1530

THE LANCET.

LONDON: SATURDAY, DECEMBER 2, 1899.

THE ASSOCIATION OF PUBLIC VACCINATORS.

THE Association of Public Vaccinators has our heartycongratulations on the success of the first annual dinner

which was held on Saturday evening, Nov. 25th, when the

Right Hon. HENRY CHAPLIN, M.P., President of the LocalGovernment Board, made what is probably the most impor-tant speech that has been uttered regarding vaccinationsince the passing of the Vaccination Act of 1898. A reportof the speeches will be found on p. 1539. Mr. E. C. GREEN-

WOOD, the President of the Association, drew attention tothe objects of the Association, which are mainly to

protect the interests of public vaccinators in Englandand Wales ; to influence public opinion in the matter

of vaccination ; and to lay the opinions of publicvaccinators before the Local Government Board and

Members of Parliament, by deputation or otherwise. These

objects are worthy of the highest praise, but the Associationis a young one, having only been in existence a little over ayear, and has not yet received the support which it deserves.Mr. CHAPLIN, who seems to have missed the good work thathas been done by the Jenner Society, intimated that somebody should be constituted to oppose the Anti-vaccinationLeague which is so active in disseminating pernicious litera-ture throughout the country, especially in districts inhabitedby the less educated members of the community. In the

Association of Public Vaccinators, especially if the Associa-tion can make common cause with the Jenner Society, we havethe basis of such a movement and we wish it every success.

True the number of public vaccinators in England and Walesis between 3000 and 4000 while the number of members of

the Association is only between 300 and 400, but we trustthat there will be speedily a considerable augmentation ofapplicants for admission.

Turning to Mr. CHAPLIN’S remarks we find muchthat is interesting. Complaints as to the character of

the lymph supplied by the National Vaccine Establish-

ment had at one time been very numerous, but this was

during the hot weather and experts had come to the con-clusion that the probable cause of the deterioration was theremoval of the lymph from the cold storages into an exces-sive change of atmosphere. When the extreme heat passedaway the complaints rapidly disappeared and at the presentmoment they are absolutely nil. The whole matter was

being carefully examined and he hoped that the difficultywould not occur in future. The effectiveness of the

lymph is, of course, of the utmost importance, and it

is no doubt in a great measure due to the alterations

in the source and preparation of the lymph that such asatisfactory increase in the number of vaccinations has beenrecorded ; no pains therefore should be spared in frequentlyinvestigating the condition of the lymph. Hitherto

the responsible authorities have done everything in their

power to assure an ample supply of pure lymph; and it is inno small way owing to their endeavours that such a great

success has been achieved. Mr. CHAPLIN reviewed the

history of the passing of the Bill and maintained that alreadythe results must be considered most satisfactory by all whofavoured vaccination. He referred to some figures whichhe had brought to the notice of Parliament which supportedthis contention and then proceeded to give some more

statistics which have not previously been made public butwhich certainly give encouragement to those who are work-

ing for the more general adoption of vaccination. There

have been no more regular or complete returns since the endof June, but he stated that he was constantly receivingreports from different parts of the country, and in no case,with one single exception, had he heard of any falling off.He gave various instances showing the increase in the numberof vaccinations. For example, in one East-end metropolitanunion the vaccinations in the 12 months to September,1898, by public vaccinators numbered 335. In the

12 months ending September of the present year

they were 1130-that was to say, nearly four times

as numerous. In three other unions in the metropolisthere were 1181 public vaccinations in the first nine

months of 1898 and 2441 in the first nine months of

1899. Several other similar facts were given, and even theseverest critics of the new Act must regard these results as

eminently satisfactory. Mr. CHAPLIN attributed the success

mainly to three factors-first to the efficiency and tact withwhich the public vaccinators had performed their duties

throughout the country ; secondly, to the use of the

new lymph which was now supplied and which had

to a great extent disarmed the apprehensions and removedthe objections of many who were previously opposed to the

practice of vaccination ; and, thirdly,to the fact that it wasthe duty of the vaccination officer, where the guardians were

opposed to vaccination, to act without their authority-a dutydirectly imposed upon him by Parliament itself.The professional objections to the working of the Vaccina-

tion Act of 1898, directed chiefly against the system of

domiciliary visits, received no attention from Mr. CHAPLIN,from whose speech there was another omission greatlyto be deplored-that of any reference to a Revacci-

nation Bill. When the Act was under discussion in

the House of Lords Lord LISTER made a most im-

portant announcement which was immediately after-

wards officially confirmed on behalf of the Government

and which went a long way in inducing the Lords to acceptthe conscience clause, though not even then by a verylarge majority. The announcement was that the Govern-

ment would during the recess set itself to consider the

preparation and introduction in the next session of Parlia-ment of a Revaccination Bill. We trust that the Govern-

ment will even yet see its way to redeem the distinct pledgewhich it gave. The absence of any reference to the matter

: in Mr. CHAPLIN’S speech is, as we have said, to be regrettedi and somewhat ominous.

THE three important principles embodied in the Metro-politan Poor-law Act of 1867, by means of which the

r Metropolitan Workhouse Infirmaries were founded, were

) that the chief administrative official of these institutions

should be a medical man, that he should be resident, andi that he should devote his whole time to the duties of hist office. The incalculable boon to the London poor of such

1531AN ETHICAL DIFFICULTY IN POOR-LAW.-THE JURISDICTION OF CORONERS.

an arrangement has been abundantly evident, and so quietlyhave these 23 large State hospitals arisen in our midst thatit is hardly realised that they have provided London with an

aggregate of nearly 14,000 hospital beds, a larger number,that is, than all the special and general hospitals puttogether. It was at first feared that the dual positionof medical man and administrator would be found to

clash. This has not been so ; indeed the arrange-ment works admirably. But every now and then the

medical man is called upon by the guardians to act in a

manner which, if it does not violate, at least strains, the.ethics of the medical profession, and especially the relationwhich should subsist between the practitioner and his

patient; and a difficulty of this kind has lately arisen in

- consequence of a new departure on the part of certain<boards of guardians.Each year large numbers of alleged lunatics are

admitted as a temporary measure to the lunacy wards

of the metropolitan workhouses. Among those so admittedwill be found a certain percentage of cases of alcoholic

mania, delirium tremens, and suicidal melancholia of

alcoholic origin. They are removed to the workhouse underthe provisions of the Lunacy Act, 1890 which, to ensure their- safety and the safety of the public, provides in those institu-tions a haven for their reception at once available and con-venient. The majority of those affected by these alcoholic- maladies become quite well within a week or 10 days andare discharged. As required by the Act of 1890 all of

them must be brought before a justice within three days of.admission to the workhouse or infirmary and the justice.generally deals with such cases in the manner advised by themedical officer who is required to examine and to certify asto their mental condition. The procedure indicated is, of

course, attended by some expense for the means of removalof the patient, for his maintenance, and for the medical fee.It has occurred to a solicitor to suggest to several of the

metropolitan boards of guardians that such persons mightbe punished for their drinking habits under the VagrantsAct (Geo. IV., Cap. 83, Sec. 3), which provides that-"Any person being able either wholly or in part to

maintain himself and wilfully refusing or neglecting to doso by which refusal or neglect he shall become chargeableuhall be deemed an idle and disorderly person within themeaning of the Act’ and on conviction before a justice maybe imprisoned for a period not exceeding one calendarmonth with hard labour."

Several boards of guardians have instructed their solicitorsto take the suggested action against the persons who havehad the misfortune to be sent to the workhouse under the

- circumstances indicated. The results have been various.

’Some cases have ended in slight punishment ; in others

’there has been failure to obtain conviction ; in others

friends have furnished funds to recoup the guardians and so’have prevented further action.With the legal aspect of the question we are not now

concerned, though it appears to us to be somewhat

- doubtful whether a person who develops delirium tremensfrom drink can be said to be " wilfully refusing or neglect-ing " to maintain himself. The important point, however,to be considered is the part that the medical officer is called

upon to play in the proposed prosecutions. Without a

4efinite statement from him that the "vagrant" " has

suffered from physical and mental incapacity and that suchincapacity was due to alcoholic excesses the case must

fall to the ground. Is any medical man justified in makingpublicly known such a fact about a patient under his care ? ’!

We think not, for by so doing he would violate a funda-mental though unwritten law of the profession to whichhe belongs. He would be divulging secrets which he had

acquired in his professional capacity. Moreover, let us

consider for a moment the logical outcome of such a lineof action. If the guardians can require their medical

officer to report to them or to state before a magistratethat certain patients are chargeable on the rates in con-

sequence of maladies brought about by their previous habitsit follows that the medical officer will have a laborious and

invidious task. If he is to report in this manner concerningalcoholic mania and delirium he should also do so

concerning cases of alcoholic cirrhosis of the liver and

a large number of other ailments which are broughtabout by culpable negligence and are commonly foundamong inmates of a workhouse infirmary. The medical

officer is of course bound by the orders of the Local

Government Board to give to the guardians any "reason-able information " concerning any case that he may be

asked about by name specifically. But it is quite anotherthing that he should be called upon to constitute himselfa judge of the culpability of his patients in general terms,and to report them to the board for the special purpose of

prosecution in a police court. Disease and pain are thesole conditions of our ministry, and just as it is contraryto the spirit of our profession that we should set ourselvesto judge of the justice, the merits, or the honesty of ourclient’s cause, so also is it contrary to the sacred trust

imposed in us that we shou’d divulge the errors of our

patient’s past.

AN inquest held recently close to the borders of Lanca-shire and Cheshire appears to have excited some interest

in that district and elsewhere owing to the interpretationof the law affecting his jurisdiction laid down by Mr. S.

BRIGHOUSE, the coroner for South-West Lancashire, whowas called upon to hold the inquiry. The death was thatof a railway-porter killed on the line of the London and

North-Western Railway Company upon the Cheshire side

of the border and the body had been removed,apparently before the death was reported to any

coroner, and by the company, to a point two miles

from the place of death and situated in Lancashire,so that when information was given with regard to it it

lay within the jurisdiction of Mr. BRIG HOUSE. In these

circumstances he seems to have observed that he had no

right to hold the inquest and could not be compelled to do

so, that strictly speaking the body ought to be sent back tothe county in which the man died in order that an inquestmight take place there, but that coroners in order to avoidthe giving of pain to relatives by sending bodies to and fro,and by a mutual understanding or courtesy, sometimes hold

inquests in cases which are out of their jurisdiction andhe accordingly proceeded with the inquiry before him. The

question is one of some importance to coroners and others ;it is one which obviously may arise at any moment and- maycause friction and litigation through a coroner refusing to

1532 THE JURISDICTION OF CORONERS.

hold an inquest in the belief that it is not his duty to do d

so. It seems, however, to us to be clear that, with all s

respect to Mr. BRIGHOUSE, his view is wrong and that a J

coroner is bound to hold an inquest whenever it is reported j to him that a body affording a proper subject for an inquest l

lies within his jurisdiction, wherever death may have taken

place. Before the Coroners Act of 18431 this was appa- i

rently not the law,2 but when that Act was passed its i

preamble and first section ran thus : " Whereas it i

often happens that it is unknown where persons

lying dead have come by their deaths and also that (

such persons may die in other places than those in i

which the cause of death happened ; be it enacted that the 1

coroner only within whose jurisdiction the body of any ]

person upon whose death an inquest ought to be holden shall be lying dead shall hold the inquest, notwithstandingthat the cause of death did not arise within the jurisdictionof such coroner." The whole of this Act, so far as it

related to England, was repealed by the Coroners Act, of1887, which now practically codifies the law on the subject.Its third section runs thus: "Where a coroner is informed

that the body of a person is lying within his jurisdictionand ....... or in such place or under such circumstances

as to require an inquest in pursuance of any Act, thecoroner, whether the cause of death arose within his juris-diction or not, shall as soon as practicable issue his

warrant," &c.

Again, the seventh section says: " The coroner only

within whose jurisdiction the body of a person upon whosedeath an inquest ought to be holden is lying shall hold theinquest," &c. Both Acts use the same expression "lying,"which can hardly be said to be one of ambiguous meaning.It would have been easy and obvious for the person who

drafted the first section of the Act of 1887 to have said:

"Where the coroner is informed that a person has

died within his jurisdiction," &c., and to have framed

Section 7 to a similar effect had it been intended

that such should be the law, while if it had been in-

tended that a coroner should commence an inquest upona body lying within his jurisdiction and close his

inquiry on finding that the deceased died outside it

some provision would have been made to meet such a case.

Clearly, in such an event the coroner of the district in whichthe death took place could do nothing towards holding a complete inquiry until the body had been moved back so asto lie within his jurisdiction, and no machinery is providedby which any such moving of the body could be com-

pelled. It is conceded that the primary object of

the Act of 1843 was to deal with the jurisdictionas affected by the place where the cause of death

arose, but it is submitted that the materiality of

the place where death took place was also dealt with

incidentally, and that the Act of 1887 now in force

treats the latter question in more distinct terms than didits predecessor. The point was, however, raised under theAct of 1843 in the case of a medical man named ELLIS 3

who was put on his trial at the Old Bailey for manslaughteron a coroner’s inquisition found in the City of London. The

1 6 and 7 Vict., cap. 12.2 Regina v. Great Western Railway Company, 3 Queen’s Bench

Reports, 340.3 Reg. v. Ellis; 2 Carrington and Kirwan’s Reports, 470.

deceased had died in the county of Surrey, his body beingsubsequently moved, and Mr. COCKBURN (afterwards ChiefJustice) for the defence submitted that there was nc"

jurisdiction to try the prisoner, the coroner havinghad no jurisdiction to commit him. Chief Justice

TINDAL declined to stop the trial at that point, intb.

mating that though he considered the clauses obscurelyworded in the Act of 1843 he had no doubt of their

meaning. The prisoner was acquitted on the facts, so no

appeal took place on the question of law, and from that,

day to this no question upon the meaning of sections limit-

ing the jurisdiction of coroners appears to have been broughtbefore the High Court. The decision cited is, however, in

point as far as it goes and was that of two judges sitting’together as was then usual in that Court.

Moreover, there is ample reason for the enactment, which,was doubtless drawn, as Acts of Parliament have to be

drawn, so as to provide a hard-and-fast rule that would fitall conceivable cases, and any other interpretation than the-one which we have given might lead to a highly undesirablestate of things. If, for instance, we consider the not un-common case of a dead body found to have been consignedby railway to some place where it is by chance discovered, insuch a case perhaps the one thing that is fairly clear is thatthe death did not take place within the jurisdiction in whichthe body lay when first its existence was reported to acoroner. We say without hesitation that it would be in-

decent to the last degree that putrefying remains should bebandied about from county to county and town to townuntil proof of the place of death should be obtained. In

many such cases no inquest would ever be held, and it must.be pointed out that until such inquest is held no one, not

even a coroner, can order a body to be buried, although thecoroner holding the inquest may order the burial before the

inquest is completed. Furthermore, if a coroner objects to.the law in such a case because it possibly throws upon him a

. duty which might more conveniently or more justly be, performed by a colleague elsewhere, he should remember

that other coroners will no doubt from time to time have ta

hold inquests where the death has occurred in his juris-diction and not in theirs. Taking into consideration, there-

. fore, the wording of the old Act and of the Act now in force,the case of Reg. v. Ellis, and the necessity for a clear rule

applicable, and applicable without delay, in all cases, we haveno doubt that the view which we have expressed above isthe correct one. We have gone into the matter technically

- and from a lawyer’s point of view because coroners, whetherf lawyers or not by training, have to decide matters of law ic.n a court of record and because it is they who are principallyh interested in the question discussed.of

THE LYMPH OF THE NATIONAL VACCINE ESTAB-LISHMENT.-At the meeting of the Torrington (Devon).Board of Guardians held on Nov. 18th a letter was readfrom the Local Government Board in answer to a com-

munication drawing attention to the unsatisfactory results.which had been obtained with lymph supplied by theNational Vaccine Establishment. The Board stated that.the vaccine referred to was used during Exceptionally hotweather which appeared to have caused a lack of uniformity.The Board added that the whole subject was receiving theircareful attention.