospheric impurities as those described in
the chances of recovery from attacks of disease?—It lessens the chances
of recovery and greatly impedes convalescence. Indeed, in many
instances, very little progress can be made until the patient is sent
out into the country. In a case of fever which occurred to a strong
healthy man, aged 24, a carman, in a close neighbourhood, the house
being without drains and ill ventilated; no progress could be effected
until he was removed into the country, although the fever had decidedly
subsided. I believe that in this case something else would have
supervened, had he not been removed. I frequently remove patients in a
respectable condition, finding no chance of recovery without it. Many of
the better conditioned houses being badly adapted for the treatment of
fevers, having low ceilings and insufficient ventilation.
What will be the difference in respect to the time of cure or
convalescence between a well and an ill-cleansed neighbourhood?—A
difference of perhaps one-half.
Suppose the rooms of each house supplied with water, the privies and
cesspools removed, drains from the houses to sewers, and the sewers so
constructed as to be cleansed, and to convey away daily such refuse as
that which is allowed to remain decomposing in the close courts during
weeks. Supposing the surfaces of the streets cleansed as frequently
after the manner in use in Philadelphia and other towns where they are
cleansed with water daily, to what extent do you conceive disease would
be reduced?—Of fevers two-thirds certainly, and other diseases would be
considerably lessened.
No. 7.
_Mr. John H. Paul_, Surgeon, Medical Officer of the City of London
Union.
In what condition in respect to cleanliness are the courts and other
places within your district, chiefly inhabited by the labouring
classes?—The cleansing of the courts and alleys in my district is
defective. I agree with what Mr. Blenkarne says in respect to cesspools.
For instance, in one room in a house in Sugar Loaf-court, Garlick-hill,
next to their common cesspool, I have frequently attended patients, and
before going, I surmise that whatever disease they are primarily
affected with, it will generally run into one of low character with
tendency to typhus. In the interval of little more than a twelvemonth, I
have attended several occupants of the house, one after the other, who
have all been, to a certain extent, similarly affected. I have generally
improved their health by giving diffusive stimuli, and have occasionally
prevailed on them to remove.
How many visits in the year may you have paid to this same
house?—Upwards of forty visits. But there are other houses where there
are similar evils, where I have had occasion to visit them still more
frequently. In one house in Star-court, Bread Street-hill, which is
similarly situated, where almost the whole of the inmates were laid up
with fever, and where I had to visit it three times a day for upwards of
three weeks. There were deaths on each floor of that house. Fever
assumed, at one time, so malignant an aspect, that there appeared to be
no possibility of saving them, except by removal. I do not remember one
case of a removal in time where death ensued. The ward inquest had the
inhabitants removed, and the house cleansed.
But was the cesspool removed?—Emptied but not removed.
Then in time you will have a recurrence of the same evils in the place
in question?—Yes, certainly.
What is the condition of children brought up in such places?—Generally
pale and emaciated, scrofulous, and apt to mesenteric disease.
You were medical attendant at the Norwood school, where the pauper
children from the city of London are taken. Do you think, that on a view
of the children, and without any positive knowledge of the sort of
residences of the parents of the children, you could on the view select
from the rest, the children who came from the courts and alleys, such as
you have described in the city of London?—I have but little doubt of it,
though generally speaking the children from the city were of rather a
better description than those from more crowded localities. Indeed, the
courts and alleys of my district are superior to those in other quarters
of the metropolis. They are situated near the banks of the Thames with a
considerable fall towards the river. Some parents also take their
children much out into the open air, and in these the influence of the
place would not be so visible, but with the majority there would be but
very little mistake. Whilst at Norwood, my chief trouble arose from this
sick and diseased class of children, who generally improved very much
after being there some little time.
What was the moral condition of these physically depressed children, as
compared with other pauper children, whose position had been less
unfavourable?—The moral condition of this depressed class of children
was generally worse also.
No. 8.
_Effects observed of Dark, Ill-ventilated, and Ill-drained Localities on
the Moral and Physical Condition of the Population of Paris._
Dr. la Chaise, in his Medical Topography of Paris, which is an early
attempt to investigate the influence of localities on the moral and
physical condition of a population, gives the following description of
the physical condition of the short-lived population bred up in the
narrow and dark streets, and ill-cleansed and badly ventilated houses of
Paris, which description may serve for comparison with those given of
the native population in the crowded and badly cleansed districts of
London.
“The Parisian,” he says, “in stature is often below what is commonly
termed middle-size. His fair skin, soft to the touch, forms a striking
contrast to that of the inhabitant of small towns, and, above all, to
the countryman, who is more exposed to the various changes of the
weather, and to the action of the sun and light. The hair of the
Parisian is generally fair or light brown, and his eyes blue. His
muscular frame is little developed, so that the form has on the whole a
feminine appearance. In the labouring class the muscles of the lower
limbs are sometimes developed, but irregularly and incompletely, which
is explained by the exercise given exclusively to certain muscles by
their employment or handicraft; these irregularities of development are
much less frequent in the rural districts where the movements, and
consequently muscular actions, are much more equally divided. The
temperament, that is to say the physical constitution peculiar to the
Parisian, differs, as is perceived, from each of the distinct and
determined forms admitted by physiologists. He seems to partake of the
union of many,—to be intermediate between those which are recognized
under the names nervous, bilious, and lymphatic-sanguine; the first
seems, however, to predominate.
“It is not, however, rare to meet in Paris with physical constitutions
entirely in the extremes and contrasted with each other; that is to say,
there are here, as in other large towns, large numbers of weakly and
debilitated, vulgarly called sickly, and others with hollow chest and
tall slim figure.
“The women of Paris are rather pretty than handsome; without regular
features, they owe to the development of the cellular tissue, and to the
fairness and fineness of the skin, a certain softness of form which is
very graceful; and a quick and spiritual eye makes one forget the
paleness of their cheeks.
“Considered morally, the portrait of the Parisian presents colours which
are not impossible to seize, notwithstanding their great variety. He may
be said generally to be lively, spiritual, industrious, and deserving
the name of frivolous. Much less perhaps is given him. He is
inquisitive, and carries into his work a taste, an ardent imagination,
and inventive mind, which he is willing to believe should compensate for
sustained activity. There necessarily results from this a great nervous
susceptibility, an _encéphalique_ predominance, which it is important to
the physician never to overlook.
“If a sound and firm organization allows a few to resist the effects of
this premature exercise of the organ of thought, a rapid increase in its
functions always shows itself in the injury done to the other organs,
and generally to the muscular system, which bear the marks of feebleness
and often of deplorable languor. In this life, too active morally and
too indolent physically, the nervous system acquires not what is
vulgarly called a feebleness or delicacy, but a susceptibility, or
rather a predominance, which is affected by the least shock. Hence that
fickleness, and that vivacity of desires, that changeableness in the
tastes, in a word that coquetry, that unequal and whimsical moody
character, those caprices and vapours. The character is not alone
affected by this excess of susceptibility; all the organs, the whole of
the economy of the body feels it in turn; the nervous system acts
particularly on the uterus, developes it prematurely; thus the women
generally arrive at puberty much earlier at Paris than in the provinces,
and especially than in the country. It is not unfrequent to find young
girls of 12 or 13 fully formed and capable of becoming mothers, whilst
in the country, even in the south, they do not attain that period till
the age of 15 or 16.”
No. 9.
NOTE TO PAGE 128, ON SIR CHRISTOPHER WREN’S PLAN FOR EXTRA MURAL
INTERMENTS, AND FOR EXCLUDING GRAVEYARDS ON THE REBUILDING OF THE CITY
OF LONDON.
Whosoever examines the various modern plans for the improvement of the
metropolis, and compares them with the plan of the architect of St.
Paul’s, will see in them only small approximations to his conceptions,
and that they only provide for a few large openings, without reference
to any general sanitary considerations, and without providing for the
mass of the population, whereas he was for “excluding all narrow dark
alleys without thoroughfares, and courts,” such as are commonly left
untouched in the new lines of streets; and he had provided that not only
“all church yards,” but “all trades that use great fires, or yield
noisome smells, be placed out of town.” If, as is confidently maintained
on such evidence as that before referred to, _ante_ p. 22 and 25, the
proportions of death might even now be reduced by one-third in the city
of London by better drainage and other sanitary measures (independently
of the removal of those courts and alleys, &c.), on the evidence of the
proportions of mortality actually prevalent in districts such as he
would have constructed, facilitating, and almost necessitating by
regular lines an early and more systematic drainage below the streets,
as well as a free and copious flow of fresh air from above, it may be as
confidently maintained that the mortality and numbers of burials would
have been reduced in like proportions from the period of the rebuilding
of the city. The whole of the deformed area stands as a monument of the
disasters incurred to the living generation, by a weak and careless
yielding, not of the present to the future, but of the present itself,
to blind and ignorant impulses, which have entailed immense
demoralization, waste of health, and life and money, and a large
proportion of the evil which now depresses the sanitary condition of the
population of that particular district which his improvements would have
covered. “The practicability of this whole scheme,” says the Parentalia,
“without loss to any man or infringement of any property, was at that
time fully demonstrated, and all material objections fully weighed and
answered; the only, and as it happened, insurmountable difficulty, was
the obstinate averseness of a great part of the citizens to alter their
old properties, and to recede from building their houses again on the
old ground and foundations, as also the distrust in many, and
unwillingness to give up their properties, though for a time only, into
the hands of public trustees or commissioners, till they might be
dispensed to them again, with more advantages to themselves than
otherwise was possible to be effected; for such a method was proposed,
that by an equal distribution of ground into buildings, leaving out
churchyards, gardens, &c. (which are to be removed out of the town),
there would have been sufficient room both for the augmentation of the
streets, disposition of the churches, halls, and all public buildings,
and to have given every proprietor full satisfaction; and although few
proprietors should happen to have been seated again directly upon the
very same ground they had possessed before the fire, yet no man would
have been thrust any considerable distance from it, but been placed, at
least, as conveniently, and sometimes more so, to their own trades than
before.” “By these means the opportunity, in a great degree, was lost of
making the new city the most magnificent, as well as commodious, for
health and trade of any upon earth, and the surveyor being thus confined
and cramped in his designs, it required no small labour and skill to
model the city in the manner it has since appeared.” The plan was
approved by the King and the Parliament, but opposed by the corporation,
who, it is stated in a history of the city institutions, by one of its
officers, conceived that they would have lost population and trade by
the plan; _i. e._, they would have been spread beyond its jurisdiction.
But on both points this policy was dreadfully mistaken. Only a
burthensome population is obtained by overcrowding, that is to say, a
larger than the natural proportions of the young and dependent, of
widowhood, and early and destitute orphanage, and of sickly and
dependent, and prematurely aged adults. As an example of the coincidence
of pecuniary economy with enlarged sanitary measures, it may be
mentioned, that it is shown in a report on a survey made for sanitary
purposes by Mr. Butler Williams of the College of Civil Engineers,
Putney, that a loss of not less than 80,000_l._ per annum is now
incurred in carriage traffic alone on two main lines of street, namely,
Holborn Hill to the Bank, and Ludgate Hill to the same point, being made
crooked and with steep acclivities instead of straight and level, as Sir
Christopher Wren designed them. It is to be regretted that the
discussions on the rebuilding of Hamburg have presented an instance of a
similar conflict of local interests, which, in a few instances, has been
so far successful as to preserve several dense masses of crowded and
unwholesome habitations for the poorer classes, in the face of the
recent experience of the sort of population which, to the surprise of
the better classes of inhabitants, issued out of them and made the city
at the time of its destruction a scene of plunder and anarchy more
terrible than the fire itself.
No. 10.
LETTER FROM THE TOWN CLERK OF STOCKPORT, ON INFANTICIDES COMMITTED
PARTLY FOR THE SAKE OF BURIAL MONEY.
DEAR SIR, _Stockport, 25th January, 1843._
I have no doubt that infanticide to a considerable extent has been
committed in the borough of Stockport; and I have been professionally
engaged in prosecuting two distinct charges of infanticide, of which I
give you the following summary:—
The first case was against Robert Standring, by trade a hatter. He had a
female child about sixteen years of age, who, from imbecility, was not
very likely to obtain her own living. One morning, about five o’clock,
he sent her to call up a labouring hatter, with whom he (the father) was
going to work during the day; but, previous to his so sending her, he
gave the child some coffee. After the child’s return she was seized with
vomiting, and all the usual symptoms of illness caused by mineral
poison, and died during the course of that day. The coroner (the late
Mr. Hollins) held an inquest on the body, but refused to allow any
surgical examination; and charging the jury that the death was a natural
one, such a verdict was returned. In about three months afterwards, the
case, and some suspicious circumstances, came to the knowledge of the
Stockport police; and I was consulted as town-clerk and clerk to the
justices. The magistrates issuing a warrant for the exhumation of the
body, I attended with a competent surgeon and chemist (Mr. John Rayner),
and a large—very large quantity of arsenic was found in the stomach, and
all parts of the body which could be affected by arsenic taken
internally were remarkably preserved from putrefaction. Standring, being
apprehended, was tried before Mr. Justice Coleridge at the Chester
Assizes. The judge apparently summed up for a conviction; but the jury,
after a long deliberation, returned a verdict of acquittal. The verdict
was an extraordinary one, and can only be accounted for by the general
feeling against capital punishments, which enables so many criminals
(capitally indicted) to escape any punishment.
The inducement for this murder, so far as it could be ascertained, was
of a twofold character; partly to obtain money from the burial friendly
societies, in which Standring had entered his child as a member, and
from which he received about 8_l._, and partly to free himself from the
future burthen of supporting the child. The judge, in summing up the
case for the consideration of the jury, remarked upon the apparent
inadequacy of the motives for the murder; but, with all due deference to
his lordship, when it is known to be an established fact that Mr.
Ashton, a manufacturer of Hyde, was murdered by two miscreants whose
only inducement was 10_l._ divided between them, there can be no scale
laid down to indicate the lowest price for murder.
The other case involved no less than three distinct cases of murder.
Robert Sandys, and Ann his wife, and George Sandys, and Honor his wife,
were brothers and sisters-in-law, living in Stockport, in two adjoining
cellars. They were bear or mat makers. Robert had two sons and two
daughters, all young children, and George had a female child also very
young. Two of the female children of Robert Sandys were one morning
taken very ill, and one of them died the same day, under very suspicious
circumstances, the neighbours publicly declaring that the children must
be poisoned. These two girls (along with their brother, a little boy
about five years of age) having been in the morning of the illness in
the company of Bridget Ryley (a girl of inoffensive but imbecile mind),
their mother, Ann Sandys, after the neighbours said the children must
have been poisoned, said, “Oh, Bridget Ryley must have given them
something.” Bridget Ryley had given them some cold cabbage, which Ann
Sandys well knew, and the boy who had been with them was not at all
unwell. Bridget Ryley was apprehended, and by accident I was present at
the coroner’s inquest. I came in just at its termination, Bridget Ryley
being in custody, and Ann Sandys being about to close her examination.
After she had concluded her examination, which was very strong against
Bridget Ryley, she began to apologize for Bridget, saying, She did not
think the poor girl (as she called her) intended any harm to the child;
and she evidently wished to make it appear that the poisoning was all a
matter of accident. Bridget Ryley was then asked to say what she knew
about the business, and she earnestly protested her innocence, saying
the child had died of the same complaint as another child of Ann Sandys
had died of three weeks before. It appeared strange that the mother of
the child should both criminate and exculpate Bridget Ryley, and I
thought I could perceive a watchful restlessness in her eye, which ill
accorded with the probable grief of a bereaved parent; I therefore
communicated to the coroner my opinion that the mother of the children
might be the murderess, and that if so, the child which had been buried
three weeks before would also prove poisoned. The coroner thought it a
very proper inquiry, and adjourned the inquest, directing this other
child to be exhumed; and it proved to have been poisoned by arsenic.
Whilst this exhumation was taking place, Honor Sandys met one of the
constables, and she expressed a wish that they would not disturb her
dear little infant. The constable told me this, and directions were
consequently given for its immediate exhumation. Arsenic had also caused
the death of this child. Ann Sandys then said that Bridget Ryley must
have poisoned them all, and that a child which Bridget Ryley had nursed
had died in a similar way. (This was after Ann Sandys was in custody and
charged with this murder.) This last child so nursed by Bridget Ryley
was exhumed, but it had died a natural death. Now all these three
children so poisoned were in friendly burial societies, and their
parents would receive for their funerals about 3_l._ for each child. The
expense of the funeral would be about 1_l._, and the profit on each
murder 2_l._, and the liberation from the future expense of keeping the
child.
At the ensuing assizes for Chester Mr. Justice Coltman postponed the
trial to enable the boy, the son of Ann Sandys, to be educated for
examination. This boy would have proved some very material facts as to
the mode in which the poison was administered, but as this did not come
out in evidence, as the boy was not considered capable of being examined
at the subsequent assizes, it is hardly fair now to state them.
Mr. Justice Erskine tried the cases, and Robert Sandys was convicted,
but his wife Ann Sandys acquitted. I afterwards was told by one of the
jury that they acquitted her because they thought she acted under the
control of her husband, and they thought that justified her acquittal.
The judge and counsel had been silent on this point, satisfied with
their own knowledge, that in murder the wife, though acting with her
husband, is guilty and punishable, and thinking the jury as wise as
themselves.
In consequence of an objection to the admissability of a statement made
by Ann Sandys before the coroner, and also to the form of the
indictment, judgment was respited to the following assizes. The judges
determined for the Crown on both points, and sentence of death was
passed on Robert Sandys. Afterwards, and without any communication to
the parties prosecuting, the sentence of death was commuted to
transportation for life. George and Honor Sandys were not tried, as the
evidence was not so conclusive against them, and Robert and Ann were
believed to be the principals in these murders.
I know it to be the opinion of some of the respectable medical
practitioners in Stockport that infanticides have been commonly
influenced by various motives—to obtain the burial moneys from the
societies in question, and to be relieved from the burthen of the
child’s support. The parties generally resort to a mineral poison,
which, causing sickness, and sometimes purging, assumes the appearance
of the diseases to which children are subject; and as they then take the
child to a surgeon who prescribes after a very cursory examination, they
thus escape any suspicion on the part of their neighbours. Each child in
Sandys’ case was so treated, but they took care not to administer the
physic obtained.
How to prevent these infanticides is a question of great difficulty. I
think these societies are of great use if under proper regulation and
inspection. These cases may be good argument for requiring the due
inspection, after death, of each child in a burial society by a surgical
examiner, who might judge, in most cases, whether a _post-mortem_
examination were advisable or not; but as these societies are very
useful on the whole, the partial misuse of them cannot avail against
their general use. Probably an application to these societies of the law
applicable to life assurance companies might tend to prevent the crime
of infanticide. The object of these burial societies is the decent
interment of the deceased member. In life insurance companies no person
is by law allowed to recover from an insurance company more money than
the value of his interest in the life of the person whose life is
insured: for instance, should his interest in a life lease be worth
500_l._ he may insure and recover 500_l._, but not 600_l._ He therefore
receives by the policy that which he loses by the death, and no more. If
he has no interest the policy is void. Now, applying this principle to
these burial societies would make it necessary that some officer of the
society should prepare for and superintend the interment of the child,
and that no further sum than requisite for the decent interment should
be expended, and no money in any case should be paid to the friends of
the deceased; also, no party should be insured in more than one society.
None of our registrars of births and deaths are medical men, and no case
of infanticide has been discovered through the instrumentality of the
Registration Act.
I shall be glad to furnish you with the briefs in these cases of murder,
should you desire them, or with any further information in my power.
In all four deaths each child was in a burial society, and arsenic was
indisputably the cause of death.
I may also mention that each death was of a female child. The male
children, more likely to be useful to their parents, were in each case
spared.
I have the honour to be,
Your most obedient servant,
HENRY COPPOCK,
_Town Clerk of Stockport, and
Clerk to the Stockport Union_.
* * * * *
[In answer to a subsequent inquiry, Mr. Coppock stated that at the time
the offences detailed in the above letter were committed, both the
parties were in employment. Standring was a hatter, in full work, and
making with industry 20_s._ a-week; the Sandys, Robert and George, were
mat-makers, not making more than from 7_s._ to 10_s._ per week each; the
women contributing, it is presumed, to the earnings of the family.]
No. 11.
A RETURN OF THE AVERAGE AGES AT WHICH DEATHS AND FUNERALS OCCURRED
DURING THE YEAR 1839 TO THE SEVERAL CLASSES OF SOCIETY IN THE SEVERAL
SUPERINTENDENT REGISTRARS’ DISTRICTS OF THE METROPOLIS.
Also of the PROPORTIONATE NUMBERS of DEATHS to the POPULATION of
each such District: setting forth the excess in Numbers of Deaths
and Funerals in each such District above the proportionate Numbers
of Deaths and Funerals in healthy and well-conditioned Town
Districts: setting forth also the amount of Reduction of the
ordinary Duration of Life of each Class in the District, as
compared with the standards of Longevity afforded by the Insurance
Tables deduced from the experience of the Population of Carlisle,
and of the County of Hereford.
The explanations given in respect to the totals inserted at § 37 are
applicable to the annexed district returns, which are only submitted as
the best approximations that can be obtained in the present state of the
registration. The practical bearing of the consideration of the ages of
deaths as well as the proportionate numbers of deaths on the subject of
provision for funerals is shown in §§ 72, 75, 76, 78, 79, 80, 81, also
§§ 160, 161, 163, 169, 173, and note to § 150, also § 205. For the sake
of those who are engaged as members of committees in the investigation
of the health of the populous towns and the causes of mortality, it may
be of public use to give full explanations of the principles on which
returns should be made to measure the relative pressure of those causes
in different localities, or amongst different classes of the community:
it may also be of use to show the necessity of careful provisions for
the registration of facts which are of great importance to every
community.
Dr. Price, in his work on Annuities and Reversionary Payments, states
that in his time the proportion of deaths in London within the bills of
mortality was rather more than 1 to 22 of the population annually, which
he states as an equivalent proposition to saying that the average
duration of life to all who died was 22 years. Again he observes that—
“One with another, then, they will have an expectation of life of 22½
years; that is, one of 22½ will die every year.” p. 255.
In p. 274, that—
“In the dukedom of Wurtemberg, the inhabitants, Mr. Susmilch says, are
numbered every year; and from the average of 5 years, ending in 1754, it
appeared that taking the towns and country together, 1 in 32 died
annually. In another province which he mentions, consisting of 635,998
inhabitants, 1 in 33 died annually. From these facts he concludes, that,
taking a whole country in _gross_, including all cities and villages,
mankind enjoy among them about 32 or 33 years each of existence. This
very probably is below the truth; from whence it will follow, that a
child born in a country parish or village has at least an expectation of
36 or 37 years; supposing the proportion of _country_ to _town_
inhabitants, to be as 3½ to 1, which, I think, this ingenious writer’s
observations prove to be nearly the case in Pomerania, Brandenburg, and
some other kingdoms.”
By Mr. Milne, in his work on Annuities, and in his article on Mortality
in the last edition of the Encyclopedia Britannica, by Dr. Bissett
Hawkins, and by nearly all statistical writers, the proportions of
deaths to the population, and the average ages of death, are treated as
equivalent. Dr. Southwood Smith has been misled to adopt the same view.
He states in his work on the Philosophy of Health, p. 135, that “There
is reason to believe that the mortality at present throughout Europe,
taking all countries together, including towns and villages, and
combining all classes into one aggregate, is 1 in 36. Susmilch, a
celebrated German writer, who flourished about the middle of the last
century, estimated it at this average at that period. The result of all
Mr. Finlaison’s investigations is, that the average for the whole of
Europe does not materially differ at the present time.” “It has been
shown that the average mortality at present at Ostend is 1 in 36, which
is the same thing as to assert that a new-born child at Ostend has an
expectation of 35½ years of life.”
Having of late had occasion to make rather extensive observations on
this subject, it appears to be a public duty to state, that in no class
of persons, in no district or country, and in no tract of time, has the
fact hitherto appeared to be in coincidence with this hypothesis; and
also that returns of the proportions of deaths to the population, when
taken singly as the exponents of the average duration of life, are often
mischievously misleading, exaggerating those chances of life sometimes
to the extent of double the real amount. If Dr. Price, instead of
resting satisfied with Susmilch’s hypothesis, had taken the actual ages
of the dying within the bills of mortality, he would have found only a
casual approximation to the hypothesis for the whole metropolis; and if
he had taken the worst conditioned districts, that, as applied to them,
it was in error full one-half. On Mr. Milne’s own data it appears that
the proportions of deaths to the population at Carlisle, instead of
coinciding with the ascertained average ages of death, 38·72, were in
the year 1780, 1 in 35; in 1787, they were 1 in 43; and in 1801, they
were 1 in 44. Having caused an average to be deduced from the actual
ages of 5,200,141 deaths which occurred in the Prussian States from 1820
to 1834, instead of 36 years, the actual average age of deaths was only
28 years and 10 months. The average ages of death in France, as deduced
from Duvillard’s table, founded on the experience of one million of
deaths, instead of being 36 years, was 28 years and 5 months.
The public errors created and maintained by taking the proportions of
deaths as exponents of the average ages of death, or of the chances of
life to the population, may be illustrated by reference to the actual
experience amongst nearly two millions of the population, or upwards of
forty-five thousand deaths in thirty-two districts, equivalent to as
many populous towns, which the Registrar-General has obligingly enabled
me to examine for the year 1839.
The Carlisle table is taken as the standard for the duration of life, to
measure the loss of life in the several districts, as it gives the
probability of life from infancy, well ascertained for one town, and
nearly coincides with the experience of the annuity offices on the
select class of lives insured by them, and with the results which I have
obtained from the mortuary registries showing the average age of death
in the county of Hereford. Each of the recognized insurance tables may,
however, be used. If the Carlisle table be taken, the chances of life at
infancy would be 38·72; by the Chester table it would be 36·70; by the
Northampton, 25·18; by the Montpellier table, 25·36; by the last Swedish
table, 39·39; by the experience of Geneva, 40·18. After the attainment
of twenty years of age these several tables give the chances of life as
follows:—by the Carlisle table it would be 41·46; by the Chester table,
36·48; by the Northampton table, 33·43; by the Montpellier table, 37·99;
by the Swedish table, 39·98; by the Geneva experience, 37·67; and by the
experience of the Equitable Society, 41·67. For civic purposes in this
country, the most important period for considering the chances of life
is after coming of age, or after the attainment of twenty-one years; the
average ages of all who die above that age in each district of the
metropolis are therefore given to illustrate the extent of loss of life
to each class of adults, which is the more important to be observed, as
it has been hastily supposed that the pressure of the more common and
removable causes of disease is almost exclusively upon the infant
population.
In illustration of the errors occasioned by taking the proportions of
deaths as the exponent of the duration of life; if we take the
proportions of deaths in the district of Islington, with its population
of 55,720, we find the deaths for the year only 1 to every 55 of the
population, which would appear to be a highly healthy standard; whereas,
when we examine the average age of death of all of that population who
have died during that year, we find it to be only 29 years: in other
words, we find that the average duration of the period of existence has
even in that district been shortened by at least nine years to all, and
to an extent of at least six years on the average to the class of
adults. If we examine the pressure of the causes of death upon each
class of the community, in the same district, we find that the class of
artisans, instead of attaining 39 _years_, have, on the average, been
cut off at 19 years; and hence that children and adults, and on the
average all those of the labouring classes who have died, have been
deprived of 20 years of the natural expectation of life; and that even
the class of adults who have died have been deprived of 15 years of
working ability, involving extensive orphanage and premature widowhood.
If we take such a district as Bethnal Green, inhabited by weavers and a
badly conditioned population, the returns of the proportionate number of
deaths to the population (1 in 41) would lead to the supposition of an
average vitality of nearly double the real amount, which appears from
this year’s return to be only 22 years for the whole population. For the
working classes in that district it is no more than 18 years. If we
carry investigations closer, and into the local causes of the mortality,
we have them developed in such evidence as that given by Mr. T. Taylor,
one of the registrars of that district;—or in other districts by such
information as that given by Mr. Worrell, the registrar of St. Pancras,
or by registrars of St. George’s, Hanover Square, or by the registrar of
a district of Marylebone, where we find the state of overcrowding (noted
in § 26), combined with the insufficient supplies of water, the
defective drainage and neglect of cleansing which is described in the
answers—attended by a reduction of 12 years’ duration of life to the
adult artisans. In the opulent parish of St. George’s, Hanover Square,
it is attended by a loss of 16 years; in Marylebone and in St. Pancras,
by a loss of 17 years. The external and internal circumstances of the
labouring population, where such results have been obtained, vary
widely, and the results are commonly the mean of extreme differences.
For example, in the parish of St. Margaret’s, Leicester, which has a
population of 22,000, almost all of whom are artisans engaged in the
manufacture of stockings, where the average age of death in the whole
parish was, during the year 1840, 18 years, I succeeded in obtaining the
ages of death in the different _streets_, when it appeared that this
average was made up as follows:—Average age of deaths in the streets
that were drained (and that by no means perfectly) 23½ years; in the
streets that were partially drained, 17½ years; in the streets that were
entirely undrained, 13½ years. Though the defective drainage and
cleansing was the main cause, it was doubtless not the only cause of
this variation. That, however, was a year of a heavy mortality, and the
average age of death in that and another district during the years 1840,
1841, and 1842, was in the streets drained 25½ years; in those partly
drained 21, and those not drained, 17 years. The general average was 21
years. The proportions of death to the population in Leicester were
during the same period, 1 in 36½. The inquiries promoted in the
districts of other towns have developed instances of large masses of
population amongst whom even lower average duration of life than any
noted in the first report is attendant on the circumstances described as
causes.
So far as estimates of the number of the people before a census was
taken may be depended upon, it appears that the proportionate numbers of
deaths in the metropolis were, at the commencement of the last century,
1 to 20. At the time the first census was taken (1801) the proportion of
deaths to the population within the bills of mortality appeared to be 1
to 39. At the present time it appears to be 1 to 40. Having had the
average ages of death within the bills of mortality in the metropolis
calculated from the earliest to the later returns published, they appear
to be, as far as they can be made out from the returns, which are only
given in quinquennial and decennial periods, as follows:—
Of all returned as having died during the
The average Age was
Years, Months.
22 years, from 1728 to 1749 25 1
25 years, from 1750 to 1774 25 6
25 years, from 1775 to 1799 26 0
25 years, from 1800 to 1825 29 0
6 years, from 1826 to 1830 29 10
Thus, whilst it would appear from the proportionate numbers of deaths to
the population that the average duration of life in the metropolis has
doubled during the last century, it appears from the returns of the
average ages themselves that it has only increased four years and nine
months, or about one-fifth. The district of the old bills of mortality
comprehends little more than one-half of the metropolis. The average age
of death for the year 1839 for the whole metropolis, it will have been
seen, is only 27 years. So far as an average for that year for the old
district can be made out from the several recent district returns, it
would appear to be no more than 26 years. But the earlier mortuary
registration was known to be extremely defective, especially in the
registration of deaths in the poorer districts, and the recent lower
averages are ascribable to the closer registration of the infantile
mortality in those districts. The earlier returns are only to be
regarded in so far as the errors from period to period are likely to
have compensated each other; they are only adduced as indicating the
degree of proportionate progression, correspondent with the general
physical improvements of the population. But the slow general
improvement, made up by the great improvements of particular classes, is
consistent with the positive deterioration of others. The average age of
death of the whole of the working classes we have seen is still no more
than 22 years in the whole of the metropolis. In large sub-districts, if
we could distinguish accurately the classes of deaths, the average would
be found to be not more than half that period: a rate of mortality
ascribable to increased over-crowding and stationary accommodation,
greatly below anything that probably existed at the commencement of the
century. The chief errors in the existing returns are errors which cause
the extent of the evils which depress the sanitary condition of the
population, and the mortality consequent on those evils to be under
estimated.
The erroneous conclusions as to the ages of the populations from the
proportions of deaths, have perhaps arisen from assumptions of the
existence of states of things rarely, if ever, found, namely, perfectly
stationary populations and perfectly stationary causes of death. I have
been asked “If 1 out of 40 die yearly, must not the average age of all
who die be 40 years?” The answer, by actual experience, as we have seen,
is, that it is often not 30 years; and perhaps the reason why it is not
so will be most conveniently illustrated by hypothetical cases. For
example, let it be assumed that in any given year 40 persons die out of
1600, which is in the proportion of 1 to 40, and in consequence of an
unusual prevalence of measles, or some disease to which children are
subject, the greater number of deaths occur amongst the infant portion
of the population, and hence, out of the 40 deaths, 20 occur at 5 years
of age, 10 at 25, and 10 at 60. Then the total existence had, would have
been (20 × 5) + (10 × 25) + (10 × 60) = 100 + 250 + 600 = 950 years, and
this divided by 40, the number who died would give 950/40 = 24 years
nearly as the average duration of life to each of the 40 who died.
On the other hand, suppose a severe winter, in which the peculiar causes
of mortality may have pressed unusually heavy upon the older lives, and
let the numbers who died have been 20, at 60 years of age; 10 at 40; and
10 at 5; in such case, the total existence enjoyed would have been (20 ×
60) + (10 × 40) + (10 × 5) = 1200 + 400 + 50 = 1650 years, which,
divided by 40, would give 1650/40 = 41¼ years as the average duration of
life to each.
And again, where, in fact, the proportion of death in one year may be
represented as 1 death out of 20 of the population; the average
existence enjoyed may be greater than when 1 in 40 died for the reason
given in the former case. As for example, in the year when 1 in 20 died,
it may have happened that the deaths were among the older lives, and
that, taking one with another, the average age of all who died might be
50; while in the other case the mortality might have been amongst the
infant population, when the average age might have been 20. If the
proportion of 1 in 40, or 1 in 20, were to obtain each year
continuously, taking one life with another, the average duration to a
population just born, of whom 1 in 40 died, and whose place should be
supplied each year by a new birth, would be about 20 years to each life,
or one-half; and of a similar population, of whom 1 out of 20 died
annually, the average duration of life to each would be about 10 years,
or one-half the period at the expiration of which all the lives would
have expired.
When these examples are considered, it will be understood that the
average age of death may remain stationary, or may go on increasing,
whilst the proportions of death remain the same, or vary. The actual
mortality of most districts is found to be coincident chiefly with its
physical condition, and is most accurately measured by the years of
vitality which have been enjoyed, _i. e._, by the average age of death.
The numbers of deaths increase or diminish considerably, and frequently
create erroneous impressions, whilst the average ages of death are found
to maintain a comparatively steady course, always nearest to the actual
condition of the population, and give the most sure indications.
The chief test of the pressure of the causes of mortality is then the
duration of life in years: and whatever age may be taken as the standard
of the natural age or the average age of the individual in any community
may be taken to correct the returns of the proportions of death in that
same community. For example, in the returns of the St. George’s, Hanover
Square district, it appears that in 1839, the proportions of deaths was
1 to 50 of the population; but the average number of years which 1325
individuals who died during that year had lived, was only 31 years, or 8
years below the average period of life in Carlisle. There was then in
that district during that year a total loss of 10,600 years of life,
which at 39 years may be considered as equal to an excess of deaths of
272 persons, and in a healthy state the proportions of deaths should
have been 1 in 63 instead of 1 in 50 of the population. The excess in
numbers of deaths in the metropolis has been measured by this standard,
the total number of years of life, would in a healthy community have
been divided in portions of not less than 39 years to every individual
who died.
The effect of migration or of emigration, in disturbing the results of
returns of the average ages of death in particular localities appears to
be commonly much exaggerated.
As formerly, when navy surgeons, overlooking the filth of their ships,
which has since been removed, and not perceiving the effects of the
atmospheric impurities arising from the overcrowding, which have since
been diminished by better ventilation, directed their whole attention to
supposed distant causes and mysterious agencies, and were wont to
ascribe the whole of the fever which ravaged a fleet to infection from
some casual hand, who was found to have been received on board from some
equally filthy and ill kept prison where the “gaol fever” had been
prevalent; so now, in some of our towns, we find much ingenuity
exercised to avoid the immediate force of the facts presented by such
returns, by a search for collateral and incidental defects in them. Thus
in Liverpool the whole of its vast excess of mortality has been charged
upon the poorer passengers who pass through the port. In other towns
also, all the excess of deaths from epidemic or infectious disease is
charged upon the vagrant population. In New York and some of the
American cities, where inquiries have been stimulated by the example of
the sanitary inquiry in this country, a common observation made on the
proved excess of mortality is, that a large proportion of “foreigners”
frequent the city. An inquiry into the cases themselves would generally
show that if, instead of the proportion of the immigrant population
being: a small per-centage, it formed a very large proportion of the
population included: still the proportion per cent. of sickness and
mortality, from consumption and other diseases, amongst the resident
population, is the greatest; and that even in lodging-houses the disease
roost frequently appears first in the occupants who are stationary, and
last in the new comers. In some badly conditioned districts, where there
is a very severe mortality observable on children, a less proportionate
amount of mortality prevails amongst the adults who are migrant, than on
other adults resident in somewhat less depressed districts, but who are
more stationary. Of all classes (unless it be the higher classes who
resort to watering-places) it is not the sickly and the weakly who
travel for subsistence as handicraftsmen, or for subsistence in
commerce, but the healthy and robust. In so far as the general results
of mortuary registration of any district are disturbed by a population
who are migrant (who are not only above the average strength, but who
generally come with the additional advantage of health by travel in the
open air and in a purer atmosphere), they are usually disturbed by
unduly raising and giving the locality an appearance of an average of
health, and the fatally deceptive chances of longevity that do not
belong to it Whilst therefore the localities gain by the average health
and strength of the migrant population, other districts have the credit
of a share of the excess of disease and mortality which really belong to
unhealthy localities. In other words, the population migrating through
such districts carry away more disease and mortality from the crowded
districts than they take into them. If there had been a mortuary
registration at Walcheren, or any pestilential stations productive of an
excessive mortality in the army, the registries probably would not have
given the localities credit for more than half the mortality which
belonged to them. The real sickness and mortality of the more depressed
town districts are often made to appear lower than they are by the
number of cases treated in distant workhouses, hospitals, and
dispensaries, for which no credit is given to the locality where the
cause of death occurred.