THE DOCTOR'S DAY

108 severe menopause in married contingency being 0.203 for married and 0.137 for 268/469 (57-14 per cent.) ; in single women, single women. SUMMARY 114/220 (51-82 per cent.) ; and among all women, 382/689 (55-42 per cent.). From the analysis of the data the following points

menstruation with women was

The differences between these values-35-45 per cent. and 57-14 per cent. for married ; 22-45 per cent. and 51-82 per cent. for the single ; 32-24 per cent. and 53-42 per cent. for all women-are greater than those which are likely to arise by mere chance. Hence we conclude that according to these data there is some evidence that a normal menstruation tends to be followed by a normal menopause and vice versa, and that the association is slightly more defined amongst single women than married

emerge :1. The proportion of

women

who carried

on

their

usual

occupation without any interruption due to symptoms attributed to the menopause was 89’7 per cent., the difference between the unmarried groups being insignificant.

married

and

2. The percentage of women free from all menopausal symptoms was 15.8. The percentage of women relatively free, flushing being the only symptom, was 20-6. The proportion in each case was greater in women. single than in married women. It must be borne in mind that the majority of women 3. Greater frequency in the following symptoms from whom these figures were obtained, being over were found amongst married women : flushing, 55, had not so much opportunity for healthy develop- headache, giddiness, rheumatic " pains, haemorrhage, ment open to them as have girls of the present day. pains in the breast, and, markedly so, obesity. In 57-5 per cent. of them were troubled with some nervous instability and change in the thyroid, the menstrual disability, whereas the proportion of cases larger proportion was amongst the unmarried. of dysmenorrhoea amongst young women is now much 4. There was little or no correlation between the "

smaller. If then a normal menstruation is found to age of onset of menstruation and the age at the last be associated with a symptomless menopause, there period for either married or single women. Notwithmay be reason to hope that in the future there will standing that a considerable number of women stated be less disturbance of health at the " change of life." that the menses had not recurred after the last confinement-which was, in some cases, definitely PREVIOUS HEALTH AND MENOPAUSAL SYMPTOMS earlier than the usual menopause age-the analysis Notes as to previous health were made in the showed that childbearing, even when allowance was schedules for the purpose of examining whether this made for age at marriage, in no way influenced the factor influenced in any way the type of menopausal age at the menopause. 5. There was some evidence that normal menstruasymptoms. In many cases the histories were indefinite, and the value of statements regarding past tion tended to be followed by a normal menopause, illnesses were difficult to assess. It was interesting and a history of dysmenorrhoea by more marked This was slightly more to note, for instance, the importance attached to menopausal symptoms. " heart trouble " by some who had reached a ripe old defined for single than married women. 6. Previous health was a factor of no marked age. Several of the old women, including one in her 90th year complained that they had " always suffered importance in influencing the onset or severity of a weak heart," though their health had been menopausal symptoms. The members of the subcommittee who presented good-no credit being allowed to the organ for the fact that it still continued to the above report to the Council of the Medical The records of previous health were, however, Women’s Federation were as follows : Lady Barrett, under " good," " fair," and " bad," and when M.S. (chairman), Prof. Winifred Cullis, D.Sc., calculations were made from this crude Dr. Letitia Fairfield, London ; Miss Ruth Nicholson, it was found that there was only a small degree M.S., Liverpool; Dr. Mona Macnaughton, Newcastlebetween the previous health and the on-Tyne ; Dr. Cecilia F. Williamson, Ipswich ; and menopausal symptoms, the coefficient of Dr. Alice E. Sanderson Clow (hon. sec.), Cheltenham.

om

herwise ligned

of

t. sified ecessary s, lationship

THE DOCTOR’S DAY " Come, tell

me how you live," I cried, ’* And what it is you doI "

,

X.-THE CORONER THE principal duty of a coroner is to investigate all sudden deaths of unknown cause, deaths from violence of all kinds, and all unnatural deaths—e.g., deaths from poison, anaesthetics, alcoholism, or industrial diseases. Most of the deaths requiring investigation are reported to the police station or to the coroner’s office, and the coroner’s officer of the borough in which the death took place then makes his inquiry and presents a written report The perusal of all these duty of the coroner, and he then decides whether an inquest will be necessary, or whether the doctor can properly and safely certify the cause of death, or whether a post-mortem examination would be likely to clear up the doubt and so avoid the necessity for an inquest. If he decides that an inquest ought to be held, then he fixes the time, directs what witnesses should be summoned, orders the removal of the body to the mortuary, orders a post-mortem examination, if required, each

day reports is

to the coroner. the first daily

manslaughter then the coroner informs the Criminal Investigation Department at New Scotland Yard, and inquiries are set on foot by them. j Roughly about half of the cases reported to the coroner

can

be dealt with under the Act of 1926

by ordering a post-mortem examination, usually by an expert pathologist ; if this reveals a natural death, then the case can be so certified by the coroner and no inquest will be required. Other cases requiring his attention are those where a death has occurred rather suddenly and unexpectedly, and, although there may not be any suspicion that the death is other than a natural one, yet the doctor may feel it his duty to inform the coroner of the death. A little inquiry will often clear up such a case, and will enable the coroner to authorise the doctor to issue a certificate of death. Then there is now an Act which requires all deaths of persons whose bodies it is sought to remove out of England to be reported to the coroner ; a consideration of the death certificate and the general circumstances surrounding the death will generally satisfy the coroner that there is no need to hold an inquest.

INQUESTS AND JURIES the summoning of a jury when necessary--e.g., a Having thus cleared his table the - coroner will street fatality, or a death from a factory accident. proceed to dispose of his daily list of inquests. He In factory cases notification is sent to the factory may have as many as 1500 cases reported to him in inspector of the time of the inquest, and if there is a year, and he will probably hold not far short of suspicion that the case may be one of murder or 800 inquests. Fortunately, a good many of these says who is to make

it, and issues his warrant for

109 be held without a jury, or he would find it to get through. All deaths from street accidents, all factory deaths, and, of course, all cases of murder and manslaughter require juries ; in such cases there are generally counsel or solicitors, or both, and the proceedings are accordingly considerably lengthened. After the relevant witnesses have been examined and cross-examined, the coroner sums up, explains to the jury the law, generally of negligence, marshals the facts proved in evidence, directs their attention to inconsistencies and improbabilities and contradictions, and their effect upon the weight of evidence, asks the jury to decide upon the facts which they accept as the correct ones, to apply the law to those proved and accepted facts, and to return a verdict upon them accordingly. After the verdict the inquisition is signed, the fees are paid, and the court is closed. Very rarely there is a verdict of murder or manslaughter, and in these cases the coroner has to read over the depositions to each witness, sign them and get them signed by him ; he has to issue his warrant for the arrest of the accused and for his committal to prison to await trial ; to give bail in case of manslaughter if he so decides ; to bind over the witnesses to give evidence at the Old Bailey; and, finally, to get the formal inquisition signed by the jury. Such committals are now very few, for, under the Act of 1926, where a person has been charged before a magistrate with these offences the coroner adjourns his inquest until the termination of the criminal proceedings. From time to time, however, the coroner has cases in which, although there is suspicion, it is not sufficient to justify the police in making an arrest, and he has to deal with the matter at length. Criminal abortions belong to this class and are most unsatisfactory and difficult, for there is generally a conspiracy of silence and deceit. I believe there is a large number of these cases in London at present, but few of them come before us. When they do come they are so veiled in secrecy and so cleverly camouflaged that it is seldom possible to bring the crime home to the perpetrator. The incriminating evidence consists, as a rule, of statements made by the deceased person or by an accomplice which cannot well be admitted in such a serious charge. can

impossible

case, the Duff case, and the earlier Pritchard case medical certificates of natural deaths were given by medical practitioners, but subsequent analyses showed arsenic to be the cause of death in all these cases-a rather disturbing reflection. I look upon all sudden and unexpected deaths as suspicious if there is a history of vomiting and diarrhoea, I take steps to avoid being led astray and by-such vague certificates of the cause of death as gastritis. Then, again, one must be watchful for deaths which appear to be due to cerebral haemorrhage but which may be due to narcotic

drugs.

Suicides and street fatalities provide us with the bulk of our cases for inquest, and when the suicide uses the now fashionable gas oven they are simple enough. Farewell letters in the writing of the deceased are a blessing to the busy coroner in suicides, but where the death took place as the result of a fall from a window, and no writing is left by the deceased, and there is an astute solicitor or counsel, the case may not be quite so easy. A diligent search by an experienced coroner’s officer will often disclose some document which throws a light upon the cause of death ; it is surprising how often such papers are overlooked. Finger-marks in the room and particularly on the window-sill now and then enable us to arrive at a conclusion. NO LIFE SO INTERESTING OR VARIED

After pretty long experience of life, and a considerable acquaintance with people engaged in all kinds of professions and businesses, I know of no life which is so interesting and so varied as that of a London coroner. The chief charm of the life lies in its complete independence. So long as you conduct your duties with efficiency no one can interfere with you. The Lord Chancellor can remove you from office, but only for incompetence or actual misconduct, and I have never heard of this power having been exercised. You arrange the work to suit public convenience and, subject to that, to suit yourself. One day it may be very heavy, but the next may be free. The work is always lightest when the weather is at its best, heaviest when the gloom and cold of winter render work preferable to leisure. If after months of continuous work you DIFFICULT CASES feel stale and weary of tragedies you can take & Complicated street smashes, where two or more holiday without asking anyone’s permission. All vehicles are involved, present great difficulty to the you have to do is to hand over the duties to your coroner. Obscure cases of food poisoning, unexplained deputy, pay him his fee, and go away. Coroners fatal fires, mysterious explosions, house collapses, who were appointed after the passing of the Act flood fatalities, all kinds of factory accidents, river of 1926 must retire at 65 years of age, but in London collisions, suicides, and scores of other problems they then receive a (maximum) pension of nearly present themselves for solution in the course of the ;1)1000 a year, which, being non-contributory, is As regards prospects, we in London year. All, or very nearly all, can be solved by close adequate. attention, by expert assistance, and by adjournments are most of us rapidly approaching the retiring and continuous investigation. In cases of great age, so there will be plenty of vacancies in a few public importance in London the L.C.C. will always years, and I know that some of my colleagues are give the coroner every assistance he may require in without assistant deputies because they cannot find the matter of engaging and paying technical experts suitable men. The newly qualified medical man who is desirous, to investigate really difficult problems ; thus the coroner’s court may find itself listening to great of becoming a coroner may wonder how to solve engineers, architects, chemists, metallurgists, fire the problem of earning his living as a doctor and experts, flying experts, explosives experts, building getting called to the bar at the same time. But research workers, ventilation engineers, or railway the bar examinations, though difficult and at times signal technicians. The viewing of the locus in quo dull, are far easier than those of the medical student. enables him to understand what would otherwise Tuition courses can be carried on by correspondence, be almost unintelligible. In certain cases of sudden the eating of dinners in Hall is just a pleasant death the autopsy may fail to reveal a definite cause formality, and a call to the bar should be within the of death ; while some coronary disease or heart reach of the average doctor within a couple of years. disease may be present, it is well within the bounds If in practice in London he can pick up the routine of possibility that these are not the real cause of work of a coroner by attending his inquests for a death. Careful inquiry into the clinical history, and few weeks or months ; once that knowledge is the absence of all signs or symptoms of poison may I acquired an assistant deputyship, followed by a enable the coroner to pass the case, but it is as well,I deputyship, should be obtainable in due course. when in doubt, to exclude poisoning by ordering The deputy takes the place of the coroner during an analysis. In London this is easy, for we are his absence, through illness or other cause, such as empowered to engage and pay analysts when we feel holidays, and it is quite easy to carry on a it desirable to have a chemical or bacteriological practice at the bar, or in medicine, whilst holding analysis performed. It will be remembered that one of these appointments and waiting for full in the Seddon case, the Armstrong case, the Greenwood coronership. a