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16
the 14 cases recorded this year, 11 are of infants
under one year of age. In 1856, only two such
cases were recorded; in 1857, not one; in 1858,
there were only four. It appears that, in general,
these cases are recorded as found dead in bed with
their parents. Such death is suggestive of culpable
carelessness on the part of parents, or of horrible
criminality. It does not appear that in these cases
Coroner's inquests are always held, and therefore no
admonition is conveyed to those who have thus carelessly
deprived their offspring of life, and no chance
afforded of bringing those (if any) who are guilty
of crime tc justice. I drew your attention last year
to the number of deaths which occurred without
the certificate of a medical attendant, and in which
no Coroner's inquest was held. I have long been
convinced that the machinery which brings this
most important institution into operation is most
deficient. In cases of death, where crime is suspected,
or where no legal medical attendant has
been called in, the circumstances should be investigated
by a properly educated medical man, whose
business it should be to investigate thoroughly the
causes of death, and on his report made to the
Coroner should the inquest be summoned. Under
the present circumstances, where it is thought
necessary to make inquiry, the person employed is
one of the parish constables, who, however conscientiously
he may perform his duties, never receives
that kind of education which would enable him to
give a satisfactory report upon the probable causes