Chapter XIII: Appendix: Page (12)

Perhaps in no manufacturing community is human life, in large
classes of men, so shortened or accompanied with such an amount of
suffering or wretchedness as in this town, in connection with
certain staple manufactures. Were the legislature to interfere and
enforce the correction of the evils, by a system of ventilation,
which is neither difficult nor expensive to put in operation, the
duties of this officer, if directed to the superintendence of this
system, would save numerous lives and prevent an incalculable amount
of misery. At present, in consequence of these evils, a majority of
the artisans is killed off from twenty-five to thirty-five years of
age, and numbers annually leaving widows and children in great
destitution, and, in most cases, dependent on the parish. The evils
are not inseparably connected with the occupation; they admit of
redress. An officer of health, by maintaining the system of
ventilation in efficient operation, would save numerous lives, would
create a better tone of mind among the artisans—for wretchedness is
closely allied with ignorance and immorality—would diminish the high
rate of mortality amongst the young under five years of age—left by
the premature death of the parent unprovided for, and lastly, would
greatly relieve the parish funds. The officer, having the power to
remove at once any case of fever from a densely populated locality,
as well as to enforce measures of prevention, such as the removal of
accumulated filth, stagnant pools of water, or the correction of any
other local circumstances, would perform duties which would redound
considerably to the advantage of the community.

§ 214. In confirmation of the views of the benefits derivable to medical science from such arrangements as those proposed, § 211, various instances might be adduced besides the last cited, § 213, and that already given in the General Report, p. 355, of the discoveries made, on an examination of 1000 cases, by M. Louis, on the nature of consumption, now generally recognized as presenting facts at variance with all ancient and previous modern opinions: but in respect of the views there stated, as to the great public importance of well-ascertained medical statistics, I submit the high confirmation derivable from the following statement contained in the recently published outlines of pathology and practice of medicine, by Dr. W. Pulteney Alison, fellow and late president of the College of Physicians at Edinburgh, and professor of the practice of medicine in the University of Edinburgh:—

“The living body,” he observes, “assumes, in many cases, different kinds of diseased action, varying remarkably in different periods of life, without any apparent or known cause; but in the greater number of cases it is generally believed that certain circumstances in the situation or condition of patients, before diseases appear, can be assigned with confidence as their causes. The efficacy of these, however, is seldom established in any other way than simply by the observation that persons known to be exposed to their influence become afflicted with certain diseases in a proportion very much greater than those who are not known to be so exposed.

“This kind of evidence is in many _individual_ cases very liable to fallacy, in consequence of the great variety of the circumstances capable of affecting health, in which individuals are placed, and of the difficulty of varying these so as to obtain such observations, in the way of induction or exclusion, as shall be decisive as to the efficacy of each. Hence the importance of the observations intended to illustrate this matter being as extensively multiplied as possible; and hence also the peculiar value, with a view to the investigation of the causes of diseases, of observations made on large and organized bodies of men, as in the experience of military and naval practitioners. All the circumstances of the whole number of men whose diseases are there observed, are in many respects exactly alike; they are accurately known to the observer, and are indeed often to a certain degree at his disposal; they are often suddenly changed, and when changed as to one portion of the individuals under observation, they are often unchanged as to another; and therefore the conditions necessary to obtaining an _experimentum crucis_ as to the efficacy of an alleged cause of disease are more frequently in the power of such an observer than of one who is conversant only with civil life.

“But when the necessary precautions as to the multiplication of facts, and the exclusion of circumstances foreign to the result in question, are observed, the efficacy of the remote causes of disease may often be determined _statistically_, and with absolute certainty; and the knowledge thus acquired as leading directly to the _prevention_ of disease, is often of the greatest importance, especially with a view to regulations of medical police. And if the human race be destined, in future ages, to possess greater wisdom and happiness in this state of existence than at present, the value of this knowledge may be expected to increase in the progress of time; because there are many diseases which the experience of ages has brought only partially within the power of medicine, but the causes of which are known, and under certain circumstances may be avoided; and the conditions necessary for avoiding them are in a great measure in the power of _communities_, though at present beyond the power of many of the individuals composing these.

“There are, indeed, various cases, of frequent occurrence, in which the study of the remote causes of disease is as practically important as anything that can be learnt as to their history, or the effects of remedies upon them. This is particularly true of epidemic diseases, and of diseases to which a tendency is given by irremediable constitutional infirmities.”

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, 2_s._ 6_d._ 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 10_s._ 6_d._ for the middle classes, and 1_l._ 1_s._ for the higher classes, charged as a part of the reduced funeral expenses.

_Estimated Scale of Charges for Interments in the Metropolis,
inclusive of Compensations; the payment for the purchase of new
Cemeteries; and new Establishment Charges._

────────────────────────┬────────────┬────────────┬────────────
│ │ Proposed │ Scale of
│ │ Charge for │Expense for
│ Existing │ Officer of │Undertaker’s
│Burial Dues.│ Health and │ Materials
│ │Registration│ and
│ │ of Death. │ Services.
│ │ │
────────────────────────┼────────────┼────────────┼────────────
│£. _s._ _d._│£. _s._ _d._│£. _s._ _d._
│ │ │
Gentry {Adults │ 10 10 0│ 1 0 0│ 21 0 0
{Children│ 5 5 0│ 1 0 0│ 3 10 0
│ │ │
1st Class {Adults │ 2 10 0│ 0 10 0│ 10 10 0
Tradesmen {Children│ 1 5 0│ 0 10 0│ 2 10 0
│ │ │
2nd Class }Adults │ 1 12 9│ 0 6 3│ 6 0 0
Tradesmen }Children│ 0 16 9│ 0 6 3│ 1 12 6
(Undescribed) } │ │ │
│ │ │
Artisans {Adults │ 0 15 6│ 0 2 6│ 1 10 0
{Children│ 0 8 9│ 0 2 6│ 0 15 0
│ │ │
Paupers {Adults │ }│ │
{Children│ }│ │
│ │ │
Totals

───────────────────────────────────────────────────────────────
────────────────────────┬───────────────┬────────────┬──────┬──────────
│ │ │Annual│ Total
│ │ Total │Number│estimated
│Charge for New │ estimated │ of │Expense of
│Cemeteries and │ Scale of │Cases │Interments
│Establishments.│ Expense of │ of │ to each
│ │ Burials. │ each │Class per
│ │ │Class.│ annum.
────────────────────────┼───────────────┼────────────┼──────┼──────────
│ £. _s._ _d._ │£. _s._ _d._│ │ £
│ │ │ │
Gentry {Adults │ 6 0 0│ 38 10 0│ 1,724│ 66,374
{Children│ 4 5 0│ 14 0 0│ 529│ 7,406
│ │ │ │
1st Class {Adults │ 3 0 0│ 16 10 0│ 3,979│ 65,655
Tradesmen {Children│ 2 0 0│ 6 5 0│ 3,703│ 23,144
│ │ │ │
2nd Class }Adults │ 1 10 0│ 9 9 0│ 2,996│ 28,312
Tradesmen }Children│ 0 10 0│ 3 5 6│ 2,761│ 9,042
(Undescribed) } │ │ │ │
│ │ │ │
Artisans {Adults │ 0 2 0│ 2 10 0│12,045│ 30,113
{Children│ 0 1 9│ 1 8 0│13,885│ 19,439
│ │ │ │
Paupers {Adults │ │ 0 13 0│ 3,655│ 2,376
{Children│ │ │ │ ——————
│ │ │ │
Totals │ 251,861
│ ———————
Or an annual saving on the estimated total expense of the │
interments and parochial charges for the whole metropolis │ 374,743
───────────────────────────────────────────────────────────────────────

§ 220. In this estimate the expense of the funerals of the classes “undescribed” in the mortuary registries may be taken as representing the second or third class of tradesmen. In the estimate of the expense of funerals of persons of the first class, no account is taken for a long cavalcade of mourning coaches; but those who are conversant with the details agree that several may be supplied, with a full retinue of hired mourners, and the expense be yet kept below one-half the present amount of charges. A confident opinion is expressed that interments might be performed, under general arrangements, with all the advantages specified, and full compensation be given, at a rate of between 5_l._ and 6_l._ each funeral, instead of about 15_l._, the present average.

§ 221. On the eight chief cemeteries opened in the metropolis by private companies, and comprising about 260 acres, or considerably more than the space occupied by all the parochial and private burial grounds whatever, a capital of about 400,000_l._ has been invested. The expenses of litigation and of procuring Acts of Parliament, and purchasing grounds, must have been excessively heavy; and it appears probable that, for an amount not much greater or not exceeding it by more than one-fifth, superior national cemeteries, with houses of reception and appropriate chapels, may be formed on the present scale of expenditure of these companies, and in a style commensurate with what is due to the metropolis of the empire. If the charge of the purchase of the land and the structural arrangements be spread over 30 years, and the payment of the money charged, with interest, on the burials of persons of the higher and middle classes, the amount might be included in the total charges for funerals above estimated for the several classes, which charges, though so much below the amount at present usually paid, are yet higher than asserted to be necessary by respectable tradesmen, ready to verify their assertions by sureties to supply the materials and service of an equal or of a better description for the public than that which they now obtain. If the charges of the new cemeteries and establishments at such rates as those suggested were taken as substitutes for the existing rates of charge for graves, the new rates would be for the middle and higher classes greatly below the charges usually found in undertakers’ bills and executors’ accounts. If those new expenses were levied in the shape of a poll tax, or as burial dues, a sum of about 5_d._ per head per annum (exclusive of the expense of collection) would suffice in the metropolis to repay the principal and interest of purchase-money in 30 years, and also to defray the annual establishment charges.

§ 222. The establishment charges of the existing eight principal cemeteries amount, it is stated, to about 7500_l._ per annum. I believe, that by appropriate arrangements of a public establishment a far more efficient service might be obtained for national cemeteries for the same money. Assuming that the greatest solemnity and the highest cathedral service is due to funerals, four full choirs of 20 choristers and four organists to lead them might be obtained for less than 10,000_l._ per annum for four national cemeteries to meet the wishes of those who desire a service of the highest solemnity. The lowest aggregate charge for the separate establishments of parochial and suburban burial grounds, if only on the scale of that of St. Martin’s-in-the-Fields, must be at the least 25,000_l._, and would probably extend to 30,000_l._ or 40,000_l._ per annum. Such an amount in connexion with national cemeteries would suffice to maintain, in addition to the superior religious establishments above described, a superior description of intermediate houses of reception for the dead, with houses and offices for the residence of the officers of public health in care of them: it would beyond that suffice to provide the means for accommodation, on a large scale, for the reception and treatment of all persons labouring under infectious diseases. It might also suffice for the establishment of public baths, in which the metropolis is also deficient.

§ 223. The number of the officers of health requisite for the due execution of the service could only be determined by experience; but, judging from analogous experience, a much smaller staff than on the first view might be expected would suffice for the performance of all the duties specified, if their whole time were devoted to them. Medical officers of dispensaries, within their districts, visit, examine, and treat twenty or thirty cases per diem; physicians in full practice, and driving to distant parts of the town, on the average (which includes cases of short visits of a few minutes and cases where a long attendance would be required), visit about three cases in the hour. This appears to be the best analogous experience. On this experience, and considering that it would be good economy to provide each officer with a one-horse vehicle, he may be expected to visit fifteen cases a-day, one day with the other, out of the daily number of deaths. The two public medical departments, the navy and the army, have rendered the highest, if not the only, public service in the prevention of disease—the navy medical department especially; which service it has been enabled to achieve from having the subjects of its care under the most complete control. The scale of remuneration to these officers, who, whatever diploma they may possess, are required to undergo, and do undergo, a special re-examination, is taken for estimating the expense. There are various grounds that, at all events at the outset, and for their superior responsibility, this class of officers should be selected. The proposed staff would be as follows:—

Per Annum.
£. _s._ _d._
An inspector of public health, of the rank of an
inspector-general of hospitals in the army, or of 657 0 0
fleets in the navy, at full pay of 1_l._ 16_s._ per
diem, at the rate given after ten years’ service

A deputy inspector-general, at the rate of the army 438 0 0
full pay of 1_l._ 4_s._ per diem

Eight inspectors of public health, of the rank of staff
surgeon, at the rate of the army full pay of 19_s._ 2,774 0 0
per diem

Two supernumeraries, of the pay of regimental surgeons, 547 10 0
at the rate of the army pay of 15_s._ per diem

Ten single horse vehicles, and ten drivers, at 1_l._ 1,638 0 0
1_s._ per week, total 3_l._ 3_s._ per week each
————— —— —
Total 6,054 10 0
————— —— —

Ten officers, visiting fifteen cases per diem, would suffice to take order such as described, for the burial of 45,000 persons. They will also be enabled in upwards of 8,000 cases to direct measures for the protection of the survivors and their neighbours from the spread of contagious disease. Supposing that each class of deaths occurred daily, with the same regularity that they occur yearly, the distribution of the duties of verification and examination may be seen from the following table, made from the Registrar-General’s returns.

─────────────────┬──────────────────────────╥────────┬────────┬────────
│ ║ Liver- │ Man- │ Leeds
│Metropolis Pop. 1,870,727 ║ pool │chester │ Pop.
│ ║ Pop. │ Pop. │168,627
│ ║223,045 │192,408 │
─────────────────┼────────┬───────┬─────────╫────────┼────────┼────────
│ Daily │ │ ║ Weekly │ │
│ Number │ Daily │ ║ Number │ Weekly │ Weekly
│ of │Number │ Total ║ of │ Number │ Number
│ Deaths │ of │ Number ║ Deaths │ of │ of
│ of │Deaths │ Daily. ║ in │ Deaths │ Deaths
│Children│ of │ ║ Liver- │in Man- │ in
│ under │Adults.│ ║ pool. │chester.│ Leeds.
│ 15. │ │ ║ │ │
─────────────────┼────────┼───────┼─────────╫────────┼────────┼────────
Epidemic, │ │ │ ║ │ │
Endemic, and │ 18│ 4–2/10│ 22–2/10║ 52–6/10│ 34–8/10│ 20–3/10
Contagious │ │ │ ║ │ │
Diseases │ │ │ ║ │ │
Sporadic │ │ │ ║ │ │
Diseases:— │ │ │ ║ │ │
Nervous Disease │ 14–6/10│ 6–6/10│ 21–2/10║ 28–7/10│ 18│ 15–6/10
Diseases of the │ │ │ ║ │ │
Respiratory │ 13–2/10│25–6/10│ 38–6/10║ 46–8/10│ 34–6/10│ 24
Organs │ │ │ ║ │ │
Diseases of the │ │ │ ║ │ │
Organs of │ │ 2–4/10│ 2–7/10║ 1–8/10│ 1–1/10│ 8/10
Circulation │ │ │ ║ │ │
Diseases of the │ │ │ ║ │ │
Digestive │ 5–5/10│ 3–8/10│ 9–3/10║ 10–5/10│ 9–5/10│ 6–1/10
Organs │ │ │ ║ │ │
Other Sporadic │ 5–4/10│12–7/10│ 18–1/10║ 13–5/10│ 16│ 10–2/10
Diseases │ │ │ ║ │ │
Old Age │ │ 9–4/10│ 9–4/10║ 5–1/10│ 5–7/10│ 5–6/10
Violent Deaths │ 1│ 2–4/10│ 3–4/10║ 3–8/10│ 4–9/10│ 2–7/10
Causes not │ 2/10│ 3/10│ 5/10║ │ │ 1
specified │ │ │ ║ │ │
─────────────────┼────────┼───────┼─────────╫────────┼────────┼────────
Total │ 58–1/10│67–2/10│ ║162–8/10│124–8/10│ 86–3/10
Total Deaths │ │ │ 125–4/10║ 23–2/10│ 17–8/10│ 12–3/10
Daily │ │ │ ║ │ │
─────────────────┴────────┴───────┴─────────╨────────┴────────┴────────

NOTE.—The data upon which this Table is calculated are taken from
the Registrar-General’s Fourth Annual Report—the Metropolis, p. 330;
Liverpool, p. 281; Manchester, p. 281; Leeds, p. 283. The Metropolis
is calculated on the average of the years 1840 and 1841, the other
places on the year 1840.

§ 224. The total number of funerals and deaths requiring verification daily would be—for Birmingham about 12, for Nottingham 5, for Leicester 3, for Derby 3. From the data above given it will be seen at how small an expenditure of time a well directed force for the prevention as well as the alleviation of misery—vast interests of the population, that are now neglected—may be placed, under responsible superintendence, and on the most sordid views of economy of money, immense savings, under proper regulations, be made. In Liverpool alone, in the business of cure or alleviation there are now engaged 50 physicians, and 250 surgeons, apothecaries, and druggists, and not one responsible public officer to investigate the causes of disease with a view to prevention. Nor has the city of London, with a population of 125,000, one such officer, though it has an expenditure of 72,000_l._ per annum in hospitals and endowed medical charities alone, for the alleviation of disease.

§ 225. There is much experience to establish the conclusion that very special qualifications are requisite for the performance of the duties of an officer of the public health. The only safe proof of the possession of such qualifications is the fact of a person having investigated successfully some scientific question on the prevention of disease to a practical end, by which the main qualification, the habit of practical investigation, and zeal and ability for the service of prevention may be placed beyond doubt. It would be no imputation on the merits of a general medical practitioner that he was found unsuited to the performance of the duties devolving on an officer of public health. The working of the Parisian administrative arrangements shows the injury done to the public service by the difficulty of retrieving any mistaken appointment, and suggests the desirableness of an arrangement to facilitate changes of the officers of health even where there is the security of a previous special examination as to the qualifications for the office. Cases would occur where officers would themselves choose to withdraw from such a service, for which they felt unsuited, if they might retire without imputation and without any severe sacrifice. If, therefore, officers of health were chosen from amongst those who had long served with honour in the army or navy medical department, the advantage would be gained of a facility of retirement being given to the officer of health (an office, indeed, which would often be trying to the constitution), and without loss of rank or of the means of livelihood.

§ 226. The arrangements for the performance of the funereal rites in public cemeteries would, of course, fall to the proper ecclesiastical authority. The architectural arrangements, and the decoration of the cemeteries, may claim the highest aid that art can give to the production of solemn religious impressions. Public monuments and works of art have of late been extensively thrown open to the population, and there is evidence that this course of proceeding has been productive of beneficial effects on those of the lower classes who have had opportunities of viewing such monuments during their holidays. But the place of burial is the object to which the views of almost every individual of that class, as well as of others, is ever most intently directed. All the structural and decorative arrangements of the national cemetery should, therefore, be made by the highest talent that can be procured, with the purpose of interesting the feelings, under the conviction that in rendering attractive that place we are preparing _the_ picture which is most frequently present to the minds of the poorest, in the hours of mental and bodily infirmity, and the last picture on earth presented to his contemplation before dissolution.

§ 227. It will have been seen that if the tendency of the public mind be followed out by the economical regulation of funeral expenses, and if the public be protected from the extortions of undertakers, considerable reductions of expense may be effected, and munificent provision may yet be made for permanent decorations.

These reductions would, also, under practicable regulations of the mode and practice of interment, admit of full and liberal compensation to all legal and proper interests affected by the proposed change of the practice, and to whom Parliament might determine that compensation should be awarded.

§ 228. In the case of the ministers of the Established Church in large towns, the surplice fees, including the burial dues, are to be considered as the main parts of their incomes. They have no tithes, and no other means of livelihood. But the burial dues are so variously regulated—in some places by custom, in other places by local Acts—that it is scarcely practicable to lay down any one scale in respect to them that would not operate unequally and unjustly. Complaints from cemetery companies are made in respect to the existing scales of compensation, which did not appear to be within my province to investigate. It appeared to me that the only satisfactory mode of determining the amount of compensation would be an adjudication and examination of the case of each parish. This would be a service, which the Commissioners for the Commutation of Tithes would be competent to render.

§ 229. The claims of families who have purchased the privilege of interment in private vaults are not, that I find, maintained to any extent by the possessors, but are rather suggested as obstacles by others. That which at the time of purchase was deemed a privilege is now proved to be an injury to the community at large, not to speak of the very families by whom the right of interment in the church which they attend is exercised. When the fact is known of the deleterious character of the miasma which arises wherever bodies waste away, it were inconsistent with all religious feeling to maintain, as a privilege, the right of endangering the health of their families, friends, or neighbours. The same observation is applicable to grave-yards attached to chapels belonging to Dissenting congregations. Burial there is an injury to the congregations themselves, and the removal of interments a benefit to them; and although any one may choose to put up with the injury, or refuse to admit the evidence of it, they can scarcely claim to continue the injury at the expense of others, or against the conviction of the majority of the community and the opinions and customs of all civilized nations by whom the practice of interments in towns is prohibited. The overwhelming evidence that what is deemed a privilege is really an injury, precludes all claim to compensation as for a loss. No claim is set forth by any congregation for compensation as for the loss of a gainful trade of burial. Setting aside, then, the question of right, it may be submitted in respect to the owners of private vaults in parochial burial grounds, whether claimants, within a given time, may not be allowed an equal space in the national cemeteries, and be allowed to transfer the remains of their ancestors thither, and erect suitable monuments to them. It may also be submitted that the sites occupied as burial grounds may be re-purchased from the congregations on liberal terms of compensation, to be kept as open spaces for the public use, and that those congregations may have equivalent spaces allotted to them at a distance from town in the new cemeteries. The authorities carrying out the change, should be enabled, on the like terms, to re-purchase from private companies such cemeteries as may be deemed eligible for the public, and engage their officers in the public service, or otherwise compensate them. The success of national cemeteries, would doubtlessly occasion loss to those who have subscribed capital in what was at the time a public improvement, and it is further submitted for consideration, whether the power of re-purchase for the public, from the proceeds of a reduced burial expenditure, might not be extended to the re-purchase of such sites even where they would not be found eligible for national cemeteries.

§ 230. If it be decided that the protection so much needed by all classes, especially by the poorest, in respect to the expense of interments shall be given, by empowering officers of health to carry out regulations the same in principle as those which have given relief and satisfaction in well regulated communities, it may then be submitted for consideration, whether the cases of the tradesmen who have devoted themselves entirely to the business of supplying funereal materials and service, and who will be wholly superseded, could not be brought within any legitimate principles and precedents of compensation, for the loss of their existing multiform monopoly by the whole or any portion of the supply having been transferred to officers responsible to the public. By means of such transference, the public gain will, in proportion to its completeness, be immense. Without it there is no apparent means of change or compensation that will not increase the existing expenses, and also increase the train of existing evils consequent on those expenses. Whatever may be the sacrifice or inconvenience experienced by this class of tradesmen from such a transference, it were a lamentable misdirection of sympathy to sustain their pecuniary interests at the expense of the perpetuation of the enormous pecuniary sacrifices of the poorest and most helpless classes. But it may be submitted that the large work of charity and justice to the public from the change proposed, need not be accomplished by the sacrifice of the real principals in the business of undertaking. If the alterations proposed were not made, it is nevertheless probable that this business will be considerably changed. The practicability and advantage of the consolidation of the business of the supply of funereal materials and services under one general management with the cemetery, and the acceptability of the institution of a place for the reception and care of the dead previous to interment, are attested by the fact of which I am informed, that in consequence of the proposed measures having been necessarily developed by the course of the present inquiry from a multitude of witnesses, joint stock companies are now preparing to adopt, as a source of emolument, similar arrangements. To those persons who are not really principals in the business, as they professed, but agents, whose only service consisted in conveying orders to real principals, and who extorted large profits from those who employed them; to those carrying on the business of undertaker only as an addition to their chief trade, and to whom the orders for a funeral was “an occasional job”—to a large proportion of these classes, the change would cause no ultimate loss, and to many it must be an eventual gain. The business as at present conducted is in principle similar to a lottery in the excessive emoluments of death, amounting to upwards of half a million of money in the metropolis alone, and which is chiefly wrested from the poorer and depressed classes. Such an amount is annually distributed in prizes, which fall with the deaths, in sums varying from a few pounds to several hundreds, amongst a crowd of expectants, which even, under the existing management, is five times more numerous than is necessary (and under the proposed arrangements ten times the number requisite), leaving the greater number poorly paid for all their waiting, notwithstanding the large sums exacted from the suffering survivors. It may confidently be pronounced, that to the majority of the class of inferior labourers, the change of system must be an eventual and very early benefit.

§ 231. As various religious communities would participate in the provision of public cemeteries, it appears preferable, for the avoidance of jealousy and any pretext for dissatisfaction, and that such different parties may be freely communicated with, that land should be purchased, and the structural arrangements made, on due consultation by the Commissioners of Woods and Forests.

§ 232. The sites for national cemeteries would be determinable on consideration of circumstances affecting public health, and by convenience of access, which the responsible officers of public health should be required to investigate on a view or survey of the circumstances of the metropolis in these respects as a whole. They would also set forth the arrangements necessary for the preparation of the ground for interment, for drainage, and the protection of the springs; and the prevention of the escape of miasma; from which regulations no class of interments and no places should be exempted.

§ 233. If the whole of the arrangements for sepulture were begun _de novo_, the most eligible principle for defraying all the public charges, and perhaps most of those charges which are now private charges, would be, as respects persons of the lower and middle ranks, by annual payments approximating to an insurance. With the wealthy classes payment at the time of interment partakes of the nature of a legacy duty, and is then made most conveniently. With the lower and a large part of the middle classes of society, the death of an adult member of the family is frequently the loss of the most productive member of the family, which occurs at a time when the family has, in almost every case, incurred severe expenses for medical treatment during illness. The charges for interment and for the mourning which custom requires, then press most grievously. A large proportion of the middle and lower classes endeavour to alleviate this pressure by spreading it over long periods by means of insurance, and amongst others by such expensive and uncertain modes as those displayed in the regulations of burial clubs. The commutation of the charge of insurance into an annual charge would be a public insurance, possessing the advantages of superior security, and the means of superior efficiency as well as of economy. The chief obstacle that stands in the way of such an arrangement is the want of a machinery for the annual collection of such a tax. It has been proposed to throw upon the poor’s rates some of the additional charges supposed to be necessary, and, in the event of the change being made by means of numerous extra-mural parochial establishments, that certainly would be necessary. But the imposition of such a charge in such a mode as to follow the incidents of the poor’s-rates would be unequal and unjust. Large districts of cottage tenements, which are now, chiefly to the benefit of the landlords of those tenements and at the expense of the other rate-payers, exempted from poor’s-rates, would escape contribution, and it is precisely in such districts that the deaths are most frequent and the burial charges would be the most burthensome. Lodgers would extensively escape the charges; strangers and foreigners, and the fluctuating population in large districts, would escape them. If there were a machinery for collection, it is submitted that the most equitable mode of levying such charges would be, like those of a burial club, _i. e._ of the nature of a poll-tax, or burial dues payable, per head, on the number of persons inhabiting each house. These might be fixed for the whole community at a minimum rate, leaving it to the friends of the deceased to pay for any higher class of funeral which they think proper.

§ 234. It is, however, to be borne in mind that in burial clubs, and in savings’ banks, large sums are now actually set apart by the labouring classes for the payment of funeral charges. Provision is, no doubt, also made by will, by other classes for defraying such charges. In the plan proposed, even including the expense of the new agency of officers of health the consideration of new sources of additional payments is rendered unnecessary. On the whole, therefore (although if bodies are immediately removed from the premises in cases where the removal is requisite for the protection of the lives of the survivors, attempts will be made to shift the expense to the public), it may be recommended that all new charges and compensations should, for the present, at least, still be defrayed from burial dues levied upon each interment. And in so far as any new expenses are for objects obviously beneficial (not to speak of those immediate charges being for the most efficient means of reducing the aggregate expenses), it will meet with ready acquiescence. I have consulted intelligent persons of the labouring classes, and discussed with them step by step the proposed changes. They have unanimously declared that these changes would all be a great gain to them, especially the proposed reduction of the expenses of interments. They have moreover urged that if they were enabled to have the funerals performed in a satisfactory manner, at a reduced expense, the applications for parochial aid would be proportionately diminished, the poorest relations would then subscribe to avert the disgrace of a parochial interment; a large proportion of the applications for such aid being now made by others than regular paupers, and in consequence of the hopelessness of their being enabled to defray the heavy expenses which are at present necessary.

§ 235. The conclusions before stated are deduced principally from the facts obtained by inquiries in the metropolis and the chief towns in the manufacturing districts. The information obtained by correspondence from Edinburgh, Glasgow, Bristol, Birmingham, Coventry, and several towns in Ireland, tends to the conclusion that the leading principles set forth in this report are applicable to all crowded town districts, with but few modifications. In all the practice of interments in towns, the crowded state of the places of burial, the apparent want of seclusion and sanctity pollute the mental associations, and offend the sentiments of the population, irrespective of any considerations of the public health; in almost all, this state of feeling is manifested by the increasing resort of persons of the higher and middle classes to such cemeteries as have been formed out of the towns by private individuals who have associated, and taken advantage of the feelings to procure subscriptions for the formation of more acceptable places of sepulture. In Manchester and Edinburgh, and a few other towns, the business of the undertaker does not appear to be on the same footing as in the metropolis; the expenses of the funerals to the labouring classes appear nevertheless to be no less oppressive, and the whole arrangements to stand in pressing need of regulation. In nearly all the towns where the grave-yards are crowded by the burials of an increasing population, evidence was tendered of outrages perpetrated upon the feelings of the population by the gravediggers in the disposal of undecomposed remains to make space for new interments. And it follows, from the circumstances that these men will not allow their own means of livelihood to be curtailed, and will, if they be permitted, or be unwatched, make way by any means for new interments. The desecrations are suspected, and from time to time are discovered. It requires a high order of education and mental qualification to maintain habitually respect for the inanimate remains of the dead and regard to the feelings of the living connected with them. In the uneducated, any common feelings of respect soon give way to every-day conveniences, and are at once obliterated by any strong necessities. The common tendencies in this respect are attested by the examples cited, of careful arrangements made to guard against them. (§ 169.) In all the populous provincial towns the need of the superior superintendence of the material arrangements for interment, and the exercise of such functions as those described as falling to a superior officer of public health, appear to be even more urgent than in the metropolis. It is, however, an error to suppose that the evils of the existing practice of interment are confined to the _larger_ towns. The burial-ground at Southampton, for example, is represented to me to be full; it is moreover not more than one-half of the extent requisite for the population of that town, which is about 28,000, and rapidly increasing. The authorities there are desirous of obtaining grounds and establishing a public cemetery in or near the town, and would, if practicable, do so without the expense of a private Act of Parliament. The grave-yard of the cathedral of Ely, for the burials arising from a population of about 7,000 is reported to be inconveniently full, and the very reverend the dean is stated to be extremely desirous of closing it and procuring a burial-ground at a distance. I have been informed by several ecclesiastical authorities, that the clergy are often much distressed by the inadequacy of the old grave-yards to meet the necessities of burial for an increasing population. The data already given as to the space required for interments will serve to show the adequacy or inadequacy of the existing burial-grounds for any population. It may be submitted that provision might be made for the relief of any district on the inspection and under the authority of properly appointed officers of health, for the provision of new and separate places of burial, on applications showing the inadequacy or unsuitableness of the existing grave-yards.

It were a reproach to the country, and its institutions and its government, and to its administrative capacity, to suppose that what is satisfactorily done in the German states may not, now that attention is directed to the subject, be generally done at least as well and satisfactorily in this country; or that the higher classes would not in whatever depends on their voluntary aid, exhibit as good and practical an example of community of feeling in taking a lead in the adoption of all arrangements tending to the common benefit, as that displayed in the states which have achieved the most satisfactory improvement of the practice of interment, by well-appointed officers of public health.

§ 236. I have thought it unnecessary to occupy attention with many details which would appear to follow the adoption of the general principles deducible from the information collected. I have given that information so fully in the text, that I have avoided extending the bulk of the Report by repeating it with prefatory or connecting matter in the Appendix.

I would now beg leave to recapitulate the chief conclusions which the information obtained under this inquiry appears to establish. They are—

I. _As to the Evils which require Remedies._

§ 237. That the emanations from human remains are of a nature to produce fatal disease, and to depress the general health of whosoever is exposed to them; and that interments in the vaults of churches, or in grave-yards surrounded by inhabited houses, contribute to the mass of atmospheric and other impurities by which the general health and average duration of life of the inhabitants is diminished. (§ 1 to 23.)

§ 238. That the places of burial in towns or crowded districts are usually destitute of proper seclusion or means for impressive religious service, and are exposed to desecrations revolting to the popular feelings; and that feelings of aversion are manifest in the increasing removals or abandonment of family vaults and places of burial, and the preference, often at increased expense, of interments in suburban cemeteries, which are better fitted to raise mental associations of greater quiet, respect, and security as places of repose. (§ 109.)

§ 239. That the greatest injury done by emanations from decomposing remains of the dead to the health of the living of the labouring classes, in many populous districts, arises from the long retention of the body before interment in the single rooms in which families of those classes live and have their meals, and sleep, and where the deaths, in the greater number of instances, take place; and that closely successive deaths of members of the same family, from the same disease, are very frequent amongst the labouring classes; and that, where the disease has not been occasioned by the emanations from the first dead body, as sometimes appears to have been the case, or where the disease has either arisen from a common cause, or may have been communicated before death from the living person, the diseases are apparently rendered much more fatal by this practice of the retention of the dead body in the one living room previous to interment. (§ 24 to 39.)

§ 240. That this practice of the prolonged retention of the dead in such crowded rooms, besides being physically injurious, is morally degrading and brutalizing. (§ 40 to 42.)

§ 241. That this practice is frequently the most powerfully influenced by the difficulty of raising the expenses of funerals, which in this country press grievously on the labouring and middle classes of the community, and are extravagant and wasteful to all classes, and occasion severe suffering and moral evil. (§ 43 to 71.)

§ 242. That, on the best proximate estimates which have been made, the total amount of the whole of the yearly expenses of funerals in the metropolis cannot be less than between six and seven hundred thousand pounds, and for the whole of Great Britain between four and five millions sterling per annum. (§ 72 to 74.)

§ 243. That it appears, upon examination in the metropolis, that notwithstanding the great expense of funerals, the existing arrangements for conducting them are on an unsatisfactory footing, and that great difficulties stand in the way of any efficient amendment, whilst the practice of interment in the crowded districts is retained. (§ 84 to 89.)

§ 244. That on the occurrence of a death amongst the poorest classes or amongst strangers, the survivors are commonly destitute of means of precaution against oppressive charges and of trustworthy advice or counsel, as to the modes of burial such as are afforded by the civic arrangements of other civilized countries. (§§ 121, 122, and vide Appendix, No. 1.)

§ 245. That on the occurrence of deaths from preventible causes of disease, there are no appointed means for the detection and removal of those causes, and that strangers and new-comers, having no warning, are successively exposed, and frequently fall victims to them. (§ 196.)

§ 246. That common causes of diseases which ravage the community, of the extent of operation of which causes it has a deep interest in knowing, pass unexamined and undetected; moreover, that in many districts there are wide opportunities for the escape of crimes, by which life is also rendered insecure, chiefly by the omission of efficient arrangements for the due verification of the fact and causes of death. (§§ 205 to 215.)

§ 247. That the numbers of funerals, and intensity of the misery attendant upon them, vary amongst the different classes of society in proportion to the internal and external circumstances of their habitations: that the deaths and funerals vary in the metropolis from 1 in every 30 of the population annually (and even more in ill-conditioned districts), to 1 in 56 in better-conditioned districts; from 1 death and funeral in every 28 inhabitants in an ill-conditioned provincial town district, to 1 in 64 in a better-conditioned rural district: such differences of the condition of the population being accompanied by still closer coincidences in the variation of the span of life, the average age of all who die in some ill-conditioned districts of the metropolis being 26 years only, whilst in better-conditioned districts it is 36 years: the variations of the age of deaths being in some provincial towns, such as Leicester, from 15 years in the ill-conditioned to 24 years in the better-conditioned districts: and as between town and rural districts 17 or 18 years for the whole population of Liverpool, and 39 years for the whole population of Hereford; and that the total excess of deaths and funerals in England and Wales alone, above the commonly attained standards of health, being at the least between thirty and forty thousand annually. (§ 75 to § 80, and district returns: Appendix.)

II. _As to the Remedies available for the Prevention or Mitigation of
these Evils._

§ 248. That the most effectual and principal means for the abatement of the evils of interments are those sanitary measures which diminish the proportionate numbers of deaths and funerals, and increase the duration of life. § 75 to § 82, and General Report, p. 370. But—

§ 249. That on the several special grounds, moral, religious, and physical, and in conformity to the best usages and authorities of primitive Christianity, § 177, and the general practice of the most civilized modern nations, the practice of interments in towns in burial places amidst the habitations of the living, and the practice of interment, in churches, ought for the future, and without any exception of places, or acceptation of persons, to be entirely prohibited. (§ 1 to § 23.)

§ 250. That the necessities of no class of the population in respect to burial ought to be abandoned as sources of private emolument to commercial associations, but that national cemeteries of a suitable description ought to be provided and maintained (as to the material arrangements), under the direction of officers duly qualified for the care of the public health. (§ 126.)