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18
Sept. 24th,—At No. 18, Wild Court, aged 4 days, daughter of a
costermonger, cause of death unknown J found dead; not certified.
Oct. 16th,—At No. 34, Henrietta Street, aged 4 years, daughter of a
journeyman carpenter, died of gastric fever, scarlet fever; not certified.
The smallest evil of a system of registration that admits of such entries
as these, is the vitiation, pro tanto, of all deductions from the death-returns.
Many of the causes of death set down are quite unreliable ; some of them may
be true, but formal evidence of their truth should be adduced. It must not
be forgotten that in the nineteen cases out of twenty were the cause of death
is certified, it is quite optional with the medical practitioner whether he give
such certificate or not. Some deaths therefore may have been uncertified
because the medical attendant has refused to grant a certificate of the cause.
Others will have been uncertified because the attendant is an unqualified practitioner.
Again some deaths may have been reported to the coroner and he may
have decided, on the circumstances ascertained by him, that no inquest was
necessary. Where this is the case it is much to be desired that the fact
should be noted by the Registrar.
But setting aside all possible cases of this sort there remain a considerable
number of uncertified deaths about which there is more serious doubt. Yet
the law authorizes the registration of such deaths, and the Registrar General
cannot instruct the local Registrars to use any discretion in their entry.
Being registered, permission for burial is obtained, and unless rumour should
chance to set in motion the police or the coroner, the cause of very suspicious
deaths is never ascertained.
The deaths extracted above will serve to show how readily disease may
be confounded with the results of injury or poison. "Rupture of a vessel on
the brain" is simulated very closely in cases of poisoning by alcohol or opium,
or may actually have been caused by an injury to the head. The symptoms
of "gastric fever" and of an irritant poison may be such as to be with difficulty
distinguished even by a medical eye. Medical inquiry again is wanted to affirm
"diphtheria" as the cause of death; it has points in common, not only with
other diseases, but with poisoning by the mineral acids. Almost before any
other cause for that sudden death in chapel, poison offers itself as a probability.
And there must have been some reason that ought to be known for the death
of that infant of four days old. It is chiefly for these little ones that the
protection of a better registration law is required.
SECTION VII.—On the Sanitary Work of 1861.
Five hundred and eighty-five houses have received improvement in the
past year, a total of 1754 nuisances having been abated. In the following
table are indicated the nature of the improvements and the neighbourhoods
affected by this sanitary work. The divisions of the districts here employed
are the same as those used in considering the localization of disease. By this
means, we may hope in a series of years to demonstrate with accuracy a connection
between the fluctuations of disease and the changes in the physical
conditions surrounding the population. In the total amount of house improvement
there is not much difference from year to year. Inspection is
chiefly given to those districts where epidemic disease shows itself, and thus
Coram Street locality was especially looked after in 1861. A hundred houses
here have been improved, and 348 separate items of sanitary improvement
have been effected in this neighbourhood alone.
Here however there are some places that baffle the endeavours of the
sanitary officers to arrest disease in them; especially the Courts leading out
of Little Coram Street. They are culs de sac, under the level of the adjacent
Streets, and therefore necessarily ill-drained ; the houses built directly upon