632 THE ELECTION OF CORONERS.—SPRING HOLIDAYS.

THE LANCET.

LONDON: SATURDAY, MARCH 31, 1888.

OF the two Bills which are at present before the Legis-lature for the purpose of amending the existing procedure forthe choice of a Coroner, we, for our part, infinitely preferthat brought by Mr. IsAACSON into the House of Commonsto that submitted by the Lord Chancellor to the House ofLords. The Lord Chancellor proposes to add to the coroner’sduties that of inquiiing into the origin of fires. This is a

course which we ourselves have urged. What, however, inour view is a much more important change is containedin the proposal to substitute appointment by the LordChancellor for election by the popular voice. The groundson which the proposed alteration will be justified are nodoubt partly the expense of popular election and partly theanalogy of other judicial appointments. We do not wishat all to minimise such considerations; but, these notwith-standing, we confess that we greatly prefer the popularchoice. It must be remembered that the coroner may have

again, as he has done in the past, to act as a palladiumagainst undue encroachments on the part of the military orthe police on the established liberties of the people. The

Lord Chancellor is probably a very good authority for makingselection among rival lawyers, and when an office whichonly a lawyer can fill is in question, we are quite con-tent to leave the appointment in his hands. But the

office of coroner is not of this kind. His inquest is

essentially different from the trial of a prisoner. What

he has to discover is the cause of death. The questionof the guilt or the innocence of any individual associatedwith the death is not primarily in issue before him atall, and does not properly lie within his jurisdiction. It

must be determined elsewhere. The question which hereally does determine is of a widely different character, andfor its elucidation he needs to be skilled, not so much in theart of piecing testimony together as in the larger art ofdeducing scientific conclusions from evidence of whateverkind, and " tracking suggestion to her inmost cell." For

this purpose it is a scientific rather than a legal training thatis necessary, and the practical wisdom of the electorate hasnever been made more conspicuously manifest than in theleaning which has been shown to men of science rather thanto men of law under the method of popular election.Another consideration whic;h tends towards the same con-

clusion is the nature of the discretion which is of necessitylodged in the corone:’s hands. His duties do not begin, likethose of any oiher judge, when the tribunal is constitutedand the cause is brought sub judice. On the coutrary, hismost responsible and most delicate duty is over then, andhas to be faced when, acting upon his own judgment, hedecides in a doubtful case whether to hold an inquest or to

dispense with it. Such a task demands in the highestmeasure science, tact, and medical knowledge-qualitieswhich it would be very sanguine to look for in any markeddegree in the nominees of the Lord Chancellor. Perhaps it

maybe said that these are not always the qualities which most I

appeal to a popular constituency; but if so, the rejoinder isconclusive. We know that popular election works fairly wellin practice: official appointment would, in this connexion,be an untried experiment, and some misgivings as to itsresults may surely be pardoned; for who can fail to bestruck with the circumstance that, whereas popular candi-dates are usually men in the prime of life, endowed with thefull energy and bonhomie of healthy manhood, the pl’otegéof the woolsack is only too often a man whom disappoint-ment has soured and long struggle has exhausted, and whofinds in promotion to a judicial office a solace for more orless of failure in a professional career.

T

WHILE summer and autumn are the seasons obviously sug-gested as the suitable time for holiday-making, cases ariseinwhich the practitioner is consulted regarding the advisabilityof a holiday in spring and the most eligible places of resortat that period. As a rule, spring holidays are not to befrequently or lightly recommended. It is the most treacherousseason of the year, suitable resorts are difficult to find, andthe comforts of home are not to be rashly relinquished forthe problematical advantages of travel. Many persons whomeditate a holiday in March or April would do well

to pause and consider whether they cannot tide over

the present emergency, and wait until the advent of warmand settled weather gives them some security against therisks which beset the tourist during the variable tempera-ture and sharp winds of spring. This admonition hardlyapplies, however, to those who are in a position to take adistant flight. Madeira, Santa Cruz, Algeria, Egypt, andmany other places which might be named, afford amplechoice to those who can take a holiday of a month or two,and to whom economy is not essential. Of the places justenumerated, the continental regions-Algeria and Egypt-are more suitable for early spring, while the oceanic islandsare tolerable, and to many agreeable, up to the verge of theearly summer. The intending tourist cannot too clearlyrealise that the spring climate of even the more favouredparts of the continent of Europe is exceedingly uncertain ,and often far more trying to health than that of mid-winter. Within the last few weeks France and Italy havebeen visited by severe snowstorms, and now is the timewhen the Mistral, the Bise, and the Fohn make themselves

unpleasantly felt in some of the regions most frequented bytourists and invalids. Many a dismal story has been told ofthe invalid who has left his own land and gone to Southern

France or Northern Italy in spring in search of warmth andsunshine-only to be driven home again or to suffer seriousdamage from wind and cold. This, however, cannot fairlybe described as the rule, but rather as a not very infrequentexception. The Riviera, which has usually so charming aclimate in early winter, has not rarely a beautiful spring, butof this the tourist can feel no assurance beforehand. Frosts

and cold winds may assail him, and the prevalent brightsunshine is apt to beget a carelessness and a neglect ofordinary precautions very perilous to health. Switzerland

does not seek to tempt the spring holiday-maker, as Juneis well advanced before it begins to wake up from its torporand prepare for the brief but busy harvest. Still less does

the Bhineland or Northern Europe offer any attractions atthis season.

633DIPHTHERIA.

Medical practitioners would do well to advise thoe of

their patients who desire a brief holiday of two or threeweeks in spring to confine themselves to the British

islands, and to remember that at this season they shouldas a rule go south rather than north, and west ratherthan east. The south-western resorts of England and

Ireland, which are so apt to prove unduly relaxing at otherseasons of the year, may often be advantageously utilisedfor temporary residence in spring. Of such we may mentionTorquay, Teignmouth, and Penzance in England, and

Queenstown and Glengarriff in Ireland. These places are to

many persons somewhat enervating at those periods of theyear when the south-west winds prevail, but in spring,when the winds are usually easterly, they are fairly mild,without being debilitating. The east coast is wholly out ofcourt at this season, and such resorts as Ilkley, Buxton, andCrieff, of which the bracing qualities are highly valuable atother times, are better avoided in spring. It is well to

remember that in the British Islands the isotherms of

winter run north and south rather than east and west, andhence that such places as Rothesay, Grange, and Llandudnoare almost as mild at this season as the more southern

sanatoria. In our islands, in fact, temperature is determinednot by latitude, but by the prevailing winds-a circumstancewhich affords the key to the meteorology of Great Britainand Ireland.. <

There is one class of persons who often need advice uponthe choice of a spring sanatorium-viz., those who, havingwintered abroad in some very warm climate, desire to spenda little time at some intermediate station when en route

homewards, rather than risk the sudden change involved ina direct journey to England. It is exceedingly hard to

suggest unobjectionable resorts to meet this indication. A

patient who leaves Algeria or Egypt at the end of March isat a real loss to decide where he can most safely halt beforereturning home in June. The Riviera naturally suggestsitself, and the shores of the Lake of Geneva have beenrecommended. Rome, Capri, and Castellamara may suitsome cases, but the spring climate of each and all of theseplaces is too variable to enable us to recommend any withthe assurance which is desirable. On the whole, patientswho have wintered in a really warm climate should not bein any,hurry to leave it at a very early date. Whatever

disadvantage may accrue from the undue warmth of suchplaces in the late spring is probably a less evil than the riskof a premature journey northwards. One of the many ad-vantages claimed for Davos, St. Moritz, and the cold winterresorts generally, is that they tend to render the patientproof against the perils which beset him on returning to hisown country after a winter’s residence abroad.

.

THERE are few diseases which present so many pointsfor inquiry as diphtheria, the modern scourge that seemsto have taken the place of typhus and small-pox incivilised humanity. It spares neither young nor old;but it is the young who suffer most. It cruelly robsmany a household of the flowers of the flock, and leavesbehind it a lasting sorrow. Who does not know of familiesthat have been thus desolated? Nay, the tale of victimsto this modern foloch includes many of the noblest ofour own profession, more often the young and energetic, I

who succumb to disease contracted in discharge of duty.How grateful, then, will the world be for any clear indi-cation of means for the mitigation of this scourge-for anylight shed upon its etiology and its nature whereby thehands of Medicine may be strengthened in its endeavour tocope with the disease. For, in spite of many inquiries intoepidemics of diphtheria, its etiology yet remains obscure.It is commonly believed to be a " filth disease," and thereare many instances, both in town and village, wheredefects of drainage have been associated with outbreaks ofdiphtheria. Again, its propagation through infected milkhas often been traced, and it was conjectured to be trans-mitted direct from the cow long before the notion of

scarlatina being so transmitted occurred to the mind.

That it cannot be generated de novo is in accordance withall that science has taught us concerning the origin ofdisease; yet many a practitioner could give examples whichseem to leave no room for any other conclusion, whilst it isnotorious that the line between tonsillitis and diphtheria isoften very finely drawn.The recent elaborate inquiry of Professor OBBTEL of

Munich, of which we have given an account in these

columns, seems to have advanced our ideas upon the natureof the disease one step, although it leaves its etiology stillin obscurity. It is true, doubtless, that the conclusions atwhich Professor OERTEL has arrived are much the same as

those which are now generally held; but his great meritlies in this-namely, that he has given such conclusionsthat basis of fact which was heretofore lacking. We have

therefore now a clearer insight into the nature of the morbidprocess, and can with greater confidence deal practicallywith the disease. The main outcome of Professor OERTEL’S

work is as follows. Diphtheria is a disease which is excitedby a specific contagium. This contagium-by analogy ratherthan from absolute demonstration-is of bacterial nature.

The implantation of the contagium upon a mucous mem-brane, usually that of the fauces, leads to changes com-mencing in the surface epithelium. It is inferred that the

virus, probably a ptomaine, at once acts upon the mucousmembrane, exciting inflammation, as shown by the leucocytalinfiltration that occurs. The leucocytes themselves becomeattacked by the virus, and undergo remarkable changeswhich lead to their disintegration. These changes, whichhave been so exhaustively studied by Professor OERTEL, aremarked by abnormal cleavage and chemical alteration ofthe cell-nuclei; they eventuate rapidly in the formationof areas of necrobiosis in the substance of the mucous

membrane. The diphtheritic false membrane is thereforebut part of a process that involves the whole mucosa.

The lymphadenitis in connexion with the altered mucoustract is strictly specific, for the glands show the same

changes as to necrobiosis as the membrane itself. Similar

lesions, but less intense and numerous, occur in the

intestine and the mesenteric glands, and also in the spleen ;but in other viscera the lesions are referable to inflammatoryreaction rather than to the essential phenomena of the

y

disease. The study is a demonstration that diphtheria is atthe outset a strictly local disease, but that in a few hoursits poison spreads in the part first affected and in its

vicinity; and in a few days it may enter the blood in suchamount as to produce the most marked evidence of systemic

634 PROVIDENT DISPENSARY SYSTEM IN MANCHESTER AND LEICESTER.

poisoning, which, if not causing death from its effect on theheart or other vital organs, may in due course produceperipheral neuritis, and perhaps myelitis.

Diphtheria, then, is not in the first instance a systemicpoison; it is local. Just as in syphilis the attempthas been made to prevent the constitutional malady byexcision of the local contagious sore, or in hydro-phobia by excision of the bite-wound, so in diphtheriait might be thought that the disease could be arrestedby dealing with the local manifestation thoroughly. This

conception has been largely put into practice from theearliest days of the history of diphtheria, and the false mem-brane has been ruthlessly destroyed only to re-form. This

period of the violent escharotic or other means of removalof the false membrane must be closed. Milder solvents are

applicable; but, if Professor OBBTEL be correct, the objectthey aim at is unattainable. The membrane may be

dissolved and detached, but the disease is not cured; forthe membrane is only the surface indication of a deep-seatedand widespread change. Nevertheless, it is well to

minimise the risk of the extension of the disease bycontagion within the body by the free disinfection of thepharynx. As for other treatment-for we have no antidotefor the diphtheritic poison,&mdash; reliance must be placed uponnutrition being maintained. How impotent such conclusionsmake us feel’ Yet what is said of diphtheria is applicableto many diseases, perhaps all of the specific fevers; and,being true, it should make us endeavour all the more tounravel the mystery of their origin, so as to prevent theoccurrence of plagues that we can do so little to stay. The

"people perish from lack of knowledge," and in these

diseases it is too often the young and promising who aresnatched away, for they are less able to resist the virulentpoison that destroys the cells which compose the body.

- --

THE towns of Manchester and Leicester have been pro-

minently identified with the Provident Dispensary system.In the former town, some thirteen years ago, there was

originated a great movement to establish provident dis-

pensaries on a large scale, and to reduce the amount ofgratuitous relief at hospitals. S )me eight or ten dispensarieshave been created under the scheme, with about 16,242paying members. The subscriptions of paying membersamount to &pound;3744, of which =E2108, or little more than half,find their way into the hands of the medical officers. There

is a decrease, according to the last year’s report, of 203 ofmembers belonging to clubs. Opinion is somewhat dividedas to the success of this great experiment, which has beengenerously assisted by the subscriptions of the wealthy. Thechairman of the recent annual meeting of the Manchester andSalford Dispensaries maintained that the system had gaineda firm footing, but he admitted that the success was far shortof what might be hoped for. Dr. STEWART, on the otherhand, one of the most active promoters of the success of

%the Pendleton Branch Dispensary, wanted a committee

appointed to inquire into the causes of what he consideredthe failure of the movement. But in this he did not suc-

ceed. The attempt to ascertain the proportion of personsat the medical charities who could afford to subscribe to a

provident dispensary has been carried out more systemati-cally in Manchester than in most places. The figures may

interest our readers. We give the results of the investigationat the Royal Infirmary for ten years. There were found

able to make such payments in 1878, 17 per cent.; in 1879,14; in 1880-81-82, 12 ; in 1883, 13 ; in 1881, 12; in 1885,9;in 1886-87, 8.

In Leicester, as our readers know, the management ofthe Provident Dispensary has been the subject of an acuteand somewhat acrimonious controversy. The Dispensaryhas been established about twenty-five years, and has beenpatronised by the Duke of RUTLAND. There were 35,583members in 1887, against 34,985 in 1886, or an increase of598. Legacies were received to the amount of &pound;380. The

members contributed about &pound;5000, and the subscribers about&pound;500. In January, Mr. S. HARRis, on behalf of his brothersand himself, generously presented a handsome new branchdispensary. This looks all very prosperous and creditable,But the Rev. Mr. ISAACS, with a deputation, appeared atthe recent annual meeting, and repeated various criticismson the management. The attendance at the meeting waslarge. Mr. ISAACS also presented a memorial from the leadingpractitioners of Leicester in support of his contention

and in favour of some essential changes. Mr. ISAACS,however, did not carry his resolution. The report of theboard was accepted. The appeal of the members to berepresented on it was rejected, and so also was a resolu-tion for a representative committee to investigate the

management. We think this is to be regretted, though wemust admit a want of definition and of proof about

Mr. ISAACS’ charges. The board assumed too much the air

of men who were conducting a thriving concern. Mr. GEE

maintained that the institution belonged to the governors,who had acquired a large freehold property, and had got alarge business," which they conducted without remunera-tion and for the benefit of the working population.

i

THE Engineer Inspector under the Public Health Act of I Tasmania has submitted to the Chief Secretary a Memo-randum on Quarantine. With the principles embodied inthe document we so largely concur that we regret the morethe tone of antagonism to the medical profession whichruns through it. Mr. MAULT is convinced that quarantineis injurious to Australasia, just as it has been found injuriousto Great Britain and to British India, and he is especiallyimpressed with the serious loss to the community whichresulted from the imposition of quarantine by the other

Australasian colonies against arrivals from Tasmanian portsduring a prevalence of small-pox at Launceston last year.Recalling the fact that quarantine restrictions, as opposedto the system of medical inspection, were decided on by theSydney Sanitary Conference of 1884, he proceeds to implythat this result was due to the circumstance that this

conference was composed exclusively of medical men, andthat in this respect it differed from the conferences of

Paris, Constantinople, Vienna, Washington, and Rome; andhe urges that the whole subject should be reconsidered bya conference composed of lay as well as medical delegates.As regards one contention Mr. MAULT is in error, for althoughthe Pome Conference nominally included lay membersrepresenting the diplomatic departments of their seseral

Governments, yet the work that was done was exclusivelythe result of the labours of the medical delegates who met

635QUARANTINE IN AUSTRALASIA.

as a Technical Commission; and in so far as that work canbe looked upon as in any way tending towards the ultimateabandonment of quarantine, it was brought about by thearguments of medical men. Indeed, although we have causeto deplore the tenacity with which many European andother medical advisers cling to quarantine, we have nohesitation in saying that the discarding of that system, in amore or less complete form, amongst different communities,has mainly been brought about by medical reasoning; andthat, in Europe at least, it is the ordinary public, and thoserepresenting them, who clamour most for the maintenanceof a system which they blindly hope may save them fromany considerable contribution towards effecting measuresof sanitary improvement. We retain the firm belief thatquarantine hinders sanitary progress; as applied to small-pox, we feel convinced that it retards the general adoptionof the only true measure of prevention-namely, vaccination;and we would gladly see the question reopened in Austral-asia. We are also of opinion that any conference dealingwith the question should, at some stage or other, includemembers representing the administrative departments of

the several States; but we cannot look hopefully to theresults of any gathering which may be the outcome ofwhat amounts really to a charge against the medical pro-fession that they have regard not to that which is practical,but to that only which accords with their "theoretical,medical, and etiological reasons." The subject is one whichcannot be dealt with apart from medical and etiologicalknowledge, and it is to be hoped that with its growth suchaction will be taken as will best ensure the promotion ofpublic health on sound and intelligent lines.

Annotations.

THE ROYAL COLLEGE OF PHYSICIANS.

" Ne quid nimis.&rsquo;&rsquo;

THE meeting of the Fellows of the College of Physicianson Monday last was an unusually large one, owing, nodoubt, chiefly to the fact that it was the last occasion

upon which Sir William Jenner would preside over theCollege which he has served so admirably, and also to thegreat and keen interest taken in the election of his successor.After the usual formal business Sir William delivered hisannual address, in the course of which he alluded to thework done by the College during the past year, and con-trasted the position of the College now with that whichit occupied seven years ago, when he was first chosenPresident. In speaking of the action of the Colleges toobtain the power to grant degrees, he expressed the opinionthat, if the movement had been supported more heartily,that power would by this time have been obtained; and hesignificantly added that the body which does eventuallyobtain the power will of necessity become the chief licensingbody in the metropolis. Sir William Jenner paid a well-merited tribute to Sir H. Pitman, whose petition to thePrivy Council contained, he said, the weightiest argumentsin support of the scheme of the Colleges. lIe then proceededto sketch the careers of the Fellows who had died duringthe past year-viz., Dr. J. B. Stewart, Mr. W. Jelly, Dr. R. G.Latham, Sir J. Dickson, Dr. John Jackson, Dr. W. C. Begley,Dr. A. Meadows, Dr. J. Popham, Dr. W. C. Adie, Dr. Francis,Dr. Arthur Farre, Dr. Wilson Fox, and Sir George Burrows.Sir William concluded by a few personal remarks, and his

address, which had been listened to with marked attention,was received with loud and long-continued applause. Onthe motion of Sir Edward Sieveking, seconded by Sir A.Garrod, a hearty vote of thanks was passed to Sir W. Jennerfor his address; and, on the suggestion of Sir H. Pitman, SirWilliam consented, to the great satisfaction of the Fellows,to allow the manuscript of his seven addresses deliveredduring his term of office to be bound and preserved in theCollege. The ballot for a new President was then taken,votes being recorded for Dr. Quain, Sir A. Clark, Dr. Wilks,Dr. G. Johnson, Sir E. Sieveking, Dr. Andrew, Sir W. Gull,and others. As no Fellow had received the requisitetwo-thirds majority, a second ballot was taken, when SirA. Clark received 79 votes and Dr. Quain 71. The newlyelected President expressed his thanks to the College forthe unsolicited honour which had been so unexpectedlyawarded him, and he was then duly inducted into office bythe Senior Censor.We regard with unfeigned satisfaction the result of the

election. There can be no doubt whatever that in SirAndrew Clark the College will possess a worthy successorto Sir W. Jenner, and one who will do much to main-tain for the College the position which it has now

assumed. Sir Andrew, who graduated M.D. of AberdeenUniversity in 1854, obtained the Fellowship of the Collegein 1858. He was Censor in 1882 and Senior Censor in1883. In 1867 he delivered the Croonian Lectures, and in1885 the Lumleian. He has also been a member of theCouncil of the College. His success in consulting practiceis well known, as is also his long and loyal connexion with the London Hospital, of which he wasan active member of the staff for thirty years, becominga year or two ago consulting physician. As a clinicalteacher he ranks very high, and the School of Medicineto which he was attached owes much to his indefatigableexertions in its service. In 1883-5 he was Presidentof the Clinical Society of London, and in 1871 occupiedthe presidential chair of the Medical Society. In 1883 hehad a baronetcy conferred upon him. We need say nothingupon his personal qualities, but we may look to him todisplay in the high office to which he has been chosen thatcalm judgment and earnestness in the promotion of theright which he has shown in the many good causes that hehas promoted with so much zeal and energy.

THE METROPOLITAN BOARD OF WORKS ANDSIR HENRY ROSCOE,

THE Metropolitan Board have made another plunge intheir insane attempts to deal with the sewage of London atthe present outfalls. They have appointed Sir HenryRoscoe, their consulting chemist, for a period of twelve

months, in connexion with the deodorisation of the sewageand the purification of the Thames, on terms at which noone can cavil. Sir Henry Roscoe is one of the most distin-guished scientific men, and his integrity is above all sus-picion. It would therefore appear at first sight that theBoard had not only adopted at last a prudent course, buthad done all that could in reason be expected of them.But, unfortunately, either of these inferences would be

entirely erroneous. It is perfectly clear that the Board

do not intend to allow a free hand to the eminentchemist they have retained. They are still obstinatelybent on retaining the present outfalls in spite of the

strong warnings of Lord Bramwell’s commission and aconsensus of adverse opinion from the greatest medicaland sanitary authorities. Sir Henry Roscoe may do some-thing to abate the nuisance, but neither he nor anyoneelse can remove it as long as the present conditionsremain. The present scientific advisers of the Board areskilful and zealous, and we believe they have done all in