THE .4 usIralian Medical yournal SEPTEMBER 15, 1890. Irtitits.

REPORT ON INDIAN HOSPITALS. (Continued.) By Wm. GARDNER, M.D. C.M. Glas. Lecturer on Surgery, Adelaide University ; Sen. Surgeon to Adelaide Hospital. GENERAL CONCLUSIONS. Construction of Hospitals. Most of the hospitals I visited are well built and well situated. 'The wards are lofty and well ventilated, and in many of them the use of tiles and cement is replacing the wooden floors and plaster of the older buildings, with corresponding advantage to the patients and the general appearance. In all the army hospitals, and in some of the civil hospitals, punkahs and mosquito curtains are supplied, which in most parts of India, are absolutely necessary to comfort. We, in Australia, might well follow this example during the summer months. As far as my limited observation goes, sanitary matters are more carefully attended to in the army, than in the civil hospitals ; but allowance must be made for the greater assistance and the smaller amount of actual hospital work done in the former. The ideal hospital for all but the large cities of India is, as pointed out to me by Surgeon-Major Hendley of Jeypore, a central administration block, with cottage hospitals scattered about the grounds, each with a nurse in charge, so that caste prejudices may be respected as far as possible. Statistics. I cannot too highly eulogize the annual returns of the hospitals, issued by the surgeons-general of the various presidencies. They are all drawn up on one plan, and the results can thus be very readily compared. Similar returns should also be forthcoming from all hospitals and dispensaries in connection with the Dufferin Fund, and until this be done, it will be impossible to form any conception of the value of their work, as distinguished from its amount. VoL. XII. No. 9. BB 386 Australian Medical Journal. SEPT. 15, 1890

Infectious or Contagious Diseases.

Leprogy, Small - pox. Cholera Central Provinces 720 96 237 Madras Presidency 4,367 250 15,783. Hyderabad Assigned Districts 284 8 92 Bombay Presidency 1,656 741 7,833 Bengal Presidency 2,787 50 4,839 Punjaub 952 339 3,033 10,766 1,484 31,817 Extracted from annual returns. With such large numbers returned under these headings in one year, it is abundantly evident that infectious hospitals are urgently required in the large towns, where diseases, such as cholera and small-pox, can be carefully treated in large numbers, and an accurate study made of both diseases. We might thus look hopefully forward to the time when both diseases would be at least reduced to a minimum. In saying this, I have not forgotten that excellent work of this kind has been done by Indian practitioners, but much remains to be accomplished. The 10,766 cases of leprosy do not, as all Indian practitioners admit, at all adequately represent the number of the population affected, for many cases do not apply for hospital relief. Very little provision is made for their treatment, and one of the burning questions of the day for the Government of India is how to segregate, in comfortable quarters, such vast numbers and prevent them from mixing at all with the general population. The experi- ment, if tried at all, must be done legally, and the retirement must be compulsory. The medical men and nurses who are sent to the settlement must retire there for life, as in the case of the lamented Father Damien. Will medical men and nurses (such as Sister Gertrude) be found coming foward ? I think so. The scheme is vast, and the difficulties in the way of its being carried out are great ; but the results to be expected are such as to stimulate the efforts of every well-wisher to India. Cataract Operations and Spectacles. The following is the list of Cataract operations in India for 1888 :— Bengal Presidency 582 Bombay 283 Punjaub 2,660 Hyderabad Assigned Districts 6 Madras Presidency 744 Central Provinces 114 4,389 SEPT. 15, 1890 Report on Indian Hospitals. 387

Surgeon-General Pinkerton, in his report on the civil hospitals and dispensaries of the Bombay Presidency draws attention to the urgent need that exists for some provision to enable poor persons, who have been operated on for cataract, to obtain spectacles. When the number of cataract operations is considered, it will be at once seen how urgently some such provision is needed. Nursing. Necessarily, from their enormous requirements in this respect, the nursing in India is, as far as one could judge from limited observation, behind that standard which is attained in other parts of the Empire. Every effort, however, is being put forth to obtain well-trained nurses from English hospitals, so that they may train up native women who will, in time, do the greater part of the work. Evidence collected from civil surgeons in various parts of India goes to show that native women are capable of being trained so as to become highly competent nurses. They are very even- tempered, and possess the delicate touch in the highest possible degree. I have been informed that they are wanting in self- reliance ; but I believe that even this invaluable requisite in a nurse will be shown to be acquired by a higher standard of training. It is not to be expected that there could be self-reliance without complete training. Were it so, I should feel disposed to apply another term to this faculty.

To what extent have the sexes in India availed themselves of the Hospitals ? The object of this question is to show in the answer the general effect of the " Purdah " system on the attendance of the female sex at the hospitals. In explanation, I may state that nearly all the women belonging to the higher classes in India are kept behind the " Purdah " or curtain, i.e., they are not allowed to be seen by any man except their husbands. The great aim then of every man who becomes rich is to " Purdah " his wives. Many women who apply at the hospitals, as I was informed, pretend to be "Purdah" women, and are really not so. Their object is to make themselves appear higher in the social scale than they really are, and it is this fact which vitiates all calculations as to how far treatment by female medical aid has reached the women of this class. The objection to their treatment by men, comes from the male side, and not from the women themselves, who would, I am told, gladly submit to anything necessary for their good. I know of one BB 2 388 Australian Medical Journal. SEPT. 15, 1890

Rajah, who has had a liberal education in Scotland, who takes his wife about with him wherever he goes, and it may be that this may become general as education spreads its influence over the people. On the other hand, I have heard objections made to female medical aid being brought to the Zenana, that women would be much more likely to assist in the plots which are continually going on where women are collected together and have no occupation. Personally, I think this objection will fall to the ground if the central committee of the Dufferin Fund select only well qualified and high-class women, they will then exert their influence only for good. I am, however, decidedly of opinion that the influence of a higher education will do more than anything else to break down the " Purdah " system, and possibly also to abolish polygamy. Leaving children out of the question, and considering the in-patients in the hospitals of the various presidencies only, there was a daily average in— Bombay Presidency of 1429 men to 334 women. Madras Presidency of ••• 1302 623

Hyderabad Assigned Districts of 71 4 fl Punjaub of •• • 1169 244 1)

Bengal Presidency of 874 3, 237

Central Provinces of 269 /9 59 or 3.4 men to every woman. This at least proves that the women of the lower orders avail themselves of hospital treatment in very fair proportion to the number of men, and there is not such a great disparity as might have been expected under the existing conditions. Differences between Indian and Australian Surgery. An essential difference between the natives of India and Australia is, that though they suffer more from shock, yet traumatic fever is infinitely less marked amongst them, which is probably due to their diet being principally a vegetable one, and to the absence of alcoholic stimulants. One of the most noticeable features, viz., the delay in having operations for deformity performed, is due to the reluctance of the natives to submit to a surgical operation, unless life is rendered a burden to them by reason of pain. To take an illustrative example : In 1888, Surgeon-Major Hendley operated successfully on five adults for hare-lip, an operation which, in European countries, is done as soon as possible 389 SEPT. 15, 1890 Report on Indian Hospitals. after birth. This shows, however, that gradually the native mind is becoming educated up to the beneficial results to be derived from good surgery. Abdominal operations for the same reason are rarely done, with the exception of ovariotomy, of which in 1888, there were only twenty-one performed, the remainder would only permit the tumour to be tapped. As the disease is very frequent, there is a great future for this operation in India. So far, Dr. Harvey, of Calcutta (Eden Hospital), has performed the greatest number done by any one operator. Operations on the kidney (one of the causes for which, viz. stone, is very frequent), are very rare, there being only two in 1888—one fatal nephrectomy, and a nephro-lithotomy which recovered. Eye operations, amputations, and operations for stone occur, however, with a frequency entirely unknown in Australia. Splendid results are obtained from litholapaxy, both in adults and children; but singularly to relate, the supra-pubic operation for stone, which is so uniformly successful with us, is here, as yet, a very fatal operation. Antiseptic surgery is as well carried out as is possible with the vast numbers which the surgeons have to treat, with frequently only limited assistance. Finally, it seems to me that it is a great pity that Indian practitioners do not start a united Medical Journal for India, because I feel sure that with their vast material, much benefit would result to medical science from such a publication, and it would also have a beneficial influence on their work. I cannot conclude without recording my impression of the very high standard of the work done in India, and my thanks to my Indian brethren for the very great kindness and courtesy they extended to me during my stay.

At the meeting of the Public Board of Health held on the 2nd inst.. Dr. Gresswell submitted a report in regard to the outbreak of typhoid at Toorak, where 23 cases occurred in families which were all supplied with milk from the same dairy. The dairy was situated in the shire of Malvern, and upon a creek into which drained an orchard on which large quantities of nightsoil were placed. Under the instructions of the local council, all the milk on hand at the dairy had been destroyed, and the sale of milk from the cows had been prohibited until after the expiry of seven days after access to the polluted creek had been prevented. The outbreak showed the necessity of a systematic periodical inspection of dairies. With such an inspection, the fouling of this creek would have been stopped long ago. 390 Australian Medical Journal. 8EPT. 15, 1890 rrrietg of Vittoria,

ORDINARY MONTHLY MEETING. WEDNESDAY, SEPTEMBER 3RD, 1890. (Hall of the Society, 8 p.m.) The President, Dr. JACKSON, occupied the chair, and there was a large attendance of members. The minutes of the preceding meeting were read and confirmed. The nominations of two new members were received. The PRESIDENT moved the following resolution :—" That this Society offers its most hearty congratulations to one of its oldest members, Dr. William Barker, of South Melbourne, on the completion of his fiftieth year of medical practice, and his forty- sixth year of practice in Victoria." He stated that Dr. Barker was an old and esteemed member of the Society, and a regular attendant at its meetings. He had much pleasure in asking the members present to pass the resolution. Dr. GIRDLESTONE, in seconding the resolution, said that we were glad to see such an old member as Dr. Barker present, we would be glad to see more of them. Dr. J. P. RYAN in supporting the motion, said that Dr. Barker had been in practice for a great many years about Melbourne, and his career had always been an honourable one. Dr. J. W. BARRETT, the Hon. Secretary, read a letter from Baron von Mueller, stating that he had intended to attend the meeting to take part in person in the offering of felicitations to Dr. Barker, but found he was unable to be present. The resolution was carried unanimously and with acclamation. Dr. BARKER sincerely thanked the members for their kindly congratulations. He had always attended the meetings of the Society, and always received satisfaction, And gained knowledge by so doing. EXHIBITS. Dr. BARRETT then exhibited a case in which the mastoid was trephined four times for chronic middle ear disease, about which he made the following remarks :- Patient, a man, aged 54, was attacked with acute abscess of the middle ear twelve months before seen. When first seen, the membrane was perforated, and chronic suppuration of the middle ear existed ; in addition, a sinus opened into the floor of the 391 SEPT. 15, 1890 Notes on Late Epidemic of Influenza.

meatus, close to the membrane through which bare bone could be felt. The discharge of pus was enormous. Soon, swelling in the side of the neck was noticeable, and severe cramps of the neck muscles was suffered. Slight mastoid tenderness and severe one- sided temporal and occipital (meningeal) headaches. The mastoid was trephined in the usual position ; the bone was sclerosed and no communication established. The operation was repeated twice more within a few months and some communica- tion established. After the third operation, the condition was decidedly unsatisfactory, the discharge of pus was still enormous, and it drained chiefly through the sinus into the meatus. There was evidently a cavity in the petrous bone. At this juncture, it burst into the naso-pharynx near the Eustachian tube, and partly drained in this way. For the fourth time the mastoid was operated on, and this time, the bone forming the posterior and the inferior walls of the meatus, together with what was left of the mastoid anterior to the lateral sinus, was chiselled away, and free drainage for the pus provided. From this time rapid recovery ensued, the patient is now perfectly well, the membrane is intact, and conversational hearing excellent. Dr. BARRETT said that he had gone to the post-mortem room recently to rehearse a mastoid operation, and had trephined the mastoid in the ordinary way, just behind and less than half an inch from the meatus. At a depth of less than half an inch, the trephine had gone through the lateral sinus, which ran much in advance of its ordinary position. Had any surgeon during the life of the subject endeavoured to trephine the mastoid, the sinus must have been injured. Dr. W. MooRE then showed a patient from whom he had removed the tongue for epithelioma seven months previously. The diseased organ was also exhibited. The following paper was then read :- SOME NOTES ON THE LATE EPIDEMIC OF INFLUENZA. By J. P. RYAN. Chevalier of the Legion of Honour. Known by many different names, such as la grippe, Russian disease, Chinese catarrh, epidemic catarrh, &c., influenza has been recognised as a special disease from a very early date. Hippocrates was probably acquainted with it. Diodorus Siculus 392 Australian Medical Journal. SEPT. 15, 1890,

describes an epidemic which affected the Athenian army in Sicily,. B.c. 415, and it occasioned a serious mortality amongst the soldiers of Charlemagne, on their return march from Italy. In the Middle Ages, it made its appearance again and again in Europe, and from the fifteenth century down to the present time,. its numerous visitations have been noted and recorded by careful observers. On many occasions it has been pandemic, and has spread from one country to another with amazing rapidity. Towards the end of the last century, it broke out almost simultaneously in London and in Cape Town. The late epidemic was felt about the same time in Melbourne, and in Arequipa, high up in the Andes of Peru. Not unfre- quently its progress has been marked by slower steps, and it has taken weeks or months in travelling from one country to another.. It is difficult to say when or how it originates, but its course for the most part has been from east to west. The majority of the later recorded epidemics have entered Europe by Eastern Russia,- have spread slowly or rapidly over Germany, France, Italy, and. Great Britain, and then have crossed the Atlantic, attacking successively the Eastern and Western States of America. We know nothing of the materies morbi of the disease. We are probably not far out in assuming it to be a micro-organism, but it must be very different from the contagium of such diseases as scarlatina or diphtheria. Whatever it may be, it is, in all probability, propagated through• the atmosphere ; otherwise it is difficult to account for its breaking out almost simultaneously in localities far removed from one another, or of its sudden appearance in ships on the high seas. It is evidently not associated with any particular condition of the atmosphere, for it prevails in hot and in cold climates, in summer as well as in winter. Nor can soil or geological formation be said to influence its course, for it has prevailed everywhere—on the seashore as well as inland, on the tops of high mountains as in low-lying marsh lands. Two prominent factors enter into the composition of the disease, viz., fever and catarrh. Some epidemics have been characterised by the predominance of fever, others by the severity of the catarrhal symptoms ; but in the majority of cases both have been present in the various epidemics. Not unfrequently bad cases have been complicated with pneumonia or 393- BEn. 15, 1890 Notes on, Late Epidemic of Influenza.

pleurisy ; but whether the cases be mild or severe, it has been noticed how often they have been accompanied or followed by an amount of physical prostration and mental depression wholly disproportionate to the severity of the attack. It is not my intention to enter into a detailed description of the epidemic which made its appearance amongst us last autumn. I shall confine myself to an account of the disease as it came under my own observation, and to illustrate the matter more- clearly, I shall read short notes of a few characteristic cases. My experience has been derived from private practice, but• much more largely from observing the numerous cases which occurred at Abbotsford. This institution numbers 720 persons, viz., 104 sisters, 313 penitents, many of them old women, and 313• children and young women, of ages varying from two to twenty years. The numbers affected were as follows :-40 sisters, 200• Iv children, and 296 penitents, or a total of 536 out of a community of 720 persons. This record includes only those who had to keep to bed for one or more days. Many others were affected, though so slightly, as not to interfere with their ordinary avocations. The- epidemic made its appearance first among the penitents, about the 27th of March. Their quarters are in a separate part of the enclosure, but there is pretty free communication between them and the sisters, and to some extent also, with the children'. It spread somewhat slowly, new cases occurring for about five weeks, and it was nearly two months before it finally disappeared from amongst them. The children were attacked on the afternoon of 7th of April. It was my usual visiting day, and in the morning no • case was reported to me. In the afternoon, seventy were down with the influenza, and during the course of the next day, I had over 100 on the sick list. Within the next forty-eight. hours 100 more become affected, but by the end of a week, all, except half-a-dozen who had bronchitis, and who, by the way, had colds before having been attacked by the prevailing epidemic, were at school or about their usual occupations. On the 15th of April, that is about the time it died out amongst the children, it attacked several of the sisters ; others, day by day, were affected, but by the end of a month, all had recovered and had resumed duty. The first case occurred on the 27th of March, the last on the 5th of May. Amongst the sisters and penitents—the majority of those attacked being women of middle age or beyond, some few being 394 Australian Medical Journal. SEPT. 15, 1890

between sixty and seventy, the disease assumed the type of an acute febrile catarrh. Exceptionally, there was a premonitory stage of cold for a few days ; but in the large majority of cases, the attack was ushered in suddenly with chilliness, frontal head- ache, pains in the back and limbs, fever and catarrhal symptoms. The latter varied from simple coryza to acute general bronchitis. In a majority, the mucous track of the frontal sinuses and naso- pharynx was principally affected ; in a lesser number, the lining membrane of the whole bronchial system was also involved. In no case was there any such complication as croupous pneumonia, or pleurisy, and in none was there a markedly prolonged conva- lescence. In a few there was vomiting and diarrhoea, probably induced or promoted by purgative medicine, which was often administered at the onset of the attack. In no case was the bladder or kidneys affected. No accurate record of temperature was kept. It varied from 99° F. to 103° F., and for the most part it fell to normal on the second or third day. In a day or two more the patients were up and about, but a few had to keep to bed for a week or two longer, on account of bronchitis. There were no serious cases, and no relapses. Amongst the children and young adults, the disease assumed a -sthenic type, and ran a short course. Its onset was very sudden for whilst at school, or at play, the affected child complained of being, or was noticed to be, ill, was put to bed cold or actually shivering, and in a few hours was in high fever, with burning dry skin, crimson face, suffused eyes, and a full and bounding pulse. Most of them complained of pain in the forehead and eye-balls, some of pain in the back of the head and neck, and many also of pains in the loins and legs. In many the temperature ran up to 103° Fahr. within the first few hours ; in a large proportion it had become normal within twenty-four. In a majority of cases, perhaps, there were mild catarrhal symptoms ; in a good many these were entirely absent ; in half a dozen there was severe general bronchitis. I shall now record, very briefly, notes of a few cases exemplifying different phases of the disease, and in conclusion shall say a few words about treatment. On the morning of the 25th of March, I was called in to see a fire brigade man, 28 years old. He was in bed, in high fever, his pulse was 110 and his temperature 102° Fahr. He complained of 395 SEPT. 15, 1890 Notes on Late Epidemic of Influenza.

pain in the forehead and at the back of the eye-balls, as well as down the back and in the thighs. He had been perfectly well until the previous afternoon, when he was attacked by chilliness, langour, and pain in the head ; he soon became hot, and was restless and feverish through the night. Next morning his temperature was normal, and though somewhat weak, he felt well enough to get up. J. C., a station owner, was seen by me on the morning of the 26th of March. He was apparently suffering from a heavy feverish cold. His face was red, his eyes suffused, his tongue foul, and his breathing was somewhat laboured. He had a hard dry cough, and complained much of pain in the sternum. Except for a slight cold, he felt quite well, until lunch time the previous day, when he began to feel out of sorts and was so cold that he had to lie down and cover himself with rugs. He had pain in his head, as well as through all his bones, and was restless and feverish all night. His breathing all over the chest and back was rough, with prolonged expiration, and here and there dry and sonorous Tiles were audible. The whole of the bronchial membrane was probably involved in an inflammatory attack, and I fully expected to witness further developments ; but to my astonishment, when I called to see him next morning, I found that he had gone out on some business, having left word that he would call at ray residence at midday. He did so, and informed me that he felt so much better in the morning that he thought he could safely get up. His temperature had become normal, his bronchial symptoms had disappeared, and he was apparently all right. However, much against my advice, he foolishly exposed himself, by going out at night, and two days afterwards he had a relapse. He had some bronchitis, and his temperature remained up for three or four days. T. M., a police constable, was seen by me on the 4th of April. On the previous day, whilst on duty, he felt , chilly and out of sorts, and had violent fits of sneezing. As lie himself expressed it, he was unable to get the cold out of his bones until he had taken some hot toddy and gone to bed. When I saw him in the morn- ing, he had well•marked catarrhal symptoms, and was in high fever. He complained much of pain in the frontal region, over the root of the nose and in his eye-balls. He went through a pretty severe attack of bronchitis, his temperature remaining above 100° Fahr. for several days, and it was three weeks before he was fit to return to duty. 396 Australian Medical Journal. SEPT. 15, 1890

J. F., a labourer, 30 years of age, who had never previously suffered from any illness, was seen by me on the 6th of April. He informed me he had a bad cold upon him for a week, but only took to his bed two days before my visit. He had a febrile temperature, with the ordinary symptoms of acute general bronchitis. Within the next few days he became decidedly worse ; the forenoon tem- perature was about 102° Fahr ; the sputa became viscid and ropy, and slightly rust-coloured ; fine crepitation was distinctly audible amidst the various bronchial riles, and there was slight, though sufficiently marked dulness of the percussion note over one back as compared with the other. He had a persistent and distressing cough, which was very much worse at night. He took very little nourishment, for his appetite was entirely gone, and his stomach was extremely irritable. He had profuse perspirations ; he lost his flesh rapidly, and hope too, and he made up his mind that his end was not far off. At one time I feared he was running into phthisis, but at the end of a fortnight, or three weeks from the beginning of the attack, his temperature became normal, the broncho-pneumonic signs began to clear up, and there was evidence of general improvement in his condition. But his convalescence was very slow, and it was another month before he was sufficiently well to resume his work. The last case with which I mean to trouble you is entirely different in character from the foregoing, and is unique, so far as my experience of the late epidemic goes, though some amongst you perhaps may have met with similar cases. It is interesting, because it bears a strong resemblance in its symptoms and course to dengue, and we know that influenza has sometimes been confounded with the latter. On the 7th of April I was called in to see a young married woman. She was in a highly feverish state, with a flushed face and dry hot skin ; her pulse was 112, and temperature 102° Fahr. She complained of pain in the forehead, back of the head, and neck, down the spine, and most severely in both groins. She had been in excellent health until late the previous afternoon, when she began to feel chilly, and to suffer from pain and stiffness in the back of her head and neck. She passed a restless night, and next morning was rather worse, for her temperature was up to 103° Fahr. She suffered a good deal from pain in the head and groins, and also from stiffness and pain in both shoulders and arms, and during the night she had been much troubled with 397 'SEPT. 15, 1890 Notes on Late Epidemic of Influenza.

cramps in the legs. Her tongue was foul, and she was inclined to

-vomit. Next day, April the 9th, she was decidedly better, the pains had nearly gone, and her temperature had fallen to 100°. By the 10th April it was normal. For two days she remained free from fever, and was able to sit up in her room, but on visiting her next morning I found she had a, relapse. Her temperature was again up to 102° Fahr.; the pains and stiffness were now felt in all her limbs, as well as in her head, neck, and back ; the tongue was covered with a light creamy fur, and she had had repeated attacks of vomiting. On the following day, the febrile symptoms had somewhat abated, but a well marked eruption of large, oval, erythematous patches had come out on her arms and legs. The fever did not quite leave her for two days longer ; the eruption faded, and the pains gradually left her, but she was much prostrated, and it was quite a fortnight before she recovered her usual strength and spirits. As regards treatment, I have very little to say. The most important matter was to put the patients in bed, and keep them there for one or more days. Wherever it was possible, I recom- mended a hot bath, or, at all events, the bathing of the feet ; and as a matter of routine, I ordered antipyrin in the early stage. In some cases I prescribed it with a pretty strong dose of alcohol, and the results appeared to the patients to be eminently satisfactory. Where catarrhal symptoms were marked, mild sedatives and expectorants were called for ; and during convalescence, I often gave quinine, or quinine with strychnine. In taking a retrospective glance at the late epidemic of influenza, and forming a judgment about it from my own point of view, I should say that it was of moderate severity, that the febrile symptoms were more marked than the catarrhal, that the onset was sudden, the duration of the attack from one to five days, the recovery rapid, and that severe chest complications, such as pneumonia and pleurisy, were very rare. In my experience, vomiting and purging were entirely exceptional ; a skin eruption was observed in only one ease ; the physical prostration and mental depression, so generally characteristic of influenza, were not of frequent occurrence, and no death was either directly or indirectly caused by it. ' 398 Australian Medical Journal. SEPT. 15, 1890

The PRESIDENT, in opening the discussion, said a few of us have had personal experience of the disease. One important point was the liability to relapse. If the patient got about to soon, a relapse generally occurred, and it was then the catarrhal symptoms came on, e.g., bronchitis, pneumonia, &c. Dr. DUNCAN said he had nothing to add to Dr. Ryan's paper, but would like to notice one feature of his own case, which he thought was unique, viz., the suddenness of the attack. He had been for a long drive, which he thoroughly enjoyed, reached home feeling in perfect health, and in half a hour he felt so ill that he was obliged to go to bed, where he remained for nine days. He took no medicine, but avoided cold, and that was the line of treatment that he afterwards adopted. Dr. LE FEVRE wished to bear testimony to the value of antipyrin. He could speak from experience, as he had had a severe attack. In the acute stage, with catarrhal symptoms, he used a diaphoretic mixture, which had no effect, or possibly aggravated the condition. He then tried large doses of quinine, which greatly increased the headache and other nervous symptoms. After that he took several doses of antipyrin, which proved most valuable. Subse- quently in practice, he relied on antipyrin, but never gave large doses, as the disease itself was sufficiently depressing ; he used five grains every six hours, and all the cases did well without a relapse. He wished to call attention to apparently cerebro-spinal symptoms, with delirium, great excitement, and in one case there was albuminuria. Dr. ADAM in his experience had come across one or two points which had not been mentioned. The temperatures were much higher ; one little girl who was quite well at eight o'clock, had a temperature of 105° at ten o'clock ; next morning it was normal. A man aged 30 was out in the morning, reached home well at two o'clock, and at five o'clock the temperature was 105.8°, with severe headache ; the following morning his temperature was nearly normal, and on the third day he was up. In some cases he preferred salicylate of soda to antipyrin. In his own case, he suffered more from gastro-intestinal complications. Mr. G. A. SYNE said he had had experience in two directions:— Firstly, as City Health Officer, all cases applying for admission to the municipal typhoid tents at the Alfred Hospital were sent to him for a certificate that they had typhoid ; he used to see five or six a day, most of which he regarded as influenza, and did not send 399 SEPT. 15, 1890 Notes on Late Epidemic of Influenza.

into hospital. In diagnosis, he relied on the suddenness of the attack, and he never heard of any case in which he was wrong. Secondly, as Medical Officer to the Police, he had had the Police Hospital crowded. One interesting case was that of a man, with a high temperature and a rash like measles, but he had gonorrhoea, and was taking copaiba. The first case admitted was complicated with acute endo- and peri-carditis. As to treatment, he frequently *gave no medicine, but simply kept the patients in bed, and gave them warm drinks, &c. Where there was much headache, he gave a few small doses of antipyrin, but he never continued its use, as he found it depressing. Quinine in small tonic doses was valuable in the later stages. When there were vague pains about the limbs, he used salicylate of soda, with quinine. Dr. DAISH said that he was especially interested in the gastro- intestinal complications. He had found them very troublesome, particularly during convalescence. He had also met with cases, especially among women, where there was intense depression, and one patient, a young man, attempted to commit suicide. He had met with one fatal case. It began with vomiting and purging and other usual symptoms. He appeared to improve for a few days. During the night he was seized with convulsions, and died. He (Dr. Daish) had had an attack, in which he suffered from pains about the shoulders, back, and limbs, followed by partial paralysis, affecting chiefly the lower extremities, not the bladder. A some- what similar case had been recorded in the Lancet, but the bladder was affected also. Dr. F. J. OWEN mentioned a patient who had two distinct attacks. After recovering from an attack in Melbourne, he went away to a country township. A month after his first attack, the epidemic reached this place, and he went through a second attack. Dr. GRESSWELL said that the disease must be studied, both from the epidemiological and the clinical point of view. A large amount of material had been obtained in response to circulars issued, asking for information on the subject of influenza, but as yet he had not had an opportunity of examining the returns. It was chiefly with a record of actual cases that we were concerned. He afterwards hoped to bring forward some definite conclusions. Dr. J. W. BARRETT said that he had seen a number of cases of chronic rhinitis, chronic catarrh of the larynx, and of the naso- pharynx. He had also met with cases of acute abscess of the middle ear, due to influenza ; also with middle ear affections,

400 Australian Medical Journal. SEPT. 15, 1890

following on throat trouble, the result of the epidemic. He had also met with cases of paralysis of accommodation. He thought these cases were all similar to those following typhoid and diphtheria, and were simply indications of lowered vitality. Dr. JOHNSON said that since he had been in the colony he had every winter seen cases similar to those met with in the late epidemic; other medical men also informed him that they had done the same. Dr. COWAN said he saw three cases of convulsions—two in children, one in an adult. Had also seen one with a cutaneous aruption. Dr. J. P. RYAN, in reply, said :—I am very pleased that my short and somewhat hastily prepared paper has had the effect of producing such an interesting discussion. You must remember that I have dealt with influenza only as it came under my own cognizance. It was not my intention to treat the subject in extenso, but rather to record the general features of the epidemic as they presented themselves to me. I had not at my disposal sufficient data, even though I had the time to deal with such interesting points as contagion, the extension of the disease to animals, &c. The account which I have given of its origin and spread amongst the children at Abbotsford, points very markedly to the great suddenness of its onset, and to such a rapid extension, as almost to preclude the possibility of its having been com- municated from one to the other. At the height of the epidemic, many of the horses in a large livery stable where I keep mine, were suffering from severe cold—was it influenza ? It is impossible to say. I do not know if other animals were similarly affected. In other epidemics it is said that horses, dogs, cats, and even birds contracted the prevailing disease. I have not, like Dr. Le Fevre, seen any cases with marked cerebro-spinal symptoms, and very few with gastro-intestinal disturbance, where one was warranted in assuming that the disturbance was part and parcel of the disease, and not an intercurrent affection. The same remark will hold good in reply to Dr. Syme's question, as to the prevalence of skin eruptions. I have met with persons who had secondary syphilitic and other skin affections, but in one case only —that referred to in my paper—have I seen any skin eruption that might be looked upon as essentially a part or product of the influenza. Dr. Barrett made some interesting remarks regarding the frequency of cases of middle ear disease as sequel of influenza.

401 SEPT. 15, 1890 British Medical Association.

Indeed, one might assume such as a likely result, but as a matter of fact, I met with no such cases. It may be supposed that cases of the kind did occur, and went to other practitioners for treat- ment. It is possible, so far as private patients are concerned, but wholly impossible at Abbotsford, where all such cases must have been brought under my notice. I thank you, gentlemen, for the patience and kind attention with which you have listened to my Paper. tbical Association.

VICTORIAN BRANCH. ORDINARY MONTHLY MEETING. Wednesday, August 20th, 1890. (Hall of the Medical Society, 8 p.m.) Mr. G. A. SYME in the chair. There was a fair attendance of members. The minutes of the previous meeting, June 25, 1890, were read and confirmed. The HON. SECRETARY apologised for the absence of the President, the Hon. Dr. Le Fevre, M.L.C., and for the absence of Dr. Chas. Ryan, who was to have read a paper. The HON. SECRETARY explained that the July meeting had been allowed to lapse, in order to make a change in the night of meeting, from the fourth to the third Wednesday. The Council were of opinion that the intervals between the meetings of this Association, and those of the Medical Society of Victoria, should be more regular in order, that cases not in time for one, might be exhibited at the other. The HON. SECRETARY reported that the presentation to Dr. J. E. Neild had been made on Monday, August 18th. An address and a cheque for £761 12s. 9d., constituted the presentation. The medical subscriptions to this fund had realised £233 10s. 6d. A letter from Mr. J. T. Rudall, F.R.C.S. was read, requesting that a short paper by him might be read at the present meeting. The HoN. SECRETARY stated that the paper would have been placed on the business list for the evening, but for the fact that the title had not been forwarded in time. It was agreed that the paper should be read at the conclusion of the business. CC 402 iludralian Medical Journal. SEPT. 15, 1890

The CHAIRMAN announced that at its meeting on the 7th August, 1890, the Council had elected the following gentlemen members of the Branch :—Dr. Walter MacGibbon, L.R.C.P., L.R.C.S. Ed., M.D. Brux., Brunswick Street, Fitzroy ; Dr. William Armstrong,. M.D., B.S. Melb., Brunswick Street, Fitzroy ; Dr. Robert Byron Duncan, F.R.C.S. Ed. (Exam.), Kyneton ; Dr. John Cuthbert,. L.R.C.S.I., L.K.Q.C.P.I., L.R.C.S. Ed., Camberwell. The following paper was then read :- INTRODUCTORY PAPER ON INFLUENZA. By J. W. SPRINGTHORPE, M.A., M.D., M.R.C.P. Hon. Physician, Melbourne Hospital. Now that our recent severe outbreak of influenza has spent its force, it becomes both appropriate and useful that we proceed to the discussion of some, at least, of the many important issues which it has raised. For a wide outlook over the whole field, we must of course wait for the results obtained by the collective investigation undertaken by Dr. Gresswell in connection with the metropolitan medical societies, and there is every reason for believing that in the mass of information there collected, we shall have such a comprehensive account of the essentials of the epidemic, as will form a valuable addition to the literature of the subject. Individual papers however, must also be forthcoming, both as introductory to discussion, and as affording opportunities for the fuller investigation of certain details. Hence the present paper. And for my prominence therewith, I must plead that the subject is one to which I have devoted some special attention for the last five years. PAST HISTORY OF THE DISEASE. Careful records of a disease, apparently identical with influenza, have existed for at least some centuries, whilst the disease itself seems to have been noticed in remote times. In the first half of the present century, ten such epidemics are recorded—that of 1830, it is worthy to notice, lasting for four years, and re-appearing four years later ; and that of 1847-8 being pandemic, and visiting even Australia, according to the late Dr. Campbell. In this category it might well be enquired, if some at least of the early "bilious fever " of those times, about which so much controversy has been waged, and which differed from our typhoid fever in prevailing in the winter, as well as in other particulars, might not have been a continuance of that visitation. Turning first to the SEPT. 15, 1890 Introductory Paper On Influenza. 403 old world, the disease seems not to have re-appeared in an epidemic form during the second half of this century, until last year. The description in " Quain's Medicine," is of the epidemic of 1847. Fagge (writing in 1888) doubts if there has been any since; and the heading "Influenza" is absent from "Neale's Digest," and " Sajous' Annual of the Medical Sciences." Here, however, our Victorian experience is different. In May 1885, a great epidemic, locally known as " fog fever," swept over a large part of Australasia, some particulars of which I collected, and embodied in a paper which may be found in the October number of the Australian Medical Journal of that year. There can, I believe, be no doubt that that outbreak was a severe epidemic of influenza, at least, as severe and extensive, caeteris paribus, as the late outbreak in England. Personally, however, I go much further, and repeat my statement made before the Intercolonial Medical Congress last year, to the effect that, in my opinion, influenzal attacks have never been absent from our community for any long period since that epidemic died away in August 1885. In January 1889, I wrote in a paper for the Congress, " observation has shown that a disease with the same general characters, has returned eabh autumn and winter since 1885, and has been specially well marked during the late winter (1888). In my own practice, both private and hospital, a very large proportion of my cases from June until lately, has been distinctly influenzal in type." In an addendum made six months latter, it is added, " six months have elapsed since the foregoing was written, and during that time . . . . and influenza have been epidemic." As bearing upon these remarks, I may here add that I have records of thirty-six such cases in my ward books, from May 1st to April 30th, 1889, and that it is no exaggeration to say that, besides numerous cases of influenza in various characteristic forms, I had seen at least fifty cases of phthisis which, in my opinion, owed their origin to influenzal attacks contracted since 1885. Such then was my recorded experience previous to the last twelve months. And that such continuance of an influenza epidemic is not unprecedented, is seen by referring to the great epidemic of 1830, which resembles our own still further, in the fact that it re-appeared in a severe form some four years later. But it may be asked, whence this epidemic of 1885, after an absence of some forty years? To this, no satisfactory reply, as far as I am aware, can be given in the Present state of our knowledge. cc 2 404 Australian Medical Journal. SEPT. 15, 1890

THE LATE EPIDEMIC. In the old world, the late epidemic has already been traced to Siberia and Northern China, where it prevailed in September last. Thence it spread to Russia, thence to Germany, thence to France, the rest of the Continent, and England, and later still to America. But we have already seen that influenza had been recorded as prevalent here in the July previous, and I have evidence that about that period it was epidemic also in parts of Queensland, if not in New Zealand also. Thus it is quite possible, that the Asiatico-European outbreak may after all have originated in Australia, and this possibility would be greatly strengthened, if the state of matters in the intermediate countries, China and Japan, could be discovered. Coming to our own country, the epidemic character of the present outbreak. became generally marked, in my experience, in the first week in March last. But from the June previous (when the last line was written in the article in the Transactions of the Congress), I can point to a series of cases right through the summer, which, symptomologically, I cannot separate from influenza. I have fairly full notes of such cases in September, October, November, and December, and I have records of some score of typical cases in January, and also in February. Undoubtedly, there was an enormous and sudden increase in cases from March onwards, and possibly, this may have been due largely to importation. Still it is difficult to say how much or how little may not have been due to the germs already present. Contrasting the present with previous outbreaks, it may be said that this is far the most extensive epidemic since 1885; that it seems to have been equally, if not more severe than that epidemic, and that comparing the two, there have been more nervous complications, more gastro-intestinal disturbance, and less anterior rhinitis and pulmonary disease, than with the previous epidemic. THE CAUSE OF THE DISEASE. Strong, though unconscious, evidence in favour of the germ origin of influenza is furnished by the negative character of the information derived from all previous epidemics. More recent knowledge points in the same direction, though the exact nature of the germ itself is still undetermined. Divers good reasons have always prevented my friend M. de Bavay, whose position as a bacteriologist is assured, from acceding to my request that he should undertake the search, and I regret this the more, because 405 SEPT. 15, 1890 Introductory Paper on Influenza. an opportunity was thus lost to Victorian medicine, such as may not occur again for a generation. Up to date, the "pneumococcus" of croupous pneumonia is the germ which European experts have found most frequently associated with an attack, and from clinical reasoning alone, the same close connection might have been predicted. But until something more definite is settled, many practical points of extreme value, besides the recognition of the germ, can only be guessed at. Thus, inter alia, we are left to conjecture whether atmospheric changes can or cannot so alter naso-pharyngeal conditions that harmless germs become pathogenic, and whether there may not be some mutual connection between the micrococcus diphtheriticus and the influenzal germ, though remaining specifically distinct; both matters of supreme importance to us at the present time. Whatever be the exact nature of the germ, however, there can be no doubt that it is to be found in the atmosphere, that it is characterised by sudden appearances and disappearances over large tracts of country, that it is almost instantaneous in action, and intensely depressant in its effects. Sometimes• it seems almost as if large bodies of air had been actually poisoned. Little, however, can yet be said of the modifying factors in its life history. In our outbreak in 1885, it was shown that "we had a winter unusually wet, unusually foggy, and unusually variable." To my mind, the main noticeable result was the extent and severity of the pul monic complications. In 1887, again, the winter was as characteristically dry, and yet influenza continued. In my paper before the Congress in January 1889, I noted that " variations of temperature and of wind seemed very frequently to have had great influence in producing relapses, if not in originating fresh cases." During the summer, it seemed as if it did not matter whether the change was from hot to , cold, or vice versa ; but since March, it is remarkable how many persons date their attacks or relapses to days, and even hours, when the change was from hot to cold, and especially to damp cold. And, I feel convinced, that to the mildness of the weather during last April and May we owe much comparative mildness in the number and extent of the pulmonary complications of the present, as compared with the 1S85 epidemic. THE SYMPTOMS, AND How THEY. ARE PRODUCED. It may be taken for granted that the causa causans is aerial, and very depressant in character, with an- especial action upon the 406 A ustralian. Medical Journal. SEPT. 15, 1890

nervous system. Necessarily, the naso-pharynx is the point of attack. The immediate products of such an agent are clinically divisable under two heads : (1) Specific catarrhal irritation, leading to inflammation and its results ; and (2) marked nerve phenomena. The naso-pharyngeal irritation is the initial and almost constant local lesion. It may be, and to my knowledge often is, overlooked, because, no complaint being made, no examina- tion is made ; but when looked for, some degree of irritation is rarely absent. (The last epidemic was characterised by the comparative absence of anterior rhinitis, with its attendant flow of tears and injection of conjunctivae ; and in certain cases the catarrhal changes were slight, whilst the nervous were severe.) This irritation is especially liable to spread. It generally invades the frontal sinuses and upper nasal region ; it frequently travels up the Eustachian tubes ; and in all but mild cases, it passes downwards, as a bronchiolitis, where the pulmonary membrane is weak ; or a gastro-duodenitis, where the latter track is more vulnerable. Hence follow the well-marked divisions—influenza with pulmonary, and influenza with gastro-intestinal complications, each deserving further attention. To return, however, to the nerve phenomena. That the nervous system is always to some extent, and frequently seriously involved, will be admitted by all. The only question is the modus operandi. Is it by the effect of the poison upon the system generally ? or by a local peripheral neuritis, with remote secondary effects ? or by local action, followed by the absorption of a ptomaine 4 The answer given can so far be only conjectural. I have already, in the paper which I wrote for the Intercolonial Congress, taken the ground that it is primarily local, and the experience of the late outbreak strengthens me in that opinion. The local nervous mechanism includes the glosso-pharyngeal, the pneumogastric, and the sympathetic nerves. Given a severe specific irritation and depression of these nerves, and as I have already ventured to show in a tabular form, the whole symptomatology of the disease could be predicted, and can be explained, if you will add thereto only the effects of the concomitant catarrhal inflammation. Already some pathological evidence has been collected in favour of this view. Trustworthy Continental observers have described a neuritis of one or more of these nerves, and a more or less extensive meningo-myelitis resulting therefrom. It is more than probable indeed that, as seems to have been proven in the case of the sister germ of 407 SEPT. 15, 1890 Introductory Paper on Influenza. diphtheria, a ptomaine is secreted, which in addition to producing local results, is absorbed, and causes a systemic infection, still operative mainly upon nervous structures. In this way we can explain cases otherwise difficult of interpretation. Taking now the combined result of catarrhal inflammation and nervous implication, we find that we may divide our cases into five classes —.(1) Cases of uncomplicated influenza, both mild and severe ; (2) Cases with pneumonic complications ; (3) Cases with gastro- intestinal complications ; (4) Cases with cardiac complications ; (5) Cases with nervous complications. The clinical pictures presented by most of these must be deferred for a future paper. It may not be out of place, however, to devote some present attention to certain points of general importance.

GENERAL REMARKS. (1) The pathological lesion, from the catarrhal point of view.— In the nose and throat there is, at least, injection of the membrane, al- most alway s folio wed by marked naso-pharyngeal catarrh, with sticky adherent mucus, and often exhibiting a tendency to hemorrhage. Intense irritation of the sinuses must be frequently present. Middle ear mischief not uncommonly follows the spread of inflammation up the Eustachian tubes. Ulceration amongst the turbinated bones may occur. Very frequently the whole membrane is markedly ill-nourished. In most cases a granular pharyngitis remains for some time, and actual sloughing of the membrane is not infrequent. Turning to the second class, we have, in addition, a bronchiolitis generally leading to a broncho-pneumonia, which is unduly resistent of treatment. Pleuro-pneumonia and pleurisy, running abnormal courses, may also occur. The whole lung com- plications, indeed, point to the additional implication of the trophic influence of the vagus. The pneumococcus and ordinary pus germs are present, and sooner or later the tubercle bacillus frequently obtains a foothold, and phthisis is established. The gastro-intestinal class of cases is, to me, of the greatest interest. A gastritis has been described by the German pathologists. But how about the enteritis ? Quain, Da Costa and others record haemorrhages from the bowel in some of these cases, and I am inclined to place several of my cases beside their's. In addition, I have in some half-dozen found more or less extensive sloughing of the mucous coat. We can, then, have ulceration and sloughing, possibly even in Peyer's patches. In the only fatal case which I have seen, and which was 408 Australian Medical Journal. SEPT. 15, 1890

diagnosed as complicated with typhoid fever, noteworthy change in the stomach and intestine were present in addition to the specific ulcerations. I have already alluded to this relationship to, and differentiation from, typhoid fever, before the late Congress, and I have found the differential diagnosis there suggested stand the test of the late epidemic. In addition, we find congestion of the liver with acute lithiasis, and quasi-rheumatic sequelm and consequent acute congestion of kidneys, and even, in exceptional cases, acute nephritis. In several cases I have noted complete and intractable atony of the colon. (2) The cardiac class of cases is also worthy of some attention. I believe that I may claim to have been the first to bring this important matter prominently forward by my paper in 1885. Here the effects seem mainly, if not entirely, due to reflex irritation. Cases characterised by syncope at the outset, rapid, intermittent, or irregular pulse, or unduly slow pulse and syncopal attacks, have been fairly frequent in this epidemic also, and to cardiac weakness thus produced I attribute several fatal cases. (3) Nervous complications, again, have been so numerous and extensive as to warrant the establishment of a fresh class. How they may be produced has been already discussed. Within my experience have occurred cases of intense cervico-brachial, mam- mary, dorso-intercostal, lumbo-abdominal, cervico-occipital, and trigeminal neuralgia or neuritis. Various visceral neuralgize have also been found—especially ovarian and renal. I have seen also profound melancholia, irregularity of the pupils, active delirium and mania, protracted insomnia, epileptiform convulsions, spinal meningitis, excruciating and intractable headache, various hysteroid phenomena, and marked somnolence all follow upon influenzal attacks, as well as paroxysmal hwmo-globinuria, spasm of the oesophagus and of extremities, general and local pareses, and joint pains without redness or swelling. Further, in three cases diabetes has quickly resumed an acute stage. The characteristic headache may, no doubt, be explained as largely due to irritation of the frontal membrane, but it is partly also the result of the depression of the vagus and sympathetic, and in some cases is apparently due to systemic infection. The almost equally characteristic lumbar pain seems to be partly neuralgic and partly the result of acute lithiasis. The cough suggests a neurotic, in addition to a catarrhal, element. The noteworthy costiveness depends upon nervous impli- cation more than upon catarrhal conditions. The sweating, which 409 SEPT. 15, 1890 Introductory Paper on Influenza. often exceeds that of acute rheumatism, and approaches the third stage of ague, is due to interference with the sympathetic system and sweat centre. The temperature, too, in severe cases, points to• nerve implication rather than to ordinary febrile conditions. Often as high as 104°, or higher, it frequently remains high without any sufficient inflammatory cause, it is liable to unaccountable alterations, often with a distinct periodicity, and its characteristic tendency to remain subnormal for days, and even weeks, must have struck all observers as suggestive of exhaustion of the therm& taxic apparatus. (4) The suddenness and severity of onset, often suggestive of accident, the general tendency to relapses, the marked manner in which the disease spends its force upon the weak spot of the system) the protracted nature of severe and complicated attacks, the spread of the disease, at first by aerial transmission, then by personal infection within a limited radius, striking, as a rule, first men, then women, then children; its incidence mainly upon those most in the open air, the great influence of neglect in producing relapses, and of nerve strain, of continued exposure, of chest weakness,'and of_ hepatic vulnerability in fashioning the complication, and the marked influence which it exerts upon concurrent disease—all can be only incidentally mentioned in the present introductory paper. (5) Lastly, the diseases with which influenza may be, and often has been, confounded, are worthy of notice. This is a matter of great clinical importance. I have seen numerous cases thus mis- taken for diphtheria, typhoid fever, acute rheumatism and phthisis. Instances have not been wanting where influenza was mistaken for ague, congestion of the brain, scarlatina, and malignant diseases. As I hope to enter into this question in detail, I will here dismiss it without further mention. TREATMENT. A few words upon treatment, and I have done. Preventatively, nothing can be done for a community. A disease which, beyond all others, needs only the atmosphere for its trans- mission, cannot be stopped by any system of quarantine or medical inspection. And but little seems available in the case of the has been secured by individual. I believe, however, prevention avoiding night and damp air, by the use of menthol inhalations, and a course of small doses of quinine Symptomatically and general nerve curatively, however, there is much to be done. As a tonic, I believe nothing is equal to a course of quinine. Fellows' 410 Australian Medical Journal. SEPT. 15, 1890

syrup, maltine and cod oil, and other forms of tonics and restora- tives are frequently necessary auxiliaries. The aid of a scientific •dietary must, of course, be invoked. Stimulants are generally necessary, and I have found especial good from St. Raphael's wine in a large number of severe cases. During the attack, nothing is of more importance, in my opinion, than confinement indoors in a warm room. Most relapses and very many of the complications have resulted from neglect or continued exposure. Turning to the symptoms, the throat almost always requires special attention. In the irritant stage, great benefit frequently follows a gargle of boracic acid (gr. x. ad. j j.), or a swab with menthol (10 per cent. in olive oil). In the chronic stage, these should be replaced by the local application of the glycerine of tannic acid, soon followed by the use of solutions of argent. nit., at least gr. xxx. ad . j j. Upon this last I would place especial stress. I am strongly of opinion that the placing of the naso-pharynx in a satisfactory state is the main safeguard against relapse, and so against complications; and I know of no application to approach the argent. nit. in value in this respect. The headache can generally be conquered, either by the use of the chloride of ammonium inhaler (Vereker's patent is the one with which I am acquainted), or by the sedative effects of -antipyrin, in doses of ten grains more or, or by the use of both combined. Locally, heat and menthol seem of most service. As an antipyretic and sedative against the general symptoms, nothing seems superior to antipyrin, using always the minimum dose. In the gastro-intestinal irritability, bismuth is of great service. The pulmonary complications must be treated upon recognised grounds, remembering the especial value of ether, ammonia, and quinine, -and not forgetting that convalescence will probably be protracted, whatever drugs are used. The gastro-intestinal complications will frequently tax every effort. Not uncommonly such cases are com- plicated by typhoid attacks, and the usual indications in diet and drugs have to be scrupulously followed. The cardiac cases have the special need of rest, and caution in the use of stimulants. For the anomalous nerve phenomena, antipyrin has been, in my hands, frequently of signal service. At times, however, nothing but full doses of morphia and atropine proved sufficient. Lastly, during recovery, it always seemed to be of the utmost value to avoid night and damp air, and change of climate frequently proved the only restorer, as well as the best preventative of complications or relapses. 411 SEPT. 15, 1890 Introductory Paper on Influenza.

Dr. J. DE B. GRIFFITH wished to understand whether Dr. Springthorpe thought that the recent epidemic, or the fog fever of 1885 had its origin in Australia. He was puzzled to know why the name Russian had been given, if the origin of the disease was so general. In his opinion, fatal cases of influenza were due to pre-existing disease. Personally, he had never seen a fatal case, but had heard of two ; in both there had been preexisting disease —one cardiac, the other pulmonary. In the cases seen by the speaker, the nervous symptoms were all prominent, e.g., great depression, intense headache, inability to get about or to shake off the disease for a long time. His treatment had been antipyrin, bed, warm drinks, very little stimulant, and saline purges, if needed. In twenty-five to thirty cases of which he had notes, he remarked that they all lived in wooden houses which were very insanitary, and which offered no resistance to extremes of heat and cold. He had noted a similar association of weatherboard houses in the epidemic of 1885. Dr. J. T. BRETT congratulated Dr. Springthorpe and the Branch upon having produced a very able paper, which showed that the writer must have seen many hundreds of cases. He was sure that if Dr. Springthorpe had been in England, he would have seen many cases of epidemic catarrh like those of the last epidemic here. Shortly after his arrival in the colony in 1882, he saw several cases of epidemic catarrh, and was particularly struck by the idea that they more resembled epidemic pneumonia. The outbreak of 1885 was more of epidemic pneumonia in type— there was less of coryza, frontal headache, and of general catarrhal symptoms, than he had been accustomed to see in epidemic catarrh in England. Of the last epidemic, he had not much experience so far as Victoria was concerned, but had seen many cases in England, some two or three hundred in Paris, nearly all the doctors ill with it in Vienna, eighty people down with it in his hotel in Rome, &c. These cases were of a rather different type from those seen here ; they were more severe, but they presented less gastro-intestinal characters. Some of the cases he saw here, looked so like typhoid, that, had he not known that influenza sometimes took on that form, he would have diagnosed them as typhoid fever. Many medical men here, were formerly under the impression that influenza signified merely a catarrh of the mucous membranes of the nose, throat, and lungs. His treatment was a warm bed and plenty of whisky. He used antipyrin for symptoms, 412 Australian Illedwal Journal. SEPT. 15, 1890

quinine and oleum morrh. for after treatment. He had heard of influenza attacking domestic and stable animals. Dr. COBB thought it well to say, as a possible explanation of the aetiology of the disease, that Dr. Whitaker had told him that no cases of influenza had occurred in the Benevolent Asylum. Dr. GRESSWELL had listened with great interest to the instructive paper which Dr. Springthorpe had read. He thought the time which Dr. Springthorpe had fixed upon for bringing forward his paper was peculiarly opportune : the epidemic had now all but subsided, and there was a chance that interest in the questions arising out of the epidemic might flag if consideration of them were further off. He hoped Dr. Springthorpe would, as he had intimated, carry out the plan which he had set out for himself, of making this paper but the first of a series on the subject. The first patients to whom his attention was drawn in Victoria, had been attacked before he arrived in the colony ; and they were, he thought, of great interest. The history of these cases showed clearly that the affection was that which had in Europe gone by the name of Russian influenza. Dr. Coane, who had care of these cases, told him that he was unable to distinguish them from others which he had had regularly every year for the past four or five years in the same locality. Then again, in examining the registers of deaths for the township of Warragul, Dr. Gresswell had found deaths attributed four or five years ago, by Dr. Cobb, to "pneumonia (influenza)." Dr. Cobb, who was present at the meeting would be able to confirm this statement. And again, Bishop Selwyn had informed him that some three years ago there was a marked outbreak of influenza in Melanesia. Facts of this sort were very suggestive, and needed to be well considered, having regard to the prevalence of "fog fever" here five years ago. He was pleased to hear that Dr. Springthorpe was making inquiries into the matter in China. Dr. Gresswell stated that the medical profession had very generously responded to the invitation for help concerning the prevalence of the disease in Victoria ; and that he hoped for one more return in order to learn the date when the prevalence subsided in the different parts of the colony. As regards the infection of animals, it would be remembered that when he first brought the question of investigating the disease before the Association, he spoke of the necessity for appealing for information to the veterinary sugeons of the colony. This appeal he hoped would be made very shortly. He was pleased to see 413 SEPT. 15, 1890 Introductory Paper on Influenza. that veterinary surgeons had made observations on the subject. Mr. Kendall had spoken of the disease having occurred in certain anthropoid apes in the Zoological Gardens of Melbourne, and also in other animals. Dr. Gresswell would not express any opinion as to the relation which influenza of horses held to influenza of man until the data were more clearly set out. It certainly was a fact, that in England influenza of horses recurred almost yearly with the regularity of recurrence of a particular season ; and if the disease were the same as that of man, the question arose as to why the latter had not manifested itself for so long a time previously to the late outbreak. He thought that quite possibly more than one disease was included in the term influenza of horses, as also in the term influenza of man ; and that great care would need to be had in getting as full information as possible on the subject. With regard to the clinical symptoms, it was interesting to hear that Dr. Springthorpe had been able to speak definitely concerning nephritis ; for almost all of the infectious diseases seemed apt to manifest themselves in renal disturbance, and, -though he had made several inquiries as to this, he bad not been very successful in getting information. As to intestinal haemorr- hage in the gastro-enteric forms of the disease, he remarked that it not only occurred in enteric fever, but that it was common in certain forms of small pox and in certain forms of scarlatina ; and it appeared, as Dr. Springthorpe had said, from the observations of himself and several European authorities, that it occurred in influenza. He was sure that a full record of the facts observed in Victoria would be read with the greatest interest in Europe. The fact that the medical officers of the Local Government Board had directly applied for information on the subject was significant enough ; and with an appeal from such a quarter, he had confidence that the medical men of Victoria would not grudge the time which they had already spent, or that which they would further give, to putting their experience of influenza on record. Mr. SYME said the Branch was much indebted to Dr. Spring- thorpe. He echoed the hope expressed by Dr. Gresswell, that the paper would be introductory to a series. Dr. SPRINGTHORPE was obliged to the members for the kindly hearing they had given to his lengthy paper. In reply to Dr. Griffith, he was not claiming for Australia the honor of inaugurating the recent universal influenza epidemic, he was simply stating facts, with the hope of assisting in obtaining a 414 Australian Medical Journal. SEPT. 15. 1890

thorough knowledge of its origin. All authorities admit that influenza, as an epidemic, has been absent from the world since 1849, but we had it here in 1885, and many medical men think we have had it ever since then. With regard to fatal cases being due to pre-existing disease, his own experience was that influenza seizes on a weak spot—that is its striking feature. Cases dying from heart complications had in nearly all instances shown pre-existing heart weakness. You might get fatal cases where there was no pre-existing disease, but as a rule, the pre-existence of any weakness determined the complication. Referring to Dr. Griffith's statement as to the association of wooden houses with influenzal cases, he would point out that influenza was generally contracted in the open air, but was of opinion that for the reasons mentioned by Dr. Griffith, such cases would do badly in such houses. Regarding what Dr. Brett had said, he knew that there were very serious difficulties in diagnosing between epidemic catarrh and influenza. Until we found a specific germ for influenza, and found such germs present in the given case, it would be impossible to arrive at absolute certainty. Such a point raised the question of the relation of minor forms to major forms. It was a singular coincidence that diphtheria had been worse since we have had a severe influenzal epidemic. Was this only because many so-called cases of diphtheria have really been influenza? As to its occurrence in animals, his horse had suffered from true influenza, not " pink-eye," nor " strangles," but a catarrh of the nose, with quite unexpected prostration. He was informed by Mr. Garton that during the epidemic of 1885, influenza was epidemic in his stables. Dr. Cobb's statement about the Benevolent Asylum people was also true of the 1885 epidemic. It was then noted that people confined in certain enclosed spaces ran less risk. Some of the lunatic asylums, and the Pentridge stockade escaped. Postmen, sailors, and others seemed affected because they were exposed to contaminated air in all parts, not because of their handling infected cargo or mail matter. Dr. Snowball as well as himself had noticed that in the recent epidemic children were not infected in the open air, but in most cases by personal infection— through their parents, &c, Dr. Gresswell's statement regarding Dr. Selwyn supported the position that he had taken up. From the clinical point of view, thegastro-intestinal form was of the greatest importance. We were accustomed here to see a number of cases of typhoid plus something, that something is often influenza. Numbers 415, SEPT. 15, 1890 Examination with the Ophthalmoscope. of the cases reported as typhoid were in his opinion influenza. As a rule, every continued fever occurring in the typhoid season is taken to be typhoid ; if lmnorrhage occur, the diagnosis is considered certain, yet you may have lmmorrhage with the gastro-intestinal form of influenza. He thought that we might find before long that even ulceration of Peyer's patches was not confined to typhoid fever. Dr. BRETT asked if Dr. Springthorpe could trace the origin of the epidemic of 1885. He thought the name of fog fever was given because a similar epidemic had just ended in California, and it had been known as fog fever. NOTE ON EXAMINATION WITH THE OPHTHAL- MOSCOPE BY ORDINARY DAYLIGHT. By JAMES T. RUDALL, F.R.C.S. Surgeon to the Alfred Hospital, &c. About nine years ago, while I was visiting the Netherlands Ophthalmic Hospital at Utrecht, Professor Snellen was good enough to direct my attention to a contrivance, which he was just then having prepared, for examining the fundus of the eye by daylight. Though simple enough, it had not been completed quite to his satisfaction. Nevertheless, I had the opportunity of making an observation or two, and I was able to see the ocular fundus very well. It was my intention, on returning home, to have the window of my study fitted for daylight examinations, by means of a darkening window shutter, with a hole to admit a beam of light, as at the -Utrecht Eye Hospital. However, on resuming practice I neglected the matter, and went on in the old way, using only the simple table gas lamp with Argand burner, sliding on ,a vertical rod, which I had devised for myself when I first began practice, and which had always been satisfactory. Some time ago, I found that I could often make an effectual ophthalmoscopic examine.tion in front of the window, and this plan I have within the last year or two many times made use of. By placing the patient a little obliquely, with his back at an angle with the plane of the window, it will be found that many eyes can be effectually examined, both in the erect and in the inverted image, without artificial light. Probably other persons may have discovered the possibility of thus seeing the fundus of the eye, but I have no recollection of anyone making it known. Is there any advantage in this kind of examination ? At present I am not prepared to 416 Australian Medical Journal. SEPT. 15, 1890

answer the question fully. The fundus is seen more naturally, so to speak, than by the orange tinted light of the lamp, and I think slight whitening of the discs comes out more decided, perhaps also, some other abnormalities will be seen better in this way ; and we may bear in mind that we are not in every case dependent on artificial light for ophthalmoscopic examination. Drs. BRETT, GRIFFITH, SYME, and KENNY spoke to the paper, all stating that the idea was not original. Dr. Brett had been taught the method by Bader, in London. Mr. Syme had practised it with Mr. Lang, at Moorfields. Dr. Griffith had found electric light the most satisfactory. Dr. Kenny pointed out that daylight was very variable, and the relative value of a series of observa- tions would not be so great as that obtained by the use of light of the same regular intensity. Undoubtedly, examination by daylight gave the colours more naturally ; he had practised the examinations at various clinics, both in England and on the Continent. Dr. Louis HENRY sought and obtained permission to record a chemical experiment he had been engaged in. He had tried to isolate the vital principal from Brown-Sequard's fluid. He had managed to obtain spermin crystals, and had formed a muriate of spermin. The crystals were very small, and required a magni- fying glass to see them. He had not obtained sufficient of them to show to the meeting (forty' testicles from twenty rabbits yielding only one grain). He however showed a solution of the muriate, amber-coloured, with a peculiar smell. In reply to a question, Dr. Henry said that the testicles of sheep or rams, contained too much fat, and required treatment with ether, &c. PATHOLOGICAL SPECIMENS. Dr. SPRINGTHORPE exhibited the organs from a patient, concern- ing which he has supplied the following notes :- W. T., mt. 56, seaman, admitted to the Melbourne Hospital, June 25, 1890. States that six weeks previous to admission his abdomen began to swell rapidly, reaching present size within a week. On examination, temperament hepatic. History.—Has had piles and jaundice, rheumatic pains in shoulders and hips, ague 35 years ago. Swamp fever six months ago—main symptoms being colicky pains, and profuse watery diarrhoea. Has never passed any blood from the bowel. At 417 SEPT. 15, 1890 Pathological Specimens present has no pain anywhere. Abdomen is distended, measuring 461 inches at umbilicus. Dulness in dependent parts ; resonance above ; distinct fluctuant wave. On June 27th was tapped, 25 pints of straw-coloured fluid being obtained. Abdomen began to swell again very rapidly, by July 6, reaching 42 inches. July 8.—Abdomen 451 inches. July 11.—Abdomen 451 inches. On July 12 (fifteen days after first tapping) was again tapped, 30 pints of fluid being obtained. July 13.—Had some vomiting and colicky pain during night, but is easy this morning. July 16.—Abdomen 421 inches. July 21.—Abdomen 431 inches. July 26.—Abdomen 45 inches. August 2.—Abdomen 471 inches (21 days after last tapping) was again tapped, 33 pints being obtained. August 4.—Had pain in abdomen last night ; easy now. August 5.—Had slight pain in abdomen yesterday, but had good night's sleep. August 6.—Pain getting worse, and in the evening was agonising. Had some vomiting and some collapse, temperature remaining below 96°. At 10 p.m. had quarter of a grain of morphia hypodermically ; pain not much relieved. At 4 a.m. on 7th, had half a grain, after which he slept. August 7.—Is semi-conscious ; rolling about. Cylindrical tumour felt extending across right side of abdomen, a little below umbilicus. This is evidently tender on manipulation, and freely movable. In the evening he died, five days after last tapping. Just before death, passed a quantity of dark-coloured blood by bowel. During illness bowels were kept freely opened E. pulv. jalap co., or E. pulv. scammony co. Post-mortem.—There was a considerable quantity of fluid in peritoneal cavity. Localised peritonitis. About four feet of small intestine were intensely congested, blackish-looking, swollen. There was actual hemorrhage beneath the peritoneal coat. The corresponding mesentery was in a similar condition, being very much thickened (about one inch through), and its veins were plugged partly with recent, and partly with decolorised, adherent clot. Mucous membrane of affected intestine was swollen, and dark red in colour. Omentum was matted together. Large DD 418 Australian Medical Journal. SEPT. 15, 1890

intestine was distended, and its mucous membranes stained with blood. Portal vein was large, and contained clot, adherent, partly organised, but softish in centre. This extended downward into splenic, but chiefly into the superior mesenteric, vein. It also extended upwards into the liver. The main portal veins in the liver were plugged. Spleen was large and tough. Liver nodular on surface, smaller ; substance not tough, and on section, the lobules were well defined. Right kidney large, left small ; cortex swollen and streaky; substance rather firm. Lung congested; old pleurisy on both sides. Heart feeble. Vittorian altbital Ntitthrent .5sotiation.

The annual meeting of the above Association took place in the Hall of the Medical Society, on Friday evening, August 8. The President, Dr. Cutts, occupied the Chair. The first business was the submission of the Report of the Committee, which was as follows : REPORT OF TIIE COMMITTEE. The experience of the Medical Benevolent Association during the past year has not differed greatly from that of previous years, save that the expenditure has been somewhat less than formerly. The income has been about the same, so that a larger sum than the average will have to be added to the permanent fund. This latter now amounts to about two thousand five hundred pounds, and it is perhaps not unreasonable that subscribers should occasionally desire to know the purpose of accumulating a fund which, as yet, has never been drawn upon for the particular purpose assigned to it in Rule XIV, namely, to relieve the widows of medical men who have complied with the very unexacting condition of subscribing for three consecutive years. The reply to this query is, that no appli- cation has yet been made by any person legally entitled to such relief, and therefore the interest has remained untouched. Never- theless, the Committee have given their attention to the feasibility of putting it to some use not of a kind originally contemplated by the founders of the Association, but yet strictly limited to those connected with the medical profession. No actual shape has been communicated to these suggestions, and therefore any counsel tending to help the Committee to a conclusion on this matter will SEPT. 15, 1890 Medical Benevolent Association. 419 be gladly received. Among the suggestions which have been offered, is a proposition that the permanent fund should be used as the basis or nucleus of a life insurance society; but the Committee think that the comparative smallness of the amount at their command should obviously indicate the virtual impossibility of employing it in this way. They think it would require some very exceptional augmentation to render such a project likely to, be carried out. It is certain, however, that in view of future demands upon the resources of the Association, the present apparently unnecessary surplus will, after a while, present no embarrassment to the Committee as to how it should be employed, other than in casual relief. The extraordinary increase in the number of medical men in this colony during the last five years, and the much keener competition in the profession than formerly, unquestionably point to coming requirements, greatly beyond those represented by the experience so far presented. Instead, therefore, of there being any occasion for withholding or withdrawing contri- butions to the fund, the Committee think there is strong reason for making special efforts to enlarge it. It may again, as in former years, be pointed out that there is an indirect service rendered by the Association to the profession, by relieving individual members of the solicitations of that numerous class of persons who live by imposture. Hardly a day passes that claims are not made which cannot be substantiated, and it is in the work of investigating and exposing these demands that much of the usefulness of the Association is manifestated. Altogether, the Committee think there is good reason for congratu- lation at the success and present prosperity of an Association which, supported by only a comparatively small percentage of the pro- fession, has yet supplied a large measure of timely relief, and has never denied its advantages to any person deserving of its consideration. Among the applications, there have not been any exceptional cases. They have represented particulars resembling those of former years. There has been no instance of special distress, and as will be seen by the Treasurer's cash statement, none demanding more than ordinary amounts for their relief. The cases refused have been more numerous than the average, but these have all been from persons who did not furnish evidence of legal qualification. There have been five Committee meetings, and there have been but few absences of members. DD 2 420 Australian Medical Journal. SEPT. 15, 1890'

TREASURER'S REPORT. THE HON. TREASURER IN ACCOUNT WITH THE VICTORIAN MEDICAL BENEVOLENT ASSOCIATION. Dr. To Balance from 1888-89 .. £130 2 8 Subscriptions (97) for 1889-90 .. .. .. • • 101 16 0 Do. for 1888-89, not included in the year's Balance Sheet .. 3 3 0 Interest on Fixed Deposits, Australian Deposit and Mortgage Bank • . .. .. .. .. 76 0 0 Interest on Current Account .. .. .. 2 8 3 Interest on Inscribed Stock, Victoria (2 years) .. 40 0 0 Interest on Queensland Government Debentures (18 months) 12 0 0 Interest on Medical Society Debentures .. 3 12 0

£369 1 11 Cr. By Grants £29 0 0 Special Grant carried forward 4 0 0 Stillwell and Co., Printing, Postage, &c. (2 years) 9 10 0 Cheque Book 0 2 0 Transferred from Current to Capital Account 176 0 0 Commission to Collector 10 3 6

228 15 6 Balance to 1890-91 (Current Account in Bank) .. 140 6 5

£369 1 11 CAPITAL ACCOUNT. Fixed Deposits in Australian Deposit and Mortgage Bank .. £1636 0 0 Victoria Inscribed Stock 500 0 0 Queensland Government Debentures 200 0 0 Medical Society Debentures 60 0 0 Savings Bank Account, including Interest .. 10 0 6 Balance to 1890-91 140 6 5

£2546 6 11 Audited and found correct, GEO. LE FEVRE, M.D., Auditor.

LIST OF SUBSCRIBERS OF ONE GUINEA, FOR 1890-91. Adam, G. R. Bryant, H. W. Crosson, H. Alsop, T. 0. F. Burke, S. J. Cutts, W. H. Amess, J. Burton, W. H. Anderson, J. Davenport, A. F. Biittner, A. Dick, T. T. Annand, G. Carstairs, J. G. Armstrong, G. A. Dowling, F. J. Clendinnen, F. J. Downie, J. F. Backholise, J. B. Coane, J. Duigan, C. B. Balls-Headley, W. Cole, F. H. Fetherston, G. H. Bennie, P. B. Cooke, J. Bird, F. D. FitzGerald, T. N. Courtenay, J. H. Fisher, A. Bowen, A. Cox, J. Brett, J. Fletcher, E. Crivelli, M. Flett, W. S. 421 SEPT. 15, 1890 Typhoid and Milk.

Ryan, C. S. Francis, H. McLean, H. R. McMillan, T. L. Schleicher, C. Grant, D. Shields, A. Haig, W. McMullen, H. Meyer, F. Simmons, E. L. Heffernan, E. B. Smith, C. Hewlett, T. Miller, J. J. Moloney, P. Smith, L. L. Hodgson, G. J. Snowball, W. Honman, A. Moore, W. Morton, J. W. W. Springthorpe, J. W. Home, G. Syme, G. A. Iredell, C. L. M. Neild, J. E. O'Brien, J. W. Thomson, G. Jackson, James Thomson, M. B. Johnston, J. M. O'Hara, H. M. Owen, F. 3. Talbot, R. Jonasson, H. Travers, G. F. Kenny, A. L. Paton, D. M. Penfold, 0. (paid previously) La Mert, L. Turner, D. Le Fevre, G. Peipers, F. Pincott, R. Walsh, W. B. Lempriere, C. (jun.) Webb, J. IL Lillies, H. Ramsey, J. K. Robertson, 3. Williams, D. J. Mailer, M. Williams, J McCarthy, C. L. Robertson, R. Rudall, J. T. Zichy-Woinarski, G. McCreery, J. V. H. S. M'Crea, W. Ryan, J. P. M'Gregor, T. M. OFFICE-BEARERS FOR 1890-91. President—Dr. Cutts ; Vice-Presidents—Dr. Jonasson and Mr. Rudall ; Treasurer—Dr. Cutts ; Joint Honorary Secretaries —Dr. Neild and Dr. Graham ; Members of Committee—Dr. C. S. Ryan, Dr. Haig, Dr. Kenny and Dr. W. Moore ; Auditors —The Hon. Dr. Le Fevre and Dr. Bennie ; Trustees—Dr. Cutts, Dr. Neild and Mr. FitzGerald. Australian ttrital (Journal. SEPTEMBER 15TH, 1890.

TYPHOID AND HILK. In the opinion of the Sanitary Commissioners, stated in their Third Progress Report, p. xxii, " It is evident that dairy farms require to be placed under much stricter supervision, and that the bye-laws (relating to dairies) must be more rigidly enforced. . . . The Health Act provides that Local Boards may make bye-laws for the inspection of grazing grounds, but such bye-laws appear to be more honoured in the breach than the observance." The recent inquiry into an outbreak of typhoid fever at Toorak, shows how correct was the opinion of the Commissioners, and how very careful and thorough inspections of dairy farms require to be. The facts may be briefly stated thus—A. number of 422 Australian Medical Journal. SEPT. 15, 189a cases of typhoid occurred at a time of year when the disease is not usually very prevalent, and in a district generally regarded as in a very good sanitary condition. Circum- stances pointed to the milk supply as the probable source of contamination. A first investigation appeared to negative this view, but a more thorough search discovered that the farm was watered by a creek to which the cows had access, and from which they drank. An orchard on which night- soil had been deposited, drained into the creek higher up its course. The Medical Inspector of the Board of Health con- sidered that the mode of contamination was thus sufficiently evident. It is not quite clear, however, what he considers to have been the exact mode of contamination. Does he believe that, by drinking infected water, the milk became infected without the cows suffering from the disease ; or is there any evidence that the cows were affected in any way ? Or, does Dr. Gresswell think that when the cows waded into the stream their udders became infected, and the germs of the disease thus passed into the milk ? Were the cans washed in the water ? It would be exceedingly interesting to know whether any typhoid bacilli could be discovered in the creek water, or in the milk of the cows ; and if discovered in the water and milk, whether they could be found in the milk after the cows had been removed from the ground and their udders carefully washed. Consequently, many will be inclined to take exception to Dr. Gresswell's view, that a bacteriological examination was not necessary. That such an investigation would be apt to prove negative in its results is very probable, but is hardly a reason for not making the attempt. If it had been stated that under existing circumstances a bacteriological examination was not very practicable, the statement would be more intel- ligible. The fact is, that a properly equipped bacteriological laboratory, in perfect working order, and in charge of an expert, does not exist in Melbourne. M. de Bavay has some of the requisite apparatus and materials in a room at the Victoria Brewery, but he has other duties to attend to than making special investigations of this kind. At the Medical School also, may be found most of the necessary appliances, 423 SErr. 15, 1890 Presentation to Dr. Neild. but they are not fitted up or in working order, and so far as we know, there is no one in Melbourne (with the exception of M. de Bavay) who is competent to conduct an inquiry with them. The eloquent address of Sir B. W. Foster, at the Birmingham meeting of the British Medical Association, forcibly illustrates the important relations of modern bacteriology to practical medicine, and especially to hygiene, and the necessity for precise scientific knowledge in all sanitary inquiries. It is high time indeed that a fully equipped bacteriological laboratory was established in Melbourne, under the charge of an expert in this new branch of science. It might advantageously be connected with the Pathological Department of the Medical School, but as its chief work would be concerned with public health matters, the Public Health Department might well defray the expense. Such laboratories, as is well known, have long been established in Germany by the Government. Koch is director of such an establishment at Berlin. They have also been established in connection with the Boards of Public Health in America. It has only to be clearly recognised that it is a necessity, in order to have one in Melbourne. PRESENTATION TO DR. NEILD. A large number of the friends of Dr. J. E. Neild assembled at the Princess Theatre, on the 18th ult., for the purpose of making a presentation to that gentleman, in recognition of the many services he has rendered to the community during his lengthened residence in Melbourne. Mr. G. S. COPPIN, M.L.C., who occupied the chair, stated that he only intended to speak of Dr. Neild as a dramatic critic, and he would leave it to Dr. Brownless, the Chancellor of the University, and Dr. Le Fevre, M.L.C., the President of the Victorian Branch of the British Medical Association, to refer to him as a physician. For thirty years Dr. Neild had been a theatrical critic, and associated with the newspaper press as although he had not always given complete satisfaction to those he criticised, he had discharged his duties in as kindly a manner as possible. Notwithstanding an occasional sting from his pen he 424 Australian, Medical Journal. SEPT. 15, 1890

had made many friends among members of the theatrical profession, and they were glad to have the opportunity of doing honour to him at the present juncture. Dr. Neild, in his writings in the past, had frequently alluded to the desirability of having complete stage mountings, so that the surroundings of a drama might approach nature as nearly as possible. His ideal seemed now to have been achieved, but the actor had hardly kept pace with the scenic artist and painter in modern advancement. Mr. ALFRED DAMPIER was then called upon to read the following address :— " To James Edward Neild, M.D., dzc. "Dear Sir,—In tendering you the accompanying testimonial, we desire to express our strong appreciation of your many and valuable services to the community during the past thirty-seven years. " In your professional career as a medical man, you have been prominently identified with the growth and development of medical science in our colony, and in connection therewith, you have ably and unselfishly discharged most honourable and im- portant duties as a teacher in the Medical School of the Melbourne University during more than a quarter of a century, and as a former President of the Medical Society of Victoria, and of the Victorian Branch of the British Medical Association. "Your name is and must ever be worthily and inseparably associated with the history of dramatic art in Victoria, as one of the ablest and most consistent critics on the Melbourne press. In that capacity you have afforded continuous intellectual pleasure to three generations of readers. You have done good work, that cannot be sufficiently appraised, in guiding and elevating public taste, and in establishing an exceptionally high standard of culture and excellence in the theatrical profession. " By your active co-operation and enthusiastic sympathy in connection with many literary, artistic, and social movements, you have displayed a generous recognition of the best and highest duties of citizenship, and aided largely in that intellectual advance- ment which has been a distinctive feature in the progress of our metropolis. " Wishing that you may enjoy many years of health, happiness, and prosperity, with honour and love and troops of friends, " We subscribe ourselves, " Respectfully and faithfully yours." 425 SEPT. 15, 1890. Presentation to Dr. Neild.

Mr. Coppin afterwards presented Dr. Neild with a cheque for £761 18s. 9d., the amount raised by private subscriptions and two benefit performances. Dr. BROWNLESS said he could bear testimony of the strongest kind as to Dr. Neild's ability as a physician, and as to the feeling of regard entertained for him by other members of the medical profession. As lecturer on forensic medicine at the University, he had discharged his duties with marked ability. Dr. LE FEVRE, M.L.C., referred to Dr. Neild's connection with the Medical Society of Victoria and the Victorian Branch of the British Medical Association, of both of which Societies he had been president, as well as his editorship of the Australian Medical Journal. The only grudge the medical profession bore to Dr. Neild was, that he had not devoted the whole of his energy and ability to the healing art, Had he done so, he would probably have been a rich man. Dr. NEILD in responding, said he felt deeply grateful for the high compliment that had been paid to him. It was said that a man of many trades was master of none. He must plead guilty to having attempted many things, but he hoped he had done some of them not very ill. The kind friendly way in which his poor efforts had been recognised, led him to suppose that he had done a little good for Melbourne. If he had had his own way, he would rather have been content with the satisfaction of having done his duty. He had always tried to do what was right, but he had sometimes run counter to the feelings of others. As a theatrical critic, it had been practically impossible to please everybody, and he had not tried to do so. He thanked all those who had contri- buted to the testimonial from the bottom of his heart. On no previous occasion had he been more deeply impressed with a feeling of satisfaction and thankfulness, and he would never forget the kind way in which he had been treated. The Charity Commission has been further engaged during the past month in taking evidence, and on the 19th ult., visited the Melbourne Hospital and inspected the whole of the hospital buildings, as well as the wards, concern- ing which many condemnatory statements have been made in evidence by different witnesses. Dr. Grant, who had condemned the institution in his evidence before the Commission, was also present, and pointed out the objectionable features of the building to which his testimony had reference. The general opinion of members of the Commission was, that the buildings were crowded together in an altogether unsatisfactory manner, but satisfac- tion was expressed at the cleanliness and order of the Hospital considering the defects against which the Committee of Management had to contend. 426 Australian Medical Journal. SEPT. 15, 1890, gebitb3,

Flushing and Morbid Blushing—Their Pathology and Treatment. By Harry Campbell, M.D., B.S. London : H. K. Lewis. Flushing and blushing have hitherto received scant attention at the hands of medical writers. Darwin discusses blushing in his well-known " Expressions of the Emotions," but otherwise these symptoms are merely mentioned in the text-books as symptoms of certain disorders, and have been the subject of a few fugitive papers. Nevertheless they are well worthy of study, for diagnostic points might be brought out by their careful observation, and more efficient relief given to those who suffer from them. The author commences his monograph by a careful account of the anatomy and physiology of the parts concerned. He lays great stress on the fact that each of the several cutaneous vascular systems (of derrnic papillae, sebaceous glands, hair follicles and sweat glands) is supplied with a distinct vaso-motor system of its own, and that any one of them may be affected independently of the other. He also makes use of Hughling Jackson's theory of evolutionary levels, and deduces from it, that as all parts of the body are represented in the highest cerebral centres, these cutaneous vascular systems must be included as well. The author then treats of flushing, which he describes "as a nerve storm in which a rush of blood to the skin, and a sense of heat, are generally the most obtrusive manifestations." It shows itself in three phases—(1) by dilatation of the cutaneous blood- vessels, accompanied by heat ; (2) contraction of the cutaneous blood-vessels with cold ; (3) excitation of the sweat glands with sweat. These phases may occur singly, or two may be present, or all three consecutively, or in any order. The different ways these may occur are classified, and are exemplified by numerous ex- amples. Perhaps the most interesting are those which seem to be, as the author suggests, on the borderland of epilepsy, and which are preceded by an aura, or signal symptom. The following may be cited as an example :- At. 64, a sensation which is distinctly not one of heat, passes up the back, starting at the level of the waist. It passes over the head to the forehead. Then the face flushes and she perspires. 427 SEPT. 15, 1890 Review.

As regards blushing, the author regards it as mental, and as the external sign of the inward working of the mind. The difference from flushing is that it is due to emotion, viz., shyness, shame, or modesty, the essential element being self attention or self consciousness. A large number of cases are given, the greater number being men who, though the author does not mention it, we should think were masturbators. The following cases are curious :- Man, aet. 21.—Always blushes before women ; he even feels, restless and uneasy in the presence of men of effeminate appearance. Man, mt. 28.—Telephone clerk. Has been shy from childhood; cannot concentrate his thoughts, and is so nervous and confused that he has the greatest difficulty in facing anyone in business. He blushes on the slightest occasion, even when speaking to people through the telephone. The chapter on treatment, is the weak point of the book. The author confessedly only briefly touches on practical treatment, and gives a disquisition on what he calls, " the philosophy of nervousness." This is highly theoretical, and not very much to the point. The following extract is novel, though we cannot quite see what it has to do with the treatment of flushing and blushing :- " If half the time at hospital that is devoted to the acquisition of theoretical and only very indirectly useful knowledge, were spent in the study of special diseases, we should turn out men much better equipped for their work, and at the same time strike at an ever-increasing danger. Why should not the first year student proceed at once to study the diseases of the eye, ear, throat, nose, and skin '? He might make considerable advance in all these specialities without any profound knowledge of anatomy and physiology, and he would come to the study of the anatomy and functions of these organs, with a zest and interest which are often found wanting." This is a terrible blow to the specialists, but we hope they will not be cast down. With the exception of the chapter on treatment, the book is well arranged, and gives evidence of a large amount of careful observation. It will be of interest to all those who do more than scratch at the surface of medical science. G. L. L. 428 Australian Medical Journal. SEPT. 15, 1890 Hospital cilteltigence.

MELBOURNE HOSPITAL. At the meeting of the Committee on the 19th ult., Mr. J. S. Butters took exception to a visit paid to the Hospital by Dr. Grant, who had questioned the employes, and entered wards without the permission of the presiding medical gentlemen. The Chairman, Mr. F. R. Godfrey, explained that Dr. Grant, who was one of the out-door physicians, and had been acting during Dr. Williams' absence, might have thought he was entitled to take the course objected to, and the matter was allowed to drop. A letter from Dr. Moore, in reference to evidence which he had given before the Charities Commission, was received, and ordered to be forwarded to the Chairman of the latter body. At the meeting of the Committee, held on the 2nd inst., Mr. F. R. Godfrey, the Chairman of the Committee appointed to re-draft the rules, submitted the result of the Committee's deliberations, and moved that they should lie on the table for a month. One of the proposed additions to the rules, provides that a House Committee shall be appointed annually, composed of five members appointed by the General Committee ; that the House Committee shall make fortnightly visits to the Hospital, visit the wards, and ascertain if there is any cause for complaint on the part of the patients, and inspect the other parts of the Hospital ; take note of anything in connection with the building or persons employed, which in their judgment requires attention ; and that they shall have power to suspend or dismiss any officer or servants not appointed by the General Committee, and also, to consider and deal with any question of increase or decrease of salaries of officers and servants, and such other matters relating to the welfare of the Hospital as they may think necessary, and report to the General Committee. A medical and surgical registrar is proposed to be provided for in the new rules. The registrar must possess a degree in medicine and surgery from the University of Melbourne, and must for at least one year have held the position of Resident Medical Officer in the Hospital. The duties of the registrar, it is proposed, shall be to supervise and be responsible for the taking of notes in the ward books, &c., 429 SEPT. 15, 1890 Hospital Intelligence. to compile a record of such cases, keep a record of all post mortems on cases in the medical wards and tents, and of all microscopical examinations concerning such cases, and at the end of the year, shall compile a statistical analysis of all the cases recorded by him, in such form as the staff may direct. There are also explicit definitions of the duties of sisters or head nurses, nurses, superintendent of night nurses, night nurses, and nurse probationers.

MEDICAL STAFF. PROPOSED ALTERATION IN ELECTION OF The Chairman moved the following alterations and amendments in the bye-laws :— 1. That the election for out-patients' physicians and surgeons take place whenever a vacancy occurs by death, promotion, or otherwise, and within a month of the time of its occurrence, by appeal to the subscribers. 2. That vacancies in the senior or in-patient staff be filled up always from the out-patient staff, by the election of the senior members on their respective sides, i.e., by rotation, according to length of service. 3. That such election be placed entirely in the hands of the Managing Committee. 4. That in the event of any member of the staff being rejected by a majority of the Committee, his place be filled up immediately by the appointment of the senior member of the corresponding out-patient staff. 5. That retiring age for members of the staff be sixty years. (N.B.—This last rule, No. 5, not to apply for five years). Bye-law No. 51 shall read—" To hold office for five years." That bye-law 52 be rescinded, and bye-law 56 substituted up to the word " qualification," omitting all subsequent words. Mr. J. S. Butters seconded the motion, which after some discussion was negatived.

ALFRED HOSPITAL. At the meeting of the Committee on the 15th ult., the biennial election of the hon. medical staff was held, when the following —Drs. members were re-elected :--Attending i n-patients.—Medical W. H. Embling, J. Jamieson, M. B. Thomson ; surgical—Drs. H. O'Hara, J. Cooke, J. T. Rudall. Attending out-patients.— 430 Australian Medical Journal. SEn. 15, 1890 Medical—Drs. H. Lillies, H. Maudsley ; surgical—Drs. F. M. Harricks, R. E. Schlesinger. Specialists—Dr. J. Cox (the throat and ear), Dr. G. F. Travers (the eye), Dr. F. W. Elsner (the skin). Hon. chloroformist, Dr. G. F. Travers. Hon. dentist, Mr. L. A. Carter. At the meeting of the Committee on the 22nd ult., Dr. F. M. Harricks and Dr. A. V. M. Anderson obtained extension of their leave of absence, being still unable from illness to attend to their duties. Further leave of absence to the end of the year was also granted to Dr. J. Jamieson, at present in England. At its meeting on the 29th ult., the Committee elected Dr. Brett to the vacant position of hon. pathologist. There were six applicants.

CHILDREN'S HOSPITAL. The twenty-first annual meeting of the subscribers to the Children's Hospital was held on the 20th ult. The following is an extract from the annual report :—" The number of in-patients under treatment during the year has totalled 880, of whom 507 were discharged cured ; 160 were relieved and made out-patients ; 72 died ; and 41 remained in hospital 30th June, 1890. The total number of out-patients treated was 7,511. £853 17s. 11d. was spent in buildings and alterations, and considerable additions will be required this year, the typhoid and nursing accommodation being very insufficient. The grant received from Government this year was only £100. Several serious outbreaks of diphtheria and scarlet fever have caused the Committee and staff much anxiety during the past year. The infection was, in the first instance, clearly traced to a visitor ; and owing to the crowded state of the wards and the beds having no rest, the disease was only overcome with difficulty. The Committee beg to again call attention to the most urgent necessity for some provision being made for the numerous infectious and typhoid cases sent away almost daily from this hospital, as many as 21 typhoid fever and six to eight diphtheria and scarlatina cases being refused in one week.

MELBOURNE DENTAL HOSPITAL. The Committee of Management met on the 25th ult., at the Dental Rooms, Melbourne Athenteum. The President of the Hospital (Dr. Le Fevre, M.L.C.) was in the chair. The Sub- 431 SEPT. 15, 1890 Vital Statistics. committee appointed recommended that the Hospital should be open daily (Saturdays, Sundays and public holidays excepted) from 9 until 11 a.m., and that five Dental Officers be appointed. The recommendation was unanimously adopted, with the addition that " a Relieving Dental Officer be also appointed." Messrs. John Iliffe, A. R. Clarke, E. J. Dillon, F. Ludbrook, L.D.S., and G. Thomson, L.D.S., were unanimously appointed the Hon. Dental Surgeons, and Mr. Horace Stevens was unanimously appointed the Hon. Relieving Dental Surgeon. The Sub-committee also reported that a lease for twelve months had been signed for a suite of rooms in Lonsdale-street, opposite the Melbourne Hos- pital ; that a contract had been let for cleaning and painting them ; and that the Hospital would be opened immediately after the next meeting of the Committee of Management. Dr. LeFevre, M.L.C., was appointed an hon. physician and anaesthetist. Dr. Spring- thorpe was appointed an hon. physician ; Mr. Fred Bird, M.S., M.R.C.S., and Mr. Syme., M.S., F.R.C.S., were appointed hon. surgeons (subject to their acceptance of these positions).

Vital ,Statistics.

The Government Statist's report on the vital statistics of Melbourne and suburbs for the month of July 1890, shows that the births of 1,621 children, viz., 822 boys and 799 girls, were registered. The deaths registered numbered 718, viz., 413 males and 305 females. To every 1000 of the population, the pro- portion of births registered was 3.54, and of deaths 1.57. One hundred and fifty-five deaths, or 22 per cent of the whole, took place in public institutions. Of those who died, 192 were under one year of age, the total number under five years being 271. In July, as compared with June, deaths from typhoid fever fell from 20 to 12, and deaths from diphtheria from 45 to 41. On the other hand, a considerably increased mortality occurred under the head of diseases of the respiratory system ; deaths from bronchitis having increased from 23 to 36, and deaths from pneumonia and congestion of the lungs from 27 to 65. Deaths from diphtheritic croup, which are not classed with those from diphtheria, fell from 10 to 8, but deaths from ordinary croup increased from 7 to 13. 432 Australian Medical Journal. SEPT. 15, 1890

DEATHS FROM TYPHOID FEVER AND DIPHTHERIA, 1888 TO 1890. (First seven months of each year.)

TYPHOID FEVER. DIPHTHERIA. MON THS.

1888 1889 1890 1888 1889 1890 January 39 70 78 February 5 15 25 63 64 73 2 13 46 March 54 91 April 89 13 18 56 43 113 63 13 26 50 May 32 92 June 36 19 35 39 20 36 July 20 16 30 45 12 17 12 14 48 41

Total .. 263 483 371 82 185 302

earresponttente.

To the Editors of the Australian Medical Journal. Sias,—A preliminary meeting of medical men favourable to the formation of a Victorian Medico-Psychological Association, was held on the 10th inst. A vote was carried that such a societyr be formed, and a Provisional Committee appointed. The object of the association is to bring together medical men who take an interest in insanity or any other form of nervous disease. A general meeting of the members will be held at an early date. Medical men wishing to join, or to obtain further information, will kindly address to Dr. Grant, Collins Street, or the writer. T am, yours &c., Asylum, Kew, JAMES V. MCCREERY. September 11, 1890. focal ,inbierts.

MEDICAL BOARD OF VICTORIA. —The following gentlemen have registered their qualifications :—Thomas Francis Riordan, Fitzroy, M.D. Ch. M. et L. Mid. Q. Univ. Irel. 1876, L.A.H. Dubl. 1877 ; James Edward Gribble, Ballarat, L. et L. Mid. R.C.P. et R.C.S. Edin. 1890, L.F.P.S. Glas. 1890; William Boake, Essendon, L.R.C. S. Irel. 1883, L.A.H. Dubl. 1884, L. et. L. Mid. K.Q.C.P. Irel. 1888; James Robert Stevenson, Footscray, M.B. et Ch. M. Edin. 1882. Additional qualifications registered :—Albert A. Parry, Ch. B. Melb. 1887, L.R.C.P. Lond. 1888, F.R.C.S. Eng. Name of deceased medical practitioner erased from the Register :—William Griffiths, L.S.A. Loud. SEPT. 15, 1890 Local Subjects. 433

HEALTH OFFicErcs.—The following appointments have been confirmed:— Borough of Browns and Scarsdale—Frank Augustus Watkins, M.R.C.S. Eng., vice James B. Hayes, L.R.C.P., resigned ; shire of Upper Yarra—William Crooke, M.R.C.S. Eng.; united shire of Metcalf e-Martin Joseph Ryan, M.B., for the north and south ridings ; shire of Mornington (east riding)—Stanley Vipan Theed, M.R.C.S. Eng., vice Charles William Rohner, M.D. ANALYSTS.—The following appointments have been confirmed :—Shire of Melton—Frederic Dunn; shire of Rodney—Frederic Dunn; shire of Wannon --John Kruse, vice Samuel Connor, M.D., resigned ; shire of Minhamite- John Kruse ; shire of Upper Yarra—Frederic Dunn. PUBLIC VACCINATORS.—The following appointments have been made — Glenlyon—john Adam Swindells, M.R.C. S . ; East Melbourne—William Robert Boyd, M.B., vice Lionel Francis Praagst, M.B.; North Carlton—Alfred William Binder, L.R.C.P., acting during the absence of Arthur William Sand ford, L.R.C.P., on leave; Broadford—George Henry Skinner, MRCS ; shire of Narracan—Alexander Bruce Bennie, M.B. Tungamah—James Forrester Matthews, M.R.C.S., vice George Attenborough Branson, M.R.C.S. VICTORIAN MILITARY FORCES.—The Honorable Surgeon George Le Fevre, M.D., from the Unattached List, has been appointed Surgeon in excess of the establishment. Surgeon John Tuthill has resigned his Commission. Dr. James Jakell Armstrong, son of Mr. James Armstrong, solicitor, Cavan, Ireland, died at Taradale on the 1st inst., at the age of 62. He was educated for the medical profession at Trinity College, Dublin, and obtained the degree of M.D. Afterwards he was admitted a Fellow of the Royal College of Surgeons, England. He shortly afterwards received a cornetcy in the Dragoons, and proceeded with his regiment to the Crimean war, where he became assistant-surgeon. Here the deceased distinguished himself by deeds of heroism, and was decorated with two medals and three clasps. He fought at Sebastopol and Balaclava. After the campaign he came to Victoria, and received an appointment in connection with the gaols, and soon relieved Dr. Paley, taking charge of the Yarra Bend Asylum. From here he was appointed by the Government as surgeon on the Victorian Railways, at a salary of £1500 per annum, taking charge of the section of the Murray line between Malmsbury and Elphinstone, making his home in Taradale, where he resided up till the time of his death, being a resident of thirty-three years' duration. For the past few years he was suffering from gout, which incapaci- tated him from actively prosecuting his profession, and for the past twelve months he has been confined to his bed through paralysis. Regulations for the registration and management of private hospitals under the Health Act were passed at the meeting of the Executive Council on the 1st inst. The regulations provide that every keeper or conductor of a private hospital is to apply for registration to the Board of Public Health if he is a medical practitioner, and to the local council if he is not. The applicant must give particulars as to the kind of cases to be taken into the private hospital, the accommodation to be provided, the names of, the medical attendants, and the maximum number of patients that it is proposed to accommodate. The board or council, as the case may be, will then inspect the building and the arrangements, and register the hospital with or without conditions. If the local council refuses to register the premises, the applicant can appeal to the board. Private hospitals are to be registered yearly, and no new institutions are to be opened until approved of by the board. In every such hospital a case book is to be kept, in which full particulars are to be given in regard to every patient admitted, the nature of the disease and operations performed, and the results of the operations. Particulars of any birth and of any death are also to be entered in the book ; in the latter case, the name of the medical attendant and nurse is also to be given. Every death or still birth is to be at once reported to the local council and the board. Periodical inspections are to be made by the officers of the board or the council, and the registration of any private hospital may EE 434 Australian Medical Journal. SEPT. 15, 1890

be cancelled by the board if it considers, on inquiry, that the management is unsatisfactory, or the premises are unsuitable, or if the orders in regard to improvements have not been carried out. A full register of each hospital is to be kept by the council and the board, giving full particulars as to the number of patients to be admitted in each room, and as to the ventilation, and any conditions imposed by the board. These regulations are the out- come of the belief that malpractice has been carried on in Melbourne to greater or less extent. a At the meeting of the Charity Commission on the 29th ult., Dr. Grant, in evidence, said the Immigrants' Home had been diverted from its original object as a home for destitute immigrants, and had become " a general over- flow pipe " for all the other hospitals, and a " free tip " for all sorts of cases. There was not much to complain of in the home at Royal-park, but at St. Kilda road the site and the buildings were alike unsuitable in size, arrange- ment, and sanitation. The funds were contemptibly small, the nursing of the " Sarah Gamp " order, and the medical supervision totally inadequate for the number to be attended. Dr. Grant suggested the removal of the existing buildings, which might be described as a " fortuitous concourse of nuisances," and the construction at Royal-park of additional buildings sufficient for the accommodation of female inmates and hospital wards. On the present site at St. Kilda-road he would suggest the erection of two casual wards, one for men and one for women, with proper bathrooms and sanitary arrangements. There ought to be an addition to the resources of the institution of all necessary medical appliances, a sufficient number of competent paid nurses and wardamen, and a resident medical inmates. officer to devote his whole time to the

BIRTHS. of a MO/tursorr.—Ondaughter. the 27th July, at Camp-street, Ballarat, the wife of W. Morrison, M.D.,

a daughter.WimcitssoN.—On the 18th ult., at Prestonia, Bright, the wife of Dr. T. F. Wilkinson, of

MARRIAGES. HAVES -PA EKES. —On the 26th ult., at Holy Trinity Church, Balaclava, by the Rev. Dr. Torrance, Horace Frederick Hayes,M.R.C.S.,, Eng., eldest son of . H. Hayes, Kambea, Caulfield, to Nancie Penrose, fourth G dent Bank of Australasia, Melbourne. daughter of the late E. S. Parkes, superinten- MAILER-HOLTOM. —On the 5th inst., at the South Melbourne Congregational Church, by the Rev. Joseph King, assisted by the Rev. James Ballantyne, Melrose Mailer, M.B., Ch.B., eldest son of Robert Mailer, Gleucairn, Moreland, to Ada Sarah, daughter of John Holtom, Avonhurst, St. Kilda-road, Melbourne. WILSON--Surra.—On the 4th inst., at Chalmers' Presbyterian Church, Adelaide, by the Rev. Dr. Paton, James T. Wilson, M.B., Professor of Anatomy in Sydney Universiy,t to Jeanie, youngest daughter of the late Rev. Walter Smith, Half-Morton, Scotland, for time of St. Peter's Presbyterian Church, Liverpool. some WiLsox—SvaioNs.—On July 29th, at St. Mary's Church, Stoke Newington, London, Frances,John Grafton Wilson, M.R.C.S., L S.A., eon of Charles Wilson, Melbourne, to Alexandra daughter of the late John Symons, of Nelson, New Zealand.

DEATHS. ARMSTRONG. - On the let inst., at Taradale, James Jakell Armstrong, M.D., M.R.C.S.I., son of the late James Armstrong, Esq., solicitor, Cavan, Ireland, aged 62 years. Looser.—On the 4th inst., at Rosenau, Burke-road, Camberwell, Helen Marguerite, dearly beloved daughter of Robert J. and Agnes E. Looeli, aged 8 weeks. MORRISON. Morrison, M.D. —On the 29th July, at Camp•street, Ballarat, the infant daughter of W.

Contributors of Papers to the Australian Medical Journal can have copies re-printed in pamphlet form by communicating with the Publishers before the issue of the Journal ••

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Library Digitised Collections

Title: Australian Medical Journal 1890

Date: 1890

Persistent Link: http://hdl.handle.net/11343/23154

File Description: Australian Medical Journal, September 1890

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