and acting for ourselves, are exposed; but we have absolutely no right to neglect the conditions that cause suffering and death among children. The failure to act and to act quickly and unceasingly until a safe milk for children, at least, is within easy reach of every mother, may be characterized as barbarous, if not criminal, indifference. It is an offense against the innocent, unquestioning confidence which children repose in their adult friends.

Under our present conditions of civilization the importance of milk is second only to that of air and water. Without milk thousands of children who grow to useful maturity would starve before they completed. the first year of their lives. The excellent work done by Dr. George W. Goler, of Rochester, N. Y., proved beyond doubt that thousands of lives. are annually lost through the use of impure milk. The reform his praiseworthy and untiring energy brought about in Rochester, by no means a very large city, reduced the mortality among children under five years from seven thousand four hundred and fifty-one for the ten years ending in 1896 to four thousand, nine hundred and sixty-five for the ten years ending in 1906. This shows a saving of two thousand four hundred and eighty-six lives, among which one thousand five hundred and fifty-four, or sixty-two and five-tenths per cent, were children under one year old, that is, had not passed the period of life during which milk forms the most important element of their daily food.

What can be done by substituting a pure milk supply for an impure one is shown by the following quotation from the New York Medical Record's London letter of July 26, 1907:

At Leeds a voluntary society established a year ago a depot for supplying a pure milk, as the corporation had no power to do so. But the health officer has made a report on the working. He concludes that, making allowance for the mortality for the first week of life and for those born moribund, there has been a saving of life of twenty-five per cent among the children using the society's milk as compared with those living in the same district at the same ages and during the same seasons fed otherwise. The experiment was on a small scale, but as far as it went was more successful than he could have anticipated.

The dairyman is not alone to blame for impure milk. As a rule, he attempts to supply a pure milk to his customers and is not conscious of the impurities and infections in the article he is distributing. The price he receives is too low for the production of a constantly pure milk. He should be better paid. If the money that now goes to druggists, doctors, undertakers and burial grounds directly through the use of impure and unwholesome milk could be diverted to the dairyman, he would be amply paid for producing a wholesome, safe milk, and the entire community would profit by having better health, fewer deaths, and less suffering.

5 New York Medical Record, August 17, 1907, p. 275.

CONCLUSIONS.

I. The dangerously tuberculous cow is an animal that may long retain the appearance and general semblance of perfect health.

2. The methods we now have to detect the presence of tubercle bacilli in the secretions and discharges from tuberculous cows are too crude to give positive results unless the bacilli are quite numerous; hence, while we can frequently obtain direct evidence that a tuberculous cow is dangerous, the failure to obtain such evidence does not prove that a tuberculous cow is safe.

3. Among tuberculous dairy cows that retain the appearance of health and are not known to be affected until they are tested with tuberculin, forty per cent or more actively expel tubercle bacilli from their bodies in a way dangerous to the health of other animals and persons.

4. Dairy cows that have been affected with tuberculosis three years or more, with possibly rare exceptions, are active agents for the dissemination of tubercle bacilli.

5. The general evidence justifies the conclusion that tuberculous cows do not expel tubercle bacilli until some time after they contract the affection. The practical importance of this is that it enables us to clean herds of tuberculous cattle by the periodic application of the tuberculin test and the segregation of all reacting animals.

6. The interval of time that elapses between infection with tuberculosis and the dangerous expulsion of tubercle bacilli can not serve as a reason for retaining a tuberculous cow in a dairy herd after the fact that she is tuberculous has been determined. The duration of the interval after infection, before the expulsion of bacilli begins, varies greatly with different animals, and it is rarely possible to ascertain how long a cow has been affected when her tuberculous condition is first discovered.

7. From the present as well as from former' investigations we know that the commonest way for tubercle bacilli to pass from the bodies of tuberculous cows is with their feces. This fact, together with the common presence of tuberculosis among dairy cows and the frequency with which cow feces are found in the milk that reaches the consumer, is clear evidence that a considerable proportion of our dairy products are infected with tubercle bacilli.

8. The danger from the presence of tuberculosis among dairy cows is not confined to the use of milk as a beverage. When tubercle bacilli are present in milk they enter the various articles of diet prepared from it, and are specially numerous in butter, in which they may remain alive seven weeks or longer without showing a diminution of virulence.

9. The distribution of tubercle bacilli from tuberculous cattle in a way to endanger human health is not left to chance. It is a commercial,

1 Bureau of Animal Industry, Bulletin 99.

systematic distribution, from door to door, or rather from table to table. As long as the use of tuberculous dairy cows is permitted, the manner in which dairy products are distributed will insure that practically every member of the human family is exposed to tuberculosis. This may explain why three European investigators from their post-mortem examinations of respectively one thousand four hundred and fifty-two, five hundred and one hundred bodies of persons who died from various causes found that, among this total of two thousand fifty-two hundred bodies no less than ninety-one per cent showed lesions of tuberculosis.

10. While the danger to which public health is exposed through the use of milk from tuberculous cows is of a magnitude almost beyond conception, it is, unfortunately, only one among many dangers to which persons are exposed through the use of impure, infected and dirty milk.

II. If the inclination of the general public does not drive it to correct the evils to which it is exposed through the use of impure, infected and dirty milk, it should bear in mind that common humanity imposes various sacred obligations, among which pure, wholesome milk for children ranks near to the first place. We have no right to shirk this obligation, and would have no inclination to shirk or ignore it if we took the time and trouble to investigate the number of deaths, especially among infants, directly due to contaminated milk. Most intelligent persons who read have some knowledge of the fact that numerous babies die from no other cause than the use of impure milk. Unfortunately, the frequency with which milk from tuberculous cows causes tuberculosis is not so clearly apparent, because of the insidious, chronic character of the affection.

12. Our dairy herds can be cleaned of tuberculous cows by the proper application of the tuberculin test and the segregation of all reacting animals. After years of observation the tuberculin test has been found to be a more nearly infallible means for diagnosing tuberculosis than any we have for diagnosing other diseases of men and animals.

PROFESSOR HAFFKINE read a paper before the Royal Society of Medicine showing that disinfection was of no avail against plague. A campaign against rats, he said, was most rational, but owing to the rapid multiplication of the survivors it was uncertain whether it was possible to make a noticeable impression within a generation. He favored inoculation, which reduced a native Indian's liability to attack to less than onethird as compared with non-inoculated Indians. Dr. Ashburton Thomson agreed with Professor Haffkine's views regarding immunization and referred to Professor Haffkine's genius in this respect. He also favored evacuation and the destruction of rats.-[Indian Public Health and Municipal Journal, February, 1908.]

EDITORIAL

THE CORONER'S SYSTEM OF THE UNITED STATES.

The need for a change in the present Coroner's system in vogue in the United States is, indeed, pressing. As it exists with us, it is practically the same as that of Great Britain—an office of our forefathers, the "Crowner's" office, useful in its day, perhaps, but now obsolete. The system in nearly all of the States is, that in every county there shall be an elective officer, called the Coroner, whose duty it is to investigate. the causes of death of people dying by accident, those dying without medical attention, and those who die by suicide or by homicide or by alleged homicide. The Coroner thereupon holds an inquisition, with or without a jury (usually composed of six men), finds a verdict and issues a burial certificate. At this inquisition, the Coroner has the right to summon witnesses and gather evidence by direct and by cross-examination. As usually conducted, the Coroner's inquisition is a joke upon the laws of evidence. No thought is given to the rights of a defendant, if there be one, and all manner of questions are asked that would be promptly objected to by a competent attorney were the case on trial in a court of record. Often an alleged defendant is practically made to incriminate himself by being deprived of the advice of counsel.

While the transactions of the Coroner's inquisition are not acceptable in a court of record, for the reason that no respect is paid to the laws of evidence in the gathering of the material for said transcript, nevertheless, the prosecuting officer has the advantage of knowing the facts already brought out by the Coroner in his inquisition, and these may be used to the marked disadvantage of the defendant. This is, in itself, a serious flaw in the system, and is absolutely incompatible with the spirit and letter of the Constitution of the United States.

Another flaw, perhaps much more serious than the inherent unconstitutional powers of the Coroner in extracting information from defendants and witnesses, is the loose and incompetent manner in which the legal autopsy is often performed by the average Coroner's autopsy physician. The autopsy physician is, ordinarily, a practitioner who happens to be appointed to his office not because he has especial fitness for the performance of the duties of said office, but because he is sponsored by the political gang which has elected the Coroner to his office. Well and good; maybe a competent physician may happen to be so sponsored, may be not. Let us grant that he is incompetent. There may be an important issue arise affecting the life or liberty of some accused individual, dependent alto

gether upon the findings of this autopsy physician. The cause of death may be natural, and the ignorant autopsy performer may mistake it for something different, perhaps poison or some other homicidal agent. An innocent man may thus be falsely accused, and may even be executed as a result of the ignorance of the Coroner's assistant. Few there are who realize that the Coroner's autopsy physician lays the foundation for every homicide case. His decision determines the nature of the indictment, and practically the whole of the State's case. And yet, with all this weight upon his shoulders, the autopsy physician's office is so obscure that it has in most counties not even an official designation; he is often any physician selected at random from the Coroner's medical acquaintances.

Another point: In cases of suspected poisoning there is no provision, in most counties, for the services of a toxicologist. This part of the work is often done by the self-same autopsy physician. He is often, neither by experience, training or inclination, capable of conducting this specialized chemical manipulation. The work is, consequently, performed in an incompetent manner, with untold possibilities of placing some one's life or liberty in jeopardy.

A reform in this direction is crying, expedient and necessary. There should be a uniform movement of the medical press of the country to correct the system in every State in the Union where this obsolete condition prevails. Massachusetts, pioneer as she is in so many good things, reformed the Coroner's system in 1877 by abolishing the office and creating the office of Medical Examiner, an officer appointed by the Governor of the Commonwealth, in each district of the State. The duties of the Medical Examiner are as follows: At the direction of the Prosecuting Attorney of the district or county, the Medical Examiner (who, in the State of Massachusetts, has always been selected because of peculiar fitness for performing the duties of his important office) proceeds to hold an autopsy and investigate, in a scientific manner, the cause of death of the deceased in question. If the information which he gathers is judged by him to be of sufficient importance to warrant putting the wheels of justice in motion, such evidence is immediately laid before the Prosecuting Attorney, a preliminary hearing is held, and the case regularly and constitutionally considered, thereby superseding the irregular and unnecessary Coroner's inquest. In this way, a competent officer conducts a legal inquiry, according to the spirit of the constitutional law of the country, and the ends of justice are well served. Some such system as this should be in vogue in every State. Civilization demands it, as justice is often defeated under the present system. This reform is one to which the entire profession should put its shoulders to the wheel and seek to bring about.