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.