§ 207. I am informed by Mr. Payne, the coroner for the city of London, that he has in some cases felt it to be his duty to send a confidential person to make inquiries for him, before he would act on the ordinary sources of information in holding inquests. I have also been informed that other coroners adopt the same laudable practice, and frequently incur the trouble and expense of previous inquiries by more trustworthy persons, in cases where the alleged cause of death is not manifest. The appointment of medical officers of health might be made without the exercise of any new or anomalous powers to relieve the coroners from such necessity, and at the same time give the public cause to be better satisfied that no really suspicious cases were shrouded and concealed, and that none escaped from inadvertence.[[42]] I believe that on the uses to be derived from the appointment of the officers in question most coroners would concur in the opinions expressed in the following answer received from Mr. Payne.
In reply to your inquiry (respecting the Medical Registrars of Deaths giving notice to the Coroner of such deaths as may appear to them to inquire to be investigated by him), I beg to say that I have long felt there has been something wanting in the machinery by which inquiries into deaths are, or ought to be regulated.
In cases of death from external violence, where the injury is apparent, the constable of the district is fully aware of the necessity of applying to the coroner; but in cases of sudden or other deaths where there is no cause apparent to a common observer, there is a necessity for some qualified person forming a judgment as to the expediency of a judicial inquiry into the cause of death, and I know of none so well qualified to form such a judgment as a member of the medical profession. The office of searcher, when properly carried out, was useful as far as it could be in the hands of old women, but that could only apply to cases in which external violence was apparent to the view on searching the body. I believe, however, that the office has now ceased to exist, and the present mode of registering deaths does not supply any means of detecting unnatural or violent deaths. I am therefore quite of opinion that a Medical Registrar (chosen for his ability and discretion) who would not unnecessarily annoy the feelings of private families, and yet make himself acquainted with the death by personal knowledge, would be a valuable addition to the present mode of ascertaining and registering deaths.
Advantages to Science from the Improvement of the Mortuary Registration.
§ 208. Extending the view from the private and public immediate and extraordinary necessities which may be met by a staff of well qualified public officers, exercising the duties and powers proposed, to the ordinary but higher public wants, it will be found they may in that position obtain in years, or even in months, indications of the certain means of prevention of disease, for which the medical experience of ages has supplied no means of cure, and only doubtful means of alleviation.
§ 209. There is not one medical man who has acted as a registrar of deaths who has been consulted on this subject, who does not state as a result of his short experience under the registration of the fact of deaths, and even of the distant and imperfect statements of the causes of death, that it has given them such a knowledge as no private practice could give of the effect of habits of life and of locality in producing disease.
§ 210. As a practical instance of the immediate advantages of placing the business of registration under the guidance of medical knowledge, may be cited the following from the statement of Mr. Jones, a medical officer, who acts as registrar of the Strand Union. Speaking of the working of the registration, he says—
I find that neither my experience as a medical officer, for many years in the parish, nor my experience as a private practitioner, give me the same extended view of the causes of death as the mortuary registration. It brings to my knowledge cases which I could not know as a private practitioner: for example, as to the occurrence of small-pox or epidemics. In such instances, it is of use to me, as it sometimes enables me to go to places where I believe children have not been vaccinated, and suggest to the family the necessity of vaccination as a measure of prevention. When I have received information of one or two cases of small-pox, I have looked to the register of births, and sent to other people to warn them of the necessity of vaccination.
§ 211. On the advantages which inquiries for the registration of death would give, the concurrent opinions of several eminent medical men may be expressed in the terms used by Dr. Calvert Holland, of Sheffield, who observes that, “From an inquiry on the spot concerning the train of symptoms preceding death, the general examination of the body, or from conversation with the medical attendant, the cause of death, with few exceptions, would probably be assigned with as much accuracy as by any plan that can possibly be devised. We should hail such an appointment as one of great value. Even in those instances in which it is difficult, from the obscurity or undefined character of the symptoms, to say precisely what is the cause of death, the inquiry would tend to dissipate the doubts or obscurity in which it might be involved. The duties of the officer, if he possessed first-rate professional abilities, would give to him a power of analyzing symptoms, of tracing cause and effect, which few practitioners possess or can acquire in a long life of professional exertions. Were the causes of death analyzed and recorded by one having no other duties, and fitted by his accomplishments to undertake the task, the medical and statistical inquirer would possess a body of information on the influence of general local circumstances as well as on particular agents in connexion with manufactures, the just value of which it is not possible to appreciate.”
§ 212. For the promotion of the new science of prevention, and the knowledge of causes necessary to it, a primary requisite is to bring large classes of cases as may be duly observed, under the eye of one observer. It would be a practicable arrangement, on the receipt of the notices of deaths, to direct the visits of one officer chiefly to cases of the same class, for the purpose of collecting information as to the common causes or antecedents. The amount of remuneration included in the estimate hereafter given might be made the means of obtaining additional time and services for carrying the inspections of the officers of health still further into the circumstances of the living; as in cases of consumption or fever, where numbers came from the same place of work or occupation, to visit and ascertain whether there was any overcrowding or any latent cause of disease.