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beadle, or the police officer, who gave information of the death to the coroner. The body was
found dead, and the public obtained no further information from the deliberation and verdict of
the jury, than it had before the inquest. In regard to some of these cases, and particularly that
of the man found dead in one of the baths in Goulston-square, there is as much reason to
believe that death was occasioned by poison, or by internal disease, as by the cause alleged.
Investigations before the coroner ought to be circumstantially and solemnly made, an d the
cause of death ascertained.
The security of the subject which is afforded by the coroner's court, cannot be too
highly prized. According to the ancient law, an inquiry before the coroner involves no suspicion
against any person, while it affords security against unfounded suspicions which will
occasionally arise in neighbourhoods on the occasion of a sudden death. In all cases, therefore,
when the cause of a sudden death is not certified by a medical practitioner, and when the
coroner is of opinion that a jury should be summoned, a post mortem examination of the body
ought to be made, so that the cause of death may be correctly ascertained." If a rigid inquiry
were made by a competent medical officer, into the cause, not only of every sudden death, but of
every death not certified by a qualified medical practitioner ; infanticide, secret poisoning, and
other kinds of homicide would be checked, if not altogether prevented, and the safety of the
public increased.
There appears to be no settled rule for the holding of inquests; the necessity of the
inquiry seems to be chiefly determined by the constable or beadle of the parish, and unless these
officials entertain the idea that there is something mysterious or suspicious in the cause of
death, a jury is not called. It is generally supposed, that all deaths which are the result of
injury, are inquired into by the coroner, but this is not the case, for, during this quarter, two
deaths occurred in the London Hospital, one by asphyxia, from injury to the spinal chord, and
the other from inflammatory fever, occasioned by an accident to the arm. In neither of these
eases was an inquest deemed necessary. Two deaths occurred in the London Hospital from
excessive drinking; in one, an inquest was holden, when the verdict returned was " Apoplexy
from excessive Drinking" ; in the other case, the patient was admitted in a state of coma, from
drink, and subsequently died, but an inquest was not holden. An inquest was holden on the
body of a child, whose death was caused by scalds, from the overturning of a tin pot of boiling
water ; while, in the previous week, there was recorded the death of a child from drinking hot
water from a tea-pot, when a jury was not summoned. The drinking of hot water from a
tea-pot is a frequent cause of death to children, and in each case, which has previously occurred
in this district, a judicial inquiry was made. Again, an inquest was holden on the body of a
child, aged 4 months, whose death was caused by convulsions ; and the verdict was " Sudden
death from convulsions; while in the mortality table (No. 7.), 31 deaths are registered as
occasioned by this disease, of which, several are uncertified by a medical practitioner; and yet in
no other instance was there an inquest. Further, it was deemed necessary to hold an inquest on
the body of a man who died of typhus fever, on board of ship in St. Katharine's Docks, when
the verdict was " Typhus Fever, unsound mind," wrhile in 19 other cases of death from fever, an
inquest was not holden. Among the records of the coroners' inquests which are included in
the mortality returns of the district, is the following verdict, " Found dead, if born alive, and if
so, how death caused unknown." Here, a child is found dead, and an inquest is deemed necessary,
while, on the other hand, a, female, aged 76, is found dead in bed, and an inquest is not held,
notwithstanding that the cause of death was uncertified by a medical practitioner.
* See Report for the Quarter ending September 26, 1857, page i.