§ 199. In cases of epidemics the saving of life by the prompt intervention of an officer of health, on the occurrence of the first death, and the immediate removal of the survivors affected, would be very considerable. In cases of fever, on the removal of patients to the fever hospital, they are often received in a state of violent delirium, or in a state of coma succeeding to violent delirium. After they have been washed in a bath, and placed in a clean bed, in the spacious and well-ventilated ward of the hospital, in a few hours, often before the visit of the physician, the violent delirium has subsided, or the state of coma having passed away consciousness has returned. Although in a great majority of cases the patients are only sent to the hospital in the last stage of disease, this mere change in the locality and external circumstances of the sufferers diminishes the proportion of deaths from one in five to one in seven. Supposing the cases occurred in equal numbers daily, the functions of registration in the metropolis would carry the officers of health to upwards of 20 cases per diem of deaths from epidemic disease, for the most part in the most wretched districts.
§ 200. The principle of this part of the proposed arrangement is in necessitating visits of inspection, and thence necessitating the initiation of measures of relief where there has hitherto been, and whence it may safely be said there will be, no complaint or initiation of measures of relief by the sufferers themselves. It is observed by Dr. Southwood Smith, in confirmation of the observations made on the demoralizing effects of the physical evils which depress the bodily condition of large classes that, as they have not the bodily vigour, so they have not the intelligence of a healthy class. One of the most melancholy proofs of this, he observes, is, that they make no effort to get into happier circumstances; their dulness and apathy indicate an equal degree of mental as of physical paralysis. And this has struck other observers who have had opportunities of becoming acquainted with the real state of these people. “The following statement impressed my mind the more, because it recalled to my recollection vividly similar cases witnessed by myself. ‘In the year 1836,’ says one of the medical officers of the West Derby Union, ‘I attended a family of thirteen, twelve of whom had typhus fever,—without a bed in the cellar, without straw or timber shavings—frequent substitutes. They lay on the floor, and so crowded that I could scarcely pass between them. In another house I attended fourteen patients: there were only two beds in the house. All the patients lay on the boards, and during their illness never had their clothes off. I met with many cases in similar conditions; yet amidst the greatest destitution and want of domestic comfort, I have never heard, during the course of twelve years’ practice, a complaint of inconvenient accommodation.’ Now this want of complaint, under such circumstances, appears to me to constitute a very melancholy part of this condition. It shows that physical wretchedness has done its worst on the human sufferer, for it has destroyed his mind. The wretchedness being greater than humanity can bear, annihilates the mental faculties—the faculties distinctive of the human being. There is a kind of satisfaction in the thought, for it sets a limit to the capacity of suffering which would otherwise be without bound.”
§ 201. In respect to any such services proposed, involving inquiry on the spot, an objection is apt to be suggested, that the exercise of such functions would be unpopular and objected to. By the sufferers it certainly would not, § 122. With portions of the population, in such a deplorable state of ignorance as that manifested, even in this country, at the time of the invasion of the cholera, when they imbibed the notion that the wells had been poisoned by the medical men, the creation of any monstrous impressions by others must be admitted to be possible; but the existence of that notion would have been no justification for closing the hospitals, for staying the work of beneficence, and suspending the performance of medical duties. Such an objection, however, implies a very large misconception as to the general state of intelligence of the working classes. There is, on this point, as regards the metropolis, the direct and decisive evidence of experience. In consequence of the difficulty of dealing satisfactorily with common hearsay evidence, some of the local registrars have, with praiseworthy care, proceeded to verify the facts of the death by inquiries made at the house where it took place, which inquiries are strictly supererogatory. The following evidence, though in part substantially a repetition of scenes already described, is here adduced less for the descriptions of places visited than as showing the manner in which these officers were received.
Mr. James Murray, the registrar of births, deaths, and marriages for the Hackney Road district of Bethnal Green, having stated that sometimes he made inquiries on the spot for the registration of deaths, speaking of the poorer population of that district, states that they have usually only a single room, and that “they never speak of occupying the same house, but the ‘same room.’”
In what proportion of cases do the bodies of those persons remain in the room in which the persons live and sleep?—It would depend upon the part of the district, for part of the higher district is highly respectable. In that district nine-tenths of them have only a single room, and no opportunity of placing the body elsewhere.
In nine-tenths of the cases the body remains in the same room?—It must be so, they have no other room.
In a coffin?—Yes; I have seen it so repeatedly.
Is the retention of the body injurious?—I think so.
When you go to register the deaths is it deemed an intrusion, or are you received with civility?—I am always received with civility in all cases.
It is not considered an intrusion?—Not at all. I myself have rather cultivated the good feeling and opinion of the working classes; they know me exceedingly well, and I have never met with any instance of incivility among them.