MEDICINE AND THE LAW.

179 oedema and punctiform haemorrhages; the spleen is enlarged, the lungs No bacilli pestis are, however, to be found in their bodies

congested. anywhere.

3. Even as much as 20 milligrammes fails to kill a guinea-pig of 200300 grammes weight. 4. An adult rat (weighing 120-200 grammes) injected with 10-15

milligrammes

of the prophylactic of medium virulence such as I with two doses of 10 milligrammes each at an interval of 9-10 days, is secured complete protection against even the most virulent B. pestis. I have a considerable number of rats which, after injection with the prophylactic, were tested by cutaneous inoculation (the most successful mode of infection of the rat) with virulent B. pestis at various periods from one to 13 weeks. These were all found fully protected, whereas the control animals inoculated cutaneously at the same time and with the same material died from typical acute plague in 36 to 72 hours. 5. As is well known, guinea-pigs are less susceptible to plague than white rats, the latter being of all the rat species which I have experimented with the most susceptible to plague. In the case of the guinea-pig a dose of 20 milligrammes of the prophylactic now in question twice injected at intervals of 10-14 daysdoes not afford protection in more than 50 per cent. of the animals; the remainder die, on subsequent injection with virulent material of plague, though their death is delayed several days (death in 9-12 days or later) and they show in the great majority of instances suppurating bubo The disease induced in these animals differs, however, from the subacute plague in an unprotected (control) guinea-pig as follows:—(a) There is but slight enlargement of the spleen, with few necrotic nodules; (ù) the liver contains either no necrotic nodules, or such nodules only very sparingly; (c) there is scarcity of B. pestis in the bubo and in the spleen—in unprotected guinea-pigs dead of subacute plague these two tissues being crowded with B. pestis; and (cl) there is much greater amount of necrosis in the lungs, the necrotic parts being packed with B, pestis. It seems, therefore, that while in the unprotected guineapig the bubo, spleen, and liver are more involved and richer in B. pestis than in the protected guinea-pig, the reverse is the case as regards the

recommend,

or

lung’.

In the experiments which in 1899 I along with Dr. Haffkine made with his prophylactic, and in the experiments which I have repeatedly made since with Haffkine prophylactic as prepared by myself, it was shown that for an adult rat 10 c c. are required to insure protection; an amount which represents, according to the statistics in India and elsewhere, at least double that required for protection of an adult human being. I assume, therefore, that 6-7 milligrammes of the dry prophylactic would suffice as a dose for the human subject. On this estimate a single large guinea-pig, dead of subacute plague, would by means of its necrotic bubo, spleen, liver, and lungs, ield something like 800-10CO human doses of the new prophylactic, an amount ot protective material equal to 3-5 litres of Haffkine’s flui i. When it is borne in mind : (1) that this dried proph lactic does not require more than about 10-18 days for its preparation-Haffkine’s requires 4-6 weeks; (2) that a large amount can be prepared of uniform stre egth ; (3) that its efficacy is easily standardised by injection into the rat; (4) that, being dry and sterile, it can be preserved without any antiseptic and unaltered for any length of time; and (5) that the protection afforded by its injection into the rat is of considerable duration, certainly many weeks ; and last, but not least, that the cost of preparation is incomparably smaller, the superiority of this orgata-prophylactic to Haffkine’s prophylactic must be obvious. As regards size of dose, it is true that the prophylactic prepared by Calmette and the Paris Pasteur Institute, which is an emulsion of dead bacilli derived from agar surface, is capable of protecting an adult white rat in doses so small as 1-2 c.c. But here again different cultures cannot be relied upon as being of equal potency, and hence no uniformity can be insured for different sets of cultures, or for the matter of that for two separate cultures from the same source ; whereas greater uniformity is to be anticipated from material derived from the same breed of guinea-pigs, all animals being of about the same weight and inoculated with material of like activity.

Professor Klein concludes his interesting report by asking the important question, Whence is derived the especial efficacy of the new prophylactic, which contains, be it remembered, not only the dead bodies of plague bacilli and associated tissue-toxin, but also, in all probability, other tissue constituents? In this connexion he admits that he has not as yet made more than preliminary experiment. But he has ascertained that the clear filtrate from a watery emulsion of the prophylactic powder possesses undoubted prophylactic efficacy. Thus, injection of an amount of clear filtrate correspondingto—i.e., obtained from-20 milligrammes of dry powder, confers immunity on the adult rat against a subsequent cutaneous infection with virulent bacillus pestis. This, he concludes, shows that the new prophylactic does not act solely by means of the bodies of the dead bacilli which it contains. A forthcoming report from the principal medical officer of the Local Government Board will deal fully with the steps adopted by Professor Klein in conducting his

experiments. MEDICINE AND THE LAW. !’iTedacal Men. recent inquest at Wandsworth a disoui-s’on took place between the coroner, Mr. Troutbeck, and a medical witness as the result of the latter having refused to give a certificate of the cause of death and having also declined to give any information as to his opinions on the subject to the coroner’s officer. The deceased, a woman more than 80

Information asked for by Coroners from

AT

a

years of age, had suffered from bronchitis and the medical man called as a witness by the coroner expressed the opinion in the witness-box that death was due to heart failure following upon this and upon some of the changes of old He had refused his certificate because he had age. heard that the old woman within three months of her decease had had a struggle with a boy in her shop which had resulted in her falling to the ground and because he considered that this might have contributed to her condition afterwards observed by him. The question of the fall does not seem to have been gone into at the inquest, at which a verdict of death from natural causes was returned, and some observations were made by Mr. Troutbeck, both when the medical witness was in the box and later during his summing up upon that gentleman’s refusal to give information to the coroner’s officer, the result of which might havebeen that no inquest would have This is an old question between coroners been held. and medical men. The former are required by the law to hold inquests where it is suspected that a patient " has died either a violent or an unnatural death or has died a sudden death of which the cause is unknown," and in order to ascertain whether such conditions prevail they naturally seek for information from any medical man who appears likely to be able to give an opinion on the subject. The medical man, on the other band. naturally objects to what appears to him to be a responsibility thrust upon him and to communicating to a coroner’s officer views which may reach the coroner himself in a distorted form. He receives no fee for this opinion, and if subsequent events show that he was wrong he may be blamed for an error which he has no opportunity to correct without post-mortem examination or a fuller knowledge of the circumstances preceding and accompanying death, such as an inquest These observations apply generally may possibly afford. two such cases of the kind indicated as may arise outside Mr. Troutbeck’s district. The attitude of that gentleman towards med:cal practitioners in the locality in which his jurisdiction lies has not been such as to obtain from them any cooperation in the performance of his duties which he has not the power to

compel.

ROYAL COLLEGE OF SURGEONS OF ENGLAND. A QUARTERLY meeting of the Council was held on Jan. llth, Mr. JOHN TWEEDY, the President, being in the chair. Mr. W. BRUCE CLARKE was introduced and having made a declaration in the terms of the oath prescribed by the. Charter of 1800 was admitted a member of the Court of Examiners. It was resolved to amend the list of universities whose graduates in medicine and surgery may present themselves for examination for the Fellowship without first becoming Members of the College, by the substitution of Victoria University of Manchester for Victoria University, and by the addition of the Universities of Liverpool, Leeds, and Sheffield. Mr. G. H. Makinswas appointed a member of the Board of Examiners in Dental Surgery in the vacancy occasioned by the retirement of Mr. W. H. A. Jacobson. The PRESIDENT announced that he had appointed Mr. Hemy T. Butlin as Hunterian Orator for the year 1907. Mr. A. W. Mayo Robson was appointed the representative of the College at the Fifteenth International Congress of Medicine to be held at Lisbon next April. ’

THE MEDICAL MAN, THE CORONER, AND THE PATHOLOGIST. THE first stage has been reached and passed in the proundertaken by the British Medical Association in order to test the legality of the employment by Mr. Troutbeck of Dr. L. Freyberger to hold post-mortem examinations in all, _or practically in all, cases coming before him The a3 coroner in the sbuth western district of London. controversy with regard to this unusual practice resorted to by a particular coroner has gone on for so long and

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