Having had the honour to be associated with the late Dr. Cowan of Glasgow, Dr. Alison, and some other gentlemen, in a committee to consider of the means of obtaining a system of mortuary registration for Scotland, and having conversed with many qualified persons who have also paid much attention to the subject, I may state confidently that the exposition above given of the advantages derivable to the public service from the improvement of vital statistics would meet with extensive concurrence, independently of the very high sanction conferred by any expression of an opinion on such a subject from Dr. Alison. The towns where the greatest mortality prevails present precisely the opportunities so highly appreciated, of observations on large and organized bodies of men, § 213, often as similar in the chief circumstances which govern their condition, as the classes presented to the observation of medical officers in the army or in the navy.
Lord Bacon observes, in his suggestions for an inquiry into the causes of death—“And this inquiry, we hope, might redound to a general good, if physicians would but exert themselves and raise their minds above the sordid considerations of cure; not deriving their honour from the necessities of mankind, but becoming ministers to the Divine power and goodness both in prolonging and restoring the life of man; especially as this may be effected by safe, commodious, and not illiberal means, though hitherto unattempted. And certainly it would be an earnest of Divine favour if, whilst we are journeying to the land of promise, our garments, those frail bodies of ours, were not greatly to wear out in the wilderness of this world.” It would accord with his great views that adequate public provision and arrangement should be made to enable physicians to render the services desired. From the earliest time to the present, when the subject of sanitary evil and desecration of grave-yards was brought before the public by the long-continued exertions of Mr. Walker, members of the medical profession have made the most strenuous exertions and sacrifices for the attainment of such objects.
It is submitted that, in whatsoever place a proper system of the verification and registration of the fact and cause of death has not been introduced, as in Ireland and Scotland, and in all populous and increasing districts, that the appointment of an officer of health, having charge and regulations of all interments, would be the most economical as well as the most efficient mode of introducing it: in every place it must be a measure of paramount importance.
§ 215. As an instance of the incompatibility of such duties as those of the proposed officer of public health, with service in connexion with any existing local administrative body, it may be mentioned that every local Board in such a town as Sheffield would comprehend some of the chief householders, who would most probably be the chief manufacturers and employers of the class of workmen, and that even the official connexion would to such minds as the workmen expose him to suspicion, and diminish his influence, for the effectuation of any voluntary changes of practice. On other grounds, such as the absence of qualification in such Boards to give superior directions; and such grounds as those specified in p. 322 and p. 349 and 350 of the General Report, it is submitted that the functions of the officer of health would be the best exercised, independently of any other local administrative body. He would, in an independent capacity, be the most powerful auxiliary of any well-intended and zealous administration of local works, and as his functions must bring him at once to the chief spots where the consequences of neglects and omissions would be often manifest in fatal events, he would, as an independent and yet responsible officer, exercise an extensive influence and an efficient check on behalf of the public at large.
§ 216. Every efficient measure of improvement of the sanitary condition of the population, must be in its mere pecuniary results a measure of a large economy (§ 80). Physicians and medical officers are of opinion that all the ordinary and extraordinary duties specified, and even more, may be done by an officer of health with the same average expenditure of time (taking one case with another), that occurs to a physician in visiting a patient, examining the case, writing out a prescription and giving instructions to attendants. I shall be able to show that it may be accomplished at a charge no greater than that now paid by the labouring classes to one of their body as a steward or officer of their burial clubs who is required to inspect and identify the body of a deceased member.
Proximate Estimate of the comparative Expense of Interments under arrangements for National Cemeteries.
Having shown the chief desiderata in respect to the improvement of the practice of interment, and the means of protecting the public health, I proceed to submit the substance of the information collected as to the means of obtaining them.
§ 217. In submitting for consideration a proximate estimate of the extent to which it is practicable to carry that reduction of the expense of interments, which is so important to the middle and lower classes, the expense of interments of gentry and persons of the middle class of life is taken at double the amount at which persons of great experience in providing for the interment of large numbers have estimated they may be executed for without any reduction of the essentials to a decent solemnity.
§ 218. The estimate takes the existing scale of burial fees of the parish of St. James, Westminster, as fees to be continued, which would, if received in a fee fund, not only provide compensation for vested interests, but go far to provide the expense of new services.
§ 219. To the estimate of the expenses of interment is superadded a fee to defray the expenses of medical officers of a board of public health. The reduction of that great source of waste and expense, the payment of two or three stages of profits, for materials, &c. of funerals (by placing them under general arrangements), would admit of this charge, which is really a means to a still greater economy, the economy of health and life, and consequently of the number of funerals themselves. Objection to these charges would scarcely have place where the pecuniary economy is immediate. The medical service proposed may be procured to the working classes (supposing it were necessary to charge the expense on the funeral) at all distances, for the same sum as that which they now pay to the unlearned inspectors, officers of their clubs, for inspection within short distances, namely, 2s. 6d. It is declared by competent witnesses, that a respectable officer of public health, a physician, performing such services as those described, would be welcomed in most families on such a charge as 10s. 6d. for the middle classes, and 1l. 1s. for the higher classes, charged as a part of the reduced funeral expenses.