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946 MEDICINE AND THE LAW. Coroner’s Inquest and Police Proceedings. AT the resumption recently of an adjourned inquest due to a traffic accident the coroner for South-East London complained that the police had interrupted the course of his inquiry. Two Lewisham men were fatally injured on August 31st, being run into by a private motor-car. On the night before the inquest the police arrested the driver of the motor-car and thereby, as the coroner contended, interfered both with the immemorial privilege of the coroner’s jury to inquire into the death of two local inhabitants and also with the driver’s right to give his own account of the incident at the earliest possible moment to the coroner and his jury. The magistrates committed the driver for trial, and he was sentenced to six months imprisonment on Oct. 17th at the Old Bailey. The concurrent operation of a coroner’s inquest and of criminal proceedings before a magistrate in cases of homicide was a duplication of machinery which engaged the attention of the Departmental Committee on Coroners 20 years ago. It had two prominent features : it wasted the time of witnesses (not to mention the accused) in attendance at successive stages of two parallel investigations, and secondly, it caused an overlapping of committals by the coroner and the magistrates. In this latter connexion it was on record that a person accused of manslaughter on board ship was once committed by a coroner for trial at Exeter Assizes and by the magistrates for trial at Bodmin. In addition to this cause of unnecessary inconvenience and expense there were the two difficulties that committal by a coroner often follows the reception of evidence not strictly admissible in the assize court, and that in practice the prosecution always preferred to act on the magisterial proceedings rather than on the inquest. On the other hand, there were instances where the dismissal of a charge before the magistrates was followed by successful prosecution at assizes on the coroner’s committal. When at length Parliament dealt with these matters in the Coroners (Amendment) Act of 1926. it decided to end the duplication by suspending the inquest. Under Section 20 if, before a coroner’s jury has given its verdict, the coroner is informed that someone has been charged before examining justices with the murder, manslaughter, or infanticide of the deceased, the coroner " shall, in the absence of reason to the contrary, adjourn the inquest" till the criminal proceedings are over. When the latter proceedings are concluded, the coroner " may . resume the adjourned inquest if he is of opinion that there is sufficient cause to do so." One adequate " reason to the contrary " against an adjournment would be, as the editor of Jervis on Coroners observes, the desirability of receiving the report of an analysis already ordered. One " sufficient cause " for resuming an inquest would be to avert a failure of justice where magistrates have refused to commit for trial. The editor of Jervis adds his opinion that in all street accidents the coroner should certainly complete his inquiry. The brief report of the inquest at Lewisham mentions the arrest of a person by the police. not the charging of that person before the magistrates. It is the latter, not the former, step which is the condition precedent to adjournment of the inquest. A coroner might be able to conclude his inquiry notwithstanding arrest; in any case he can (and, in the Lewisham case, no doubt rightly did) complete it later. The police, of course, are under no obligation to time their moves in a case of suspected homicide so as to suit the coroner. As, however, the relations of coroner and police are mutually helpful, it is undesirable that one inquiry should seem to be jockeying the other for position. Some part perhaps of Major Whitehouse’s complaint is in effect directed not against the action of the police to-day but against that of Parliament in 1926. In some respects, as the British Medical Association stated to the Departmental Committee many years ago, the office of coroner is a vestigial structure. Parliament is unlikely to restore to that office the power which it took away in 1926 ; it may even make yet further inroads, though the Home Secretary has just announced his view that the amending legislation of 1926 is sufficient for the present. _______________ SURGICAL CATGUT. THE preparation of surgical catgut involves the production of material which is free from bacterial contamination, and yet remains flexible, strong, and absorbable. Lord Lister, who introduced sterilised catgut into surgical use, spent 40 years in attempting to improve its manufacture, and the Medical Research Council, in a preface to a green book’ published to-day, state that the work recorded therein stands in historical succession to his classical studies. They draw attention to the dilemma by which the catgut maker is confronted. Catgut can be efficiently sterilised, but every method of disinfection has some effect in diminishing the tensile strength of the ligature, upon which its surgical value and the safety of the patient depends. The efforts of Prof. Bulloch and his colleagues have been directed to ascertaining the methods by which bacteriological sterility can be achieved with least damage to the physical qualities of the material. Their investigations have had among valuable positive results at least one negative finding of importance-the discredit of biniodide of mercury as a suitable sterilising agent. The genera! conclusions reached are summarised as follows :- 1. It has been shown that the pH of the collagen ribbon wash liquid is an important factor in the production of ligatures. To prevent degradation a wash liquid of pH 4-7 is required, but for optimum strength pH 8-9. A com- promise may be effected by carrying through most of the- process of washing in a solution of pH 4-7 and finishing with a bath of alkali at pH 8-9. For this same reason the- ribbons should not be washed in water before spinning. 2. Optimum strength of ligature is obtained by using narrow ribbons and spinning each individually and then collectively, so that each ribbon makes 2-5 turns per inch and then collectively a further 5 turns per inch. It is important that the spinning should be uniform otherwise the strength and diameter along its length will vary. 3. It has been shown that when ligature is treated with iodine an acid is produced which is harmful for the reason given in (1). Means of reducing or eliminating this effect have been worked out by the use of potassium iodate. 4. It has been demonstrated that the treatment of ligature for 8-9 days in such a way that it absorbs 12 per cent. of its weight of iodine ensures sterility. 5. The disadvantages of excessive treatment with iodine have been demonstrated and the advantages of removing the iodine from the ligature after sterilising indicated. 6. Data have been obtained whereby control of the amount of the absorbed iodine may be obtained. 7. The advantages of incorporating glycerol in the iodine solution and in the final alcohol solution have been illustrated, particularly from the point of view of flexibility of the ligature, and therefore, strength of the knot. 8. It has been shown that the ligature in aqueous iodine swells. This may be reduced by treating it under tension, when its tensile strength is increased. Important practical issues are raised by this report. Deaths from tetanus and other infections are known to have resulted from the use of contaminated ligatures, and though fatal results attributed to the use of imperfect catgut are numerically very rare indeed in relation to the vast total number of ligatures used in surgical operations, it is nevertheless recorded that some infection was found in every one of eight batches of catgut ligatures purchased in 1927. The data given in this report and the experience gained in obtaining them have already been useful in the guidance of administrative action. The licensing authority under the Therapeutic Substances Act has decided to add surgical catgut to the list of substances 1 The Preparation of Catgut for Surgical Use. By W. Bulloch, L. H. Lampitt, and J. H. Bushill. Medical Research Council, Special Report Series No. 138. H.M. Stationery Office. 1929. Pp. 178. 4s.
