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.