THE 4ustrah'an Medical Yournal JANUARY 15, 1891. J_1 Socitty Victoria.

ADJOURNED MONTHLY MEETING. TUESDAY, DECEMBER 16, 1 8 9 O. (Hall of the Society, 8 p.m.) The President, Dr. JACKSON, occupied the chair, and there was a small attendance of members. Nominations of office-bearers for 1891 were received. The following paper was then read :- A CASE OF EMPHYSEMA, FOLLOWING SOME RUPTURE OF THE EUSTACHIAN TUBE. By AUGUSTUS LEO KENNY, M.B., B.S. J. II. B., aet. 32, married, Civil Engineer, residing in an adjoining colony, came to consult me on July 18, 1890. He complained of deafness of the left ear, which he had noticed for eighteen months. Previous history good, with the exception that he had had fever and ague, and had taken a quantity of quinine by way of treatment; lived in the open air, and took vigorous athletic exercise, such as rowing. With his right ear he could hear my watch at fifteen inches (it is ordinarily heard at five feet) ; with the left he could not hear it when placed in firm contact with the auricle. Ordinary conver- sation was heard with the right ear ; one had almost to shout in order to be heard in the left. The diapason (tuning fork), when placed on the vertex of his byskull, was heard equally in both ears, and no change was perceived the patient on blocking each ear alternately. On testing by Rinne's method, i.e., comparing the length of time during which the sound of the fork is heard when held close to the ear (aerial conduction), with that during which the sound is heard with the handle of the fork firmly pressed to the mastoid (bone c onduction), it was found that bone conduction was very good, thewhilst aerial conduction was defective, though more defective in right (fifteen seconds), than in the left ear (two minutes). By Gardiner Brown's method, i.e., placing the handle of the fork (vibrating) on the root of the nose, and holding it firmly VOL• XIII. No. 1. A 2 Australian Medical Journal. JAN. 15, 1891 there until the patient declares that the sound has ceased, then observing for what space of time you can feel the vibrations through the handle after the patient ceases to hear the sound, the hearing was perfect, no vibrations being perceptible after the patient failed to hear the sound. These tests showed that the deafness was not due to disease of the auditory nerve, but to disease of, or defect in, the conducting apparatus. On inspection, the right meatus was found plugged with cerumen. After this had been removed by syringing, the membrana tympani was seen to be somewhat opaque, the triangular shining spot clearly defined. The membrane moved freely with the use of Siegle's pneumatic speculum. The left membrane was slightly. opaque, indrawn (not strongly), and pale. The triangular spot was well seen, and the movements were fairly good with Siegle's speculum. Inspection of the nose anteriorly showed congested swelling of the right inferior turbinated body, and two spurs growing from the cartilaginous portion of the left side of the septum, about the level of the inferior turbinated body. The pharynx showed large granu- lations on the posterior wall. By posterior rhinoscopy, the middle and lower turbinated bodies on both sides were considerably hypertrophied, as also the superior on the left side ; they presented a polypoid appearance. The enlargements of the inferior turbinated bones caused considerable difficulty in the manipulation of the Eustachian catheter, so much so that it could not be passed into the left tubal orifice through the left nostril. The left tube and tympanum had to be inflated per catheter passed through the right nostril. The right tube was found to be free, but the left was constricted, and gave faint moist roles and gurgling sounds. The hearing was not improved by the inflation. With the galvan-o-cautery, I freely cauterised the enlarged posterior ends of the inferior turbinated bodies from the front, and also burned several of the larger granules in the pharynx. After three days, the use of the catheter was resumed, both tubes being inflated through the right nostril. Fine bougies were passed into the left tube per catheter, twice weekly. These were tightly gripped, but after their use inflation was performed more satisfactorily. On July 31, 1890, a catgut bougie was passed into the left tube as usual. At the end of consultation, patient made attempts JAL 15, 1891 A Case of Emphysema. 3

to inflate his tubes, according to Valsalva's method, using a great amount of force, and causing marked congestion of the head. About eight hours later I was called to see him. I found him semi-collapsed, with a grave sense of impending danger, dyspncea, intense constricting girdle-pain in the chest, about the level of the nipples, and a tendency to syncope. He and his wife told me that shortly after leaving my surgery a swelling suddenly appeared in the left side of the neck, below the ear, and behind the ramus of the lower jaw—this had increased both upwards and down- wards, and his present symptoms had come on gradually—had been more severe, but were now abating. Whilst examining, patient had an attack of syncope, which yielded to inhalation of nitrite of amyl (three minim capsule). Marked crepitation on palpation was observed, extending from some distance above the left ear down along the front edge of the sterno-mastoid, under- neath the lower jaw and the floor of the mouth, reaching as high as the right ear, extending across the front of the neck to the right s terno-mastoid, thence to the sternum, being there lost in the chest. It was thought some crepitation could be felt below the ensiform cartilage, but this was doubtful. There was, clearly, extensive emphysema of the subcutaneous cellular tissue, origina- ting in the neighbourhood of the left Eustachian tube, and 'extending into the inediastinum, mechanically interfering with respiration, and the heart's action. On examination, no laceration or rupture in the nose or nasopharynx could be detected, the point of entry of the air was evidently in the Eustachian tube, through a tear caused by the bougie, and enlarged by the patient's efforts, or possibly caused by those efforts. The patient was relieved by taking cardiac and respiratory stimulants, hot fomentations to the neck, boro-glyceride as a gargle and nasal douche. The emphysema gradually disappeared, underthough the slight chin. crepitation could be felt for some three or four days These cases are interesting because of their comparative rarity. I have never seen another such case, and very brief mention is made of them in the text-books. Hartmann, of Berlin, in his book on the Ear states that " alarming and even dangerous accidents may be caused by the catheter injuring the mucous membrane, and inflating the subjacent and surrounding tissues with air. This happens most frequently after passing bougies into the Eustachian tube. The emphysema produced in this manner extends to the A 2 4 Australian Medical Journal. JAN. 15, 1891

lateral wall of the pharynx, the soft palate, the uvula, and even to the glottis, sometimes extending also externally down the neck, even to the chest. Its symptoms are a feeling as of a foreign body in the throat, pain, difficulty in swallowing, and, in very severe cases, a choking sensation." I was not able to examine the patient's larynx ; probably there was oedema of the glottis ; there was no oedema of the pharynx. An element of anxiety existed on account of the possibility of the air in the cellular tissue becoming septic, as a result of the previous cauterisation of the turbinated bones. On several occasions since then I have bougied the tube, and inflated the tympanum, but have failed to detect any false passage. Dr. BARRETT said that Dr. Kenny had done good service in bringing forward such a case, on account of its great rarity. It brought up the question of the relative advisability of inflation by means of the Eustachian catheter, and by other methods. It was urged that by Valsalva's method, the ossicles might be dislocated, and the membrane thus rendered lax. He thought little of the objection, and was in the habit of using this method, but it should not be done violently. Dr. HOOPER mentioned that he had seen two cases of emphysema of the neck, coming on in the expulsive stage of labour in strong healthy women. Dr. KENNY, in reply, said that although many authorities condemned auto-inflation, he believed in it if done mildly. The advantage of the catheter was, that you could inflate one ear only.

The following papers were then read :- A CASE OF SYNCOPE DURING CHLOROFORM ADMINISTRATION. By JAMES W. BARRETT, M.D. A young man, pale and nervous, submitted to an operation for strabismus at the Victorian Eye and Ear Hospital. Dr. Gray operated, dividing both internal recti. There was no evidence of heart disease. There were present in the room, besides Dr. Gray and myself, Dr. Palmer of Ararat, and Dr. Gutheil, the house surgeon. For some time past I have noticed that during this operation the heart-beat is often slowed, and sometimes stopped during the JAL 15, 1891 Respiratory Failure during Chloroform Adminis. 5 hooking forward of the tendon, consequently I was more than "usually alert. I gave chloroform slowly and carefully until the conjunctivae were insensitive ; Dr. Gray then introduced the speculum into the right eye, when slight reflex squeezing of the lids took place. He proceeded with the operation, whilst I kept my finger on the pulse. Whilst he pulled forward and divided the tendon, the heart stopped for a period of certainly more than two beats—I judged it three or four beats. The face slightly blanched, but the breathing was not .affected. I drew the atten- tion of those present to the stoppage, and Dr. Palmer noted the pallor. The patient remaining under the antesthetic, breathing well, and heart beating normally, Dr. Gray introduced the speculum into the left eye, when, if I remember rightly, slight reflex contraction of the lids again occurred. Dr. Gray was dividing the tendon, when the heart and the breathing stopped, the face blanched, and all the appearances of fatal syncope were manifested. The head was immediately over-extended and lowered, nitrite of amyl inhaled, and forcible artificial respiration resorted to. Shortly the breathing and the heart action were resumed. The patient remained profoundly unconscious for some minutes (all ordinary reflex action being abolished), and did not perfectly recover for twenty-four hours, that is to say on the following day he still manifested tendency to syncope when attending at the hospital. In the light of recent events, I desire to place this case on record to show—(1) that whatever was the cause, the heart stopped before the respiration ; (2) that the division of the rectus was the exciting cause of the heart failure ; (3) that chloroform hadrefle xbeen to given to such an extent as to abolish the conjunctival speculum, the finger, but not to abolish some reflex to the

I know of no cases in which I regard chloroform more danger- ous than in the case of young, nervous, debilitated adults, during the squint operation.

A CASE OF RESPIRATORY FAILURE DURING CHLOROFORM ADMINISTRATION. By JAMES W. BARRETT, M.D. A boy, aged 7, was affected with a tumour of the larynx (papilloma), which grew over the rima glottis, caused dyspncea, and for which I performed tracheotomy. Some months later, 6 Australian Medical Journal. JAN. 15, 1€19$

I endeavoured to remove the tumour. Three methods were open to me—(1) The endo-laryngeal method, with chloroform. (2) The endo-laryngeal method, without chloroform. (3) The method of laryngo-fissure. The parents ruled (3) out of court, and I essayed (1). In the first instance, I determined to introduce the Mackenzie antero-posterior forceps in the midline, and seize the tumour. Dr. A. S. Aitchison gave chloroform for me. A mask was applied over the tracheotomy tube (for reasons. that need not here be. detailed), and a small quantity of chloroform was applied. After a few inspirations, the boy became unconcious, stopped breathing, and became livid, the heart continuing to beat vigorously. After a few anxious minutes of artificial respira- tion, he recovered, and shortly after came nearly out of the influence of the chloroform. Determined to make an attempt to remove the tumour, I introduced my finger into the pharynx, and examined the upper aperture of the larynx, when immediately laryngeal and thoracic expiratory spasms were induced. There was nothing novel in this, so I continued the examination till compelled to desist by the alarming lividity. Again some resort to artificial respiration was wanted. After waiting a time, a like• attempt was followed by a similar result, and the operation was abandoned. This case I take to be one in which a small quantity of chloroform introduced directly into the lungs, caused the failure of an abnormal respiratory centre. This abnormality was shown by the fact, that a moderate stimulus of the superior laryngeal nerve was more powerful to cause expiratory spasm, than the circulation of de-oxygenated blood through the medulla to cause inspiration. Dr. G. HORNE mentioned two cases within the last three weeks in which he had seen troublesome symptoms arise during chloro- form administration. In the first case he was administering the chloroform, whilst Dr. Cole performed circumcision, the patient being a very nervous young man. He became quite faint, and then his breathing stopped. Nitrite of amyl was used without benefit ; but after artificial respiration had been used for a few minutes, the patient came round. The other case was that of a nervous girl, to whom chloroform was administered for curetting the uterus. Her pulse stopped first, then the breathing. Nitrite• of amyl was again no good ; but the patient recovered when artificial respiration was performed. Jell. 15, 1891 Respiratory Failure during Chloroform Adminis.

Dr. BARRETT, in reply, said that he now thought that ether would have been better for the first case, and he was now giving ether to all such patients in whom the muscular system is generally deficient, and in whom the cardiac muscle is not up to the normal. He only brought forward the second case as showing that the inspiratory centre was very insensible to stimuli. Oita' xycittp of Victoria.

ORDINARY MONTHLY MEETING. WEDNESDAY, JANUARY 7TH, 1891. (Hall of the Society, 8 p.m.) Dr. JACKSON, President, in the chair. There was a large attendance of members. The minutes of the meeting, December 10, 1890, and the adjourned meeting, December 16, 1890, were read and confirmed. A letter from the Hon. Sec. of the Queensland Medico-Ethical Association was read, and on the motion of Dr. Neild, seconded by Dr. Le Fevre, was referred to the Committee. The HON. SECRETARY made a report with reference to the plebiscite, taken to ascertain the opinion of the members regarding the formation of sections. The time for returning these papers was extended for one month. Dr. George Shirres, M.D., D.P.H. Aberdeen, of the Board of Public Health, was elected a member of the Society. CORRESPONDENCE. A letter from the Hon. Secretary of the Victorian Branch of forthe amBritish Medical Association, with reference to the proposals algamation, was read. It stated, that at a Special General Meeting of the Members of the Branch, the following resolution was carried :—" That the Hon. Secretary be requested to write to the Medical Society of Victoria, asking its members to agree to some such basis of amalgamation as those mentioned in the enclosed circular, subject to another meeting of the members of them."the Branch notifying them, and the home authorities agreeing to The following are the proposals referred to :- (1) The Victorian Medical Society, to be called in future, the Victorian Medical Society (with which is 8 Australian Medical Journal. JAN. 15, 1891

incorporated the Victorian Branch of the British Medical Association). (2) All Members of the British Medical Association (Victorian Branch) to become Members of the Victorian Medical Society (without election). (3) An Assistant Secretary to be appointed to undertake (a) the distribution of the British Medical Journal, and (b) any other British Medical Association work that may be required. (4) Members of the Victorian Medical Society to take the British Medical Journal or not, just as they wish ; if they take it, they will pay about 1 ls. per annum for it. Dr. BARRETT explained that the action referred to in the proposals had been taken because the Committee had been informed that there was a very general desire on the part of members of the Branch to amalgamate the two Societies, and had thought it well, accordingly, to take the initiative. Clause 4 was to be improved. There was a project to continue the Victorian Branch of the British Medical Association as a section of the Society, no one to be a member without first becoming a member of the Society. Dr. BRETT asked the President or Secretary of the Branch, whether they had taken any steps to ascertain the legality of the step proposed to be taken. From experience of the Madras Branch, he thought the Council at home would not consent. We would have to give up being members of the Victorian Branch, and become unattached members of the British Medical . Medical Association. Dr. LE FEVRE, as President of the Victorian Branch of the British Medical Association, said that for the last two years he had felt that there was a great waste of time and energy in the separate meetings of the two bodies. For part of the year there had been bare quorums at the meetings of the Branch, difficulty in the proper supply of papers, practically the same members attending both meetings, the members of the Committee of one and the Council of the other were almost identical. The Victorian Branch were indebted to the Society for the use of the hall. Although very good progress had been made, and the number of members in eight or nine years of growth had reached 160, yet JAN. 15, 1891 Medical Society of Victoria. 9 many thought the Branch was not occupying the position it should. There were only sixty members of the Branch not members of the Medical Society, and it would be better that the brains, energy and money of the two Societies should be concen- trated. It was only the Presidents and Secretaries of the two bodies who could accurately judge of the hard work required to keep the two bodies going. Amalgamation would be of material help to the Medical Association financially, and in the good quality of the work done. On the authority of Dr. Henry, who had been instrumental in the formation of the Branch, he believed that the proposal would meet with the approval of the Home Association, even on the present basis. Dr. Henry had forwarded to the Council of the Association a statement of the whole scheme, and had recommended their acceptance of it. The motion carried at the Special Meeting still leaves the matter open to the Home Association and the Branch. The voting was almost unanimous in re commending the course indicated in the Honorary Secre- tary's letter ; there were two votes against, but he believed that they were given under misapprehension, and that such misappre- hension would be removed at the next meeting of the Branch. Dr. J. P. RYAN proposed, "That the action of the Committee in its efforts to amalgamate the two Societies be endorsed by the Medical Society." It was not necessary to refer to the unhappy incidents which caused the foundation of the Victorian Branch of the British Medical Association—that was due to misappre- hension, which, under other conditions, might have operated differently. -Unfortunately, there were troubles amongst the themembers at the time regarding admissions, &c., and this helped secession. The profession in the Colony was not numerous enoughh for two Societies. He trusted that the good sense of the the wishing conciliation would meet with success.; that formee tworly. Societies would join hands and work harmoniously as Dr. B ALLS-IlEADLEv seconded the motion. Medical men should be united. It was important legally, and the Colony was too small for two. independent Societies. to Dr. NEILD had no disposition to oppose the motion, but wished correct possible misapprehension of the remarks made by Dr. J. P. Ryan. There had been in no sense a secession in the formation of the Victorian Branch of the British Medical Association. Dr. Henry and himself had instituted the Branch 10 Australian Medical Journal. Jew. 15, 1891

because there had been a long expressed desire for it, on the grounds that it would be advantageous to be connected with such a great organisation, and because the British Medical Journal could be the more easily obtained. Whatever differences might have existed in the Medical Society, the foundation of the Branch was merely coincident—those who met to form it, with one exception, were members of the Society—none seceded. Two or three years later there was a desire to associate with the Medical Society, but the proposal made by the Branch was not favorably received. Since then the Branch had gone on well and fairly. There was no antagonism, and no opposition. He was glad than the overtures in the present instance came from the Society. He was not aware that anything had been said in the Branch, desiring to amalgamate, for some time—the urgency for such a step had not made itself apparent—hence this movement took him by surprise. He was indisposed to support an amalgamation involving the sinking of the individuality of the Branch. Inasmuch as the Branch was part of a very large Association, he did not think it fair that the Branch should be told that it was in its own interest that it should be fused in the Medical Society. The Branch was going on fairly and satisfactorily, and there was nothing obligatory to make it fuse. He did not see that fusion, admitting that it was highly desirable on both sides, was easy. There were many difficulties. The rules of the two Societies provide for distinctly different forms of government and of organisation. He would express his approval of the idea of amalgamation, but would refer the details to some special meeting of the Committee of the Medical Society with the Council of the Victorian Branch of the British Medical Association. Dr. J. P. RYAN was clad to be corrected by Dr. Neild as to the origin of the Victorian Branch of the British Medical Association, and to and that the feeling which he feared existed did not exist, and never had existed. Dr. NEILD said that if the motion were carried, the matter should be referred to the Committee of the Society and the Council of the Association, whose report should be referred to a general meeting of the two Societies. Dr. GRANT spoke in support of Dr. Neild's suggestion. Dr. KENNY said that the matter, as it came from the British Medical Association, did not bind them to anything, nor was Dr. Ryan's motion binding. It seemed that the proper course would it JAR. 15, 1891 Annual Report. be to carry Dr. Ryan's motion, then Dr. Neild's proposal could be considered. Dr. Ryan's motion was then put to the meeting, and carried nem. con. Dr. NEILD then moved, and Dr. GRANT seconded, a resolution to the effect that the matter be referred to the Committees of the two Societies, which was carried. The SECRETARY then read the Report of the Committee for the year 1890 as follows :— REPORT OF COMMITTEE FOR 1890. The Committee have again to congratulate the members on the steady progress made by the Society in all directions, and look back with satisfaction on a prosperous year. The Society now numbers 22 life members, 192 ordinary members, 15 corresponding members, 12 honorary members- 241 in all. During the year 17 new ordinary members have been elected, two ordinary members have become life members, three more corresponding members, and one an honorary member. Death has removed three names from the roll, non-payment of subscription has been the cause of the erasure of another name, and three have resigned. When it is remembered that during 1890 the subscription was raised to £2 2s., the condition of affairs indicated may be regarded as thoroughly sound. The Society is thus in receipt of an incom e of over £400 per annum, and the increase of the subscription and issue of the Journal to members has proved to be a wise change. th There have been 11 meetings (and one adjourned meeting) for e transaction of scientific business, at which the average attendance has been 18. At these meetings, the following business has been transacted.. Papers have been read on the following subjects : " Punctured Fracture of the Skull," by Mr. Girdlestone. " Uterine Fibroids," by Dr. Carnegie McMullen. Intussuseeption," by Dr. G. S. Ryan. " Some Skin Diseases," by Dr. Stirling. " Removal of a Pharyngeal Tumour," by Mr. Girdlestone. " Abdominal Hydatids," by Dr. Duncan. " Porro's Operation," by Dr. Rothwell Adam."

12 Australian Medical Journal. JAN. 15, 1891

" Foreign Bodies in the Eye," by Dt. J. W. Barrett. " Influenza Epidemic," by Dr. J. P. Ryan. " Bacilluria of Roberts," by Dr. Ross. " Chole-cystotomy," by Dr. Balls-Headley. " Chole-cystotomy," by Dr. C. S. Ryan. Chole-cystotomy," by Dr. Moore. " Chloroform Administration," by Dr. J. W. Barrett. " Rupture of the Eustachian Tube," by Dr. Kenny. The following papers were read as introductory to a discussion : " On Removal of the Tongue for Epithelioma," by Dr. Moore. " On Removal of the Tongue for Epithelioma," by Dr. Duncan. In addition, the Society (in conjunction with the British Medical Association) assisted Dr. Gresswell to frame a circular to the profession on the subject of the influenza epidemic. Cases have been exhibited as follows : Excision of Clavicle, by Dr. F. D. Bird. Excision of Astragalus, by Dr. F. D. Bird. Excision of Tongue, by Dr. Moore. Removal of Mastoid, by Dr. J. W. Barrett. Excision of Hip, by Dr. C. S. Ryan. Fracture of Patella, by Dr. C. S. Ryan. Goitre, by Dr. Hooper. Porro's Operation, by Bothwell Adam. Gun-shot Wound of Jaw, by Dr. Moore. Paralysis of Thumb Muscles, by Dr. F. D. Bird. Pathological Exhibits by Dr. Hooper, Dr. Syme, Dr. Barrett, Dr. Duncan, Dr. Moore, Dr. Woinarski (Ballarat), Dr. Cowan. Exhibits of Instruments by Dr. Hodgson and Mr. Lewis. The continuation of the practice of initiating discussions has proved of interest, and its success indicates a line of action to be taken in future. In addition to the meetings at which this business was transacted, and the Annual Meeting, three special meetings were held, at one of which a paper was read by Dr. J. W. Barrett, on " The Abuse of the Hospital System." At this meeting members expressed themselves freely on the subject of the loose manner in which the hospitals were managed, and a Committee was formed to formulate conclusions. These conclusions were adopted at another special meeting, and made public. It is satisfactory to note that the Charitable Commission has, in its progress report, to some extent endorsed these conclusions. At the second special meeting, the question of Government Medical

JAN. 15, 1891 Annual Report. 13

Fees was discussed. At the third, the question of the prevention of the formation of Special Societies, by forming Special Sections of the Society, was discussed with much vigor. The matter is still sub judice. Yet again the Committee has to report that the Amending Medical Bill is still existent on paper only. The late Government adopted the Bill drafted by the two Societies, with some modfica- tions (courteously consulting the Societies in connection with it), introduced it, had it read for the first time, and circulated ; then the Government went out, and the Bill took its place with the slaughtered innocents. The completion of Dr. Neild's work of twenty-seven years will be deferred further. However, for the first time, a Government has adopted the principle contended for— that the public have a right to know the practitioner who has been properly trained from him who has not been so trained. The matter now before the Society is one of great import, viz., the desirability of amalgamating the Victorian Medical Society and the Victorian Branch of the British Medical Association. Both Societies have identical objects, the latter being virtually a Victorian Medical Society, which distributes the British Medical Journal. It meets in the Hall of the older Society, publishes its proceedings in the official organ of the older Society, and most of its members are members of, and its office-bearers officers of, the Victorian Medical Society, and under these circumstances it is felt that force would be conserved, and the prospects of the future of medicine here materially improved, if an amalgamation could be effected. If fused into one extremely powerful Society, the result can but be beneficial to all. attendanceThe Committee has met 12 times during the year. The has been as follows :— Dr. Jackson (absent through Dr. Balls-Headley illnessllness durin 5 g part b the year) of Dr. Grant 8 8 Dr. Girdlestone 8 Professor Al len(alasent in Dr. Moore Europe) 11 0 Dr. Meyer Dr. Hinchcliffe 0 Dr. Neild 12 Dr. Le Fevre Dr. Webb 4 Dr. Syme 6 7 Dr. J. P. Ryan 10 Dr. Barrett 12 Dr. C. S. Ryan Dr. Adam 3 4 Dr. Williams Dr. F. D.Bird 4 (absent through illness) 1 14 Australian Medical Journal. JAN. 15, 1891

The Committee, in conclusion, trusts that the foregoing report, embodying as it does the record of substantial progress, will be accepted as an evidence of the headway a scientific Society is making in a practical and work-a-day community. On the motion of Dr. NEILD, seconded by Dr. BRETT, the Committee's Report was adopted. The LIBRARIAN'S Report was then read by the Secretary. LIBRARIAN'S REPORT. I am happy to be able to state that the Library progresses as satisfactorily as it has done for the last eight years. Our set of British Medical Journals is all but completed, and several additions have been made during the last year to the collection of illustrations and plates. I have the honour to acknowledge the following donations :—Royal Medical Chirurgical Society, Photos. and Transactions ; Clinical Society, Transactions ; Obstetrical Society, Transactions; Baron von Mueller, Journals; Mr. Hayter, Reports. Dr. Daish £1 Is., Dr. Lawrence £1 ls., Dr. Howard £1, Dr. Kenny £1 ls., Dr. Owen £1 ls., Dr. Hooper £1 Is., Dr. Horne £1 ls., Dr. Laycock ls., Dr. Brett £1, Dr. Snow- ball Cash for Books £2 2s., Sydenham Society £7 Os. 9d. Dr. NEILD, in a eulogistic manner, proposed the adoption of the Librarian's Report, which was seconded by Dr. LE FEVRE, and carried by acclamation. Dr. LE FEVRE then read the Treasurer's Report for the past year. TREASURER'S REPORT. Mr. PRESIDENT AND GENTLEMEN,—I have the honour to submit for your approval a statement of accounts for the past year, and a balance-sheet showing the position of the Society on December 31st, 1890 :— The Treasurer in account with the Medical Society of Victoria for the year ending 81st December, 1890. Dr. I' R. d. To Balance from 1889 .. 61 18 5 „ Subscriptions and Entrance Fees 322 4 6

£384 2 11

Cr. s. d. By Interest on Debentures .. • . 4 16 0 „ Insurance.. • • . • 1 0 0 , Repairs to Hall .. • • • . 3 0 0

JAN. 15, 1891 Annual Report. 15

s. d. By Gas .. 3 15 1 „ " Caretaker's Salary and Household Sundries .. 20 4 0 Stillwell and Co., for Printing and Postage 222 11 6 Detmold, for Binding, &c. 20 9 7 Periodicals and Freight .. 43 19 0 )9 Furniture .. • 19 13 0 Petty Cash, per Secretary and Treasurer 7 4 6 ,, Stamps in hand .. 0 4 6 Rates .. 5 5 0 Sydenham Society 1 6 0 ,, Cheque Book .. 0 8 4 Exchange .. . 0 3 0 Cash overpaid into Bank by Treasurer 0 2 0 ,, Balance, Cash in Bank .. 30 1 5

£384 2 11 Audited and found correct, P. B. BENNIE, Auditor. BALANCE SHEET, DECEMBER 31ST, 1890. ASSETS. s. d. By Hall and Furniture .. 1000 0 0 ,, Subscriptions in Arrears 207 18 0 Cash in Bank .. 30 1 5

£1237 19 5 LI X s. d. To Debentures Outstanding 280 0 0 „ Interest Due .. 31 13 0 „ Balance in favour of Society .. 926 6 5

£1237 19 5 Audited and found correct, P. B. BENNIE, Auditor. The present holders of debentures are :- Dr. Balls-Headley Barker 5 Dr. 0. V. Lawrence •• 5 Mr. Bowen 2 „ Le Fevre .. • • 1 „ FitzGereld .. 5 „ MacGillivray •• 10 5 mMer RudiRcal all • • ,, A. S. Gray .. 2 .. E. M. James 5 Benevolentnevolent Society .. 12 The Hall and Furniture are set down in the balance sheet at the low valuation of £1000. Though the Society cannot realise been spent in building and furnishing. With regard to subscriptions in arrears, many members have been accustomed to pay their subscriptions for the previous year at each annual meeting, though, by the rules of the Society, subscrip-

16 Australian Medical Journal. JAN. 15, 1891

tions are due on the first day of the year, in advance. As the Society has now increased its current expenses, in order to supply members with the Australian Medical Journal, it will be necessary in future to collect subscriptions early in each year. GEO. LE FEVRE, M.D., Treasurer. Mr. C. S. RYAN proposed, and Dr. ADAM seconded, the adoption of the Report, which was carried unanimously.

ELECTION OF OFFICE-BEARERS. The following were then elected office-bearers for 1891 : —Presi- dent, Dr. Hinchcliff ; Vice-Presidents, Professor Allen and Mr. C. S. Ryan ; Hon. Treasurer, Dr. Le Fevre ; Hon. Librarian, Mr. J. H. Webb; Secretary, Dr. J. W. Barrett; Members of Com- mittee—Drs. Adam, Balls-Headley, F. D. Bird, Girdlestone, Grant, Jamieson, Jackson, Neild, J. P. Ryan, and Williams ; Auditors, Drs. Barker and Bennie. Dr. JACKSON then introduced the President-elect, and vacated the chair. Dr. HINCHCLIFF, on taking the chair, said that he very highly esteemed the honor which had been conferred upon him, and though he was not resident in Melbourne, he would endeavour to do his duty to the Society, and, if possible, to do credit to himself and to the Society generally. He then called upon the retiring President (Dr. Jackson) to read his address.

PRESIDENT'S ADDRESS. GENTLEMEN—On this the completion of my year of office, I am glad to think that the Society, now in the thirty-sixth year of its existence, is in the enjoyment of a sound vitality, and that nothing has occurred during the past twelve months to mar its prosperity or to hinder its progress. I am pleased to congratulate the Society upon a steady increase in the number of its members, and the absence of any kind of defection. The papers submitted and discussed have been all of them excellent, both in the matter and the manner that have characterised them, and there has always been, on the occasions of our meeting, a dispassionate manner of debate, indicative of genuine scientific earnestness. There has clearly been a con- viction that we come together for mutual benefit and instruction, studiously avoiding display, and foregoing the opportunity for mere argumentation to secure victory.

JAN. 15, 1891 President's Address. 17

Our library, under the enthusiastic management of Dr. Webb, has been, as heretofore, enlarged and improved, so that, now, we possess such a collection of medical works of reference as probably is unequalled on this side of the Equator. I regret to say, that our hopes of an amendment of the Medical Act have again been dissipated. The late Government took up the questionL with an apparent determination to carry it through egislature, and, but for the political changes which brought a new Government into existence at the end of the session, we should, I think, at this moment have been enjoying the benefit of an Amended Medical Act, for which very desirable piece of legislation we have been waiting these twenty-six years. It is not to be expected that the present Government will take up the work of medical reform commenced by their predecessors. In common with most Governments, and, unhappily, with the bulk of the community, they are supremely itdifferent is for on the subject of medicine as a profession. Apparently, every man to use his own judgment, such as it is, determinin in g how or by whom he will be treated. Indeed, some legislators, in a burst of cheap generosity, have declared, not only that an unqualified pretender is as competent to treat disease as an educated practitioner, but that he is probably the superior of this latter. It would almost seem as if your quack were heaven-born, and came into the world with a mission to bless mankind, which mission education would only impair. Consequently, whenever it has been urged upon the Legislature by the profession that the Medical Act only imperfectly served the end it is theoretically understood to fulfil, the taunt Las generally been ready at hand, that we were only fighting to obtain and to conserve privileges for ourselves, and that with the public weal we had no concern. Even if this latter imputation had any basis of truth, I do not know that we have any less right than those of other callings, whose privileges are secured by law, to. make sure of the advantages it has cost us so much to obtain. But, as we of this guild quite well know, the interests of the , public are much more closely involved in the obtainment of an Amended Act than are our own. The public require to be saved from themselves. They have, of course, the abstract right to adopt and to undergo any form of medical treatment they please, but it is only due to them that they should know who those are to whom they resign themselves for treatment ; and it is substan- is 18 Australian Medical Journal JAN. 15, 1891 tially only thus much that is asked for, namely, that the unqualified charlatan shall be known to be a charlatan, and shall not sail under the stolen colours of those who have undergone the severe educational training which, at this day at least, is imperative to all who desire to pass through the recognised portals of the pro- fession. We have been engaged, and indeed a good deal exercised, during the year in matters relating to the charitable institutions of the colony. It was necessary that some of the evidence taken by the Charities Commission should be medical evidence, and accordingly this Society was invited to send representatives to furnish such special information as they only could tender. A principal subject of inquiry on these occasions was furnished by the Melbourne Hospital, and the declared necessity for its removal, or its re-building. Almost of necessity, there was a differ- ence of opinion on this question, and I am not sure if the difference was not to be explained, in some measure, on the grounds of personal preference, if not of prejudice. As the original charitable institution of the colony, the Melbourne Hospital necessarily claims prominent consideration, and as it is confessedly the most important metropolitan charity, its condition necessarily has a peculiar interest. It need hardly be said that the leading hospital of Victoria should be as far as possible perfect in its appointments, and that both its arrangements and its organisation should be in accordance with the most recently accepted improvements in hospital requirements. It is nobody's fault that the Melbourne Hospital is not in entire accordance with modern hygienic conditions. It has been built piecemeal, as occasion required, and it is no reflection upon those who, from time to time, constructed it, to say that it does not now fulfil the demands of hospital needs. But it is certain that it has outlived its term of existence, and whether the new Metropolitan Hospital shall be built upon a site removed from the present one, or be rebuilt upon the site where now it stands, may be a question for considera- tion. Remembering the hourly necessities which arise for the immediate reception of cases, both of accident and disease in a large city like this of Melbourne, it is certainly well to inquire how far the inconvenience of distance from the present situation may be balanced by the advantages of improved location. The oft-quoted example of St. Thomas' Hospital, London, may be again referred to. The collective medical science of England Jex. 15, 1891 President's Address. 19

decided in favour of the institution being rebuilt within the metropolitan area, instead of its being taken away to a suburban neighbourhood, which, if greatly hygienically preferable to its original situation, would render it of subordinate use as a means of prompt relief. No doubt the facility of communication between different and even distant points of the metropolis in this city, should have some weight as an argument in determining the removal of the site, as well as that of the building ; and the contiguity reco of the suggested site to the University, has no doubt its mmendation, in that at least one of the purposes of the hospital is to supply the opportunity for study to the students of our Medical School. In connection with the subject of hospitals, has come up the question of charitable relief generally. With institutions other than those devoted to the treatment of disease and accident, we have, as a profession, no concern, but inasmuch as the larger portion of the charities of the colony are hospitals, and as hospitals cannot exist without medical officers, we are therefore interested in the maintenan ce of that sort of supervision which shall ensure that the recipients of relief deserve what they obtain. I am obliged to confess that there is good reason for believing that at least half of the patients at our hospitals are undeserving of the gratuitous benefits they demand, and that the charities of the commoncolony are,b to a large extent, an unnecessary burden upon the enevolence. And in thus specifying the nature of the unmerited claims preferred, I do not include that class of unfor- tunates whose distresses are traceable to improvidence and self indulgence. For the destitute man, however his destitution may have been caused, is an object of commiseration, and as such is entitled to relief. But besides this large class of self-created paupers, there is another class, who, while possessing sufficient means of maintenance, and never denying themselves even the luxuries which abundant wages enable them to obtain, do not scruple to take advantage of charitable relief in whatever way thebestowed. habit of And multiplying yet, in the face of this obvious practice of imposture, institutio charitable funds, and so-called benevolent n s goes on. The system is a distinctly pauperising one, and the medical profession are perpetually called upon to aidtoo in supporting it. I am sorry to say that medical men often lend themselves in the furtherance of such demoralising efforts, and it is because they do so lend themselves that pseudo- B 2 20 Australian Medical Journal. JAN. 15, 1891

philanthropists persist in extending the work whose effect is only to deaden self-reliance, to discourage self-effort, and, indirectly, to create the belief that thrift and prudence are superfluous qualities. It must so happen, because possibly well-intentioned, but certainly ill-advised, persons provide means of sustenance and relief, im- posing no conditions in the way of their obtainment. Not entirely unallied with the system of medical relief, as sup- plied by our charities, is the practice of medical attendance upon members of friendly societies. This question also has been the subject of lively discussion during the past year. It is not to be expected that the club-patient will ever admit that he receives the equivalent of attendance for his contribution to his club-doctor. He belongs to a class who demand much, and give as little as possible in return. And as there is an eager competition for these offices of club-doctor, it is hardly to be wondered at if the general conclusion outside the profession should be that the advantages of club-practice are on the side of the profession. But the truth is, that the friendly societies are absolute masters of the situation, and they consequently dictate terms which they know must be accepted. It is certain that the profession is overcrowded, especially in the metropolitan district, and to young men com- mencing practice in the widely-extending suburbs of Melbourne, there is virtually no option in the taking of clubs. A beginning has to be made somehow, and the beginning is accordingly made very often under circumstances which involve a renunciation of self-respect, not only because the remuneration for the services rendered is inadequate, but especially because the relations between medical man and patient are not, as they should be, those of guardian and friend, but of tyrannical master and unwilling, if obsequious, servant. I think few influences have more signally tended to degrade the dignity of medicine than club-practice as it obtains in this part of the world. And there seems to be no remedy for the evil, nor can there well be, so long as the office is contended for by competitors whose condition is that of the apothecary in "Romeo and Juliet," when he consented to supply that impossible poison which acted with such unaccountable rapidity upon the purchaser. Much has recently been said concerning paying hospitals and private hospitals. There can be no question that many cases, especially surgical cases, cannot properly be treated in private houses. They require special conditions, suitable appliances, and JAL15, 1891 President's Address. 21

skilled nursing, which in their completeness and sufficiency, can be obtained only in a hospital of some kind. The endeavour has been made to obtain such advantages for the better class of patients, in hospitals originally intended for the reception only of the needy edy and the destitute. But there are many objections to devoting charitable institutions to this purpose, and, consequently, there have been established several private hospitals, some of which fulfil their purpose very well. It is a matter for con- isiderationn how far it might be preferable to aggregate such cases One large building, rather than to distribute them in smaller structures. It is certain that the very natural and reasonable desire for privacy, rather favours the latter method. At the time, there are advantages in a large and well appointed building, uullding, arranged according to the latest and best hygienic principles, which commend themselves to careful attention. any case, that would seem to be a judicious provision in the 'abbe Health Act, which contemplates the official inspection of private hospitals. For it is easy to see how establishments of this kind might be ill-directed, and therefore, much abused. For is a no mystery and no secret, inasmuch as recent disclosures have d emonstrated it, that some persons in this city receive into quasi-hospitals pregnant women for abortion purposes. The need for the regular inspection of such establishments is, therefore, obvious enough. In the beginning of the year, the new Public Health Act came into operation, and the Board of Public Health commenced to exercise its functions. Both the statute and the corporate body represented a new departure in public hygiene in this city. The compositionnatur of the Board, especially, was an innovation in the e of an e s xperiment, for, whereas previously this body had con- leistedf of persons selected by reason of their presumed special know- dge of hygiene, the new act provided that it should be composed persons re presenting and elected from and by the municipal councils of the colony. The chairman, too, was chosen apparently for the reason that he had given no special attention to hygiene, but had been engaged during all his official life in the department of education. As a set-off, however, to this curious disregard of the principle of particular fitness, the Act provided for the engage- ment of a recognised expert in sanitary science, who should not only be the adviser and executive officer of the Board, but who should be a member of it, taking part in its proceedings, and 22 Australian Medical Journal. Jim 15, 1891 sharing in its decisions. And I wish here to say, that in the selection of Dr. Gresswell for this very important office, the Government have been exceptionally fortunate, for not only did that gentleman come to us with the very highest recommendations, but he showed immediately on his arrival that he possessed both the knowledge and the ability necessary to fit him for the duties he had to perform. He has been with us only a twelvemonth, but he has made himself so well-known by the intelligent activity with which his work has been done, that he is already one of the most notable of our public men. And his functions have been exercised with tact, prudence, and a courteous consideration for the feelings of everyone with whom he has been brought in contact. Moreover, he at once identified himself with the profession of which he is so distinguished member, and showed an eager desire to act with us in the important labour he had been commissioned to execute. I dwell especially upon this readiness of Dr. Gresswell to associate himself with the brotherhood of medicine, inasmuch as it has not been the invariable practice of those coming hither from the old country, to do expert work, to recognise in those of the same craft as themselves, confreres and associates. Dr. Gresswell has a stupendous undertaking before him. He has to rescue a new city from the perils of filth-diseases. He has to persuade a people sunk into indifference to nearly all health conditions, that dirt in its larger meaning is the potential factor of untold calamities. He will have to be an apostle of physical purity, preaching for ever the evangel of that grace which is placed next to godliness. And in this crusade against misplaced matter, he has the good wishes and the goodwill of all truly good men and women. The progress of medicine beyond the sea has, for some time past, appeared to centralise in the declared discovery of a cure for phthisis. Dr. Koch's name has been so conspicuously and honour- ably associated with the etiology of tuberculosis, and his claim to the merit of having determined the existence and the operations of the bacillus upon which tuberculous disease depends, that any declaration coming from him was, of necessity, received with atten- tion and respect. When therefore, we were informed that he had de- termined the method of arresting the progress of the patho-genesis due to the presence of this microbe, the attention of the scientific world. here as well as in Europe, was at once arrested. That the public should eagerly accept the assurances conveyed in fragmen-

Ij JAN. 15, 1891 President's Address. 23

tary telegrams, that consumption was no longer to be ranked among the opprobria nzedicor um, was, if not logical, at any rate not unnatural The belief in specifics has always been a fixed article of the common creed. From the time when Naaman thought that his leprosy ought to be healed by the prophet Elijah striking his hand over the place, there has been a general belief in the magic of specifics. It is, therefore, nothing surprising that the whole world should have been moved by the supposed discovery of a specific for phthisis. But we are yet virtually in the dark as to what the specific is, how it operates, or to what extent it can accomplish all the good that is claimed for it. Its discoverer has given, as yet, but an uncertain sound as to its power in neutra- lising the activity of the causative microbe ; and even supposing that it possesses some of the powers claimed for it, it would appear as if its potency were limited by many conditions. It does not seem to possess, nor is it declared to possess, a prophylactic influence such as we associate with the exhibition of the vaccine virus. Nobody, of course, would venture to charge the discoverer of this tuberculo-bacillicide with insincerity, or disingenuousness in putting forth this project before the world; but it is hardly too much to say that it would have been well if so illustrious a scientist as Dr. Koch had pursued his investigations a little longer in private before speaking so confidently of victories that are yet, as it would seem, unaccomplished. A discovery, which is only in the stage of experiment, cannot justly be reckoned as a scientific truth. It is easy to predict success from imperfectly formulated data, but it is not so easy to make the success clear, however much of hopefulness there may be in the minds both of an inventor and of those who look to be benefited by the inven- tion. The utmost we can say, therefore, with reference to Dr. Koch's anti-tubercle " lymph " is, that so eminent a pathologist is well entitled to the respectful attention of patient waiting. I have mentioned, incidentally, the subject of vaccination, and as within the last few days a vessel has entered our chief port, with a crew suffering from small-pox, it is right that I should speak further on a question which has also come before the Public of this colony, quite lately in connection with the arrival from England of a person suffering from the anti- Vaccination craze. This is a mental twist, which shows itself in periodical outbursts in the old country, among a certain class of the community, who discover a passion or an eccentricity, which

24 Australian Medical Journal. JAN. 15, 1891

prompts them to oppose existing institutions of approved utility. I should offer an affront to this Society if I were to make any reply to the statements of persons so ill-informed in the history of preventive medicine, as to deny the efficacy of vaccination, and to question the blessings which its adoption has conferred upon mankind during the last hundred years. Jenner's discovery was one of those facts which it is a confession of deplorable ignorance to doubt. It has been asked by those in authority, that this Society should meet to consider the objections preferred by a person ignorant of medical science, against the system of enforced vaccination. It might as reasonably be asked of us, that we should assemble to refute Harvey's discovery of the circulation of the blood, or to carry a motion, that Newton was in error on the subject of gravitation. Reverting back to our own private affairs as a Society, it has been proposed that a fusion should be effected between the Medical Society of Victoria and the Victorian Branch of the British Medical Association. It should not be impossible, and it is probable, that such a union may come about, but the matter, it would seem, can hardly be finally settled without reference on the part of the Branch to the central governing body of the Association. It is certain that there is no real antagonism between the two societies; their objects are identical, they meet under the same roof, and there is practically no difference in their procedure. It has been long thought that the two bodies might become substantially one without any necessary surrender of their several individuality. No doubt some little difficulty presents itself in the way of accomplishing this latter provision, but whether we fuse or we continue in our separate existences, we can harmoniously work towards a common end, our purpose being to benefit the science we practise, and to help each other by an interchange of thought and the record of experience. In ceasing to occupy the chair of this Society, I have again to thank you for the honour to which you advanced me when you elected me to the office of President. I am deeply sensible of the goodwill which that election evinced, and I trust I may al ways merit the favour you have exhibited towards me, and deserve the respect and confidence of which it is my hope always to be worthy.

The President, Dr. HINCHCLIFF, in proposing a vote of thanks to Dr. Jackson for his address, said he was sure no one would JAR. 15, 1891 Roll of Members. 25 differ from the remarks so clearly made on the subjects touched upon. He himself was particularly in accord with the views expressed, more especially with regard to the relations of the pro- fession to the public, and especially with reference to lodges. Dr. J. P. RYAN seconded the proposal, and said that Dr. Jackson had conducted the affairs of the Society in a noble manner. His year would also be noted for the hospitality with which he had treated the members of the Society. Dr. JACKSON thanked members for the cordial manner in which they had received his address. The ordinary business being concluded, members were entertained by Dr. Jackson at a social gathering, in the ball of the Society.

ROLL OF MEMBERS. The following is the roll of members up to December 31, 1890. Asterisks are placed before the names of those who have been Presidents :— LIFE MEMBERS. *Balls-Headley, Walter, M.A., M.D. et C.M. Cantab., M.D. Melb., F.R.C.P. Lond. Barrett, James William, M.D. et M.S. Melb., F.R.C.S. Eng., Collins Street. Bird, Frederick Dougan, M.B. et M.S. Melb., M.R.C.S. Eng., Collins Street. *Bird, Samuel Dougan, M.D. St. A. et Melb., L.R.C.P. Lond., M.R.C.S. Eng, L.S.A. Lond., Collins Street. *Bowen, Thomas Aubrey, L.K. et Q.C.P.I., M.R.C.S. Eng., Collins Street. Burke, Stephen John, M.R.C.S. Eng, L.K.Q.C.P.I., Victoria Street, North Melbourne. *Cutts, William Henry, M.D. Ed. et Melb., L.S.A. Lond., Auburn Road, Hawthorn. Cutts, William Henry, jun., M.B. et B.S. Mello., Oakleigh. *Fetherston, Gerald Henry, M.D. Melb., L.R.C.P.Ed.,L.F.P.S.G., L.A.H.D., High Street, Windsor. *FitzGerald, Thomas Naghten, F.R.C.S.I., Lonsdale Street. Fletcher, Arthur Augustus, M.D. et B.S. Melb., M.R.C.S. Eng., Lygon Street, Carlton. *Haig, William, M.D. Maryland (U.S.), Bank Street, South Melbourne. 26 Australian Medical Journal. JAN. 15, 1891

*Hewlett, Thomas, M.R.C.S. Eng., L.S.A. Lond., Nicholson Street, Fitzroy. *Jackson, James, M.D. Lond. et Melb., M.R.C.S. Eng. Lawrence, Octavius Vernon, M.D. et Ch. B. Melb., Brunswick Street, Fitzroy. Maclnerney, James Richard, L. et L. M.K.Q.C.P.I., L.R.C.S.I. et L.A.H.D., Brunswick Street, Fitzroy. *Moloney, Patrick, M.B. Melb., Collins Street. Morton, Francis William Watson, L.R.C.P. et S. Ed., L.M. Ed., Brunswick Street, Fitzroy. *Neild, James Edward, M.D. et B.S. Melb., L.S.A. Lond., Spring Street. Penfold, Oliver, M.R.C.S. Eng., L.S.A. Lond., Sandhurst. Webb, John Holden, M.R.C.S. Eng., L.R.C.P. Lond., Exhibition Street. ORDINARY MEMBERS. A'Beckett, William Goldsmid, M.R.C.S. Eng., L.S.A. Lond., Wellington Street, St. Kilda. Adam, George Rothwell Wilson, M.B. et Ch. M. Ed., Collins Street. Aitchison, Alexander Smith, M.B. et Ch. B. Melb., Merton Street, Albert Park. Aitchison, Roderick, M.A. ; M.B. et Ch. B. Melb., Chapel Street, Prah ran. Allen, Harry Brookes, M.D. et B.S. Melb., Melbourne University. Alsop, Thomas Osmond Fabian, M.B. et Ch. M. et L.M. M.R.C.S. Eng., Bur wood Road, Hawthorn. Anderson, Alfred Victor Millard, M.B. et B.S. Melb., Alfred Hospital. Anderson, Eugene Wilton, M.D. Melb., L. et L.M.R.C.S. et L.R.C.P. Edin., Burwood Road, Hawthorn. Anderson, James, L. et L.M.R.C.P. et S. Ed., L.F.P.S.G., Footscray. Anderson, T. C., M.A. ; M.B., C.M. Aberd., Footscray. Annand, George, M.D. et B.S. Melb., M.R.C.S. Eng., L. et L.M.R.C.P. et S. Ed., High Street, St. Kilda. Armstrong, William, M.D. et B.S. Melb., Brunswick Street, Fitzroy. Astles, Harvey Eustace, M.D. St. A., F.R.C.P. Ed., Collins Street. Backhouse, John Burder, M.B. et B.S. Melb., Bay Street, Brighton. JAN. 15, 1891 Roll of Members. 27

Bage, Charles, M.D. et B.S. Melb., Toorak Road, South Yarra. Barker, Walter Herbert, M.R.C.S. Eng , L. et L.M.R.C.P. Edin., Asylum, Kew. Barker, William, M.R.C.S. Eng, South Melbourne. Barrett, James, M.D. Syd., M.R.C.S. Eng, L.S.A. Lond., South Melbourne. Bennie, Peter Bruce, M.A. ; M.D. et B.S. Melb., Collins Street. Bird, William Joshua, M.B. Melb., Boort. Black, Archibald Grant, M.B. et Ch. M. Glas., Brighton. Brett, John Talbot, M.R.C.S. Eng., L.R.C.P. Lond., Collins Street. Bryant, H. W., L.R.C.P. et S. Ed., Williamstown. Burton, William Henry, M.D. Toronto, M.R.C.S. Eng., L.R.C.P. Lond., Church Street, Richmond. Caffyn, Mannington, M.R.C.S. Eng., Toorak Road, South Yarra. Campbell, James, M.D. et Ch. M. McGill Univ., Montreal, Moonee Ponds. Carney, John Henry, M.B. Melb., Kyabram. Clayton, William Mayne, L.R.C.S.I., L.K.Q.C.P.I. et L.M. Clendinnen, Frederick John, M.D. et D. Ch. Brux., L. et L. M.R.C.P. et S. Ed., L. et L. M.K.Q.C.P.I., L.R.C.P. Loud., Hawksburn. Coane, James, L.R.C.S.I, L. et L.M.R.C.P. Ed., Brighton. Cole, Frank Hobill, M.B. Melb., Rathdown Street, Carlton. Cooke, John, M.R.C.S. Eng, L.S.A. Lond., Prahran. Courtenay, John Hoyested, L. et. M. et L. M.K.Q.C.P.I., L.R.C.S.I., L.R.C.P. Lond., Clarendon Street, E. Melbourne. Cowan, B. Stewart, M.B. et Ch. M. Glas., Alphington. Craig, W. J., M.B. Melb., Melbourne Hospital. Crivelli, Marcel, M.D. Paris, South Melbourne. Dais"), William Christian, M.D. et B.S. Melb., Howe Crescent, South Melbourne. Davenport, Arthur Frederick, M.B. Lond., M.R.C.S. Eng., St. Kilda. Davies, Thomas Sidney, L. et L. M.R.C.P. Ed., L.R.C.S. Ed., L. F. P. S. G., Williamstown. Dickinson, George Dixon, M.B. et Ch. M. Ed., M.R.C.S. Eng., Moonee Ponds. Dowling, Francis Joseph, M.B. Lond., F.R.C.S. Ed., M.R.C.S. Eng., L.S.A. Lond., Church Street, Richmond. Downie, T. Taylor, M.B. et Ch. M. Glas., Clifton Hill. 28 Australian Medical Journal. JAN. 15, 1891

Duigan, Charles Beamish, L.R.C.P. et S. Edin., Church Street, Richmond. Duncan, Robert Byron, F.R.C.S. Ed., Kyneton. Dunn, Robert Henry, M.R.C.S. Eng., Maryborough. Duret, Charles, M.D. Paris, South Melbourne. Dyring, Carl Peter Wilhelm, M.B. Melb., Coburg. Eccles, Jacob V., M.D. Michigan, U.S., Collins Street. Embling, Herbert Augustus, M.B. et B.S. Melb., L. et L. Mid. R.C.P. Ed., L. et L. Mid. F.P.S.G., Hawthorn. Fenwick, H. M., M.R.C.S. Eng., M.B. Dur., Lygon St, Carlton. Fetherston, Richard Herbert Joseph, M.D. et C.M. Edin •f L.R.C.S.I., L. et L.M.K.Q.C.P.I., Women's Hospital, Carlton. Fetherstonhaugh, Charles, M.B. et Ch. M. Dub., L. et L.M. R. C. S.I. North Melbourne. Fetherstonhaugh, R. Trevor, 1VI.R.C.S. Eng., L.R.C.P. Lond. Kyneton. Finlay, William, M.D. San Francisco, Bathurst, N.S.W. Fishbourne, John William Yorke, M.B. et Ch. M. Dub., Moone Ponds. Fleetwood, Thomas Falkner, M.A. Dub. et Melb.; M.B. Dub. F.R. C. S. I., Warrnambool. Fletcher, Edward, M.R.C.S. Eng., Lygon Street, Carlton. Foster, Thomas, M.R.C.S. Eng., Colac. Fox, William Robert, L.R.C.P. et S. Ed., North Fitzroy. Fyffe, Benjamin, M.R.C.S. Eng., L.R.C.P. Lond., Gore Street, Fitzroy. Gaffney, C. Burke, F.R.C.S. Irel., L. et L. Mid. K.Q.C.P. Irel., Sandhurst. Girdlestone, Tharp Mountain, F.R.C.S. Eng., Collins Street. Goldie, James Joseph, L.R.C.S. Ed., Williamstown. Grant, David, M.A.; M.D., Ch. M. Edin., Collins Street. Gray, Andrew Sexton, M.R.C.S. Eng., Collins Street. Gray, Charles Edward, M.D. et M. Ch. T.C.D., Auburn. Gresswell, D. Ast]ey, M.A., M.D. Oxon., M.R.C.S. Eng., D.P.H. Cantab., Board of Public Health, Melbourne. Griffith, James de Burgh, M.D. et Ch. M. Dub., Elgin Street, Carlton. Gurdon, E. J., M.R.C.S. Eng., L. R.C.P. Ed., Brighton. Hamilton, A. T., L.R.C.S. Ed., L.R.C.P. Ed., L.F.P.S. Glas., Cathedral Hotel, Swanston St reet. Hamilton, F. G., M.R.C.S. Eng., Brunswick. JAN. 15, 1891 Roll of Members. 29

Hayes, Horace F., M.B. et B.S. Melb., M.R.C.S. Eng., Caulfield. Heffernan, Edward Bonaventure, M.D. et B.S. Melb., Brunswick Street, Fitzroy. Henderson, Arthur Vincent, M.B. et B.S. Melb., Camberwell. Hinchcliff, Edwin, M.D. Ed. et Melb., M.R.C.S. Eng , Sandhurst. Hodgson, Thomas, M.B. et B.S. Melb., Franklin Hotel, Sunbury. Honman, Andrew, M.R.C.S. Eng., L.S.A. Lond., Williamstown. Hooper, Francis Leopold, M.R.C.S. Eng., L.S.A., Mornington. Hooper, John William Dunbar, L.R.C.P. et S. Ed., Collins Street. Horne, George, M.A. ; M.B., B.S. Melb., North Fitzroy. Howard, George Thomas, B.A.; M.B., Ch. B. Melb., Nicholson Street, North Fitzroy. Hutchinson, Benjamin Clay, M.D. Edin. et Melb., St. Kilda. Ick, Thomas Edwin, M.A. ; M.B. Melb., Essendon. Iredell, Charles Lesingham Maynard, L. et L.M.R.C.P. Ed., M.R.C.S. Eng , L.S.A., Collins Street. *James, Edwin Matthews, M.R.C.S. Eng., L.S.A. Lond., Collins Street. *Jamieson, James, M.D. Glas. et Melb., Ch. M. Glas., Collins Street. Jermyn, David, L.R.C.S.I., Port Fairy. Johnson, F. Miller, M.D., C.M. Ed., Ferrars Place, Albert Park. Johnston, James Couper, M.B. et Ch. M. Ed., St. Kilda. *Jonasson, Hermann, M.D. Wurz. et Melb., Collins Street. Joske, Alexander Sydney, M.B. et B.S. Melb., Greville Street,. Prahran. Keenan, A. J. W., L. et L.M.R.C.P. et L.R.C.S. Ed., College Street, Hyde Park, Sydney, N.S.W. Kennedy, J. T., L.R.C.P. et S. Ed., Cobram. Kenny, Augustus Leo, M.B. et. B.S. Melb., Collins Street. Lalor, Joseph, L.K.Q.C.P.I., L.R.C.S.I. et L.M., Ch. D. et. M.D. et Mid. D. Brux., Richmond. Lawrence, A. S., M.B. Melb., Regent Street, Preston. Lawrence, H. F., M.R.C.P. Lond., Brunswick Street, Fitzroy. Laycock, G. L., M.B. Ed., Collins Street. Le Fevre, George, M.D. et Ch. M. Ed., M.D. Melb., Lond., Collins Street. Lempriere, Charles, M.B., Ch. M. Edin., South Yarra. Lewellin, Augustus John Richard, M.B. et RS. Melb., L.K.Q.C.P.I., 145 Collins Street. Lillies, Herbert, M.R.C.S. Eng., L.R.C.P. Ed., Armadale. Loosli, Robert James, M.B., B.S. Melb., Camberwell. 30 Australian Medical Journal. JAN. 15, 1891

Lynch, Peter, L. et L.M.R.C.P. et L.R.C.S. Ed., L.F.P.S. Glas. Carlton. *MacGillivray, Paul Howard, M.A. Mar. Coll. Aberd. et Melb. ; M.R.C.S. Eng., Sandhurst. M'Cardel, E. J., M.D. C.M. Canada, M.R.C.S. Eng, Wangaratta. McCarthy, Charles Louis, M.B. et B.S. Melb., Footscray. McCreery, James Vernon, L.R.C.S.I., Asylum, Kew. McGibbon, Walter, M.D. Brussels, L. et L.M.R.C.P. Ed., L.R.C.S. Ed., L.F.P.S. Glas., Fitzroy. McLean, Hector Rath, M.B. et Ch. M. Edin., Williamstown. *McMillan, Thomas Law, M.D. St. A., L.R.C.P. et S. Ed., Toorak Road, South Yarra. McMullen, J. C., L.K.Q.C.P.I., High Street, St. Kilda. Mailer, Melrose, M.B., B.S. Melb., North Carlton. Malcohnson, John Finlay, L.F.P.S.G., L.A.H.D., P. Melbourne. Martell, H. B., M.B. B.S. Melb., Women's Hospital, Carlton. Maudsley, Henry, M.D. Lond., M.R.C.P. Lond., M.R.C.S. Eng., Collins Street. Meyer, Felix, M.B. et B.S. Melb., Lygon Street, Carlton. Miller, Hubert Lindsay, L. et L.M.R.C.P. et S. Ed., M.D. et Ch. et Mid. Brux., Warrna IT1 bool. Miller, Joseph John, M. B. et B.S. Melb., Sydney Road, Brunswick. Mitchell, Henry St. John, L.F.P.S.G., L.R.C.P. Ed., Toorak Road, Toorak. Mollison, Crawford Henry, M.B., B.S. Melb., M.R.C.S. Eng., Balaclava. Molyneux, John Francis, M.R.C.S. Eng., L.R.C.P. Ed., Williamstown. Moore, William, M.D., M.S. Melb., Collins Street. Morrison, Alexander, L. et L.M.R.C.P. et S. Ed., Albert Street East Melbourne. Mullen, William Lowell, M.A. ; M.D. et B.S. Melb., Collins Street. Nickoll, John Sayer, M.R.C.S. Eng., L.S.A. Lond., Hawthorn. Nihill, John Edward, M.D., B.S. Dur., M.R.C.S. Eng., L.S.A. Lond. Noyes, Alfred William Finch, M.R.C.S. Eng., Deniliquin, N.S.W. Noyes, A. W. Finch, M.R. C.S. Eng., L.R.C.P. Lond., L.S.A. Lond., Collins Street. Nutting, Philip, M.R.C.S. Eng., L.R.C. P. Lond., Elsternwick.

11 JAN. 15, 1891 Roll of Members. 31

O'Brien, John Aloysius, M.B. et Ch. M. Glas., Asylum, Sunbury. O'Brien, John William, M.B. et Ch. B. T.C.D., F.R.C.S.I., Collins Street. O'Donnell, N., M.B. Melb., Victoria Street, North Melbourne. O'Sullivan, E. F., M.D. et C.M., L.M.K.Q.C.P.I., Yarrawonga. O'Sullivan, Michael 'Mich, L. et L.M.R.C.P. et S. Ed., Collins Street. Owen, Frederic James, M.D. et B.S. Melb., Brunswick Street, North Fitzroy. Owen, William Hall, L. et L.M., K.Q.C.P.I., South Melbourne. Palmer, George, M.B. Melb., Ararat. Peipers, Friedrich, M.D. Berlin, St. James' Park, Hawthorn. Pestell, J. H., L.R. C. S. Ed., L.R.C.P. Ed., L.F.P.S. Glas., Kyneton. Pettigrew, Augustus Joseph Walford, M.R.C.S. Eng., L.S.A. Lond., Campordown. Pincott, Rupert, M.R.C.S. Eng., L.S.A. Lond., Geelong. Pinnock, Robert Denham, M.B. et Ch. M. Glas., Ballarat. Plowman, Sidney, F.R.C.S. Eng., College of Pharmacy, Swanston Street. Power, Richard, L.R.C.P. Ed., L.R.C.S.I., St. Kilda. Ray, H., M.D. C.M. Glas., L. et L. M.R.C.P., L.R.C.S. Ed., Victoria Street, Carlton. Reid, George More, M.D. Edin., M.R.C.S. Eng., L.R.C.P. Lond., Castlemaine. *Robertson, James, M.A. Aber. et Melb.; M.D. Aber. L.R.C.S. Ed., Collins Street. Robinson, Leonard, M.D. et Ch. M. Roy. Univ. Irel., Hamilton. Ross, J. B., M.D. Wurzburg, Warrnambool. it-tidal', James Thomas, F.R.C.S. Eng., Collins Street. Ruddle, Reginald George, M.D. et. B.S. Melb., Daylesford. Russell, R. Hamilton, F.R.C.S. Eng., L.R.C.P., L.S.A. Lond., Glenferrie Road, Hawthorn. Ryan, Charles Snodgrass, M.B. Ed. et Melb., Ch. M. Ed., Collins Street. *Ryan, James Patrick, L.K.Q.C.P.I., L.R.C.S.I., Collins Street. Ryan, Martin Joseph, M.B. et. B.S. Melb., Kyneton. Ryan, Timothy Bernard, M.B. et B.S. Melb., Clifton Hill. Schlesinger, Richard Emil, M.B. et Ch. M. Edin., M.R.C.S. Eng , Wellington Street, St. Kilda. Shields, Andrew, M.D. Ed , King Street, West Melbourne. Simons, Charles Nathaniel, L.S.A. Lond., L.R.C.S. Irel., Brighton. 32 Australian Medical Journal. JAN. 15, 1891

Small, John, L.R.C.P. et S. Ed., Geelong. Smith, Charles, M.D. Lond. et Melb., L.R.C.P. Lond., M.R.C.S. Eng., Casterton. Smith, Stephen Maberley, M.R.C.S. Eng., L. et L.M.R.C.P. Ed., Yarra Street, Geelong. Smith, William Beattie, F.R.C.S. Ed., L.R.C.P. Ed., Ararat. Snowball, William, M.B. et Ch. B. Melb., L.R.C.S. et L.M. Ed., L.S.A., Victoria Street, Carlton. Sparrow, William Christopher, L. K. Q. C. P.I., M.R. C. S . Eng., Albert Park. Springthorpe, John William, M A ; M.D. et B.S. Melb., M.R.C.P. Lond., Collins Street. Stackpoole, A. R., L. et L. M. R.C.P. et L.R.C.S. Ed., Hawthorn. Steel, Thomas Henry, M.D. Glas., L.F.P.S.G., Toorak. Steven, Alexander, M.D. et Ch. Edin., M.R.C.S. Eng., Hawthorn. Stirling, Robert Andrew, M.B. et Ch. B. Melb., L.R.C.P. et S. Ed., Lonsdale Street. Sturdee, A. H., M.R.C.S. Eng , Frankston. Sweetnam, William Francis, M.D. et Ch.M. Q.U.I., Mortlake. Syme, George Adlington, M.B. et M.S. Melb., F.R.C.S. Eng, Collins Street. Taaffe, Oliver Grenville, L. et L.M.R.C.P. et L.R.C.S. Edin., Rochester. Talbot, Robert, M.D., Edin. et Melb., B.S. Melb., Brunswick. Taylor, Inglis, M.B. C.M. Edin., F.R.C.S. Ed., Exhibition Street. Thomas, J. Caldwell, M.D. et M.A.O.R. Univ. Irel., L. et L. Mid. R.C.P. et, R.C.S. Edin., L.F.P.S. Glas., P. Melbourne. Thomson, John Rae Menzies, M.B. Melb., Essendon. Tremearne, John, M.R.C.S. Eng , Creswick. Wall, M., M.D. Munich., Colac. Walsh, William Butler, M.D. Dub. et Melb., F.R.C.S.I., Kew. Webster, G. A., M.B. Cantab., M.R.C.P., Toorak Road, South Yarra. Westbrook, Charles, M.R.C.S. Eng., Tungamah. Wilkinson, John Francis, M.B. et B.S. Melb., Bright. *Williams, John, M.D. Ed. et Melb., M.R.C.S. Eng , Collins Street. Wisewould, Percy, M.B. Ch. M. Edin., Bacchus Marsh. Woinarski, Gustave Henry Zichy, M.B. et B.S. Melb., West Melbourne. Woinarski, Stanislaus Emil Antony Zichy, M.B. et B.S. Melb., Ballarat. JAN. 15, 1891 Roll of Members. 33

Workman, Francis, M.R.C.S. Eng , L.S.A. Lond., W. Melbourne. Wynne, Joseph Gillis, L.A.H. Dub., L. et L. Mid. R.C.P. et R.C.S. Edin.

CORRESPONDING MEMBERS. Clutterbuck, James Bennett, M.D. Giess., L.S.A. Lond. *Ford, Frederick Thomas West, M.R.C.S. Eng. Gardner, William, M.D. et Ch. M. Glas. Harris, Henry Louis, M.B. et B.S. Melb. Harrison, William Atkinson, M.B. et Ch. M., B.Sc. Edin. Hunter, C. D., M.B. Glas., L.F.P.S.G. Kennedy, Patrick, L.R.C.S.I., L. et L.M.K.Q.C.P.I. Little, Joseph Henry, M.B. et Ch. M. Ed. Porter, Charles Frederick, M.R.C.S. Eng., L.K.Q.C.P.I. Poulton, Benjamin, M.D. Melb., M.R.C.S. Eng Smith, Patrick, M.D. Syd. Stawell, R. R., M.B. Melb. Thomas, John Davies, M.D. Lond., F.R.C.S. Eng, L.R.C.P. Lond., L.S.A. Lond. Wood, Arthur Jeffreys, M.B. et B.S. Melb. Wood, William Atkinson, M.B. et B.S. Melb. Woods, William Cleaver, M.D. et C.M. Edin.

HONORARY MEMBERS. Archer, William Henry, formerly Registrar-General of Victoria, Hawthorn. Barnes, Robert, M.D., F.R.C.P. Lond., &c., Ex-Pres. Obstetrical Society of London. Black, Thomas, M.D., St. Kilda. Bosisto, Joseph, Ex-President Pharmaceutical Society of Victoria, Richmond. Davis, John Hall, M.D., F.R.C.P. Lond., Ex-Pres. Obstetrical Society of London. Ellery, Robert L. J., F.R.S., Government Astronomer of Victoria, Ex-President of the Royal Society of Victoria, The Observa- tory. *Graham, George, M.D. Melb., M.R.C.S. Eng, Richmond. Maclean, David Purdie, L. R. C. S. Ed., L.S.A. Lond., Williamstown. McCrea, William, M.B. Lond. et Melb., M.R.C.S. Eng., L.S.A. Lond. Ralph, Thomas Shearman, M.R.C.S. Eng., L.S.A. Lond., President of the Microscopical Society of Victoria, Carlton. 34 Australian Medical Journal. hag. 15, 1891

Stuart, Thomas Peter Anderson, M.D. et. C.M. Edin., Professor of Anatomy and Physiology in the University of Sydney. Von Mueller, Baron Sir Ferdinand, F.R.S., K.C.M.G., Ph. D. &c., &c., Government Botanist of Victoria, South Yarra.

Airitisk Manta' Assotiation.

VICTORIAN BRANCH. ORDINARY MONTHLY MEETING. Wednesday, December 17, 1890. (Hall of the Medical Society, 8 p.m.) The Vice-President, Dr. SHIELDS, in the chair. There was a large attendance of members. The minutes of previous meeting, November 19, 1890, were read and confirmed. The HON. SECRETARY read the following list of nominations for membership of Council for 1891 :—Drs. Adams, Balls-Headley, Barrett, Bird, Brett, Cobb, Cutts, Davenport, Fetherston, R. H., Fishbourne, Fitzgerald, Fulton, Grant, Gresswell, Hewlett, Hooper, Kenny, Laycock, Le Fevre, Lillies, Maudsley, Meyer, McColl, Neild, O'Sullivan, Rowan, Rudall, Ryan, C. S., Shields, Snow- ball, Springthorpe, Stirling, Syme, Thomson, Willmott. It announced that the ballot would take place at the Annual Meeting in January. Dr. L. HENRY drew attention to the great number of nomina- tions, and suggested that it would be proper to ascertain whether all those gentlemen named were desirous of standing. On the motion of Dr. NEILD, seconded by Dr. FELIX MEYER, it was decided to supply to those gentlemen nominated a list of nominations, with the request that they would signify their intention to stand or to withdraw. The HON. SECRETARY read a communication from Dr. RALPH, asking that he might be allowed to bring before the members a recent discovery made by himself, of " some hitherto undiscovered vegetable (I) organism, recently observed in typhoid blood." OH the motion of Dr. NEILD, seconded by Dr. J. R. THOMSON, it was resolved that, should time permit, Dr. Ralph might be heard at the close of the discussion on Dr. Gresswell's paper. •JAN. 15, 1891 Management of Communicable Disease. 35

The reading of the following paper was then continued from the previous meeting :- THE MANAGEMENT OF COMMUNICABLE DISEASE. By D. ASTLEY GRESSWELL, M.A., M.D. Oxon., D.P.H. Camb. Mr. VICE-PRESIDENT AND GENTLEMEN,-1 have the pleasure this evening of resuming the subject' with which I dealt at the last meeting. On that occasion I read a circular on the Manage- ment of Communicable Disease in general. This evening I propose to read a circular on Typhoid Fever, setting out certain particulars regarding the symptoms, treatment and prevention of the disease. TYPHOID OR ENTERIC FEVER. (Often, also called Gastric, Low, Colonial, or Infantile Remittent, Fever.) The first symptoms* are weakness, loss of appetite, forehead headache, chilliness and flushing of the face ; soon the bowels become loose, and the stools have a pea-soup appearance, though there may be constipation throughout. The headache generally passes off in about a week, and the patient becomes worse, so that if not already in bed the patient soon becomes compelled to lie up. The onset is generally gradual, but it may be sudden. About ten out of every hundred persons affected with this disease die of it. With this disease in your house get medical advice at once, and apply to the Council of your district for instructions as to what you are to do in order to prevent the spreading of the disease. The following are a few general conditions to be observed. From the first, and throughout the attack, the patient must be kept lying down in bed, not being allowed to sit up for any purpose whatever. From the first, and throughout, the patient must be fed solely on milk (milk which has been boiled as directed below), unboiled eggs, chicken broth, or beef tea ; limewater or sodawater may be added to the milk. The best brandy or champagne may be required, but it should be given only under medical advice. Give No opening medicine, except under medical advice ; if such advice cannot be got, an injection may be given if required. During the Illness, and for fully two weeks after all symptoms of fever have " If ,4 diarrhoea co-exists with frontal headache, disturbed sleep, and general febrile symptoms, increasing towards night," we may suspect typhoid fever.—(Dr. Murchison.) C 2

36 Australian Medical Journal. JAN. 15, 189/

disappeared, the above treatment is to be continued ; then more solid foods, such as custards and bread and milk, may be given ; still later a little fish or chicken, and finally meat ; the return to solid food being very gradual, and the milk diet being used again at once if any sign of fever re-appears. Even after all this, the patient must be most careful in getting about, for death has occurred after a patient has been up and about for many days. The disease is most certainly produced* by swallowing, and most authorities think by inhaling, particles from the solid and fluid' discharges of typhoid patients. These discharges contain the poison, and for years past they have been disposed of on the land, though they have not been first rendered innocuous. They are thus blown about as dust, and so gain access to open waters, exposed milk, and other foods ; they pass into water also from street gutters through faultily constructed and faultily situated water-pipes, and into tanks in which roof-water is collected ; they are carried, also, in rain-water over the surface of the soil, and through the subsoil, into wells and underground tanks. Numbers of large outbreaks of typhoid fever have been distinctly shown to be due to water or to milk contaminated with solid and fluid discharges of typhoid patients. PREVENTION. (A) Do not take any water or milk, or anything manufactured with either water or milk, which has not been thoroughly boiled or thoroughly filtered. Water.—Boil your water for half-an-hour, put it aside to settle and cool, take off the upper three-quarters for drinking, and throw the rest away. Or, filter your water, through either a Chamber- land-Pasteurt or a Jefferyt filter, cleansing the filter once a week.

" This disease is spread by peisons swallowing in water or milk, or taking into their lungs, very small portions of animal substance which have come from the bowels of other men, perhaps of men ill with this fever. Stated in this bare way, it seems frightful ; but I have purposely thus stated it that the hideous nature of the mode of spreading may be seen, and because until it is known by every one this fever will prevail. When once it is seen by all that the disease is really one of want of cleanliness, and of defective attention to the disposal of excreta, typhoid fever will die out. Let it once be clearly proved that it is entirely preventable, and that certain measures can prevent it, and then an educated people will insist on these measures, Ij and will aid in their execution."—(Parkes.) To pass water through these filters a certain amount of pressure is required, except in the case of one of the forms of Chamberland-Pasteur

JAL 15, 1891 Management of Communicable Disease. 37

If you can neither boil nor use such perfect filters as these, get a vessel 4 feet deep at least, with a partition extending from the top to half-an-inch of the bottom, and fill it 2i feet deep on each side of the partition with a thoroughly boiled filtering material. This material may be clean sand. It is better, however, to put in sand only 2 feet deep, and over the sand to put a layer, 6 inches thick, of granular animal charcoal, or of polarite ; or, better still, to put the charcoal at the bottom, over this a piece of asbestos cloth, and over the asbestos, the sand. Pour the water into the vessel on one side of the partition, and use the water that rises above the sand On the other side of the partition, throwing away the first ten gallons. If you cannot get a vessel with a partition, get a vessel 5 feet deep, make a hole through the bottom, cover the hole with a piece of cloth (preferably, asbestos cloth), over this put some gravel to form a layer 2 inches deep, over this put a layer of sand 2i feet deep, and over this a layer of granular animal charcoal 1 foot deep ; or put the animal charcoal below the sand, but in this case put a layer of asbestos cloth between the charcoal and the sand. In any case turn out all the filtering materials every fortnight, and boil each of them separately fos fifteen minutes in water, strain of, and boil a second time for fifteen minutes ; and then replace the materials as before. Be careful to do this also in the first instance. [There still is need of a filter which can be readily put into a fire and be burnt through, or be readily baked as frequently as desired "—one constructed, say, of asbestos or of earthenware.] Other precautions in connexion with water are as follow (2) Take no drinks (such as aerated waters or ginger-beer), no ice, no ice-cream, unless you are satisfied that the water or the milk (or both, as the case may be) used in the manufacture of these articles has been thoroughly boiled or thoroughly filtered. Every seller of such articles should be able to show you a certificate of recent date from a competent authority if such is the case. (3) Never take water out of the boxes over the fire-plugs ; it is poison. (4) If you filters. This pressure can easily be got by connecting the filter to a water- service pipe, the pressure of water in the pipe is sufficient for the purpose ; or it may be got by connecting the filter to the lower end of a vertical tube conducting water to the filter from a tank above, or again it may be got by using a small force-pump. If the individual householder be unable to buy a filter as perfect as these filters are, the suggestion might be considered whether two or more householders would not advantageously combine for the purpose. Philanthropy, in this connexion, would be of the greatest service. 38 Australian Medical Journal. JAN. 15, 1891 are compelled to use rain-water collected from the roof, see that the roof-gutters and spouts are kept clean ; see that the spout deliver- ing the water into the receiving-tank is provided with a separator, which prevents the first washings from passing into the tank ; and see that the tank itself is protected against admission of other impurities, and that it is frequently cleaned out If you must, for want of room, for cooling,or for any other purpose, store your water in an underground reservoir (a dangerous procedure in any case), in the first place construct a well-formed chamber with walls of puddled clay, lined inside by bricks laid in cement, and inside that chamber place the tank in which the water is to be stored. The tank must be supplied with two vertical pipes, one for admis- sion of air, and the other for pumping up the water. Rain-water must always be boiled or filtered. (5) If, on leaving home, you are unable to carry or get water properly boiled or filtered, take a pocket-filter with you, selecting one which can be boiled or baked, or otherwise cleansed when required ; the compressed carbon block, for instance, which is not expensive. (6) Do not waste water supplied in a public service, for by so doing there is risk of reducing the pressure in the pipes to such an extent as to bring about pollution of the water through faulty fire-plugs and leaks. A general and excessive use of the Yan Yean water on gardens in and about Melbourne does, at certain seasons, give rise to such . risk. (7) In factories, shops, and such like places properly filtered water should, it is suggested, be supplied for all persons engaged on the premises. Milk.—Take milk only from establishments where you have satisfied yourself on the following points, viz. :—That the cows eat wholesome food and drink wholesome water (water, i.e., which is not polluted by sewage or by matters draining from cowsheds, from manure heaps, or other such filth) ; that cows with diseased udders are not milked ; that the milking sheds are properly drained ; that the milk cans are cleansed only with recently and thoroughly boiled water ; that the milking is done in a cleanly fashion (not, for instance, with the udders uncleansed, or with the milker's hands unclean or dipped from time to time in the milk) ; that the milk cans, pails, and strainers, the churn and other dairy articles, and the dairy itself, are kept thoroughly clean, and are far from every kind of filth; that all persons living on or near the dairy-farm or milk-store are clean in their habits, and observe cleanliness throughout their households. Every milk-seller should 39 JAN. 15, 1891 Management of Communicable Disease. be able to show you a certificate of recent date from a competent authority if the milk is carefully protected against admixture with filth. If the milk-seller cannot show such certificate, or if you have grounds for supposing that such certificate is not genuine or correct, apply to the Council of the district or districts from which the milk is derived for leave to see the quarterly report which Councils are required to make on the dairy-farms, dairies, and milk-shops in their several districts. A sediment at the bottom of your milk-jug, after the milk has been allowed to settle awhile, is dirt from the udder or from the milker's hands, or from foul water which has been added to the milk, or it is dust (i.e., especially in a district of open drains, filthladen with disease germs), which the milk-seller has not thought it necessary to keep out of the milk. A milk-seller convicted of milk-adulteration will not only be unequal to the task of being honest to you, but will be careless also as to poisoning you with foul water taken for the purpose of carrying out his dishonest processes. And even after taking this care to get milk of good quality, it is desirable to boil, or to almost boil, it for half-an-hour, by placing in a saucepan or porcelain vessel, and floating it that length of time in water kept boiling. If you use condensed milk, either get such as has been condensed at a high temperature, or add water to it and then boil it. (B) Wash Fruit and Vegetables thoroughly in wholesome water, i.e., in water which has been properly boiled or filtered. For this purpose, put them into a sieve, and let the water play freely over them ; don't be content with merely dipping them in water, for they will come out almost, if not quite, as bad as they go in. All such articles as lettuce and celery, after being thus washed, should be cut up so that every leaf may be subjected to a current of wholesome water. (C) Keep your food free from foul air, from dust, and from flies, which come laden with filth from festering street gutters, right-of- ways, closets, garbage, and refuse-tips. (D) Keep your house and premises thoroughly clean.—Apply deodorant liberally every day to the closet-pan, and either chlorinated lime or slaked lime to the drain, and to all unclean surfaces.* The right-of-way and the street channel should be

* Instead of applying chlorinated lime to the drain, it is better to filter and disinfect all matters that drain from your house. This can be effected by means of sawdust, spent tan, and chlorinated lime.

40 Australian Medical Journal. JAN. 15, 1891

similarly disinfected. See that your premises are properly levelled and paved. The house-drain should be an impervious pipe ; if it be a gutter, at any rate see that it is sufficient to carry off the matters discharged into it, and that it is impervious. See, an particular, that no pipe from the interior of the house is connected directly with any closed drain outside the house. See that stables, cow-sheds, and like places are properly paved and drained. Whitewash in the house and in the outhouses repeatedly. (E) Keep the children from playing about the closet, over the gutter in the street, and in the right-of-way, as also from making mud-pies, and do not allow them to take food with dirty hands. (F) Do not enter upon the occupation of a house unless you are assured by a competent authority that it is in a wholesome con- dition ; and, if any person has been lately suffering from fever in the house, that disinfection has been properly carried out. In the course of reading of his circular, Dr. Gresswell showed a Chamberland-Pasteur filter, with broken candles of different texture—one kind used for filtering under pressure, and another for filtering without pressure. As regards beverages, he pointed out that whereas many paid great attention to the purification of the water used in the manufacture of them, others did not, and that it was desirable to teach the people the importance of such purifi- cation, for by so doing, the manufacturers would find it to their interest to use only water which could be unhesitatingly regarded as wholesome. The advisability of inserting a clause, as to employers providing wholesome water for persons engaged oa their premises, had been mentioned to him by Dr. L. Henry. Passing on to the precautions to be taken in regard of milk, he observed that there was ample room for improvement in our dairies, cowsheds, and milk shops. He said that no fewer than three outbreaks of disease in the Metropolitan area had been traced to milk since May of this year. Having regard to this fact, and to the great number of outbreaks which have of late years been traced to milk, he was convinced that the milk-supply was a matter to be closely watched, in connection with typhoid fever and other disease. Dr. Gresswell also drew attention to a pail- filter, which was described in connection with the circular read at the previous meeting ; and be showed how dark turbid and foul water, on passing through this filter, was freed of suspended matter and strongly charged with chlorine. He also exhibited a bead-sash, which he had had provided with two Tobin's tubes; he had JAN. 15, 1891 Management of Communicable Disease. 41 not seen the combination in use anywhere, but he thought it met, in an economical manner, a considerable number of cases in which the necessary area for inlet of air could not be got by means of the bead-sash alone. He also pointed out how Bateman's fireplug was constructed, and how it admitted of pollution of the water by matters which gain access to the box (over the ball-plug chamber) from below as well as from above. Dr. Gresswell remarked, too, that the number of deaths from typhoid in various parts of England, as compared with the number of cases reported, was much higher than it was in Victoria.

Dr. NEILD felt called upon to express his great gratification in listening to the clear, incisive, and eminently and completely practical remarks of Dr. Gresswell. No doubt with some of the matters referred to, we were completely familiar, but it would be undoubtedly to the great advantage of the people generally that these matters should be put into circular form, and that they should be easily accessible. Most of us were aware of the great difficulty there was in getting people to observe the most ordinary sanitary precautions ; they shocked and horrified one with their absolute total neglect of ordinary decency. In order to bring about a better state of affairs, he would assure Dr. Gresswell that - the Association would freely and gladly give to him such help as it could. Ile was greatly pleased to hear the matter of fire plugs emphasised. He remembered the time when these plugs were first laid in Melbourne, and at that time he drew attention in The Argus newspaper to the fact that they would be eminently unsuitable, but this, and similar protests from himself and from others, were completely disregarded. They were called "fastidious sanitary dreamers." Lately some removals have been made, but they are merely removals of the boxes for the sake of change, and the original evil still remains. The plugs should be in some form of posts. They have simply taken the plugs from the gutters and put them three or four feet away in the roadway ; the effects are nearly as bad as when they were in the gutters. On this account, he had been very pleased to see, in the newspaper reports, Dr. Gresswell emphasising his disapproval of this imperfect remedy ; in point of fact, no remedy at all. He hoped that Dr. Gresswell would never rest until he had compelled the authorities to deal properly with the plugs. He was sure that a quantity of the milk drunk in Melbourne was unwholesome. Cows 42 Australian Medical Journal. JAN. 15, 1891 should not be kept within the City boundary. On Tuesday last, in the large reserve to the east of the Melbourne morgue, a place used as a corporation tip for many months, and where similar use has been re-commenced, he counted forty-seven cows in the area used for grazing ; most of these cows were munching abominable things found by them in these rubbish heaps. In the same place a number of workmen who had been employed near there some time since had extemporised a closet of the rudest possible description, and this had since been used by innumerable filthy vagrants, consequently an immense amount of faecal matter had lain there for months, to be dessicated by the hot sun, and blown by the wind all over the city. In many other public places in the City of Melbourne he had noticed abominations equally offensive and loathsome, and dangerous to the public health. The washing of fruit was very necessary. With such fruits as the banana, orange, &c., which were peeled before eating, washing might be dispensed with ; but cherries, strawberries, and such like strongly needed it, the more so when we noted the filthy habits of many of the foreign fruit hawkers who thronged the streets of the city, and by whom these fruits were handled and re-handled times without number. In this direction, too, he would refer to the apparently persistent determination of fruit growers and market gardeners in carrying their empty fruit cases on the top of loads of manure. Only recently he had counted thirteen such carts on the St. Kilda Road. This was an offence against the City Bye- Laws, but the authorities were lax, and the police, whose duty he believed it was to prosecute in these cases, totally disregarded them. Another matter that had attracted his attention was the filthy condition of the horse-troughs outside many of the hotels. These were allowed to remain in a most disgusting condition, but could easily be made much less offensive. In summer time, when the water pressure is low, people frequently take water from the horse- troughs. He had seen children and dogs drinking from these troughs together, and they were very convenient for the dogs, no doubt. They were never scrubbed or cleaned, were filthy to look at, and helped very much to propagate disease. We all feel that the Colony has acquired a very valuable authority in Dr. Gresswell, and, though as yet engaged only in the initial stage of sanitary improvement, judging by his zeal, earnestness, and special knowledge, we soon shall have very great improve- ment. 43 J.N. 15, 1891 Management of Communicable Disease.

Dr. J. R. M. THOMSON said that Dr. Neild had instanced many cases in which the advice of medical men was disregarded by local authorities. He would instance a very glaring case. In his report on the sanitary condition of Melbourne, Dr. Gresswell drew attention to the fact that the flats around Flemington and Kensington were used as rubbish tips. Quite recently, he (Dr. Thomson) had observed that cottages were being erected on those very rubbish tips so protested against by Dr. Gresswell. Dr. L. HENRY remarked that there was one matter that had not been touched upon so far. While we had received many very valuable suggestions, the organisation necessary to see these suggestions carried out did not exist. Personally he was of opinion that it would be necessary that an organisation be formed for the purpose of assisting in this work. The department of which Dr. Gresswell is head is one in which a great deal is intended before it will be perfect. To become a Sanitary Inspector or a Medical Officer of Health in older countries, e.g., Germany, requires an examination. Such appointments are there eagerly sought after, on account of the distinction conferred. Something of the kind is necessary here. It would be impossible for individuals to carry out all the suggestions given there this evening. It requires an extra amount of intelligence to deal with sanitary matters. We require a sanitary army, properly drilled, and well officered. He would like to see the functions of Dr. Gresswell more autocratic than they are. In the suggestions for typhoid fever, he thought directions for sponging the patient in cases of high temperature should be added. He would also like Dr. Gresswell to suggest where the filters mentioned might be obtained. In the matter of the use of ice, in England there was an agitation to have none but distilled water used in the manufacture of ice. He wished to endorse all that Dr. Neild had said with regard to the interesting character of the paper. Dr. BRETT wished to understand if Dr. Gresswell had stated that the death-rate of typhoid in England was double that of Victoria. Dr. GRESSWELL said that it was the proportion of deaths to notifications—returns to which he had referred in England and in this Colony. It was fatality, and not mortality, of which he- had spoken. Dr. BRETT was of opinion that numbers of cases were misreported as typhoid fever in Victoria. He thought many of the cases were 44 A ustralian Medical Journal. JAN. 15, 1891 gastro-enteritis, or sequelm of influenza. The diagnosis not being correct, the comparison was hardly fair. Dr. HOOPER remarked that when one endeavoured to get patients to take sanitary measures in regard to their houses, they often met you with the question, " What do you do in that way yourself ?" Dr. CARSTAIRS said that, on account of his deafness, he had been unable to follow Dr. Gresswell's remarks, but that Dr. Gresswell had kindly allowed him to look at the paper, and as a result, he would wish to make one or two statements regarding typhoid fever. He hoped to read a paper on the subject before the Branch in a month or two from now. He was glad to note that the entrance of the typhoid poison by the respiratory passages was recognised in the paper. In the recent " Quain's Dictionary," this was said to be possible, but not likely. Entrance by means of food, milk, vegetables, was the general view. He held an opposite view. He believed it to be contracted by inhalation, and by inhalation only, in the large majority of cases. He believed that there was no true milk epidemic in which there had not been several typhoid patients in the dairy, the nurses of these patients milking the cows and seeing to the cans, dm. Dr. Russell, of Glasgow, in an article, "Typhoid Traced to its Source," noted a particular epidemic of typhoid fever in Glasgow. It was connected with the milk from a certain farm. All points were examined, but at the end of the statement came the remark that there were originally two or three cases of typhoid fever at the dairy, and that none originated elsewhere previous to the occurrence of these cases at the dairy. Those who stick at the pathogenic theory are bound to blame food and drink. He could not understand how people could regard typhoid fever as a specific disease, and yet maintain insanitary surroundings as its cause. Typhoid fever is a germ disease, and one cannot get it without the typhoid germ. No amount of insanitary surroundings per se will produce it. Typhoid breeds true every time. In his paper, he will refer to the influence of heat and of season on typhoid. Dr. GRESSWELL, in answer, said that he was glad that Dr. Brett had referred to the comparison which he had made between the returns of typhoid fever for England, and those for Victoria ; because he (Dr. Gresswell) evidently had not stated the case clearly. He repeated that it was fatality, and not mortality, to which he had referred. He was aware that there was a tendency to confound the one with the other. The facts were, he thought, JAN. 15, 1891 Management of Communicable Disease. 45 as he had stated. The contrast suggested various considerations ; for instance, that the typhoid fever of the last year or more was not so severe here as it was in certain parts of England, or that persons were reported here as suffering from typhoid fever who were not so suffering, or again, that in England mild cases of typhoid had not been reported. He did not pretend to give a rationale of the facts ; but he thought they were worthy of atten- tion. Dr. Henry had pointed out that the directions were too numerous to be carried out. He (Dr. Gresswell) did not suppose that they would be, until individuals became more fully acquainted with the mtiology of the disease ; still, he anticipated that the essentials of this etiology would become common knowledge in course of time, and he thought that the directions given in the circular would tend to that end. Dr. Henry had pointed out that it was laxity and inefficiency of sanitary administration that lay at the root of the typhoid and other disease-prevalences in this country. This matter he (Dr. Gresswell) had himself strongly emphasized in his report on the sanitary condition of Melbourne and of its suburbs ; and amendment was undoubtedly taking place in this matter. All the same, it was necessary he was convinced, to bring home to the minds of the people—to the individual—such details as he had put together in his circular. He fully concurred with what Dr. Neild had said concerning the want of appreciation on the part of the people as to the modes in which typhoid fever was introduced into the system. It did seem too had to ask the individual to see after so many matters ; but he thought that when the individual did begin to inquire into the milk service, and the purification of the water used in the manu- facture of beverages, ice, and other such articles, persons engaged in the sale of these things would see that it was to their pecuniary interest to give full satisfaction in answer to all relevant inquiries. Dr. SHIELDS said the Branch was indebted to Dr. Gresswell for his paper and his explanations. It seemed to him that it was too late to take up Dr. Ralph's communication. Dr. RALPH stated that his object was that, as we were entering on the typhoid fever season, he would like to interest some medical men who were skilled with the microscope, and had some experience in bacteriological methods, in the discovery he had made, with the hope that they would follow it up and check his observations. He would be pleased to meet such gentlemen there, or at the Royal Society, or any other convenient place. 46 Australian Medical Journal. JAN. 15, 1891

Daring the evening, Dr. GRESSWELL showed his pail filter in operation, a simple application of Tobin's ventilating tubes to the bead sash, the Chamberland-Pasteur porcelain filter, and solutions of carbolic acid in water, and in water with glycerine. Australian ffiebital ),ournal. JANUARY 15TH, 1891.

THE NEW YEAR. The year that has just passed has been marked by some occurrences of great interest to the members of our profession. The Victorian Medical Society, whose organ the Journal now is, in a more direct sense than formerly, has had a peaceful and prosperous year. That there has been progress might be assumed, from the circumstance that some members have thought that the time has come for the formation of sections, which would take up special depart- ments of medical work. This is a matter, with regard to which there may well be difference of opinion, and while it is not necessary here to discuss the reasons for and against, few if any will be prepared to deny the abstract desirability of specialising, in the literary and scientific, as well as in the practical every-day work of the members of the Society. Those who are in doubt as to the propriety of taking this step, at the present time, would probably have their hesitations removed, if another change, now talked of, could be brought about. Very many of the members of the Medical Society are also members of the Victorian Branch of the British Medical Association, and cannot find time to take part in the working of both Societies. If the proposed amalgamation could be brought about, though at some sacrifice to one or both, there would be less likelihood of meetings of sections interfering materially with attendance at the ordinary monthly meetings. It would be vain to form one or two successful sections, if the attendance at general meetings were to be interfered with to any consider- able extent. Most of us are busy men, to whom regular JAN. 15, 1891 The New Year. 47 attendance on meetings easily becomes a burden, and the lightening of that burden, by amalgamation of the two Societies now existing, would be felt as a relief by many. Never previously in the history of the colony has so much and such earnest attention been given to questions of sanitation, as during the year 1890. The Central Board of Health has had its constitution completely re-modelled, with results which, so far, appear to be entirely satisfactory. In its deliberations, the New Board of Public Health has had the benefit of expert advice from Dr. Gresswell, who came to Victoria with au excellent reputation as a scientific observer and practical worker in various departments of Public Hygiene. Local bodies have been stirred up to take action, and improvements, great and numerous, are either in con- templation or actually being carried out. Improved methods of night-soil disposal, and arrangements for the destruction of much of the rubbish, which is now tipped in the most convenient spots, should do something toward reducing the prevalence of epidemic diseases, and lowering the rate of mortality in Melbourne. That rate is now discreditably high, when compared with that of cities in the Old World, which are in many ways less favourably circumstanced. Still more is to be expected, however, from the great undertaking of carrying out a comprehensive system of underground drainage. The report, recently presented by Mr. Mansergh, may be said to have brought the question fairly within the range of practical politics ; and the power given by Parliament, for the formation of a Metropolitan Board of Works, makes it possible to have operations begun at no distant date. If the new Board, thus created, rises to the occasion, and if the representatives on it, from the many municipalities in the Metropolitan area, will boldly recognise that a liberal expenditure on sanitary works is really a wise economy, we must, before many years pass, see removed the reproach, which now rests on Melbourne, of being not only the least healthy of the Australian capitals, but less healthy than cities like London and Birmingham, which have not such great natural advantages. Public opinion has been stirred, by the exceptionally high mortality from both 48 Australian Medical Journal. JAN. 15, 1891 typhoid and diphtheria, during 1888-89, and even in the beginning of 1890. Happily, there are marked indications of a decline in the prevalence of both diseases. If, however, this decline is made an excuse for inaction or half-measures, the misfortune will be great. Reduced prevalence is the rule with all epidemics, for a longer or shorter time after great outbreaks, and unless the permanent sanitary improve- ments, which everybody desires during the period of high mortality, be not quickly and thoroughly carried out, we shall inevitably have a return of the diseases mentioned, with an intensity perhaps exceeding even that of 1889. Leaving our own smaller world, and regarding the great field of medical activity in the older countries of Europe, it has also to be said that the year 1890 has been marked by some events of striking importance. The Berlin meeting of the International Medical Congress was in several ways by far the most successful of these triennial gatherings. The attendance was very large, the number of members enrolled being about 5600. Perhaps the most striking feature, in the tabulation of nationalities represented, was the large number of members belonging to the United States of America, more considerably than from Great Britain and its numerous Colonies and dependencies. If for nothing else, this meeting will be memorable as the one at which the preliminary announcement was made, by Professor R. Koch, of his success in discovering an agent which he believed to have a curative action in cases of tuberculosis. It is perhaps unfortunate that the announcement was thus prematurely made. There is reason to believe that Koch was induced to say what he did, because some of the leaders of the profession in Berlin, and possibly prominent persons outside its ranks, thought that a discovery of such importance should befittingly get publicity best at a great international gathering in the German capital. That the discovery is one of cardinal importance must be at once admitted, in view of the reports which have since reached us. It marks a completely new departure in therapeutics, in so far as it is the first use of a specific virus for curative, and not merely preventive, purposes. While the results SAN. 15, 1891 The New Year. 49

obtained by competent observers conclusively show that the new remedy does exercise a specific influence, of a destructive kind, on tuberculous tissue, it may safely be assumed that the limits to its permanently curative action will be ultimately much narrower than sanguine persons are now inclined to believe. Sufficient time has not elapsed, to test the reality and permanence of the cures which have been reported, and we do not know enough yet of the nature of the remedy, and of its mode of action to justify very positive expressions of opinion. But what- ever may be the limitations to the practical application of this remarkable discovery, it marks the first distinct step toward the realisation of what pathologists and physicians have long hoped to see attained—some mode of treating the specific infective diseases, which would consist in inhibiting the growth, within the organism, of the Contagium, animatwm, to which they owe their origin. If this, which till recently was little better than a dream, should be realised in practice, it will be owing to the labours of Robert Koch more than to those of any other man. If realised, it may also be truly said, that the discovery is not only the greatest of our own times, but that it will rank with the greatest scientific achievements of any age. There is honest pride in saying that, to no class of persons, all over the world, will this discovery give more genuine satisfaction than to the medical profession. Our boast is that the prevention of disease is our constant aim, almost more than its cure, whatever be the material results as regards ourselves. As far as possible, in our special circumstances, it has been the aim of the conductors of the Journal to keep it abreast with the progress of science and practice in all departments of medicine; and looking forward to increased help from our contributors in carrying out that end, we wish them and all our readers a HAPPY NEW YEAR.

Dr. Molloy, of the Melbourne Hospital, and Dr. Rothwell Adam, of Hotham Street, East Melbourne, have been elected members of the Hon. Medical Staff of the Austin Hospital. 50 Australian Medical Journal. JAIL 15,189

VICTORIAN BRANCH OF THE BRITISH MEDICAL ASSOCIATION—THE PRESIDENT'S DINNER. A dinner was given in the Freemasons' Hall, Collins Street, on Tuesday evening, January 13, by Dr. Le Fevre, the President of the Victorian Branch of the British Medical Association, to the Members of that Branch. The chair was occupied by Dr. Le Fevre, and there were about 100 gentlemen present. The usual loyal toasts were proposed by the Chairman, and duly honoured. The CHAIRMAN proposed " The Parliament of Victoria," and in doing so said that it had been hoped that some of the Ministry would have been inveigled to the dinner, so that they might have slated them for not passing an Amending Medical Act last session, but they had not attended. The Premier had sent a telegram regretting that he could not be present, and others of the Ministry could not do so because they were out of town. It was to be hoped, however, that the new Medical Act would be passed next session. He should not trouble his guests with much speaking that evening, as he had asked them together for enjoy- ment, and the speaking in connection with the scientific work of the Branch of their Society would be done at the Annual Meeting, which would be held in a few days. Dr. JACKSON proposed "The University," and in doing so said the University was doing very good work, and he thought the various Governments of this Colony were to be complimented for the assistance they had given the authorities of the University in carrying on their duties. Dr. BROWNLESS, Chancellor of the University, responded to the toast, and said that though he had been asked to acknowledge the compliment paid to the University, he felt that he had been invited to the gathering that evening because he was one of the very oldest of the medical men of this colony. As head of the University, he thanked all present for the manner in which they had just honoured it. He might say that he was the founder of the Medical School of the University, and he was proud to say that the Medical School here was considered by the medical authorities of Great Britain to be one of the best schools in the world. He might also state that the other schools of the Univer- sity were held in high esteem by the learned authorities of Great Britain. JAN. 15, 1891 University Intelligence. 51

Dr. NEILD proposed " The British Medical Association," and in doing so gave a short historical resume of its career. He said it was perhaps now the most important scientific society in the world, and it numbered about 11,000 members. The Branch here had done good service in the furtherance of health, and one of its most active members had been Dr. Le Fevre, their present president. Dr. SHIELDS, in responding, said the Branch of the Society here was in a most flourishing condition, and had now 160 members. Dr. BALLS-HEADLEY, as a member of the Medical Society of Victoria, returned thanks. He said that the Society had worked strongly for years past, with a view to the conservation of health, and he was happy to say that there was now an important Public Board of Health, with an able man as its adviser. The toast of " Kindred Societies " was proposed by Dr. BALLS- HEADLEY. Dr. GRESSWELL, as a member of the Public Board of Health, responded to the toast. He said that kindred societies held the highest opinion of the British Medical Society and its works. There was no association which had wielded such enormous influences for the good of the public as it had done, and kindred societies had therefore the greatest pleasure in holding out the hands of friendship to it. Dr. ROWAN proposed "Commercial Interests," and the toast was responded to by Mr. A. PRIESTLY. Several other toasts were proposed and honoured, and the pro- ceedings then closed.

THE MELBOURNE UNIVERSITY. The following were the successful candidates in Medicine, at the second pass examinations, recently held at the University:— First Year.—William Alexander Forsyth, Alfreda Hilda Gamble, Gustave Alfred Hagenauer, Ida Gertrude Margaret Halley, Glen Album Knight, Harold Valdemar Munster, Alfred Ernest Walsh. Second Year.—Robert Hodgson Anderson, Robert Lee Brown, Robert John Fullerton, Colin Gray, John Daniel Hurst, Edward Bernard Levy, Maurice Patrick MacGillicuddy, Stanley James Docker Read, Gavin Shaw. P 2

52 Australian Medical Journal. JAL 15, 1891

Third Year.—Thomas William Brown, Ernest Arthur Dombrain, William James Hallows, George Joseph Ley, Robert Henry Strong. Fourth Year.—George Armstrong, Edward Brookes, Egbert John Connell, Ernest Alfred de Ravin, Samuel Arthur Ewing, Paul Ward Farmer, John Kennedy Freyer, John Leslie Henderson, David Henry Edward Lines, Frank Ernest Littlewood, Elizabeth Alice Maud O'Hara, William Henry Rigby, Helen Hannah Mary Sexton, Grace Clara Stone. Fifth Year.—Stanley Seymour Argyle, John Henry Joseph Crowley, Joseph Milton D'Amer Drew, Edgar Holcroft, William Waugh Hope. The following gentlemen were admitted to Degrees in Medicine or Surgery at the University, on the 29th ult. :— Bachelors of Medicine.—Stanley Seymour Argyle, James M. D. Drew, Edgar Holcroft, and William Waugh Hope. Bachelor of Surgery.—Leslie Davies.

1 Nospital ntelligente.

MELBOURNE HOSPITAL. At the meeting of the Committee held on the 6th inst., exten- sion of leave was granted to Dr. M'Inerney, one of the hon. physicians, who is at present on a visit to Europe. It was also resolved to request Dr. M'Inerney to visit Berlin, in order to investigate Dr. Koch's method of treating consumption, as the accredited representative of the Hospital, but without expense to it. The Lady Superintendent drew the attention of the Committee to the accommodation provided for those nurses who are engaged nursing contagious cases. During the past week there had been seven nurses working amongst diphtheria and scarlet fever. It was only possible for four of these to be in a measure separated from the others. The three others were obliged to be mixed up with the general nursing staff, both at meals and in their bedrooms. There was some idea of using the new refractory wards for isolated cases, and, if so, she was afraid it would be impossible for her to supply the nurses who undoubtedly would be required for those cases, and the whole question of the accommodation of the nursing staff should be carefully and at once considered. At the present

JAN. 15, 1891 Vital Statistics.

time there were two nurses sleeping in bedrooms which were only large enough for one. The consequence was that they felt more tired and worn-out in the morning than at night after their day's work. The matter was referred to the Building Committee, with power to act. ALFRED HOSPITAL. At a meeting of the Committee held on the 9th ult., Dr. W. H. Embling, chairman of the Hon. Medical Staff, reported that at a meeting of the Staff held on January 5, it was decided to recom- mend—(1) That the best way of disinfecting the canvas of the tents that had been pulled down would be to saturate it in a solution of corrosive sublimate, of a strength of 1 in 2000 ; (2) That it was desirable to asphalt the ground under the tent floor prior to re-erection of tents ; (3) That it was desirable, when the camp was re-formed, to have the same amount of space between the tent-walls as in the past. Upon discussion, the managers decided to inquire from the chairman of the Hon. Staff the reasons why it would be necessary to asphalt the ground under the floor. The remainder of the report was held in abeyance. trrtistits.

The Government Statist's report on the Vital Statistics of Melbourne and Suburbs for the month of November, 1890, shows that the births of 1,249 children, viz., 641 boys, and 608 girls, were registered. The deaths registered numbered 581, viz., 304 males, and 277 females. To every 1,000 of the population of the district, the proportion of births registered was 2.72, and of deaths registered 1.27. Of those who died, 141 were under one year of age ; the total number under five years being 204. In the month of November, 14 deaths from puerperal fever, miscarriage, or accidents of childbirth were registered, and as the registered births numbered 1,249, one death of a mother occurred to every 89 births. Four deaths were set down to typhoid fever in November, which is 1 more than in September, but with that exception, a smaller number than had been recorded in any month since November, 1886. Deaths from diphtheria during the month numbered 18, or 2 less than in October, 9 less than in September, and the same number as in August. In addition to Ilj

54 Australian Medical Journal. JAN. 15, 1891

the deaths from diphtheria, 5 deaths were set down to diphtheritic croup in the month under notice, as against 2 such deaths in ii October, 3 in September, and 7 in August.

DEATHS FROM TYPHOID FEVER AND DIPHTHERIA, 1888 TO 1890.

TYPHOID FEVER. DIPHTHERIA. MONTHS. 1888 1889 1890 1888 1889 1890

January • • 39 70 78' 5 15 25 February • • 63 64 73 2 13 46 March • • 54 91 89 13 18 56 April • • 43 113 63 13 26 50 May • • 32 92 36 19 35 39 June • • 20 36 20 16 30 45 July • • 12 17 12 14 48 41 August • • 9 16 5 11 33 18 September • • 9 6 3 11 37 27 October • • 10 6 7 9 21 20 November • • 8 16 4 8 27 18 Total .. 299 527 390 121 300 485

Local ithiertS,

MEDICAL. BOARD OF VICTORIA.—The following gentlemen have registered their qualifications :—George Ernest Morrison, Geelong, M.B. et Ch M. Edin. 1887 ; William Johnson, Upper Hawthorn, L. et L. Mid. R.C.P. et R.C.S. Edin. 1890, L.F.P.S. Glas. 1890 ; Stanley Seymour Argyle, Windsor, M.B. Melb. 1890 ; Joseph Hilliard Johnson, Northcote, M.B. et Ch. M. Edin. 1890 ; Edgar Holcroft, Melbourne, M.B. Melb. 1890 ; Joseph Milton d'Amer-Drew, Richmond, M.B. Melb. 1890 ; William Waugh Hope, Moorabool, M.B. Melb. 1890 ; John Henry Joseph Crowley, Sandhurst, M.B. Melb. 1890 ; Albert Ernest Foster, Melbourne, M.R.C.S. Eng. 1883, L.S.A. Lond. 1884; Otto Ferdinand Grnelin, Melbourne, Staats Examen Halle 1889, M.D. Leipzig 1890. Name of deceased medical pra5titioner erased from the Register :—John F. W. Manson, M.B. Melb. HEALTH OFFICERS.—The following appointments have been confirmed :- Shire of Dimboola —William Clow Little, M.D. ; Shire of Mount Rouse— Frank Arthur Sweetnam, L.R.C.P., vice William S R Woodford, M.B., resigned. James de Burgh Griffith, M.B., has been appointed Assistant Health Officer, temporarily, at the Quarantine Station. PUBLIC VACCINATORS.—The following appointments have been made :— Maffra—William Boake, L.R.C.S., vice W. H. Brown, M.R.C.S., whose resignation has been accepted ; St. Arnaud—John David Collier, L.R.C. S., vice J. J. Wolfenden, L.R.C.S., deceased. Gerald Henry Fetherston, M.D., J.P., has been appointed an Official Visitor of the Lunatic Asylums at Yarra Bend and Kew. Dr. H. Paynter Sloggett, M.R.C.S. Eng., has been appointed Resident Surgeon at the Eye and Ear Hospital, vice Dr. E. Gutheil, resigned. JAN. 15, 1891 Local Subjects.

A letter, in accordance with section seven of the Act, having been sent to the last-known address of each of the undermentioned persons, and no answer having been returned to such letter within the period of six months from the sending thereof, their names have been erased from the Register accordingly :- Addison, G. Ford, R. G. Lewis, J. K. Service, J. Airey, G. Furnival, F. H. Little, W. Shaw, A. Altmann, C. A. Glanville, U. G. D. Lloyd, D. Shaw, G. Anderson, T. Godson, E. Lucas, T. P. Shells, W. F. M. Andrews, S. Goodall, W. A. Maberly, G. F. Sibley, J. C. Ap-John, G. L. M. Gordon, J. M. Maddan, J. C. Sides, R. Ascher, E. Govett, E. Magill, M. Smith, H. Atkinson, W. J. Grady, J. F. Marks, E. G. K. Smith, J. Barker, W. H. Graham, J. Martin, C. Smith, J. W. Barnes, G. F. Grant, C. J. Mathison, M. Smith, S. Bell, G. L. Gray, J. R. Maxton, L. Sorley, H. Blyth, D. Hamilton, A. J. Middleton, J. Stevenson, F. C. Blyth, J. G. Hammond, S. Morton, J. Stewart, J. Bride, J. G. Hanson, H. H. H. Muirhead, M. A. Stewart, W. R. Burns, W. Harris, H. L. Muller, C. Stokes, G. P, Cashel, E. B. Harvey, J. T. Mureh, W. Strutt, C. E. Clark, C. A. D. Hedley, C. Murdoch, J. Stutt, A. E. Cobbett, R. N. Herdegen, M. Murphy, M. D. Sutherland, W. S. Corder, S. R. Hewer, H. J. Muskett, P. E. Symes, R. H. Cotterell, W. Hill, J H McCarthy, H. Taafe, J. F. H. Coward, H. Hooter, W. H. de B. Macfarlane, W. H. Tattersall, J. W. Crawford, J. Hogg, J. B. McGachen,F.W.D. Taylor, F. Crowther, A. B. Hutchinson, T. H. AlcGwire, W. W. Telford, J. C. Cumming, W. Jackson, E. S. Mackintosh, A. Thomas, J. Cuthbert, W. T. Jackson, W. H. Maclennan, J.N.E. Tresidder, E. S. Dashwood, W. H. Johnson, J. McNeece, J. M. Turnley, G. W. Davidson, G. F. Johnson, J. J. Nevill, W. N. Vanes, A. B. Dickenson, A. N. Jones, S. E. R. O'Connell, J. Wades, J. B. W. Dickson, L. F. Keatinge, J. J. Oliver, J. Waite, G. Dixon, C. Kelly, E. Owen, R. J. Walker, G. R. P. Dobie, H. E. N. Kennedy, J. Palmer, J. R. Walker, H. E. Docking, T. Kennedy, J. W. Park, J. S. Wardale, J. A. W. Drought, P. J. Kennedy, P. Peel, R. Warren, J. M. Drummond,J.H.G. Kent, C. G. Poland, J. H. Webb, F. E. Edmunds, D. T. Knight, G. H. Pope, H. A. L. Webb, M. Eichler, C. F. Langdon, J. A. Prendergast, J. J. Wilson, J. R. Elliott F. J. Langston, W. Richardson, C. S. Wilson, J. S. Fafie, R. Lawson, T. C. Roche, J. Woodforde, A. E. Faskally, G. B. Leggatt, A. J. Ross, D. Wright, W. H. Ferguson, J. Leonard, J. Rundle, G. E. Wuth, E. M. Ferguson, R. Lermitte, C. G. Salter, A. E. Wylie, M. Fitzgerald, J. De Vine, C. L. Semple, A. Yeatman, J. W. Fonsworth, J. C. Lewers, T. R. Sarjeant, G. Young, W. E. Forbes, H. F. Lewis, F. W.

BIRTHS. CUSCADEN.—On the 13th ult., at 336 Bay-street, Pert Melbourne, the Wife of Dr. G. Cuseaden, of a daughter. a aon,M ULLALLY. —On the 25th ult., at Ballarat, the wife of W. T. Mullally, M.D., M. Ch., of

POULTON.—At North Terrace, Adelaide, on the 2nd inst., the wife of B. Poulton, M.D., of a daughter. RYAN.—On the 13th ult., at 3 Michael-street, North Fitzroy, the wife of Dr. 1'. B. ItYat, of a daughter. 56 Australian Medical fournal. JAN. 15, 1891

MARRIAGES. BENNIE—RYAN.—By special license, at Mountain View, South Preston, by the Rev. John Fulford, Alexander Bruce, M.A., M.B., B.S., son of James Bennie, late H.M.C., to Maude May, daughter of the late Wolryche Whitmore Ryan, H.M.C., and niece of Sir Charles Lister Ryan, K.C.B., Burley Bushes, England. MARTIN—JONES.—On the 16th ult., at St. Mary's, Caulfield, near Melbourne, by the Rev. Ernest J. Barnett, M.A., Head Master of the Caulfield Grammar School, Melbourne, assisted by the Rev. G. E. W. Sproule, incumbent of St. Clement's, Elsternwick, Dr. J. Wilson Martin, of Urana, N.S.W., formerly Medical Superintendent of the Creswick District Hospital, to Florence, youngest daughter of the late W. L. Jones, Esq., of Creswick, Victoria. Pnwaos7—Wir.Louoiniv.--On the 20th ult., at Trinity Church, East Melbourne, by the Rev. H. N. Wollaston, assisted by the Rev. W. G. Hindley, Dr. Lionel Praagst, elder son of James T. Praagst, C.E., of Richmond, to Hilda Willoughby, elder daughter of Howard Willoughby, of East Melbourne. STANHOPE—BROWNING.—On the 25th November, 1890, at the residence of the bride's parents, Portsea, by the Rev. Dr. Bevan, Alfred Burton, eldest son of William Stanhope, South Melbourne, to Helena, second daughter of J. H. Browning, M.D., J.P., Quarantine Station. DEATHS. MANSON. —On the 19th ult., at the residence of Mr. Donald Ross, Avenue-road, Royal Park, John Frederick William, M.B. et B.S., late of Dunolly, second son of John Manson, of North Melbourne, aged 27 years.

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Title: Australian Medical Journal 1891

Date: 1891

Persistent Link: http://hdl.handle.net/11343/23155

File Description: Australian Medical Journal, January 1891

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