Speculum Placet, Inspice

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100 CONTENTS

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102 Si Speculum Placet, Inspice. tbe %peatturn

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104

ALICE O'HARA, M.B., B.S.

the Zpecutuni

No. 119 NOVEMBER, 1926

$urface Anatomp (By J. S. MacDONALD.) To the artist, surface anatomy is of great importance and interest. It is not, however, as anatomy that it is of value to him, but because a knowledge of it gives him something general to go on in the way of appre- ciating and portraying appearances when dealing with living forms. For specific form he must rely on his eyes ; otherwise, when depicting any other animal than the human, he would need to be quite familiar with the anatomy of that particular one. Surface anatomy then is for him really apparent anatomy, and he has little concern for what actually lies under the skin. Most artists have taken a course of anatomy, and learned the canons of proportion and the general shapes , of muscles, bones, tendons,, fleshy and fatty regions, but nearly always (and quite rightly, and of necessity) these forms have been demonstrated to him as they should be at normal, This gives them a good starting-o1 point, but for developing in the direction of realism, painters must resort to the live model and their eyesight, and leave u. synthetic normality and knowledge behind, This synthesis was well recognised by the Greeks, who knew little or nothing of anatomy except by sight. They early composed their figures, taking from different models those models' best developed features and building up from them something ideal. As they never indulged in portraiture, but only carved the bodies of gods, heroes or athletes, their formula stood them in very good stead. Yet it was only while they remained a serene people that this composite, balanced type served them. In Hellenistic times they developed nerves and the desire to reproduce bodily nervous irregularity. They then resorted to the actual model, and recorded the portraits of individual, personal limbs and muscles. All those who followed them did, more or less, as the later Greeks did, and that is how the matter stands to-day. An inside knowledge of anatomy is of use to artists only for purposes of generalization. With such knowledge they can take their work some distance without models. They know their main proportions, and can approximate to the shape and surface variety of their various features, their relief or depression, relative lerigth and breadth, and the angles at which planes meet, cut into or recede from, each other. For pictorial purposes, the names of these parts of the human body, or their functions, do not bother them a ha'p'orth—they see men as trees, walking without anatomical significance. They know that, if they set down correctly the right light and shade, caught and cast by body holes and lumps, the proper anatomy will follow. Their eyes are less than most, men's antenna of extensible length. They see as on a ground glass, without acquired internal knowledge. And they are well acquainted with the vagaries of living forms, as may be easily grasped when one asks, 105 106 THE SPECULUM.

'What is the surface anatomy of a born cripple ?" Or the legs of a Masai, with his wavy shin bones and lank heels ? Why do some people possess a gastrocnemius like a cricket ball and high up toward the back of the knee. while others have that muscle shaped like an ear of maize; or sagging? Efficient or inefficient functioning seem to have nothing to do with it. Jim Jeffries had big joints ; Jim Corbett small ones. Bob Fitzsimmons was knock-kneed, yet rested his feet mainly on the outer side of his sole. . J. 0. Anderson's right arm is all out of proportion (owing to development) to his left. The zygomatic muscles of a given number of comedians will operate in just as many different ways, and so will the rest of their facial muscles, which will all combine differently. Yet, essentially, we are all cut on the same pattern. Where our scrutiny is not directed (that is to parts not ordinarily visible) we might as well have standardized spare parts. "Lend us a patella, old man, will you?" and so forth. Except in illustrations on the beaches and the athletic fields, we possess only heads and hands. A lay figure would suffice for nearly everything an illustrator would need in the way of figures, unless he were illustrating a cock-pit full of bloody seamen in various fighting attitudes, a swimming carnival, or some such crowded and semi-nude subjects. For "close-ups," he would have to employ a model, not trusting to his memory or learning. The men of the Renascence were extraordinarily keen on . anatomy ; they had a mania for it, and the relative measurements that could he got out of it. They made every man the height of seven and a-half of his heads, and saw to it that every sternum equalled four or five other bones in length. Not forgetting the social side of anatomy, they insisted that ulnas should know their place, and not dare to move in the same circle as radii. They split it to the world that the sterno-cleido-mastoid muscle was a muscle that couldn't hide its function from them, and put external obliques like life- belts on their figures. They did not bother much (graphically) with women,

for women are not surface-anatomically , of great interest. With their mind on the race, as the figure of speech is, they were on the look-out for muscles ; split,- rippling, corrugated or lumpy muscles, and consequently the suave contours of femininity did not (for the time being) get the attention they deserve. Michael Angelo, Raphael Leonardo, all were deeply learned in anatomy. They left precious little of the area of any bare body unadorned with muscles developed to perfection. Unlike the Greeks, who daily weltered in nudity and had no internal knowledge of anatomy, the Italians had great knowledge and little chance of observation. It was the knowledge of sophistication, and they overdid it in their work. . Yet, it was a great aid, and enabled them to compose vast, multi-figured groups in an infinity of attitudes which otherwise they would have been powerless to do. Each figure was a separate study, capable of consideration, apart from the ensemble and testable by the canons of scale. The undeveloped had no place in their scheme of things. They had their recipe worked out to the limit. They also had canons of expression, which were mainly muscular,' with little consideration for individual idiosyncrasy. Consequently, faces and bodies were reduced to a few fixed types, and remained so until recent times. In his desire for variety of types and his propensity to avail himself of the model, the modern artist is just the opposite. But he must still rely on a long and hard period of study of anatomy to help him out. Obviously he THE SPECULUM. 107 cannot have his wish of posing large groups of living models at the same time and pourtraying at first hand the variety they exhibit. No, he must work from his knowledge first and correct from the model, adding or sub- tracting where the pictorial exigencies require. He is an eclectic, built of the Pericleian Greek and the Renascence Italian. His powers of observation are not as keen as the one ; his knowledge not so full as the other. But he has gained in that he gives more variety than either, and has acquired the faculty of seeing impressionistically, which means that the eye "sees over" things not dwelling- on them, separately to analyse or dissect them, but taking them in as a whole and in order of visual importance. For them, anatomy is something fervid. A naked figure standing on the brink of a pond has his reflection mirrored in that pond, slightly distorted by a suspicion of ripple ; and the reflection is upside down. How is the reflection to be painted correctly, and who is to judge of its correctness ? It's a reflection I've often made Myself, and it still embarrasses me. I ask myself the question, and a disconcerting voice observes, "And a damned silly answer you'll get!"

Ebe litosarp. The hours I spent with Ostelin Bring childhood days all back to me, rd watch each minim every nurse put in, My Rosary, my Rosary. Each hour I knew, 'twas to my cost, With Sunlight and 01. Morrhuae. Intensive treatment makes me , say I've lost, My Rosary, my Rosary. T.

I had an Oxyuris, Who came in and out at night, I often tried to catch him, But the Darling hated light. He ate up all my nourishment, Aggravated my Pruritis, I tried to scratch his eyes out, And was rewarded with Cystitis. At last I gave him Santonin, That night out popped his head, So I stabbed him with a nail file : R.I.P.—Thank God he's dead. T. 108 THE SPECULUM. Coincidence. In the last edition of The Speculum a poem appeared, entitled, "Lament— Commencement"' which ran :- "Not because, but although I was A little bit shot with the drinks I'd had, I know you were sweet, though I know you not, And because I know, I am glad. A day's hard racketing fun with 'the boys,' My thoughts all of revel and drinking When at night from out of the crowd you came, Since then its of you I've been thinking. Just as you came, so you slipped away, I remember a supper, though I don't your name And I let you go like the fool I was; I was drinking again when your taxi came. Now its back again to the midnight oil, Gone are Bacchus and Venus and laughter ; But unknown girl of Commencement time, Sincerest thanks in this halting rhyme, For your gift of a mood that matched with mine— I'm glad of your kisses—and after." You read it, perhaps, and may remember it was not signed. A curious reader, a certain Miss M— being desirous of finding out the author's name, wrote to her friend, Mr. who is on The Speculum staff. hoping that he would give the desired information. Upon his refusing, this young lady, having strong suspicions as to Mr. X. being the real author. proceeded to devise devious ways and means wherewith to find out once and for all "Who did write the damned thing?" And when women conspire— beware !!

A week or so later, Mr. X. awoke with a had dose of that "morning after" feeling, so common among medical students. (A natural consequence of overwork !—Ed.). He was welcomed with the cheery sound of the postman's whistle, and 'the arrival of a letter.,. Our hero was evidently. expecting news of a pleaSant nature, for overcoming his excusable drowsi- ness, he eagerly examined the letter. It was, however, addressed in a strange handwriting, and exchanging expectation for curiosity, he opened it and read as follows :- "Dear Mr. X—, "I am writing to you in the hope that you will be able to help me in a very difficult quest. Mr. S told me you were on The Speculum, staff, and also where to find you. "In the last issue of The Speculum there was a poem entitled 'Lament.' Can you tell me who wrote it? I must know. "Would you send the enclosed letter to its author if you know him ? "If not, just tear it up, and forget all about it. "I am sorry to be so much bother, but this is a matter of life and death LYNETTE BOWEN."

THE SPECULUM. 109 .

"Oh, Hell!" said the unfortunate Mr. X—. This on top of the "morning after" feeling was a bit much, because you see he was the author of the poem. . - He opened theenctosed letter—it was a most amazing one—and read :— "Dearest Boy.— "I thought you had forgotten me and all that happened on Commence- ment night. I have been repenting most bitterly. "To-day, though, I read your poem—I know it must be yours—in the last Speculum, and had to write at once. "Dearest, I adore you. Will you meet me on Thursday night, any time, anywhere, not too early though, as I can't get away till late. "You will meet me, beloved, won't you? Then I shall not regret my `kisses—and after.' I shall scarcely live till I see you. "Yours unconditionally, LYNETTE BOWEN." Then followed an address. Mr. X. wrinkled his manly brow and again invoked the powers of darkness. The position, as he feared it, was this :—The incident he had chosen as a theme for his poem, though only a chance shaft, had gone home. The imaginery rencontre was apparently only too real. The foolish girl had apparently forgotten the "Gipsy's Warning," and listened to the honeyed words of a medical student. (Libel!—Ed.). Poor soul. What to do, that was the question. It would be rather r isky to meet her—and yet—! Mr. X. was lunching that day with his friend, the curious Miss M—, and a Miss P , so he decided to consult them on his dilemma—women being wise in such matters. Miss M advised him emphatically to meet the girl "just for the fun of it." Mr. X., however, was undecided, and so wrote a very sweet letter to Miss Lynette Bowen, stating that the episode, in his eyes, was forgotten'. Then, feeling a very virtuous student, he proceeded to put the whole matter from his mind.

A few weeks later the noble Mr. X. met Miss M—, and she handed him a letter, telling him to read it. It commenced :- "Dear Miss Bowen-4' It was the virtuous boy's letter to the fair "Lynette." Salut! Miss M—! Verily woman's curiosity can not be withstood. M,I.K.

How would you like to be me, In position Lithotomy? Because of my Cirrhosis, I've now got Venous Ptosis, And am waiting for the Clamp and Cautery. . 110 THE SPECULUM.

An Echo of the War, • There can be no doubt that the Casualty Surgeon was becoming distinctly exasperated in his attempt to examine the throat of a small boy, whose mother was inclined to attribute his troubles to his "nerves." Mother was no great help, child was .complete hindrance, and time was flying. Somewhere back in the hospital a bell rang—a familiar sound—which' only drew his attention by the fact that its sound was emphasised by the blare from half a dozen motor tooters in the court-yard. Another line was adding itself to the wrinkles of annoyance on his face, when the sudden silence in his usually noisy domain brought another thought uppermost. 11-11-11! For a moment he sti-aightened his back and looked out of the window With eyes temporarily blind to • the familiar scene. As the silence held, a succession of half-formed images flitted across the screen of his memory. A ,scrap of a khaki tunic, with a well-known colour patch—a turn of a long, muddy road—the blinding flash of H. E. at night—poppies—champagne- green trees and red roofs—a Face—last and one most lasting—One Face, just as it looked in the instant it changed from the face of a well-loved friend to a piece of clay. As suddenly as they had come, the visions were gone. With a half- start he came to himself, and bent again to his task. But the wrinkles had left his face and the edge his voice, and his hands were gentle again. What would the Host of Happy Warriors—and He above • al1L-Lthink of a man who lost hiS temper with a sick, frightened child?.. There was a hint of shame in his voice as he gave the mother directions as to what to do for her baby, and it will be many days ere the memory of that moment leaves him.' The Curriculum. Strictly as prijmiS'ed in the last isStte'Of The Specithim, the curriculum haS. ,met with a determined= attack by the M.S.S. It-is not, a new sport, for the past generations have indulged in it sporadically for probably as far back as the foundation of the Medical School. But the present suggestions for alterations, differing from many of „those that have been put forward before, do not haggle over comparatively. lninotipOints; they are a careful criticism of the CourSe front the :;tudents - point Of view. The time, too, is opportune, since a new 'Hospital and :\ledical School may shortly he commenced. It is obvious that no Course, however c ■ iistituted. can be entirely satisfactory. Opinions differ as to the aim of the teaching; whether it should be academic in nattire„ or sev-erely practical ; upon the length. and so on. Criticism, howe'ver, will always be rife upon the sequence of the subjects of THE SPECULUM. 111

medicine; they are all interrelated, and all require to be refreshed after the set work is completed. In thiS regard, the factor of "interest" comes into play, and appears to be rather important—anatomy and physiology tend to be dry and poorly Marnt unless they can be related to clinical experience. Suggestions to remedy this will be noted. • Stress is ;aid, too, upon the thorough teaching of the various minor operations of surgery. This is most important, for the average student, unlike the budding engineer, does not appear to have much knowledge of how to use his fingers. To the really keen student, the arrangement of the curriculum matters but little, provided facilities are made available for individual work; to the not-so-keen and unsystematic, it is of prime importance. Presentation. At the conclusion of lectures in obstetrics and gyn ecology this year, a gold wristlet watch was presented to the Lecturer, Dr. A. M. Wilson. In making the• presentation on behalf of Fourth Year, Mr. Williams, the representative, spoke of the consideration and kindness Dr. Wilson had shown his class. A generous and valuable example of this was the providing of complete typed notes for each student. These notes will be very valuable when examiners have to be faced, and also in practice afterwards. The three cheers given showed that the class appreciated Dr. Wilson's interest. Regrets. We had hoped to include in this issue an article by a member or members of the nursing staffs of one or more of the hospitals. This, in order that we might view ourselves from a new angle, and perhaps correct defi- ciencies, if such should be brought to view. We know the opinion of our professors and honoraries, of our fellow sufferers in the Course, and of the general public, but up to now we have lathed yet another mirror, held up by our contemporaries. Our hopes have been clashed by the non-appearance of such an article, • though we held out every inducementnot the least of which was a guarantee of complete anonymity in regard to the authoress's bidentity. We cannot conceive inability as a reason for our lack of contri- ution from this source,. nor can we think The Speculum is too mild a medium for expression of adequate feeling. All we can do is to register regret at lack of the desired article, and trust its reason is not indifference. Commentaries. In this issue it will be noted that no Cornmentaries are set. Two Com- mentaries, one Surgical and one C,N.S., Will be printed and distributed late in the first term of next year. The results of Dr. Colville's Commentary, printed in the last issue, will be announced at a later date. In future, results of Commentaries will not be published in The Speculum, on account of the short time available between the closing date for contributions and .the date of going to press. 112 THE SPECULUM.

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Send all Contributions to— BUSINESS MANAGER, STUDENTS' ROOM, MELBOURNE HOSPITAL. THE SPECULUM. 113 Obituarr. ALICE O'HARA, 1.B., B.S. We regret to record the death, in August last, of Dr. Alice O'Hara, at the age of 23 years. • Alice O'Hara was educated at the CathOlic Ladies' College, East Melbourne. In 1921 she entered the Melbourne University as a medical student, completing her course in June of this year. At the beginning of the year she had the intention of joining - her brother, Dr. J. O'Hara, to whom she had recently paid a visit, in practice in Queensland, on the completion of her course. As soon as the Finals were over, she went for a short trip to Sydney, returning in time to have her degrees conferred. 'Whilst visiting some friends at Cobden, she became ill, and passed away within a very short time. Her fine character, her conscientiousness, her cheerful temperament, and her retiring personality, had endeared her to many acquaintances and friends, and particularly to those who were her fellow-students. We extend our deepest sympathy to her relatives in their loss.

'Rota; from General 'Practice. When the final degree of M.B., 13.S.,. has been conferred, and a year's practical experience in hospital or as a locum has been obtained, the start of the practice of medicine is to begin. There are two problems ahead. The first difficulty is in regard to where a start in practice is to be made. At the present time, the profession is overcrowded in the suburbs ; the country has still fresh possibilities. In the town, there are two courses. A suburb may be selected, irrespective of the number of doctors in that district. In putting your plate in that district, it is wise to start right up close to the bunch; then something must come your way, and, if you are able to deliver the goods, a definite start is made. Everyone has opportunity placed in his way ; hut, if he lacks the knowledge, the skill, the courage, or the application, it may be cast aside. In selecting such a spot whereon to build up a practice, a very slow beginning is to be expected ; 150 to £200 are average takings for the first year. Hence .such a selection necessarily means that there are sufficient financial resources at least to last one year. Those expenses, unless shared by the members of your family living in the same house, will not he under £1.0 weekly. In addition, there is equipment, upon which it repays to lavish money. When a start is made in a growing young suburb, practice conies much quicker. The main attributes necessary for a successful practitioner are diligence and a good manner. Knowledge is, of course, a sine qua non. When a patient is very ill, or if there is disquietude on the part of the relatives, a consultation should he suggested. This will spike their guns, and allow you to have the say in regard to the consultant you may prefer yourself. A consultation will strengthen your position, and is not regarded by the public as a. confession. of weakness. In certain instances, do not let the consultant get out of your earshot with the relatives (verb. sap.)

13 I-I THE SPECULUM.

When called to a case, there may .be numerous relatives, and, what are more pathogenic, friends. They undoubte dlv- require more treatment than the patient. Give every attention and kindness to the patient, but to the Aunty, who is most forward in giving her diagnosis of the case, devote your charm and skill. Sink all pride. Treat her as a colleague, and ask her opinion. If she has diagnosed a chill on the liver, or a cold in the kidneys, agree with her, but tell her that, in addition, it had spread to the lungs, causing pneumonia, i f the latter is the disease really. Your success in that house--nay, your reputation within the broadcasting area of her tongue, depends on Aunty. Your gorge may rise; nausea and vomiting may he imminent ; but, if you can swallow, apparently enjoy and digest her fare,. you will be rewarded. Aunty will be found to have many good points, and she will be. just as forward and dominating. in her circle in championing your cause as she was in talking about things she knew nothing about. Flattery can almost raze a fortress. Success in practice does not depend so much in diagnosing the disease correctly, but in convincing the patient and the relatives that you are right. If called out at night, ,do not vent your spleen on the patient. You have gone ; youas may well be y our charming self. Besides, if you have been nasty, you stand a small chance of .remuneration. A definition of a good manner does not include bluffness, heartiness, huckstering, or "the heavy." It is the silent eloquence that convinces. That vague term, "nice," kindness, gentleness, and the power of listening to the patient are the attributes of what the public regard as a 0c-id manner; If 'yoti have been attentive and kind to a patient whom you are erroneously treating for gastritis, and, as a result, the surgeon .subsequently operates for general peritonitis from a ruptured appendix, your previous kindness will yet carry you through with the .relatives,. That the inflammation spread from the stomach to the appendix will be readily believed if you vouchsafe such an explanation. If the patient-dies, it will be said that, if .vou could not diagnose the case, no one could. But if you were gruff, or told Atinty that she did not know what she was talking about, then woe betide you. A charm of manner, particularly if associated with knowledge, will overcome' many hurdles. Most peOple, in private practice, get better, whatever the treatment. Many of the illnesses are trivial ones. Hence it is not so much the skill, but vtur kindness and the personal im- pression that you leave with the patient, that is so important. He of the grand manner, the haughty accent, and who cannot listen to Aunty, the superman, has a handicap, despite his knowledge. - Do not spare the patient's pocket when special investigations are indicated. It is better to forego your own fee than omit an X-ray or pathological examination, which carries the diagnosis to the limits of clinical certainty ; for a correct diagnoSis is its own reward. In the foregoing, it is not suggested that manner is the he-all and end-all, but, as most cases do not call for a great deal of skill, it is the manner in which the patient is dealt with that is so important. Moreover, you will not be allowed to handle a serious, case when it arises, if Your manner has been unconvincing in an unimportant one, or if dis- liked by the relatives. The other difficulty referred to is in regard to the actual knowledge acquired. This is very theoretical, and not associated with 'any 'responsibility. Experience is the greatest of all teachers. If those teaching could relate the mistakes they are making, and have made, without thereby losing status in their pupils' eyes, much might be learned. A quinsy of some days' duration in the now delirious patient may, when you are faced with it 'for the first time, present a hair-raising spectacle. Opening-`the abscess is a painless operation, as the writer can testify. A general anaesthetic is very dangerous, whilst - a. local is useless. An incision with an ordinary scalpel at the site of election is an inch at least medial to the internal • THE SPECULUM.' 115

carotid and lingual and tonsillar branches. of . the external maxillary arising from the external carotid, the endangered blood vessels. As soon as pus wells out of the incision (which may be fully an inch deep) along the knife thrust, stop, and an artery forceps is opened in the incision. Hilton's method is very painful, and not necessary. The forceps are not used- for finding pus, but merely to hold the incision open. If the incision is not held open for a few minutes each day, the pus will usually not drain, the temperature rises, the abscess increases in size, until it bursts itself through the incision made a few days before. This is an example, but the operation of tonsillectomy is one that a general practitioner should he able to .perform, but is usually inefficient, because he has not been taught. If tonsillotomy is performed, in the attempted enucleation, septic crypts are cut across. The cut surface cicatrices, and the infected crypts are now closed collections of pus, and the infection is • absorbed into the blood stream, via the lymphatics of the bucco-pharyngeal fascia, which forms the tonsillar bed. The infection is a closed one, and is analogous to the absorption of pus into the blood from an abscess on A. devitalised tooth. If such a pocket of pus bursts into the cellular space behind the tonsil,. quinsy forms. Scarlet fever, rheumatic fever, chorea, etc., are commonly met with in practice, and in all the linking bond is septic tonsils. People who are always having sore throats, had breath, spitting up the cheesy pis of infected crypts, glands in the neck, and chronic ill-health, form another. group. Such tonsils may not be apparent, but if the anterior palatal arch is retracted with a hook, the full extent of the flat septic tonsil will be apparent. Small grey pearl-like elevations, i f painted With cocaine, and pricked, exude pus. Actual pus, due to such an abscess having burst itself, spots the tonsil like a mild follicular tonsilitis. 'you are conscien- tiously able to perform the operation, there are numerous opportunities in practice, to the patients' benefit, and the operator's pocket. To watch, on many occasions, the detailed manceuvering of the specialist in the out-patients, with actual experience as well, is a certain way of acquiring skill, If you are asked, as is often the case, to guarantee that "they will not grow again," you may then do so, but it cannot be promised that there will be no more sore throats. The lymphoid tissue on the posterior pharyngeal wall hypertrophies after tonsillectomy, and may become inflamed, associated with a temperature and sore and enlarged glands in the neck. Rut it is nothing like tonsillitis, nor is it commonly as severe as just described. The question of tonsils was discussed at some length to illustrate how the new medico is situated in regard to practical knowledge. Responsibility he has not had, up to the present. He may or may not have had the opportunity of diagnosing acute appendicitis, intestinal obstruction, or ectopic rupture. In regard to the latter, one case seen had no other indication but a history of being two weeks overdue, and agonising pain in the left shoulder, that came on suddenly. There was no abdominal tenderness, and nothing to he felt P. yet at operation there was a ruptured ectopic of the left tube, with blood under the left diaphragm, irritating the phrenic nerve, with referred pain in the shoulder. Fainting in a married woman, who may have missed a period, or had what she regards as an unduly long menstruation, is very suggestive of ectopic gestation as a spot diagnosis. Similarly, fainting in a man, to whom it is unusual, and in the absence of cardiovascular disease, suggests either a bleeding duodenal ulcer, or, if he has been drinking, gastric bleeding. The association of diabetes and carbuncle is well known, but the appearance of air-hunger in a patient with a septic throat was the Arst indication of unsuspected diabetes, with Coma, precipitating death. Motto :. Always examine the urine. ':',.Always make a visual examination of the cervix with a speculum, if a vaginal 116 THE SPECULUM.

examination is indicated. Early carcinoma of the cervix, endocervicitis and infected lacerations may be detected, which would be otherwise missed by the glove examination. Sub-total hysterectomy for fibroids has been performed, in the presence of cancer, at the cervix, due to this omission. • Similarly, the mental and neurasthenic symptoms -associated with infections and tears of the cervix will respond magically to treatment, and redound glory to the discoverer. Text books refer to the possible grave causes of bleeding after the menopause, but such occasional bleeding is fairly commonly met with in practice, having no such significance, although it always requires investigation. An electric head lamp is a very necessary aid for examining the cervix, the throat, the ears, for illuminating the perineum when inserting stitches after child-birth, and so on. If a child is running a high temperature, and has a cold in the head, particularly if rubbing the ears, they should be examined. The signs of a pleural effusion at the right base may he due to a hydatid cyst of the upper surface of the liver displacing the diaphragm upwards as far as the axilla. This is commonly tapped, and a subphrenic abscess may follow. It illustrates also that all fluid drawn off should be examined. Unless T.B. is found in the sputum, a lung lesion may be due to an empyema, suppurating hydatid of the lung, or abscess. That such a mistake can happen is in frequent evidence at the Austin Hospital for so-called incurables. Similarly, suppurating hydatid of the liver may be chronic, and not associated with a temperature. The picture then is one exactly like cancer of the liver. Blood-spitting may come from the teeth, tonsils, or back of the nose. The moral to be drawn from these instances is that no case is to he regarded as hopeless until thoroughly investigated, and that any prognosis, based on a mere clinical diagnosis of a serious disease, is like a brick house on wooden foundations. Unless there is T.B. in the sputum, a tumour that can be seen and felt, X-ray evidence of a stone or ulcer, microscopic evidence of malignancy, etc., then your diagnosis of those conditions may be wrong, and likewise the prognosis. When one remembers that, in the statistics of one of the leading University hospitals in America, 60 per cent. of the conditions, seen P.M., were wrongly or incompletely diagnosed, and that in the Adelaide Hospital, -last year, only 53 per cent. of cases at P.M. were essentially quite correct, you are inclined to ponder on the limitations of clinical diagnostic methods, based upon signs and symptoms, and then give a prognosis. Vincent's angina is a trap, as the throat looks exactly like a diphtheritic one, but there are no constitutional symptoms, and the throat is not even sore, often. If it has been present for some days, there is a large ulcer, resembling syphilis. The Vincent's organism and a negative Wasserman is conclusive. A mother, pointing to her little girl as obviously having mumps, asked for a school certificate for absence. She had large bilateral swellings behinds the angles of the mandible. On examining the child's throat, however, there was a membrane which gave a positive diphtheria swab. The throat could easily have been overlooked, as the child denied any sore throat, although the swelling was due to lymph glands, and not the - parotid. There are three medical conditions which simulate both acute and chronic abdominal diseases. They are heart disease, uraemia, and cirrhosis of the liver. The enlarged liver of myocarditis may be painful, and associated with vomiting, or even jaundice. If the case is operated upon for gall-stones, the pulse may show auricular fibrillation next day as a protest. The enlarged liver has even caused the patient to be sent to the Austin Hospital as carcinoma of the liver, the mitral stenosis being overlooked. Abdominal angina, both major and minor, is always a THE SPECULUM. 117 trap, and N common. It has been truly said that, if a man complains of his stomach, examine his heart. Unfortunately, it is not always possible to find clinical evidence of disease. Chronic urwmia may produce chronic cachexia and gastric symptoms, yet no carcinoma of the stomach, as anticipated, is found at the operation. On seeing a woman who had vomited several times since midnight, the cheery opinion that she would be all right in the morning was given by the half-awake doctor. She died in urxmic convulsions three hours later. Perihepatitis mimics gall-stone colic. Gastric symptoms occurring after the age of forty is just as often due to gallstones, heart disease and chronic uraemia as to the oft-quoted cancer. The pre- monitory symptom, abdominal pain, of colitis (a very common condition in practice) can simulate the acute abdomen, and when in the loin is indistinguishable from renal colic at 3 a.m. Whereas in public hospital—at least, the in-doors—patients are really sick, in private practice many of the ills are imaginary. It is then necessary to separate the cockle from the wheat, before accepting pains and so on as evidence of disease. In the out-door, as a student, unless the patients have something to feel, to see or to hear, they are of no interest. But it is these "uninteresting cases" that will require a lot of attention in general practice. And, finally, when such people develop pneumonia, appendicitis, or a "real" disease, then they will have none but you. T.K.

. 7 6

. 111.1111 METAMORPHOSIS 11$ THE SPIACULUM.

Ebe Vrotberboob. When the student dons his white coat he is assuming the badge sym- bolical of a vast brotherhood. He probably- does not think of the significance of the simple action that custom renders mechanical. . Probably because at the usual hour when white coats are being put on, he is rushing off to a. clinic, with the slow awakening that results from a previous late night. (At work, Of• course.) . White is for medical and other purposes, which are obvious, a suitable and "clean looking" colour (or lack of colour), but I am sure there is some historical basis, some derivative history behind this white coat, that trans- forms the ordinary beer-drinking mortal into a student. If there is not such a history, I . am sure some imaginative soul could invent one, dating back to Druids, long beards, mistletoe, white robes and muttered incanta- tions, or something equally picturesque. However, the brotherhood to which I refer is not, most decidedly not, a religious one, and the white coat to which I refer is the familiar short white coat of the student. The longer garments of more or less snowy white that give distinction to surgeons, residents and goal umpires, at the same time marks them as a race apart. Added years may add length to our coats, but at present we are at one with a vast army whose ranks I shall briefly detail. Wardsmen are one with us—their white coats are not always "as the lilies," but neither is their work. Speaking of wardsmen, students and .residents, brings up the fact that not so many years ago the white coat was not compulsory for students in hospital. Upon its, becoming so, fierce discussion waged as to the type to be adopted—long or short. Basing their contentions against length for students, the residents maintained the possibility of their being mistaken for students should the latter be permitted the use of long coats. That awful possibility was averted, however, and we can refer now to another member of our brotherhood. f The Barman! What a world of memories that simple title will bring forth. Let it'be understood, however, that not all barmen wear white coats. It is only in the larger and better shrines of Bacchus that the high priests of the ivy crowned god are thus clothed. Barbers, too,' fall into two groups. Some wear long white coats, and are indiStinguishable from famous surgeons, but. others adopt the familiar regalia. Ice' cream vendors in some instances 'adopt our emblem, and let not the ice cream vendor be scorned. Ice cream is a food of high caloric value. Waiters ! Here, again types vary, but many members of this noble band identify themselves 'with us by the coat. . There are others in our brotherhood space, denies Mention, but it is significant that •01 its members are servants of humanity. When you next change into your white coat spare a thought for those who are shaving and shingling, wheeling in patients, bearing the world's filet mignon, and whispering in the ear of the universe, "Say when, sir !" Such is our ministering paternity—the brotherhood on whom the sun never sets. . THE ...SPECULUM. 119 Mill. Dance. Wednesday night,,September 22nd, was the night chosen by- the students for their Return Dance . to members of the NIA. Resident and Nui.sing Staffs. One imagines that those responsible for the . selection of the date consulted the stars before choosing it, and though not astrologers, we feel sure Venus, Bacchus, and the god of good weather, whoever he be, were in the ascendant itt the horsocope cast. It would be impossible to imagine .a better night—mildly warm, still, and complete with a moon. O.P. had undergone its customary metamorphosis, as had indeed the nursing staff, though perhaps one had rather say in regard to their trans- ference, from one delightful phase, to another. The arrangements—one almost, in view of what we have said re astrology, adds the weather—were in the capable-, hands of Noel Williams, with a trusty band of helpers, whom we wish to thank very much for all their work, which ranged from the moving of forms to the scientific dissection, of funds. The weather being as it was, it is not surprising that the lifts were in constant motion. We must qualify constant, as one of our diligent staff reports an embarassing stoppage of one midway between floors. Other reports have also come to hand regarding an unfortunate student adventuring on the roof, who fell several feet into a boiler room. It took quite a long time to persuade him he hadn't fallen six stories to the ground. We feel we have referred to the weather qUite a lot, but even our coldly impassionate special reporter felt swayed by it and other , , potent influences that were at work that night. They were all wonderful! Being the souls of discretion, we cannot indicate many of trte brightest incidents of that happy- night. They must ,go "all unreported and unread," but not forgotten, we imagine, by- the participants. For the above-mentioned reasons of discretion, we cannot either allow our artist to ,print his masterly impressionistic work entitled "Moonlight,in 019, 22.10.26," We have very fond memories of the Occasion though, and sincerely hope the Resident and Nursing Staffs enjoyed themselves. We did!

" 3tthe. At seventeen sweet Julie Cotton Had a form not soon forgotten, But its lithe and shapely pattern Looked most ravishing in satin, For the "undies" Julie sat in Were—just plain and simple cotton. Julie's life has moved a panel Since she married Captain Flannel. Yesterday at Scott's I met her, Looking plumper, yes, and better. I remarked (good 'taste forgotten), . "Lost your slimness with your Cotton!" Julie smiled, "I can't look thin While I've Flannel next my 'skin." 120 THE SPECULUM. Ebe %car. The day we visited Kew was a delightful summer day that had crept into September. The fine heat of the sun brought a vision of gay beaches and cool water. The suggestion of a southern breeze recalled that it was spring. As we passed down the long drive, lined by shady trees, fresh grass and clusters of flowers, and soon caught, on the green fields below us, the gleam of the curving river, like silver in sunlight, it occurred to us that those who made this spot their home had possibly much to commend their sense. Have you ever been inside an asylum, other than as an inmate ? It's intriguing. Our first patient was a cheerful little man with low forehead, prominent, active eyes and active moustache. Words poured from him in an endless stream as he chattered of the unfairness of the Government, whom he had loaned millions of pounds sterling, with nothing in return. Our next was a tight-lipped, self-satisfied-looking fellow (I've met some very like him at the hospital), who believed that he was God. He refused to talk shop. Then came a harsh-voiced woman, who spoke nonsense of treacle farms, parrot shares and blanc mange quarries. and an intelligent, sad-eyed young man with persecutory delusions, who might have steppel from a Friday- morning clinic. My eye then caught a young fellow who stood alone in a corner of the room. As I approached him, his foot started to tap nervously. His gaze dropped before mine. "How long have you been here ?" I asked. The foot tapped faster. "Three years." "And how did you come to be here in the first place ?" He hesitated. "I—I'd rather not say. You wouldn't understand." I put my hand on his shoulder. "Come," I exclaimed, "I'm a doctor, and am especially interested in your case. I want you to tell me just what happened, and why you came here. I'm your friend, and may be able to help you." He looked at me curiously. "You are a doctor ?" "Yes;" I replied, "I am." He smiled. "You know, in a place like this, people seem to think you are mad. They tell me I suffer from delusions. I say it is a matter of opinion. I know students come out here,"—he pointed—"they're students. And You are a doctor ?" "Of course !" I insisted. I couldn't let this chance slip. "Of course I'm a doctor. I don't blame you not wanting to talk to students. Now, tell me, why did they bring you here?" He sighed. "My story is a long one. It should not surprise you to know that for some years I studied medicine at Dunedin." "You studied medicine !" "Yes. As a boy my great ambition was to be a doctor. It was the one calling I had been intended for. I read greedily all the tales of medical and surgical skill I could find." "My father wished to make a clerk of me, and it was against his will THE SPECULUM. 121

that I attempted a profession. He said that I would not stand the strain of responsibility. I knew better. I felt that I had a future. "It was when I started at the hospital that I had an awakening. For the first time I came to realise something of what medicine really meant. There was much in it I had not foreseen. There were parts that were repugnant to me, that made me tremble with nausea when I viewed them. ' "A revelation that stunned me was that of venereal diseases. One day I saw a man whose face and body were covered with hideous sores. It was syphilis. I was sick after seeing him. "More terrible was the sight of a young girl whose prettiness was blasted by a single disfigurement—an eye seamed and blinded with the ravages of venereal disease. I have never forgotten that. My flesh creeps when I think of it. • "It only blazed into my understanding, with that girl, that women, as well as men, could have the diseases. When I grasped what that meant, it horrified me. I had not realised before, I had always looked on woman as pure, as incapable of contamination, as ideal. Even the simple form of a girl had been a thing of beauty to me. The sound of her laughter, the expression of her eyes, were an inspiration. "You can imagine something of what it meant to me when I found that my ideal in the flesh was sometimes unclean and vile. It meant that my ideals in the spirit were built on false foundations." I interrupted : "But, my dear fellow, all women are not the same. Only the few are vile and unclean. There are many women in the world quite worthy of your Ideal." He put up his hand. "One moment, please ! Let me finish." "In the wards one morning I was shown, on the abdomen of a girl, the scar of an operation. She was a girl with laughing, dark eyes, and an air of freshness about her. You cannot conceive of my horror and astonishment when the doctor disclosed the nature of her complaint. I seemed to see her suddenly defiled, her eyes scarred and blinded, like that girl I had seen before. The awful significance of this appalled me. That scar was the incarnation of evil ! • "It began to haunt me. Night and day, sleeping or waking, I saw it. For all I knew, every woman with a scar was evil, contaminated. How was I to know ! My God! The thought nearly drove me mad. "My health broke down, and with my people I left New Zealand for Australia. We finally settled in Melbourne. I had been quite well some months, when the tragedy happened. "I was spending a week with a seaside party at Christmas. With them was a girl whose beauty had done much to make me forget the past. She was young and attractive, and with her went the sunshine. Though she did not dream it, she became my Ideal in the flesh. "One evening, when I could not sleep, I heard a slight noise in the room above. The thought of burglars chilled me. and with chattering teeth I crept upstairs. Suddenly pushing open the door I switched on the light Alas ! it was no burglar. It was she, undressing in the dark ; she standing there almost naked, beautiful as a picture, her eyes wide with terror, a silken garment in her clenched hand. I could only gaze on her form with esctasy, when, with a flash, I saw something—something livid on her white flesh. It was a scar! THE SPECULUM.

"Then, my God ! my ,mind must have turned. I. approached her with accusing hands,-like an executioner. She tried to cover her nakedness with address, and screamed. But I saw only that hellish scar, whiCh mocked me. The girl before me was vile and loathsome with sin and disease. Something is me was on fire. I would destroy her, shatter her as she had shattered my Ideal ! The terror in her eyes was guilt! My God! ----" His. voice trembled and broke. I could see that the memory was too much, for him. When he continued, his voice was still unsteady. "They overpowered me, of course. Thank heaven, she suffered no hurt.. Oh, you may laugh, you may say I was mad; I can, say the same myself to-day. . But it was real at the time ; it is real to m:f now that I have lost the girl I.loved. I sometimes think it might be easier if I had someone to talk to, someone to write to ; but there is nobody who understands." . I was deeply affected by his story. The intelligence of the man was undoubted;, yet, self-confessed, he was mentally unbalanced, and had even possessed homicidal tendencies. What could I do for him? Little more, at any rate, than give him my address. This I did. "Should you feel inclined," I volunteered, "you now have someone to write to who under stands." The look of gratitude he gave me was sweeter than reward. At the door I asked the attendant the identity of my late companion. :"That Sir, is Dr. Bryne. He grinned. "Been puttin' it across yer, as 'e ? 'E sometimes does that with the stoodents. 'E's a card, orrite." Seeing my distressed surprise, he added: "But don't let that worry yer, young feller. Yer not the first. It's only a joke of 'is." • "No doubt," I replied, "but the damned man has my name and address." A.M.H.

plea for 113rigbter Cext ,boolls. "Very well, you may kiss me," she whispered softly. He moved closer to her ; his arm slid around her waist. For the. moment,.ecstasy-was his. I expect that' by now I have snared a reader. If so, I am content, and if he will but accept my apologies for the deception, I am content. For I freely admit that .I have used a bait, and have attempted to disguise my pUrpose. But, dear Sir, your dignity has suffered no slight at my hands Stich deception is usual in literature of the better class, for an author is a student of human nature, and, as such, he realises that the real, honest, ' ordinary and actual,events in life have no appeal in our hours of recreation. What we want is_ something of the extraordinary ; something that never occurs in real life ; .something that requires imagination, both to construct and understand. . Why, do you suppose, when the old Colonel flicks on - the electric light of his study is the villain disclosed bending over the desk, a revolver in his hand and a beady look in his eye? It is because the author knows that such an event must be rare in your experience, and in case it is not, he proceeds THE SPECULUM. 1 2,J

to plumb you further ; for suddenly the lights go out, and when they are restored the 01(1 Colonel lies stabbed to the heart, the French windows are open, the rhododendrons are crushed, and there is a fresh footprint in the soft earth; while the only thing left to tell which way the villain hay1 escaped is a small heap of cigarette ash on the window sill. Why has the pirate captain but one eye and a peg leg? Why does the calm, silent Westerner cause his level gaze to bore into the petty soul of the man who stoic his father's timber rights? -Why does the hero turn out to be merely stunned by a ricochet? It is because the unexpected claims our passive attention; truth must be modified before it appeals to us. Now, this principle, dear reader ; is by no means new; but I have enunciated it through the medium of The Speculum, because it appears that medical authors do not realise it, or, at all events, disregard it. Their writings consist of facts only. Imagination is restricted to retiology, and even there it is meagrely evoked and freely admitted. Now, I hold that . Medicine and Surgery would lose much of their terror if only the text books were written on the style of novels. Thereby passive attention would supplant active, with consequent relief to the near ones. Also, one could read them in one's spare time without feeling that one had wasted an opportunity. ": I will support my argument with a few examples. Who, for example,' would fail to 'recognise this? Cyril Wakefield closed the front door and divested himself of his hat and coat. His wife came into the hall to meet him. "Why, Gracie !" he exclaimed tenderly, stooping to kiss her. "Yoti don't look very well." "I haven't been too well for about a week," she said ; "but Live tried to battle along; but I can't any longer. I just can't. Excuse me, a moment." So saying, she left him. Wakefield slowly went into the diningroom and sat down to his evening meal. There was a confused hissing sound off stage, and his wife reappeared. "You must buck up, old girl," he said gruffly, meaning to be kind. "Oh, you always say that!" she cried irritably. "But it's no use, I'm really ill. I've got a splitting headache, and I've got absolutely no energy: Then this morning 'my nose bled for ever so long." "I hope yoti're not having a vicarious spell again?" asked Wakefield. "No," she returned ; "this is different. I think I'll go to bed. I'm not hungry. Excuse me a moment." Left again, ,Cyril Wakefield soliloquized. "Poor little 'Wciman," he mused; "she seems pretty sick. She's got quite a cough, too. I wonder how I could help her. Ah! I know. I'll clean the grate. Now- let me see. First, some newspaper." He was interrupted by the confused noise off the stage, and his wife returned. "Gracie, dear," he said gently, "you must go to bed. Let me feel your pulse. Goodness, how hot your hand is, but the pulse doesn't seem fast. Anyway, you run off to bed. But before you go, you might tell me where I can find some old newspaper." "Oh," she faltered,.flushing a little; "I'm afraid it's all used up." Or, again, take this one.

124 THE SPECULUM.

I studied him closely, for he repaid the scrutiny. He seemed old, very old, and his clothes were shabby and disreputable. His boots, in particular, were rotting and stained. His air was preoccupied, but gradually, it seemed to me, a look of firm resolve appeared, and he trotted round to the back of the little country store. Presently he re-appeared, and, to my observant eye, he appeared crestfallen. For a while he stood there chewing a piece of grass. Then once more he trotted to the back courtyard. He was away rather longer, but returned eventually. I decided to engage him in conversation. "Are you the oldest inhabitant here ?" I asked with a dreaming smile. "Yes, Miss, that I be," he returned. Smell, it has been said, is a wonderful necromancer. Now that I was close to him, I caught the sensation that wafted me over- the years to my childhood's days. And many a good hiding I had because of it, until a young doctor pointed out to my mother that I had an irritable nervous system, and cured it once for all with a good close of santonin. I moved into a less characteristic zone. "And how old might you be ?" I asked, pursuing my line. "Eighty-three, Miss," he answered proudly. "I be six year older than old Tom Gosling yonner," and he jerked his thumb towards a figure asleep in a chair under the shop verandah. "Now, Miss, I want to see a man about something. If you wait here I won't be long." And once more he went behind the shop. My curiosity was well aroused, so I decided to wait at all costs. It was with great difficulty that I restrained myself from following him, but dignity came to my rescue. Eventually, he returned, and I was sure that, somehow, he had been disappointed. "Why do you chew that grass ?" I asked. "I dunno quite," he said. "The doctor told me it would be good for me." "Why, whatever is it ?" I asked. He showed me the piece. It was obviously a runner of triticiam refens. "Goodness me, whatever does that do for you ?" "It eases me quite a lot, Miss," he replied ; "but just you wait here a moment ; there's something I forgot to tell that man." Again he disappeared behind the shop. It was too much for my self-control, I had to follow him. When I came on him he was holding something in each hand. "Why," I exclaimed in surprise ; "whatever are you doing with that piece of fencing wire ?" "PSORIASIS."

No wonder their coffers they fill, Sitting on top •of Collins-street hill, For when patients get there They are gasping for air, And hear, 'Rest, Digitalis', Guy's Pill." T. THE SPECULUM. 125 Abe f11).%.%. 1pinner. The day, Friday, October the 13th; the place, Anzac House, and the hour 7 p.m.—such was the setting, and the occasion was the Annual I.S.S.N Dinner. The subsequent train of events was most enjoyable. Like the disciples of Epicurean philosophy, we ate, drank, and were merry. The greatest of the Epicurean trinity was the "merry-making," under which comprehensive term we include the main feature of the function —the speeches. We will pass over the incidentals of food and drink, merely pausing here to set the seal of our appreciation on their excellence, and come to the speeches and merry-making. Professor Osborne, our chairman, delighted us again with a characteristic speech. We always expect much of him in this, amongst other respects, and are never disappointed. We Were very happy listening to his speech and in drinking the proposed toast after it, felt happy in being members of the M.S.S., a body about which some very nice things were said. The Speculum, we are pleased to say, also coming in for honourable mention. We shall not attempt to detail the remaining speeches, made by all our guests, and by others present beyond indicating a few impressions gained from them.. Apart from some excellent and, to judge by the applause and percussion effects rendered by the listeners, much appreciated "stories," we learnt several things. First, appreciation was expressed of . the fact that The Speculum was "regaining its former Rabelaisian quality." This in an age of distressing ".`morality" is most encouraging. From another weighty source we learnt that the education of a medical student was not complete till the student had gauged his beer-drinking capacities. Once, again, the furore this remark created indicates that several, at least, who were present had taken a course to learn their individual quantities—a long course, under the professorship of the ivy-crowned god. Common to all remarks made was a tendency to deplore the wane in the social side of our course. Stories of the past sound like those of an era which, in comparison with this, sounds "like the spacious times of great Elizabeth." Best of all, however, was a unanimous and sincere expression of good- will between teacher and taught ; between our professors and honoraries, and the M.S.S. Everything combined to place us in a desirable state of mind—wine, food, song and sentiments. The only obvious omission was doubtless sought after the departure. Thus was the Dinner of 1926, and great was our enjoyment of it. And now for the sting—we hope it will be such in the tail of these words. As a dinner the function was up to all expectations ; as a student function the attendance was pitiful. We realise all the many legitimate arguments and reasons against attendance, but wherever posSible, effort should be made to overcome them, because it is an official enterprise of oui Society. Setting aside the question 12b THE SPECULUM.

of a certain sense of duty, there is everythin to appeal to those who want a good time in return for their attendance. Work, money,. time, opportunity, had luck are the only things that should prevent attendance, and, in our humble opinion, those medical students who complete a course without a complete attendance at M.S:S. functions, will be lacking in "a liberal education." With those unavoidably- absent from this year's Dinner we sympathise the others ; their philosophy is beyond our comprehension.

,Zucb is lite. Lucinda sighs, and plainly won't believe I have to work. I, who should receive Instead of doubt—her sympathy. I know A certain tavern whose joys I must forego, And yet another place of warmth and light, Wherein to dance was lately my delight. But I must work. Examinations loom Too near,' and lack of work presages doom. Yet it is sad and hardly done to boot To one long used to pleasant lotus fruit. The green baize table, the pleasant fellow feeling, And the cards with full hands in the dealing Must be forgotten now. Yes, I must toil, Burning the long past midnight oil, Study and solve as best I can The thousand woes of the flesh of man. Yet it is sad, as'I have said, Because Lucinda's lips are red.

A pbrsician to his Assistant. A.V. 1500. A FRAGMENT. " And so the day is done, my- good Ascanio. You have barred both doors—drawn shutters close? 'Tis well. There are such as love me, not might well profit by an oversight in this. I had the craftsmen make all fastenings strong. "An excellent day, my son—this day. You marked the mighty clink, where fell the ducal purse in payment for the draught I gave. You marked. r trust, I showed no eagerness to snatch it up and count the fee—till he was gone. It is well to dissemble interest in duCats, my boy ; our lofty craft should seem to set but little value on them. "That draught will cure the Dtke, his stripling son. because---ArMY Bose, my good Ascanio !—his ill is of mine own devising. - You will remem- THE SPECULUM. 127

ber Andrea, a knave I leeched and did some service for a half year gone ? Certain powders discreetly employed by him discharged his debt of gratitude—he is attendant on the ducal person. It is well, my son, to remember those to whom one does a service lest they forget. "Thus was the child's ill procured, and so you see why I can cure most ;ertainly. It will stand me well. "The veiled lady whom 1 gave the philtre to the end her unrequited love might find its satisfaction, she, too, paid well ; and well she might. She is of the noble house of the Orsini. I had her followed when first she came, and found 'twas so. "It is well, my son, to know the station of them that seek your aid. A rough cloak may hide a jewelledgirdle—or, in truth—a dagger, to which end I wear this tine corselet beneath my gown, you have been so curious on. "I bade the lady give the potion to her laggard love in a full measure of Falernian wine, best done when the moon should he at its full. "That, too, will be success for me. Tell me, Ascanio, what man could resist the alchemy of the eyes and lips of the Donna Giuliana Orsini, and at the moon's full and with a bpker of Falernian to fire him ? "And, too, there is a certain drug I 'have used, should he need further urge, "You kept the blood we drew from out that ancient crone we bled at noon ? Good boy ;. 'tis scarce and hardly come by in a city grown so virtuous of bloodshed, and has a sovereign power in cure of falling sicknesses "You must observe most closely in our art, Ascanio,. else how had I discovered Zarga's ruse this day ? "The envious charlatan, hearing that I hold the secret for the cure of the French evil, sought to wrest it from me by a clumsy trick. Sent Regio his 'furnace boy to me, complaining of the malady. "He posed to be a soldier of the Borgia, come lately from the east, where he had incurred this ill. "But I noted well his hands, Ascanio, scarred by biting acids—not the scars of war, and knew him for imposture. "So that I sent him off, with gentle words, but with an unguent mixed of barbel seeds, such as is like to sorely blister them that seek to wrest my - Secrets from me. Such is observation. "Zarga and his impudence irketh me of late. He bath set it abroad I am a charlatan, and bath done my credit much wrong. . Fetch me yonder phials that stand upon the shelf next that skull. No— the' red, and so,• the blue. "These are rare and costly blendings. I had them at great price of 'a Levantine, who had them of an Arab master. They are of great antiquity. Poisons both, but in their working such that he who dies therefrom does not depart from the manner of a usual death. Thus they are most useful in 'a.H city grown most suspicious of our craft. • "They have not had use since the legate Alonzo—Cesare Borgia's foe— died at Padua, of plague. "Fetch me my measures, crystals and decanting phials. Place them so by me near these precious fluids. Zarga Vows most troublesome of late. I must instruct you in their use " 4 "K.." 128 THE SPECULUM.

Dorinda Dearest,— What do you think ? I've yet another engagement to tell you about. It's Gwen this time, and we were simply too thrilled when she arrived one afternoon wearing the ring. Palpation and percussion show a ring off to advantage if they do nothing else. They also seem to give one quite a standing with the patients—rings, I mean, although percussion helps, too. Perhaps if Ella had been wearing one in Cas. the other morning one of the patients wouldn't have accused her of tickling him, but then he mightn't have given her the orange, either ! I must tell you about a patient I had a few days ago. I had reached the abdo., and was doing "inspection," when I noticed a scar in the infra umbilical region, so I asked her what had been done there. She said, "I don't know what they did to me, but they called it 'History Deuteronomy.' " I'm seriously thinking of cultivating my crowning glory and taking to spectacles, and then, perhaps, patients will be more respectful. • I was examining a lump on the back of a mettlesome old sport, and on asking how long it had been there, was informed with asperity that he'd had it long before I was born. Disconcerting, what ? Our dinner was a tremendous success.. There were very nearly as many officials as students at it. and we all made complimentary speeches about each other, and came away feeling very bucked with ourselves in particular, and the Medical profession in general. The Melbourne Hospital Hop revealed domestic talent in many unexpected places. Why, in the dissection of pineapples and oranges, we couldn't hold a candle to our male colleagues. Well, my dear, Path. is clamouring. Yours till exitus lethalis, • ES M ERA LDA; THE SPECULUM. 129

"ilei it wae in the Veginning-- tf We may reasonably suppose that the practise of medicine commenced at the time of the acquisition by man of the attribute of reason, for, having filled himself with unhygienic food, would he not seek some means of alle- viating much of the pain and distress incident upon his precarious mode of existence ? Crude splints and other appliances for the healing of obvious lesions are among the records of very early ages of mankind, while the belief that pain is a visitation of the gods in punishment for sin is a very obvious starting point for the use of superstition, especially in those conditions which are unaccompanied by any readily-demonstrable wounds. Perhaps A-dam may be blamed for many of the early methods of medicine ; may he not have partaken of the first apple in the hope that it would prove a panacea for "the weariness, the fever, and the fret," accompanying the never-ending search for larger and finer fig leaves for the adornment of his not unloving spouse ? And when the Divine wrath had banished him from Eden, can it not be imagined that Adam forthwith decided that herbalism was a false doctrine, and that a religious superstition would more adequately protect him from the "ills that flesh is heir to"? At least such suppositions provide us with a more or less unsatisfactory explanation of the herbal and superstitious principles upon which the foundations of medicine were laid, and which persist, unfortunately, to the present day. The practise of medicine has always had (and probably will always have), a background of quackery of various sorts, against which the learning of the Egyptians, of Hippocrates and Alexandria, of the Arabians, and of the present era which dates hack to Harvey, stands out in sharp contrast. The Egyptians appear to have had some rational conception of disease, as evidenced in the observations of Moses, and indirectly, by their success in the technique of embalming, but there is no great step forward until the time of Hippocrates. It was he who first enunciated the doctrines under which the rational study of Medicine is now conducted. Hippocrates (B:C. 460) collected the scattered knowledge of his time (prior to which the records of Grecian medicine are very vague), and added thereto the fruits of his own genius. He postulated three desiderata for the successful treatment of disease, a knowledge of exciting causes, a knowledge of normal functions, and accurate observation. It was the latter of these in which his chief merit lay. So great was the progress made by Hippocrates that for some centuries afterwards his followers made no substantial additions to medical science, but referred to his works whenever occasion for dis- pute arose. Although Hippocrates recognised the value of the study of human anatomy, its practise was almost impossible owing to the superstitious reverence of the Greeks for their dead. At Alexandria, which became soon after its foundation the centre of learning and science. however, the study of anatomy was assiduously practised, notably by Herophilus and Erasistratus. For some centuries afterwards physicians were divided into two classes, the Dogmatists and the Empiricists, the former following the teachings of Hippocrates and Alexandria, while the latter maintained that the first two c 530 THE SPECULUM.

of the Hippocratic principles were unnecessary and unattainable, and that experience should be the sole guide to practise. At Rome medicine was in more or less disrepute, the first physician of note being Asclepiades, whose pupil, Themison, of Laodicea, founded the school of the Methodists. This school differed from the Dogmatists in that they believed the solids of the body to be the primary seat of disease, and that the involvement of the fluids was entirely secondary. Towards the end of the first century, Celsus collected and digested the knowledge of his time in his work "de Mediciana," which took almost equal rank with the Hippocratic writings. It shows the great progress made through the labours of the anatomists of Alexandria, and treats of many of the operations of surgery, including wounds of the intestines, injuries to the brain, and the use of ligatures. Some half century later, Galen came to Rome at the invitation of the Emperor Marcus Aurelius, and he, having mastered the knowledge of his time, turned his talents to the construction of a summary which, when completed, forms a perfect encyclopaedia of contemporary medicine. As With Hippocrates, his work was regarded as the

I :4 ultimate authority for some centuries afterwards, everything that appeared to be in opposition was summarily rejected. It is not until the 15th century that the work of Galen seems to have been seriously challenged. pf In the period between the close of the 2nd, and the middle of the 7th. centuries, there were but few names of note in medical science. Paulus Aeginata (A.D. 640) stands out as a voluminous writer who completed the records to that date. • From the 7th to the 12th century the Arabians were alone responsible for any advances in the science. Their conquest of Alexandria gave access to the works of Hippocrates, Galen and others, which were translated into Arabic and extensively studied. One of the most distinguished of the Arabian school was Rhazes, who flourished in Bagdad toward the close of the 9th century. Elk, too, was a voluminous writer, but his works are mostly compilations from the Greek, with some original observations- on small-pox and measles. The most distinguished author, however, was Avicenna (A.D. 980), the Galen of the Arabian Empire. His work, the "Canon," became the classical textbook of the -physicians of the 12th and 13th centuries, among whom the Spaniards, Avenzour and Averrhoes are prominent. During the remainder of the middle ages a sort of Galeno- Arabian conception of medicine flourished, fostered chiefly by ignorant monks, and suffering from every conceivable variety of superstition and misconception. Two authors stand out in this dark period, Albertus Magnus and Roger Bacon, the one a prelate in high favour with the Papacy, and the other a Franciscan monk. Still, some little progress was made, for the medical school of Salermo was established in the 12th century, and followed by several others, and in the 14th century the study of anatomy was restored by Mondini at Bologna. In 1453 the fall of Constantinople dispersed a number of learned men through Europe, giving a fresh impulse to the study of medical science and literature ; the study of Hippocrates was revived, and faith in Galen received a considerable set-back. At the commencement of the 16th century the study of medical science as we know it to-day was really founded. "Cum grano salis" became the THE SPECULUM. 131

watchword of the time. Linacre, in England, gave lectures on physic at Oxford, and founded the College of Physicians. Paracelsus founded the sect of chemical physicians, who. contemning the learning of the Galenists, set themselves to the study of chemistry, maintaining that the operations of Physiology were subject to the same laws that govern inorganic matter. It is to this principle that the great advances made by modern medicine are due, for there is a definite, clear cut break away from the superstition, and the blind faith in speculatidn as opposed to experiment, that so grossly en- cumbered the practise of medicine through many valuable centuries. Carry- ing on this principle and practising the doctrine of Hippocrates, the names of the 17th century are worthy of all honour ; Harvey-, Sydenham, Willis, Mal- pighi, Riolan, Bartholin , Pecquet, Asellus, Fallopius. In the 18th century the clinical teaching of medicine had become established, principally under Boerhaave, who was appointed lecturer in the theory of medicine at Leyden in 1701, and four years later was appointed consulting physician to St. Augustine's Hospital, where he instituted a course of clinical lectures. A man of vast erudition, he brought some sort of order to the mass of material that had been accumulating during the past century. Such is a necessarily brief outline of the history of medicine up to the 18th century. Since that time the progress that has been made has been so tremendous that it is difficult to assess the merit of the work of any particular school or individual, and to those who desire a resume of the period may be recommended the address of Sfr William Osler, upon "The. Medicine of the 19th Century." AR FUF.

Alterations to the Curriculum. During the earlier part of this year the Committee of the \I.5.5. has had the - details of the Curriculum under review. A sub-committee, under Mr. Price, was formed, and a series of resolutions forwarded to the General Committee. These were debated, and Mr. Keogh appointed to draw up recommendations to be forwarded to the Faculty of Medicine. The fdllow- Ma, which has been accepted by the General Committee, and forwarded, is Mr. Keogh's report :- The objective of a medical course should be the production of efficient medical men—or at any rate of men who, having taken their final degrees, and having been licenced to practise are capable practitioners. It seems to us as medical students, therefore, that throughout the course the greatest emphasis must be put on the acquirement of skill in medical and surgical technique. It is for this reason also that the General Medical Council on formulating a five-year course, recommends that during the last three years clinical subjects should he studied. Here we have a 5 2-3 year course, of which only 2 2-3 years are devoted to subjects of clinical study-, and of these

132 THE SPECULUM.

• 2 2-3 years, one is divided between hospital and University in such a manner that clinical work is subordinated to passing of examinations in pre-clinical subjects. It can hardly be claimed that the man who has completed finals is prepared for public practice. The more brilliant men get residentships, the weaker are launched on the public. The shortage of hospital positions cannot be altered, but an increase in the proportion of the course devoted to clinical study would be a step in the right direction. The reasons for the unduly low proportions of actual hospital study are as follow :— L The adherence, most marked in the early part of the course, to the arbi- trary University terms with excessively long vacations. 2. The disproportionate length of time devoted to the study of pre-medical subjects in Division 1. 3. The length of time devoted to Anatomy here in compa.rison with Eng- land. 4. The postponement of attendance at the Hospitals to 4th year. Suggestions as to radical alterations hardly lie within our province, but may we suggesf as regards- 1. A vacation of two months would be ample from the students' point of view at the end of 1st and 2nd years. 2. The curriculum could be abridged to cover two terms instead of three if Intermediate Chemistry. and Physics were compulsory entrance subjects, vide the revised recommendations of the General Medical Council. The course in Natural Philosophy, for example, is un- doubtedly valuable as training in scientific method, but most of what is learned is of no direct use to the student, and is rapidly forgotten. It would surely be preferable to study Biophysics in greater detail. 3. We doubt if the average student shows adequate results for the two years spent on Anatomy. At least as good results might be expected from a more intensive 18 months' course, or a two-year course, with less time devoted to Anatomy. As it is at present, any student who devotes the time available for Anatomy to dissection can readily complete his term's dissections in six weeks. 4. In our opinion, attendance at the hospital, if only to a limited degree, should commence in second year. The following we consider to be practical suggestions. capable of almost immediate introduction if approved First Year: No alteration. We would suggest that Zoology he taught, with special reference to Human Anatomy and Physiology, vide the recommendations of the G.M.C.. For example, we suggest that- 1. In dissection of animals , (frog, rabbit, etc.), that direct comparison be made with the corresponding human anatomy, either by anatomical specimens, or if that is unpractical, by drawings and . diagrams. 2. That, as far as possible, the same nomenclature be employed for human and animal anatomy. 3. Lectures in Osteology in 2nd, and 3rd terms—one a we ek. 4. That an effort be made to relate the lectures in. Nat . Phil. to the

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Students' future clinical work—e.g., special reference might be made to the mechanics of fractures and splints'.• to diathermy, faradism, ionisation, .etc. Second Year: We would suggest the following changes 1. Attendance at the hospitals in groups one afternoon or morning a week in 2nd and' 3rd terms for demonstrations (a) Medical . and surgical applied Anatomy. (b) Junior asualtycasualty work with instruction in bandaging, the making of plasters, diathermy, X-ray, etc. 9 (a) An examination in Anatomy. (b) A written and practical examination in histology and embryology. Those who fail in Histology and Embryology, but pass in Anatomy to be allowed to carry the subject to 3rd year. Third Year: As at present, but in addition Two lectures a week in General Pathology in 1st and 2nd terms. One lecture a week in General Pathology in 3rd term. Practical class in Pathological Histology once a week for 'two hours in 1st and 2nd and 3rd terms. We propose that the slides be prepared by the Pathology Department, and made available to students. Attendance in groups at the hospital one afternoon or morning a week for instruction in— (a) Physical signs. . • • (b) Surgical technique, e.g., asepsis, taking of blood specimens, passing of catheters, enemas, bowel and bladder washouts, etc. The abolition of the examination in Histology at the end of 3rd year, except for those who have failed to pass in Histology and Embryology in second year. We are of opinion that throughout first, second and third years' lectures should be related to clinical work as far as possible, and be illustrated by the demonstration of cases from the hospitals. This particularly applies to Physiology. Fourth Year: As at present, but The present class in Pathological Histology, which starts February 1st for the preparation of slides, to be abolished. A re-arrangement of Pathology lectures in consequence of the work clone in Pathology in third year. Lectures in Materia Medica to commence on February 1st. The examination in Mat. Med. to be held at the end of first term. Fifth. Year: The present lectures in Medicine and Surgery to be delivered at the three hospitals by members of the staffs of the respective hospitals, 134 THE SPECULUM.

according to a syllabus laid down by the Faculty, and identical for the three hospitals. Forensic Lectures to commence on February 1st. The examination in Forensic to be at the end of 1st term. At each hospital there should be at least 2 1'. `l's. and one lecture or demonstration in clinical pathology per week during fifth year. The lectures and demonstrations in clinical pathology should be delivered according to a syllabus, to be the same for'the three hospitals. This particularly applies to the Alfred Hospital. Sixth Year: To be devoted entirely to hospital practice.

NOTES ON ,THE ABOVE PROPOSED CHANGES.

1. Attendance at the Hospitals in Second and Third Years. We consider that such attendance would accentuate the interest of the student in Anatomy and Physiology, and that it would enable a thorough grounding in Physical Examination of patients, thereby greatly increasing the value of the Fourth Year hospital work. 2. The Alteration in the Second Year Examination. We wish to see Pathology introduced in Third Year, and it is necessary to omit some part of the present Third Year. If an examination in Histology - be held at the end of Second Year, that which is at present held in Third Year could be omitted. 3. The Introduction of Pathology into Third Year. It is obvious that a year is quite inadequate for a course in Pathology. The above scheme provides for a two-year course, plus Clinical Pathology in the concluding years of the course. 4. The Commencement of Lectures in Mat. Med. and Forensic Medicine early. with Examinations at the End of the First Term. This would prevent some of the overcrowding of the lecture syllabus in Fourth Year. The students would prefer an examination shortly after the conclusion of lectures. 5. The Honours System. We consider- 1. That every student should be eligible to sit for honours in every subject. 2. That the student sitting for Honours should also sit for the Pass paper in that subject, and be classed on both papers, but passed on the Pass paper, exceptinc , in Final Honours. when the Student should be classed on the Honour Papers only. We ask, in conclusion, that in any matters affecting the re-organisation of the course (which we understand is under discussion at present) that the Committee of the M.S.S. be consulted, and we should suggest that a delegate from the committee be allowed to attend discussions on such matters. The students can realise the effect as a whole of proposals which, in detail, appear efficient, but in effect may prove inefficient as regards the student. THE SPECULUM. 135 A first pear setter. I Traditionally, the medical student is a hard-baked son of infamy. Popular fancy would have it that he and iniquity form a perfect example of symbiosis. Times, change, however, and it cannot be gainsaid that, as a whole, we have become more decorous. Until recently we were entirely ignorant of whence the leavening arose, but the publication of the following letter, forwarded to us from an unknown source, will serve to fix the foss et origo Boni. Need we say how heartily we endorse the writer's opinions ?—Ed. Speculum.] To my Dear Friend and Kind Tutor, Pastor Hardy. Since it was due to your advice, and also in some measure to the great interest in things medical derived from the perusal of your oft-quoted work, that 1 first took up the study of medicine, I feel that I owe you some account of my doings. I assure you, dear Pastor, that I have ever kept your memory green, and have steadfastly tried to live my life in the way I know you would have me live it—putting aside all sinful lusts and pleasures of the flesh, and by my example striving to lead others to the light. For it is only right and proper that you should know the medical student's life to be full of snares and pitfalls, in which the weak and erring must inevitably be caught. Also, I am very sorry to say that a great many of the ,students are not altogether the type of men I would care to have marry my little sister, Rachael. Most of them, indeed, are given to sinful and violent language, even in their ordinary conversation. Others, again; are so steeped in vice and depravity, that they have lost all sight of God, and—I blush to mention it—drink ale and other potions of the devil in vast quantities, and at every conceivable oPportunity. A few—but heaven be praised ! but a very few—openly consort with scarlet women in yellow taxis, boasting of their lascivious amours and shocking debaucheries, and holding to high ridicule those amongst us with clean hearts and a profound trust in God. • . Such is my daily company. Every night, in my lonely little room, I go down on my knees and, after offering thanks for my own seemly and virtuous life, I wrestle in prayer with .the devil for the sake of these lost lambs. It is a proud boast amongst the students that Satan himself once came to the Medical School'to try to add to his knowledge. He left, after' a week, in despair at his own cbmparative piety ! A story such as this gives you some idea as to the characters of many to be found in the Medical School, although, in justice to these wretched profligates, I should mention that perhaps the nature of the course itself has much to do with the spirit of lewdness which pervades the students. One loses all touch with culture, even the lecturers being affected. It is simply soulLshocking to hear the brazen manner in which our lecturer casually refers to certain dreadful portions of the human anatomy. These references invariably arouse the enthusiasm of a certain class of students, who, by a vulgar stamping of the feet, mark their complete appreciation of the matter in hand. And ladies present, too! Oh, dear me! it is dreadful, dreadful! I wish so much that you were here, dear Pastor, for sometimes I feel the task I have set myself altogether beyond my powers. Still, while there are sinful hearts to be cleansed, I hope I will not falter. I have formed round myself a little devout band of Godly men, but, alas ! we are . so few against the hosts of Satan. Even so, we can claim a fair measure of success in our own year, for here, with a few notable exceptions, the material is more easily moulded, being less deeply 136 THE SPECULUM.

• students.sunk in the quagmires of vice, and not yet imbued with the traditions of older Another prevalent iniquity here is that of dancing. To my way of thinking, this vice was specially invented by Beelzebub himself for the undoing of the young and thoughtless, who, alas ! are only too ready to trip gaily down this easy road to Avernus, heedless of the little gibbering demons and the grisly spectres—Vice, Lust and Drunkenness, with their attendant satellites, Failure and Ruin--which lurk about the way. Although Many godless people scoff at and revile me for my views, yet, while there is breath in my body and a drop of blood in my clean--let us sing praise— heart, will I continue to do what is my self-imposed duty. Do not think, dear Pastor, that my views are parallel to those of the stern and sombre Puritans. It is not so. No, I myself eagerly grasp any opportunities for harmless and sincere pleasures. Never will I forget the delirious joys at the last Sunday School picnic, followed by the Church Bazaar at night. I felt quite— yes, quite dissipated, the next day. And but last Saturday afternoon, when the president of the Ladies' Sewing Guild, Miss Stitchin Time--. But enough. I only wished you to know that I am not in the least above these worldly pleasures. But dancing. . . . I cannot for a moment agree with the close intermingling of the sexes, with consequent opportunities of certain intimacies which dancing invariably affords. To my mind, .it is simply tempting Providence, and is only the first step which leads to sin. Now, it happened last term that a so-called dance had been arranged by certain members of first year,. Whilst inwardly deploring the fact, I did not openly oppose it, for I thought that, by taking a seemingly broad view of the matter, might later be able to work more good than the harm . which, I knew, must inevitably follow a debauchery of this kind. Results have fully justified my action, for, although the dance was held, it was, as is only right, a very grave and dignified gathering. Better still, I now command the respect and admiration of nearly the whole year, who, indeed, are a very pious and God-fearing hand. This, of course, not including a handful of riotous and dreadful profligates, whom I can only describe scornfully as "real medical students." These are thoroughly imbued with what THEY call the "good old traditions of King Cavernosa," which once made the medical students famous. Notorious is the better word, in my opinion. Although not yet, I longingly dream of the day when the casual observer on the Block during Commencement Morning will not be able to tell a medical student from an arts student. HEAVEN HELP US TO SAVE OURSELVES ! And the day is not far distant. This first year will some day be a senior year, regarded with something very like awe by the lesser fry, and whose model and decorous behaviour will be an inspiring example to follow. Their courteous manners, and elegant conversation, free of anything smacking of 'stable, taproom or bawdy house, will be as balm to the afflicted. The dreadful journal published by the M.S.S., now eagerly awaited and enthusiastically read, to the accompaniment of ribald and obscene mirth, will be cleansed and purified up to the high standard set by the M.U.M. Happy day ! Like Joan of Arc, of glorious memory, I, too, have had my visions, and .not until the immaculate reputation of the medical students is a byword in the Univer- sity will I rest content. Not only I, but many others have this laudable ambition, and the "real medical students" must look to themselves, for we are united by a common cause in our fight for right and respectability. Now, dear Pastor, I must rush away, for I have a meeting of the Choir Boys' THE SPECULUM. 137

Association to attend, and later am to take the chair at a meeting to discuss how the profits of our last bazaar are to be spent. Before I close, however, I would very much like your advice, Pastor, on a certain matter I have in mind. To me, it seems extremely important, and should be attended to at once, before the beginning of the coming year. You see, the students from "higher up" have brought certain proposals concerning the alteration of the present course, and have asked for any suggestions that might occur to us. Now, it seems to me that there is room for improvement in the—well-----rather unmoral conditions under which students of anatomy must, perforce, work. The embarrassing idea of walking into the dissecting room, accompanied by one of the charming ladies of my own year, and to be suddenly confronted by naked and conspicuously displayed human bodies of both sexes, fairly haunts me. It is my suggestion that,• for the first few weeks, at any rate, the bodies should be lightly yet sufficiently clad in any garments suitable, according to sex--trousers, say, for the men, and—er—well—oh! I just can't write it, Pastor ; it looks too dreadful on paper, but you know what I mean—for the females. Of course, you understand I am not referring to the female students. In any case, could you please let me know what you think ? I remain, Your loving pupil, WILLIE B. GOOD, R.E.H., R.G.P.

ff.

epsters. Now, Oysters you know are slippery things, That's why they're so easily eaten; Zoologists place them in various types, The ordinary ones can't be beaten. The second class gave to Ziehl-Nielson his fame, And have often brought men to their knees, The commonest place that we see them is Path., As Sputum—for Tubercle, please. T.

Impulse. Two blue eyes were strangely tender As they lifted up his head, As they raised him from the fender, Two blue eyes were strangely tender, Nevermore would he offend her, She had quenched that flame with lead! Two blue eyes were strangely tender, As they lifted up his head. .22 SHORT. 138 THE SPECULUM. concerning " Circumcision." Will overseas newspapers please note the quotation marks in their copy.' It is not that I wish these journalistic signs to express any notion of "double entendre," for such intellectual pastime is beyond me; nor even to suggest something funny, for I assure you the subject is one which cannot, and should not, be approached with any air of levity or facetiousness—least of all in the casualty dressing cubicle, Balsam.where it is bound up with a considerable amount of pain, suffering and—Friar's No. It is to the operation itself that I allude—the familiar "circe," as we designate it in the vernacular, or, for use in cablegrams, billets doux and code, the On . This operation has been called by a well-known author the one consolation of a cas, student's life, and he is probably not far wrong. One's first operation, actually ! What a wonderful feeling when the last suture's tied, the last lymphatic secured, the urethra restored, the glans repaired, and you walk outside and tell the mother she may come in and see her darling boy. "He's quite all right, mother," yoU always say. s,. And you stalk through crowds of waiting casualties, with head in the air, >,0 like the great surgeon you—are. "Bring forth your gastroenterostomies and your hysterectomies," you feel like shouting, bloodily adding, "Let's have a Roman 1. holiday." I once knew a chap who was the envy of his fellows, because he had done eleven circes—they, only about three. I can picture that fellow in some future day, like some old redskin chieftain, telling over his scalps, now dry and withered, before a crowd of wide-eyed, open-mouthed youngsters, and relating his hair- raising experiences. But, if I continue long in this vein, I fear me I will be starting a Holy War or something, as well as offending the Editor, and 1 would prefer to do neither, for I have had a horror of Holy Wars ever since my school days, and our Editor is quite a nice man, really. [Er—thanks.—Ed.] What I actually wanted to tell you, before 1 started on this extraordinary preamble, was about one of my own circes—I mean one that I did--the second, in point of fact. I don't want to harry you with technical detail of actual surgical procedure. Suffice it to say that, after a considerable number of ligations and plastic operations, I did eventually achieve what i set out to do, namely, the removal of a certain amount of the young gentleman's--I mean I did really finish the operation. After I had dressed the little devil for about a week, I handed him over to his mother, and told her she needn't bring him back any more. She was even more overjoyed than I was. "Oh! ain't that grand, Tommy'" she exclaimed to her infant prodigy, aged about six. "Say thank you to the doctor, Tommy. That's right" (after Tommy had added an ingenious "ta-ta" with ungrateful gusto). "Come on, now, 'Pommy! E's only got ter go an get is hears fixed now, and 'e'll be a regelar toff. Won't yer, Tommy ?" The blue blood of aristocracy has passed, and with the changing times new standards have been set up. But surely they have their disadvantage "HAP." THE SPECULUM. 1399

(IDebicat 3ccounte. (uv Fl. . DARBY, Probably the 'greatest bugbear in a doctor's life, and that which gives him more worry than any of his cases, is looking after his accounts, but, with the institu- tion of a correct and simplified system, the work of this all-important and most necessary department can be reduced to a minimum. Of course, where a doctor's practice is very large, the assistance of an accountant, to keep his books up to date and get his accounts out regularly and properly, is essential, as the doctor has as much as he can do to manage his practice, and must be relieved from the worry and tediousness of doing work which is irksome to him. After all, this is the concern and interest of somebody who is trained. and skilled in this particular function. After a strenuous day's work, a doctor is too fagged at night to write up his books, and so it goes on, day after day and week after week, until, in desperation, he fixes some final night and generally works on till the early hours of next morning, trying to unravel questions which are months old. Then, instead of charging a proper fee, he probably cuts all his accounts, and decides, "Oh, that will do, any- how." Whereas, if somebody else is keeping the work up to date for him, his accounts are sent out regularly and properly, his cash takings are kept up, and, although. he may be paying fees to have the work done, it is proved in more than one instance that the extra cash raked in is greater than these fees. • One case came , tinder my notice of a busy suburban practitioner, who has been keeping his own accounts for years. Some of his patients sent me up to see him, as they had not received any accounts for some time, and, having to ask him, a long time after treatment, for their account, he would then say, "Oh, yes ; how many visits, and what did I attend you for ?" On investigating his system, which, in hiS opinion, was most efficient, workable and accurate, I found he was omitting altogether to re-render any previous accounts which he had sent out, and which had not been paid. As he was not keeping a separate account for each patient, if anybody paid even the slightest amount off an account, he completely lost track of the account, and would never render one for the balance, thus losing a tremendous amount of money annually. The only way for a doctor to make his maximum income is to start from bedrock, and keep a diary right up to date for all the work he does, and to record in a separate book all the cash he receives. The diary should be kept open, and close to his reach all the time he is in the surgery, and, as soon as he finishes with one patient, it only takes him half a second to write clown his name and address before the next patient comes in. A most useful and time-saving help is an electric bell in the waiting-room, with the bell push right alongside the doctor's hand ; he merely rings the bell for the next patient to come in. It is during this time that he has the opportunity of jotting down the patient's name. All this seems childish, but it is by following out a few minor details that a tremendous amount of worry is saved later on. I find doctors trying to keep in their head for a week the names of patients they have seen during the week, and then attempting to write up their diaries from memory. The best time to enter the diary up for visits made outside is the next morning, before a single patient is seen, as the names, if not all written down on the "visiting list" taken round, are fresh in the memory, and a few moments spent like this each day save hours and hours of unnecessary labour at the end of the week—or month—trying to remember back. The doctor, having kept his diary entered up to date, and also his cash book, 140 THE SPECULUM.

recording all the amounts of money received, the work of the accountant starts, and it is his duty to write up a card for each patient, giving his full name and address, and to enter up all the visits made, operations, etc., done during the month, and to credit the account with any cash paid. The cards need to be separated into two divisions, one being "Patients still under treatment," and the other "Accounts sent out." At the end of each month the first section must be gone through, so that the cards of patients that are finished with can be taken out, and the amount of the accounts to be sent assessed on the cards ; then, as soon as the accounts have been sent out, these cards should be filed away in the second section. The doctor himself is the only one to go through the first section, as he alone knows which patients are finished with, whether an account has to be sent or not, and which accounts have to be sent in quickly to catch the birds of passage. Once every two months is quite sufficient to re-render the accounts in the second section which have been sent out, and it is only necessary for the doctor himself periodically to look through this section, as his accountant can do it for him each month. If the cards are dated every time an account is sent out, examination of each one will give the date when the next account has to be rendered, arid whenever either section is being gone through, any cards paid in full should be taken out, ruled off, and filed away somewhere else. There are many systems of keeping doctors' accounts, but this one takes the minimum of time, and is the most efficient for anybody with limited time at his iPl disposal. I have found many instances of huge bound and loose-leaf ledgers being used, and hours and hours being wasted through them, because every time any accounts have to be sent out, the book must be traversed from cover to cover, and every account that is entered has to be examined. When the book has been used for a few years, the time wasted is enormous. Whether the doctor himself, or an accountant, or his nurse, is looking after his books, the card system is by far the best and most efficient, and if ever a sale of a practice has to be effected, all the information and figures required can be extracted in a few minutes, and also the cash receipts for income tax purposes can he ascertained from the monthly totals in the cash book.

Corresponbence. (To the Editor of The Speculum.) Dear Sir,--Why should military men be the only people who are given annual camps, night schools, etc. ? This is very excellent in its way, but, in my opinion, might, with advantage, be extended to many classes. of the community. Why should not a course of intensive training be given to the members of a profession, compared with which a military career is but a thing of yesterday ? My scheme could be carried out somewhat after these lines :- 1. A riding school could be instituted. 2. A week's course of jumping would improve the general physique. 3. An annual camp could be held for a short time. 4. French could he taught at evening classes, with special attention to writing of letters. the 5. Practical demonstrations could be given in the correct deportment when walking along Collins-street. THE SPECULUM. 141

6. Special classes could be taken to various mills, factories, etc., so as to be shown grinding in all its forms. 7. Finally, annual practical and theoretical exams. could be held, and prizes given for speed, endurance and general proficiency. I hope that this scheme will merit your serious consideration, and receive the attention it deserves.-1 remain, yours, etc., ; [We especially endorse the 6th provision.—Ed. Spec.]

"Have you ever tried this 'ere Birth Control ?" "No—what's that ?" " Well, I'm not sure, but I think it means keeping the lights on." 142 THE SPECULUM.

Ube. Mythology of Egypt. Egypt, ot, more strictly, the early history of Egypt, has an intense fascination. There is, too, a similar fascination in the myths and legends of other ancient races—the harsh and forbidding mythology of Scandinavia; the gentle folk-lore of the Germanic 'countries ; the strangely materialistic, idealistic fancies of early Greece and Rome; the heavy antiquity of India and China ; the quaint, formal aristocracy of Japan. In these one may trace the origin of many customs of to-day, and learn, albeit with somewhat superior amusement, the efforts of men to explain the mysteries of the universe. There are many things which we take for granted— secure in explanations learned in childhood—that our forefathers questioned deeply: The rising and the setting of the sun, the sea, life, and countless others. These they endeavoured to account for in their legends, and thus much their legends hold in common. But the Egyptian civilisation had been the greatest and most enduring, and its particular fascination lies in the air of mystery which surrounds its buried remnants, supplements to the written and pictured story which has descended in hieroglyphs to us. The civilisation of Egypt persisted for a period of three thousand five hundred years ; its foundations were laid something over five thousand years ago. In that time, according to some authorities, it had spread from the borders of the Nile across the islands of the Indian Ocean, thence, by island after island, across the Pacific to South America. There, in Peru, may be seen the ruins of ancient cities, with temples built to the Children of the Sun, Horus and Set of the Egyptians ; Manco Capac and Mama Oclo Huaco, of the Peruvians. How this Egyptian influence found its •way—if it actually did so—to Peru, has baffled anthropologists. The evidence in its favour lies chiefly in the discovery of the effigies of the Children of the Sun before the temples ; they stand mysteriously making the sign of the initiate■ .o f the temple of Ra. The traveller in ; frica, who himself, knows the sign and handgrip, may be surprised to find it given and received among the. central tribes. The Australian aborigines, when their boys are admitted to the status of manhood, set up two poles, between which each lad must walk to a bed of fire. The resemblance to the cere- mony of initiation of the priests of Ra will be noted. It is claimed by some that the twin poles, set to north and south, are a survival of the legend that Horus and Set raised the heavens from the earth, and set up pillars to maintain them. Prob- ably, however, the two poles have no more significance than that of a totem. In popular estimation, the central figure of Egyptian mythology is the god Osiris, a king of pre-dynastic Egypt, raised to the status of divinity by subSequent generations. He became a powerful god of the earlier mythology, taking rank over many lesser gods in a polytheistic system. He is said to have taught the Egyptians the art of agriculture, and to have travelled through to countries to the south and east. of the Mediterranean, arid thence to Europe, spreading civilisation and the worship of a Supreme Being. On hiS return to Egypt, he was murdered by his brother, Set, the God of Darkness. It is probable that Osiris was identical with the sun, hence his murder typifies the change from day to night. The body of Osiris "was believed to have been cut in pieces and distributed over Egypt, to which was owed the extraordinary fertility of the land bordering the Nile. In this way Osiris became identified with fertility. To Isis, the wife of Osiris, who was later represented in the Egyptian mind by a star, Sothis, appearing only in the sky at yearly intervals, was accounted the flooding of the Nile, flowing with her tears • when she returned to weep for her murdered husband. In their games, the children Of the Nile side were wont to THE SPECULUM. 143 interpret the grief of Isis. A model of Osiris, formed of clay and baked, was dis- membered, and the pieces hidden, sought for, and regained. Over them would bend a naked brown girl, in imaginary weeping. The search for the pieces of the image typified the search of Isis for the pieces of Osiris' body. In this there may be the underlying idea of fertility, arising _from a. union of man and woman. The land bordering the Nile was fertile from an inherent quality, gained by the dis- tribution of the body of Osiris, but this fertility was held in abeyance by Isis, who• had collected the remnants of Osiris, only to be expressed when she returned to mourn his death, her tears causing the Nile to flood and bring forth crops. Here, too, may be the association of a dual fertility with the Scarab, the beetle which was supposed spontaneously to be generated in the slime left by the receding waters of the Nile. The position of Osiris in Egyptian mythology varies with the passage cif time. Originally, he was a man, the son of a god, who was to become a divinity by popular legend. In this he is paralleled by the story of Romulus and Remus, the mythological founders of Rome, and a similar character may be found in • the mythology of most countries. Osiris, too, as with Romulus and Remus, appears to . have been'the forebear of the reigning house. Khufu claimed to be a descendant of Horus, the son of Osiris, and therefore of divine descent. With the advent of the dynastic period of Egyptian history, the worship of Ra becomes prominent. Primarily the religion of Thebes, and therefore purely local, . its power and influence spread rapidly, until, at the time when the Pharaoh Khufu —Cheops, as we familiarly know the divine descendant of Horus—commenced the building of the Great Pyramid, Osiris was considered merely as a manifestation of Ra, and the Pharaoh his nominee. The worship of Ra persisted, with varia- tions, until after the rise of Christianity. Osiris, it has .been said, came to be considered as a manifestation of Ra, and therein lieS the key to the Egyptian system of theology. The Egyptians, even among their most advanced thinkers, never attained to the notion of a pure monotheism. To them it was incredible that a single god, in his own person, could perform the multitudinous duties attributed to him. It is for this reason that the lesser gods appear ; they are Manifestations of the supreme god, who takes those forms whenever it is necessary to perform the particular duty allotted to them. In the later dynasties, the more advanced of the theologians more closely allied Ra and Osiris in a union representing resurrection. Ka and Osiris have often been confused, and considered identiCal. This arose probably from the earlier worship of the sun as Osiris himself, - while the sun was held, in later ages, to he the chief manifestation of Ra. To Ra was erected the temple of the sun at An (Heliopolis). Here, according to popular legend, were kept the two boats used by Ra for his daily journey across the sky—the Mad boat for the morning, and the Sekti boat. for the afternoon. Here, too, Ra would come each morning to wash his intolerably bright face in the sacred pool in the temple courtyard. This pool alone survives, of all the vast city of the sun, to-day. The legend of the boats of Ra is purely folk-lore, and was never subscribed to by the priests. The priests of the temple of Ra gained initiation by passing through the seven lesser degrees of the unrevealable mysteries of Osiris. Naked, except for a cable tow around the neck, and a hood which covered the head and eyes, they were conducted by a guardian to an apparently blank wall, where they were halted by armed wardens lightly touching a spear point to the breast. A whispered pass- word from the guardian gave them the secret of passage—Ragririt, the door of stone. A triangular door, supported upon its apex, opened, and they were led by 144 THE SPECULUM.

a sharply-descending passage, typifying the descent to the underworld, to a place of fire, whence they were delivered by whispered passwords. Thence they were led by winding passages, passing each of the seven wardens with a prompted word,

—From "Smith's Weekly." Pharaoh (showing friend around back yard): " Just a bit of a chicken house I'm running up." to a room, where, left foot first, they were guided seven times around. With a knife pricking at the breast, they took an oath. Then, being asked what they most desired, they answered, "Light." Immediately the hoods were removed. They found themselves between the Tet and Tettu, the twin pillars of Osiris, the one signifying "to establish," and THE SPECULUM. 145

the other "strength," and, together, "to establish eternally." Facing them was a representation of the jackal god, Anubis, from whom they learnt the sign and handgrip of the novitiate of the temple of Ra. Finally, they were forced, separately, into a stone sarcophagus, in simulation of the violent death of Osiris, whence they emerged, reborn, in the grip of Anubis. That ritual has been handed down for thousands of years ; to the ancient Greeks as the Eleusinian mysteries, with Dionvsius in the place of Osiris ; to the ancient Persians with Mithra as the slain one, and brought thence by legionnaries to Rome. To the priests of the temple of R a was entrusted the overseeing of the building of the Great Pyramid of Cheops, destined to be the resting place of the ka of its builder, Khufu, of divine descent from Horns, the son of Osiris ; there to remain and confer upon the peoples of Egypt the bounty of its divinity. To the Egyptians, man was composed of body, soul and ka. The soul, at death, left the body and went elsewhere, but the ka, or divine essential double, remained with the body until the resurrection. It corresponds with the ethereal resurrected body of Christianity. Said to have been built by one hundred thousand workmen, within a genera- tion, the Great Pyramid has, for five thousand years, excited the curiosity and admiration of men. There has been cherished a legend of occult esoteric wisdom symbolised therein. There are many legends, too, of immense treasures, to be reached by passages from a triangular door, which was not discovered until the Caliph Al Mamun had quarried his way through the walls, in the hope of finding treasure. All that rewarded him was an immense, lidless sarcophagus, which may or may not have held the body of Cheops—Pharaoh. The structure lies with its points accurately aligned north, south, east and west. It is almost exactly upon the 30th degree of latitude, an exact third of the distance from pole to equator, and its dimensions are in direct relationship to the diameter of the earth and the distance of the earth from the sun. It is said that a precise prophecy of August 4, 1914, and of November 11, 1918, is to be read in the length of its passages, and that there is evidence of another world convulsion, to commence on May 20. 1928, ceasing in 1936. "Who knows ? AR FUF.

IDefeat. We speak of the million diseases As dogs beneath our command. And soothingly order nice mixtures With ingredients suitably planned. With drugs both synthetic and natural, We lay siege to each human ill With haustus, injection and linctus, With lotion and powder and pill. Yet we are the slaves • of coryza; In defeat let each bow his head, And carefully dodging his patients, Go to whisky and lemon and bed,

. 146 THE SPECULUM. Ebe tag %traw. The little sad-faced man in over-size felt hat and baggy trousers looked strangely familiar. His pale blue eyes met mine. "Edgar !" "Jim !" The next moment we were gripping hands. I had not seen Edgar Straw for some years. After Finals, our paths had diverged. As a student, I had been drawn to him by his lovable disposition and his total unconsciousness of self. What a rarity this, in a student ! Edgar, in fact, swung rather to the other extreme—he had an inferiority complex. In clinics he had always been the scapegoat. Slow to think, he was a target for the caustic comments of honoraries. Sensitive to a degree, he was as little able to demur, when unfairly "picked on," as he was to broadcast his knowledge. His constant blush became a feature of the clinics, and his silence was interpreted as ignorance. As is so often the case with people who are unduly modest, he was taken at his own valuation. Should there be a hitch at an operation when he was assist- ing, he was to blame. If a bottle of ether smashed into a thousand fragments, Straw must have been holding it. When the diathermy refused to act, the honorary looked round the theatre with a meaning air. After everyone else in the clinic had failed to answer a question, Straw was—in desperation—appealed to. He came to be regarded as the dual emblem of bad luck and incompetence. He became labelled, because of his unfortunate name, "The Last Straw." For all this, or perhaps because of it, I liked him. I liked the views he held but did not circulate. I liked the way he "consumed his own smoke." Unlike those most active in criticising him, he preferred thought to talk. He was not enamoured of the music of his voice. I had always hoped—somehow, against hope--that things would change for him when he started on his own. 1 had often endeavoured to instil self-confidence into him, without much success. I had pointed out how much straighter the path would be when he was outside, away from the hospital world, with its deities. Alas! it was not to be. He hadn't been through a year when he succumbed to a deity more exacting than any he had known as a student. He married. I first heard her facetiously described as "a barmaid with a hernia." This was vulgar, and, of course, incorrect. Then I met her. She was an acrimonious, neurotic, nagging woman, some years his senior, and lacked, alas ! the grace of manners. In popular parlance, she had "hooked him." Thenceforward she led poor Straw a dance such as lie had never conceived, and his sensitive disposition and his pocket reeled under the strain. I had heard from him only twice since his marriage. His letters said little, but they taught me much. The poor fellow was distinctly unhappy. I knew that, if ever man regretted an unfortunate marriage, he did. Now, after some years, this unexpected meeting in the street! I asked him to dinner next evening, and he came. As we sat by the study fire, he told me of his work—the one thing that had kept him going—but not a word about the woman. It was Saturday—the night they broadcast the wrestling from the Stadium--and I showed him the wireless set that had given me so much pleasure. Suddenly he exclaimed : "But you didn't hear about Ethel, did you ?" "No," I replied, "What was that " THE SPECULUM. 147

He laughed, shortly. "It was really .quite remarkable—almost like a 'fairy- tale. Last month I decided to take Ethel for a fortnight to Healesville. She had been very run down and nervy"—I guessed what that meant—"and badly needed a change. We left Hamilton first thing on a perfect morning. On the way, I picked up from Johnson, the chemist, a tonic for her. She won't take bitters, so I ordered pills—arsenic, iron, the usual thing, you know, with 1/40 of strych. "We made a good trip, and reached Gracedale in time for dinner. But for the fact that Ethel was still in the 'blues,' I felt splendid. "We spent most of the evening by the fire, and then I proposed a walk before bedtime. I knew it would be the only thing to buck Ethel up. She took some persuading, I tell you. "It was a glorious moonlight night, and the air was crisp.. We had walked a quarter of a mile, I suppose, when Ethel suddenly complained that she couldn't go any further ; she felt too 'knocked out. Just as I was beginning to enjoy it, too! Luckily, I remembered the panacea—the pills—only to find, next moment, that I - had left them back at the house ! There was only one thing to do. We turned back. "As we drew near the house, I heard agitated voices, then a man's bellow : " `Dr. Stra-aw! Dr. Stra-a-a-aw!' " 'All right,' I yelled, as I started to run, 'I'm coming.' "From the crowd on the verandah a man rushed down the path to meet me. He was panting. 'The pills, doctor,' he jerked, 'the pills your wife has—they're poisoned!' "I gripped his arm. 'What do you mean, man ?' I snapped. 'What do you mean—poisoned?' " "They're poisoned, doctor,' he gasped, 'overdosed with strychnine—we just got it over the wireless !' "I felt suddenly faint. The enormity of the thing appalled me. 'It's all right,' I said, shakily, 'my wife has not taken them. We left them behind in the house.' "A cry of relief went up from the crowd on the verandah. I felt very like an actor in a melodrama, and very sick, at the same moment." Straw smiled grimly. "It turned out," he went on, "that each of those pills contained grains of strychnine, instead of 1/40. Johnson had dispensed them himself. He had gone to bed early that night, and, while looking over the day's work he suddenly realised that he had weighed out a fatal dose. He dressed frantically, and rushed to the police station. I had left no address but 'Healesville.' The police couldn't get me. The only thing to do was wire Russell-street. Russell- street at once broadcasted. "The message came through at ten. But for the fact that I had forgotten to take the pills in my pocket, it would have been too late. We would have been a mile from- the house, and Ethel—poisoned !" "My God !" I exclaimed, "it must have given you a terrible shock !" "It did." He smiled wanly. "Shook me up for some days, I can tell you." Poor Straw ! As usual, his luck at the last moment had turned him down. A.M.H. -

Women would be more charming if one could fall into her arms without falling intto her hands. 148 THE SPECULUM. Ebe (XI:lorries of Annbte the Coroner. PREFATORY NOTE. The Egyptians considered the sky was the skin of the belly of Hathor the Moon Cow. Hathor's four legs were the four pillars of the Universe. Ra, the sun god, was every day carried through the heavens by Hathor. Osiris, the chief god of Duat (sometimes confused with Ra) was murdered by his brother Set. Horns, like all Solar deities, is hawk-headed. The Horus Ra is the rising sun and the Osiris Ra the setting sun. The moon disappeared once a month by being eaten by a great sow, and grows again by eating the stars. The scarab or beetle is 411 amulet for protecting the heart, and the symbol of Kephera the Creator—God. NOTE TO FIG. 1. • Behind Anubis is a Bennu Bird (a Heron). -up the tree in which he burns himself when old. The two eyes of Horus are over the door. Outside is the Hathor Moon. NOTE TO FIG. 2. Set holds the brain of Anubis while Horns incises it. An animal sacred to Set is standing in the Nile. Anubic the Coroner was a god whose great forensic learning had made him famous throughout the ancient world. His mud but on the Nile banks was of singular magnificence, and, on account of the many forensic treasures it contained, was carefully guarded night and day by Horus and Set. Anubis was obviously worried as he tossed about in bed, his ears rigidly pricked and his pearly teeth crunching scarabs. He was on the biggest case of his life, the parties concerned nearly all being gods. As he tossed from side to side he became more and more agitated. "Damn that pig!" he thought. "Now how could that pig be guilty of the homicide of that drunk cow, who murdered the inhabitants of the Nile . banks at the request. of her lover, who was murdered before she even knew him by Set my guardian. The more I think over this case the more muddled I get. I am asked to believe that, although the pig eat Hathor the cow a fortnight ago, yet that cow will be back again in a fortnight, and also that she has been eaten once every month since time started being measured by Thoth. And further, I am requested to suspend judgment until I hear the evidence of Hathor, will be alive in a fortnight. That does not worry me so much as it did on thethe first occasion I had to sentence a totem for his own murder. That, of course, was the famous case of Phoenix. Bennu who before our very eyes climbed a tree in Heliopolis and set fire to it, so burning himself to death. Yet another Bennu arose out of his smoke and tried to persuade us that as he was here to give evidence he could not have committed the suicide which we saw him do. Now, is the homicide of a murdered, homicide? And could Ra have asked Hathor to murder the inhabitants when he himself was already lnurderedl Also were there any inhabitants' of the Nile to murder since at this time we all lived in Somaliland? "The whole case is most puzzling. All my forensic dogmas are being upset. Only yesterday I had to deal with that strange case of Teta the Sage who obviously inflicted that single wound of exit (never before recorded) on Apis the Bull before the very eyes of King Khufu. Now a single wound of exit could only be inflicted by the murdered himself and so must be suicide. But the King saw it inflicted by Teta, who later by placino - the head to the East and the body to the West caused each to approach the otherb by words of power until they finally met and. walked off. Apis swears that he was murdered, vet personally, being an obStetrician, I 'don't believe he. was ever born, and so I don't think he .. exists, THE SPECULUM. 149

although the [King saw it and swears he was murdered. I regard his yarn about originating by a beam of moonshine falling on his mother as all moonshine. A person who was never born obviously could not be murdered, for I first enunciated with great clarity that the law has no interest in the unborn child. All the same T had to convict Teta on the King's evidence, though I fear I may lose no small amount of prestige in the appeal.

Fig. 1.7 " Anubis was obviously worried."

"But to return to that •pig case. Another remarkable thing is that Ra every day is carried through the heavens in the stomach of Hathor, so that of necessity he must be dead and digested. Therefore he could not have been murdered by Set as he must already have been dead and also he could not have asked Hathor to murder the inhabitants. But as Hathor is eaten by the pig she could not carry Ra into the heavens, especially as neither of them exists. Yet I saw Ra there this very day, so everything is of necessity impossible." At this stage the keen eye of HoruS observed that if Anubis perspired any more the Nile would rise up in flood, so he injected just the bare grain of atropine and Anubis began to toss about in comfort. After Set had replenished the supply of scarabs, Anubis continued his reflections. "Now that is also a remarkable case I have listed for to-morrow. It seems certain that Telephron was poisoned by his wife—my head is hot. His evidence on his recall from Duat (or Hades as those Greeks will call it) seems most convincing—if only I could sweat my head would grow cool. But I am not sure what my position is with regard to that weasel taking the nose and ears of the living instead of the dead Telephron. Personally, I can't see that any of them 150 THE SPECULUM. exists ; the whole • case is impossible. Teleph•on could not take Hathor's nose as she was eaten. Damn that pig !---" Horns and Set were horrified to see their beloved Anubis reject the whiskers of a scarab as he entered upon this low muttering delirium. As they were rushing to his assistance they were startled by three resounding smacks, after which Anubis fell back and quietly gave up his Ka to his father Osiris and his

Fig. 2. — " Removed their dead master's brain." mother Nephthys. Horns and Set, maddened by grief, shed tears as they finished off the scarabs. Then overcome with curiosity, they carried Anubis to the banks of the Nile and quietly removed their dead master's brain, finding that the three smacks had come from the thrombosis of the anterior, middle, and posterior cerebral arteries in that order, due to the enormous heat produced by the vigorous cerebration of Anubis. "This case is unique," said they solemnly, as they added it to the first section of Chapter IV of their master's text book called "Lectures en Forensic Medicine." THE SPECULUM. 151

bow to be an bonorarr. This is the third of a medico-educational series of talks I am giving to contemporary journals, and I would refer readers for the others to "How to Have Twins Though Bald," in Smith's, and "Why Cornet Players get Emphysema," in the War Cry. Not that these have anything to do with Honoraries. The idea of a bald- headed Honorary with emphysema is as Gilbertian as that of a cornetist with twins is hermaphroditic. I mention them simply to show that there arc these questions, and that they must be attacked in a scientific manner, as I propose to deal with this one; viz., in steps, one, two, three, and four. Firstly, it is borne in upon me that the greatest attribute of an Honorary is some striking peculiarity of dress or person. I mean., everyone is familiar with Kilvv's Kollar and Conrad's Crop (I don't mean his (esophagus), and Somebody Else's Spats, and things like these. Why, even at the Alfred, there is one very famous surgeon whose white coat always seems a bit crazy at the collar—always half way' down his back. And another, whose coat seems to have girdle pains, or a sense of constriction or something round the waist. Dreadfully tight it is. Unfortunately, nearly all these little dodges have been availed of by now, and I can suggest only a few new ones to you budding - Honoraries. Try cultivating, say, a wart on the nose, ear or throat ; or, if this be not successful, a highly-enter- taining mannerism would be clinicing sans culotte, though I understand Dr. Pelaco has commercialized this idea somewhat. If this is unfeasable, as it might well be, if the gentleman has housemaid's knee, or even gene valgum. I would suggest chewing gum, or something of that nature. Care must, however, be exer- cised in operations and similar proceedings requiring degrees of asepsis. Secondly, I think that it is always wise to have a definite set manner in dealing with patients and students. There are lots of manners to choose from. You can be a Holy Terror, and wield a metaphorical bludgeon over your victim's head, like Mr. McC or Dr. S. S 1; or you can be more subdued--say "Yes, yes !" all the time, and agree with the old lady that quite possibly it is the weather that has caused her womb to twist, but you don't know till you, etc., etc. Then there is that Sherlock Holmes manner we all know, I mean, the patient comes in, looking rather poorly, and our Miracle Man says, "Ah, ha! I can see you have an internal complaint !" Or a young man comes in, looking sheepish, and the Dr., who has had an early Boy Scout training, says, "How long have you had it ?" You have your choice of manners ! Thirdly, to be a really good 'Honorary, you must have a motto like the mythical hero who was always merry and bright. We all know that Dr. L— would feel professionally nude if he were not allowed to proclaim his "Trust in B.C.C. and me," whilst Dr. A.V.M.A. would be at an absolute loss if he could not ask the Resident, "Has a Wasserman been taken ?" And who would recognise Mr. J. R. A as an eve specialist if he did not hear that "These drops will make your pupils large and your sight misty, but without them we cannot examine your eyes." Then there is another man, who is always saving, "Night time is the time to sleep." Other good stunts of .this nature might be suggested, for what they are worth. For instance, one could make tight lacing a hobby, or high heels, or low necks. The routine question, "Have you ever been tightly laced?" would, I feel sure, elicit some very illuminating information. The choice of a catchword I leave it to you, but, as you see, it is a valuable aid to any .Honorary. In conclusion—and here I wish to conclude, unlike the Rector when he says 152 THE SPECULUM.

"lastly," does last—the fourth attribute of an Honorary is a certain amount of knowledge. Of course this is not really as important as the three preceding ones, but it should he considered in passing, especially by students aspiring to be Honoraries such as Monsieur X-- of the Alfred, and Monsieur Trois Etoiles at the Melb., and I suppose there is one at St. V's., too. When all is said and done, Honoraries can't go on for ever, although some of them certainly do their best in clinics. You may all be Honoraries some day, and if any one of these few remarks have been of any use to von, then am I amply rewarded. HAP.

" What's the matter with you?" "Mother says I've got worms, so I'm trying to catch them with a hook." THE SPECULUM. 153

"Ube Ebtrteentb Chinaman." THE STRANGE STORY OF ITS SURVIVORS. Consciousness returned shortly to Roger Blundell. as he lay in the shallow rock pool. His first feeling tone was one of pleasure, and this, rising to his higher centres gradually, declared itself as delicious warmth. For the tropic sun was already high in the cloudless sky, and was bathing the rocky beach with its best ultraviolet, and the placid pools were ready to assume the functions of balnea callida. As the oedema of his neopallium gradually absorbed, perception led on to ideation. What. was his orientation ? This mystery remained unsolved until suddenly the synapses concerned with memory resumed their function. First there grew on him the conviction that he was Roger Blundell, cabin boy of that ill- starred merchantman "The Thirteenth Chinaman," trading in the Marshall group. Vividly now he recalled it allL--the delirious plungings of the doomed ship as she spun to the will of the typhoon, the darkness, so black as to physically oppress, the raging seas, ever and again breaking over the bows -With relentless fury. And then that shivering impact, when, blindly obeying Newton's First Law of Motion, he had catapulted over the side and into the foaming water. But now his impressions were more confused. Dimly he recalled his struggles with the elements, his lips and fingers cyanotic, with patches of emphysema appearing in his lungs, and a functional systolic murmur developing over his xiphoid process. Then, it seemed, had Nature taken pity on his pessimistic thalamus, and ; with a well-judged blow from a floating spar, rendered his centres ischxmic, without any fractures or haemorrhages along the line of the force. By now sentiments and volition were restored to him. \\ hat . of his com- . rades.? How had they fared ? He sat up suddenly, but his vasomotor, centre was still a shade hypotonic, and a transient giddiness, with dimness of vision, swept over him. Then he vomited--a watery vomitus, with little or no food, • no blood, bile or mucus, and a large increase in total chlorides. Some sand and seaweed, and a small rock, weighing about 300 grains, were present. Feeling much refreshed, Roger staggered to his feet. He perceived that Fate had placed him on a broad lava beach, at the foot of an ancient and apparently extinct volcano. The air was still, and devoid of all sound save the gentle lapping of the waves. No living thing could he seeneither bird, animal nor plant. On all sides desolation reigned supreme. Roger groaned with the bitterness of his spirit. Of what avail were his supple coronaries; which had stood him in such good stead during the night ? In a fortnight at most the glycogen in his liver would he used; then he would commence to metabolize his own tissues. And even before then he would in all probability be dehydrated, with its attendant ills of anuria and constipation. He stifled a blasphemy, and set off to explore. He completed a circle of the island in about a quarter of an hour, but not a thing could he perceive on that inhospitable shore, save only rock and water. He stood on a pinnacle of rock and swept the horizon with his gaze. Then, with an auricular extrasystole, there commenced an attack of tachycardia. For, allow- ing all due weight to the personal error, he was convinced that, about a mile from the shore, was a raft slowly but steadily advancing. Soon. they were within hail, and he could pick out the crew.. There were the Bosun, Sam . Sloborn,- the ship's carpenter, and a seaman, Jenkins. "Halloa, then, Roger • Blundell, cried the Bosun, as he came ashore. "We never expected to see you in life again •!"

F. 154 THE SPECULUM.

"It won't be for long, sir," said Roger, cryptically. "What!" cried the Bosun, turning pale under his bushy heard. "Good God, boy. You can't mean that we are marooned on a desert island?" Roger slowly inclined his head. The men stared at each other aghast. "Are you quite sure?" asked the Bosun, hope reviving. "Have you explored the whole island ?" "Well, I haven't been up the summit yet," admitted Roger. • "Then go now," said the Bosun. "While you're gone, we three will hold a council of war." "Aye, aye, sir !" said Roger, and set off briskly for the top of the volcano. "Now," resumed the Bosun, judicially, "what are we going to do? The meeting is open to suggestions." "Water ! Give me water !" moaned Jenkins. "The prodigal's return," sneered Sam. "It is quite clear," continued the Bosun, "that we can't eat lava. Now the point is—what else is there to .eat on the island ?" "Only ourselves," said Sam, throwing some more sand into the wheels of progress. "Perish the thought !" said the Bosun, eyeing Sam with disfavour.. "Now, you'll agree that vegetables are food?" "Aye, aye!" "Well, wood is a vegetable. Therefore food." "Do you mean us to eat wood ?" asked Sam. "Sure. Why not ?" "I never heard of such a thing." "You're not too old yet to learn," said the Bosun, directing his sarcasm at Sam's locus minori resistantiae. "Anyway, that's all there is to eat. Therefore 1•! we must eat wood. That's only logical." "It's not," growled Sam. "It's only ridiculous." "Ho !" snorted the Bosun. "Is that so? Well, let me tell you I'm in command here, and my orders are—Eat that raft !" "But I lost me teeth in the storm !" wailed Jenkins. "Don't quibble," said the Bosun. "Can't you get someone to chew it for you? Now, you loafers. Fall to and •eat that raft." "What about yourself'?" asked Sam, truculently. "You mind your own business." "I know you, said Sam, with sudden suspicion. "You're going to wait until we've bitten the outside layers off, and then you'll come in for the decent bits that the salt hasn't got to !" "Sam Slobom," returned the Bosun, wearily, "You're as suspicious as a papery scar. Hello! What's the matter with young Roger ?" he asked. "He's gone mad from thirst," suggested Jenkins. "He'll break his neck running down hill like that," commented the Bosun. "Water ! Water ! I've found water !" came Bob's shout. The effect was magical. With one accord they dashed to where the boy waited. "Where ? \\There ?" shouted the Bosun, hoarse with emotion. "There's a pool up at the top of the mountain !" cried Roger, his eyes exhibit- ing hippus with excitement. So, scrambling and panting, he led them to the pool. There, like men -demented, they lay down and sucked in the clear liquid. "Ha, that's better," shouted the Bosun, jovially. • "Now for the raft!" THE SPECULUM. 155

"I'm not going to eat the raft," said Sam, sullenly. "So !" said the Bosun. "Mutiny is it ? This'll go well in the log." "Well, the log won't go well in me," declared Sam. "I've got a far better scheme," said Jenkins, now fully recovered. "Why not eat seaweed ?" "Whoever heard of such a thing ?" said the Bosun. "Seaweed is vegetable—therefore food," said Jenkins. "But far less nutritious than wood." "But more easily digested." • "True," said the Bosun, magnanimously. "Seaweed it is, then. To the beach !" "If I might make a suggestion," ventured Roger. "Why not soak the seaweed in water to get the salt out ?" "Why not, indeed?" quoth the Bosun. "It shall be done." And so, in the space of an hour they had filled their stomachs with fresh seaweed, rich in vitamins. The water had by that time reached the colono of the older men. But poor Roger was still a child, and had not quite recovered from the pyiorosplasm of infancy. Accordingly, there was some residuum, and, much though he regretted it, he was able to eat only a small quantity. So, with Nature's immediate needs satisfied, and being thoroughly tired out by their experiences, the men laid clown on the hard rocks and slept. It was glorious morning when the Bosun awoke. He rose to his feet and yawned prodigiously. Then a most disconcerting thing happened... • His trousers felldc4ri! He hastily replaced them, tightened his belt, and looked round furtively to see if he had been observed. Such an occurrence would be fatal to his prestige. But three soft palates vibrated sonorously. "Come on! Get up!" roared the Bosun, lustily. "Spring to it !" Three men sprang into life at his command, and two pairs of trousers fell down. At this phenomenon the Bosun jumped backwards in consternation. To his horror, his boots slipped off ! "Look at Sam's legs !" shouted Jenkins, his eyes starting. "You mind your own business !" said Sam, wrathfully. •Then his tone altered to one of horror. "But look at your own ! Good God, we're starving! We're done ! We're wasting to shadows," he screamed in a stark tenor. "Blood and bones ! He's right !" said the Bosun, his voice a mere whisper. "Look how our coats are sagging over our arms." At this moment Jenkins put his • hat on. It slipped over his head, till it rested on his ears ! Sam Slohom howled in misery. "Come, come!" cried the Bosun, the first to recover himself. "If we're Starving, it's all right. We must eat. Come, let's get some more seaweed." "Aye, aye, sir!" came the ready chorus. And with morale already restored, they dashed to their breakfast. * * • * Now, two pairs of trousers fell down. One stayed up. This belonged to Roger Blundell. When this youth saw what had happened to his fellows, his self-control deserted him. Here, dissolution seemed imminent. He must get away. Accordingly, he bolted. In the general dismay, his absence was not noted. Once he had got out of sight of his gaunt companions, he recovered somewhat, and pulled up. He examined hiMself 'carefully. He was certainly wasted, but not much, and motor- power Was good, with no alteration in sensation. Moreover, he 156 THE SPECULUM. had no cough, nor was there eVidence•of any malignancy. He was about to do a blood film, when he noticed a Party of men on the beach. Shouting lustily, he ran towards them. "Strike me !" cried one of the men. "What's the matter ?" "Help us, for God's sake !" shouted Roger. "We have been wrecked on this dreadful place, and are dying of starvation. All we have lived on is seaweed." "Merciful heavens !" cried the spokesman. "How much have you eaten ?" "Not much myself," said Roger, in surprise, 'but the others have eaten a lot." "Quick, then," said the man. "Take me to them at once. A couple of you men bring the intravenous glucose .apparatus." Alas ! what a scene was prepared for them! It appeared as though three heaps of clothing lay on the beach. Careful search revealed the wasted, shrunken forms. "There is no hope," said the man, simply. "What has happened?" whispered Bob, almost in syncope from a reflex via the higher centres. "My boy," said the man, solemnly, "do you know what we are doing on this island ?" • - "We are collecting seaweed. And do you know the name of this seaweed?" "No" "It is fucus vesiculosis."* "PSORIASIS." *FOCUS Vesiculosis. A seaweed famed for its de-fatting qualities. Reputed' to be even more potent than thyreoid, Turkish baths, and other aids to slimness.

Causerie. Lectures—at least, some of them—have been proving rather interesting of late. Reminiscences of "Post Mortem" and "Mere Mortals" have been brought vividly before-our tired eyes, and there have been times when we've thought there is some consolation in being a medical student. Apropos, to a certain extent, of this rather vague preamble, is a visit I paid the other night to a friend's flat. The friend, I must add, is not a medical student, so that his brow is unfurrowed, and he has had time to engage in dalliance and the amorous pursuits. At least thirty portraits of the fair sex adorning his walls testify to their extent. Now there was once, so a lecturer told us, au unfortunate princess of the NileTside, whose hypersexuality was marked. For each new lover, the lady would add one block to a pyramid, whose foundations we assume to have been laid at an early age, its earliness limited only by the extent of Oriental precocity. Finally-. a mighty pyramid was completed. Now perhaps you will understand—though my friend, Lothario, didn't—why I said "pyramid!" when invited to admire the galaxy of beauty in his room. "Man, know thyself"—and it seems essential that woman should, too. The winner of a ladies' 100 yards championship was operated on, subsequent to the race, for removal of a small tumour in the inguinal region. The said tumour proving to be pure testicular tissue, one wonders if the prize was returned, on the grounds of the winner's non-eligibility to compete in a ladies' champ. THE SPECULUM. 157

Though it is the custom in certain hill districts of India to provide a musical accompaniment to childbirth, beyond a much-scorned article in an American journal, no attempt seems to have been made to introduce the practice into modern medicine. In India, the obstetrician is more musician than medico, and the flute, rather than the forceps, provides instrumental accompaniment to delivery. The choice of suitable incidental music would, of necessity, be the subject of careful study, and probably a suitable motif, carried out andante or largo, would induce the infant to appear in slow and orderly manner. Abuses could, however, creep into this adjunct to accouchement. Doubtless, those inclined to "hurry it on a bit" would play head over perineum, furioso, instead of largo. The whole thing .sounds rather improbable, but the day may dawn when Beethoven and breech presentations will automatically associate themselves in the medical mind, and the obstetrician be a familiar figure with his instrument bag in one hand and a portable gramophone in the other. Time and space do not permit me to tell you of many more wonders we have heard of, and also we have an important engagement. It is reported that at a hotel nearby, every time a customer's elbow bends, his mouth opens. We must rush away at once to investigate this important and unusual reflex combination.

Account liZenbereb. I had a night out, I remember, • • With wine and with woman—no song. I remember the going was heavy, And all of the bills very long. There was quite a large one, for taxis And our epicurean feast, As such, was charged up according; But that, though large, was the least. The wine—in fact, it was whisky— Was sold at ambrosial rate; There were other items that evening Whose details I cannot relate. However, I thpught I had squared up Completely, but only to-day, I find—I'm a medical student— That now there's the devil to pay.

Concerning Man.—He was not made for any useful purpose for the reason that he hasn't served any; he was most likely not even made intentionally, and his, working himself up out of the oyster bed to his present position was probably a matter' of surprise and regret to the Creator. . . For his history, in all ages, in all climes, in all circumstances, furnishes oceans and continents of proof that of all the creatures that were made he is the most detestable. Of the entire brood he is the only one—the solitary one—that possesses malice. .. Also in all that bit he is the only one that has a nasty mind. MARK TWAIN. 158 THE SPECULUM. On INC That exams. are upon us. That "don't we know it, too." That multiplicity of stethoscopes pertains only to honoraries. That Simmonds does not think so. That the "Phantom of the Opera" isn't the only phantom. That there is one "of Ward 022, M.H." That, of course, there is also the obstetrical phantom. That there are some advantages in being married. That there aren't. That some prominent personalities are soon to investigate this problem. That absence makes the heart grow fonder. That absinthe makes the breath smell stronger. That Hst Aether et Ammonia does, too. That Thorburn takes Wassermans well. That Nurse painfully retakes them. That the University is going to the dogs. That the students have been there for a long time. That "slay me with flagons" will be a popular expression after the exams. That the ice-box is a chilly place. That all is lost. That all is not lost. That the famous sailor, Bill, can save us. That the old squire once again has been foully murdered. That all these tragedies are working in the light of exams. That "one thing is certain, and the rest is lies." That "the year that is gone forever dies." That we're going to make the most of it. That "in vino veritas." That we're going to find out, if so, That the wages of sin is ± ± +. That "where there's a will there's a way." That often there is only the will.

Cbtlbren's Corner. CONDUCTED BY UNCLE EPIGLOTTIS. Broadcasted from the Famous Station, 3NAB. Hullo, children! Uncle Epi. speaking. Now, I have a long story to tell you. to-night, so I am going to wish you all a happy birthday. Shake hands with your. little friends for me, and have a happy time. And if you look in father's obstetric bag you'll find something nice the Wireless Bird brought for all expectant mothers, and which he will lend you for to-night. So, kiddies, seize your little comforters and listen in.

THE SPECULUM. 159

Now, children, I hope you all say your prayers every night, because my story is about a little boy called Wiley Mann, who wouldn't say his prayers. One night when he was fast asleep the Devil came and took him down to Hell. On their way the Devil showed Wiley a lot of men, who frequent hospitals, suffering from a dread disease called Retention, and said : "Wiley, all these men are called Prostates, and you will see how we torture them in He11. 4 When they reached Hell, the air was black with wriggly things, called Spiro- nemes, which bite the Prostates with their carious canines, and then roll round and round and laugh with glee. The Devil shoved some of them away, and took Wiley into his private office. Now, any fathers that are listening, instead of having dinner, this was just to show Wiley what nice medicine they give all new admis- sions. On a shelf, children, were a lot of bottles (like some in father's cupboard), labelled "Fine Old Scotch." "Of course, Wiley," remarked the Devil, "you are too young to drink this, but it is my first joke on all Prostates, because, when they see it they seize it, like you children would a tart." And, calling up his chief chemist, he said : "Gimbernat, refill those bottles with Haustus Croton Oil nix." Gimbernat, like all good servants, did as he was told. Now, Russell, darling, you remember to do what Nursev tells you in future, Mid remember not to kick her, as it does so predispose to carcinoma. Well, children, soon the Prostates for the evening began to arrive, and, as I said, their eyes lit up when they saw the bottle. "You silly old men," said the Devil, "you know this stuff will only make your Retention worse ; but you can have one dose each. And, Wiley," he continued, "this mixture is good for them, because they often suffer from another complaint called constipation." So, children, you might tell your mothers about it. It is better for your coated tongues than California Syrup of Figs, and just as easy to take. All kiddies will love it. When you reach your fourth year, darlings, you will understand its action. Having given the Prostates their medicine, the Devil took Wiley along to another part of Hell, where Prostates, whose Retention had reached an acute stage, were jumping round in agony upon the sulphur sward. "This, Wiley," said the Devil, "is the special form of torture reserved for all these bad old men." Now, there is only one way to relieve Retention, and it is done by a wonderful machine called a Katheter. You might find one in daddy's bag, and ask him to explain how to use it. As they say in the advertisement, dears, the man who thought of "Specula" was a clever man, but the man who thought of Katheters a genius. At any rate, in this suburban Hell were a lot of Prostates dancing round, trying to reach the Katheters, which were hung up on dead Spironemes, just out of their grasp. Here they are kept till Vesica ruptures, and then they die. Ask daddy anything in this you don't understand, as the Wireless Bird didn't explain it all to me. Now, children, it's getting late, and I must stop. Eileen, dear, don't forget to take your extra drop of atropine to-night, and all of you say your prayers. Kiss mummy for me, and to-morrow tell you another story. Good-night. Good-night. T.

When Eve first saw her reflection in a pool, she sought out Adam and accused him of infidelity. 160 THE SPECULUM. Experiments in Camaraberie-14o. 4. It was a bright and cheerful morning, and this, combined with the fact that I'd gone to bed at a Christian hour the night before, resulted in my appearance at the , hospital at an unusually early hour. After putting on a white coat--a new one, it so happened—and packing stethoscope and plessor in the right-hand pocket, I found there was quite half an hour left before our surgeon, Mr. X., would clinic us in the wards. I determined to spend it profitably. I had been allotted one patient on the women's side, so, on the principle of ladies first, made my way to her. She had been operated on the day before by Mr. X., and I had "assisted." You know, my brothers, the extent of the "assistance" ! The patient in question was quite an appealing little lady, of the type who calls you "doctor" in all sincerity. She was eager for details of the operation, and seemed quite thrilled to know that I had "assisted." As well as I could, I gave her some idea of the mutilation her anatomy had suffered, but I'm afraid a salpingo oophorectomy necessitated by Niesserian infection is a difficult basis of conversation to maintain for one of my modesty. Then I expounded the marvels , of modern surgery, and, under the stimula- tion of her evident admiration and misconception of my share in her operation, ventured an occasional "we" in referring to the deeds of great surgeons. When I left her she thanked me warmly for all I had done, and I felt exalted, albeit somewhat hypocritically so. I left the ward, marching with the "great surgeon tread." You know—that impressive, firm-footed, head forward, purpose- ful walk so characteristic of our honorary surgeons. There still being some time before the advent of Mr. X., I decided to go across to the men's side, and have a look at "Mac's" arm. "Mac" is a chronic, and there is but little, he does not know of hospital life. Full of elation after my inspiring time in the women's ward, I approached Mac with the customary "Goodmorninghowareyouletmehavealookatyourarn'f greeting. With the confident assurance of the chronic, he answered : "I think I'll leave it till 'Doctor' X. comes along. He conies of a Thursday, don't 'e, to give youse boys yer lesson ?" I turned and left the ward, to seek solace in a cigarette. The great surgeon walk was gone.

Ebe herbalist. The "Heathen Chinee," upon whom immortality has perhaps been conferred by Bret Harte, lives no less to-day in the role of herbalist. At least, that is the popular conception, for one thinks of a Chinese herbalist rather than one of another race. On the whole, however, the Chinese variety appears to be comparatively innocuous ; it is chiefly to their white confreres that this article refers. Herbalism is a phase in the development of allopathy, long since passed, yet its exponents persist in their misguided activities, with no small degree of financial success. This, doubtless, is a testimony to the inherent optimism of the human race; doubtless, also, a testimony to its ignorance and leaning to the mysterious. Nowhere better can you observe the paranoid tendency of mankind to rationalise upon false premises than amongst those who uphold the merits of herbalism. THE SPECULUM. 161

Herbal remedies, they will tell you, must, of necessity, he much more valuable than mineral, for they are nearer allied in composition to human flesh. Epsom salts, a mineral drug, is violently rejected by the intestine—a patent demonstration of its unsuitability as a therapeutic agent. "Vegetable Laxative Pills" should, therefore, be much less distressing ; yet personally I find them extremely potent, if colic may be taken as a measure ! Organotherapv should have immense scope in this connection. But herbalists may he a reputable body of men. I have often been told by one of their protagonists that they are men who have had years of valuable experience of disease. Surely this must qualify them to practise with success ? Alas ! "experience is fallacious," empiricism is their watchword, and lobelia the most successful of their "remedies." Probably the best known of the dodges that have been employed by quack practitioners relates to the treatment of cancer in such accessible situations as the lip. Here, a plaster compounded with arsenic ensures an area of necrosis after an appropriate interval, and, with luck, the growth is replaced by an ulcer. With more luck, and a robust constitution, the ulcer may heal, with beneficial results to the quack and deplorable results to the patient. That, however, is between his gods and him. Gallstones (and any attack of pain in the right hypochondrimn, or elsewhere, for that matter, may be conveniently diagnosed as "gallstones"), are a profitable source of revenue. Soap, judiciously administered, provides the basis of beautiful "choleliths," which are later passed P.R., and collected and treasured by the grateful patient. The pain has probably ceased by effluxion of time. Another wily gentleman, not content with the orthodox methods of chicanery, resorts to a more complicated manoeuvre to prove his skill in treatment. His patient is fed upon a mixture of starch, bismuth and kino eucalypti. 'Constipation ensues, and the treatment is continued until the unhappy victim is on the verge of stercoral ulceration. Follows a brisk purge, when the scybali that are passed are a delight to the eye, a relief to the patient, and a testimonial to the herbalist. The man who employs this means of augmenting his income is still practising in Melbourne, and charges £1/1/- to £2/2/- for consultation and prescription. The art of diagnosis, so difficult to acquire as a student, troubles your herbalist not at all. One, be it said, has gained sufficient from his experience to use a stethoscope. He applies it, not to the heart or lungs, but to the part affected. This erudite citizen, who was proceeded against in a New Zealand court for damages on account of unskilful treatment of a goitre, had used his stethoscope with excellent effect by placing it upon the neck of his patient. Information thus obtained enabled him to state confidently that the patient's "kidneys were badly sprained, one lung was practically gone, and the water was an inch from her heart." The goitre, he explained, was a secondary matter. In the ensuing fourteen months, he presumably made a brave attempt to jack up the kidneys, rebuild the lung, and dam the water a little further back from the heart. The patient died before he could make a start on the goitre. Another Melbourne herbalist diagnoses by observation of the finger nails, and particularly by slightly raising one from its bed. Not a little painful. Still another advertises that he diagnoses solely by feeling the pulse, which "records every change in the body." Opium, in the form of Tinct. Camph. Co. largely, plays not a small part in the therapeutics of the herbalist. Paracelsus is said to have owed his success in treatment to a store of opium, collected during his wanderings. • In the case before the Supreme Court of New Zealand, quoted above, the 162 THE SPECULUM.

defendant had a woman under treatment for goitre. She had been advised by It friend to refuse operation in favour of herbal treatment. After examining her with a stethoscope applied to the neck, the herbalist advised a course of pills, a plaster, a day mixture and a night mixture. The nature of the pills or the plaster was not disclosed in the report of the court proceedings, but the day mixture was a commonly used tonic, containing a proportion of strychnine, while the night mixture contained gr. I of opium to the dose. Under this treatment the patient was declared to have improved for a short period. Later, when the symptoms became more pressing, the night mixture was occasionally substituted for the day mixture. The patient would then sleep twelve or more hours, and was over- 7 joyed. Shortly her health definitely became worse, and she died fourteen months after commencing treatment. At his first visit, the herbalist told her, "It is a lucky day for you that you called me in. Had you gone to the operating table in that condition you would never have come off it alive. In three months vou will he running about." • Damages to the extent of 1600 were awarded against him. Some years ago, several of us spent a holiday at Woodend. One afternoon, golf being contradicted by rain, we were sitting by the fire in the hotel, when a car stopped outside, and disgorged a man. He wandered in, hatless, wet, and a little drunk. He was wearing a composite outfit—the trousers of a defunct dinner suit, stiff shirt, with appropriate collar and tie, an ordinary waistcoat and coat, dancing pumps, and purple socks. His hair was long, black, greasy and untidy. It appeared to have been shingled. He sat down, pulled out a paper full of sand- wiches, and commenced to eat. We fell into conversation with him, and learned that he was a herbalist. He had been on the vaudeville stage, but found that herbalism was more profitable. A suggestion that a hot bath might be an advantage met with disfavour. It produced the' sweat, we were told, and hence Pneumonia and asthma. That re- minded him that he had removed a cupful of mucus from the bronchials of a man who had pneumonia. Questioned as to the aetiology of asthma, he gave a garbled but vaguely correct description. His treatment indicated that he was aware of the value of lobelia. His knowledge of tuberculosis was confined to T.B. of the lung. He explained that it was like a pack of cards, which gradually stacked up and replaced the lung. He could cure it effectually. I have since seen one of his advertisements, in which he claims to have cured a returned soldier of T.B. of the spine. Apparently his acquaintance of T.B. has extended in the interim. Cancer could be treated by herbs. We were offered a private viewing of the cancers, with their roots, which he had removed, if we would call at his Melbourne address. Syphilis he regarded as a "blood system disease." He had cured 2337 cases with Gum Guiacum, Rhubarb and Sulphur. Questioned as to whether he had a reliable abortifacient, he remained uncom- municative, but declared that he had had excellent results in the treatment of sterility. • King Ned, he said, had brought in appendicitis. Treatment consisted of inversion of the patient, massage of the stomach, into which the poison drained, and finally a purge to get rid of it. His knowledge of anatomy was nil. When asked the location of various organs, he said that they all corresponded to the signs of the Zodiac. He had had one great triumph. On one occasion he had "defied" the X-rays_ A patient had been rayed at the Williamstown Hospital, with a negative result. Our herbalist, when consulted, did not examine the patient, but went into his THE SPECULUM. 163

"studio" and sat down and thought. After thinking for some time, he had grasped the patient's condition. His verdict was : "A spot of blood on the fourth • or fifth lumbar." We were not enlightened as the significance of the spot, nor its treatment. The Australian Herbalists' Association has a membership of some twenty Melbourne herbalists. This body attempted, in 1925, to obtain legal recognition. Although, originally, there was no standard qualification for membership, it was proposed that, if recognition be given, the following would be required for admis- sion :- A. (1) A working knowledge of the uses of properties of herbs, roots, harks, leaves, stems, seeds, etc., and their therapeutic actions on the human body. Text book, Dr. Fox's Botanic Guide to Health. (2) That the test of diagnosis be by symptoms of the complaint under review. B. Physiology.—The functions of the organic system, namely, heart, lungs, stomach, liver, intestines, kidneys, eve, ear, nerves, circulatory system, and excretory functions. Text book, Mr. Furneaux' Human Physiology. That's that ! The examiners for qualifiCation as a M.A.H.A. were to be appointed from that body itself. One presumes that, despite the simplicity of the requirements, entrances would be few and far between. A nice, close little corporation of monopolists in quackery. "Growths" are the stand-by of the quack. Unfortunately, not all are dealt with so satisfactorily as indicated by the following extract from a letter written by a 'nurse at the Women's Hospital to her sister :-- "The sordidness depresses me ; withal it is a funny place. Such as to-day. A lass arrived here (23rd September, 1925). She had been attending a Chinaman for months, paying out a lot of good cash to have a growth treated. At the last minute he (the Chink) got the wind up, and sent her post haste in here, without telling her anything. She refused . to admit or think she was . The pain started, and became more frequent. She yelled out for a nurse to massage her, to relieve the pain, then yelled again, 'Come quick, the growth is coming away.' And away the growth came—a live male, 9 lb. weight, all on the emergency table, twenty minutes after her admittance." AR FUF.

c0,40 Prominent Personalities, Teddy Gault.—The genial Teddy possesses a keen eye for a push bike. It is rumoured that the \V arrnambool will see him yet. Exhibitioner in Physiology, honours, elsewhere—ergo, persistent and conscientious worker. Pulls a wicked oar, and edits The Wyvern in his spare moments. At one time business manager of the Spec/dun/. Shortly to retire into seclusion, with a view to annexing the Exes. in Finals. Jack Richmond.—Who is probably better known by the title of "Sec." A prominent figure in M.S.S. social activities, and a well known personality. Rowing and ability as a jockey (see Medical Derby, 1926) are among his proficien- cies. A good fellow, and always "with the boys" in work and pleasure, adversity and success. Eric Eddy, A. H.—Wrongly called "Cliff" by a fourth year contemporary. Puts in very good work on the athletic field and in the Wilson Hall. Jumps the crossbar and the examination hurdle alike successfully. Strong, but not silent.

164' THE SPECULUM.

Hugh Burns.—Returned soldier. Has always been an. enthusiastic worker on behalf of the M.S.S. Com- menced as year rep., finally becoming treasurer for the year 1925. True to the characteristics of the class, his administration met with marked success. His portrait, reproduced herewith, although drawn by a denizen of the Yarra Bank, catches his grave and judicious manner. Absorptions : Rowing, tennis, and his pipe.

Bobby Munro.—Third year, Queen's. "A most noble youth." Prosector in Anatomy, and a footballer of repute. Stretcher-bearing and a capacity to smile are also attributes. E. G. Robertson.—Familiarly known as Old Egg, but the resemblance is entirely superficial—it is almost certain that he has no albumen. An earnest and successful worker, he is well known at the various hospitals. He spends his mornings at the Melbourne, his afternoons at the Kid's, and his evenings at the Women's. In his leisure hours he amuses himself with tennis (in the summer), and his Buick (in the week ends), and Amaryllis (in the shade). His many friends will he pleased to learn of his complete recovery from the effects of his recent confinement at Vimy House, where he was delivered of a pair of fine bouncing tonsils.

%picuta.

Small boy is annoying his sister and her inamorata, who are sitting on a s fa. Sister : "Go away, Johnnie." Johnnie: "Won't !" Sister : "I'll give you sixpence if you will." Johnnie: "No." Sister : "I'll give you some chocolates." Johnnie: "I want a watch." Sister : "Well, you can't—you're too young."

THE SPECULUM. 165

Sweet Young Thing (at a dinner party, to deaf old gentleman next to her) : "Do you like bananas ?" "'No ; I prefer the old-fashioned nightshirt." O 0 0 01:113 James : "Hasn't that girl got bandy legs ? I wonder - how she got them ?" John : "Probably on pleasure bent." CICIC1000 A small girl was visiting her mother, who had just entered a maternity hospital. She refused to come near her mother ; and stood in a corner. When invited to come and kiss her mother, she stood her ground, and, refusing, said : "No ; I might catch what you've got." • CI 0 00•010 When a patient answers in the --, it's always well to try and get proof +.

1:10013CI0 A.: "I met the heroine of The Vanishing Race to-day." B.: "Who is she?" A.: "Nurse M 11." O 0 0 0 0 0 Highwayman (holding up car) : "Where, madam, is your husband ?" Woman (flushing) : "He's under the seat." ' ' ••• Highwayman : "Then I won't take nothing. It's bad enough having a hits- band like that, without being robbed 'into the bargain." O 0000.0 Host : "Let's have your honest opinion about this wine." Guest : "It's worthless." Host : "Yes, that's what Jones says about your opinion, but I want to hear it, just the same." O 0 CI 0 1:1' El Comedian : "I can't go on for a minute, sir. I feel funny." Manager : "Funny! Great Scott, man ! Go on at once, and make the most of it while it lasts." O 00000 Stewardess : "Madam, I have attended to your every need, but you are 'still unsatisfied. What do you want .now ?" Seasick Lady: "I want the earth." O 00013 - 1:1 Jacqueline: "But why should I marry you ? I don't love you." Jacques : " 'S no matter. Shan't he at home much, you know." O 00006 Lily : "Last night I drank seven cocktails. I wonder if I did wrong ?" Billy : "Good heavens, girl ! Don't you remember ?" 66 THE SPECULUM.

Clinician: "What is the chance of this being an inguinal hernia?" Student (examining patient) : "Oh—ah—I—" Clinician : "Come along, now. What odds will you lay—you're holding the bag?" O CI CI 0 0 CI Sense of humour was displayed by the lady whose baby, born during a pre- cipitate labour, was named "Flora." CI El 0 0 0 CI Professor : "In a case of chlorosis, murmurs can he heard at all orifices. O 0 0 CI CI 6 Professor (at conclusion of lecture) : "The student who was asleep dnring the lecture is marked absent." Sixteen students rushed . down, after the lecture, to look at the roll-book, "just to make sure!" O CI 0 0 0 0 Bush Surgery. During an operation, in which the cords of the brachial plexus were exposed. a "surgeon" from "the States" was heard to remark, on observing them: "What are them tendons ?" CI 0 0 0 To the Children's Hospital. Dear Madam,—Having been recentiebeded by Dr. C to bring our dauthter in the hosipal for appertian; will you kindly let us know if there is a bed? She is staffing from a cliff pallet. Kindly oblige by return of post. O CI Nomenclature. A rose by any other name may smell the same, but a bone by any other name can, apparently, profoundly affect the anatomical susceptibilities of the Royal .College of Surgeons. We quote an authority :- "If you called the os magnum the greater multangular at the College of Surgeons, you would cause emesis !"

Commentaries The prize is awarded to E. M. Tymms, whose commentary was exceedingly good. Those submitted by T. G. B. Allen and A. 0. Green are also worthy of commendation. SUI1SEQUENT HISTORY OF THE CASE. The patient was considered to be suffering from heart failure consequent on rheumatic myocarditis and precipitated by an influenza! attack; the hwmaturia was ascribed to rupture of an arteriosclerotic vessel in the kidney pelvis, and the albuminaria casts to passive congestion of the kidneys. Digitalis was stopped at once, and the vomiting ceased in two days; the patient, however, remained very intolerant to the drug, which induced vomiting within a few days every time administration was recommended. In spite of rest, venesection and diuretics, the oedema persisted, and indeed, became more marked in the arms. Death from hypostatic pneumonia occurred just two months after the examination detailed in the commentary. Post-mortem examination showed: Chronic adhesive mediastino-pericarditis; chronic myocarditis; general THE SPEC ULUM. 167 arteriosclerosis; hypostatic pneumonia; nutmeg liver; minor grade of chronic nephritis; genito-urinary tract otherwise clear. COMMENTS. The dominant pathological process in this patient, chronic adhesive mediastino- pericarditis, is one which is very difficult of diagnosis. An indication of the difficulties with a satisfactory general account of the condition will be found in Osler's and Price's text books. In this instance its detection was not essential to the writing of a satisfactory commentary. Heart failure, following on rheumatism, and, on the available evidence, reasonably attributed to chronic myocarditis, was the central fact on which the commentary should have been made to pivot. None of the entrants brought out this point with sufficient clearness. Their failure was largely due to lack of imagination —and only very little was needed. None of them seemed to realize that the commentary described a real patient who presented a pressing problem in diagnosis and management. The first essential in writing a commentary is to visualize the patient and to imagine oneself in charge of the case. Such an attitude alone can give point and definition to the discussion. For example: Several answers discussed the haematuria at great length, with much elaboration of many highly improbable causes, before men- tioning that the patient was suffering from heart failure. In actual fact, it was relatively unimportant and requ_red consideration mainly from the point of view that it might have had some value in assessing the pathological processes at work. The commentaries should have reflected this attitude. The second common fault—an almost natural corollary of the first—was that of not sticking to the facts. It was surprising to find that not one of the competitors discussed the fact that the oedema had increased, despite rest and digitalis in adequate doses. What they did do was to discuss the treatment of heart failure and oedema without any reference to this particular patient. In other words, they used the facts as pegs on which to hang abstract discussions. The commentary should be concrete; that is, in this instance, it should discuss heart failure in this patient, not heart failure in general. As a result of these faults most of the answers lacked balance; non-essentials were discussed at too great length and allowed to obscure the main argument. This is a matter which time and intelligent attention to clinical work will largely remedy. But to write a logical commentary, it is necessary to know what the conclusion is going to be before commencing to write. The case must be pondered for some time, and the diagnostic possibilities narrowed down to two, or at most three, before the answer is attempted. A final diagnosis is not necessary, or even desirable, since ideas and con- clusions will shape themselves more definitely during the writing. During the initial contemplation of the problem, notes should be made in such a way that they can be used as a guide to the time available as the fleeting three hours pass rapidly. Only in these ways can a commentary be made logical, balanced and compaet; these are the essentials to success. Despite the fact that students view the making of notes before commencing to write an answer of any sort with repugnance, or even with alarm, the following skeleton outline is submitted as being a satisfactory one on which to write this commentary:— (1) Discussion of the facts, showing that the patient was suffering from heart failure, and of their significance in elucidating the mechanics of that state. (2) Why was the heart failing? Two possible causes are outstanding:— (a) Rheumatism. The absence of valvular disease requites comment. (b) Arteriosclerosis. On top of these, the effect of an acute toxaemia, which precipitated the crisis. Its nature? Cause of haematuria? (3) State a tentative diagnosis:— Chronic myocarditis—rheumatic. Rule out kidneys. Influenza. Cause of hanaturia? (4) Managenient of the case. Treatment of heart failure. Poor response to digitalis and signs of intolerance. Investigations—Renal function and Wassermann. (5) Prognosis. Grave, owing to poor response to treatment. Should temporary recovery occur, fuller investigation of renal function and of the cause of haematuria. 168 THE SPECULUM.

HINTS TO COMMENTATORS. It is impossible to lay down set rules for the composition of a commentary, since different minds will necessarily approach the problem presented in different ways. The following principles are, however, of general application:— Try to visualize the patient and imagine yourself actually in charge of the patient. Think over the whole case ; and try to narrow down the diagnostic :poSsibilities before commencing to write. Half an hour in a three-hour examination is not too much to devote to this. Make notes while you are thinking. For purposes of discussion, group symptoms • with reference either to time or to organs or systems. Do not attempt to discuss them individually. Try to make • your whole argument lead to a reasoned conclusion. Stick to the facts of the case. MEDICAL AND SURGICAL COMMENTARIES. A Medical Commentary (C.N.S.), and a. Surgical Commentary will he printed. a,nd circulated to members of the M.S.S. one month before the next isue' of the "SpectiluM."

"Where to?" "Home!" "Seem in a hurry." "M' dam wife mended a hole in me trousers with a mustard plaster!" THE SPECULUM.

lbospitat anb pear 14otes. Melbourne lbospital 'Rotes. Great changes have come to pass since our last annals were published. Many who were but students among us are now in the ranks of the Anointed. We offer our congratulations to those who crossed the abyss safely. More particularly do we offer congratulations to Orme (God bless his plus fours!), who again demonstrated that the M.H. leads the way, while Hughie Gallagher and Bob Syme also deserve much praise., 1 Those who now wear long white coats and sup with Sisters are:—Orme Smith, Bob Syme, Ben. Buttsworth, Hugh Gallagher, "Chew" Evans, Eddie Varley, Geoffrey Pen- nington, Les. Westacott, Walter Long, John Begg, Elgin Dahlenburg, Gavan Duffy. Tom Sayle, Rae Allen, Ralph Skinner, Harold Love, Tom Giblin, ...Man Murray, and V. R. Johnson. The Registrars are Ern. Cooper, "Nip" McLean, E. Hughes-Jones, and "Jerry" Ashton, who between whiles seem to be pursuing the "wee white ba'" o'er the links. No doubt it is a great life, and a great privilege for Buttsy to discuss with Zeddy how Melbourne became premiers, whilst we students look on with envy. But let's work and pray, and some day, maybe, we, too, may have such privileges. Fifth Year are in the wards again. A new system is in vogue whereby one does Surgery, and is attached to a medical clinician, or vice versa. Siddy finds this system hard to understand, and sees no reason why we should not take medical histories, at least one a week. Sid has lost his distressing little habit of pulling students' ears (but not their legs), and proves himself a nuisance on physiology and function. Its few satellites find it hard to draw pictures of a cross section of the end, "please marking in all the tracks," and explaining point blank the mechanism of combined extension and forward swinging of the arm with alternate fletion and extension of the index finger. Of course it's easy, with years of "thinking things out for yourself," so our "follow after reflex" enables us to continue to patronize him. With many students away at the Kids' and Women's, we are kept busy, and Harold and Eric are said to be expert in the art of lumbar puncture. Specials are nearly finished now, but we were terribly jealous of Theo, who pirated several ladies at Kew with his accustomed sang-froid. One promised him one of her diamond mines, and another offered him a proposal of marriage, although it isn't Leap Year. But the prize was snatched from us by an A.H. man, who collected the young nurse from the Children's Department. These children's nurses are always liable to be useful We shudder at the threats of Dr. Philpott, who says we pay only passive attention to our lectures. But no doubt we will have learnt enough to develop echolaia at our orals, and thus probably get our Certificate signed. Pray God it's in our little book. O.P. clinics are thronged by a mixed medley of Fourth and Sixth Year students, the latter demonstrating (on patients) to the young belles of Fourth Year the H. and R. method of palpation. Can it be this opportunity of so shining is the condensed wisdom of Treacle and Bloisy which attracts them to these regions? A notice is to be posted in O.P. warning patients who have been examined by all and then cliniqued upon, to beware of Tom, who lurks in corners and persistently pounces upon them just when they are told "you can get dressed up now:.' It's just his little way. From O.P. comes the story of the similarity of Gyno. and Eye clinics, as all the patients complain "that they haven't seen anything for some time." F 170 THE SPECULUM.

The Clinical Society has held two meetings since last issue. The one held at the Kids' proved a first help to the few who attended. Ian's views on baby feeding are certainly novel, and possibly explain why he's such a "big boy" now. Mick Simmonds, while not qung Wheeler-Jack, enlightened us with a few practical points. The last meeting held at the M.H. was a great success in all respects, the class room being crowded, and many, we believe, remembering that each person requires at least 500 cubic feet of air space, stayed at home rather than risk suffocation. All present sat and listened with awe, while Eric Price presented a miniature edition of Purves Stewart, and then sat, attacked by a functional hypoglossal paralysis. But Treacle soon proved that he at least wasn't awed, and dispensed, the words of wisdom. After that, the remaining cases proved too easy. Amongst other diversions we tried our skill at the Law in August. Many were called, but Fritz Osborne . was chosen to wear the Corona Veneris, happily twisted out of a fiver. Aided by MoBison and "Police Gazettes," others successfully negotiated this minor hurdle. With great pleasure we note that Ben„ is about to enter the lists of matrimony. We've long been watching him, rushing away after Lunacy, and coming back with Ivanhoe grass indelibly impressed upon him. 'Congratulations all round. And with him goes Miss Gwen, who flashes three diamonds, and also receives our best wishes. In spite of them, we still fancy Mitch. as -tur ideal for a steady partner. And our efforts on "the light fantastic" were supplanted by two dances. That given by the Nursing Staff was most enjoyable. Numerous Honoraries rolled up with their wives, and demonstrated. the equal dexterity of their fingers and toes. The Staff are to be congratulated upon their organising ability, their dancing, and their arrangement of Linen Cupboards, etc. The Students' return dance was equally enjoyable. The bump of locality.inhereat in most of us was admirably demonstrated by the unfailing accuracy with which many directed their steps to the Students' Room between dances. (Unhappily that will be no more, as the famous room is being converted into quarters for maids). Next morning told its tale, lacerated fingers, partial frost bite, and other pathological peculiarities of unknown aetiology. being privately treated. Even the Cas. bottle of absolute alcohol was missing. We have since heard that McMeek., after noticing the gyrations of many, considers that the inventor of the Charleston must have suffered from a cerebellar tumor. And now we are looking forward to the time when 8.30 lectures will be a thing of the past, and we can once more enjoy our beauty sleep. We have to thank Dr. McMeekin for his fine series of lectures on C.N.S., which were really enjoyable. And so, having "writ our little piece," we close down till 1927.

1bo3pital tiotcs.

The end of term is always a worrying time. Cleopatra found it so many hundreds of years ago. Fourth Year find it so at the present moment. In a few days they stand or fall on their knowledge of Path., and their intimate acquaintance with that refreshing feature of modern home-life, the two-gallon flush. Our best wishes to them. Fifth Year are finishing off "Specials"—some with the ophthalmoscope, others with their fingers—and for the first time are approaching that state of ignorance which is the earliest sign of knowledge. By August they should know nothing. The calm routine of Casualty was strangely unruffled by the presence of Henley. But the weather was, alas! too perfect for argument. Those who graced the verdant banks of the river and caught stray glimpses of the starlit sky above were quite con- tented. Scarcely a fortnight later there walked into a Thursday afternoon clinic one of the prettiest girls you could hope to see. She was one of the obvious reasons why Casualty had been so quiet that night. I really feel ashamed to give her h;story in rhyme, but it sounds so much catchier that way. This dusky young maid (an enticer!) Encountered, at Henley, a spicer. At the first, with disfavour She viewed what he gave 'er, But now--well, she knows it is Neisser! THE SPECULUM. 171

While in the reminiscent vein we cannot but recall the splendid effort of Harry Downes, last Finals, in bringing the Obstetrics Ex. and half that in Medicine, to the Alfred. His was our finest feat for many years. Orme Sri -nth, • who captured the rest Of the "Exes.," and was easily top man of the year, has our hearty congratulations on his brilliant achievement. - Congratulations also to Dr. Carrington on his appointment as Super. of the A.H. If facial expression is any indication, he is already enjoying the job. The competition for the Hailes Cup ; some weeks overdue, is still undecided. Whether the fault is lack of organization, lack of time or lack of balls, is not certain. In the event of another walk-over the Alfred will have won the cup without the loss of a single game—surely a record! Should the match be played, however, we will give University another go for it next year. Though the last few months of hoSpital life have been devoid of social activity, there has been no dearth of private enterprise. Hymen—the God we hear so much about, but, personally, have not vet seen—is to be made much of in the near future. Even Honoraries are not to be exempt. Though we are fairly used to quick develop- ments, this certainly was a surprise. . Amongst ourselves, we congratulate Alan and his fiancee on their mutual; good fortune. We might add that some of the Residents who are devotees to Venus have had some Very bright parties of late. More than this we cannot be "egged on" to disclose. Glen has again came into the public eve. Everyone just at present is wondering why he can't stick to the medical wards while he is doing medicine. We don't mean to butt in, or anything like that, but we are interested in Glen, and we want him to get the most out of his work. Must he go to the theatre to study flutter? Bill, the strong silent man, is reported to have returned to the grass during his stay on Cas., and his confrere, Willie, of the carbuncles, has become famous in the clinics. He has a peculiar aptitude for expoUnding the unexpected. Recently A.V.M. was clinicing on a case of aortic incompetence with very high blood pressure. He made the typical query—"Now in what types of case would you not expect a high blood pressure?"—and Willie briskly replied: "Chinamen, sir." Accurate, but it broke up the clinic. . If there is one word whose constant usage should result in its extermination, that word is definitely., It seems one's lot in the clinics to find that the physical sign or condition one failed to reveal was definitely present. The word becomes irritating:. It cuts out all protest. It closes the subject as finally as "I say that so and so is present, and that's the, end of the argument." Honoraries, of course, can use the term with impunity, but when students in their prematurity make a permanent practice of it the result is pitiable. Mannerism or not, to me it always savours of paranoia. So constantly has the request for material for the "Speculum" been met by the reply, "Well, give me something to write about and I'll do it," that I unstintingly present the following plot and theme as a germ for a hospital tale.' Basil Ducrey, a young and ardent pathologist, is in love with Spiro, the fascinating daughter of Mr. and Mrs. Keat. The father, a clear old man, is a gardener who would give away his last barrow-load of manure. For some years he has had a hydrocoele, but has not let it interfere with the education of his child. The mother is one of those negative women—her only positive qualities are her Wassermann and her love for her (laughter. (This gives family atmosphere.) Spiro herself, black-eyed and willowy, is a child of nature. One eltening, while doing the splits, she notices a mole on the inside of her thigh. Basil must never see it, this one blotch on her beauty! To him she is as pure as if she were sterilized (she probably is). No, Basil must never see it! Next day it is removed by a Dr. Neece, who sends it to a pathologist for section. The report comes back "Melanotic sarcoma, highly malignant." Spiro is in a frenzy of despair. What can she do? She is too young to die, too -beautiful. Her magnificent endocrine system to perish without a trial? Youth to vanish, and .Love? God forbid! She decides. While she has life she shall live! She rings Ducrey. Can he come with her at once? What?—doing blood film?— .can't possibly? Brute! Is that all he cares for her! She slams down the receiver. And at that moment her adorer, Charles H. Anchor. enters, his eyes full of passion for her. It is the psychological moment. When he leaves she leaves with him. Early next morning:: a .car returning to town at terrific. speed strikes a stanchion in St. Kilda-road. The Man:is killed. The woman, not yet dead, - is taken to hospital. 172 THE SPECULUM.

She opens her eyes to find Ducrey bending over her. "Dearest," he whispers, with infinite tenderness, "how did it happen?" In a few broken sentences she tells him—tells all—her condemnation to a living death—his refusal to come with her when she asked him. Her eyes close wearily. The terrible truth flashes on him. "My God," he cries, "I've killed you! I've killed you!" He wrings his hands. Her eyes bravely protest. With broken sobs he tells her. "Dearest—I made a frightful mistake—I rang Dr. Neece—only this morning—and told him. Yesterday- I reported—the wrong section— it was—not a cancer—just a mole—" Suddenly he grasps her in his arms. "Spiro, my own! look at me! Say you see me! Look at me, my darling! . . . . " His eyes widen with horror. She is dead. No reference is intended to our present Path. Registrar in the above tale. He is not the hero. So far as we know none of his mistakes has as yet been fatal. Moreover, no blood count could deter him from going out. Should the Residents desire a friendly contest at hockey or tennis between now and Christmas, we shall be pleased to tackle them. Just now we can think of no finer preparation for the joy of quaffing Foster's and Vic. Bitter. And the weather is certainly becoming thirsty.

%t. Vincent's 'notes.

Once again to put the doings of the noble lads of St. V's. on paper. The main topic of interest for some weeks past has been the daily game of Coon-Can, with now and then a turn at two-up to relieve the monotony of waiting for clinicians, who generally turn up at the crucial moment of the game. Tom Carroll seems to have phenomenal luck at the game, and his broad smile after every win affords a contrast to Frankie Donoghue, who shells out and curses the luck. Dinny generally carts a little of the winnings away, while Sol. is rarely out of pocket. The rest of us grin and bear it. There are rumours floating about that two of the lads are contemplating turning up Med., or at least if they don't do that they will certainly be Naval Doctors, for already they sport the costumes of retired sea captains. Dr. Dan. drops in occasionally to tell us how he dropped another eight hundred last week. Yet he never seems to be bankrupt. They say that little Eddie pinches all the chocolates when he crawls up to see his sister. No chocs. no Eddie, is his motto. Leo. Geraghty, who hasn't been too well of late. is looking much better since "Billy" has returned. Of course absence makes the systole less powerful. We've discovered the man with the perpetual grin, and we don't know if it's fixed on or natural. Anyone -discovering a method of removing it, painlessly or otherwise, will be presented with a shop-soiled dog-biscuit. We don't see much of the Fifth Year round the hospital now. .On those rare occasions on which we do we hear Niggery moaning about the two guineas he saw go west when he entered for Public Health. How anyone with any brains could flop Public Health has got me beaten. Concerning the ladies, we see so little of Phyll that we are beginning to think she is a wraith. Miss R—, we hand the bouquet to you as the chocolate queen. Dr. J. S., , we expect better of you than making tame puns on the names of the students in your clinic. This time you are let off with a caution. Next time, i5 to the M.S.S. without the option.

Our finances are in a parlous condition. Sol. has a harrassed look these days. We are thinking of biting the ears of the Fifth Year soon. The other clay Dinny came down to the students' room while we were waiting for Hughie. He turned to a student, and the following illuminating conversation took place. Dinnv: "I went into the wards, but I' couldn't take a histoly as the police were there." Student: "Good heavens! What were the police doing there?" Dinny: "I didn't say the police, you -- fool, I said a pliest." It appears that he meant a priest was there. Nuff said.

THE SPECULUM. 173

And now to test the acumen of the clever boys we set the following puzzles. Any one unable to refer the following quotations to their authors will be referred back to their studies for another year, as Dicky Berry would say. Well, here are the memorable words. 1. "Good-marnin', Sorr, how are you this marnin'?" 2. "Iss der any vaccines to-day, sir?" 3. "Of course it might be this, but then again it might be that, and I wouldn't like to say that it's this, because I've seen cases like that." 4. "I dunno, you fellows don't seem to take any interest in your work. When I was a student, etc." 5. "May dear man, it mayght be anything." Leaving the elucidation pf the following to the more erudite, we must now close these few notes with best wishes for success for all of St. V's. nurses and students in the exams. which are only too close by this time. Also, as a new hand will pen these lines in future, the present Fourth Year wish to welcome the incoming Fourth Year, exhorting them to uphold the noble traditions of their predecessors. 2nb rear Votes. On dit- That we're a bright lot. That our examiners think otherwise. That only fifteen passed Prosectors. That the other fifty-five think they should have, too.

That second year's curriculum is ideal . That third year is EASY. That the proposed new curriculum says so. That we agree with radiologists, That fat people are `‘`betes noirs." That X-rays have a "romantique" use. That Dr. Colin MacDonald said so. That it is because they help tell the age of "mummies." That "Pansy" should have won the Ugly Man Contest. That we did our bit. That Pansy's photo was auctioned for a pound. That one of our number' bought it. That Prof. Berry is leaving the Anatomy School next year. That we are sorry. That we hope to leave with him. That we have two "true blues" in our midst—Cussen and Petchell—and two "near blues"—Dungan and Sewell. That we are all "blue" in the mi'st of exams.

First rear 'notes. Since the last appearance of this Journal, several notable events, now occupying much space in the book of red letter days, have taken place. Firstly, for the sake of those who were foolish enough to stay at home, or stupid enough to be completely ignorant of our intentions, we would like to devote a few lines to the subject of the First Year dance. Suggested by a bold brazen few who later received all the kicks and none of the ha'pence, the idea gained strength and gradually wore down the opposition, which we can truthfully say, was no mean force. Certain almost insuperable difficulties cropped up, but as a result of titanic efforts on the part of the dance committee, these were successfully overcome, and on Monday, August 9th, a crowd of over 125 gathered at fit e—Melba Hall and danced gaily till the wee small hours. 17-1- THE SPECULUM.

• The most unusual feature, we believe, was the balance-sheet, which showed a nett profit of i5/19/2. This money, in notes and coins of the realm, is now safely tucked away in the coffers of the Registrar, and is to be put towards the fund for building that fine, new Club House, of which we hear so much. Great credit is due to Miss Margaret Troup and the other ladies of First Year for the manner in which they carried out the catering arrangements. Indeed, the very fact that a profit was shown is due largely to the happy knack possessed by Miss Troup of acquiring things at almost negligible cost. As is usual in third term, the sole conversation of most students is devoted to the fast approaching examinations. That tiny cloud on the horizon, scarcely perceptible in first term, has now attained almost terrifying proportions, and has cast a gloom over all but the most sanguine of us. Many of us, with an eye on next Commencement, are, putting tremendous energy into our work, and in the happy event of "tricking" the examiners, feel sure that next year the Editor of the Spec. will have no occasion to regret that "Second Year brethren are inarticulate." Our genial lecturer in Chemistry, Dr. Hartung, has now won a strong position in the affections of all. We consider his gift as a raconteur unparalleled in this University. and only wish we could take him along with us in the course. By the way, we would like to point out to certain noisy members of 'the year that a stamp, after all, is only a stamp, and to take advantage of a good-tempered lecturer involves The question, not of temerity, but of good manners. We feel sure, also, that the size of their feet is inversely proportioned to their good taste. Anyone possessed with this frantic back to childhood desire to create a din should at least be thorough and try it during a Nat. Phil. lecture. They have our full permission, and, incidentally, our deepest sympathy. Much speculation has lately been caused by a certain member of our year. A kind of furry appearance has been noticeable on his upper lip ., and opinions are tersely divided as to its cause. Some have it that it is a new and terrible pathological condition caused by the imbibing of beer and eye-strain, produced from gazing on Charleston legs. Others, again, maintain that it is due to a certain fungus, formerly unknown, the spores of which are contained in large numbers in the ordinary ladies' lip stick. How- ever, after a searching examination in strong sunlight, we are forced. to conclude that it is incipient moustache formation, due to a puerile longing to emulate the manly "tooth-brush" of our representative. Our Nat. Phil. lecturer used a happy analogy the other day to illustrate the process of electrolysis. He compared a sodium chloride solution with a ballroom during a dance. The passage of the current had a similar effect on the salt as the sudden opening at one end of the room of a free bar, and a toilet salon at the other, would have on the couples dancing. We very much fear, however, that in the latter case inappropriates ions would be found at both electrodes. In conclusion, the First Year representative wishes • it to be known that he thanks the seven "stickers" who stood behind him in the recent unfortunate disagreement over the dance programmes.

THE S ['ECU LLJM. 175

Cliff Ellingworth.—Med. Super. West London Hospital. N'larried in \ugusi. Les. Middleton.—Med. Super. Great Ortnond St. Hospital. Ceddie Swanton.—Edinburgh. (Married before leaving Melbourne). Podge Williams.--London. M.R.C.P., and a baby daughter. • Tick Hadley.—F.R.C.S. In London. Returning in October. Alf. Johnson.—Post grad. work, London. Vic. Delaney.—Ditto. Len. Johnston.—House surgeon, Golden Square Throat Hospital, London. R. Duncan.—House surgeon, Central London Ophthalmic Hospital. Has recently obtained D.O.M.S. Ron. Stott.—Eyes, London. Did locum for Duncan at C.L.O. Hospital. Alec. Herrington John Barnaby Post grad. work, London. Tom Cowling George Simpson.—M.R.C.P. Resident at Oueen Charlotte Maternity Hospital, London. Mick Healey.—Skin, London. Now in Edinburgh. Horace Thomas.—Over from India for post grad. work in London. Laddie Lazarus.—London. Has got primary F.R.C.S.•,' W. G. Livingstone (1923).—Ipswich Hospital. A. R. Moreton (1925).—Sale Hospital. R. H. F. Rockett (1925).—Perth General and Supreme Court. Tom King (1923).—Married. Private. St. Kilda.. Harold Love (1925).—Convalescent Hospital. Vic. Wallace.—Government Medical Officer, Port Moresby. Blackwater and Yaws. W. R. Trembath (1917).—Sea Lake. H. Jacobs (1917).—Collins Street. H. G. Brown (1917).—Kilmore. Noel McClure (1917).—Hay, N.S.W. J. Kennedy (1918).—Shepparton. Gillis Wynne (1918).—Collins Street. 176 THE SPECULUM.

. Jimmy Robertson.—De onport, Tasmania. Ginger Inglis.—Kew. Harold Moore (1917).—Kew. Bert Shugg (1918).—Hobart. Bill Fitchett (1918).—Elsternwick. Horace Waters (1918).—Brisbane. Chas. Cunningham (1.918).—Private, North Melbourne. Colin McDonald (1918).—Collins.Street. E. Gandevia (1917).—Locum. Cheltenham. Mick Cust (1920).—Fitzroy. Wilfred Forster (1918) .—Overseas somewhere. Jack Whitaker (1917).—Collins Street and Clifton Hill. Engaged. J. F. Chambers (1917).—Collins Street. A. L. Mcinnas (1924).—With Syd. Crawcour. John Searby (1924).—Woodend. Clive Backhouse (1917) .—Rabaul. Norm. Albiston (1918).—Been in England. Tom Hendry (1918).—Beulah. With pipe. John. Green (1917).--Moonee Ponds. M. L. Coutts (1917).---Rabaul. Keith Fairley (1920).—Collins Street. E. H. Derrick (1920).--Irvinebank. Torn Millar (1923).—Fairfield. Claude Hallett (1924).—Adelaide. Bill Flannagan.—Private. Donald. Stewart Macky (1914).—Pakenham. Frank Kerr.—Public Health Department. Bill Callopy (1920).—Private. Merino. Lux Meagher.—Back from the Continent. Val. Podger (1923).—Cranbourne. Frank Grant (1922).—Wodonga. Jim Shelton (1921).—Carnegie. John Byrne.—Yarraville. Torn Nihill.—Ouyen. Chum Hanly.—Birchip. Leo Tighe.—Elwood. Jack Cahill.—North Fitzroy. Tom Noonan (1910).—Caulfield. Norman Davies (1902).—Benalla. H. L. FINLAY & FYFFE REAL ESTATE AGENTS National Bank Buildings C. 2643 C. 2643 (Eastern Branch) 89 Collins Street

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181 ANTICALOR

Anticalor, as the name implies, is a scientific antiseptic preparation a modified form of Kaolin Poultice - designed to supersede the old crude absorbing agents in the main- tenance of blood circulation in parts affected by any form of Congestion or Inflammation. Physicians may confidently use Anticalor in the local treatment of Bronchitis, Pleurisy, Pneumonia, Peritonitis, Tonsilitis, Bruises, Sprains, Boils, Eczema, Inflammation of the Bowels, Sep- tic Wounds, Abscesses, Synovitis, etc., etc.

ANTICALOR IS PACKED IN THREE SIZES FOR RETAIL SALE, AND IN 5-lb. TINS FOR HOSPITAL USE. pRopkiEToks: ROCKE, TOMPSITT & CO. Pty. Ltd., Melbourne

. . . . . Melbourne Sports Depot

THE LARGEST IMPORTERS OF SPORTING REQUISITES IN AUSTRALASIA

WE MAKE A SPECIALITY OF TENNIS RACKETS AND BALLS Shipments of which arrive monthly from the Leading Makers AYERS, PROSSERS, SLAZENGERS, BUSSEYS AND OTHERS. BALLS BY ALL THE LEADING MAKERS. Nets, Markers, Scorebooks, Posts, Presses, &c., in Great Variety.

CALL AND INSPECT OUR STOCK Melbourne Sports Depot 55-57 ELIZABETH STREET, MELBOURNE

182 DODGE BROTHERS MOTOR CARS

ODGE BROTHERS TOURING CAR is D almost invariably selected by those who rely on motor car transport to carry them over bad roads in comfort. The simplicity of its power plant design, and the superior strength and quality of the alloy steels used in vital parts, give assurance that, with a minimum of attention, it can be relied upon to go wherever there is traction.

Chassis .. . £265 Roadster ... £320 Touring Car . £325 B. Sedan . £420 Five Balloon Tyres

If fitted with Magneto Ignition £10 extra

Canada Cycle & Motor Co. (Victoria) PTY. LTD. 352-358 Latrobe Street Melbourne Phone Nos. F 3155-6-7-8

183 Announcement

HE Pluriglandular Preparations made by The T Harrower Laboratory are now available in Australia. A complete stock is held by Fassett & Johnson Limited 233 Clarence St. Sydney, N.S.W.

One of the most important of these preparations is known as Tabs. THYRO-OVARIAN Co. (Harrower) and is now in use by forty thousand medical men in two continents in the treatment of amenorrhea, dysmenorrhea, etc. A copy of "A Manual of Pluriglandular Therapy " by Henry R. Harrower, M.D. (300 pages) will be sent free on receipt of your request by Messrs. Fassett & Johnson Ltd., as above.

ENDOCRINES LIMITED Sole Distributors for The Harrower Laboratory, 72 Wigmore Street, London, W.1.

184 SPECIAL NOTICE TO MEDICAL STUDENTS

REMEMBER That the best Substitute for Human Milk is LACTOGEN (THE NATURAL MILK FOOD) 1. Because ORDINARY COWS' MILK is not always fresh, and IS OFTEN TUBERCULAR 2. LACTOGEN is made from PURE, FRESH, COUNTRY COWS' MILK, and the Milk is taken from Cows which have been tested for Tuberculosis 3. LACTOGEN is made within a few hours from the time the TESTED COWS ARE MILKED 4. LACTOGEN is made in a hygienic, scientific factory, UNDER THE STRICTEST SUPER- VISION 5. In feeding Children on LACTOGEN, Mothers can prepare Fresh Food for their Children WHICH CLOSELY APPROXIMATES HUMAN MILK

MEDICAL STUDENTS REMEMBER LACTOGEN FOR INFANT FEEDING AND INVALIDS Established 30 Years Telephone Central 4298 After Business Hours, Windsor 1531 JAMES LITTLE MEDICAL PUBLISHER IMPORTER of MEDICAL and SURGICAL WORKS

Medical Agent for the sale and purchase of Practices Assistants and Locum Tenentes supplied

" CENTREWAY," COLLINS STREET, MELBOURNE (Take Elevator to 3rd Floor)

A CHOICE COLLECTION OF THE LATEST BOOKS ON MEDICINE, SURGERY AND NURSING ALWAYS ON HAND. ALSO Students' Text Books :

DISEASES OF THE CHEST AND PHYSICAL DIAGNOSIS. By Norris and Landis. Third Edition, Revised, 1924. YOUNG'S PRACTICE OF UROLOGY, based on a Study of 12,500 cases. THE MAYO CLINIC. One Volume. Annually. THE SURGICAL CLINICS OF NORTH AMERICA. Every other month, February to December each year. THE MEDICAL CLINICS OF NORTH AMERICA. Every other month. Clinic year, July to June each year. (Equal to a Post-graduate Course.) BICKHAM'S OPERATIVE SURGERY. Six Volumes and Index Volume. Now complete. About 6000 pages and 6378 beautiful illustrations. 50/- per volume. Index volume free. SURGICAL PATHOLOGY. By William Boyd, M.D., M.R.C.P.Ed., F.R.S.C. 1925. The latest and best on the subject. VAQUEZ AND LAIDLAW ON THE HEART. The Latest and the Best. Published September, 1924. PEDIATRICS BY 150 SPECIALISTS. Edited by Isaac. A. Abt, M.D. In eight volumes and index volume. Illustrated. 50/- per volume and index volume free. MacCALLUM'S PATHOLOGY. New Third Edition. September, 1924. The recognised standard.

Brown, Prior & Co. Pty. Ltd.. Printcraft House. 430 Little Bourke Street. Melbourne.

Library Digitised Collections

Title: Speculum 1926

Date: 1926

Persistent Link: http://hdl.handle.net/11343/24202

File Description: Speculum: issue 119, November 1926