misspelled original of the announcement in the directory. But Newton backed down in such inglorious haste that the documents were not brought before the court.

Meanwhile, Mr. Theodore H. Tyndale, a lawyer, and now a most efficient member of our Medico-Legal Society, read before the American Social Science Association a paper showing that the coroner system then in force was an anachronism, and a very dangerous one.

He showed that, by existing laws, a coroner, though appointed by the governor and council, could be displaced only by an address of both Houses of the Legislature to the governor; that if six jurors who were summoned did not respond, the coroner could form a jury from the bystanders, and therefore could influence and manipulate them as he chose; that by the consent of the majority of this jury he could make a private inquest, and that, while giving bonds for only $500, he could take charge of all the property upon or near the person of the deceased. It may be said, however, that coroners could not easily hoodwink the authorities by an independent disposition of the body (for dissecting purposes, for example) and defraud the city by manufacturing charges for pretended expenses. This was in a great measure prevented by the vigilance of the overseers of the poor.

Mr. Tyndale further showed that there was no law limiting the number of coroners, and finally how a timid or corrupt coroner could shield a criminal, thus endangering public safety, and how by malice or vindictiveness he could work much harm. He asserted that two coroners were enough for the city of Boston, that juries were mere dummies, and claimed that the office of coroner should be divided into two,-one medical, the other legal. He also produced figures which demonstrated that, in one year, inquests under the old system cost the city $10,769.74. The salaries of the two medical examiners now acting for the whole of Suffolk County amount to only $6000.

This exposition created a deep impression. The Social Science Association at once gave the matter earnest heed, but the first formal step was taken by the councillors of the Massachusetts Medical Society, who at their October meeting in 1876 thoroughly discussed the subject, and appointed a committee which was requested to report at the February meeting in 1877. Here then at the same time were several influences working together, viz., Tyndale's paper, the consequent activity of the Social Science Association, the practical step taken by the Massachusetts Medical Society, and the disgraceful appointment of Newton as coroner. The councillors of the Medical Society next appointed a committee of five, and invested it with full powers to treat and co-operate with committees of other

organizations, and with any persons interested in reforming the coroner laws. A bill was then presented to the State Legislature, which placed it in the hands of a special committee. The petition for the extinguishment of Newton was likewise being pushed, and added much influence to the forces at work in favor of abolishing the whole corrupt system.

As you may imagine, heaven and earth were moved by the friends of the coroners in opposition to the movement. This adverse influence weakening, an attempt was made to secure the appointment of more than two medical examiners. One of the coroners was notoriously active. He defended the old system, and then calmly applied for a position under the new. The bill went through the Legislature in triumph. It killed the old system. The satisfaction of lawyers, physicians, and all well-disposed persons was great.

Meanwhile, Coroner Newton had played another card. He sent in his resignation. The governor and his council very properly refused to act upon it until the evidence of Newton's remarkable unfitness was made public. In this course they were upheld by the Legislature in a motion which most emphatically indicated the fact that in Massachusetts a public servant cannot escape the results of misconduct by a resignation. In June the man was dishonorably discharged by the governor. One month later the coroner system, with its disgraces, its peculations, its antiquity, was expunged from Massachusetts. It was replaced by the new plan,-a plan now working with the most thorough success. I can best show its character by giving you the new law concerning medical examiners. Its first section was the bullet which killed the deadly parasite of the past: I. "The offices of coroner and special coroner are hereby abolished."

Stripped of verbiage unnecessary here, the remainder of the law is as follows:

2. The governor and council may appoint two medical examiners for Suffolk County, and for each other county such number as may be designated by the county commissioners. These men to be "able and discreet men, learned in the science of medicine."

3. The annual salary of each medical examiner in Suffolk to be $3000; in other counties $4 for a view without a necropsy; for view and autopsy, $30; for travel, five cents per mile to and fro.

4. The medical examiners to hold their offices for a period of seven years, but may be removed by governor and council for cause shown.

5. Before entering office, medical examiners to be sworn and give bonds for $5000 for faithful performance of duties. Failure to do this within thirty days of appointment displaces, and another man is chosen.

6. County commissioners are directed to

divide their counties into districts suitable for one medical examiner, but each examiner may, if need be, act in any portion of his county.

7. Medical examiners are to make examination of such bodies only as are supposed to have died by violence.

8. Upon notification, the examiner must take charge of a body; if, on view, he consider further examination necessary, he must obtain authority from the district attorney, mayor, or selectmen of the district, and then, in presence of two or more persons (whose attendance may be compelled), make an autopsy, and reduce to writing every fact which may show condition of the body and manner or cause of death; likewise names of witnesses. Before making the autopsy he must call attention of witnesses to position and appearance of body.

9. If he decide that death was caused by violence, he shall at once notify the legal authorities of the district, file a copy of his record of the necropsy in a court or with a trial justice, and another with the district attorney; also notify clerk or registrar of marriages, births, and deaths of whatever may serve to identify the dead.

10. The court or justice must then hold an inquest, which may be private. Witnesses may be isolated; district attorney or his deputy may attend and examine witnesses. The same holds good in case of death by railroad accident or other casualty.

11. Legal authorities may compel attendance of witnesses; the latter to be allowed the same fees and be subject to same penalties as when served by a subpoena to attend a criminal prosecution.

12. After hearing the testimony, the presiding justice shall draw up a report, in which he shall find and certify when and how the person came to his death, with all details. If the death have been caused by some other person, the name of said person must be mentioned in the report and filed with the records of the superior court of the county in question.

13. If murder, manslaughter, or assault have been committed, the justice may bind over all necessary witnesses to appear at proper time and place.

14. If the person charged with the offence be at large, the justice shall take steps to apprehend him by the usual legal process.

15. Ifthe medical examiner report that death was not caused by violence, and the district attorney be of contrary opinion, the latter, or the attorney-general, may cause an inquest to be holden, at which he or a deputy shall be present and examine witnesses.

16. If necessary, the medical examiner may call a chemist to his aid, the latter to be paid by the county.

17. When the examiner views or examines the body of a stranger, he shall bury the same

at the expense of the county wherein it is found.

18. The medical examiner may allow reasonable compensation for services rendered by others in securing bodies found in the waters of the commonwealth, but nothing shall be paid for the search for a body.

19. The medical examiner is authorized to take charge of property found upon or near a body, and shall deliver the same to proper custodians, or in their absence, after sixty days, to a public administrator.

20. Any examiner who shall fraudulently refuse or neglect to deliver such property within three days after demand, shall be punished by imprisonment not exceeding two years, or by fine not exceeding $500.

21. The medical examiner shall return account of all expenses of each view or autopsy, including his fees, to the county commissioners of the county wherein examination is made, and shall annex the written authority under which the autopsy was made. Said commissioners (in Boston the auditor) shall audit such accounts and certify to the treasurer of the commonwealth, or county, as the case may be, what items therein are deemed just and reasonable, which shall be paid by said treasurer to the person entitled to receive the same.

Sections 22 and 25 do not require mention. Such being the law, it will at once be seen that law and medicine act together in deciding questions connected with a death by violence. Under the old system the inefficient coroner and his triply ignorant jury represented both law and medicine. Quoting in part from Mr. Tyndale's paper, read last year before the Medico-Legal Society, "Under the new system the medical examiner's share of the case terminates with his report. He may become a witness, but he has nothing further to investigate or decide. This is the business of the courts, and the medical examiner is not expected to take the responsibility of deciding the legal merits of the case. This is the business of the judge, and his alone. Thus, the examination is made by the examiner, the inquest by the court. The duties of each are distinct, and this arrangement insures evenhanded justice."

The real effect of the law is a medico-legal co-operation. This is what we have needed. Formerly, in coroner cases, we had neither law nor medicine: we had only an arbitrary, generally incapable, coroner. Now we have exact and scientific medical autopsies, followed by equally exact inquests in the courts. There should be no coroner in any well-regulated city. We have known, and Philadelphia now sees, the imperfection, danger, and temptations of such an office. If Pennsylvania will but adopt our law, she also will then shake off an antiquated, absurd, unintelligent system. If she can modify any portion of our law, and thus give it greater perfection, we shall be glad to adopt her modifications. Not to pass

and enforce such a law after our successful trial of it, and after the disgraceful wrangle for the coroner's office which Philadelphia continually witnesses, together with the peculiar administration of his office which has been revealed in the case of your present coroner,— with all this in view, can Pennsylvania permit a continuation of the coroner system? To put such power into any man's hands is wrong. To permit such an office to become the object of political warfare is wrong. To admit to such a position men so inefficient, so uneducated, as the more recent, at least, of Philadelphia coroners have been, is a wrong and a mistake so striking, so singular, so surprising, that one wonders how and why it has been allowed to continue. But in this country we move against wrong far too slowly. When will Fhiladelphia again have such an opportunity to make the change? You have, all gathered and garnered, sufficient evidence, fresh and recent in character, as to why the change should be made.

Our law so hedges in the medical examiner that he can simply do his duty. Section 19 suggests the only temptation to which our examiners are exposed. But remember that these men are not the choice of Irish politicians. They are carefully selected by wiselychosen men, who then recommend them to the governor and council for appointment. Thus, they run a gauntlet of sober-minded and intelligent men. They must, then, be men not only of first-rate ability, but men of solid, well-tried character. And such are the men who are now acting as medical examiners for this commonwealth. This is shown by the faithfulness with which thus far they have performed their duties, by the accurate and scientific nature of their reports, and by the scholarly papers which they have read before their society. Reference to this society (the Medico-Legal) must be reserved for another letter. In closing, I cannot forbear expressing the hope that this hasty sketch of the way in which we threw off and got rid of the burdensome disgrace which afflicted us so many years may not be without its influence upon the physicians and lawyers of Pennsylvania. Get rid of the old and imperfect coroner system, and adopt the scientific medico-legal combination which is so gratifying in our State. Therein alone lie self-respect and safety.

BOSTON, October 1, 1879.

H. O.

LITHOTRITY AT A SINGLE SITTING.-Sir Henry Thompson publishes in the British Medical Journal for August 2 a report of thirteen cases of lithotrity at a single sitting recently performed by him. In the last case, that of a man aged 78, the stone, weighing upwards of an ounce, was removed at two sittings. The whole series of cases was successful, and the mortality nil.

A few points in the anatomy of this joint must first be briefly adverted to, which, although perhaps well known to some, certainly seem to have been overlooked by the majority of surgeons.

An attentive consideration of the nature and extent of the movements of the shoulderjoint will demonstrate the fact that its ligaments cannot by any possibility keep the component bones in close contact, as this arrangement would inevitably interfere with the free play of the articulation. In the dissected specimen, indeed, the humeral head drops away from the glenoid fossa, so as to leave a considerable interval between them. The muscles which arise and are inserted in the neighborhood of the joint, viz., the deltoid, supra- and infra-spinatus, subscapular, the scapular head of the triceps, and above all the long head of the biceps, keep the joint surfaces in contact,-aided by atmospheric pressure, and not the ligaments. If the dissected joint be examined, abduction will be found to be arrested by the greater tuberosity of the humerus impinging against the under surface of the acromion process of the scapula. Any elevation of the arm above the horizontal is due largely, as Morris has pointed out, to the action of the trapezius. The fibres of this muscle pursue the same course as those of the deltoid, so that, functionally considered, they may be viewed as one muscle, having the spine of the scapula and the clavicle interposed.

Still another important point to be remembered is the attachment of the deltoid muscle, about the middle of the outer portion of the shaft of the humerus. The ordinary statement found in works treating of luxations is that this joint is so frequently displaced because its socket is so shallow, and the force is so applied as to cause the head of the humerus to impinge against the weakest portion of the capsule. If by "the weakest portion of the capsule" is meant the part least supported by muscles, the statement may be correct; but the examination of comparatively few specimens will prove what a priori we ought to have inferred from the freedom of movement, viz., that no one portion of the capsule is invariably stronger than another, since the purpose of

the constant thickening of any segment of such a ligament is to limit certain movements.

The reasons assigned for this liability to displacement are in the main incorrect, as will be presently shown.

It may be stated as an axiom, that when the long axis of the head of the bone in any enarthrodial joint coincides with the centre of the socket, it is perfectly secure against luxation. What prevents a man from displacing the head of his humerus when striking an adversary, where force is applied at the distal end of the extremity in a manner not unlike that which occurs when a luxation takes place? Let us examine the mechanism of what is called "striking out from the shoulder." When the arm is drawn back preparatory to the blow, the scapula is carried towards the spine, and is enabled by the motion taking place at the acromio-clavicular joint to present its glenoid fossa forward, thus providing a firm bearing for the head of the humerus upon the centre of the socket. As the blow is delivered, the angle formed by the clavicle and scapula is rendered more acute, so that when the arm is fully extended, the side of the body being at the same time advanced, the centre of the glenoid fossa coincides with the long axis of the humerus. The proof of the necessity for this exact adaptation is seen when a man actually luxates his humerus when unskilfully striking a blow, as has been recorded in one instance.

Malgaigne asserts that muscular contraction cannot be much concerned in producing luxations, since a bone can be as readily displaced in the cadaver as in the living subject. The case quoted of luxation from striking a blow refutes this statement, as well as the impossibility of determining how much or how little force is exerted in producing displacement during life.

Displacements of the scapulo-humeral articulation occur chiefly in two ways, viz., from direct force, ie., a fall upon the shoulder; and from indirect force, i.e., a fall upon the elbow or hand when abducted, or at least partially abducted, as well as flexed or extended.

The mechanism in the first case is as follows. All are personally familiar with the fact that, in falling, a sudden spasmodic contraction of the muscles of the part which is about to strike the ground takes place, which is nature's effort to prevent injury. Thus the arms, in falling prone, are stretched out and made rigid to protect the head, etc. The effect of this contraction, when luxation is from direct force, is to draw the scapula towards the spine, whereby the glenoid fossa is compelled to face obliquely forward and outward; so that when the shoulder strikes the ground, instead of the glenoid cavity presenting its surface at right angles to the long axis of the head of the humerus, an inclined

plane is formed, along which the head of the bone glides, aided by the spasmodically contracted abductors, with an impetus that no ligament can resist, landing the bone in some portion of the axilla, varying somewhat with the direction of the force, and which muscles remain, in fact, to draw the bone into its new position. In the luxation upon the dorsum of the scapula, owing to the direction of the force, and the inability of the scapular head (glenoid fossa) to assume its normal position in time, the head of the bone is forced along an inclined plane in the reverse direction to that pursued in a displacement forward.

When indirect force displaces the bone, it acts still more advantageously, viz., there is a double lever action, which can be best understood by a reference to the diagram.

The spasmodic contraction of the muscles fixes the scapula, so that when the arm reaches its limit of abduction* the impingement of the greater tuberosity of the humerus against the under surface of the acromion process fairly forces the bone out of its socket. Thus, the point of contact of the tuberosity and the acromion is the fulcrum F', by means of which P, the power, or blow applied to the arm, is enabled to move W, the resistance, viz., it ruptures the capsule; this is a lever of the first kind.

But the contraction of the deltoid provides a second fulcrum, F, at its point of attachment to the humerus, which enables MM - the pectoralis major, latissimus dorsi, and teres major musclest-to overcome the resistance, W, or, in other words, to rupture the capsular ligament and drag the bone out of place; this is a lever of the third kind.

With such enormous mechanical advantages for displacement, no depth of socket or strength of ligaments could avail much.

In brief, this seems to be the correct explanation of the apparent ease with which the scapulo-humeral joint is displaced, although some points have been omitted which, in a minor degree, aid in its luxation. Sufficient, however, has been said to render the matter clear, it is hoped, and to show that it is not such a simple mechanical problem as it is usually thought to be.

* Combined with either extension or flexion of the humerus. Probably the infra-spinatus and teres minor aid.

Discussion.

The President, in opening the discussion, said that he believed that sufficient importance had not been attached to the action of the supra- and infra-spinatus muscles in studying the pathology of luxations. He referred to the experiments of Sir Astley Cooper, in which all the muscles of the shoulder-joint except the supra-spinatus were removed, and the head of the bone still remained in its socket. The method of reduction of luxations of the shoulder-joint by manipulation is dependent upon a knowledge of the action of these scapular muscles.

Dr. O. H. Allis said that, in his experiments upon the cadaver, he had not been able to produce luxations of the shoulder as readily as he could of the hip-joint. As the capsular ligament is thinner in the shoulder, it is evident that the muscles must play a very important part in the prevention or production of dislocations. In luxations, when the force is sufficient to carry the head of the bone out of its socket, the muscles are torn as well as the ligament, which shows that it is not the capsule alone that holds the bone in place. He had also noticed the occurrence of spontaneous reduction by muscular action after the failure of the attempts of a surgeon. Dr. Hamilton, in his work on fractures, reports such a case.

Dr. H. Leaman said that he had a case of axillary dislocation of the humerus of three months standing, and inquired whether it would be proper to make persistent efforts at reduction or not.

Dr. Henry H. Smith, from the chair, replied

that after the adhesions had been broken up, such a dislocation could generally be reduced with the greatest facility by manipulation. He mentioned the case of a muscular driver of a dray, who had sustained a dislocation of the humerus, and an attempt to reduce by Jarvis's adjuster had failed; he then used manipulation, and the reduction was readily accomplished.

Dr. Allis remarked that the character of the wound in the capsule would have much to do with the facility of reduction. If slit-like, as has been stated, it would furnish a reason for occasional failure in reduction.

Dr. Nancrede said that the muscles play a more important part in keeping the head of the humerus in its socket than the ligaments around the joint; indeed, the ligaments must constantly be somewhat relaxed to allow free circumduction of the arm. He then referred to the insertion of the muscles coming from the scapula, and their actions. Having learned the method of reducing dislocations of the shoulder-joint from the President, Dr. Smith, thirteen years ago, he had employed it ever since. He had failed once in a case of some duration, when he came to the conclusion that it had been complicated by fracture of the humerus.

As for the shape of the tear in the capsular

ligament, he had never dissected a recent dislocation, but could see no reason why it should be slit-like. It would more likely be the case that the sub-scapularis should be torn, and the tear in the capsule must then take place transversely rather than in the direction in which the force was applied. He had noticed in one case that atrophy of the deltoid followed a luxation which had been promptly reduced; this atrophy he explained through an involvement of the circumflex nerve, either in the original injury or by the subsequent inflammation. In illustration of the ease of reduction in some cases, he referred to a girl who came back to the Episcopal Hospital every few weeks to have her humerus put back into its socket. On one occasion she was unruly and tried to run away. The doctor caught her by the arm as she ran, and the bone slipped into place.

Dr. Charles H. Thomas presented a metric gauge, and made some remarks upon this convenient method of verifying the sizes of urethral instruments (see vol. ix. page 501).

Dr. W. B. Atkinson introduced Dr. Nardyz, of Greece, who exhibited a number of models of pathological objects prepared by a new process.

PATHOLOGICAL SOCIETY OF PHILADELPHIA.

THURSDAY EVENING, MAY 22, 1879. THE PRESIDENT, DR. H. LENOX HODGE, in the chair.

Specimens of contraction and dilatation of the orifices of the coronary arteries. Presented by Dr. FREDERICK P. HENRY.

J. Hospital on March 3, 1879.

M., a sailor, æt. 31, was admitted to the

He complained of a constant pain in the chest, on the right side, anteriorly, over the second intercostal space. At times there were exacerbations, during which the pain travelled down both arms. Besides this there were complaints of steadily increasing weakness and almost nightly seminal emissions. The man was unusually well developed as to his muscular system, but his skin was sallow and dirty-looking.

When about twenty years old he was subject to convulsions, of which no definite account could be obtained, and about ten years ago (i.e., when about twenty-one) had an attack of general edema. Eight years ago he had a chancre, and three years ago he was treated in the Episcopal Hospital for facial neuralgia, and again, a year after, for intermittent fever. For the last three years he has been subject to spermatorrhoea. He knew of no cause for his last illness, unless it was exposure to wet and cold, and straining in pulling the ship's ropes.

The chest was carefully examined on more than one occasion, especially over the seat of