The Smallest Room But One The recent emigration of a senior English forensic pathologist to Australia,

primarily because of working conditions said to be 'dreary, dismal and even Dickensian' (I), has once again momentarily focussed attention on the sad plight of those pathologists regularly condemned to perform Coroners' autopsies in the mortuaries of the English rural, and smaller urban, districts.

Small, poorly lit, wretchedly ventilated, freezingly cold in winter, malodour- ously warm in summer, often without refrigeration or proper working surfaces and with their woefully inadequate Victorian plumbing in a permanent state of semi-occlusion from the anatomical debris of decades, these buildings still stand in council yards, by sewage works and rubbish tips all over the land, the subject of the prying curiosity of agile children and awkward silences at local council meetings. Next to public conveniences, to which many of them bear a curious and revealing architectural resemblance, they are usually the smallest buildings erected and maintained by the local authority and one cannot help but feel that their size accurately reflects the interest taken in them. The architectural and pathological deficiencies of these rural mortuaries have been widely publicised, particularly in the Lancet (2), (3), (4), and the general state of mortuary accom- modation in the country was the subject of an A.C.P. special committee investigation in 1960 (5). The associated problems of staffing and cleaning these small premises on a part-time basis and of providing for the proper viewing of bodies by relatives are well known. Even the transport of bodies to and from the mortuary often creates difficulties, inasmuch as the police, who in some areas traditionally perform this task, and the local ambulance service both contend, and with some justification, that this work falls outside their proper line of duty. The use of local undertaking firms to provide this transport can give rise to resentment if the work is not shared equally between the interested parties. The time wasted by a pathologist travelling between these village mortuaries is relatively enormous and since almost none of them are on the telephone he is incommunicado from the instant he sets out until his return to base. All these and many other disadvantages have been pointed out on many occasions and yet these places still survive. Worse, it is still the practice for even major medico-legal autopsies, including cases of murder involving the whole paraphernalia of the C.I.D., finger print, photography and forensic science people, to be carried out in these tiny local mortuaries, a custom fraught with inconvenience and danger to all concerned.

There are, however, recent signs that some local authorities are at last beginning to realise the inadequacy of the facilities they have provided. Mor- tuaries are slowly being upgraded by the piecemeal installation of such things as refrigerators, benching, new sinks and better lighting. Though the intention may be good, the immediate effects of these changes are not always so- refrigeration usually markedly reduces the already tiny working area still further, whilst in two mortuaries known to the writer the new 'fridge' is so sited that the freshly autopsied cadavers have to be manoeuvred outside in view of the street before they can be placed in it ! Further, is this bit by bit tinkering really what we want ? The more money which is now spent by local councils in patching up these places, the more difficult it becomes ultimately to recom- mend their closure. Is this then not the time, when the wind of change is blowing or preparing to blow through our entire Coroners' system, for a great reassessment of our public mortuary service and its re-shaping to meet future needs ?

I. (1965) Daily Telegraph, 14th August. 2. (1642) " I n England Now," Lancet, 1,237. 3. (1946) Editorial Lancet, 1,388.

4. (1959) Widdicombe File, Lancet 11, 1081.

5. (1961) Mortuary Design and Hazards, J . Clin. Path. 14,103. 175

Surely basic to all such planning should be the removal of the responsibility for providing post mortem facilities, a t any rate, from the smaller local authori- ties and the vesting of it in the County Council or some other central regional authority. The financial burden of building, maintaining and staffing a mortuary is a large one to a small council and the money is at present largely recovered from the County Council anyway, through fees paid by the Coroners for the use of the premises. Handing over to a central authority would relieve the local council of this burden and would not substantially increase the County's financial commitments. I t would further enable the central authority to assess the autopsy facilities available in the region and to make the best use of these taking into account geographical, technical, transport and population factors. One envisages at least one main public mortuary, in each region, preferably sited close to a Home Office Forensic Science Laboratory or a University Depart- ment of Forensic Medicine, or both, and forming with these places a central medico-legal institute-fully equipped to deal with all major forensic problems. The transfer of a body from one Coroner's area to another is a simple matter of informal agreement and no loss of jurisdiction over the case is involved so that this would prove no problem in practice.

At the periphery, almost all of the small village morgues now in use could be closed entirely or perhaps modified so that their sole function was the storage and identification of bodies. No mortuary at present dealing with less than 200 cases per year would be likely to survive except for unusual geographical reasons. Their place could be taken by the establishment at suitable sites in the region of three or four large modern mortuaries, preferably near to premises suitable for use as a Coroner's Court which could, in conjunction with the central medico-legal institute, deal with all of the Coroner's work for the whole area. Such places would, of course, be staffed by full-time mortuary personnel and indeed could serve as accredited training centres for mortuary technicians in the same way as the central institutes could for aspiring forensic pathologists. Some of them might well be Regional Hospital Board/County Council joint user establishments based on large newly-erected hospitals and indeed this seems a sensible way of avoiding duplication in the provision of mortuary facilities, providing that the administrative balance of power could be main-

. . tained.

In some remote areas the need might be met, as it is at present in many places, by the responsible authority coming to some financial agreement with the local hospital over the use of the mortuary when necessary. This is in the writer's view perhaps the least desirable arrangement, since many of the local hospital mortuaries are themselves in a parlous, poorly equipped state and also some National Health Service pathologists, understandably, come to regard hospital mortuaries as very much their own so that difficulties can, though with the exercise of tact rarely do, arise, when they require to be suddenly requisi- tioned for an outside expert performing what may well be a long autopsy.

Financially, part of the cost of a comprehensive mortuary scheme could be met by the various local authorities using the service in any one region either by block grant or on a 'per capita' basis. The increased cost of transporting bodies over the longer distances would be partially offset by the saving in travelling allowances paid to pathologists. The amount of transport required would surely justify the creation of a special body-carrying service-infinitely preferable to the indiscriminate use of ambulances which is the rule in most places to-day. Each mortuary would clearly require one or two vans and appropriately trained operating staff to be used for body collection within its own area.

Perhaps the greatest saving which would accrue from the introduction of such a scheme, however, would be that of the pathologists' time. As the investigation of sudden and unexpected death in the community steadily becomes more rigorous and thorough, it seems likely that the numh-r of medico-legal autopsies

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required will, quite properly, rise substantially and there is at present certainly no indication of a future plethora of either hospital or forensic pathologists to deal adequately with this situation. Indeed, for various reasons, of which poor working conditions is only one, recruitment into forensic pathology gives cause for the gravest anxiety as to the future of the speciality. I t is, therefore, surely sensible that conditions be provided for our forensic pathologists, which enable them to make the fullest and most economical use of their time, skill and experience. When fifteen years of a man's liberty can still turn on a patholog- ical opinion, surely only the highest standards of professional judgement, exercised in the most favourable conditions, can be acceptable.

A series of talented individual pathologists have in the past gained for Britain an enviable reputation in the field of forensic pathology, despite the inadequacy of the facilities available to them. We have muddled through to the top in the best British tradition, in dingy mortuaries and cramped inconvenient labora- tories while on the Continent centralisation and the establishment of modern medico-legal institutes has proceeded apace. We surely still have the individual talent-let us provide such facilities here as will encourage its full development and use in the fight against crime.

A.U.