A supplementary report on the results of a special inquiry into the practice of interment in towns.

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 The cover of the coffin must then be immediately withdrawn, the face of the deceased uncovered, and the hands and feet disengaged from the bandages attached to them.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.

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.

(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.

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 1s. 6d. to 4s. 6d. 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 80,000l. 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.