• 122 AUGUST, 1928

THE SPECULUM --mew= /rya

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•••- • • • •••t

CONTENTS

Page.,

• • • • • • • 57

59

60

61

.. 63

64

67

.. 67

68

70

72

74

76

77

78

.. 79

is

c4 r, it?

/0'

Page.

Acute General Peritonitis .. .. 9

The Medical Student and the Hospital 13

Editorial, . . .18

Business Page .. .. 20

The Spirit of Enquiry in the Practice Of Medicine .. 21

"Casino Notes" .. 32

If Spalte Had Been a Geographer .. 39

Incidents in the History of a Few Drugs in Comment Use .. .. 40

The History of Syphilis .. .. 42

Portrait of a Dog Swallowing an 45

The Zeiss Works .. 46

Inaugural Lecture 50

The A B C of Vitamins 53

Annual General Meeting'of the M.S.S. 54

Lay of the LaSt Spirochaete 56

Extracts from Our Commonplace Book •

Mr. Barber's Address ..

Ladies' Letter ..

Correspondence ..

Some Physiological Gems

Scrapings ..

From a Patient ..

An Anatomical. Rhapsody

The Ninks Mystery ..

Mr. Bonney's Address ..

Specula

Review ..

Hymn to Hymen ..

Fraternal Frivolities .

Old Boys' Column ..

Hospital and Year Notes

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8

tin Zpecutum No. 122 AUGUST, 1928

Acute Oeneral peritonitis W. R. GROVES, M.D., F.C.S.A., Honorary Surgeon to the Kyneton Hospital.

I deem it both a pleasure and a privilege to have been asked to contribute this article to The Speculum,. A regular subscriber to that journal, indebted for Touch entertainment and not a little instruction, I gladly take this opportunity to congratulate the M.S.S. in producing from year to year such a creditable publication.

By way of introduction to the subject of acute peritonitis I would draw attention to a few anatomical, physiological, and pathological considerations in regard to the peritoneum.

The surface area of the peritoneum, equal to that of the integuement, some 17,500 sq. inches, being so vast, suggests the probablity that it is never entirely involved in general peritonitis, and that therefore this term is a misnomer. Moreover, the term general peritonitis is loosely used to cover quite variable degrees of unlocalised peritonitis. In an article reported in the A.M.J., 19/2/27, I suggested that these cases of urlocalised acute peritonitis might be divided into focal, generalising, and generalised. Dr. John B. Deaner, of America, suggests the terms diffusing and diffused.

Focal peritonitis would signify the condition present when an acute focus, such as an inflamed appendix, has led to inflammation of the peritoneum in its immediate neighbourhood, unlocalised by adhesions, and with exudate already diffusing—the early stage of a spreading peritonitis.

Generalising peritonitis denotes the case with peritoneal inflammation, as indicated by hyperwmia and distending bowel amidst copious free fluid (exu-dated), present over a large area, but not all of the abdominal cavity. Except in the neighbourhood of the fccus, the inflammation would not yet have reached the purulent stage. Generalised peritonitis is present when the inflammation has reached the purulent stage in practically all areas. There will be uniform and great distension, with "silent" abdomen, and absolute obstipation due to complete absence of peristalsis.

An appreciation of these varying degrees of unlocalised acute peritonitis is necessary to determine the method of treatment to be adopted in the individual case.

Other factors bearing cn treatment are the following :- The peritoneal exudate thrown out so freely in the early hyperaemic stage

of a .peritonitis is entirely protective and defensive in nature. It has been said "The insulted peritoneum weeps, and by its tears defends itself."

The portions of peritcneum most active in absorption are the diaphragmatic, ornental, and enteronic, ir the order named ; and the least active is that of the pelvic region.

10 THE SPECULUM.

Absorption is encouraged by peristalsis and by movements of the diaphragm, and also by any exfoliation of endothelium, as occurs from tearing of adhe-sives, etc.

As peritoneal inflammation advances in degree the underlying bowel wall is so affected that first of all hypoperistalsis, and finally complete absence of peristalsis ; with increasing distension and obstipation, result.

Up till some eight years ago I treated these cases on the lines which I believed to be the accepted practice of the day, the sine qua non being the necessity of overcoming the obstipation and distension by every means available, enemata, purgatives, eserine, pituitrin, etc , avoiding above all things the exhibi-tion of morphia, which would favour the obstipation.

The last case I treated on these lines I shall never forget. A boy of eight-some days ill of appendicitis—at operation appendix gangrenous and ruptured —generalising peritonitis present, subsequently becoming generalised, with great distension, obstipation, and repeated vomiting. Facies Hippocratica, evidencing acute suffering. Little or no sleep, yet one dare not give any morphia. On the other hand, one had to worry the little patient constantly with enemata, injec-tions of pituitrin, etc., passage of rectal tubes, and give purgatives to try and combat the awful distension. How anxiously enquiries were made from time to time as to whether any flatus had been passed ! Added to the dressings of the wound, including the manipulation of, tubes (the wound breaking down badly, as is customary in these cases), there were the salines to be given subcutaneously when the rectum became intolerant. Also the distressing vomiting necessitated the use of the stomach tube. As is . usual, the boy remained acutely conscious of his sufferings, and a braver patient than this little lad I never remember treating. In my enthusiasm "to do everything possible" I literally tortured the boy, obedient to the teaching I had had drummed into me as a student, not to give morphia. He died after an illness of some eight days, still maintaining his wonderful fortitude.

I have not exaggerated one bit in the above account, and it was all very nearly as distressing to myself as to the patient. And now, believing that the treatment given in this case was not only wron7„ but almost diametrically oppo-site to what it should have been, I have reason to appreciate the dictum that it is as much the province of a physician to relieve suffering as it is to treat disease.

Whatever may be said for or against the me thod of treatment I now adopt, it at least saves suffering. The patient drows§s through his serious illness, hardly conscious of distress and of what is being done to him. The treatment is made easy for both doctor and nurse, and recovery can hopefully be looked for—all because the affected peritoneum is put at rest and the sensorium shielded from the insults of pain and distress.

In the A.M.J. of September 10th, 1921, is a full , report of the first two cases I treated by what was then a new method, granting that it is based on the principle underlying the treatment advocated years Previously by Ochsner. The method was introduced to me by an article which appeared in the B.M.J. of September 20th, 1919, by Major Basil Hughes, giviig a report on 21 consecu-tive cases so treated, with only one death. As a resift of my favourable early-experience with the treatment, my colleagues in Kynebn adopted it, and we have not yet lost a case under it. What is more, from out experience of the use of morphia in these cases we have, on the principle thh "what is sauce for the goose is sauce for the gpsling," come to use it more ani more in the after treat-ment of all abdominal operations, our rule being to allow such cases sufficient

THE SPECULUM. 11

morphia to relieve any undue pain. We are convinced that the results are entirely advantageous.

In America the doctrine of rest for the inflamed peritoneum appears to have been widely accepted. In the Lankenau Hospital it is spoken of as the "regula-tion treatment " One also sees it referred to as the "Fowler-Murphy-Ochsner" treatment (posture-fluid-morphia). Now as to details.

Operation.—It may be taken as an accepted principle that the original focus should be removed. If, however, an extensive search be necessary, or if undue difficulty be encountered, leave the focus and close the abdomen without delay, after providing a drain to the depths of the pelvis. A generalised peritonitis will result. In those cases where the focus is removed with care and a minimum

of disturbance earlier resolution may be looked for. Certainly one should not attempt to remove the focus if a generalised

peritonitis is already present, with its well-developed distension. In such a case the most one should do is to introduce a drain into the pelvis, operating under local anaesthesia with narcosis or under spinal anaesthesia. In America at the present time it appears that it is becoming the practice in these cases to with-hold all operative procedures until, under the Fowler-Murphy-Oschner treat-ment, the peritonitis has resolved to a local condition, as I shall describe later. Then the focus is removed, but I am afraid I would be content to leave well alone. Both the cases I reported in 1921 recovered completely without having the original focus removed, and it has never troubled them since. One was definitely an appendicitis in origin, with a history of typical previous attacks. As in many localised abscess cases, it appears that in these peritonitis cases which recover the appendix, if anything of it remains may give no further trouble.

In regard to the question of drainage, purely focal cases, where the focus is removed without further peritoneal infection, as frbm rupture of a gan-grenous appendix during removal, require no drainage, Where the focus is removed in generalising cases drainage of the focal area and pelvis should be established. i am sure it is inadvisable to lead drainage tubes out through the original wound. A separate stab wound should be made for them, even if necessary quite close to the original wound. This al ows of proper closure of the operation wound, except' for a small rubber tissue drain leading from the subcutaneous tissues at one end of the wound. The reason for this is that in these cases contamination of the wound is most 1 kely. Infection, if it develops, occurs in the subcutaneous layer, and a small chain therefrom prevents or limits it. It is removed on the second or third day, when the intra-peritoneal tubes are as well removed, or at least shortened. It i; questionable whether they serve any purpose after 48 hours except to keep tie wound open, and a short tube will serve for this.,

Posture.—As soon as possible after operation the patient is placed and nursed in the Fowler position, and a proper understanding of this is important. The body must be supported at an angle to the legs, that is, the flexure is at the hips and not at the lumbar spine. Any flexion of the spine will result in increased tension of the alrLdy tense abdomen, and this`condition obtains if the patient is allowed to slip down at all from the correct Fcwler position.

The Introduction of Fluid.—These cases need an abimdance . of fluid, which is mostly given per rectum, either by continuous drip ec in amounts of about six ounces every four-six' hours. If there is no vomiting, or very little, I find that frequent sips of water by the mouth do no harm, bit, of course, no drinks

12 THE SPECULUM.

are allowed. Where vomiting occurs there is more demand for fluids in addition to loss of chlorides, and saline may have to be given subcutaneously or even intravenously. Intramuscular injections beneath the fascia lata are advocated by some.

An increase in output of urine and a lessening of its high colour are favoured by an adequate supply of fluid, and are early favourable signs.

Vontiting.—I have been struck with the fact that quite bad cases of peri-tonitis, under the treament I am advocating, not infrequently have little or no vomiting. Where it is a prominent symptom larage must be employed, and this is no trial to the patient under the influence of morphia. Further, the tube can be left in quite a considerable time, which permits of frequent washings.

Morphia.—The fundamental principle in the treatment of these cases is the assistance of Nature in its effort Jo provide rest for the inflamed peritoneum. Nature's efforts to this end is first of all manifest in the rigidity of the abdominal muscles, which is followed by the paresis of the bowel wall in the involved areas. When the peritonitis is generalised all peristalsis ceases, by which time we have established absolute obstipation without even passage of flatus and a silent abdomen. By the third or fourth day after operation there is enormous distension, so that one feels, at one's first experience of it, that something really must be done or the patient will blow up. But you must not be tempted—simply carry on. Watch the epigastric region. You will notice how abruptly the abdominal wall rises from the relatively sunken sternum. About the fourth or fifth day signs of resolution may be hopefully looked for. The first indica-tion of it may be some passing of flatus or some gurgling in the previously silent abdomen, only heard with the stethoscope. Soon after, or without these pre-monitary signs, the bowels will act. Now note the epigastric region. It will be less . prominent and appreciably softer. This softening then extends to the flanks,' and the flaccidity gradually spreads over the abdomen, till the only tumefaction remaining is in the region of the original focus. All this time the bowels act naturally ''from time to time, in spite of the fact that morphia is still being given in sufficient amount to keep the patient comfortable.

As soon as signs of resolution are definitely indicated by bowel action, nourishing fluids are allowed by the mouth, and an enema is permissible, though I have always been content to leave the bowels alone.

Having described the course of events that result from putting the peri 7 toneurn to rest by "spliating the bowel," it only remains to state the means we

May adopt to assist Nature in establishing this condition. The first is to give nothing by the mouth (except sips of water where there

is no vomiting) till resolution has set in. The ,next is to employ larage to diminish vomiting, if frequent. Then purgatives and enemata are to be abso-lutely withheld. Finall!, morphia is given in repeated doses and in amounts to adequately rest the patient. It not only diminishes bowel movement, thereby resting the peritoneum, but it shields the sensorium. At first doses of gr. hypodermically every fou• hours are given in adult cases. Subsequently the doses are repeated as often as may be required to keep the patient from being restless or complaining of pain. Atropine 1/240 gr. and strvch. 1/40 gr. are given with most doses.

Crile advocated pushing the morphia till the breathing was slowed quite appreciably, but there siems no necessity for such large dosage.

The morphia is cortinued so long as the patient's comfort seems to demand it.

THE SPECULUM. 13

This, then, is the treatment which 1 can recommend with confidence.. It seems sensible, being based on fundamental principles, and it is humane and in my experience wonderfully effective.

No doubt better methods may yet be evolved. With such methods of treat-ment as Jejunostomv, Costain's Drainage of the Thoracic Duct, etc., I have had, no experience. They certainly do not simplify the treatment. Simplicity may be claimed for the FowlerrMurphy-Ochsner treatment, and the simple things that succeed are always the best.

There is just one thing I would ask, which is that when this treatment is employed carry it out in its entirety and don't be tempted to give an occasional aperient or any other way defeat the objective at which it aims.

Arr

Ebe flInebical %MOM ant) We hospital L. E. HURLEY, M.D., M.S.

On entering the hospital the medical student is surrounded by an atmosphere entirely different to that which he has become accustomed to in the earlier and more academic years of his training, and must expect for a time to be more or less bewildered. For the first time he comes into contact with patients, with living, thinking, feeling and suffering humanity, and really becomes a member of the medical profession, in just the same way that all true practitioners of medicine are students, in the widest sense of the term, right to the end of their professional career.

The first thing to acquire, if it be not already an inherent possession, is a sympathetic understanding of human nature, saddened and warped as it often is by disease and suffering. The best physician is the best inspirer of hope. and in order to be this you must have sympathy, the priceless gift of being able to see the other's fellow's point of view, and of imagining yourself, for the time being ; to be in his position. Don't look upon the patient as merely a subject or case, from which something can be learned, but as a sufferer from disease, the cause of which 'von are attempting to discover and to alleviate. The patient, who is just .as•muci under your care as if you were already in active practice, is very quick in sensing in what light he is regarded, and will co-operate or not accordingly. To be a Successful physician, a kindly, tolerant sympathy, and a practical knowledge. of human nature and psychology are absolutely essen-tial. This constitutes the art of medicine, and a good deal of your future success will rightly depend on it. To many it is an inherent quality, but to .others it has to a certain extent to be acquired. Few can fully attain to it without free association with their fellow-men, and wide reading, apart from that more directly connected with medical subjects.- A thorough knowledge of the science of medicine is, of course, necessary, but your aim is to become, not merely biochemists, physiologists and anatomists, but efficient practitioners of medicine.

At the commencement of your clinical work it is essential to remember that, in order to appreciate the abnormal, one must have a clear conception of what constitutes the normal range of variation. Time spent in examining healthy chests and abdomens is time well spent. • it is useless to attempt to

14

THE SPECULUM.

weigh judicially slight pathological changes in the lungs unless you are able to recognise with confidence the normal differences between the right and left lung apices. It is only by repeated examination of the normal abdomen that one is able to estimate clinical tenderness, and to appreciate that, normally, the right iliac fossa to palpation is slightly "different" to the left. A failure to recognise this has been responsible for the removal of many normal appendices. The area medial to the inferior angle of the right scapula is normally a little duller to percussion than the corresponding area on the left side, and the right diaphragm is normally higher than the left. These are only a few of many examples which serve to illustrate that the examination of the normal is of immense value, not only in educating yourselves in the various methods of clinical examination, for until you are able to recognise the normal variations your methods need further perfecting, but in enabling you to recognise what is and what is not pathological. Confidence in your negative findings is the supreme test of efficiency in conduct-ing a clinical examination. There is a great difference between knowledge which has been gained by direct observation and experience and that which has been acquired from hearsay or reading. The established facts of medicine and surgery are well set out in text books, but no manual, however excellent it may be, can replace clinical observation. The old method of teaching, "which stuffs, crams, pours in, spoon feeds, and as a 'sort of death-bed repentance institutes creative work after graduation," is being replaced by the Socratic method, which requires the student to use his own mind and to do his own thinking. Liszt formed capable pianists by making his pupils do all the playing, only inter-vening to help them with some difficult passage. Osler taught in the same man-ner in marked contrast to his predecessors, who did nearly all their teaching in the lecture theatre. Teaching given in the wards and the out-patient depart-ment is not necessarily "clinical." It becomes so only if the work is actually done by the student, the teacher being there merely to assist, to correct, and to suggest lines of thought and examination. A long lecture given in the wards on the general aspects of, say, hzematuria or jaundice is not clinical teaching, and would have been much better delivered, after due preparation, in the lecture theatre and to the whole body of students.

In the out-patient department, as well as in the wards, case notes should he taken of patients examined, and the history and physical examination recorded. Any facts bearing on the case, gleaned either from reading or from suggestions put forward by the clinical teachers, should be set down. No reading is more effective than that done in connection with an actual case, especially if it be a difficult one. For every mistake due to lack of knowledge there are probably at least ten resulting from lack of or inaccurate observation. The basis of any science rests on careful and accurate observation, followed by logical deduc-tion therefrom. Medicine, although it will always to a certain extent be an art, is ever struggling to become a science.

Develop early the critical faculty. This, in conjunction with even only a superficial study of the history of medicine, is the best antidote to the fads and fashions to which our profession is only too prone. You have frequently been told that pain does not rise to consciousness, that you have no memory of pain (what a blessing it would be if it were so), and that therefore the pain fibers end in the thalamus. Yet you do not hesitate to ask the patient where he has had pain, of what character it was, and in what direction it radiated. How often is it stated that a systolic murmur at the base of the sternum is present in tricuspid regurgitation, and vet how rarely is it heard in the wards, although the post-mortem room shows only too clearly how frequent the lesion is. Accept

THE . SPECULUM. 15

on trust nothing which you can put to the acid test of direct observation, and if you take infinite care and trouble in the examination of patients confidence in your own findings will come as a matter of course. If an observed fact conflicts with current theory, do not question the fact, but re-examine the theory. I remember, some years ago, seeing a patient who had been operated on for a fractured spine. The surgeon was confident that the spinal cord had been com-pletely severed, a distinct gap being present in the cord at the site of injury. Contrary to the then accepted physiological views, the lower limbs were spastic; yet the observed facts were freely questioned, while the theory went unchal-lenged. Before theorising as to the causes of phenomena be as sure as you can that the phenomena have been accurately observed. It is much more important to know the physical signs of a pleural effusion than to be able to discuss learnedly the conflicting theories which are advanced to account for them.

A constant source of worry to many of you is an inability to harmonise the words of wisdom which flow from different lips. Do the facts of medicine vary from day to day, or "is there a fashion in the cut of the robe of Aesculapius just as in that of more mundane garments ?" In reading the literature on diseases of obscure or unknown etiology, such as idiopathic epilepsy—if, indeed, it be a disease—one gets interesting sidelights on the passing fashions of the day—original sin, uterine displacements, focal infection, autonomic imbalance, polyglandular upset, anaphylaxis, subconscious mental conflict, lack of vita-mines ; each has had or is still having its day. I do not mean to imply that these factors do not operate in causing disease, but an etiological significance should not be ascribed to them without some scientific basis. An ordinary unscientific practitioner would not be guilty of the following :—"Duodenal ulcer is the end result of psychogenic maladjustment. Unconscious hate, unconscious flight, hyperadrenalxmia, with later exhaustion ; duodenal spasm as a com-pensating tension state, and finally ulcer as a link in the chain." Beware of being "too scientific" or "too physiological." Medicine is still far from being an exact science, and this being so difference of opinion must exist. We have gained a good deal of solid territory, but on the frontiers the battle is still raging. We are advancing largely by trial and error, and each new theory and each apparent discovery need thorough trial and testing before becoming consolidated territory. Each discovery pushes the frontier a little further forward. but in the words of the late Sir Harry Allen "infinity lies beyond." In the forefront of the battle, and making an undue proportion of the din, is the "faddist," acquiring whole continents by the simple process of attributing all or most diseases to "lack of vitamines" or "focal infection." Beware of him; but at the same time beware of throwing away the germ of truth which may lie beneath his mountain of theory. There is plenty of well-explored territory to master and conquer without bothering too much about the smoke which issues from the battle line. By this I mean that you should use good modern text books, for example, Osler, which represent the accumulated experience of able men Journals are necessary, not from the point of view of keeping yourselves "up to date," for medicine is not of mushroom growth, but for reference in difficult and unusual cases, which cannot be described at length in standard text hooks of ordinary dimensions. The faddist receives altogether too much con-sideration from editors of medical, journals, while those who have something substantial to contribute are notoriously backward in rushing into print. In the words of Robert Hutchison, "It is always well in handing the cup of knowledge to the young to wait until the froth has settled."

While firmly believing that Clinical study in the hospital is the most

16 THE SPECULUM.

important part of your training, yet systematic reading and the set lecture have a very distinct place. In the set lecture those fundamental physiological, patho-logical and anatomical principles, on which the various clinical manifestations of disease depend, are enunciated, and thus an immense amount of time in the wards is saved. In many diseases the major part of the teaching can be well done in the lecture theatre to the whole body of students, and more time is then left, in the wards and the out-patient department, for the demonstration of the peculiar features of interest in each individual case.

In systematic reading the taking of notes is an immense aid. Osier fre-quently referred to himself as "a note book man," and right to the end of his life was in the habit of jotting down any new facts acquired in the course of his reading. This practice adds a new interest to the work, puts it on a sys-tematic basis, and is the best corrective to those hazy, indefinite ideas which are frequently acquired from hasty reading. Notes taken in this way are very useful at the end of the year for purposes of revision.

Text books published in the form of tabulated summaries cannot be too strongly condemned. Their only possible justification is that they may be of use in the last few weeks preceding examination, and then only after a good text book has been thoroughly read. They fail altogether in giving perspective, in giving an intelligent understanding of those underlying pathological and physiological principles which determine the various manifestations of diseases, a knowledge of which is essential to their true appreciation. Few diseases conform to a set type, and therefore, in your systematic reading, you must ever have an enquiring mind, asking all the time how the clinical features can be correlated with the known etiological, pathological and physiological facts. For instance, in sub-acute bacterial endocarditis, which is usually due to the strepto-coccus viridans, although in a small percentage of cases other organisms are present, the infecting agent enters through an unknown portal, and lodges on a heart valve which has usually been damaged by some previous infection. Other-wise it would be difficult for the organism to obtain a footing. Having lodged on the valve, it then sets up a low-grade inflammation of varying intensity. intermittently discharging organisms into the blood stream. As a result, clinical manifestations due to the following causes would be expected :-

(1) Injury to the heart valve, usually giving signs of a valve lesion. The myocardium is usually not directly involved, hence marked cardiac failure is, as a rule, absent. In a few cases the myocardium may have been previously damaged, and in these cardiac failure may be a promi-nent feature.

(2) A low-grade generalised infection, causing fever, anaemia, sweating. gradual failure of health, etc.

(3) Emboli of two kinds, bacterial or small fragments of the infected valve, causing in the kidney glomerular nephritis or infarction, in the skin Osler's nodes or purpuric spots with pale centres, in the central nervous system, cerebral embolism or meningitis, and so on.

Study all the clinical features in the light of the above factors, and see how, and to what extent, they can be explained. One would also expect that the disease may have a slow, insidious onset, due to the general infection, or occa-sionally an apparently abrupt onset, due to the early occurrence of embolism. This could be exemplified much further, but will serve to illustrate the mode of attack. Get to know diseases as living entities, with an understanding as far as possible of the why and wherefore of their various manifestations, and not as dry bones in the form of tabular lists of signs and symptoms. In this matter

THE SPECULUM. 17

the systematic lecture is of great assistance,, -but most of it you can do for yourselves.

In conclusion. I offer no excuse for urging that there is no short road to achievement. A perusal of the lives of great men shows only too clearly that genius is nine-tenths perspiration and one-tenth inspiration. Lister, Pasteur, and John Hunter had inspiration, but they were in addition ardent disciples of the gospel of work. Work is the magic key that Will unlock most doors, and there is no pleasure that this world offers which is more lasting, more legitimate or more solid than that which results from healthy achievement. As an anonymous writer has said, "Temperance, cleanliness,. activity are the three cardinal virtues of the body ; as Faith, Hope and Charity are of the soul. It is easier to repeat incessant formulae of prayer than persistently to keep one's self unspotted from the world, and it is easier for fat old sinners to paddle about barefoot in the dew of a Kneipp cure than to abandon once and for ever their darling sins of greed and indolence. One hears a constant cry of Lo here ! or Lo there! and all the world rushes to sit hopefully under the blue glass or swathe itself in pure wool in the ever-renewed belief that some substitute may be found for the fatiguing necessity of obedience to the three rules."

UP WHERE THE DRESS BEGINS.

(With Acknowledgments to the Rotary Journal.)

Up where the garters used to clasp 'er, That's where the dress begins ; Up where it would shock the old-time jasper, That's where the dress begins. Up till the knee-cap is below it (Knee-cap was there, but we didn't know it Back in the days ere she chose to show it), That's where the dress begins. Up where at one time it wasn't decent, That's where the dress begins. Up higher yet in the days more recent, That's where the dress begins. Up where the briars will never gash it. Up where the mud will never splash it, Up where the—up where the—oh, well, dash it, That's where the dress begins.

ANONYMOUS. (For all kinds of reasons).

B

18

THE SPECULUM.

A Plea for the Study of the History of Medicine. 44

. es ist ein gross Ergetzen, Sich in den Geist der Zeiten zu versetzen, Zu schauen wie vor uns ein weiser. Mann gedacht, Und wie wir's dann zuletzt so herrlich weit gebracht."

—Goethe. It is a matter for regret that in this University there is no provision made

for the teaching of the history of medicine. But the curriculum is crowded enough already, and the addition of such a course may not prove an unmixed blessing. For all that, there are many excellent reasons why every medical student during his course should make it his business to become acquainted with the lives and labours of the pioneers of his profession. There are few studies more fascinating and few mental recreations more satisfying than the reading of biographies of men of science. The average text book, however accurate and lucid it may be in the presentation of the facts of a particular science, tends to create in the mind of the student a false impression in regard to that science. Too often a science, as presented in a text book, seems to have sprung fully formed, like Pallas out of the brain of Zeus, from the inkpot of the author. The student tends to regard his science as biologists regarded organic nature in pre-evolutionary days as having suddenly come into existence, in its present form, by a process of special creation. But organic nature is now recognised as having a history extending into the remote past, and to understand its present state we must study this history or, as we put it to-day, we must study it in the light of evolution. "Sein" can only be understood in the light of "Werden." So it is with science.

As the student peruses history he finds that what are now the commonplaces of his science have been established only after generations of ceaseless toil and often in the face of fierce opposition. The heresies of the past now come out of the mouths of babes and sucklings. Thus the heliocentric theory of the solar system is now a matter of every-day knowledge, but when it was enunciated it shook the intellectual world to the depths, and caused the sword of the Church Militant to leap from its scabbard, the immortal book in which it was first propounded being honoured by a place on the Index Expurgatorius.

De Quincey has divided all writing into a portion which is literature, and seeks to communicate power, and a portion which is not literature, and seeks to communicate knowledge. The portion which is literature inspires, the portion which is not literature informs. In the sense in which J am now going to speak the history of medicine belongs, to the first category. "Dull would he be of soul" who could not draw inspiration for the tasks of the daily round from a study of the lives of those great workers with which the pages of the history of medi-cine are adorned. They did not, like Carlyle, preach the gospel of work ; they lived it. "Ah, John," Dr. Maxwell Garihshore is reported to have said to

THE SPECULUM. 19

Hunter, "you are always at work." Yes, he was always at work, and he stands in history as an immortal example of what work, combined with genius, can achieve.

And then there are those rare spirits, men like Aristotle, "Stagira's all-embracing sage," Leonardo, Goethe, men who traversed the whole of the intel- . lectual domain. They, too, have their lessons for us. The field of modern knowledge is so wide, and its various parts so well cultivated, that it seems that the day when an Aristotle "took all knowledge for his province" is past, but for all that they remain as living examples for us to follow, as closely as we can, in our own mental development. They are the apostles of that mental many-sidedness, that breadth and variety of taste and interest, which make for the full life .

And, finally, the study of history gives us that sense of spiritual continuity with the great figures of the past which is sometimes needed as a shield against the cynicism of the worldling. The medical student who studies the history of his profession feels himself a member, a humble one though he may be, of a glorious fellowship, of an intellectual aristocracy which includes Aristotle and Galen, Vesalius and Harvey, Pasteur and Koch, men who scorned delights and lived laborious days in the service of Truth, and left the human mind per-manently enriched by their labours. His daily work is given an added dignity by the consciousness that he is a co-worker with the immortals.

Commentary Prize. The prize offered by Dr. Mackeddie for the best solution of the case pub-

lished in the last issue of The Speculum has been awarded to J. Bastow.

W. A. Hailes Tennis Trophy. The trophy offered by Mr. W. A. Hailes for competition among the various

Hospitals and the Medical Section of the University has been won this year by the Melbourne Hospital team. We desire to take this opportunity of thanking Mr. Hailes for the keen interest he has displayed in the sporting activities of students.

Teacher had worn a short skirt to school for the first time. Shortly after school began a small boy put up his hand. "Please, miss, I can see your knee," he piped.

"Tommy Jones, you're a very naughty boy," said teacher. "Go home and tell your mother you're not to come to school for a week."

A few minutes later another hand shot up. "Please miss, I can see the lace on your drawers."

"Jacky Brown, put on your hat and go home, and don't come back for a month. You've a had, wicked mind to see such things."

Shortly after teacher dropped a piece of I chalk, and stooped to pick it up. As she stood up a small boy in the 'front seat got up, took his hat, and started to walk out.

"Where are you going?" cried teacher. "My school days are over," said the boy.

THE SPECULUM, •

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THE SPECULUM. 21

Zbe s pirit of t nquiry in the 'practice of flDebtctne FRANK TRINCA, M.C., M.D., B.S.

On being asked for a contribution to The Speculum the choice of a subject was governed by an extract from the leading article in the Australian Medical Journal, 28/4/28. Here it was stated : "Original thought and a spirit of investi-gation in students will have to be encouraged, and examiners will have to recog-nise that orthodox medicine may be faulty, and that an ingenious reply by a candidate, provided that it is based on an understanding of the main problems, should be accepted, even if it is at times at variance with the pet views of the examiner."

On encountering this dictum in the more usual matter of fact medical journalism of Australia, the student cannot but mentally enquire in regard to its possible application in regard to the personal part he is playing, and is destined to play as a unit in the existing medical scheme.

When the apparently simple suggestions put forward in the above text are analysed they at once present certain difficulties that are evident, not only from the point of view of the student, but also from that of those responsible for his tutorial guidance. For the birth of the spirit of investigation in any subject demands a priori, a working knowledge of the fundaments of established know-ledge, before researches can be conducted, in that otherwise they will follow the tendency to cover fields already opened by other investigators. Though such does not preclude the development of a spirit of enquiry and originality in the student, it imposes for the time limitations, yet which, if properly understood, may be the better negotiated. It is thus the prime duty in regard to tutorial guidance of a student to bring the student into as varied a contact as possible with the practical working material and established procedures in dealing with the problems associated therewith ; but at the same time the view must he incul-cated that such knowledge of accepted viewpoints is but a working formula 'capable of an individual elaboration on which the fuller value of its ultimate application depends. And on this sub-structure the graduate builds as each year of experience accrues, a personal power of interpretation and application that brings in its train the intuitive power to diagnose, clinically handle and treat each affected individual, that is a personal possession of the clinician that can-not in toto be transmitted. And though we are prone to designate the student period as that devoted to the mass production and absorption of a knowledge that is gained to negotiate the very pressing examination barriers that present themselves in strong perspective between the examinee and his life's career, it is in the post-graduate peried that the truer analytical student period is entered upon. To expect, therefore, any undue manifestation of executive originality in the undergraduate before he is a compendium of signs, symptoms, and methods of constituted treatment is to put the cart before the horse. In the interim, however, there is no reason why accommodation should not be prepared for the metaphorical horse. To so guide this undergraduate in his efforts to grapple with the problems presented by what are the hundred and one diverse occupations that constitute his career, that he may be encouraged to develop not only the memory extent of his knowledge, but also his own potential powers of optimum application of his growing knowledge, is the ideal of his balanced education.

For each student there exists a still uncharted deStiny and career which will allocate hig efforts to a branch of endeavour in a 'science which in its p1 6serit extent can be mastered, in its entirety, by no single inifid:

22

THE SPECULUM.

And the education of the student should be so moulded that as his graduate days are imminent he may have begun to realise his own personal predilection, and prevent the inharmonious sequel of his constituting a round peg in a square hole. As this latter vista is opened up, just as in the case of the examination barrier to the pursuit of originality, so there now arises between the graduate and his ideal, the very pressing urge in most cases, of applying his stock-in-trade of knowledge to the gaining of a livelihood.

The more fortunately circumstanced graduate after his hospital training, seeking a specialty, or pure research, as his final goal, migrates overseas to the broader field of available material and organised post-graduate tuition. The less so enter the field of general practice, and gain their ability in the hard school of domestic practice, in which their success depends on the manner in which they rise to their responsibilities in entering the homes of the sick and, where humanly possible, leaving the homes of the restored. In such practice most will realise that just as human ability in general will tend towards classical, mathe-matical and technical tendencies, so in the broad gamut of every-day practice certain aspects will have more appeal, based on a greater natural understanding and power to deal with the problems involved. And so through the avenue also of general practice will issue ultimately a band of specialised workers who, as their special efforts are recognised, will abandon general practice for their special and enlarging forte. And in these two classes, where technical ability is equal, it is in the latter that there cannot but be encountered the broader vision in which the specialist still regards the human economy as a whole ; and is awake to the never-to-be-forgotten fact that, where local disorder arises in any one bodily system, its correction frequently demands an appreciation of the possi-bility that this local manipulation may be but a secondary effect of an existing cause operating in an apparently unrelated bodily system which reflexly projects its influence on a sister system.

As Sir James MacKenzie, perhaps the greatest of physicians, emphasised, in effect, to his death bed, the most fundamental necessity in a combined common sense and scientific outlook on disease is to regard local organic activity and its disorder as merely a link in a composite bodily system of organs, in which every organ participates in the activity of every other. And apparently local disease is just as often a reflexly projected upset in another system.

Looking beyond the relatively narrow field of contemporary knowledge, and possessing a vision in regard to broad principles, along with future efforts must be directed, Sir James MacKenzie had his opponents. His charge against contemporary medicine was that, in its confinement to the academic and technical branches of its labours, it tended to submerge its common sense and forget that there was an equally important human or clinical field that to him provided the main inspiration to diagnosis, academic research, and direction of schemes of treatment And so to-day there is still room for compromise, and each school whose thoughts, like all thoughts, are a reflex of their environment, levies on the one hand the accusation that the clinical school is too thinly supplied by facts, and on the other that the academic worker forgets the individual in the disease. Familiarity with current periodical literature overseas cannot but impress this dissension, which it is sought to overcome by the greater practical association of the clinical and academic branches of medicine under modern hospital conditions.

Theoretically were it possible to combine in each developing medical mind an all-embracing command of constituted medical science this dissension would disappear. Until recently many of the most eminent authorities of the different

THE SPECULUM. 23

branches of medical science had reached their eminence after decade long divorce from clinical contact with the patient. The patient, as the source of the restricted pathological manifestations they studied, presented also other unstudied aspects of the same problem, which robbed such watertight compartment study of much of its value, and often allowed it to drift into unproductive channels and medical narrowmindedness. To adopt a simile, the purely academic worker could be compared to an observer wandering across a plain seeking for knowledge of the pebbles scattered upon its surface. Were the observer a chemist he would look from without inwards and have his mind concentrated on the solving of their chemical constitution and molecular relationships.

If, however, in his place there wandered a geologist, his mind would look from within outwards. And in the general relationships of the pebbles on the plain he would attempt to visualise the significance of these relationships and construct therefrom a conception of the nature of the cliff of their common origin and the position of the strata productive of the fragments in their dis-cordant relationships. The suggestions that the cliff existed would inspire a search for its existence. And to stretch the analogy still further, if in a stratum in such a cliff there were found, for example, pitch-blende (to stir up memories of recent chemical studies), the family existence in this medium of radium, uranium and thorium would react again to the advantage of the chemical investigator as contributing practical confirming proof towards the modern theory of the origin of atoms one from the other in succession, as they occur in similar order in the periodic atomic classification. And so must they occur in their final natural association. In this parable, then, is a principle on which know-ledge must advance. The ultimate basis of established knowledge, if it is to progress, is that of experimental academic data. In linking the details of the present, science can construct the history of the past and erect a scaffolding of principles that forecast future knowledge. Such point to the chosen few, among many finger posts of advance that are offered, which will keep advances in their most productive channels. In this manner hypotheses suggest the experimen-tation from which ensuing data accrue. To regard in turn, however, such hypothesis as themselves facts before experimental confirmation or the reverse is obtained, and construct further principles, is to destroy the value of scientific enquiry, and lead to the errors so potential in deduction divorced from academic co-operation (not domination, let it be emphasised.)

To the academician is the duty of constructing our scientific alphabet; to the broader enquirer having such in mind the task of applying it to its optimum uses in the prose and at times poetry of scientific knowledge. For profound as is our scientific armamentarium, and equal to that of any established sister science, yet it is but a set of children's tools compared with its task of analysing the profoundly complex mechanism that is the product of vital evolution over untold millions of years. And in the mutual denials of the contending academic and clinical schools who are staged in this foregoing simile, always remember the dictum that the affirmations of science are frequently of value, the denials rarely. For time and again in the history of science the discovery of a minor fact has as a corollary had enunciated with its record that the existence of an opposing possibility is now denied. A decade later a critical enquiry in the face of this denial proves its fallaciousness, and both facts but need a third to correlate them in a wider knowledge.

In his education in a more enlightened decade the medical student has more and more the opportunity of combining these two ideals. And just as he will realise that there are problems of which that of the isolation of Insulin, the

24

THE SPECULUM.

elaboration of the Wassermann, are examples, which are the closed preserves of the academic worker, so in clinical practice he will find that here inspiration in its own problems is equally catered for and opportunity for such perhaps greater. The findings are like the opportunities of life. And just as an uncon-sidered and irrelevant encounter may in the face of a concerted policy determine a life's destiny, so the prizes of research do not present themselves necessarily to purposive seeking. For investigations in one field may present accidentally the solution of a problem previously insoluble in its own sphere.

The writer was once treating a child for diarrhoea, aged four months, which had an acute eczema of the face. Putting the child in albumen water while present in the house, the result was alarming. The white of egg was expelled across the bed, and the child's eyes and lips exhibited marked oedema, while it scratched furiously at the eczema, which became congested and underwent copious exudation. Such could not but start the following train of thought :-The reaction to egg white manifested as giant urticaria of the eyelids and lips was an anaphylactic phenomenon, or simply put, food poisoning. The aggrava-tion of the eczema showed an allied origin. Now milk is a cow's egg in effect, and as the child was on pure milk at four months of age, was the eczema not a reaction to its diet? Boiling the milk half an hour cleared up the eczema in a few weeks. Later, adoption of de-sensitization by hypodermic injection of a few minims of albumen-water, 1-50,000, has cured much more intractable cases.

Again, a further spur to research is that of necessity, and in contact with the human responsibility of life and death, the final impetus is often deter-mined, which will overcome the stubborn hindrance to one's task, that is born of previous ignorance.

To achieve such ideals and develop not only an academic sense, but also a parallel outlook, which will realise that there is a common sense aspect of the ailing individual which embraces the whole field of nature, which constitutes his environment, the student must till the first furrow in his student days. If a graduate of a decade or more experience had presented to him, with his then knowledge, the opportunity of pursuing his medical apprenticeship again, a series of experiences in his later contacts with the problems of sick humanity would arise before him to magnify the use to which he would put the opportunity.

And the writer would, at the outset, come to grips with a respected research worker in our midst who, at a recent function, expressed the view that to the clinical worker only superficial observation is available, and as all the "pickings" in this field have been garnered, the laboratory worker alone carried the banner of research. It is proposed, then, to present to the critical enquiry of the reader a few among many impressions gathered in this clinical field that may indicate lines along which it is to be hoped the ultimate medical ideal of eliminat-ing ill-health from our midst may in part be attained. And it is to be remembered that the term clinical is not synonymous in its meaning with the term superficial. To practice the clinical art alone is to retrogress from a wireless age to one of equestrian transport. To practice it in conjunction with the technical extensions of the senses by modern medical equipment is to heal the patient rather than merely to practice an interesting form of science.

Our technical equipment of X-rays, stethescope, biochemical tests, etc., etc., are but an artificial extension of the human senses. But primarily it is the human senses and their reflex activities which are the executive nucleus that possess the discrimination born of previous accumulated experience, to direct our accessory academic elaboration of the natural senses to their selected goals. And such goals have frequently to be exposed as well as aimed at, both of which are performances demanding precision.

THE SPECULUM. 25 •

Broadly. speaking, in regard to the interpretation of disease it must be realised that there is a distinct contrast between public hospital practice and disease as encountered in private practice. In the public hospital the criterion of entry is one which is based on the fact that denial of admission may reasonably involve life and death, or permanent impairment. Hospital disease is thus, in the main, end diseases, presenting frequently, but not as frequently as one would desire, gross signs and symptoms which renders the percentages of successful diagnosis much more favourable and accessible to technical investigation. Modern medical journalism is distressed at our lack of knowledge of border line disease, with its vague symptomatology and vaguer presentation of tangible signs.

Translated, then, to a realm of disease more incipient in nature and obscure in its warning signs, yet of profound importance to the sufferer, the early graduate soon finds that long familiarity with swallowing the camel of end disease during his evolving education, tends to interfere considerably in his subsequent finesse in negotiating the gnat of incipient disease. Looking ahead, then, the undergraduate in this really serious problem must, at the outset, realise that he must seek also a working experience in this minor field as he conducts his investigations among major disease under public hospital conditions.

It is only by later graduate experience that the principles can be fully realised, by which the clinician can apply our relatively inadequate armanien-tarium to its fullest value in the practice of medicine ; and that such principles are the ones that should have been applied during the preparatory opportunities offered by the clinical material of the public hospital. It is proposed, then, to stress certain aspects of the medical outlook under a few chosen headings and attempt to indicate the essential and unavoidable necessity of cultivating the clinical as well as the academic outlook.

THE CONSIDERATION OF ENVIRONMENTAL FACTORS IN HEALTH AND DISEASE.

Both from the point of view of the origin of disease and that of prevention of its recurrence, there must be a never-ceasing search for causes.

Had biological science reached its ideal standard, there would be charted out on the one hand a complete series of environmental influences constituted by every factor on which life is dependent, and on the other the complete physiological representation of how these causative factors are translated by the living vehicle into the effective mechanism of life. Theoretically, if these environmental factors, as a result of which life has been elaborated and still maintained, were presented to and availed of by human forms in normal quan-tity. quality and time, disease other than infection would be practically non-existent. And where the living unit had, by accident or design, avoided its responsibility in providing its mechanism with its environmental requirements, then disease could be diagnosed and rectified as an upset of a known mechanism. To attain, as far as present knowledge permits, as complete a chart of these causative and effective factors should be the ideal of the biological student. By such an all-embracing conception only is the outlook developed that studies not only the manifestations of the diseases per se, but seeks for a very frequent cause towards which prophylaxis can be exercised. And so, in promoting a cure, there is guarded against at the same time the repeated labour of effecting a similar cure at repeated intervals in the individual's future life history. A simple example of this precept was encountered recently in the out-patient department.

26 THE SPECULUM.

A well-nourished male, aged 17, presented himself with a dyspeptic type of facies, and it was noticed he was a cook's apprentice. Before any interrogation he was sent with a student to the interrogation room for the student to enquire into a possible history of early gastric ulceration. The student returned and said the diagnosis fitted the case, and asked how it was forecasted. He was asked if he had looked at the patient's occupation, and whether he had enquired if the boy was indulging in tit-bits of food at frequent intervals. This also being found to be the case, suitable advice was given that far out-weighed the value of a temporary restriction of diet and the exhibition of pulv. ant. acid.

While, on a later occasion, this case was being discussed, a middle-aged male presented himself with a history of hxmatemesis for a week and defined symptoms of gastric ulceration that had previously been confirmed by X-ray examination. The student at once pointed to his occupation, that of a cook, and he, too, admitted he had indulged for years in a similar practice. It is not inferred that this disorder is confined to chefs, but that we must never forget to study the individual in his reaction to environment as well as the disease. The essential use of clinical enquiry is thus emphasised, for technical enquiry, necessary as it is, is confined to the limits of the human body and in no way can invade many of the environmental strings which, for better or for worse, are the source of all processes within such confines.

Regarded from such a basis, the personal history of the patient must he regarded at the outset as one of the main avenues by which the student can familiarise himself with the manifestations of incipient disease where it grades into causes. Superficially there is a tendency to regard the development of disease as a gradient from the mild to the severe. At the apex of a diverging cone is perfect health, at the base the major exacerbations of disease. This is not so, for in many cases an insignificant symptom may for years be the only index of an ultimate crisis with sudden oscillation into incapacitating ill-health. And when the grossly affected are encountered, an analytical history of its antecedent stages will expose the ways and means by which incipient symp-tomatology, as encountered in the out-patient department and private practice, is exhibited as the forerunner of end disease. A few examples may illustrate this. Thus, when there is encountered a case of gall stone colic in a usually rotund individual, there is as a rule a precursor period of flatulent dyspepsia. which may be associated merely with discomfort free from colic but is charac-terised by poor response to medication. A realisation of this possibility may thus, before all the later complications arise which may imperil life where gallstones are concerned, allow at times of an early diagnosis, and operative relief under uncomplicated conditions.

Quite recently a male, aged 35, of this type, was seen who had no pain, but was tender on deep pressure over the gall bladder ; on X-ray examination, shewed a gallstone the size of a penny. On the recognition of early signs, then, depends in great part the prevention of later serious sequeLT ; and when a patient suffering from a minor incipient symptom presents himself, it must be remembered his investment in a consultation is an insurance premium against pathological disasters of the future. There is a wealth of interest thus, not only in defined but also in insignificant disease. And in hospital practice, as far as possible, cases should be studied in their order and in each sought not only the positive and simple, but an analysis of the vague and all it may portend. Though in hospital practice one tends as a student to seek out the former, it is not a practical consideration in later practice to enter one's waiting room and ask, "Any interesting cases ?" and send the others home.

THE SPECULUM. 27

The value of hospital practice is that in seeing in a short time a large succession of cases of the same disorder certain repeated manifestations in a varying pattern in each individual—an outstanding example of how the foregoing principles may be applied might be aptly presented—directs one's researches to basic principles. In out-patient hospital practice, no disorder offers greater scope than that of thyroid upset, which, in its far-reaching effects on systemic health, demands the profoundest consideration. To thyroid study there is just as much a clinical as an academic aspect. To the latter we are dependent for our knowledge of end results of biochemical, histological, and pharmoco-logical effects. Such, however, do not go back to origins. Than the thyroid, there is, in reality, no more important organ to be studied not only per se, but in its participation in health and disease in general. For if there is traced effective life from ingestion to executive function, the thyroid stands supreme in its dominance of metabolism. Used as the basis of growth, ingested food, to use a simile, must be regarded as comprising not only the raw product bricks of tissue architecture, but also vitamins or sunlight in indirect form, that are the tools that apportion the bricks into a co-ordinated, as opposed to a hap-hazard, structure seen in rachitic defects based on vitamine deficiency. To the apex of this thyroid domain converge all the preliminary details of metabolism of ingested food, and the thyroid and other endocrines as intermediate links, apportion the end results to the fashioning of individual types of bodily struc-ture and expression of nervous function and personality in its varied manifes-tations.

In the thyroid resides what may be termed the chemical ego which conducts life development from infancy to senility outside the domain of will.

The part played in general functional and structural development by the thyroid in life is exhibited by the difference between a cretin and a normal individual. The thyroid is essentially an anabolic as well as a katabolic organ, though academic research is focussed on its latter function. Its anabolising function brings into play the harmazone fashioned from the vitamine, and is associated with vago-tonic activity, while the thyroxin molecule reared on an iodine and tyrosin basis, governs the katabolic phase, and is associated more with sympathetic autonomic manifestations.

Nature, recognising the essential value of this mechanism, has laid down four times as much thyroid tissue as is required for function at rest. Despite this prodigality, for hereditary and hygienic reasons the thyroid in many indi-viduals is living on the bread line. And when strain of life is enjoined, em-barrassment occurs not only in local functional and pathological manifestations, but in systemic health in general.

And in the appreciation of the part played by the environmental phenome-non of strain, rests the clue to the solution of much that is involved in local and general thyroid disorder.

The study of the thyroid disorder is not merely the essential academic problem of biochemistry and histology, and a search for variations in vitro that will lead to the isolation of a toxin or variation of the nature of thyroid secretion involved.

And if there is to be provided an example that outweighs any measure of precept, that a clinical outlook is as necessary and as distinct an adjunct to the practice of medicine as an academic one, no more fitting subject could be chosen than that of normal and abnormal thyroid function in its underlying association with the whole life of the individual.

If there are studied analytically a series of hundred of individuals with

28

THE SPECULUM.

thyroid disorder once more, there can be traced the gradation of the incipient into the gross. Similarly, more recent researches into associated histological pictures have departed more than heretofore from attempts at hard and fast classi-fications. This incipient phase, based on varied influences, may remain stationary, retrogress or in turn progress along contrasting lines of tangible disorder. If, however, by analytical history of environmental factors sufficient steps are retraced, in all such cases they arrive at the common starting point that commences with strain. To arrive at how this strain operates itself involves a series of contrasting situations. Strain itself may be actual or relative. In the former case the individual attempts more than human resource, according to his own standard, can cope with. In the latter a debilitated physiological economy senses ordinary strain as relatively excessive.

Now, if one attempts to classify the types of strain underlyinab the origin

of thyroid upset, the first is that of the individual unknowingly calling on its thyroid to perform its activities without sufficient iodine in a manner that is analagous to expecting the blood to perform efficiently without sufficient oxygen. In both cases a hyperplasia of a compensatory type ensues. Such constitute the first studied type of goitre, the endemic. Where spasmodic cases occur in non-goitrous districts, a different situation is involved. The first human and clinical aspect is that the condition is much more common in the female and rarely seen in the male. In this sexual selection rises one of these many inconsistencies that are one of the main urges of science in its search for explanations.

The physicist, finding a lack of agreement between calculations of a pheno-menon from two different standpoints, sums up the situation as that of the search for the last decimal point.

Now , in the writer's experience, the causes of goitre in the male come under two headings. Speaking generally, the capacity of any tissue to sustain strain depends on its hereditary or developmental perfection, which differs in the hazard of different birthrights. Such is emphatically seen when conscription demands an estimation of national health. And where the percentage of unfits is con-cerned, apart from the effects of alcoholic, mentally defective and syphilitic parentage, prolonged malnutrition operates as the first deciding factor.

In no domain of medicine has common sense been more over-ruled by the fallibilities of science to the detriment of the former than in that of dietetic estimation. And in the whole history of medicine no more harmful doctrine has been promulgated than that of the minimum diet. During the writer's student days an academic investigator, taking a series of athletic students, put them on a minimum calorific diet for some months and, finding no ill-effects; decided that mankind ingests beyond requirements. Such, taken in conjunction with vague impressions of the harmfulness of meat in gout, which is associated with a tendency to arterio sclerosis, has given rise to a world-wide diction in scientific, often as well as lay mind, that meat is the main harmful ingredient in supposedly excessive diet, and so the world to-day avoids as far as possible what may be termed a protein intemperance. This observation is based on a consecutive enquiry for five years into the dietetic outlook of every individual encountered in private practice. Now, to turn to thyroid and other disorders, what is the true position of affairs ? For in the male, unsubjected to the main procreative burdens, the occurrence of goitre is almost unavoidably in types of malnutrition who sense the strain of life in a relative manner.

Having sought in detail as far as possible the protein history of thousands Of patientS over many years, the conclusions arrived at may he summed up as follows :—

THE .SPECULUM. 29

In the first place the band of healthy students during a few months lived, without obvious call on their final reserves, on the excess of reserves laid down since infancy. If the experiment had been conducted for as many years as it had months, as is unconsciously done by the toast and tea feeders, who throng our consulting rooms, there would have inevitably ensued nervous and bodily asthenia, body-wide fundamental disorders and lowered resistance to many diseases, and ultimately, if persisted in over a life-time, premature and not delayed senility. It must be ever remembered that the human being is com-parable to a machine that uses its iron as well as fuel. And the iron or protein must be constantly replaced or there will be a permanent insufficiency and sub-normal function. Oxidation is only an adjunct to a more complex energy providing katabolism that is seen so obviously in starvation. On this turnover and its constant replacement spontaneity in life depends.

Each bodily call in every organ has not only fixed technical elements, but a greater content of mobile interchangeable tissue. And optimum health depends on the maintenance of this reserve in the promotion of electrical, as well as thermal, aspects of vital energy. In the establishing of the foundations of these cell tissues in the young, when the protein supply of a milk diet ceases, there is no more important rule in national health and existence than a simple protein diet in the second year of life and onwards. Let this period pass and a slop diet be instituted for the first five years of life, and a defective foundation is laid that is as inimical to the ensuing super-structure, as is vitamin deficency and its rachitic defects in the first year of life. The longer meat is withheld the more temperamental becomes the child and the greater its anorexia and distaste for meat, that will accompany it through life. Each step of life is laid down structurally in its proper time, and if delay occurs in providing earlier develop-mental requirements, the hand of time cannot be put back and the defect rectified. And a full diet protein stands alone in its basic importance. Such principles are essentially a huMan study, and though we prove detailed dietetic causes and effects in the experimental animal, the latter does not in later life follow an occupation and succumb to the strain of life as a result of early attrition. Some years ago the writer picked out of a clinic five individuals of the army reject type. that tend to break down under the rigours of mid-winter and swell the hospital clientele. Before examining these patients a student was asked to look for alar chests and Harrison's sulci, enlarged ends to the long bones, visceroptosis, possible thyroid prominence on stretching the neck, tachy-cardia on exertion. Further, there could be predicted so-called tubercular-shaped heart, premature arterial thickening, probably mitral stenosis in the absence of a rheumatic history, and a general asthenic and neurasthenic aspect.

Attention was also directed to percussion of the pulmonary apical and hilar regions. One male could be said to have defined goitre, all were hyperthyroidic in the nervous and metabolic balance, three on X-ray examination exhibited a stomach resting below the crest of the ileum, three had a pulmonary dulness and cog wheel breathing, and also exhibited in varying degrees the syndrome represented. To this state of affairs there can be but one answer. The vita-mine essential to all life processes and deficient in the diet of these individuals in infancy not only laid down eburnated and rarefied bones with deviation from normal symmetry, but in every tissue parallel defects occurred in the cell archi-tecture, with so-called tubular-shaped heart and a relative lack of elasticity in the mitral cusps, with a similar basis underlying the atonicity of the alimentarum, and the defective balance of thyroid and other general organic structures. While in women there may be encountered asymmetry of uterine development and

30

THE SPECULUM.

posture, akin to that seen in the other organs mentioned. A case of this type that is of outstanding interest was a woman who had menstrual pain of a degree that rendered her to a potentially suicidal state. The pain simulated that of labour. An acute retroflexion being found, a Baldy Webster replacement was satisfactorily performed, and for six months considerable relief was gained, the womb being in as near normal a position as could be attained, when examina-tion was made three months later. Two years later the whole syndrome had returned and examination exposed complete retroflexion. A hysterectomy was demanded by husband and wife, as there were two children. This was reluctantly performed, the ligaments being still in position but stretched posteriorly to their full capacity by a recurrence of the original uterine posture, based evidently on a loss of equilibrium in the balance of normal uterine musculature.

The writer sent the uterus to the pathologist to estimate the proportion of muscle and interstitial tissue on the basis of hypothesis later suggested. There was found more fibrous interstitial tissue than muscle. And the rational explana-tion appeared to be as follows :—

As the living unit bases its main functional activity on parenchyma, which is the more highly specialised protein content of the body, in cases of sub-protein feeding here followed throughout life, the constant wastage of katabolism for energy purposes reduces the balance of this tissue in the balance of cell struc-ture. A compensatory hypertrophy of a low grade insterstitial tissue ensues in all organs; and so there arises early arterio sclerosis, and a body-wide em-barrassment of parenchyma by non-functioning supporting tissue.

In support of this contention, cases typical of large groups may be de-scribed.

A male, aged 78, exhibited gallstones colic after mowing a lawn for two hours. In a general examination he said he was in perfect health, and his arteries would, on palpitation, be normal for a young man, while his blood pressure was 80-120.

A male, aged 26, had been unable to work for 10 years except spasmodically. He exhibited the above malnutrition syndrome and had a tubercular apex con-firmed by X-ray, but no cough, a gastric ulcer and arteries of a markedly hyper-plastic type. For the latter a modified prognosis was given. He was almost a non-meat eater. Apart from treating his defined disorders, the gradual exhibition of a meat diet was increased and in six months his arteries were practically normal to palpation and he is on full duty. Recently in the O.P. department, three cases were seen in quick succession with pipe stem arteries. All as regards age were in the fifties. All were non-meat eaters and one had a low b.p. and the other two had a high diastolic pressure with a systolic pressure of over 200 mm. In these cases the pardon of a protein diet came too late. If arterio sclerosis is encountered in a life-long meat eater, there is little doubt that alcoholic, syphilitic, congenital or acquired, or some other toxin, ,is involved. But as like breeds like, the stigmatic or rachitic states and sub-protein states in parents can be traced as a diathesis in a milder degree, in the ensuing generation and so complicates the picture. To ask a patient to-day, with the prevailing miscon-ception, whether he indulges in a full meat diet is to place him on his guard as if he were questioned in regard to alcoholic intemperance. To emphasise its importance to mothers of growing children often occasions much surprise.

Seeing a cartoon in a recent American paper of an irate patient confronting a computed clinician, could not but arouse a degree of sympathy. The doctor had just said, "You have arterio sclerosis and must give up meat." The patient retorted, "I haven't eaten it for years !"

THE SPECULUM. 31

In such matters, then, let us recognise the essential value of the academic and metrical, whose part truths as they accrue are the stepping-stones to final whole truth.

But though the histological and biochemical potentialities of the experimental animal are profound, its environment is still that of the animal without the complicating factors that are involved in a civilized environment that so further complicate the question of dietetics and other aspects of the human family.

Before proceeding with the interrupted thyroid discussion, it is necessary to make some general observations on future complicating factors in nutrition, if what constitutes the latter is to be assessed in proper perspective. As an early measure of estimation of the health of patients, body weight was regarded as a valuable criterion. Such regarded alone, is at times misleading. The human family, just as it can be divided into optimists and pessimists and gradations between, can also be structurally classed as anabolics and katabolics. The normal individual is an equable balance of both. Broadly, the metabolic purpose of life is that of constant storage and constant wastage by katabolism for energy purposes. Optimum vital energy depends on the provision of a constant turn-over of properly-balanced diet. In the upset of this balance arise the variations in human structural types and often the types of disorder they are susceptible to. There are encountered in medical practice many abnormal "anabolics and katabolics." The katabolic type bases his or her diathesis primarily on an overplay of the thyroid katabolic phase, and so they are attenuated and sym-pathetic in their emotional reactions. The latter are exaggerated by over-energi-sation, those affected are mentally restless and tend to an inhibitory outlook on life. To take one type-disorder that is encountered in these types, if they are prone to alimentary disorder, it tends to ulceration. On the other hand, in the case of abnormal anabolics, such types are the subjects of asthenic endocrine activity, and the function of storage and removal for energy purposes is defec-tive. They lose, as it were, the keys of their own larder. Weight here is no criterion of health and reduction is associated with improved well-being, just as increase is in the former type. To take a type disorder of anabolic types, it seems more than coincidence that where alimentary upset occurs, this type is not so prone to exhibit katabolic ulceration but abnormal anabolic gallstone formation. Several patients of this type are under treatment who are improving in every symptom by reduction of weight. One, a middle-aged lady, was 18 stone. She was of hypo-pitutary and thyroid type. Her daughter conforms to the same build and a constitutional neurasthenia. The mother has a seven-months' child and of rachitic habits. Having a small pelvis, her daughter was prematurely delivered at 71 months in the interests of the mother. The pre-maturity in both cases laid down defective tissue architecture and sub-endocrine activity. Another woman of 17 stone was becoming asthenic and increasing in weight. She was a non-meat eater and had stored added carbohydrate to compensate. X-ray of the chest showed healed calcified glands and calcified lung infiltration of long standing, without any marked symptomatic accompani-ments. Long toxic attrition against the endocrines has further disturbed the balance. Here anabolism was defective in quality, and the katabolic key did not appear to fit in with the requirements of attempted release of tissue reserves. In these and other cases the experiment was tried of using cod liver oil' to provide an efficient harmazone and so restore this lack of harmony. Weight fell at the rate of pounds a week, and one more instance of the value of general clinical principle seemed registered.

To return after' this digression to thyroid upset, it is just this type subjected

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THE SPECULUM.

CASINO NOTES.

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Abe, Bid, Boggy, George, Gos, Bot, Mich, Gid

THE SPECULUM. 33

to ante-natal,, infantile and life-long developmental malnutrition that exhibits endocrine aberrations which are projected into every aspect of an already un-balanced structure and function.

As a result, the maturation of basic driving forces behind life inherent in the endocrines suffer. In the promotion of life-long development, the endo-crines do not carry out their normal task on the basis of a constant, unaltered rhythm. There is a curve of rising and falling growth. Growth is at its opti-mum up to 7 years of age, with set-backs at times of teething in early infancy. Such are general inhibitory crises with mental irritability, alimentary inertia, etc. Between 7 and 12 years of age growth is relatively less. Again a period of dentition. Growth is again enhanced till the bones set in later puberty and a further relapse occurse. On maturity being reached further crises operate, but now change of figure rather than difference of stature obtains. In the growth periods of increased anabolism, life is more excitory, while the inhibitory phases are colored by a hobble-de-hoy outlook in puberty crises, neurasthenic upset of inhibitory type in the change of life when the figure sets, to quote examples. And ill-health frequently can be attributed to the laboured maturation of these physiological irregularities, where sub-normal architectural perfection obtains.

In the female, besides that of self-preservation there exists the rival force of life, that of sacrifice for pro-creation. In inhibitory periods just mentioned, and in the associated crises of menstruation, pregnancy and the climateric, the thyroid normally enlarges and assumes a katabolic habitus to supply the require-ments of gestation or direct the scene-shifting between the acts of life manifested by such phases as the menopause, when the figure, is modified.

At such a time the body in its several systems is more sympathicotonic than vagotonic and in a phase of inhibition, all excitory phases tending to oscillation into this latter phase. Physiologically, it is an experimental law that all excita-tion oscillates after. its performance into an ensuing inhibition. And when we find goitre in the female recurring most frequently in those who overwork in these inhibitory phases of menstruation, pregnancy and the menopause, or as a result of the strain thrown on the thyroid by fighting prolonged disease, there seems little doubt that goitre is an accentuation of the physiological phase of inhibition, at first functional, but later having structural accompaniments based on prolongation of altered metabolism. Survey of the clinical histories of cases of goitre relegates the cause thus to home work in the case of school girls, office and factory work performed by women when well and unwell, the recent mother who supports her family often with the disabilities of prolapse, severe mental trauma, as being chased by a maniac during one of the physiological crises, the mental strain of incompatability of marriage. While such causes find their most fertile soil in the malnutrition types.

The last case seen in the male sex was a man aged 55, who nearly died of diphtheria at 10 years of age and had had a thyroid swelling ever since—a by no means isolated example.

In thyroid upset there is, as in all disease, a grading from the subliminal, seen as merely an irritability or change of disposition, to a manifestation of excessive hyperplasia during a certain vital crises, such as pregnancy, up to defined disease grading from hyperplasia to fulminating disorders. Where goitre is present in the parent it may be transmitted through several generations. To classify these types ultimately there must be considered not only the varied exciting causes, and their gradual or sudden operation, but also the soil and the reactions of that soil according to the phase of development it is passing through. On all this is implanted often the added strain of fighting concurrent

;A .

:7

34

THE SPECULUM.

disease. There is needed in the clinical outlook a conception that energetic output of life is not that of a combustion process in a simple engine. Rather is every vital manifestation an energetic output of a parallel phase of progressive struc-tural development. Evolving structural progress and energetic function, in-voluntary and voluntary, are inseparable parts of a common mechanism of every detailed cell in its electrical rhythm governing growth and function. Just as when a gas is compressed and it becomes heated ; and, conversely, heating a gas causes it to expand, structure and energetic accompaniment going hand in hand, so in life function and structure are reciprocally inter-related. Either tail can wag the dog. And just as when insidiously over a prolonged period, a hidden tubercular or septic focus calls into play the known antitoxic fight and katabolic attack on the foreign organism and can result in goitre, and eventually neurosis, and even insanity by upset of the endocrine direction of mental activity, so. conversely, long continued conjugal incompatibility can, in the accumulating upset of voluntary and emotional function, cause a grading thyroid disorder that chews the grossest histological changes. A woman is under treatment who was normal on marriage. The husband, who was abnormal mentally, engaged in many years of persecution. of his family by senseless antics, such as making his daughter have a second bath after, she had just had one, of holding his hand over her mouth while she tried to take her meals. The woman has had thyroid-ectomy performed, and the balance of her thyroid gland is sclerotic and modular.

Disease thus have not only symptoms and signs, but also habits of behaviour. To the clinical diagnostic machine of the human mind is left the task of record-ing this latter field that is inexhaustible. A disease is an event or a point in a series of events or processes, and not a thing. And just as diagnostically such a viewpoint must he adopted, so in the realms of treatment on such an under-standing of a disease as a far-reaching process, involving every detail of an individual's life, does success in its optimum percentage depend.

Try, then, to trace hack such processes to their early causes and cast the outlook beyond the confines of immediate organs and regard the human body as one composite organ divided into subsidiary organs, in any of which, as well as the obvious one, causative factors of disease may arise. Where endo-crine upset occurs, no organ escapes. While, conversely, if strain of life is enjoined, its repercussion falls on the endocrine team and the vicious cycle this entails. And the prime responsibility stands clear that prophylaxis in national health rests on the provision of every member of the race with an efficient endocrine system by the recognition of the importance of an optimum nutrition and a conservation of this efficiency by avoidance of provocative dangers during life. If such is attained, secondary diseases of an infective nature will be better guarded against and fought, the standard of national, physical and mental efficiency will rise, many diseases will tend to disappear from the map of medical classification, and the ensuing generation will, in the converting of a vicious cycle into a beneficial one, reap incalculable benefit.

THE LESSON TO BE LEARNED FROM THE CLINICAL OUTLOOK 0.N TUBERCLE IN ITS INSIDIOUS FORMS.

Science bases its progress on classification. Once classification is attempted, however. the danger must be realised of separating related phenomena by a tyranny of artificial barriers.

THE SPECULUM. 35

The importance of this dictum in confining our outlook of endocrine upset to an academic analysis of endocrine disease has been briefly illustrated.

Speaking generally, the responsibilities of diagnosis demands that such be based on defined evidenca. But only severe grades of disease may evince such signs. And so for the want of them incipient disease flourishes and may go unrecognised. Here again, only by the clinical appreciation of a long series of graduated stages of a disease can the clinician hope to shed light on the prevailing darkness. How often in a diagnosis of T.B. is the tyranny of a

. sputum confirmation demanded. Yet, if we reassure ourselves in its absence, how much prophylactic precaution may be denied as regards the future.

In the writer's opinion, which, like all else here, is submitted to the critical survey of the reader merely as a personal viewpoint, is that if 100 cases of tubercle were taken they would present a diversity as marked as that of a series of different diseases. In that 100 a very few would have to be called consumption, perhaps three or four per cent. There may be a score of cases of pleurisy. Of the balance, a series without cough, some even without catarrh, can be, by X-ray examination, shewn to have healed calcified' lesions and enlarged and calcified glands of doubtful aetiology. Though some of those can claim autogenous cure, the balance of at least 50% would manifest, for reasons later laid down, an infinite variety of reactions to their disorder. In this connexion the following reasoning, based on evidence presented by variations in resonance derived by deep percussion and X-ray evidence of density of hilar shadows, may provide food for reflection as to the direction future investigation may trend in arriving at one of the main causative factors behind a large group of diseases.

In regard to percussion, the usual outlook is governed mainly by a symmetry of resonance. If the student, as he should, develops an ear for the normal from the percussion of health y types, he will also be struck by the fact that there are also grades of resonance of the lungs as a whole in different chests, apart from mere considerations of thickness of the chest wall. Such is elicited by using firm pressure, even backed up by some body weight of the percussor, on the pleximeter fingers. Such, in rendering the ribs as a whole more elliptical, invests the ribs with a tension and elasticity which turns them into a sounding hoard. Vibrations now sent around- the ribs with plexor percussion, however light, break up at the rib terminations and course through the lung as a whole. In this way the deep tissues of the hilum can be explored from the point of view of hearing, as well as touch. The value of this method is that it brings clinical examination into line with X-ray estimation. The view of the radio-logist towards hilar shadows is necessarily a conservative one. The diagnosis of tuberculosis exercises an effect on a patient that may threaten his entire future outlook. And no X-ray picture may be studied without a parallel survey of the attendant clinical signs. Some degree of calcification is normal in all hilar shadows. Calcification, however, is also determined to the site of Infective mischief in the lungs as part of the reparative process. And by its extent, site, and associa-tion with pictures of lung mottling, cotton-wool patches, gland enlargement and degree of interlacing network beyond the normal limits of distribution, an opinion is finally derived. In this connexion an interesting experiment was conducted. A girl, aged 22. presented herself with luernophysis after three weeks of bronchitis. There were T.B. bacilli in the sputum. Three other members of the family had been treated for pleurisy or actual tuberculosis. Examination exposed no .crepitations,' but deep dulness in the upper lobes of the lungs. She appeared healthy outwardly. X-ray examination chewed a translucent patch about an inch across, designated by X-ray examination as tubercular. The

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THE SPECULUM

patient was submitted to active counter irritation for 3 months and given large doses of calcium. The patient was seen on the second occasion at the end of 3 months and had no signs or symptoms. On referring the patient to the radiologist, the statement was made that a more adverse report would probably be made, for such is governed in part by the measure of calcification that is an index of its need in immune measures. The report being made by an independent investigator, the condition was reported on as aggravated, as com-pared with the first occasion, and a second area was detected in the other lung. The girl, however, was in robust health, returned to office work, married 6 months later and is now 6 months pregnant, with no return of symptoms. The limitations of X-ray analysis as to the significance of calcification is thus obvi-ous. For, in the first lung, it did not realise the calcium need was fulfilled. In the second lung it needed added calcification to expose T.B. Now, in utilis-ing this deep percussion method for many years, the following conviction has been arrived at, viz., that these hyperplastic hilar types, whether based on insidious T.B. or prolonged simple bronchial infection, itself often a reflex of antral infection, exhibit a syndrome that spreads its ramifications through the whole practice of medicine. For, after years of latent development, there appears to arise an interstitial hyperplasia in the lung and mediastinal tissues that interferes with the headquarters of the main autonomic plexuses of the body. Through this area course reflex arcs that involve every main organic function. And so when such types, on whose vagal and sympathetic nerve endings are constantly impinging toxic and trophic effects, exhibit as sequels a range of diverse functional and later organic upsets, the logical connexion between the two is deserving of further enquiry. Thus the vagus supplies the lung and stomach. Where, apart from abuse of food, spontaneous dyspepsia develops, especially in toast and tea breakfast adolescents, grading over years into gastric and duo-denal ulceration, it is first these dull hilar types that exhibit such a disorder which is here regarded as an abnormal sequel in the shape of what is first a functional, and later an organic, reflex trophic effect.

Again, to go a little further afield, from the pelvic viscera to the mammary glands course reflex arcs, which bring about trophic changes associated with lac-tation that occur apart from hormone stimulation. Where interference with this arc is enjoined by a bacterial influence on its lines of communication that is noted for its cell stimulating activities (seen as tubercle formation and mental activation) ; there is grounds for at least attempting to determine the possibility as to whether what are abnormal trophic, rather than inflammatory changes, of chronic mastitis, and also many other disorders so receive their reflex activa-tion. Thus it is known that the vague excites pancreatic activity, and early diabetic cases have been treated in which, when only early damage has occurred, the obliteration of gross hilar dullness has allowed of a return of normal pan-creatic function. And so, by such reflex effects, paroxysmal tachycardia, goitrous change of a particular type, perhaps gallstones, for which there is evidence, and also neurasthenia, appear to be enjoined. And supporting such a contention is the fact that elimination of this dullness promotes a doubly rapid cure and a prevention against future recurrence which cannot but be taken into account. This particularly applies to chronic infection, such as tonsiiitis, catarrhal states, pyelitis, and rheumatoid conditions, whose depredations are magnified in a soil already dealing with an infective burden. So far can clinical suggestion take us, and it remains for academic investigation to seek for tangible confirmation of the very great possibilities offered.

THE SPECULUM. 37

THE NEED FOR A CLINICAL PHYSIOLOGY BASED ON PATHOLOGICAL MANIFESTATIONS.

To those who read between the lines in the clinical field there is offered the opportunity of elaborating a branch of physiology that the study of normal life cannot offer. For there are many essential, yet unobtrusive, phases of life which give no evidence of their presence unless disturbed. To take a simple example :—It is known that just as the reflex activities of vision promote gastric secretion, so gastric-colic reflexes exist to prepare the lower alimentary levels for their labours as gastric function operates. Now the czecum is a head station of the bowel. And if local inflammation due to chronic appendicitis over-excites the nervous receiving area, a reflex from the stomach to the excum, to the effect that it is full and therefore excal preparation must be put into opera-tion, will he interpreted as the stomach being over-full, and reflex vomiting will occur. Similarly, if the maim empties and notifies the stomach of this circum-stance, and so adds its • reflex quota to the preparation of appetite. a message will come through. of an excitory or inhibitory nature, according to vagal or sympathetic activation. In the former case there will be a hunger pain, in the latter, anorexia. Such a suggestion can be applied to the isolation of the trophic reflex suggested between the pelvic viscera and the mamma:. And so, when a trophic reflex arc is suggested between the pelvis and mamma!, which may, on interference, give abnormal trophic changes, it remains to seek for such an arc at times of physiological crises, during which such reflexes operate. And the way suggested is in the direction of a system of electro physiology and pathology, by which such phenomena may best lend themselves to estimation. The fore-going. attempt to arouse the imaginative faculty in the analysis of a few isolated aspects of Medicine has also as its motive the desire to demonstrate the fact that the clinical faculty in research will never cease to exploit the field which it is its own province to define. It is not a lazy substitute for the scientific practice of medicine, but an essential adjunct by which best can be filled the gaps in our knowledge, the burden of which falls on the Shoulders of those who carry that greatest of all responsibilities at the bedside, that never equally falls on the - .shoulders of the academic worker, who should thus, 'where he errs in this direction, be more tolerant. in his at times not unguarded criticism. If your choice be that of an academic worker he sure that you are for life a half-time clinician, and seek the spur of necessity in your researches, for too much research is to-day conducted into the rarities of disease, while the common prob-lems of the community from very familiarity are frequently ignored.

The press informs us that in England alone 5,000,000 weeks' wages, or £20,000,000 per annum, is lost owing to rheumatism alone. And yet the whole scientific world emphatically denies this class meat because meat is harmful in gout of non-infective origin. And yet one must depend, among other things, for success in fighting what is a chronic infection, waging an attrition com-parable to tubercle on a forced protein diet, if results are to be obtained at all. An analytical survey of this disease in a large series of graded cases shows there is no difference, except in degree, between a fibrositis in a local muscle or joint tissue and associated neuritis, and the most crippling and fatal form of rheumatoid arthritis. The variation depends entirely on the soil, the region and extent of tissue affected, and its hygienic deficiencies. And the text hook in its classification of advanced types of disease tends to give little index of the long preparatory years of simple precursor stages that grade retrogressively into the insignificant, that simple prophylactic precautions can eliminate. And

38 THE SPECULUM.

among such determining factors the part played by the attrition of chronic hillar mischief is an outstanding one.

As space is limited, the measures adopted to deal with hilar disorder may be deferred to a later issue if any interest aroused should deserve it.

And finally, in attempting to master a practical working mental picture of disease, the student should not attempt to achieve this from text book descrip-tion alone, but read the latter where possible in the light of accompanying clinical observation. An amusing example of the difficulty of attempting to interpret an unfamiliar disease from text book familiarity alone still lives vividly in the writer's mind.

A clinician revered by the students for his meticulous thoroughness and grasp of medicine was demonstrating a case of "Syringomyelia," with atrophy of the interosseous muscles of the fingers. Text book reference to this disorder, after seeing this case, did not seem to harmonise the clinical picture seen and that described. For some time this case was a star O.P. item. Some time after the patient was first seen he developed nodules beneath the skin in different parts of the body, and a diagnosis of multiple sarcoma was suggested. Soon after, about 20 students and three leading clinicians held a consultation, as new complications had arisen in the shape of an erythematous rash and a granuloma of the calf, which was looked upon as Frambesia or Yaws.

About nine months after the solution of mystery was presented in the morning press.

Mr. 0 f, a Russian, had been diagnosed as leprosy, and had been sent to a lazarette !

A passing reflection that the incubation period of contacts was ten years could, perhaps, under the circumstances be forgiven. If the reader has borne with the multiple digressions of the foregoing context, expanded far beyond the original intention, with due apologies to the editor, it is hoped he will realise that as flotsam on the ever-advancing tide of uncertain knowledge, each and every one of us must over and above a utilisation of contemporary knowledge, render himself more adequate for his task by his own interpretation of the problems he encounters.

As Dr. John Hunter replied, do not ask me what I said yesterday, but what I think to day. And if even on substantial grounds, one must erect many stair-cases before one of them takes us to the second flight of knowledge, there is more reward in one self-erected than many ready-made, if the zeal and monetary sacrifice of our research workers is any guide to the compensation they derive from their researches.

ANOTHER LIBEL'

After the discovery of the gonococcus by Weisser in 1879, Bokai claimed to have produced gonorrhoea in three out of six medical students by inoculating them with the artificially cultivated organism. The following criticism of Bokai's work was made by Dr. W. T. Bedford, of Chicago :—"For one familiar with the natural history of medical students, the experiments would have been far more convincing if the dauntless three had been kept in solitary confinement for a week before and after the inoculation."

_L. —1

G77,077Z-071A-C,

ProjectiLm_.

THE SPECULUM. 39

IF SPALTE HAD BEEN A GEOGRAPHER!

Our Atlases as They Might Have Been

The above, all accurately drawn to the same scale, represent different ways in which a skull-shaped mass of land situated in the Northern

Hemisphere might be mapped.

40 THE SPECULUM

incibents in the bistorp of a few 1Drugs in Common Vise BYRON L. STANTON, M.R.C.P. (Lon.), M.B., B.S. (Melb. ), M .P.S.

A study of the history and romance of drugs is as replete with interest as the proverbial egg is full of meat, and though the subject is an inexhaustible one, the presentation of some observations relating to a few in common use may stimulate a wholesome curiosity as to the origin of others.

From earliest periods the man in the street has had an unshakable faith in the "medicinal and occult qualities" of herbs, and the remarkable empiricism of their early application is but imperfectly replaced, even in these days, by a more scientific rationale.

"The Lord hath created medicines out of the earth, and he that is wise will not abhor them."—Ecc. xxxviii.

Among the earliest recognised drugs are the spices ; for example, both cinnamon and cassia are mentioned as precious substances in the Mosaic writings and in the Biblical hooks of Psalms, Proverbs, Canticles, Revelations, etc., while writers of such antiquity as Theophrastus, Herodotus, Galen, Pliny, and others make constant reference to them.

Cassia, under the name of Kioli, finds a place in the earliest Chinese herbal —that of the Emperor Shen-nung, who reigned about 2700 B.C.

Among the imports into Egypt • in the 17th century B.C. are cassia, gold, ivory, frankincense, and apis, while about 240 B.C. Selencus II., King of Syria, made an offering to the temple of Apollo at Miletus of vessels of gold and silver, together with two pounds of cinnamon, of cassia, frankincense and myrrh.

Cinnamon appears in the "herbals" of Northern Europe in the beginning of the 6th century, and in A.D. 475 Gemmulus, a Roman deacon, sent to Boni-face, Archbishop of Costus—cure magna reverentia— f our ounces of cinnamon and two ounces of pepper.

Coming nearer to our own time, it is interesting to note that this spice was included among the New Year's gifts to Philip and Mary (1556) and to Queen Elizabeth (1561).

According to Nich. Culpepper (1653),. cinnamon and cassia "cause a sweet breath, provoke urine and the menses, cause a speedy delivery in travail, and help coughs and defluxions of humours upon the lungs."

"There is scarce a better remedy for women in labour than a dram of cinnamon newly beaten into powder and taken with white wine."

Myrrh has been esteemed from the remotest periods as a constituent of incense, perfumes and unguents. It was an ingredient in the holy oil used in the Jewish ceremonial, as laid down by Moses, and was also used by the Egyptians in the process of embalming.

In the wardrobe accounts of Edward I. there is an entry on January 6, 1299, for gold, frankincense and myrrh, offered by the King in his chapel, it being the feast of Epiphany. This custom is still observed by the English Sovereigns, who make the same annual presentation in the Chapel Royal, London

Ginger, under the old Sanskrit name of "Sringabera," occurs in the earliest records of Indian medicine, and was in common use among the Greeks and Romans. Saxon leech hooks of the 11th century make frequent reference to it, while, during the 13th and 14th centuries, it was, next to pepper, the com-monest of spices, costing 1/7 a pound—or about the price of a sheep !

Ginger, if the estimate of our predecessors is to be relied on. "helps diges-tion, warms the stomach, clears the sight. and is profitable for old men."

Rhubarb, like cassia, found favour in the herbal of Shen-nung, 2700 B.C.

THE SPECULUM. 41

The dried root was introduced into Europe about 114 B.C. by overland routes from China, but was not cultivated there until 1867.

"A dram of the dried root, with a scruple of ginger, made into a powder, and taken fasting in a draught or mess of warm broth, purges choler and . phlegm downwards very gently and safely, without danger."

"The powder taken with cassia and washed Venice turpentine, cleanses the reins,* and strengthens them afterwards, and is very effectual to stay the ..onorrhcea.."

Cinchona bark ranks among the more modern drugs, being introduced to Europe from South America in the 17th century. Its medicinal virtues were unknown to most of the natives of South America, but the red bark—Cinchona succirubra--was much used as a dye.

Its first medicinal application to the treatment of fever is reported by a Jesuit missionary who was cured of an intermittent fever—probably malaria—by the administration of the bark in 1630.

Some years later, the wife of the Viceroy of Peru (the Count of Chinchon) was cured of the "tertiana" in the same way. On her recovery the Countess collected large quantities of the bark, which she distributed among those suffer-ing from fever. From her association with the drug it derived its name, Chin-chon bark or Polvo de la Condesa—the Countess' Powder.

In 1658, a year remarkable in England for the prevalence of an epidemic of intermittent fever, the Mercurius Politicus—one of the earliest of English news-papers—contained many advertisements for "the excellent powder known by the name of Jesuits' powder," an appellation derived from its wide and gratuitous distribution by the Jesuit fathers.

Its reputation was much augmented by that remarkable apothecary, Robert Talbor, who in 1672 published a small book—P_vretologia: A Rational Account of the Cause and Cure of Agues." Though not a member of the College of Physicians, Talbor was in 1678 appointed physician to Charles II., whom he cured of tertian fever by his secret remedy. Members of the royal households in France and Spain were also successfully treated by Talbor. Louis XIV. induced him, for a consideration of 2000 Louis d'or and an annual pension of 2000 livres, to reveal his secret remedy, which proved to consist of large doses of cinchona bark infused in wine.

In conclusion, one is tempted to make a few references to some remedies which, happily, are not now in common use. These, relating to a primitive organotherapy, are quoted from Culpepper, and still find favour among the omniscient old "medicine women" in outback English villages.

"Eels, being put into wine or beer, and suffered to die in it, he that drinks of it will never endure that sort of liquor again." Not so unreasonable, after all !

"The brain of sparrows, being eaten, provokes lust exceedingly." "A sheep's or goat's bladder being burnt, and the ashes given internally,

helps the diabetes." "The brain of a hare, being roasted, makes children breed teeth easily, their

gums being rubbed with it." "The powder of earthworms, put into an hollow tooth, makes it drop out." These examples are the more interesting, when we have the Author's

assurance that the sum total of his knowledge was attained after consultation with Dr. Reason and Dr. Experience, by the advice of Mother Nature, and with the help of Dr. Diligence—even though Mr. Honesty—"a stranger in our days" (1653)—warned him not to publish it to the world.

*The office of the reins is to make a separation between the blood and the urine. Medicines appropriated to the veins and bladder are called nephriticals.

42 E SPECULUM.

the ibistory of Syphilis "that foule el, ill, which all men reprove,

That rotts the marrow, and consumes the braine." —Spenser.

At the outset of an inquiry into the history of syphilis we are faced with the difficult and much-discussed question of its origin. Has the disease existed in Europe from remote .antiquity, or was it introduced from the New World in comparatively recent times ? The latter view was advocated by Montejo y Robledo before the fourth meeting of the International American Congress in 1882. His views were confirmed by Binz (1893) and Seler (1895). These authors relied principally upon Spanish records, but Iwan Bloch, in his work, Der Ursprung der Syphilis (1901), arrived at the same conclusion on wider grounds. In an article contributed to D'Arcy Power and Murphy's System of Syphilis (1908) he summarises his position thus : "Thanks to improvements in historical criticism and to advances in the science of pathology, I believe that it is now possible to give a definite and positive answer to the question of the recent origin of syphilis in the Old World. All available statements and facts point to the last decade of the fifteenth century—particularly the years 1493-1500--as the time when syphilis first appeared in the Old World. There is not a particle of evidence to show that the disease existed in Europe before that time."

Among Spanish writers contemporary with the return of Columbus from the New World are Ruy Diaz de Isla (1462-1542?), Oviedo, and Las Casas. These all support the American origin of syphilis. The most important of them, de Isla, was in practice in Barcelona in 1493, the year in which Colum-bus arrived in Barcelona from the New World, after his first voyage of dis-covery. Later, between the years 1.510 and 1520, he published a work on syphilis, in which he embodied his views as to its origin. In this work he tells us that the disease was unknown in Europe before 1493, and that it was brought from the island of Haiti, or Espanola, to Barcelona by the crew of Columbus. De Isla treated several of the men of Columbus on their arrival in Barcelona. The disease was unknown to the sailors and to de Isla him-self.

Spanish mercenaries infected with syphilis joined the army of Charles VIII , of France, and thus the disease was carried to Italy. The stay of the French army in Naples, between February and May, 1495, syphilized the city. The disease then rapidly spread through Italy. It had reached the borders of France, Switzerland, and Germany by June, 1495. The disease reached England and Scotland about 1497.

The epidemic of syphilis which raged in Europe at the end of the fifteenth century was of great severity. Bloch lays stress on the features of the disease at the time, such as the early appearance of secondary symptoms, the high fever and the frequency of fatal endings, as indicating that it was of recent introduction. The same severity of the disease is noted wherever syphilis is introduced into what Bloch calls a "virgin" country.

If syphilis had existed in Europe during prehistoric times, antiquity and the Middle Ages, we would expect to find signs Of syphilis in the abundant skeletal remains of these periods. The fact is, however, that not a single pre-Columbian bone showing syphilitic changes has been discovered. Elliot Smith and his co-workers examined "some 40,000 bodies in every part of the Nile Valley, belonging to every period of Egyptian history ; in no single case was evidence of syphilis detected."

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Additional evidence for the American origin of syphilis would be fur-nished by the discovery in America of pre-Columbian bones showing definite signs of spyhilitic change. In the mounds and graves of Tennessee Joseph Jones found skulls which showed undoubted syphilitic lesions. Regarding these bones he said : "The diseased bones which I collected from the stone graves of Tennessee are probably the most ancient syphilitic bones in the world." The difficulty is, however, that it is not certain that these graves belong to the pre-Columbian period.

At first the disease was not known by the name of syphilis, but was called the Neapolitan disease, the French pox, or Morbus Gallicus. The name by which it is now known was given to it by Jerome Fracastoro, Professor of Logic at Padua, in a poem entitled "Syphilis sive Morbus Gallicus," pub-lished in 1530. The etymology of the name is doubtful. One suggestion is that it is derived from the Greek o-vv with, OtAav, to love ; another is that it comes from the Greek o-tc0A, meaning maimed or crippled.

The early writers on syphilis clearly differentiated it from the other venereal diseases. Paracelsus, however, in 1530 called gonorrhcea "French gonorrhcea," and became responsible for the pernicious doctrine of the identity of syphilis and gonorrhcea which persisted up to the time of Ricord. and which even the great Hunter embraced.

Mercury and guaiacum were early introduced as the remedies. Diaz de Isla, in the work already mentioned, refers to the use of guaiacum as a remedy by the Indians of Haiti. As early as 1500, Berengario da Carpi in-troduced inunction with mercury as a form of treatment. Before the middle of the century Mattioli introduced internal administration of mercury. Victor Robinson assigns the honour for this advance to Paracelsus. Van Swieten introduced the internal use of sublimate. Mercury remained the specific for the disease until 1910, when Paul Ehrlich gave salvarsan to the world.

Prominent names in the history of syphilis in the sixteenth century are those of Jean Fernel (1496?-1558), Paracelsus (1493-1541), Gabriel Fallopius (1523-62), and Ambrose Pare (1510-90).

Fernel was the one to insist that for syphilitic infection to take place a lesion of the epidermis was necessary.

Paracelsus divided the disease into stages and recognised its hereditary character. The erroneous view of the identity of the venereal diseases is found in the work, De Morbo Gallicus (Padua, 1564), of the distinguished anatomist, Fallopius. Fallopius opposed the use of mercury and advocated a form of condom as a prophylactic measure against syphilis.

Ambroise Pare, the great French surgeon, "employed the speculum for examination of vaginal and uterine veneral affections, pointed out the in-dolence of the syphilitic bubo, and made the first detailed communication upon hereditary syphilis" (Bloch). He also observed the connection between syphilis and aneurism.

In the seventeenth century Sydenham noticed the lessened virulence of the disease, compared with its virulence at the end of the fifteenth century. He considered syphilis and yaws to be identical.

In the eighteenth century we must not the names of Lancisi (1654- 1720). Giovanni Battista Morgagni (1682-1771). John Hunter (1728-1793), and Benjamin Bell (1749-1806). Lancisi was the first to describe cardiac syphilis, and in his work. De niotu corals et oueurysmatibis (Naples, 1738), he drew attention to the connection existing between syphilis and aneurism of the heart and great vessels. Morgagni, the great pathologist, who'm Cohnheim described as the "Begriinder" or special pathology, did much to

44 THE SPECULUM.

establish the existence of visceral syphilis. "He was the first to discover syphilitic disease of the cerebral vessels: decribed pulmonary syphilis, its complication with pulmonary tuberculosis, syphilitic bone affections, syphilitic laryngitis, syphilitic disease of the heart and great vessels, and hie) cerebri. In spite of Ricord's dictum, "At last, John Hunter came and laid the true foundation of the science of veneral affections," we must re-gard the work of Hunter on venereal disease as a retardative influence on the advance of our knowledge. Bloch summarises the contribution of Hun-ter thus : "The culminating point of the period of retrogression in scientific knowledge of syphilitic affections is certainly occupied by John Hunter." In 1767 Hunter inoculated himself on the glans and prepuce with gonorrwal pus, and produced not only gonorrhoea but also syphilis. Ricord later ex-plained this result by the hypothesis of a chancre of the urethra. The angina pectoris, which was the cause of Hunter's death, was probably a tertiary result of the syphilis thus acquired. As a result of this experiment, Hunter was led to the conclusion that there was only one venereal virus which could produce syphilis, gonorrhoea, or soft chancre. His own words were, "There are three forms of the venereal infection, gonorrhoea, chancre and the lues venerea . . they all arise from the same poison." Hunter, in spite of the work of Morgagni, denied the existence of visceral syphilis. "I have not seen that the brain, heart, stomach, liver, kidneys, and other viscera have been attacked by syphilis, although such cases have been described by authors." Proksch says that this denial "amply sufficed to cause visceral syphilis almost completely to disappear for more than half a century from the text-books upon venereal diseases." The ideas of Hunter, however, did not go wholly without opposition. Benjamin Bell, in his work, Treatise on Gonorrhcea virulenta and ides venerea, denied the identity of the viruses of syphilis and gonorrhoea. His views found support in the work of Hernandez, who, at the beginning of the nineteenth century, inoculated with gonorrhoea seventeen convicts at Toulon.

Philippe Ricord (1800-89) must be regarded as the founder of our modern knowledge of syphilis. He worked at the Hopital du Midi, where, in the years 1831-7, he performed 2500 inoculations, and as a result of these researches he overthrew Hunter's idea as to the identity of gonorrhoea and syphilis. The great work in which he embodied his conclusions is the Trait( pratique des maladies veneriennes (Paris, 1838). Ricord also made an important contribution in his distinction between the chancre 111011 (soft sore) and the chancre dur (hard sore).

Oliver \Vendall Holmes described Ricord as "the Voltaire of the pelvic literature—a sceptic as to the morality of the race in general, who would have submitted Dianna to treatment with his mineral specifics, and ordered a course of blue pills for the vestal virgins."

'Fite first decade of the twentieth century witnessed more progress in our knowledge of syphilis than any previous one. In 1903-4 Metchnikoff and Roux succeeded in inoculating apes with syphilis. "The initial victory was won." On March 3, 1905, Fritz Schaudinn (1871-1906), working with Hoffmann, crowned a lifetime of work devoted to the study of the protozoa by the discovery of the causative organism of syphilis----the spirochaete This Drinkwater justly describes as "the most important discovery in the whole history of syphilis." The brilliant Schaudinn died at the age of 35, having accomplished more in his brief career than most men do in their three score years and ten, and with his name we may fittingly bring this history to a close.

—GRAFTER.

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PORTRAIT OF A DOG SWALLOWING AN ANGEL

46

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Zbe Zeiss Morhe Though the name of Zeiss has become so well known in its connection

with optical products of the very highest standard, it may surprise many to learn that Carl Zeiss first established himself at Jena as recently as 1846, as a scientific instrument maker. His first attention was given to microscopes, since those in existence at that time were not real scientific achievements, but the result of hundredfold trials. The lenses required for the eyepieces and objectives were ground and polished and the resulting images of small objects carefully viewed and criticised. In this way, the succeeding years furnished an increasing store of information as to the form of lenses which were required to attain a certain result ; or, rather, to express ourselves more correctly in a negative sense, how the lenses should be formed and combined in order to eliminate certain defects, such as unsharp images, a difference in the central and marginal magnification, coloured fringes, insufficient light, etc. When the data of a lens were slightly altered, in order to eliminate a certain defect in the image, it was frequently found, as might be readily ex-pected, that, whilst the original intention was attained, the other defects possibly became accentuated. Changes were introduced again and again, and since a faultless optical image is required to possess a multitude of good qualities, there would be such an immense number of conditions to fulfil that probably centuries Would not have sufficed in order ultimately to arrive at the discovery of the ideal microscope, and even then it would need the oft-repeated help of an extraordinary stroke of luck.

The ambition of Zeiss to evolve a microscope based on scientific formula, and the production of which could he undertaken without dependence upon the old trial and error system, led him to seek the assistance of Ernst Abbe. The latter was the son of •a foreman spinner in Eisenach. He subsequently studied at Jena and Goettingen, and graduated as a doctor of philosophy. In 1863 he attached himself to the University of Jena by a thesis on the cal-culation of errors arising in the subject of mathematics, physics and astronomy. In 1866 he began his connection with Carl Zeiss, and in 1870

. he was appointed an extraordinary professor at the University. It was only natural that we should begin by surveying the person of Carl

Zeiss as the founder of the great world-famed establishment which bears his name. But though Zeiss was the founder of the little workshop which even-tually grew into the Jena Works, it is to Abbe, now also since years numbered among the departed, that we must turn as the real founder in a wider and nobler sense of what is known to the world as a mighty industrial and sociological monument. If it be true that the world's largest optical works would not have been in existence if it had not been for the personality, the intelligence, and the character of its original founder, it is equally- certain that the contributory influence of Abbe is an integral factor in the continuance of its existence, not only in the sense, as we already know, that Zeiss alone would not have been able to set his wings to. reach such heights, but also in that other sense that it was by a sheer miracle of fate that Zeiss became associated with this above all men ; for he might have searched the wide world over and not have found another who was so perfectly attuned to his great task, who so clearly fathomed its significance, and bent his rare special gifts so whole-heartedly upon his envisaged goal. Abbe brought with him a most fortunate quality. He was wholly uninitiated in optical routine. This was a singularly important factor, for, while the great majority of problems affecting the progress of humanity demands the services of highly trained and experienced specialists, the very highest problems, which force us to recon-

THE SPECULUM. 47

struct our fundamental aspect of things, stand in a significantly different category. Their solution demands, apart from general and deep scientific insight, minds which have not fallen under the sway of recognised systems of research or become narrowed in their visions by an excessive faith in authority.

Abbe's work in regard to optical science was so extensive that even an outline would not be possible within the scope of this article ; it is also so well known that an attempt to summarise may, perhaps, be regarded as super-fluous. As he conquered the mathematical and physical problems which con-fronted him, however, he was faced with the serious obstacle of the insuf-ficiency of glass material which existed at that time. "For years." so Abbe relates in reference to his work with Carl Zeiss, "we combined with sober optics a species of dream optics ; in which combinations made of hypothetical glass. existing only in our imagination, were employed to discuss the pro-gress which might be achieved if the glass-makers could only be induced to adapt themselves to the advancing requirements of practical optics." It was Dr. Otto Schott who came to his rescue and who later became the founder of the famous Jena Glass Works. Schott made, first at Witten, experimental melting operations, doing so on a very small scale, say, one or two ounces at a time, but very carefully studying all the chemical constituents which might possibly give rise to vitreous fusions. Abbe, with the notable assistance of Dr. Riedel, then examined the resulting specimens with the spectrometer specially invented or partly improved by Abbe. Very soon it was found that certain relations subsisted between the chemical composition and the optical properties, and this furnished the basis of a systematic con-tinuation of the work. The importance of the production of glass possessing the qualities sought after by Abbe and Zeiss cannot, of course, be over-estimated, and, as events proved, the joint efforts of Abbe and Schott, their mutual promptings and deliberations, have been attended with most beneficent results, and it is difficult indeed in these days to dissociate the Zeiss Works from the glass works.

\\Then Abbe and Schott found themselves possessed of the new kinds of glass, it naturally suggested itself to their minds to extend the consequences of the new achievements from the microscope to the other branches of prac-tical optics. The suggestion ripened all the more readily into action since it was precisely at this time that Abbe had begun clearly to realise the necessity of rendering the growing establishment less dependent upon the vicissitudes which imperilled the existence of an undertaking concentrating upon a single object of manufacture. The result was that an attack was launched upon photographic optics, and probably there could not have been a more pro-pitious moment for this departure. The first notable result of the new en-deavours was a photographic lens computed by Dr. P. Rudolph, which visibly surpassed the then existing types of lenses in their performance. The new lenses, the formula of which was worked out by Rudolph, based on founda-tions prepared by Abbe, were given the name "anastigmat," which has now become so generally used.

After many years of strenuous activity in other domains of practical optics, Abbe, astronomer that he was, was at last able to satisfy a long cherished wish, and thus to apply the optical and mechanical resources of the establishment to the ideal purposes of astronomy. Hence the establishment of the astronomical department. A more recent production of this depart-ment is the Zeiss Planetarium. The apparatus may be regarded as an as-semblage of eighty-two projection lanterns, by means of which all fixed stars which can be seen with the unaided eye, up to the sixth magnitude, as well

48

fl-IE SPECULUM.

as the sun, moon and the planets, Mercury, Venus, Mars, Jupiter and Saturn, are shown in motion on the inner surface of a hemispherical projection screen. All these projection lanterns are controlled by ingenious electrically-operated mechanisms, and the resulting appearances and movements are such that the spectators, hundreds of whom may be accommodated under this artificial sky, will have the impression that they are contemplating Nature's great heavens. Whilst the natural movements of the heavenly bodies are so slow from the human aspect that the mind behind the eye is unable to in-terpret them in terms of coherently related pictures, the mechanisms which control the movements across the artificial sky can be accelerated to such an extent that the spectators may see the processes which occupy days and years condensed into the span of a few minutes. They are enabled to study and understand these processes, unhindered by the vicissitudes which stand in the way of astronomical observation, and the mathematical mysteries of the planetary movements, those of the sun and moon, and the changes of the seasons are reduced to intelligently continuous and readily followed motions. It is not surprising that almost every spectator, who for the first time sees the stars shine forth on this sky on earth, unconsciously proclaims his delight and is stirred by a sense of revelation. It is not surprising, but it is also a lamentable proof of the veil of ignorance that curtains off the natural heavens from the mental eye of human beings. And when we remem-ber that millions of people in large towns hardly ever see the starry heavens at all, we cannot over-estimate the ethical and educational value of this won-derful interpreter of Nature's mighty rule in space.

In passing from the astronomical department, mention might well be made of the Zeiss prismatic field glasses, which merit special interest, in view of the wide appreciation with which they have met throughout the world. In these, the distance between the objectives is about double that between the eyepieces, and hence they roughly double the natural power of seeing in relief. For certain purposes, for instance, where surface-like bodies are to be viewed, glasses are so arranged that the distance between the objectives is less than that between the eyes. The various glasses are designed for use on travels, for watching sports and for hunting, as well as for use in the theatre and concert hall. Their manufacture has attained immense propor-tions. They are to be met all over the globe ; there is no country where they are not in use ; there is no modern army where they have not been intro-duced as service glasses. A notable advance was made about the middle of 1920, when the 70-degree eyepiece, invented in 1917, was made to furnish a means of bringing out the Zeiss wide-angled field glasses. These glasses, though scarcely heavier than the older standard glasses, embrace a field of view which is half as large again.

A further development of the use of prisms, such as those used in field glasses, led to the production of periscopes, range finders, etc., which were applied with such valuable effect during the Great War.

A department which, though small in output, has grown in importance of recent years is the measuring instrument department. This has been re-sponsible for the Abbe refractometer and its modifications, which have proved so valuable in industry, the interferrometer, stereocomparator, etc., etc.

The geodetic department has also been responsible for valuable improve-ments in surveying instruments, particularly in regard to securing greater accuracy.

Such an establishment as the Jena Works was not likely to enter upon the manufacture of spectacle lenses until scientific investigations by notable ophthalmologists of the underlying problems had furnished an answer to the

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question of providing maximum efficiency in its fundamental bearings and prepared its practical solution. When this stage had been reached it still needed the wide experience in theoretical and practical optics which Professor M. von Rohr, of the scientific staff of the Zeiss Works, was able to bring to bear upon the subject, before the first trigonometrical computation of a new order of scientific spectacle lenses could be carried out. As a result, Zeiss Punktal spectacle lenses are now produced in very large numbers. Shortly explained, they have the distinct advantage that, whereas vision through the outer margins of ordinary spectacle lenses is blurred and distorted, the fully corrected Punktal lens gives absolutely clear vision right to the edge of the glass. Whilst the Punktal lenses have been devised to provide a scientific correction of the common deficiencies of vision, attention has also been given to the matter of providing assistance for persons whose visual acuity is too low to be remedied by the wearing of ordinary spectacles. Telescopic spec-tacles and telescopic magnifiers are now available which will restore the ability to read to persons whose visual acuity has declined to even as low as one-fiftieth of the normal. The medico-optical department of the Zeiss Works has also provided numerous instruments and appliances—some of a most elaborate nature—for examination of all parts :of the eye. These have been invaluable to ophthalmologists in their studies, and surer methods of the treatment of eye troubles are the result.

No article on the Zeiss Works would be complete without some explana-tion of the principles on which the establishment is conducted, for it is nov-as might possibly be supposed—conducted for the benefit of a number of shareholders.

For nearly thirty years, from. 1846 to 1875, Carl Zeiss, the founder of the optical works, was the sole proprietor. From the latter date onwards Carl Zeiss and Ernst Abbe were joint owners. In 1881, the eldest son of the former, Dr. Roderich Zeiss, entered as third partner, but in 1888. a year after the death of his father, he withdrew from 'the management. In the year 1891 Abbe called into being the Carl Zeiss Foundation, named after his departed colleague, and he surrendered by a deed of gift his proprietary interests in the optical works and his rights as a, partner in the glass works. The charter of the Carl Zeiss Foundation was officially approved by the then ruling Grand Duke of Saxony, and on the 1st of October, 1896, entered upon the stage of full legal force. The revision provided for at the outset took place in 1905, and the revised charter has been in force since January 1, 1906. The owner, therefore, of the Zeiss Works is the Carl Zeiss Foundation. Its sphere of ownership embraces, apart from certain participations in other en-terprises, the optical works and the glass works, the latter until April, 1919. in conjunction with Dr. Schott, and subsequently as Foundation property pure and simple, Dr. Schott having transferred his share to the Foundation, and having exchanged his position as an owner for that of a member of the directing staff.

The Foundation is conducted by an administrative body appointed in accordance with Abbe's directions, provision having been made for the workers to enjoy 'certain bonuses and benefits ; these take the form of pension and housing schemes, instructional classes, etc., etc. Various scientific and public institutions have also received benefactions from the Foundation, par-ticularly the Jena University.

It has been said that the Carl Zeiss Foundation and its undertakings are nothing more or less than a co-operative association. In half a sense this is quite true. It is correct, inasmuch as no capital is introduced from out-side, instead of which the enterprise generates or augments its own capital,

D

50 THE SPECULUM.

and inasmuch also as in this case capital is not, as ordinarily, the master but the servant of the work. It is, however, incorrect, inasmuch as the course of the undertaking is not conducted by the associated workers, but by a permanent authoritative body, and inasmuch as this body is not responsible to the individual constituent members but to the whole only. However, the members do not co-operate in any way financially, but solely with their ability to work. Briefly stated, and to use Abbe's own definition : The optical establishment is a co-opertive association for production, but solely within the limits of its economic interests, and not in regard to administra-tion and management.

Hence the Foundation embodies only the good, to the exclusion of the dangerous side of the co-operative system.

Inaugural 'lecture to Mebical %tubentti of the Melbourne liomital, March, 1028

By B. T. Z\\ \ R, Dean of Clinical School.

On behalf of the Medical Staff of this hospital I extend a hearty welcome to those of you who are commencing your hospital studies.

The advances which have taken place in the fields of Medicine and Sur-gery have added to the complexity of the Medical curriculum. Those of you who are commencing your hospital work may find it somewhat difficult to properly assess the purpose and the relation of each of the subjects of our Scheme of Medical Education. Various factors have accentuated this diffi-culty.

There is, first of all, the lack of co-operation between the academic and the clinical divisions of the studies of the Medical Course. Owing to the location, in relation to the University, of the hospitals which serve as clinical schools, the academic or University part of the curriculum is more or less divorced from the clinical part. In the Medical Schools at home each school is self-contained, and in them there exists a close relationship between the academic and the clinical studies right through the student-years.

In the second place, our system of examinations tends to encourage the student to plan his or her work with a view to success in the examination of any particular subject, rather than on broad lines, and when the prescribed examination has been passed it is imagined that that subject is finished with and its relationship and application of its knowledge to what follows is lost sight of.

Now, the study of your preliminary subjects, Physics, Biology, and Chemistry, is intended to teach you certain important principles ; to train you to observe and to prove for yourselves the truth of certain established laws and to develop in you a scientific mind, so that you may draw correct con-clusions from facts which you have observed. These subjects are followed by those of Anatomy and Physiology. In Anatomy you have been taught how the human body is constituted normally ; whilst in your study of Physiology you have learned how such a normal body functions.

In the hospital work which you have now commenced you will be faced,

THE SPECULUM. 51

constantly, with problems, the result of an abnormal development in the human body or because it or certain parts of it have ceased to function normally.

It will be obvious to you that, in order to recognise and correct such abnormalities, it is essential that you should continue to keep yourselves well informed in your preliminary subjects of Anatomy and Physiology and the advances in them, and to apply your knowledge of these subjects to the solu-tion of the problems with which you will be faced.

I next desire to stress the value of clinical pathology, i.e., the collection and examination of specimens of urine, sputum, exudates, discharges, blood, excreta, etc., as an aid to the solution of clinical problems ; and equally in importance the regular attendance at post-mortem examinations, especially of of those patients which you have had an opportunity of investigating in order. that, by means of a careful correlation of the signs and symptoms obserVed by you with the post-mortem findings, you may either gain assurance or learn to correct the errors of your findings or interpretations. A post-mortem ex-. amination of a case which you have investigated will, more than anything else, help to add to your fund of knowledge, in that it will prove or disprove the correctness of your clinical findings or the conclusions based thereon.

I cannot impress upon you too strongly to avail yourselves of every opportunity of thus adding to your knowledge. You should bear it in mind and practise it right through your medical career.

In your investigation of morbid conditions you will be taught the use of various chemical, bio-chemical and physical tests; the results of some of these and of others will be supplied to you. When assessing their value you must give them the most careful consideration in the light of the clinical signs and symptoms present in the particular case under investigation. Always remember that the history, the symptoms, and the physical signs re-main the main channel by which a diagnosis should be made. Such•means as X-ray, bio-chemical, and the other examinations are there to complete, 'con-firm, correct or to throw new light upon, a diagnosis;

To introduce you to, and to aid you in, your hospital work, the Medical Staff of this hospital has compiled a small hand-book. It tells you what to look for and how. It is, however, essential that you should learn to observe and to reason for yourselVes and to form your own conclusions.

When you become members of the Medical profession you will have to shOulder certain obligations to your professional colleagues. - . These have been sanctified by long-continued custom and form a code of Medical Ethics. Their ultimate object is in the interests of the community. Your lectures on this subject 'will inform you as to your obligations...is this. direction ; and you should be most meticulous in carrying the advice -they Contain into practice.

In preparing yourselves for the profession of medicine remember always that it is the high ideals of this praession which haVe made it what it is. It is your duty to familiarise yourselves with these ideals and to live up to the same. The lectures and addresses of the late. Sir William Osler, published under the title of Acquinimitas and Other Addresses, give an excellent outline of these ideals, itid'eVery Medical Student should be:fainiliar with them.

Whilst you work in this hospital you are subject to certain rules and regulations .-di 4'w; up by the Gmiiiiittce of Management. .Yourrnist acquaint, Yourselves with these and oonforin - to them. ' ' • •

• 'T(i''tlie'SfCk - WhO'- -come• tinder your care or investig;ation always, extend the ,greatest possible''eOnsideration. and deal' with than as 'ycitt'your-' selves Willie to be dealt with under similar circumstances.

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Whilst you -are pursuing the study of medicine do not neglect your interests in other spheres of life, such as Sport, art, and literature, and if in your preparatory studies any of you have become proficient in modern lan-guages other than English, I would strongly advise you to continue to make full use of such an accomplishment. I can assure you that it will be a great asset to you in your post-graduate studies.

Your personal health and physical fitness . should always receive your closest attention. The work of the Medieal .course is extremely strenuous, and good work can only be done so long as you keep yourselves physically fit and well. Your work in the hospital, moreover, exposes you to certain dangers peculiar to its environment. There -is the special. risk of exposure to tubercular and other infections. It is a matter of experience that a num-ber of students become infected with tubercle during their medical course. In your hospital work it should be remembered that a factor of paramount importance in the production of tuberculosis is the presence of the tubercle bacillus; and that you should be careful to carry out precautionary measures ivherever risk of .infection exists.

• The possibility of the presence of the tubercle bacillus in your food, especially in your milk supply, should also be borne in mind and guarded against. You should particularly avoid risk of infection when your general health and resistance are below par.

The innocent infection by syphilis has been much , reduced since the diagnosis and:'eontrol of this disease have been placed on sounder lines by the use of biochemical methods and arsenical preparations; nevertheless, it is well that, in all ulcerations and inflammatory swellings, you should safe-guard yourself against risk of infection by adopting the necessary precau-tions of surgical` cleanliness.

Finally, I append a list of books well worthy of your perusal :

Aequinimitas, tuith Other Addresses. (Sir William Osler.) Counsels and Ideals from the Writings of William Osler. (Camac.) The Memoirs and Letters of Sir James Paget. (Stephen Paget.) The Life of Pasteur. The Masters of Medicine Series. Oliver Wendell Holmes—Breakfast Table Series, Life of Sir William Osler. (Cushing.) Recent Advances in Medical Education in England. (Sir George Newman.) The Life . of Lord Lister. (Godlee.) Interpreters of Nature. (Sir George Newman.) In conclusion, I wish that your work in this hospital will be full of in-

terest and that it will be crowned with success.

THE MEBICAL STUDENT IN ANTIQUITY.

Languid I lay, and thou earnest, 0 Symmachus, quickly to see me; Quickly thou tamest, and with thee a hundred medical students ; The hundred pawed _me all over with hands congealed by the north wind; Ague before I had none, but now, by Apollo, I have it!

MARTIAL.

THE SPECULUM.

be it 113 C of Vitamins (With Acknowledgments to the St. Bartholome w's I o'spital Journal.)

A.

Oh, fine and fat was Ralph the rat, And his eye was a clear cold grey.

How mournful that he ate less fat As day succeeded day,

Till he found each cornea daily hornier, Lacking its .vitamin A.

"I missed my vitamin A, my dears," That rat was heard to say ;

"And you'll find your eyes will keratinise If you miss your vitamin A."

B.

Now polished rice is extremely nice At a high suburban tea,

But Arbuthnot La.ne remarks with pain That it lacks all vitamin B,

And beri-beri is very, very Hard on the nerves, says he.

"Oh, take your vitamin B, my dears," I heard that surgeon say ;

"If I hadn't been fed on standard bread I shouldn't be here to-day."

C.

The scurvy dew through the schooner's crew As they sailed on the Arctic sea.

They were far from land and their food was canned, So they got no vitamin C.

For "Devil's the use of orange juice," The Skipper had said, said he.

They were victualled with pickled pork, my dears. Those mariners bold and free ;

Yet life's 'but brief on the best corned beef If you don't get vitamin C.

D.

The epiphyses of Jemima's knees Were a truly appalling sight ;

For the rickets strikes whom it jolly well likes If vitamin D's not right,

Though its plots we foil with our cod-liver oil Or our ultra-violet light.

So swallow your cod-liver oil, my dears, And bonny big babies you'll be ;

Though it makes you sick, it's a cure for the rickets, And teeming with vitamin D.

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E.

Now, vitamin D and A, B and C Will ensure that you're happy and strong ;

But that's no use ; you must reproduce Or the race won't last for long,

So vitamin E is the stuff for me, And its praises end my song.

We'll double the birthrate yet, my dears, If we all eat vitamin E.

We can blast the hopes of Maria Stopes By taking it with our tea.

—C.H.A.

Annual General Meeting of the (10.%.%. HELD IN THE ANATOMY SCHOOL ON THURSDAY, APRIL 9th,

AT 8 P,M.

Fallopius had done his work well, and all was in readiness for our annual gathering at 8 o'clock, but as the attendance was small until nearly 8.15 we commenced a little late-157 present.

Professor R. J. A. Berry was chairman, and in acknowledging his election as President of our Society stated that he appreciated the honour, and was always prepared to help the students all he could. (Much applause.)

The following Vice-Presidents were elected :—Professor Osborne, Professor McCallum, Mr. B. T. Zwar, Mr. W. A. Hailes, Mr. Hamilton-Russell, Dr. A. V. Anderson, Dr. A. M. Wilson, Dr. Murray Morton.

As the annual report for the year 1927 was on printed sheets, no time was wasted in reading it

The report read as follows :— Melbourne Hospital,

Students'. Room, April 4th, 1928.

Mr. President, Ladies and Gentlemen.— Your Committee has the honour to place before you the Annual Report and

Balance Sheet for the year 1927. Last year showed a still further increase in the apathy shown by the mem-

bers towards the doings of the Society. The Annual Dinner was cut out because of the poor attendance, and consequent financial loss, shown on that function in 1926. The Annual Dance was held at the Embassy. It was but poorly attended, only 70 students being present. Socially it did not approach the high standard of M.S.S. functions of the past. This state of disinterested-ness has even extended so far as to jeopardise the future existence of The Speculum. Students are not supporting their magazine, and the production of each new issue is becoming increasingly more difficult.

The M.S.S. library received valuable contributions from Mr. B. T. Zwar and Dr. R. R. Wettenhall, both of whom we thank. The entire libraries of the late Mr. Frank Andrew and the late Dr. G. M. Maggs were donated to the M.S.S. We thank those responsible for these gifts

THE SPECULUM. 55

We thank Dr. MacKeddie for presenting a prize for a Commentary. . The W. A. Hailes tennis trophy was not competed for this year. We

apologise to Mr. Hailes. The following having subscribed to life membership have been duly elected:

Dr. K R. Cordner, Dr. J. Rosenthal, Dr. R. W. Chambers, Dr. W. L. Arm-strong, Dr. N. H. Fairley, Dr. J. R. Bell. and Mr. P. W. Farmer, junr. Dr. H. A. Body, Dr. R. Ellery, and Dr. I. J. Wood, in recognition of their ser-vices to the Society, have been elected honorary life members.

Medical students and practitioners sustained a great loss in the death of Dr. Richard Bull (Lecturer in Bacteriology). He was indeed a great friend of the students. Another popular member of the medical profession—Dr. G. M. Maggs7–also died an untimely death. To the relatives of both these gentlemen we extend our deepest sympathies.

Owing to his unceasing efforts, under adverse conditions, Mr. E. K. Rodda (the editor of The Speculum) delivered to us Specuhinis containing a number of very useful articles.

The Treasurer's Balance Sheet shows a satisfactory financial position, as. although we started last year with a credit balance of £17/5/6, there was an account, outstanding for L24/13/6. At the conclusion of the year we show a clear credit of i17/0/7. This position has only been reached by sacrificing the dinner, and curtailing any other M.S.S. activities that were apt to be a charge on the funds.

The year reps. have on the whole collected their subscriptions well, but some have failed lamentably. Next year Mr. Oxer—our new Treasurer—will tighten up this loophole, but in reality the satisfactory state of the accounts is entirely due to the ceaseless activity of Mr. Grove in collecting Speculum sub-scriptions from old boys.

The following have been elected office-bearers for the year 1928-29 :— Hon. Secretary : Mr. S. W. Williams. Hon. Treasurer : Mr. G. M. Oxer. Editor : Mr P. G. Reynolds. Business Manager : Mr. J. Grove. Manager of Medleys: Mr. N. Cust.

In conclusion, your Committee would like to see the members take a more decided interest in the affairs of the Society.

On behalf of the Committee, NOEL S. WILLIAMS,

Hon. Secretary.

The "Freshmen" were then welcomed to the Society and cordially elected members.

Mr Farran gave forth a scheme for stabilising our dwindling annual func-tions, whereby each member should pay a subscription of entitling him to one ticket for the dinner and one for the ball. It was not well received, and Mr. Oxer struck the audience's fancy by moving an amendment to have the subscription 7/6. This was carried unanimously (150 to 6).

Professor Berry then introduced Dr. Hamilton Fairley. who had been investigating the nasty ways of the snakes in India, but was now carrying on similar work at the Walter and Eliza Hall Institute of Research. A most entertaining and instructive address followed, with occasional hair-raising sen-sations on the part of those in the front row as "Pambo" walked past with a wriggling death adder or tiger snake in his hands. Dr. Fairlev was intensely

56

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practical, and showed the rapid action of snake venom on laboratory animals. An insight into part of his own researches was given in the demonstration of the impressions on dental wax of the snakes' jaws on biting.

A hearty vote of thanks was accorded the lecturer for the unique demon-stration and address, and for the large amount of trouble which he had taken in their preparation. Few annual meetings have been enjoyed as much as this one was, and the satisfied audience dispersed at the late hour of 10.15 p.m.

Lag of the last $pirocbaete S.P. was a wrathful bug to see, And a wrathful bug he well might be ; As he swam around in solitary state He howled aloud at his dismal fate ; For he the last of a family old Was held in thrall by a scientist bold. "Here's me in the midst of human brine," He howled; then dropping his voice to a whine, He prayed his captor to set him free, If only to go on a temporary spree. But his captor gave him a wintry smile, For he was immune to a spirochaete's wile. The scientist bold took a platinum wire, And soon it was shining red-hot in the fire. S.P tried to dodge underneath a lamella, His crafty cell-nucleus far down his flagella. Then gnashing his gums, he swam in full flight, And inside a pus-cell he stayed for the night. The following day was dreary and cold, And S.P. was looking world-weary and old. When suddenly down came a bolt from the blue ; He sprang to attention—one turn of his screw. The bolt from the blue was a platinum loop That caught S.P. up in a terrible swoop. His master gave vent to a cynical laugh The whiles he invented S.P.'s epitaph. Still laughing, he was in a whimsical strain, What time he piled on the Giemsa stain. At once our friend Pallidum started to bleat, And craven in death proved no true spirochaete. And as he lay backwards to yield up the ghost, He thought of the man who had been his last host, This man was a squire of lowly degree— A Master of Arts and a double L.B. This host had treated him long and well-.krseno-benzol and HgC1.*

*Presumably Ung. Hyd. Subchlor.

THE SPECULUM. 57

S.P. was a doleful bug to see, And a dolorous bug he well might be. For was he not dyeing a brilliant pink Without the comfort of Indian Ink? With curling twists of his tail far-flung, He died, tmhonoured, unwept, unsung.

Extracts from our Commonplace 800I "THE SEVEN AGES OF MAN," CLINICALLY DESCRIBED.

Causes of Acute Retention.

1. "The infant; mewling and puking in the nurse's arms." The cause of his retention is undoubtedly either extreme phimosis or atresia meati.

2. "The whining schoolboy, with his satchel," has probably a stone in his bladder.

3. "The lover sighing like a furnace" is likely to be a case of retention following acute urethritis.

4. "The soldier, full of strange oaths," has almost certainly a urethral stricture.

5. "The justice, in fair round belly with good capon lin'd," is highly prob-ably a case of prostatic enlargement.

6. When "the sixth age shifts into the lean and slipper'd pantaloon," a common cause of acute retention is cystitis complicated by ropy mucus.

7. And the last age "that ends this strange, eventful history" is atony of his bladder."

HAMILTON BAILEY (Physical Signs: in Clinical Surgery).

"It is useless for a man to attempt to dictate as to what an insect appre-ciates and what it does not. An insect possesses sense-organs unrepresented in us or in any vertebrate. We may know the young mother is wrong when she says her baby makes some response because the angels are whispering to him ; we may guess that satisfactory peristalsis is at the root of it. We may be sure the spinster is incorrect when she diagnoses all the hidden meanings in Fido's actions ; what she postulates to be anxiety on her account may be due to nothing more than the presence of ecto- or entero- parasites in the dog.

"When we speak thus of clothing we regard it more as an expression of the quality of the internal nervous system than as a protection from the weather, or as a guarantee of modesty ; and, indeed, we have much justification for so regarding it. Ornament is earlier than clothing. The paint and the shell neck-laces of the Aurignacian culture paved the way for the bone sewing needle of the Solutrean. It would, however, be more in accordance with modern good taste to consider woman's love of dress as an expression of her innate modesty ; but it would also be quite legitimate to speculate if it were not due to the fact that she is, at heart, a rake.

58 THE SPECULUM.

"Suppose we meet a man who, in every visible character, evinces a makeup that we would estimate belonged to a cut-throat. We may yet see that man deport himself like a school miss and utter the sentiments of a young curate. These things do not invalidate our thesis—they would not deceive a woman who had intuition. The chances are that the man looks like a cut-throat and is a cut-throat ;'but knowing himself to be a potential cut-throat he hides his apti-tudes in this direction under some other guise. We may know that we look meek and are meek ; the more reason, therefore, to act as though we were bold. Many a one with a harsh exterior and with' a harsh nature, from which sympathy is lacking, realises the lack that is in him. It is this person who would not feel a pang of sorrow at reading the obituary notices of yourself and the whole of your family, yet insists, at any chance meeting, on the most eager inquiries concerning your health and that of your dear wife and the children. This is where man has introduced a complication into an otherwise very simple state of affairs. Being a sparrow, and knowing he is a sparrow, he yet may act the robin. Of a truth we may all wear a cockade. Where would most of us be in the esteem of our fellows did we not appreciate the proper employment of panache. It is for the student of his fellows, be he a physician or policeman, to discriminate between the panache and the patient."

F. WOOD JONES (The Matrix of the Mind). * *

"Not only is the saliva made use of for a great variety of purposes, and numberless articles are for one reason or another placed in the mouth, but, for no reason whatever, and all unconsciously, the fingers are with great frequency raised to the lips or the nose. Who can doubt that if the salivary glands secreted indigo the fingers would not continually be stained a deep blue, and who can doubt that if the nasal and oral secretions contain the germs of disease these germs will not be almost as constantly found upon the fingers? All successful commerce is reciprocal, and in this universal trade in human saliva the fingers not only bring foreign secretions to the mouth of their owner, but there, exchang-ing it for his own, distribute the latter to everything that the hand touches. This happens not once, but scores and hundreds of times during the day's round of the individual. The cook spreads his saliva on the muffins and rolls, the waitress infects the glasses and spoons, the moistened fingers of the peddler arrange his fruit, the thumb of the milkman is in his measure, the reader moistens the pages of his book, the conductor his transfer tickets, the "lady" the fingers of her glove. Everyone is busily engaged in this distribution of saliva, so that the end of each day finds this secretion freely distributed on the doors, window sills, furniture, and playthings in the home, the straps of trolley-cars, the rails and counters and desks of shops and public buildings, and, indeed, upon everything that the hands of man touch. What avails it if the pathogens do die quickly? A fresh supply is furnished each day. Besides the moistening of the fingers with saliva and the use of the common drinking cup, the mouth is put to numberless improper uses which may result in the spread of infection. It is used to hold pins, string, pencils, paper and money. The lips are used to moisten the pencil, to point the thread for the needle, to wet postage stamps and envelopes. Chil-dren 'swap' apples, cake, and lollipops, while men exchange their pipes and women their hatpins. Sometimes the mother is seen 'cleansing' the face of her child with her saliva-moistened handkerchief, and perhaps the visitor is shortly after invited to kiss the little one."

CHAPIN, quoted by Rosenau (Preventive Medicine and Hygiene).

THE SPECULUM. 5.9

flOr.lBarber's flObress On 16th May a very interesting lunch-hour address was delivered to the

University Branch of the M.S.S. by the Rev. J. Andrew Barber, Mr. G. M. Oxer presiding. The subject was "Medical Conditions in Central Australia." Mr. Barber is organising the "Flying Doctor" scheme or the Aerial Medical Service, which, with the co-operation of the Commonwealth Government, has just been inaugu-rated at Cloncurry, in Queensland, by the Australian Inland Mission. It was decided during the war by the A.I.M. executive that aeroplanes and wireless form the only method of providing medical attention wherever needed in the "Never-Never," and the appointment of Dr. Welch as Flying Doctor is the culmination of a dozen years of hard work and organisation.

In Central and Northern Australia the big problem is, How to make life endurable for the few white people—and especially the women—who must live lonely and isolated lives if the great inland is to be used at all. In country where about 4000 head of cattle are required to make a living, and which will support only one bullock to four acres, the distances between homesteads are obviously very great. The A.I.M. has set itself the task of solving the big problem men-tioned, and one of the means used has been the establishment of about a dozen nursing homes in West Australia, Northern Territory and Queensland. These used to be called hostels, until in Perth one time Mr. Barber in an interview told the reporter he was going North to visit the hostels. Next day the paper stated that "the Rev. j. A. Barber was setting out on a 7000-mile trip to visit all the pubs. in Northern Australia." Each nursing home is in charge of two highly-trained nurses. Each home has club rooms attached, and the nurses, when not busy with patients. make these the social centre of the district, thus doing a great deal to make life more pleasant for the lonely settlers. The home is the medical centre for hundreds of miles around, and the fact of there being medical aid available is a tremendous safeguard to the small and scattered white popu-lation. Dread of the results of any possible accident is minimised ; and white women, who might otherwise not dare to venture out into the hack country, will go out with lighter hearts, knowing that at the time of confinement skilled medical attention will be available.

The Mission has now gone a step further. It has provided nurses and hos-pitals, and now it is going to provide doctors. Recently Mr. Barber and Dr. Simpson, a Melbourne graduate, toured the North, making a final study of the matter, and as a result several strategic centres have been chosen, such as Port Headland, Hall's Creek, Alice Springs, and Cloncurry, from which zones of 300 miles' radius could be worked by a doctor with an aero ambulance at his dis-posal. Means of communication between homesteads and the hospital are. of course, essential, and for this purpose wireless is to be used. This can also be used for ordinary conversation, another big step towards making life more pleasant for the settlers. Incidentally, no suitable wireless installation was avail-able, but the A.I.M. itself, after considerable scientific investigation, has at last devised a set weighing only 50-60 lbs., which can be turned out for some £33, and which will transmit 2000 miles.

The results already achieved by nurses who are not afraid to swim flooded and crocodile-infested rivers, half a mile or more wide, in order to reach a patient are a splendid record of service, and it now remains to he seen how much more can he achieved by a highly-trained medical man with a well-equipped hospital and an aeroplane ambulance at his command.

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e (,„ Xabes -

Ma Chere Marie,— I hope you have purchased your ticket for the Medical Women's Dinner.

The ruling element is Scottish, but you need not fear. You never can tell, but I think it's more likely to be a crayfish we'll be having than haggis. We have placed a ban on crayfish in the Women's Room, though. It's all very well seeing a crayfish now and again, but as for living with one while its owner is on Cas. is rather more than we can abide.

We have been falling over one another of late in the Women's Room. It's most disconcerting to find twenty pairs of legs where you want to stand, at least two coats on your own particular hat peg, and enough noise to deafen a donkey.

We had great joy in cheering up the Fourth Year people before their first day of case-taking. Our star raconteur kindly offered to accompany all and sundry around to their eases and hold their hands. I am not sure, but I do not think anyone accepted her offer. Our Sixth Year sisters are, at present, like the winter sun, seen for a few brief moments, when they endeavour to speed our lagging footsteps, and then they are lost behind the mists and clouds of Osier, Price and Tidy. We have been enjoying a fairly tolerable existence, despite specials and eight-thirties. These particular inventions of the Evil One are not at all popular.

• We have finished one fortnight on Cas., which was quite an education for us. We had not dreamed before that we were wasting our time doing Med. and that we ought to be married. But, then, before we went on Cas. we had not made the acquaintance of D.X. That means more than meets the eye, at first, as you will some day learn. When you have tripped over the feet of an ataxic member of the community, and heard as you recovered yourself, "Wonderful woman, wonderful woman, long 'air, too, none o' yer bobbed ones," you will perhaps understand. One of our number was told that she was "the best one with a knife around this 'ere joint." One grateful patient's farewell was : "Good-bye, miss, thank you very much, miss ; I hope you'll turn out to be real clever. You know, some of the women are better than the men."

At present we are preparing for our stay at the Women's. I might tell you we do not expect to return alive ; in fact, we have already apportioned our lockers and hat pegs to certain members of the Fourth Year. It is rumoured that the mortality from frostbite is very high among the students there, who find eight-thirties over • in Walter and Eliza the warmest paft of the day. We expect to find the aforesaid eight-thirties no difficulty in a few weeks' time, since

THE SPECULUM. 61

we gather from 'some that our beds at the 'Women's are never inhabited. Did we not remember the teaching of our Professor of Anatomy we should be dead from fright already. However, we have not forgotten the terrible fate of the woman student who listened to the other students. Well, my child, the fire is burnt out, and I must bid you good-night.

Ton amie d6youee, CORINNE.

CorreeponOence To the Editor, The Speculum.

Sir,—No doubt everybody has been wondering what is the reason for my long absence from the pages of this magazine. I know you all read eagerly of my wonderful experiences in private practice.

Since settling in Canberra, from which I wrote my last letter, I have had plenty of time for research work. I am now in a position to tell the world of my new invention for operating on hxmorrhoids. The accompanying picture is a photograph of it. As there are not many people in Canberra who are afflicted with that dread disease of piles, in the meantime I have lent the instru-ment to the Melbourne Harbour Trust, who seem to have taken a great fancy to it. I have only lent it to 'them so that if any patient with piles should turn up I can easily get them to send it up to me.

62

THE SPECULUM.

1 would be very much obliged if any of you fellows could give me and my machine a trial. Perhaps some of the surgeons at the Alfred might let me try it on their patients.—Yours very sincerely,

AMBROSE MUD, M.B., B.S.

To the Editor, The Speculum.

Sir,—I have just finished reading the section devoted to "Dreams" in Pro-fessor Berry's new work—Brain and Mind. This subject, always an absorbing one to most people, has recalled somewhat vividly a' most extraordinary dream or, perhaps better, hallucination, which I myself quite recently experienced.

It took place on Gala Night, Commencement, 1928. Sitting in a lecture room in the new Arts building with some friends, I was enjoying a witty and most original performance presented by the very talented members of the Medical Medleys. Suddenly and without a moment's warning the scene shifted. The drab and uncomfortable surroundings of the lecture room gave place to the upholstered splendour of the Tivoli Theatre, Bourke Street, and to my utter amazement I realised that once more I was witnessing the Review of 1927, featuring Olsen and Johnson, the American humorists.

Indeed, the effect was so profoundly realistic that I even experienced the sharp nips of pulex irritans, and immediately a scratching reflex came into action. The heavy fumes of beer, pickled onions and garlic (I always patronise the cheapest seats at the Tivoli) enveloped me like a cloak, and there before my very eyes grimaced and gibbered the famous comedians. The charming voice of Olsen, singing his latest song hit, was quite as offensive as usual, whilst the handsome face of Johnson, distorted by an ingratiating grin, was as vacant-looking as ever.

Quite suddenly the scene again changed, and I found myself back once more in the lecture room. Mechanically standing up, I moved slowly to the door with the crowd, and once outside a reviving breeze played gently on my forehead.

Now the fact that I had actually been to a show of some sort was undoubted, for I distinctly remembered paying my admission money. It seemed equally clear that the show was the Medical Medleys, and yet—well, I have been forced to the conclusion that I dreamed.

The dream was commonplace enough in itself, but there is one interesting point to be noted, for last year at the corresponding time I had another strangely similar dream. In that case, however, the swiftly-changing scenes moved between the Capitol, St. Paul's. The Diggers, Bedlam, and the Mad House.—Yours, etc.,

J ACQUES.

One of our well-known citizens received a great shock the other day. His false teeth were missing. After searching in every conceivable hiding-place, he came, reluctantly and fearfully, to the conclusion that he had swallowed them. He told a sympathetic friend of his mishap, and the friend told him that he would have to be particularly careful when travelling in the train. "Why ?" anxiously queried the victim. "So that you don't bite the buttons off the seat."

■

THE CiESfIR fir' THE ZOO

THE SPECULUM. 63

$ome ll)bp6tological Gems (A prize will not be given to persons identifying the author of these statements.)

"The pituitary body is the divinity which shapes our ends." "—and by chicken I do not mean those athletic veterans of the farmyard." "Six years of arduous study and people forsake you for the advice of an

ancient neighbour." "The proper diet of mankind is man—but there are certain considerations

weighing against . this." w "In France we make the acquaintance of fat in very unexpected places."

"Man is a spendthrift, but woman is a bargain hunter, even in calories." "Periodically over Parliament is poured the assuaging balm of silence." "—but he, of course, spoke to politicians in terms which they could under-

stand—lies." "Galvani, whose name is for ever enshrined in galvanised iron." "Cucumber is 96 per cent. water and 4 per cent. 'such stuff as dreams are

made on.' " "After some years the cup that inebriates as well as cheers finally encar-

nadines the proboscis." "It is the ambition of every soap maker to make a yard of water stand

on end." PHYSIOG.

64

THE ' SPECULUM.

SCraPinge

By "CURETTE."

ALAN'S EAR. It is rumoured that Alan turned up for treatment at the M.H. one day

last term with an everted ear-drum. He gave a history of having taken hori-zontal refreshments the night before.

Curette has not yet been able to ascertain whether the lady's name was Vacuette or Electrolux.

ARTHUR'S CHIN. Small beginnings sometimes lead to great things. Who would have thought

that Arthur, when he started playfully to crunch liqueur glasses, would progress through wine glasses and hotel tumblers till lately a bloody scar on his chin bears witness to his latest feat of biting a pint-pot in twain? There may yet be some-thing greater to come, for Curette recently came upon Arthur in the privacy of his room eyeing tentatively a more massive receptacle.

LES PRECIEUSES. Those who bewail the lack of social life among medical students should

attend the Salon held every afternoon at Table 3. the dissecting room. Here, over the marble slab, becomingly decorated with interesting portions of H. Sapiens, beauty vies with beauty, and wit with wit. Though Sid and Dolor are habitues, a popular M.H. man has shown a lingering affection for the Anatomy School. He is a firm stayer, but rumours of a combination of junior student, bridge parties and the theatre, indicate, that his turn, too, may soon end.

Curette is eighth on the waiting list.

LITTLE ETHYL AND THE YOUNG STUDENT. The Honours class in Imbibition has several vacant places open to pass

students and freshmen desiring to increase their capacity and improve their technique. A charge is made for material consumed only.

One of the most brilliant members, when admitted to the class quite recently, was unable to detect even large quantities of whisky in the beer sup-plied to him in the course of his entrance examination. As a result of this and subsequent training he is now a firm believer in the axiom "Whisky-beer, very queer." his volumetric work and vital capacity have greatly improved, and he is even said to be conducting original research on his own account.

YOUTH HAS ITS FLING. A credible witness told Curette a curious tale. Attracted by the sound of scuffling and laboured breathing, he glanced

behind the curtain which conceals the rear elevations of the Venus of Milo and her scantily clad companions from the curious gaze.

The sight encountered was one calculated to shock one of less puritanical outlook than this poor fellow, who fled incontinent to recount with tears in his eyes how he had seen two maidens whose beauty had erstwhile been exceeded only by their virtuous demeanour panting in the embraces of their ardent swains.

Curette, after a few moments of horrified misgiving, found on further questioning that these young people's actions were probably not understood, and it seems not unlikely that they were merely dancing.

THE SPECULUM. 65

Now the act of dancing, as performed by the latest importation at the Embassy, is, under certain conditions, in danger of being greatly misconstrued, especially by such unworldly, not to say unearthly, beings as some of our live specimens at the Anatomy School.

Therefore, Curette, out of the wisdom of iexperience, suggests that the exhi-

bition of some form of musical instrument is indicated to prevent any misunder-standing of the true nature of the postures and writhings of the participants. Sid, at least, could bring his ukulele.

THE MADONNA OF THE SLEEPING CARS. Our Matrimonial Committee is investigating the possibilities arising out of

Ramsay's alleged adventures on the Mildura train during the last vacation. In our next issue we hope to publish full details for the benefit of those

interested in the possibilities of romance on the rails. .

A CONTRADICTION.

There is absolutely no truth in the rumour that Messrs. Olsen and Johnson intend to sue the producer of the Medical Medley's for breach of copyright.

THE THREE WISE MEN. A philosopher, a neurologist, a sporting journalist and lineal descendant

of Ananias adjourned last vacation to the journalist's week-end shack, shooting box, hunting lodge, or whatever he may call it, to repair the bodily ravages and chromatalysis resulting from their first half-year in hospital.

Although they doubtless, as is their wont, solved the problem of the uni-verse, Curette is anxious to ascertain how the great minds of this ethereal trio solved a more sordid problem when the journalist accidentally burned to the ground an outhouse that subserved an humble but essential function.

A FLUTTER IN THE DOVECOTE.

Professor Berry recently complained of excessive noise from a room on the ground floor Curette has ascertained that at the time complained of there was a heated argument in the Women Students' Room between Miss X— and Miss Y as to who would he the next to ensnare Jim's vagrant affections.

LOVE LAUGHS AT LOCKSMITHS. Talking about love, those in a position to know best assure Curette that

there is no foundation in fact for the story that when our most susceptible colleague steps in to seek comfort in the flowing bowl the local publicans lock up their wives.

A STAGE WHISPER. The producer of the Medical Medleys, like Oscar Asche, that other great

actor-manager, is a great stickler for perfection of detail. Everyone at Com-mencement was impressed by the beauty of the stage settings and the graceful dancing and good looks of the ballets. He spares no trouble or expense in his search for suitable types ; in fact, Curette, chatting behind the scenes, heard that the great man had found it necessary to discharge a complete ballet at the eleventh hour and replace it with a more truly girlish company.

66 THE SPECULUM.

MEDS. DANCE BY PROXY.

All loyal Meds. will be glad to hear for the first time about the IVL.S.S. University Branch dance this term. It was a great success, being well attended by students of Law, Engineering, Arts, Agriculture and Architecture. The committee was greatly encouraged by the attendance of fully a dozen Meds. The Colleges were also represented, but he came late and went home early.

THE HORROR OF IT!

The rhythmic waves of sex-appeal which flood the dissecting room during certain hours of the anatomical day become at times almost unbearable, and several good men are said to have gone down under the strain.

Our worst case has become a dipsomaniac, and has paranoidac delusions of persecution. Another is prey to nareiscism, and wears a different suit every day.

Normie has been found making compulsive movements, which Albie diag-nosed as being due to a massage complex, and is trying to sublimate by the methods of Berry and Freud.

Working along different lines, Curette has recently traced the source of the trouble by shadowing certain figures clad in motor coats, who always make for one spot, attracted apparently by some chemotaxic mechanism.

Having located the fair broadcasters of It, Curette, though hardly yet in the running, does not altogether despair of gaining at least a scraping acquaintance.

CORYZA.

The seven deadly sins which all mankind Must shun, lest haply in the soup they fall, Are manifest and clear to one and all, And most avoid them. Yet the mind In safe presagement of their snare, is blind To others ; subtle serpents that appal When once perceived, and hold as bird in thrall The victim, trembling, yet to death resigned. So, "Rupert," Colonel of the scalpel keen, In visage grim and gown of white attired, Waging stern warfare on some hug unseen, Meet was it that the erring nurse he fired Who, in your presence dared, when need arose, TO GET A FIFTH-YEAR MED. TO WIPE HER NOSE!!

DOWNSI DEUP.

THE SPECULUM. 67

from a Patient was actually written by a qooman patient (This in one of the Medical Wards

of the Melbourne Hospital.—Ed.)

This life of ours Was surely never meant to be As in its nakedness it is ; Unhealthy, sick, in squalid dark Of Ignorance, nurturing the fester That eats up health. Repeating Loathsome habits day by day, Till little children come To hear the loathsomeness, and carry on Their parents' beastliness. just God! C) why this curse on us? To me who would see Mankind Fair to look upon, with naught grotesque,— I want to see a world as fair Within its city deeps As in Thy wide-spaced highways Where ihe heavens' blue clearness Canopies 1711Y handiwork, More beautiful than e'er was wrought by Man.

Rut here upon this bed the nights and days Are filled with ghastly sound, inhuman cries, That rend thro' my racked brain, and spoil All else for me.

Man, built in this, Thine image, Here set upon by filth without and in. 0 God, is this Thy creed?— Thy mercy ?—God, how long, how long?

G.N.

an Anatomical 11Zbap6obv Oh, come where your comrades carve up the cadaver,

And catch hold of colons with culpable claws, Where they, cleave through the carpus and cut up carotids.

And cover the corpse for the good of the cause.

Where glottis and gullet and gingivae gather, And Galen, Gennari and Gudden all listen,

While gay Gracomini gesticulates gladly, Gianuzzi gallivants with the capsule of Glisson.

Where the pancreas plays with the peritoneum, And pleurae parade with the primitive streak,

Where the pronator passes the time with a plexus, And premolars make every effort to speak.

68

THE SPECULUM.

So bury your Berry and burn up your bone set, Brace up your biceps and brachial veins,

Burst through the bursae and blow up your bronchi, Bestir your basilic and brush up your brains.

Yes, fly where the formalin gives off its fragrance. With fatty effluvia well up to the fore,

Where fairy-faced flappers flit round in profusion, And Fallopius flicks off the flesh from the floor.

Ebe 1Rinhe anpoterp Silas H. Ninks sat at his monumental mahogany desk, his head in his

hands. His office on the twenty-seventh floor of the Skinner Building was silent except for the soft ticking of a beautiful clock and the mutter of traffic arising from Bull Street below like the lazy droning of far-away bees. Occasionally a low moan came from his lips.

One—two—three—four—five ! The vibrant melody of the clock rang out, and the great financier raised. his head for a moment, regarding it fixedly.

Five o'clock ! So his hour had come. For a minute longer he bowed his head in silence, and then, galvanised into action by the very silence itself, reached feverishly into a drawer of the desk and drew out a sinister-looking object. He stood erect, glanced once more around his private office, and deliberately placed the revolver against his left temple. The bark of the weapon echoed emptily around the room ; and Silas H. Ninks, financial wizard and multi-millionaire, was no more.

"Here, Arnott! There's something bloody funny about this Ninks affair. The old goat blows his brains out all over the glorious Persian rug, and the ensuing investigation reveals that the great Ninks has only 500,000 dollars left of his supposed fortune. Business had not hit him so hard as all that; but there was some leakage Bank reports large withdrawals of big denomination bills and gold certificates over the last ten years, and greatly increased within the last twelve months. See if you can find out what blood-sucking skeleton lies behind this." It was the editor of the Megaphone instructing his pet staff criminologist. The suicide of Silas H. Ninks had greatly thrilled the nation and the press, especially the tabloid' variety, were having great fun with this nine-day wonder.

"Uh-huh!" was the criminologist's trenchant comment, and, turning rapidly on his heel, strode from the inner sanctum to seek the stimulation necessary in solving such problems at the nearest petrol pump.•

For three days the Megaphone office knew not the lugubrious and exacting presence of Arnott, and rumour was rampant. Some said that he was hot on the trail 'of an international organisation of financier-destroyers, others that he was working out a mathematical theory of the suicide with the aid of a book of navigation tables and a volume of crosswords for beginners. But the editor sat firm and worried not. He knew his pet criminologist.

THE SPECULUM. 69

It was on the eve of the fourth clay that the prodigal returned—haggard and worn, but with the light of triumph glowing in his eyes. Omitting the formality of knocking, he strode into the holy of holies and confronted his chief with a wad of copy paper and a sheaf of photographs.

"There you are," he grunted, and promptly collapsed. Here is the elucidation of the great Ninks mystery, which was never made

known to the aesthetic patrons of the tabloid press for financial reasons. Here it is in all the glowing inspiration of the report of the superhuman Arnott.

"Great has been the stir created by the death of the famous financier, Silas H. Ninks, and the consequent revelation of his financial state. Rumour has been rife, and it is due to the great reading public to expose the false insinuations of certain sections of the press.

"Ninks was not a knave. Perhaps he was a fool. At least he was the victim of an obsession and the machinations of an inimical international com-bine of business men. Until yesterday it was not known to anybody but Ninks' clam-like valet and the combine mentioned that Ninks suffered from a very peculiar aberration.

"After days of unremitting toil and investigation our special investigator made a visit to the Ninks mansion last night, and with certain facts he had gathered succeeded in third-degreeing the oyster-valet of the dead man, and sifted the truth of this sensational matter.

"The most peculiar manifestation of a strange obsession was discovered. "Ten years ago, Ninks, awed by his own growing wealth, bethought himself

of a way to be constantly reminded of his consequent responsibility to himself and his business. He started lighting his pipe with a fifty dollar bill, but then he was ordered by his doctor to give up smoking. Next he started to paper his study with gold certificates, but when this was barely started he discovered dishonesty in his workmen and discontinued this project.

"For a while he was in despair as to the means of accomplishing his desire. He was determined to have a constant and steady reminder of his wealth in a very obvious form, as his memory was not quite what it used to be. Finally it occurred to him that he must associate his desire with one of the necessary functions of life. He could not breathe ten dollar bills ; he could not eat gold certificates ; he could not sleep stocks and shares ; he could not drink pearls ground in wine, as his doctor had also forbidden him alcohol. Then there came to him the glowing idea associated with the least dignified of all the necessary functions of mankind.

"Without delay he built in his various homes and offices luxurious strong-room cubicles, to which he alone knew the combination, and retiring to one of these regularly each day was cleverly reminded of his responsibilities by his necessary use of gold certificates and bills of big denomination.

"Under normal circumstances this should have given no cause for alarm, but just one short year ago this strange secret came into the possession of an opposing financial . syndicate by some devious means.

"For long they pondered it. Could they bring about the ruin of their opponent by this. The senior member of the syndicate spoke of publication of this secret, but it was pointed out that this would have no effect on the financial status of Ninks. It was the junior member of the insidious syndicate who hit upon the Napoleonic plan that brought about the downfall of the financial colossus.

"By subtle scheming he introduced a trusted servant of his into the Ninks

be as cook, and supplied her with a rare but highly effective purgative, to

be administered in dishes prepared. So began the downfall of the great Ninks.

70 THE SPECULUM.

"He could not free himself from a usage of ten years. He must have big hills and gold certificates in his retiring rooms. With tears in his eyes he besought the greatest doctors of the land to rid him of this undignified affliction which sent him flying to his bizarre strongrooms at all hours of the day and night. But the matter baffled the best of the profession, working as they were in the dark.

"At the same time as this the opposing syndicate made a strong attack on Ninks in the great Bull Street Exchange. Normally the financial giant could have withstood this drain upon his immense resources, but with the other unknown drain on health and wealth he was lost. For a year he fought gal-lantly on, but, finally, down to his last half-million or so, with poverty staring him in the face, he gave way to the terrible strain, and took his own life."

Having read this far the editor of the Megaphone cursed low and fluently, and reluctantly consigned the report to the waste-paper basket. For was not the syndicate referred to deeply interested in the financial side of the Megaphone? So was the world's greatest newspaper story lost to the light of day.

BUSTER.

konnep's Antos On Wednesday, 2nd May. over two hundred members of the M.S.S., with

several of our Professors, Lecturers and city practitioners, met in the Anatomy Theatre to hear Mr Victor .Bonney, F.R.C.S. Seldom has there been delivered in the Anatomy Theatre an address so dignified, so charmingly phrased, so quietly eloquent, as that which we were privileged to hear on that occasion, and not one who heard it went away with other than an enhanced idea of the profession of which M r. Bonney is so distinguished an ornament—distinguished in speech, in hearing, and in achievement.

At the outset Mr. Bonney referred to the dfference between operating and surgery. Operating is a skilled trade : surgery is an art. Two postulations were given for the attainment of proficiency in this art—time and work. Men's capacities vary, but in all cases several years of hard work are necessary to gain the mere rudiments: but from then on the surgeon should improve during every year that lie is spared to carry on his great work. Man is, however, naturally lazy, and a stimulus to the cerebral cells is required. There are two such stimuli, interest or gain, aspiration or ambition. Most great men mix these two.

The sheet-anchor of surgery is anatomy. Good surgeons spend much time demonstrating in Schools of Anatomy. Co-equal with this is pathology, learned not in books but in the research laboratory. Nothing so fits the mind for surgery as the altruism and imagination cultivated in a pathological laboratory under a good pathologist. Knowledge of general medicine, too, is essential. Surgery does not oust the physician. An operation is a therapeutic measure just as are other methods of treatment. Surgeons who do not recognise this are apt to degrade their art to mere nechanicalism • In Mr. Bonney's opinion, phy-sicians are, on the average, of high intellectuality than are surgeons. There is nothing heroic in operating except the heroism of the patient. There is, how-ever, something heroic in surgery.

THE SPECULUM. 71

There could he nothing better for a young surgical practitioner than to serve under a great surgeon. Most great surgeons have, themselves, served under great surgeons. Yet a man must not become a mere mental parasite. Pickings from the work of great men spells mediocrity. One must he independent in mind. Two other qualities are also requisites--memory and imagination. Memory, properly used, enables one to deduce. imagination, to induce. Imagina-tion is a subtle and intangible quality. The mind must roam free and clutch those vague impressions which from time to time emerge as a result of past experience. It cannot be created, but it may be stimulated by education in all kinds of knowledge. Ideas are interchangeable between the various arts and sciences. Not only does wide knowledge conduce to imagination, but it helps everyone to he an artist. It is also the basis of sympathy—that is, ability to put oneself in the other person's position. Sympathy is the cardinal virtue in a surgeon. But judgment and balance are also needed. Balance is required to guard against surgical tinkering, whose sign manual is four abdominal scars. Sturdy self-reliance and quiet fortitude are essential to help one to carry out the best measures for the patient, even at the cost of adverse criticism and consequent possible loss of prestige. All young surgeons should be nervous—not through conscious inadquacy—but through keenness to do superlatively well. Humility and reverence, too : these also are required. A surgeon will make mistakes, and he should always he ready to see the point of view of others in similar circumstances. The surgeon should have reverence for great prede-cessors. Though perfection is not attainable, these have achieved what is humanly possible ; and no one should enter on this great and noble art unless he is willing to aim thus high. Certainly, surgery is a means of livelihood ; but so

i king as it is surgery and not mere operating it cannot become commercial, for the surgeon gives that which hasno money equivalent—himself and his art.

(With Acknowledgments to The Bulletin.)

\Vhen Fear and Doubt were safely wed, They cautiously begot a kid ;

I t's eves were blind ; its mother said, "We'll call it Faith," and so they did.

S YD. C.

72 THE SPECULUM.

C21

Visitor in London (to nice young man) : "Can you direct me to the Queen's

N.V.N1 ( in falsetto tones) : "Oh, 1 didn't know we had one."

0 0 El 0 13 0 The vicar announced the text of his next sermon, The WidoTo's Mite. Curate : "Rut you can't deliver that sermon." Vicar: "Why not?" Curate: "Well, there are four of them in the congregation, and three of

them do."

The French breakfast : A roll in bed lyith coffee. The American ditto: A roll in bed with honey.

Nurse in Refractory Ward, to Patient: "Here, Nvhv haven't you eaten your porridge?" Patient: "I'm not allowed to; it's got sugar on it." Nurse: "Who told you not to eat sugar?" Patient: "The doctor, nurse. Look at my chart." On the chart was the following: "Urine. No sugar."

O 0 0 0 0 0 A.: "'What's the difference between a man and a woman?" B.: "Oh, there's such a vast difference; so vast, one can't conceive."

O 0 0 0 0 0

When a man is engaged to a girl everyone thinks there is something wrong with him, but when a man marries a girl everyone thinks there is something wrong with her.

. 0 0

0 0 0 0

From "Answers to Correspondents": "Yes, the 'p' in surph-hathing is silent, as in pneumonia."

THE SPECULUM. 73

According to a well-known clinician at the Kids', Mr. Clapp's passion for slogans has again led to his undoing.

The following slogan he desired printed on the back of the new periodical weekly tickets :—"The best safety device is the careful man."

This appeared only on the women's tickets.

O CI 0

Alpha : "Who cries the loudest, a man or _a woman?" Beta : "A man, of course. He sits on his bottom and bawls all day."

El CI 0 O Cl

Stoodent (taking history) : "And have you any trouble with your courses?" "No, doctor, I don't wear 'em."

▪ CI CI 0 O 0

Med ii al ixology.

A. : "Who's that venereal old gentleman over there, with the horn-rimmed testicles ?"

B.: "Oh, he's our new rectum; ain't ver been reduced?"

O Cl CI CI

An elderly bishop in full clerical regalia came to Dr. X., who diagnosed prostatic trouble and performed a P.R. Ten years later the bishop had a recur-rence of symptoms and returned to Dr. X., this time wearing mufti. The doctor proceeded with a P.R. examination.

Presently : "Oh, good afternoon, my Lord Bishop, I didn't recognise you !"

CI CI CI CI CI 0

Teacher : "Concrete is that which can be seen. Abstract is that which cannot be seen. Now, give me an example of the concrete."

Eric. "My trousers." Teacher : "Very good. Nov give me an example of the abstract." Eric : "Yours."

• a

Guest, at dinner, making enquiry concerning a certain pompous-looking gentleman: "I hear he's an O.B.E. What does 0.$.E. stand for ?"

Friend : "Omnia bovis excreta, I should say."

• O 0 CI

Clinician (to students) : "Yes, you will find she has an ante uterus." Patient : "Will a douche get them out, doctor?"

o o 0 0

The man with the prostate was doing 18 holes on the links, accompanied by a chauffeur-caddy and dog, and his condition had been less persistent than usual. At the 17th hole the following dialogue took place :

"Well, I wasn't so bad to-day, was I, James?" "No, sir, you were only two up on the dog."

74

THE SPECULUM.

A doctor, during his treatment of a certain patient, had occasion to give him an enema. A few weeks later the patient received the account. "Services to date, il/1/-."

- Man at Telephone Box : "Hullo, is "No, the number of the Morgue is "Hell ! the V.D. clinic will be 606

0 0

that the Morgue ?" 13 now." next."

0 • Moses : "Have you heard about v

with a shilling." Solomon : "Oh, vot a terrible blunt

8

oung Isaacs ? His father cut him off

instrument to use !"

'Review The' .Matrix of the Mind. Frederic Wood Jones and Stanley D. Porteus. (Uni-

versity Press Association, University of Hawaii, T.H., 451 pp., SO figs.) Both the authors of this work are, or should be, well known to Melbourne

medical students. Professor Wood Jones, F.R.S., for some years Professor of Anatomy in Adelaide, is remembered for the striking lecture he gave here some years ago. His fame in the fields of neurology, comparative anatomy, and anthropology is too widespread for any of us not to have at least heard of him. Professor Porteus is himself a Melbourne man, and was for some time lecturer on Experimental Education in this University. The Research Training School at Vineland, New Jersey, became world-famous while he was its Director, largely as a result of his pre-eminent understanding of the psychology of the "backward" or mentally defective child.

In the territory of Hawaii there is going on what is probably the greateSt large-scale experiment in racial mixture that has ever been observed by trained scientists. The mixture of native Hawaiian, Chinese and Japanese, and the new race which is springing up as a result of the free intermingling of these stocks, has directed the attention of the scientific world to Hawaii. A grant from the Rockefeller Foundation to the University of Hawaii for the purpose of studying this experiment has made possible the appointment of two leading biologists, who are devoting all their energies to the first really scientific observation of a racial mixture. These are the authors of The Matrix of the Mind. The book itself is, in the words of the authors, "intended to provide a common back-ground upon which our further studies of human material might be projected." and this is what constitutes its peculiar interest. We are all familiar with the anatomist, who can see nothing but neurons and axons, and, with the psycho-logist, for whom, apparently, nerve-cells do not exist. A book written by an anatomist and a psychologist, in which one has to look at the table of contents before he can be sure whether it is the anatomist or the psychologist whose words one is reading on any particular page, is unknown.

The first two-thirds of the book consists of a masterly exposition of the ontagenetic and phylogenetic development of the human nervous system. Very little of textbook fact is repeated, and its value lies mainly in that it renders

THE SPECULUM.

75

a new and illuminating viewpoint, illuminating , particularly from the stand of the physician. An outstanding feature of all VG ood Jones' writings is that they exhibit a fresh and original mind, which refuses to accept any conclusion merely upon authority. In all his books we find, therefore, new ideas which seem so simple and so self-evident that we wonder why we have never thought of them ourselves. The tendency of specialisation is towards narrowness of outlook, and it is only the greater minds that can preserve the broad outlook which sees the simple things. The book is full of these ; a single instance must suffice :-Why is the ventral portion of the grey matter of the spinal cord motor in function and the dorsal portion sensory ? Because, as the neural groove inf olds, the central area is the part that has been the longest—phylogenetically—devoted to the formation of the internal nervous system. On the edge of the groove it is more or less touch and go whether a particular cell forms part of the external nervous system, the skin, or the internal nervous system. Therefore, it is only reasonable to suppose that such a cell or cells, being the most recently involved in the formation of the internal nervous system, will be most nearly allied in function to the cells of the external nervous system, i.e., sensory, while the oldest inturned cells will perform that part of the nervous function which is dependent on specialisation inside the body; i.e., they will be motor. Could anything be simpler or more self-evident? But it takes a touch of genius to see the simple things.

The second part of the book is, perhaps, even more interesting. We have the picture of a psychologist, a Professor of Clinical Psychology, who has dared to think in terms of neurons and their communications. It is admittedly unusual to see an anatomist who preserves the faculty of simple thinking about com- plicated processes ; it is almost miraculous to see a psychologist with any Common sense. The average psychologist knows no neurology, and for his explanation falls back on metaphysics—which has the merit of being an excellent burrow from which it is impossible to dig him out, since he retires farther and farther into its fastnesses. As an instrument of precision it has its demerits, since by its arguments one can prove equally well the truth or falsehood of any statement which is sufficiently vague to be a subject for its use.

The correlation of structure and function which this book presents to anyone interested in the normal and abnormal processes of the human nervous system is such that the book should find a place on the shelves of every medical student, and should prove an invaluable introduction to anyone who is under-taking any serious study of the problems of sociology.

f

THE KISS.

That kiss I took at eventide— I pressed my lips to thine, And strove with my impassion'd voice To tell what love was mine.

That kiss—which I shall ne'er forget, Lives on my lips to-day----I think I'll see a doctor now, Who'll clear the thing away.

76 THE SPECULUM.

HYMN TO HYMEN.

With expectation mounting high, Hearts beating, eyes agleam,

We cross the stately Women's porch, Which place, God grant, we'll not debauch, And in our turn receive the torch—

The new Obstetric Team!. A glorious destiny is ours !

God grant we shall not fail!! Into our hands is delegate The maintenance of the birth-rate ; We'll do our duty by the State

With live female and male! Alas ! our ardour soon abates

And good resolves collapse. The parous moans—they move us not, The babe unborn can go to pot, Avernus foul can claim the lot,

Ere scarce a night elapse. For day and night our ears are filled

With Sister's gentle chide As, by a cold and malignant fate, The peri. is torn on the infant's pate. We get no sleep, but we rise too late

And breakfastless abide. Then ante-natal claims its hour,

The jaded senses reel As Hughie shows with much aplomb Just how P.V. and per abdom.,

To gauge the mess resulting from The status hymeneal.

The evening brings no repose, Nor rest for weary head.

Maybe there are not infant yells, Perchance no amniotic smells, But in between abnormal bells

There's Edda to be read. And so the weary round goes on

Till Extern. takes its place, Where abdo. shows the kid's a breech, P.V., the dammed thing's out of reach, And then with a multiferous screech

She pushes down a face. My dear young friends, it's far from me

To shake your resolution, But though full many a sigh you'll heave At thought of sisters you'll bereave, It's my belief you'll blithely leave

This natal institution. . "PSORIASIS."

THE SPECULUM. 77

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78 THE SPECULUM.

Dinner On the night of Thursday, 19th July, some seventy worshippers of Asclepius,

ranging in rank from high priest to temple boy, decided to forego their devotions for the nonce and show their respect for Dionysus, another quite respectable deity. The place chosen for the rites was the Ambassador's Plantations, and the result was a highly enjoyable evening for all concerned. The sacred beverage was freely partaken of, its diuretic action being much in evidence, causing a constant migration towards a certain door. The oratory was of the highest standard, worthy of the best traditions of past functions. Altogether, it was one of the most successful dinners which have been held for a long time, and the only regret that can be expressed is that more M.S.S. members did not avail themselves of the opportunity.

. 4.

Ted Tunbridge.—Married. Backed a winner. Alec. Swain.—Private, Malmsbury. "Jiggy" Farrar Keith Ross Cec. Kiug Engaged. Heartiest Congratulations! Frank Ross Harold Maunder .)

Bob Mankey

Southby C. Grenville Retallick J Abe Fryberg.—Brisbane General Hospital. A. A. A. Aitken.—Private, 442 Lonsdale Street. Cigar Connoisseur. Sam. Booth.—Private, Harley Street. Visiting Victoria. Lewis L. Phillips.—Resident, Kyneton Hospital. Budding golf champion. Bert Hiller.—Resigned Bendigo Hospital. Going abroad. Les. Edmunds.—Assistant, W. Rennick, Coburg. Len. Ball.—F.R.C. S. Noel Guttridge.—Toowoomba. Does the Wassies for a district of 200,000 sq.

miles area.

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THE SPECULUM.

bospital ant) pear Votes. Melbourne lbospital Rotes

FIFTH YEAR. The year 1928 has found the Melbourne Hospital with its most important quota of

5th Year Students to date, yet there has been no gesture of the authorities to acknow-ledge the fact.

It is, however, pleasing to note that our respiratory exchange is regarded as being so low, and our moral stands so exalted, that three Cas. men are permitted to repose in one room. We look forward to the perhaps not distant future when, with the onward march of progress at the M.H., the standard will become high enough to enable three to be accommodated in one bed.

Cas. is an epoch in the soporific life of the 5th year man. The good student, for instance, is allowed to gaze from a distance at the celestial sight, of residents at meals, and there is even a tradition that some of the more favoured souls have sat in a seat yet warm from. the embraces of the Super. We hear that Ginger has drawn a red ring around the date of his glorious fortnight, whether as a memorial to the above events or for a more practical purpose remains to be seen. It is certain that he has gone off his drink, and often murmurs the mystic number, "280." A medical man (name not available) is to be consulted.

Following the cruel suppression of Casino activities, the social centre is now the library—while the furniture holds out. Here on cold mornings a conversations club meets, and such subjects as beauty, goodness, and love (with special reference to the staff) are discussed in a genteel way. Members are requested not to talk loudly, as hospital visitors may be disturbed. The general religious tone among the men remains high, and the 4th Year evangelists are hopeful of yet more sweeping reform's.

Specials have descended on us like an infectious disease, and our minds are being filled with such stock of magic lore as is given to few mortals to master. But when we are advised by Dr. K. to wear woollen underpants (men students only), and by Dr. D. not to on any account, what is one to do? We understand that some of the more conscientious skin students have taken to wearing rubber.

Which reminds us that there has been a prolific crop of social heads among our ranks of late. That dread disorder, Nurseomania, is raging. In other words, some of the younger brethren have discovered that the Angel of the Ward can also be an Angel of the Sward. Ah, us ! how it reminds us of our youth. Stuffy and Mo are said to take it in turns to go out on the rampage—while the other stays home and guards the conjoint pile. They are even willing to make a book on the percentage of successes. Odds on application.

The trouble about half-past eight lectures is that they are so often half past, when, and if, we arrive. Sometimes the lecturer comes late just to cheer us up, but we regret to announce that the lecturer in Surgery, First Term, was always early. Faithful Frank (known to his friends as "Acro") is said to have been five minutes late for a lecture and to have missed a clinic last term.

The morning tea refrigerator has again opened with a flourish of trumpets. We like the people, we like the pantry, and we like the Robur Tea (commission on this from Ed. Alcock), but worms though we be, we think we deserve a better end than to be frozen to death four at a time, or crushed if five get in. The price calls' up the tempting alternative of the flowing pot. Married men and other impecunious souls have been observed sneaking down to the O.P. Canteen to gorge on the cheap and in comfort. One Alister has been seen to disguise himself with a bandage and an old crutch, such is his craving.

' I

80 THE SPECULUM.

No account of our activties would be complete without Doctor Philpott and his merry playmates at Royal Park. We learn quite a lot. Even though our ideas of ideation, verbigeration, and echolalia are a little hazy, we now know where Jack gets his good looks from, and why Fred. never talks about his past.

We fear that Lex. has found that his loved one's heart is shared by another Talbot, which may be seen any morning ornamenting the hospital yard. The owner is said to be looking for a fair co-occupant. Only those who need no threatening should apply, as he is tender-hearted.

The women are at present learning to do the family washing; in other words, they are receiving their obstetrical training. Great benefits are expected to accrue. The fortunate patients learn the touch of a woman's hand, and the next fortunate batch may confidently expect to find no butter on the ceiling or very dead fish nailed under the table.

Congratulations to Jack and Joe on their pleasant holiday at Fairfield, and to another Jack (known to his friends as "Angel-face") on his only managing to break his passenger's neck and put his own eye in a sling. Likewise to Yock, on his splendid record (24 infants of Jewish extraction), and to Basil on his great ability to dodge work at the Women's. Max is still faithful, and will, we hope, not be forgotten at the day of judgment. Ed. has evolved a ne* and artistic incision for sebaceous cysts. We understand that Josephine holds the record for this delicate operation, and also for putting in stitches with one hand. She is said to be suffering from a retracted mem-brane.

Special congratulations to Mr. Alan Murray (known to his friends as "Angus") on his brilliant, dramatic and sudden solution of the problem, "How to Keep Warm in Winter."

Another of our number has pledged himself to be true for ever and a day (Saturdays and holidays excepted), but we can't divulge his name. It is a great secret. He was seen, however, secretly piloting a fair cargo around the Kids', and Mr. Downs's heart missed a beat as she peeped in the theatre door. Yes, the patient died.

Commiserations to genial Stan. Williams on his high appointment, his great ability, and his onerous duties: He has collected a sub., and will purchase a strong tin opener.

Also to Godfrey. We can state officially that he has gone off his food until next November. Enormous sums are at stake.

In the hush following this stupendous announcement, we withdraw till next time.

FOURTH YEAR. Some say— That we're Overdosed and Under-dozed. That an exam. in second term disturbs the communal peace. That the Path. lecture room is d—d cold. That two black objects standing in two corners contain frozen water and make it

colder. That the Portsea trip was wet inside and out. That the return journey was punctur-ated with blow-outs and blow-ins. That Percy considers, limestone and water upset the equilibrium. That's all.

Elfreb lbospitat 'Rotes SIXTH YEAR.

Finals cast their enveloping gloom before them, and the social lights of sixth year flicker and go out.

The night before the late forensic exam. only three venturesome spirits, whose amorous instincts were more powerful than their dread of the vagaries of the Govern-ment Pathologist, turned up at the Students' and Residents' Dance at the Ormond Hall, and were well repaid for their daring in consolations of a very enjoyable evening.

Our honoraries have nobly rallied to the support of our flagging intellects, and if good coaching has anything to do with it, we ought to be sparking a lot better after the August ordeal than any of us would have thought possible.

A forecast of the Medicine paper as a certain honorary would like it:— Question 1.—In what respect did Bolderiff anticipate Bolton, and what did Pavlov's

dogs think about it, anyway ? 2.—What do you know about the following :-

(a) Levaditti's globoid body. (b) Gibson's streptothrix. (c) Vulpian-Bernhardt's pet name.

THE SPECULUM.

81

3.—What did old Landouzy Dejerine have in mind when Charcot Marie Tooth drew a blank in the lottery.

Etc. Our budding neurologists are in great form, though not quite shrewd enough yet

to lay traps for our learned prototype. We sympathise with Bill D— in his wasted though brilliant theories as to the

reason why a certain patient's peripheral neuritis only affected one leg. It seems that the other leg had been mislaid some time ago during the patient's career.

Things we would like to know :— 1. Why our white-haired boy has suddenly developed such a love of children? 2. Why Harry H— thinks there are such a lot of good capes in Ward 3 (three)? 3. Why our acrobatic troupe—Henry and Bill—don't perform at the Tivoli ? 4. Why Eric E— always rings up from the Students' Room, when there are no

students about? 5. Why doesn't "Tich" endow a house for impecunious bookies ? 6. What is wrong with Laurie's socks? 7. Where Paddy got his knowledge of corsets from ?

FIFTH YEAR. Life at the A.H. is still the same as it has ever been, if one may believe the "old

heads"—an agreeable synthesis of work and play—innocent, as far as the latter is concerned, although sometimes, perhaps, not so very. We seem to have it worked out to a fine art, how one may relax holiday, or otherwise enjoy oneself, and thereafter take up the strain of work so gradually that one would never notice the change, if any.

There are some enthusiasts, of course, who wander round the place "week in, week out, from morn till night,"'

in search of the aortic regurg., or "gnasm," particularly the latter. They seem to know a little medicine, hut, Lord knows, how much scandal. These nurses do talk, don't they ?

Cas. has s become extremely popular, especially with the younger and more hand-some students, who, in some cases, have exhibited astounding form as social successes. It has been wonderful to observe the blossoming into men of poise and passion of the former buds of coyness and (one could well believe) innocence.

Geoff. has not finished his improvements to the red "Singer" yet. It has had a complete change of spare parts and passengers, but is still not the ideal car. It's too small for one thing; a seven passenger would be the ideal size.

Sixth year are approaching the last fence in the straight with no euphoria, but on the whole, a philosophy which is commendable. Bill B— has no tremor in his bari-tone and "Tich" still cocks a steady eye over the sights of his Willys-Knight, or what-ever breed of rifle he uses. The eyes of the whole hospital are on this year's finalists, hoping for a repetition of the 1927 effort.

The motor bike club is B.N.D. The bottom fell out of it when the two baby Triumphs became one. Bill Bossence rides it when it goes, using Bill Stephens' magneto and back wheel. One live rat is better than two dead ones, but still, we lost a quarter of our membership, and the garage has never seemed the same place since.

By the way—here's one passed on to his clinic by an I.P. physician—the answer of a Melbourne schoolgirl to the question in a hygiene exam. paper. "What is adolescence?" "The dangerous age between puberty and adultery."

FOURTH YEAR. January 17th found another tin of new students opened and eight "very junior

students," to use the words of the affable "Jock," spick and span hopped out. Although not exactly greeted with a brass band, they quickly made their presence felt, and their reflexes responding quickly to the magic title of "doctor," one could find them in all sorts of outlandish places searching for knowledge. Anyhow, it's not all been slogging work, for we have our fun. Take Dr. T.'s case, who came in suffering from a discharge from her rectum. "Have you ever had piles ?" quoth the honorary. "Oh, yes," the dear lady said, "I have had SMALL piles." "How do you know that?" Dr. T. asked. "Because a doctor told me last year I suffered from pyelitis."

Then there was the—er—"male" case of Raph's who always called him "dear" and "love," and when asked how he felt, would say, "coldy cold," or "tighty tight." Un-fortunately. we lost Oscar during the term, and we sincerely sympathise with him in his recent bereavement. Ralph, too, had a spell away with pneumonia, but is now back again letting patients spit in his face for the chance of inspecting a septic tonsil. Hush ? Let no dog bark, tragedy has nearly happened, and the fair name of the hospital almost irreparably besmirched. Someone started a "coon-can" school, and

82

THE SPECULUM.

several reckless senior men were seen gambling for pennies. The staff was horrified, and an edict issued, signed by everyone who has been connected with the hospital since its inception, forbidding such degrading incidents.

Cyril, the daddy of us all, earned quite a bit of notoriety the other day, for he appeared in town and at lectures in a huge fur coat. Some thought he was a noted actor, others cheered, thinking Nobile had been rescued. Rossie and Marcus, the two black crows, will never be accused of being the "early birds to catch the worm," for the gate roll seems to be their life-long worry. Marcus says that they post spies at all corners, and when the Erskine flyer plugs up the drive the roll is hurried away to those hidden recesses where all rolls seem to go. Rex did a great amount of work making the Residents' and Students' Dance the best ever. Could anyone tell me why it is that after each dance an acute inflammation occurs and everyone seemed to marginate and then diapedese towards the doors, leaving the warm, cheerful atmosphere for the blizzard outer air. Why, oh, why? Bob seems to be our star clinician, but the "little man" is a serious contender for the honours. Despite myriads of blunders we are still ever ready with our diagnosis. Rex asked one honorary, after listening to a lecture on rheumatoid cases and B.C.C., whether B.C.C. were any good for gastric ulcers. Cyril, despite the fact that he stated in lecture that the external spermatic nerve runs into the femoral vein, always strikes a winner by suggesting a Wasserman whenever the patient has tattoo marks.

tbirD Jear 'Dotes After the machinations of the examiners in November and March the present third

year was forced to leave some staunch followers behind to the trials of another second year, and collected only one member of last year's Div. II.; but, undaunted by this depletion, we stepped forward boldly to the main business of first term—Commencement.

The unofficial Med. theatre night could hardly be pronounced a success, not much of the show being seen by our members, owing to the unseemly attitude adopted by the theatre management concerned to the patronage of University students, and Med. students in particular. The Block was successfully paraded by all faculties, and here we did our bit before adjourning to the more serious business of producing a good performance on the Saturday evening at the Medical Medleys. Third year men were well represented here, and, although the show may not have been a great success as a show, the financial result was extremely gratifying to all who did so much to make the Medical Medleys, 1928, a success. About £50 represented the profits returned.

Some of our number are to be congratulated upon their inclusion and performances in representative Varsity teams during the first term vac.—Officer, who rowed in the crew at Mannum; Fenton-Bowen, who captained the aths. team in Sydney ; and Palandri, who was a member of the winning rifle shooting team. Congratulations should also be tendered at this stage, we think, to friend Perc. on his strenuous efforts towards that state we, who are not so fortunate, abhor—the matrimonial tangle. Still. youth must have its fling, so we suffer Perc. to babble of love without being interested ourselves.

Another matter that should be elucidated has worried many of our year for some time now. Was it a well thought out scheme for making sure of this year's anatomy which resulted in Laz. having to reach down the pointer for Prof. Berry in his lecture one Tuesday morning?

As these notes go to print just after the Med. dance, it is an opportune time to speak once more of the general apathy of the majority of Med. students towards functions run by their own faculty. Held in Melba Hall, June 8th, this dance was most enjoyable to those few who attended. Had it not been for people outside the faculty the M.S.S. would have had a considerable loss on the evening, a thing which reflects badly upon the interest of Med. students in their own affairs.

Miss M. Troup, of second year, and J. G. Johnson, one of our year reps., were the energetic secretaries, and it is to their untiring efforts that the dance resulted in a small profit, which, unfortunately, was wiped out by some unnecessary hooliganism for which we had to pay.

In view of the fact that it is so hard to run these shows at anything but a loss, it will be seriously considered cutting them out altogether. Such a proceeding would, we think, be detrimental to the status of the Medical faculty, but unless all members will give their whole-hearted support to these things such a course will have to be taken very soon.

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THE SPECULUM.

Second Wear Rotes "We look before and after, And pine for what is not."—(Ed.)

First Wear Rotes At 9 a.m. on Monday, March 19, about fifty doctors in embryo entered the Zoology

Lecture Theatre, some to commence the varied and hectic career of a medical student, some to continue it. This comparatively small number speaks hopefully for those who have either the ability or the extreme good fortune to trick the examiners until the end of their course, and then make the usual attempt to obtain a hospital appointment.

The number of "old familiar faces in both front and back benches is not a great encouragement to the "fresher" members of the year, but we trust that all may this year surmount the barrier, and eventually achieve a position from which to scorn examiners and their wiles.

Commencement this year received quite good and effective support from the First Year Meds., who added their mite to bring the faculty show on top in the Commence-ment Revels—this speaks well for coming years.

A rumour is current that during Chem. lectures quite interesting little bridge parties are sometimes held in the back benches. We hope for our own sakes that the Chem. exam. is as easy as the members of these parties appear to expect. However, December will show.

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YEUCLIN TABLETS YEUCLIN TABLETS YEUCLIN TABLETS

Compound B Special for Containing in each Diabetic Patients

Phenolphthalein ;; gr.

DOSE : 1 to 4 TABLETS

SUPPLIED IN BOTTLES OF 50 AND 100 TABLETS

"If you want to know whether you are destined to be a success or a failure in life, you can easily find out. The test is simple, and it is infallible. Are you able to save money? If not, drop out. You will lose. You may think not, but you will lose as sure as you live. The seed of success is not in you."

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THE time to learn to save money is when you have little to save !

In other words the careful use of money in the period of education will render easy the wise use of money in later life.

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from such trifles may develop habits and consequences of

profound importance.

THE

STATE SAVINGS BANK OF VICTORIA

200 Branches and 398 Agencies in Victoria

Head Office : 139-153 ELIZABETH ST., MELBOURNE, C.1.

GEO. E. EMERY, General Manager.

ESTABLISHED 1888

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 ST., MELBOURNE, C.I (Take Elevator to 3rd Floor)

A CHOICE COLLECTION OF THE LATEST BOOKS ON MEDICINE, SURGERY AND NURSING ALWAYS ON HAND. ALSO

Students' Text Books: FRENCH'S DIFFERENTIAL DIAGNOSIS. WARING'S OPERATIVE SURGERY. ROSE AND CARLESS' MANUAL OF SURGERY. MacCALLUM'S PATHOLOGY. DISEASES OF THE CHEST AND PHYSICAL DIAGNOSIS. By Norris

and Landis. Third Edition, Revised, 1924. 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.) SURGICAL PATHOLOGY. By Wiliam Boyd, M.D., M.R.C.P., Ed. F.R.S.C.

1925. The latest and best on the subject. BEDSIDE DIAGNOSIS. Edited by George Blumer, M.D. 3 Volumes con-

taining 2820 pages, with 890 illustrations. Price, complete, £61151-, with separate index volume free, 1928.

DE LEE'S PRINCIPLES OF OBSTETRICS. New Fifth Edition, 1928. EWING'S NEOPLASTIC DISEASES. New Second Edition, 1928. DE TAKAT'S LOCAL ANZESTHESIA. Octavo of 225 pages, with 117

illustrations. 1928. Price, 18/-.

A GOOD STOCK OF SURGICAL INSTRUMENTS, Stethoscopes, 9/6. Plessors, 4/6. Dissecting sets, 25/- each. Best quality Surgeons' Gloves,

3/- pair.

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

Library Digitised Collections

Title:Speculum 1928

Date:1928

Persistent Link:http://hdl.handle.net/11343/24204