THE AUSTRALIAN

MEDICAL JOURNAL, FEBRUARY, 1876.

MEDICAL SOCIETY OF VICTORIA.

ORDINARY MONTHLY MEETING.

WEDNESDAY, FEBRUARY 2, 1876.

(117 Collins Street East.) Present : Dr. McMillan, Dr. Blair, Dr. Jonasson, Mr. Girdlestone,

Mr. Gillbee, Dr. Neild, Dr. Williams, Dr. Molloy,] Dr. Graham, Dr. Ryan, Dr. Bowen.

RESIGNATION OF MEMBER. A letter was received from Dr. G. T. Teague forwarding his

resignation as a member of the Society.

RESIGNATION OF MEMBER OF COMMITTEE. The honorary secretary announced the resignation of Mr. Ruda11

as a member of committee, and the election of Dr. Jonasson in his place.

PRESENTATION OF BOOK. The honorary librarian announced the presentation of a copy of

Hayter's " Notes of the Colony of Victoria."

NEW MEMBERS. The following gentlemen were elected members of the Society :

Dr. Jackson of Mount Gambier, Dr. Wilson of Adelaide, Dr. Snowball of Carlton, Dr. Heffernan of West Melbourne, and Mr. Lawton of the Melbourne Hospital.

One gentleman was proposed.

EXHIBITS. Dr. Blair exhibited an elastic tourniquet, which consisted of an

elastic cylindrical band, held by split tubular clips. It was objected that such a tourniquet strangulated as well as compressed. Dr. Blair also exhibited an eye-dropper, consisting of a small long-tubed funnel, having an elastic cover over the cup end. Dr. Bowen

VOL. XXI.

34 Medical Society of Victoria. [Feb.

showed an improvement upon this, in which the dropper was made to serve the use of a stopper to the bottle containing the solution to be employed. This he had had in use six yeais.

The following paper was then read by the honorary secretary :

SURGICAL NOTES OF TWO CASES OF GUNSHOT WOUNDS.

By A. T. GUNNING, L.R.C.S.E.

CASE 1.—On March 17, 1871, I went in the night to attend a young man, A. G., wt. 24, a groom at an hotel twenty miles distant. When I arrived I found him in bed, but he did not seem faint or exhausted, as I was led to expect. He said he felt very little pain. He stated that on drawing out his gun from behind his bed it exploded, and lodged its contents in his breast, near his left arm ; that there had been considerable bleeding for a short time from the wound. There were two ounces of No. 3 shot in the charge, according to his account. On making an examination, I found a ragged circular wound situated over the left pectoral axillary fold, about an inch from its lower edge. The wound was about an inch and a half in diameter. The finger in the wound indicated its direction to be upwards and inwards, towards the clavicle. The finger could not reach the bottom of the wound. There was neither shot nor wadding to be felt. The upper part of the chest, above the clavicle and about the scapula, was carefully examined, but there was nothing found to indicate the presence of shot. There was no sign of paralysis of the arm, and its sensation was normal. There was no difficulty of breathing, and no emphysema. As matters seemed so auspicious, I thought it injudicious to probe or disturb the bottom of the wound for the sake of finding where the shot had lodged, for in doing so perhaps I might bring on haemorrhage ; I therefore made a long conical pledget of lint, and saturated it well with the tinct. ferri mur., then introduced it as far as I could. Some lint with carbolic acid lotion being placed over the mouth of the wound and an opiate given, he was left.

18th.—He was seen in the morning. There were no other unpleasant symptoms ; feels quite easy.

20th.—Visited. All going on well ; lint removed, and some carbolic acid lotion injected into the wound ; no discharge of an offensive nature, and no sign to indicate the position of the shot.

10th April.—Seen again. Wound healed. 22nd April.—Visited. At this time a small projection over the site

of the wound, seeming to contain pus, it was evacuated by a small incision; about a drachm of pus escaped; carbolic acid lotion was injected. A few days after this he brought to me about half an ounce of flattened No. 3 shot, which he said had escaped from the opening ; and several times afterwards smaller quantities came out, but he never saw any wadding.

In about two months from the time of his meeting with the

1876.] Ma. GUNNING on two Gunshot Wounds. 34

accident he was quite well, and was performing his ordinary duties. Occasionally he complains of a slight stiffness in the shoulder.

The question seems difficult to answer—How so large a charge of shot could have remained in the vicinity of such important parts, and inflict so little injury ? When the shot took effect, the arm, in the act of drawing out the gun, was no doubt well abducted, the shot entering the great pectoral muscle, parallel to the axillary vessels and nerves ; both the greater and lesser pectorals, as well as their respective fascias, being well on the stretch, it most likely remained between them. Had it gone higher it must have fractured the clavicle and endangered the large vessels close to it ; of course if its direction had been either a little more outwards or inwards, a fatal result might have been looked for.

CASE 2.—A. S , a young man mt. 23, was shooting parrots off a crop in a wheat paddock, about a quarter of a mile from his house. Not returning at his usual meal-time, his sister went out to call him, when she found him extended on the ground and bleeding from a large wound in the face. A large quantity of blood lay in a pool under his head ; he was quite insensible ; his gun lay a few yards from him. Assistance being got, he was removed to the house, and I was sent for. I arrived at 10 p.m., having twenty-five miles to go. I found him still unconscious ; the face soiled with the powder and blood ; the eyes closed, the right eyelid much ecchymosed, also the right temple and part of the forehead above the eye. These parts felt spongy to the finger. On lifting the right eyelid, the pupil was seen to be nearly natural, but on examining the left one it was found much dilated. On removing some cloths saturated with blood from the face, a large ragged wound was seen extending from near the angle of the jaw towards the right temple, about three inches in length. There was no bleeding from it, but some slight oozing of blood from the right ear. On Putting the finger into the wound, the masseter muscle was found torn through, also the tendon and part of the temporal muscle. The zygomatic process was fractured and torn away, a part of• the bone being loose in the wound. The finger passing more deeply felt an oblong irregular fracture in the squamous portion of the temporal bone, about one and a half inches long and half an inch wide, the portion of bone corresponding to this fracture being absent. Through this opening the finger passed into the cavity of the cranium, and could feel a mass of clots and broken up brain-substance. No foreign substance like shot•or ball could be felt. There was no pulse to be felt at the wrist. The right arm and leg were in continual action, but both the left arm and leg were paralysed and Insensible to pinching or other irritation. A pledget of lint was placed over the wound, as nothing could be done for his benefit by any surgical interference. About half-past 3 a.m. his breathing, which had hitherto been quiet, became more laborious ; the right arm and leg became more frequent in their movements, till he finally expired at 7 a.m.

Post-mortem examination twenty-nine hours after death. The D 2

36 MR. FORD on Vital Statistics of Police Force. [Feb,

body exhales a strong smell of decomposition, although the weather is rather cold. On dividing the scalp, some effused blood is seen between it and the skull. The calvarium being removed, the longi-tudinal sinus was found rather empty. There was some effused blood between the dura mater and the bone. The fracture in the tem-poral bone was the same as already described ; but an additions/ fracture ran up from it vertically, through the right parietal, nearly to the vertex ; another shorter one arose from the centre of impact, and went off at an angle of 60 0. The brain itself did not seem to quite fill the cavity of the skull. Opposite the seat of the open fracture, the brain was much mashed up and mixed with clots. At this spot two large pieces of brown paper, loosely rolled up, the first about an inch long by half an inch thick, and the second about twice as large, were found. Thinking the shot must be farther in the brain, it was removed and placed on a plate, then sliced in various directions, but nothing like shot could be discovered. This failing, the whole brain was carefully manipulated through the fingers, but not a vestige of shot was to be found. The only conclusion that could be arrived at was, that the loose paper wadding, driven by the explosion at so short a distance, was sufficient to produce the mischief. The brother of the deceased informed me afterwards that he has frequently known the deceased to use only paper and powder, for the sake of making a loud report.

Narracoorte, Mosquito Plains, South Australia.

VITAL STATISTICS OF POLICE FORCE OF VICTORIA, From January 1, 1874, to December 31, 1875.

Compiled by F. T. WEST FORD,

Medical Officer to the Force, &c., assisted by the Police Department.

The vital statistics now presented are in continuation and in the same form as those preceding, and it will be found that they vary very little from previous statements. As usual, the principal ailments treated in hospital are rheumatism, catarrh, and disorders of the digestive functions and alimentary canal.

There were admitted to hospital in 1874, 319 cases, and in 1875, 340 cases ; and the time spent in hospital for each case averages 14 days. The daily sick it is impossible to arrive at, because, although the greater number of patients come into hospital from the city and suburbs, a large number also come from the country districts ; and these, I may remark, are generally chronic cases, and principally cause the apparent large number of days spent in hospital per case.

The mortality, as usual, has been very small. The only death in hospital during the two years was from exhaustion from perineal fistula. The man came into hospital in an exhausted state, having been under treatment outside for many months, and he could not rally.

1876.] MR. FORD On Vital Statistics oF Police Force. 37

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1876.] Poisonous Houses.

Only two cases of scarlet fever have been treated in hospital, and they did well.

The force, numerically, as compared with the two previous years, is slightly in excess, as far as the men are concerned, but there are fewer officers.

The superannuations, as compared with two previous years, have been much larger, and in consequence a greater number of men have been taken on.

I may in conclusion repeat what I stated in my last report, viz., that only men come into hospital who are really unable from illness to perform duty. Slight or trivial cases rarely come under my notice.

109 Collins-street east, February 29, 1876.

Insfralian #ournal. FEBRUARY 1876.

POISON OUS HOUSES.

Among the many difficulties met with by medical men in their treatment of disease, are the unfavourable conditions represented by dwelling-houses, either originally unsuitable by reason of faulty construction, or which have become unsuitable on account of decay. The absence of other than surface-drainage is an almost necessary cause of damp foundations, and as the materials of most buildings in and about Melbourne are favourable to capillary attraction, it is the exception to find dry walls, and other than damp •floors. The subsoil being still extensively charged with fculence, notwithstanding the filling up of many cesspits, the moisture so absorbed and carried up into the rooms, conveys with it whatever disease-germs it may happen to contain. We do not require to be reminded that the products of decomposition of organic matter are distinct from specific disease-germs, but it seems as if it had been forgotten, that, although disease-germs are not gases arising from putre-faction, they are not the sole agents of mischief in the production of disease. But there can be little doubt that the walls of many houses distribute both poisonous gases and infective disease-germs, and that even if a true zymotic ferment is not always occasioned, there is more or less septicaemia occasioned. More especially is this the case, owing to the absence of means of proper ventilation. It. happens, therefore, constantly that the medical attendant

40 Poisonous Houses. [Feb.

declares the house in which a patient is living to be unhealthy. A damp mildew smell meets him the moment he enters the door ; it is not perceptible by the inmates, for, like all other evils, this of foulness, whether it be evident to the sense of sight or smell, is rendered tolerable by use ; but its effects are evident, if in nothing else than the slow convalescence of the patient, and in the more serious result of chronic visceral lesion, or glandular and skin complications.

It is those who live in poisonous houses of this kind whom we are generally unable to send away during con-valescence into the country. They are obliged to stay where they are, and to continue to breathe infected air, and we have to confess ourselves unable to combat the disease, medicinally and dietetically, so long as the other conditions necessary to recovery are wanting.

Putting it shortly, thousands of people live in rotten houses, standing upon damp filthy sites. The law is in-operative to compel the owners of such property to pull them down and rebuild them ; and no amount of repairs would suffice to make them properly habitable.

We have lately had several royal commissions to in-vestigate questions possessing not a tithe of the importance that this of healthy dwelling-houses does. The truth is, the existence of these poisonous habitations is not credited. There are hundreds of them rank, dank, mildewed piles of soft brick and mud-mortar, fixed in black ooze, which rises through millions of spiracles in the walls, and discharges itself into the air, already impure enough by reason of the unliberated gases of expiration.

The class of persons who attend as out-patients at our hospitals, represent pretty well the effects of living in houses of this kind. Everyone familiar with hospital out-patient practice, knows how many people he has to treat, whose complaints are of an indefinite kind. " Debility," or " Dyspepsia," is the convenient vagueness in which we take refuge in such cases. The truth is, they are all examples more or less of blood-poisoning. The circulating fluid has been rendered unsuitable for maintaining the efficiency of the nerve-supply, and so the several processes of digestion, assimilation, and secretion are ill performed. Remembering, moreover, how habitually this class neglect the other conditions of cleanliness, temperance, and good food, it is not at all surprising that the function of nutrition is impaired, the further element of septicwmia being added.

One would have thought that with such an obvious necessity for improvement in. respect of houses, any health

1876.] Poisonous Houses. 41

act ought to have included a clause making it compulsory upon the owners of poisonous houses, either to put them in order, or to submit to have them dealt with by properly-constituted authorities, having power to deal with them according to their requirements. A rational view of the situation, and a due regard to the common health, points to the propriety of such houses being rebuilt at the State's cost, and the sum so expended charged as a mortgage upon the property. If the health of the people be indeed the highest law, nothing less than a summary proceeding of this kind will suffice in remedying the evil. The selfishness of most landlords, especially those owning cottage-property, renders the desirability of such a method evident. The whole city requires revision in this way. There ought to be an official inspection and report made of every house within the metropolitan district, and, acting upon this report, proceedings ought to be taken with a view to a complete sweeping away of all such buildings as, being injurious to health, could not be properly repaired, and the repair of those which would admit of it. We do not doubt that if a comprehensive measure, conferring power to deal with the property of the city in this way were passed, the common health would be greatly improved.

There is no doubt, too, that both the Health Act and the Building Act are defective, in respect of the conditions imposed upon those who put up new houses. Some of the conditions indeed are unnecessary for any hygienic good they effect, while others which would be of essential service are omitted. We give the Central Board of Health every credit for enforcing the provisions of the Health Act as it exists ; but this statute does not go half far enough, and the Amending Health Bill—one of the few good works of the present session—contains nothing to supply this omission.

If ever we should have a legislature in this colony capable of understanding what is meant by the laws of health, we may find them applying themselves to the subject now being dealt with by us. At present such a measure is quite too much to hope for, and so the evil of poisonous houses will go on increasing, year by year, as the materials suffer disintegration, and as the soil becomes more and more saturated, with gas-evolving and disease-germ nourishing filth.

42

Mr. Beaney's Doings. [Feb.

MR. BEANEY'S DOINGS. The month of February, 1876, will be associated a good deal

with the affairs of Mr. Beaney, if ever the medical history of this colony should come to be written. It would have been thought that the notoriety which came to him in connexion with the death of Robert Berth should have been sufficient. Two other cases, however, occurred about the beginning of this month, which brought his name into further conspicuousness, and the lecture he subsequently delivered a fortnight afterwards, with the title of " Doctors Differ," seems to suggest that this unexpected prominence is not altogether unacceptable to him, however distasteful it might be generally, to those who do not confound notoriety with popularity.

On the 1st of February, an inquest was held upon the body of a patient in the hospital, named Ann Kelly, a married woman, who having been admitted on November 15, 1875, suffering from disease of the knee-joint, had been operated upon by Mr. Beaney on December 2, and who died on Januray 29.

Dr. Williams, one of the resident physicians of the hospital thus described the operation :—I was present at the operation, which was performed on the 2nd December, 1875. I took no part in the operation. Dr. Lewellin administered the chloroform. The patient was on the operating table an hour. I saw the patient brought into the room, but did not examine her. She appeared plump and healthy. There was no appearance of consumption. She was said to have disease of the knee joint. The operation was this : an incision was made in the first instance of a semilunar shape, below and on each side of the knee-cap. By this means the joint was exposed and laid open. The leg was then bent on the thigh, with the intention of sawing off the ends of both bones of the leg at the same time. This could not be done—that is to say, the leg could not be got into sufficient apposition with the thigh, and the ends of the thigh and leg bone were separately sawn off. They were then put into apposition ; but it was found that they did not fit. A slice was then taken from each bone again. It was now found that the cancellous structure of the cut end of the bone was more pulpy than natural. A scoop or gouge was then used, and the interior of the bone was scooped out of the upper bone, as far as the instrument would reach. The structure brought away seemed to be the same at the upper part—as far as the scoop reached—as at the lower part of the bone. There was then a kind of general suggestion among the persons present to amputate. This was done by making a posterior flap. The flaps were then brought together, enclosing the hollowed-out bone, and the operation was completed. The original intention was only to make an excision of the knee joint, and this was changed to amputation. I saw the woman afterwards on two occasions before she died, but not to examine her.

The post-mortem examination made by Drs. Hunt and Lawrence was as follows :—Externally the body was that of a well-nourished young woman. There was a slight mark of a blister over the

1876.] Mr. Beaney's Doings. 43

stomach. The left leg had been amputated through the knee-joint, through the lower extremity of the thigh bone. The thigh above tvas much swollen, and there were marks of three small abscesses at the upper and inner side of the thigh. The skin in this situation was of a dark reddish colour. The skin around the edges of the flaps was of a livid colour. The flap had separated on the inner side, and the granulations were dark-coloured and unhealthy-looking. Internally the membranes of the brain were somewhat congested, but otherwise the brain was healthy. In the chest, the left lung was adherent to the chest-wall, and when separated there were redness and congestion of the pleural surfaces, and some effusion of lymph. There was tubercle in the upper parts of both lungs. The heart was soft and fatty, and the walls thin—weight 7 oz. The liver was large, had a nodular appearance, and was very soft and waxy. The spleen presented a normal appearance. The stomach contained a small quantity of dark grumous fluid, but was otherwise healthy. The kidneys and supra-renal capsules were healthy. The pancreas and also the bowels were healthy. The uterus and bladder Were healthy. In opening up the stump, a sero-purulent fluid was found under the shaft of the bone. The end of the sawed bone was covered by a mass of lymph. The shaft of the bone was split up by us for a distance of about eight inches. For a distance of about three inches and a half, the cancellous structure appeared to have been scooped out, and its place occupied by lymph, blood and pus. The patella was in a slightly diseased state. The cause of death was exhaustion from the effects of the amputation, and partly from the diseased condition of the organs of the body. I think the liver was in a state of disease before the operation, and also the heart. The state of the lungs may have been subsequent to the operation. The state of the organs could have been overlooked at a consultation. I think that if there was disease of the bone, the amputation should have been performed higher, so as to get rid of the diseased bone. I do not think it was wise to leave the bone in the state in which it was.

Mr. Beaney observed that the bone as shown was completely scooped out, but that it was filled at the time the post-mortem was made, and that in his opinion the substance was new bone.

Dr. Lawrence replied that the cancellous structure of the bone Was absent, and it had apparently been removed by surgical means. Its place was occupied by lymph and some pus. The lymph was partly organised. Part of the bone was in a state of necrosis, which accounted for the presence of the pus. The dead portion of of the bone would cause the pus. He thought it would have been better to amputate higher up, and that he had never known a case in which the medullary canal was scooped out to the extent of three inches.

Dr. Williams described the bone which remained, as separated into two shells, the inner structure being nearly all dead. He was strongly of opinion that the amputation should have been above the diseased portions of bone. He believed the vomiting from the-

44 Mr. Beaney's Doings. [Feb.

exhaustion of which the patient was said to have died, to have been due to the operation and not to any special disease of the stomach.

The hospital books showed that from the day of the operation to her death, the pulse ranged from 120 to 148.

Dr. Smythe, of Sandridge, who was present at the operation, said he should have preferred to risk a higher operation than to leave the bone as it was left.

A good deal of evidenee was taken as to the previous history and treatment of the patient, but it was but little pertinent to the investigation, which had for its principal object, to determine whether an amputation of the thigh, leaving a quantity of diseased bone unremoved, was justifiable surgery.

Mr. Fisher gave his version of the post-mortem examination, which was to the effect that there were strong pleuritic adhesions, tubercles in both upper lobes of the lungs, yellow atrophy of the liver, and a good deal of irritation of the stomach. The periosteum of the bone was healthy, there were no sinuses, and the wound was normally suppurating. He approved of the scooping out process, and believed that the occurrence of erysipelas determined the fatal issue of the case.

Dr. Blair also thought the scooping out process was good surgery. Mr. Fitzgerald's evidence was as follows : In such a case as that

of the deceased, before deciding to excise the bone, I should have examined the chest for tubercles. If I found this disease I should amputate and not excise the joint. If I found it necessary to amputate I should do so above the diseased bone. In gouging out the interior of the bone, its lining membrane would have been removed, and the vitality of the bone would be destroyed. The bone would, in such a case, become inflamed, and die, and act as a foreign body. It would require a very strong constitution to recover in such a case, and not then for many months. It was in my opinion bad surgery to leave this bone as it was left. I was not present at the operation, nor was I called to consult. I have examined the whole interior of the bone. It is dead. The dead bone would all have to separate and come away, before the stump could permanently heal.

The coroner, Dr. Youl, in summing up, pointed out that the operation had been performed without a consultation, and that if there had been a consultation, in all probability the patient's life would have been saved, by its being suggested as necessary to amputate higher up. He believed the diseased condition of the viscera had resulted after the operation. This he thought had been performed with a certain amount of recklessness, but the evidence did not disclose gross carelessness.

The verdict of the jury was : That the deceased, Margaret Ann Kelly, died from the effects of an operation performed upon her by Mr. Beaney. The jury are of opinion that Mr. Beaney was very rash in performing the operation without consulting with the other honorary surgeons, and the jury would wish that the committee of the Hospital should strictly prohibit the practice in future.

1876.] Mr. Beaney's Doings. 45

The other case was of a very different kind. Mr. Adolph Joske, a gentleman well connected, and well known to the mercantile world of this city, fell through a trap-door in the warehouse of Mr. David Webster, in Queen-street, on the forenoon of the 29th of January, and was taken in an insensible condition to the Melbourne Hospital, where he died on the following morning about seven o'clock. Mr. Beaney, whose case it was, was sent for at half-past one on Saturday afternoon, and at half-past seven by the son of the deceased, whom he promised he would come as soon as he had attended to some private patients. He was also seen at five o'clock of the same afternoon by Dr. Jonasson, who explained the grave nature of the case, and wha obtained from him a promise that he would go at once. At mid-night an official written notice was delivered to him informing him of the urgent need of his presence, and yet he did not attend until Sunday afternoon. No post-mortem examination was made, and the jury returned a verdict: "That the deceased died from concussion of the brain, caused by an accidental fall through a lift-opening on the previous day, and they request the coroner to call the attention of the Hospital Committee to the neglect of the honorary surgeon, Mr. Beaney, in not attending to the case."

Mr. Beaney, however, did not accept either this censure or that implied in the verdict in the other case, but lodged a complaint against his house-surgeon, Mr. Lawton, upon whose shoulders he endeavoured to fix the blame of mischance in both cases. The nature of the charge will be understood by the following reply contained in a letter addressed by Mr. Lawton to The Argus of date February 12 :

" To the Editor of The Argus. " Sir,—In your issue of 2nd inst., letters appeared from Mr. Beaney,

containing accusations against me. I enclose you the following statements made in reply. Mr. Beaney's letter having appeared in the public prints, it is no more than justice that the same prominence should be given to my statements in reply. Mr. Beaney came to the hospital on Saturday afternoon ; he did not visit any of the wards, he went to the dead-house to be present at the post mortem examination of Mrs. Kelly. I was also in the dead-house, and intended acquainting Mr. Beaney of Mr. Joske's case. I had no opportunity of mentioning it to Mr. Beaney at first, as he was engaged in conversation with some of the doctors present, and in looking at the structures as they were removed. In the meantime Mr. Beaney was called out of the room, and when he came in again he requested me to write a death-certificate for a woman, whose husband was waiting outside,' who had recently been a patient in one of his wards. I went to do this as requested, and in order to procure the information required, it was necessary to go into ward 22 to consult the case-book ; this took up some little time. I wrote the certificate, and gave it to the man. Shortly after this, Dr. Jonasson was introduced to me by Dr. Williams, and Dr. Jonasson and I, with Mr. Joske's brother and Dr. Lawrence, went into the

46

Mr. Beaney's Doings. [Feb.

ward to see the patient. We agreed that Mr. Beaney should be sent for, and Mr. Joske's brother volunteered to go at once, and both Dr. Jonasson and I saw him start in a cab for Mr. Beaney. Under ordinary circumstances I should have written a note to Mr. Beaney, but as the brother of Mr. Joske started immediately, I did not •consider it to be necessary. As Mr. Beaney did not come by about half-past six, I requested Mr. Joske's son, who was in the ward, to go for him. He went, and found Mr. Beaney was not at home, so he waited until Mr. Beaney returned. As Mr. Beaney had not arrived by 11.45 p.m., I wrote a note and sent it to him by the porter. The porter came back to me and said 'It is all right, Sir.' I waited up until late (two a.m.), but Mr. Beaney did not come, nor did he appear till about mid-day on Sunday. The patient died about 6.50 a.m. In the meantime I did what I thought was right for the patient. I have since ascertained that Dr. Jonasson called during the afternoon and explained the case to Mr. Beaney, asking him to go and see the patient, which Mr. Beaney promised to do at once. You will thus see that Mr. Beaney was at least on three different occasions communicated with, and that even after receiving my written communication he took no notice of it.

" The other charge made by Mr. Beaney against me is that I injected morphia after he ordered it to be omitted. This is really a question of discretion on the part of the resident staff. My state-ment in reply to the charge is as follows :—After being told by Mr. Beaney to omit the morphia injections, which Mrs. Kelly was having twice a day, I followed his instructions ; therefore his charge of what he calls direct disobedience and ignoring instructions falls to the ground, until one night, after the usual rounds, the night nurse came for me saying Mrs. Kelly was very bad. I went up to the ward, and found her screaming, shouting, and restless, with widely dilated pupils, in fact with all the symptoms of poisoning with atropine, which drug she had been taking for some days under Mr. Beaney's directions. Seeing this to be the case, I injected the morphia, which is the physiological antidote for poisoning with atropine. After this Mrs. Kelly became calm, and passed a quiet night. I mentioned this by the bedside of the patient on the following morning to Mr. Beaney, at the time of his visit, and gave my reasons for doing so (injecting the morphia), and I distinctly remember making use of the simile to Mr. Beaney, that her pupils were dilated like saucers, and that literally repre-sented their state. Mr. Beaney made no remarks to me in reply, and certainly gave no directions as to the use or disuse of the injections ; so I naturally inferred that he did not disapprove of my treatment, and that I should continue to act on my own judgment as circumstances might require. The next evening Mrs. Kelly was in pain, and very excited ; I pursued the same treatment with the same result. Again the injections were omitted until the night prior to her death, when I was passing by the ward door on quite another errand, Mrs. Kelly, hearing my footsteps, told the nurse to call me in. I went in. She complained of pain in her abdomen

1876.] Mr. Beaney's Doings. 47

and restlessness. She was also suffering from the loss of her accustomed dose of morphia, and in consequence of her then con-dition, she being low, weary, restless and sleepless, and at her earnest solicitation, I considered the injection imperatively demanded, and I have no hesitation in saying if the dose of morphia had not been administered she would have sunk earlier than she did. On the morning of her death she was quite sensible ; the spoke intelligently, and took nourishment. The chloral draught mentioned by Mr. Beaney, and which was evidently intended as a substitute for the morphia, was administered according to his direc-tions, and was vomited immediately. In answer to the charge of what Mr. Beaney calls direct disobedience, I maintain that on the first and second nights (after the interval of omission) I gave a dose of morphia, had I not given it, Mrs. Kelly would not have lasted twenty-four hours. She was screaming, tossing her arms, and rolling her head about in such a manner that exhaustion would have ensued, from which she would inevitably have sunk ; and I beg to state the instructions of Mr. Beaney were not wilfully ignored, but instead of that being the case, the morphia injections, when they were administered by me, were given on exceptional occasions, and only when absolutely necessary. Mention of the injection is made in the case-book on 4th December, of vomiting on 3rd December (the day after the operation), and any person who has taken morphia for such a length of time as Mrs. Kelly had taken it, and even twice a day for a considerable part of the time, is much more likely to suffer from its sudden withdrawal, than from an isolated or occasional dose of the drug.—I am, &c., F. LAWTON.

" P.S.—At the inquest held on the body of Mrs. Kelly, Mr. Beaney made no mention of the morphia injections."

Next in this series of events we have Mr. Beaney's lecture, delivered on the 12th of February, in the Athenmum, the title being " Doctors Differ." Boiled down, this lecture may be summarised as an estimate of the relative worth of the whole profession in Melbourne, and of Mr. Beaney. The author, whoever he may be—for nobody accuses Mr. Beaney of being able to write ten con-secutive lines of readable English—adopted the allegorical style, and, describing the profession in a city denominated Kennaquhair, alluded, with more or less pointedness, to various medical men in this city who do not happen to be of the same mode of thinking and acting as Mr. Beaney, keeping however this proposition always distinctily before the audience, that to achieve success is to deserve it. A country journal speaking of this lecture says : " Oddly enough, we do not see by the report in The Argus, that Mr. Beaney said a word about the ugly fact that a certain practitioner of `Kennaquhair' was once tried for a capital 'offence, and, indeed, though he made some allusions to pretty actresses,' he never Mentioned the name of Mary Lewis, about whose death and in whose memory he might be supposed to feel some interest. The sketch of the profession in Kennaquhair' seems to us singularly

48 Rights of Medical Graduates. [Feb.

incomplete without reference to this cause celebre." Perhaps Mr. Beaney is reserving this part of the allegory for another occasion, when he will probably extend it further by letting us into the secret of how that same hypothetical practitioner gets a reputation for very questionable authorship, by hiring needy and not too scrupulous writers to compile books for him ; how further he advertises himself indirectly by having 'these most unsavoury publications announced, and when possible puffed, in every newspaper in the colonies ; how, still further, he causes his patients to view their ailments through the magnifying medium compounded of their fears and his exaggera-tions ; how he contracts to cure, where cure is impossible ; how he procures for himself public appointments by an indirect process of self-election ; how, in like manner, he procures that he shall be feted at banquets, himself being the chief entertainer ; and how generally he denies practically that those who practise the vocation of medicine, need have any higher aspirations than those which consort with material success, and the reeky breath of vulgar popularity. This allegory may most aptly be added to the others, when next Mr. Beaney lectures at the Athenaeum.

THE RIGHTS OF MEDICAL GRADUATES OF THE UNIVERSITY OF MELBOURNE.

A meeting of the graduates and undei-graduates of the Melbourne University was held in the Mayor's room, Town Hall, on January 14, to consider matters relating to the conduct of the Melbourne .Hospital committee, in refusing to permit Dr. Lewellin to perform surgeon's duty at the hospital. The Rev. Dr. Bromby in the chair. The object of the meeting having been stated, the hon. secretary, Mr. Browning, pointed out that a preliminary meeting had been held, at which the following memorial had been decided on, and was presented to the hospital committee at their last meeting

1. Referring to rule 1, sec. 5, regarding the resident-surgeons, the word ' college' cannot be strictly interpreted to bear out the construction that the committee have at present put upon it. If so, a master of surgery of any university would be excluded, whereas a licentiate of medicine of any college (not having , passed any examina-tion in surgery) would be eligible for the office. 2. That up to the present time graduates of this University have filled the position of surgical resident, as shown by numerous precedents during the last nine years, viz.—Drs. Rees, Moloney, Ashworth, Teague, Duncan, and Annand; also students, viz.—Mr. Thomas and Mr. Allen. 3. The abruptness of the present decision of the committee, they having given no notice of it in any way, so that some provision might have been made. 4. That the present objection was raised in a similar case eighteen months ago (viz., on Dr, Duncan's application to transfer), and it was then ruled unanimously by the committee that Dr. Duncan was eligible. 5. The very serious injury that would be

1876.] Rights of Medical Graduates. 49

done to the students who have begun and are continuing their studies, no opportunity being given them, after graduating, to hold any appointment as surgeon in this hospital, whereas the Medical Licensing Board of Victoria recognise the holder of a degree of the Melbourne University, as one perfectly qualified to practise medicine, surgery and midwifery. 6. That such a decision would lead to a severance between the hospital and the University, greatly to the detriment of all students of medicine of this University, and that such decision forming a precedent, the country hospitals would at once close their doors to all Melbourne graduates. 7. That the surgical course of study necessitated by the University for a degree in medicine, is the same as that followed out by the universities and examining bodies of the United Kingdom for diplomas in surgery. 8. That the University of Melbourne is the only medical examining body in Victoria, but it has not the power of granting any special degree in surgery."

This memorial had, the hon. secretary stated, been virtually shelved, and therefore some further action on the part of gentlemen concerned became necessary.

The following resolutions were then adopted :- " That this meeting of graduates and under-graduates of the

University of Melbourne, expresses its regret that the committee of the Melbourne Hospital, in refusing to permit Dr. Lewellin to perform surgical duties, should have cast an unmerited slight upon the bachelor of medicine degree, the condition for the attainment of which includes a course of surgical studies equal to that which is demanded by several licensing bodies in the old country, for surgical qualificationsionly."

" That this meeting constitute itself into a committee, with power to add to its number, for the purpose of maintaining its rights and privileges belonging to those holding degrees of the University of Melbourne, and that it be a recommendation from this meeting to the committee, to consider the desirability of forming a permanent association, having the above object in view."

" That it be an instruction from this meeting to the committee just appointed, to take steps to secure powers to the University to grant degrees in surgery, and to secure the registration of colonial Medical graduates in the British Medical Register, without pro-ceeding to England."

" That the council of the University be petitioned to include in the University Degree Bills before the Assembly at present, a declaration that the degree of M.B. Melbourne includes the qualifi-cation of B.S., or else to at once take up the provisions for the B.S. degree into the bill abovementioned."

A sub-committee was formed to carry out the objects of the Meeting.

Rights of Medical Graduates. [Feb.

A few days subsequent to this meeting the subjoined memorial numerously signed, was forwarded to the council of the University : " To the Chanceller, Vice-Chancellor, and Members of the Council

of the University of Melbourne. " Gentlemen,—We, the undersigned, graduates and undergraduates

in the University, would most respectfully draw the attention of the council to the present indefinite and most unsatisfactory status of Bachelors of Medicine of the University of Melbourne. We would most especially draw the attention of the council to a recent decision of the committee of management of the Melbourne Hospital, to the effect that Bachelors of Medicine of the Melbourne University are not qualified for the post of resident-surgeon to that institution. This decision of our leading metropolitan hospital, which is itself in process of affiliation to the medical school of the Melbourne University, must lead to similar action on the part of the other leading hospitals in this colony, thus degrading and crippling the degree in question as a general qualification. And yet the course for the degree of M.B. in this University includes a thorough training and rigid examination in all the branches of surgical education. And in no university or college is there any similar course for a simple physician's diploma or certificate. Nay more, the course for the degree. of M.B. Mel-bourne includes all the qualifications for the degrees of M.B. and B.S. London, as will be seen from the following table.

" QUALIFICATIONS FOR M. B., MELBOURNE. "Three courses of dissections. -" Two courses of lectures on anatomy. "Three examinations in anatomy, written, oral, and by dissection, including

descriptive and surgical anatomy. "Two years' lectures on surgery and surgical pathology. "Lectures on operative surgery. " Three years' hospital practice in all, including nearly eighteen months' dressership. u Two written examinations in systematic surgery and surgical pathology. " Clinical examination in surgery. "Examination in operative surgery. "Certificate of minor surgery, &c.

" QUALIFICATIONS FOR M.B. AND B.S., LONDON. " Two courses of dissections. u One course of lectures on anatomy. "Similar examinations in anatomy, descriptive and surgical. u One course of lectures on surgery. u One course of lectures on pathology. "Lectures on operative surgery. " Two years' hospital practice, medical and surgical, and six months' with

special charge of cases. " A written examination and oral in surgery and one in pathology. "Similar clinical examination in surgery. " Similar examination in surgery. "Examination in the application of surgical apparatus.

" So that the Bachelor of Medicine of the Melbourne University does more anatomy, and as much or more hospital practice, than the

41.B.B.S. of London. The relation of the M.B. degree of Mel-bourne to the M.B. Ch. M. degree of Glasgow, for instance, is very

1876.] Lady McCulloch's Home for Convalescents. ' 51

similar. Furthermore, in the Degrees in Surgery Bill' at present before the Legislative Assembly, provisions were at the first reading made for the degrees of both Bachelor and Master in Surgery, but since then the degree of Bachelor in Surgery has been dropped from the bill. The only construction that can be put upon this is, that the qualifications for the degree of M.B. in this University include all the qualifications for the degree of Bachelor in Surgery. But again, the surgical qualifications included in the course for the degree of KB. Melbourne, precisely correspond to the medical qualifications in the same. We woul4 also respectfully submit that even when power is obtained by the council to grant the degree of Master in Surgery, this will in no way obviate the insufficiency from a surgical point of view of the diploma of Bachelor of Medicine. For the degree of Master in Surgery will not be within reach of a student for five years after obtaining the degree of M.B., as Bachelors of Medicine of Melbourne University, will not in future be able to avail themselves of the power of entering the examination for the degree of Master in Surgery, after two years' surgical practice in an hospital, as that practice will now be closed to them from the insufficiency of their degree. And if a Bachelor of Medicine wishes to devote himself specially to the practice of surgery, it is a very great hardship, and entails great risk of failure in his profession, to have to enter the private practice of surgery, without the experience and prestige gained by holding for one or two years, the post of resident-surgeon in a large hospital. We request the attention of the council to this matter, the more confidently that one of the conditions of affiliation proposed by the council to the Melbourne Hospital, was that in all appointments to the resident staff, graduates of Melbourne University should have the preference to gentlemen from other universities or colleges. We would with the utmost submission plead that when we commenced our studies in this University, the full belief existed that the degree of M ; B. would entitle its holders to rank as surgeons and physicians.

" We would therefore most urgently pray the council, either-1st. To definitely recognise the degree of M.B. Melbourne as a double degree, including a special qualification in both medicine and surgery, if necessary causing a bill to this effect to be introduced into Parliament ; or, 2nd. To obtain power as speedily as possible to grant the degree of Bachelor of Surgery, such degree to be con-ferred on all who hold the diploma of M.B. Melbourne, under the present regulations, without further examination."

LADY M'CULLOCH'S HOME FOR CONVALESCENTS. (From the Argus.)

Of the many benevolent institutions established throughout Victoria for the relief of the sick and distressed poor, there is none that re-dounds more to the honour of the founder, than the convalescent home for necessitous women, established and maintained by Lady M'Culloch entirely at her own cost. The establishment is, we believe, the only

E 2

52 Lady McCulloch:8 Home for Convalescents. [Feb.

one of its character in Victoria. For nearly two years this home has been at work doing good in such a quiet manner, that very few people in Victoria are even aware of its existence. The situation chosen by Lady M'Culloch as the scene of her truly benevolent work, is remarkably well suited to the purpose. The house is situated on the summit of the rising ground that stretches from the east of the Brighton-road, and close to the junction of the Kooyong and Glen Eira roads. The soil is well drained, and the air extremely fresh and pure. The view from the house is a most charming and extensive one, commanding a wide expanse of Port Phillip Bay. The You Yangs stand out well-defined against the southern sky. The shipping in Hobson's Bay and the hills to the north-west of Melbourne are well in view. There is scarcely a locality in the neighbourhood of Melbourne which commands such a beautiful stretch of scenery, both seaward and landward. Owing to its elevated situation, the residents at the home always have the full benefit of the faintest sea breeze that is blowing. The property was bought by Lady M'Culloch from Mr. G. 0. Duncan, the inspector-general of penal establishments, in April 1874, and on the 10th of June following, the first patients were received. The building and premises generally were so well arranged that it has not been found necessary to make any but the very slightest alterations, the principal one being to turn the coachhouse into a laundry. The home is

of accommodating eight inmates, who are usually received from the Melbourne and Alfred Hospitals. Persons recovering from typhus and scarlet fever, or any other infectious disease, are not eligible for admission ; nor is it contemplated to admit children under 12 years of age to the home. The inmates are received for two weeks, which may in some cases be extended to a month ; but in none, except very extreme cases, are any of the patients allowed to remain more than a month, the object of the home being to assist poor and necessitous women recovering from illness, and not to form a hospital for incurables. The inmates are maintained during their stay free of charge. A liberal dietary scale is established, and no other food is allowed to be introduced into the house. Thanks to the excellence of the management, the salubrious situation of the home, and perfect rest, there has never been a death in the home since it was established, and with the exception of a few consumptive patients, all those who have visited the home have left it completely restored to health. Last year 80 patients received the benefit of a short stay at the home. During the first five months of the present year, 60 patients visited the home. At this time the scarlet fever became so bad, that fur fear of infection the reception of inmates from the hospitals was discontinued, and has not yet been resumed. In the meantime private cases are being received. The house is most substantially built of brick, stuccoed, with ample room for eight inmates, and separate apartments for the lady superintendent. The offices are all very conveniently arranged, and the most perfect cleanliness and order reigns throughout the establishment. On the south side of the house is a very broad verandah, which, in fine

1876.] Melbourne Hospital Chronicles. 53

weather, is the favourite resort of the inmates, as it is sheltered from the heat of the sun, and the view is remarkably fine. The grounds are six acres in extent, being laid down in flower-garden and shrub-bery, in which the inmates take shelter when the sea breeze blows too keenly, fruit-garden, and paddock for the two cows kept on the establishment. Lady M'Culloch has lately purchased a few small allotments fronting the Glen Eira road, which projected into the property, and thus avoided what has always been looked upon as an eyesore to the home. One female servant is kept on the premises to do the kitchen work ; all the rest of the work is done by the inmates. Visitors are received on Fridays, but as the home is so far away from town, the visitors are few, and this rule is not very strictly enforced. The police-station is situated at one corner of the property, and thus gives the inmates and other residents a feeling of complete security, which from its retired situation would otherwise be wanting. The home possesses another great advantage. There is only one publichouse in the district, and that is fully two miles away. The health of the inmates is attended to by Dr. Dempster, of St. Kilda, who visits the home regularly. As soon as all danger from scarlet fever is at an end, fresh inmates will be received from the hospitals. The amount of good done by the home can hardly be estimated by those who do not know in what condition patients often leave the hospitals, where every bed is wanted. As soon as the disease is cured, the patient has to leave, and often they are suffering from extreme weakness, and have neither home nor friends to go to. It was to meet such cases that Lady M'Culloch's noble act of benevolence was directed, and so well is the institution suited to the purpose for which it was intended, that it is seldom that Inmates, who, on admission, are often unable to walk, require to stay a month till they are in good health. There can be no doubt the home has been the cause of saving many useful lives to the community, by rendering convalescent poor women fit to work for their living.

MELBOURNE HOSPITAL CHRONICLES.

December 14th.—Meeting of Committee : A letter was received from Dr. Motherwell, in reply to a communication from the com-mittee, calling his attention to the 64th bye-law, prohibiting admis-sion to the hospital, of persons suffering from delirium tremens. Dr. Motherwell replied that he was perfectly conversant with the bye-law referred to, and he failed to perceive what the committee wished to call his attention to.

A satisfactory explanation was received from the resident surgeons relative to the alleged case of neglect in attending to a case of fracture.

Six weeks' leave of absence was granted to Dr. Annand, and Mr. Lawton, M.R.C.S. Eng., was appointed to act for him.

Leave of absence was granted to Dr. Duncan from Saturday to

54 Melbourne Hospital Chronicles. [Feb.

Monday, on the ground that he had taken a wife, the indulgence not to be considered as a precedent.

The date of election of honorary assistant physician was fixed for the 20th December, and the candidates were announced to be Dr. Jonasson, Dr. Balls-Headley, and Dr. Healy.

It was resolved, on the motion of Mr. KNAGGS : " That a rule be framed by the committee of management to the effect that the lecturer on surgery at the University, shall be empowered to examine in the wards of the Hospital any students in surgery who shall be in attendance in the practice of the Hospital, at such times as may be approved of by the committee, and during their pleasure."

The CHAIRMAN called attention to a letter from Dr. Robertson, which appeared in The Argus, and in which he controverted a state-ment made at the last committee-meeting, to the effect that none of the assistants or patients had suffered from contact with scarlet fever patients placed in the same ward. Dr. Robertson stated that two nurses and some patients had died from scarlet fever caught in the Hospital, and he (the chairman) wished to know if this were the case, as he thought it would be very reprehensible to do anything which would endanger the lives of persons in the Hospital, no matter under what advice.

Mr. BAILLIERE gave notice that he would move : " That a return be furnished showing the weekly attendance of each honorary surgeon and physician since date of his election ; the number of operations performed by each surgeon, and the names of the honorary surgeons present at such operations ; the number of consultations summoned by each surgeon, and the names of those surgeons who attended the same." '

December 20th.—Election of Assistant Physician : The election of an honorary assistant physician took place on the above date, the following being the result :—

Dr. JONASSON - 416 Dr. HEALY - - 220 Dr. BALLS-HEADLEY - - 183

Dr. JONASSON, therefore, was elected. December 2l st.—Meeting of Committee : The election of Dr.

Jonasson was reported. A letter was read from the city coroner, Dr. Youl, transmitting

the rider attached to the verdict of the jury on the boy Michael Barry, recommending that the committee should insist on strict adherence to rule 7, relative to consultations of the honorary staff before the carrying out of capital operations. A communication was received from Dr. Lewellin, resident physician, calling attention to a letter which appeared in The Argus of Saturday, 18th, from Mr. Alexander Fisher, surgeon, asserting that the chloroform had been carelessly administered to the deceased. As this statement was calculated to injure the institution, and also seriously affect his (Dr. Le wellin's) reputation, he respectfully requested that the committee should take steps to have the matter fully and fairly investigated-

1876.] Melbourne Hospital Chronicles. 55

A letter was also received from Mr. Beaney, relative to the same subject, and stating that he had no desire to override the wholesome rules made for the management of the hospital. He had omitted to call a consultation in this case, simply through being accustomed in his private practice to act on his own responsibility; but in future he would strictly adhere to the rules of the institution.

A sub-committee was appointed to investigate the charge made against Dr. Lewellin.

It was resolved : " That Dr. Yours letter be acknowledged, and that gentleman informed that it was the intention of the committee in future to insist upon the rule referred to being complied with."

It was resolved : " That it be an instruction to the resident medical and surgical' staff, to inform the secretary of all consultations, in order that notice of the same may be forwarded to the honorary consulting physicians or surgeons, or such as may be called on cases on their respective sides of the hospital."

December 28th.—Meeting of Committee : The chairman reported the receipt of a letter from Dr. Webb, complaining of an assault having been committed upon him by Dr. Duncan. The letter was referred to the house-committee. Letters were also read from Dr. Duncan resigning his office of resident surgeon, and from Dr. Lewellin, applying to be transferred from the medical to the surgical side.

The sub-committee appointed to investigate the complaint against Dr. Lewellin, reported that there were no grounds whatever for the charges which had been made in Mr. Fisher's letter.

Mr. Gums gave notice of the following motion for that day four weeks :—" New rule in place of Rule 7.—No important operation in surgery shall be performed unless the following conditions have been complied with, viz.:-1. That the patient shall have given his consent to such operation, unless unable to do so. 2. That such operation shall be sanctioned on consultation by a majority of the honorary consulting surgeons and honorary surgeons present, cases of emergency excepted. 3. That such operation shall be sanctioned by at least one of such honorary consulting or honorary surgeons in addition to the surgeon performing such operation. All consultations, excepting emergency cases as aforesaid, shall be held on Tuesday of the week, in the consultation room, and the result of each of such consultations shall be entered in the consultation-book, and the majority of the surgeons present as aforesaid shall subscribe their names in such book. All important operations (emergency cases excepted) shall be performed at two o'clock on Mondays and Thurs-days of the week, and no operations shall be performed on Sunday unless of absolute necessity, and all notices directed to be given to the hon. surgeons for attendance at such operations, shall likewise le given to the hon. consulting surgeons."

January 4th.—Committee Meeting : A letter received from Dr. Webb, withdrawing his charge against Dr. Duncan. A letter

56 Melbourne Hospital Chronicles. [Feb.

from Dr. Duncan, conveying his resignation as resident-surgeon. Dr. Lewellin's application to be transferred to the surgical side of the house refused, on the ground that as M.B. Melb. he was not qualified.

January 1 lth.—Committee Meeting : A letter received from Dr. Lewellin, pointing out the injustice of not permitting him to act on the surgical side of the hospital. Also, a communication from students of the University of Melbourne, urging the surgical sufficiency of the M.B. degree. It was resolved that legal opinion be obtained as to the eligibility of Dr. Lewellin to stand as a candidate for the office vacated by Dr. Duncan.

January 18th.—Committee Meeting : The following opinion from Mr. Higinbotham was read—

There has not been at any time an Act of Parliament in force in Victoria bearing the title of " The Medical Registration Act," and it is by no means clear that Rule 1 of Section V., which prescribes the qualification of resident-surgeon, has any legal force, or that there is any qualification required by law, either for the office of resident-surgeon or for that of resident-physician to the Melbourne Hospital. But assuming that "The Medical Practitioners Act 1862," No. 158, which was in force when these rules were made, or " The Medical Practitioners Statute 1866," which is now in force, be the Registration Act referred to by the rule, I think that Dr. Lewellin is duly qualified under the rule by virtue of his degree of M.B. from the Melbourne University. The word " college " must be held, I think, here to include a university, and cannot be limited to the "colleges " enumerated in the third schedule of the latter Act, for these include colleges of physicians, and according to such limited interpretation, a licen-tiate of the Royal College of Physicians of London, or of the Queen's College of Physicians of Ireland, would be qualified under the rule to be appointed resident-surgeon, while a " master in surgery of some British or Colonial University " (schedule 3, section 10), conferring such degree, would not be qualified. It was the intention of all the Medical Practi-tioners Acts passed in Victoria that a qualification, in either medicine or surgery, should enable the registered practitioner to practise either branch of the profession, and a similar extended meaning must, I think, be given, if any meaning can be given at all, to the hospital rule in question. The reason assigned by the Committee for refusing Dr. Lewellin's application appears to me to be erroneous. But assuming Dr. Lewellin to be duly qualified under the rule for the office of resident-surgeon, be has, of course, no legal right to demand that his application shall be granted.

16th January, 1876. GEO. HIGINBOTHAM.

It was proposed, but not carried, that Dr. Lewellin should be a candidate for the office vacated by Dr. Duncan. It was also pro-posed and not carried that the day of election be postponed for one month, to give time for further consideration. It was resolved that it be a recommendation to the governors, at the annual meeting, to constitute as life governors of the hospital Dr. Black, Dr. Cutts, Dr. Barker, and Messrs. Garrard, Gillbee, and Rudall.

January 25th.—Committee Meeting : Leave of absence for one fortnight was granted to Mr. James, Dr. Ryan to act in his place during his absence.

The following report of the sub-committee appointed to consider

1876.] Melbourne Hospital Chronicles. 57

the qualifications of candidates for the post of resident-surgeon, was brought up—

Your committee, having examined the degrees and diplomas of the can-didates submitted for their inspection, and seeing that Mr. Higinbotham has expressed his opinion on the case submitted to him, that persons holding the M.B. degree of the Melbourne University are eligible to be admitted as candidates to fill the post of resident-surgeon in the Melbourne Hospital, are of opinion that the three gentlemen who have offered them-selves as candidates are eligible for election. The names of the candidates are—Messrs. Heffernan, Kennedy, and Lawton.

ROBERT KNAGGS, Chairman.

After considerable discussion the report was adopted, leaving out the name of Dr. Heffernan. A ballot was then taken, and Dr. Kennedy was elected. Mr. Bullen gave notice of motion for that day month for the alteration of the rule, so as to render holders of the M.B. degree eligible as candidates for resident-surgeon.

January 26th.—Annual Meeting : Mr. JEREMIAH DWYER moved, " That the Committee of Management is deserving of severe censure, and should resign, for not having carried out the resolution of the special general meeting held on May 20, 1875, viz.: That such alterations be made in the by-laws of the hospital as will admit the holders of degrees of M.B. Melbourne University, being eligible for election to the office of honorary surgeon to the institu-tion.' " After a long discussion this motion was modified as follows, and carried by a large majority : " That the members of the • Committee of Management who were a majority, and opposed the -carrying out of the resolution of May 20, are deserving of severe censure, and should resign for not having carried out that resolu-tion."

Mr. DERBIN WILDER gave notice of motion as follows : " That, having regard to the large sum which the State contributes to the funds of the Melbourne Hospital, this meeting is of opinion that the Government should appoint a responsible officer as a member of the board."

The following members of Committee were elected : Professor Ilearn, Dr. Lawrence, and Messrs. McGuigan, Hood, and Anderson.

February 1.—Committee Meeting : A letter from the chairman of the annual meeting, conveying the preceding resolution, was received. Also, a letter from Dr. Heffernan, protesting against the decision of the Committee in refusing to permit him to be a candidate for the office of resident-surgeon.

The following communications were received: From Mr. Beaney- Melbourne, Jan. 31.

The Chairman and Committee of the Melbourne Hospital. Gentlemen,—I regret to have to bring under your notice a case of direct

'disobedience on the part of Mr. Lawton, resident-surgeon, and request you will take into your serious consideration the utter impossibility of effecting a cure of the patients under my charge, if my instructions are wilfully ignored. The charge I have to make against Mr. Lawton is as follows: A patient, Mrs. Margaret Kelly, now deceased, was under my care for some 'Weeks in the hospital. During the treatment it was found necessary to

58 News from Europe and America. [Feb.

administer hypodermic injections of morphia at bedtime. For some days prior to her death, she suffered from obstinate vomiting, and fearing the morphia was doing her harm, I told Mr. Lawton not to inject ber again. On visiting her the following day, I found she had been injected as usual. I then, in the presence of the nurse, distinctly expressed my disapproval of my orders not having been carried out. I also wrote a prescription in the case-book for a chloral draught, adding at the same time, in presence of the matron, that I would not allow the patient to be injected again with morphia. In the face of all these instructions, I find that Mr. Lawton paid not the slightest attention, and even injected the woman at 1 o'clock in the morning, from which she never rallied, and died in the evening.

I would also call your attention to the case of the late Mr. Joske, who, according to Mr. Lawton's evidence, was admitted between 11 and 12 a.m. on Saturday. I was present in the hospital the same day between the hours of 1 and 3, and saw and spoke to Mr. Lawton, who never mentioned that a serious accident had been admitted. The first official intimation I had of the case at all was contained in a letter, which I now enclose, and in which I am told a patient whom I never saw is much worse. Had Mr. Lawton done his duty he should have directed my attention immediately to the case, and his not doing so is evidence of direct neglect or sheer incapacity on his part.

The following is the enclosure— JAMES G. BEANEY.

Melbourne Hospital, Jan. 29, 1876, 11.45 p.m.

Sir,—I beg to inform you that the patient Joske, who was admitted this afternoon, suffering from concussion, shock, &c., is much worse.

F. LAWTON.

Melbourne, Jan. 31, 1876. The Secretary Melbourne Hospital.

Sir,—I do myself the honour to inform you that at an inquest held this day in the Melbourne Hospital, upon view of the body of Mr. Adolphe Joske, I was requested by the jury to bring under the notice of the Com-mittee the neglect of Mr. Heaney in not visiting the deceased, although; repeatedly requested to do so.

RICHD. TOOL.

These communications were referred to a sub-committee, consisting of Messrs. Gillbee, McGuigan, Hood, Phillips, and Bailliere.

The certificate with the seal of the institution was granted to Dr. Duncan, for having served two years in the hospital.

ABRIDGEMENT OF NEWS FROM EUROPE AND AMERICA.

Dr. Spencer Thomson, in the Lancet, professes to have found in qelseminum sempervirens (yellow jasmine) a specific for the instant relief of neuralgia affecting those branches of the trifacial nerve supplying the upper and lower jaws—more particularly the latter, and more especially when in either jaw the pain is referred to the teeth or alveoli. The dose is 20 minims of the tincture to be repeated any time after an hour and a half, if relief is not given. For neuralgia affecting the orbital and frontal nerves which gelse-minum seems powerless to relieve, phosphorus is highly serviceable in 1-36th of a grain doses.

From Dr. Youl-

1876.] News from Europe and America. 59

Mr. Bucknill, in Medical Times and Gazette, recommends the use of creosote for tape and round worms. One drop of creosote made into pill with pulv. tragacanthze three times a day—half an hour after each meal—is given at first. The dose is gradually increased up to three drops, and about the seventh day, a dose of castor oil is given.

M. Isambert, of Paris, says the Practitioner, quoting Gazette Medicale de Paris, demonstrates that chlorate of potass in passing through the body gives out neither oxygen nor chlorine, but is eliminated en masse by the secretions.

The Journal of Obstetrics strongly recommends the injection into the uterine cavity, in cases of haemorrhage, of tincture of iodine instead of salts of iron. Because, since the iron produces coagula-tion of the blood in the orifices of the blood-vessels, there is danger that the coagulation may follow the vessels into the substance of the uterus, producing dangerous thrombi, and hardening the blood already in the cavity ; and the uterus being unable to expel it, the Mass may after a few days decompose and give rise to septicaemia. Moreover, the favourable results from the use of iron seem due to its power to excite dormant reflex action, in which function it is decidedly inferior to iodine.

Dr. J. Keith Anderson, in the Practitioner, recommends as an effectual remedy for the paroxysm of spasmodic asthma, the hypo-dermic injection of 1-6th grain of hydrochlorate of morphia.

Dr. Felix Planat, says the Edinburgh Medical Journal, to whom was recently awarded the Barbier Prize of the Paris Academy of Medicine, recommends the active principle of cocculus indicus as a

remedy for epilepsy. He prepares it thus : cocculus indicus, 200 grammes ; alcohol, 1000 grammes ; macerate for three weeks. Give two to three drops daily, at first—and then diminish the dose gradually. The treatment should be continued for several months.

The Nashville Medical Journal, quoted in the Edinburgh Medical Journal, has the following :—If the fingers of an injured arm can be placed by the surgeon or the patient upon the sound shoulder, while the elbow touches the thorax, there can be no dislocation, and if this cannot be done there must be dislocation. In other words, it is physically impossible to bring the elbow in contact with the sternum or front of the thorax if there be a dislocation, and the inability to do this is proof positive of the existence of dislocation, inasmuch as no other injury of the shoulder-joint can induce this inability.

In a paper read by Dr. W. Craig, at the Medico-Chirurgical Society of Edinburgh, according to the Medical Times and Gazette, it was stated that several bodies had been injected with a solution ,

of hydrate of chloral (90 grains to each body), and used in the

60 News from Europe and America. [Feb.

University dissecting-rooms. The results were as good as by the ordinary preserving processes ; the nerves were more easily dissected out, though the muscles were somewhat flabbier. The writer of the paper exhibited several pathological specimens which had been in a solution for many months, of which the colour was good and the state of preservation complete. A lotion of the strength of from Eve to fifteen grains was stated to form an excellent application to wounds, ulcers, burns, as well as in many surgical cases.

According to the Medical Times and Gazzette, Dr. J. Legeen has discovered an improved method of detecting sugar in the urine. The suspected urine is filtered through animal charcoal, which is then washed out with a little distilled water. To this wash-water Trommer's test, i.e., the copper test, is applied in the usual way. Very minute quantities of sugar can thus be detected.

The Medical Society of Calvados, says the Gazette Hebdomadaire, quoted in the Medical Times and Gazette, in regard to consultations with homceopaths, lately resolved, " That any practitioner calling himself a homceopath or practising in that capacity is to be con-sidered as performing an act of charlatanism ; and consequently that any member of this society should refuse to meet him " The report also adds that homceopathy at the present day, is but a vain demonstration, since it is nowhere actually practised, serving as a cloak for charlatanism.

Dr. James M. Williamson of the National Hospital for Consump-tion, Ventnor, states in the Lancet, the results of fifty cases of hmmoptysis, treated with ergot. Out of the fifty cases bleeding was checked in forty-four instances. Forty-minim doses of the liquid extract were given twice within the first hour, and guided by the results, at least every two hours afterwards, the dose being diminished and given less frequently as the hmmorrhage subsides. If four or five full doses made no impression, the remedy was abandoned for another. Ergot never causes griping nor constipation, never interferes as some astringents do with a liberal use of milk, and as it was successful in 88 per cent. of cases in which it was tried, the writer of the paper recommends that it should be the drug first tried in all cases of hinoptysis.

Dr. Nitzsche, surgeon to several Austrian factories, stated, says the Lancet, at the Gray Congress, that in burns where the epidermis is preserved but much serum is underneath, the serum can be removed without the destructicn of the epidermis. This is effected by the application of thick fruit jellies, such as quince or raspberry, or by compresses soaked in the jelly so as to be considerably thickened. By the law of exosmose, the serum transudes into the jelly or compress ; after a day or two the application is removed and the epidermis is found shrivelled up, and the parts beneath protected from inflammation and ulceration.

1 876.] Correspondence.

CORRESPONDENCE.

MENTAL DUALITY. To the Editor of The Australian Medical Journal.

Sir,—On Saturday morning, 5th October last, about two a.m., I was thrown out of my buggy, and lay in the road until between nine and ten a.m. unconscious. The accident occurred through one of the horses having lost its winkers and head-gear, and not being Under sufficient control at the time, one side of the buggy, in Crossing a deep rut, came in contact with a wooden post, and I must have been flung forwards from twenty to thirty feet with great violence, the result being a sprained ankle, fracture of the small bone of the right leg, severe contusions about the body, the left temple grazed on the side, and the right ear lacerated as if from sliding over the ground. During the week following, with care, the inflammation of the instep was reduced, and the bruises generally disappeared, but the pain in the right temple was at times very acute, culminating on the Saturday morning following the accident, in a singular condition of semi-delirium. At that time I was under engagement to read a paper on drainage, before the Warrnambool Farmers' Club, another before the Health Society, and a third before the Royal Society. I had been anxious lest my mishap should Cause disappointment, and having reason to suppose one of the daily newspapers inimical to me, and unlikely to give publicity to the cause of delay, the illusion took the form of obstruction to the setting up of some type, but I had no idea what the type was being set up for, only that I had a dreadful nervous feeling of irritation at the obstruction so caused.

I imagined there was a cast iron frame four or five inches square, With a square hole in the centre through it, into which the type, When set, passed almost like a metal ribbon, but from some cause the newspaper before alluded to, flung in one after another, a couple of cat skins, which were fastened to two of the type, and obstructed everything. In this distress I began moaning " Oh ! if only F.* knew, if only F. were here, he could explain." How long thin lasted I cannot say, but I think from half an hour to an hour, and My wife in her distress spoke to me and said, " Well, I will send for

" but on hearing this, the sound side of the brain said, " What is the use of sending for him, he can do nothing I "

In thinking over the matter subsequently, it has occurred to me that this is an exemplification of the dual character of the brain, showing how one part may be incapable of acting normally, whilst the other is comparatively unaffected, the mind, however, being scarcely conscious of the absurdity of the ideas passing through it, and due to the injury of one hemisphere, until aroused to activity by the appeal made to it in spoken words.

It is a question to me, whether such an illustration of mental

* A well-known member of the press, and an old friend.

62 Local Topics. [Feb.

duality would have occurred, if the injury had taken effect in the side or posterior portion of the brain.

Without professing myself a phrenologist, I think it is generally admitted that in some way the intellect or reasoning powers are intimately connected with the anterior portion of the head, whilst the passions and feeling are connected with the central and posterior portions ; consequently, if the above be granted, the reason is tolerably plain why the injury, to one side of the forehead, may to a certain extent be reasoned upon, by the opposite lobe within certain limits.

The region of injury was about where the phrenologists have numbered 9, 32, 20, and 19, so that you may note, that according to the so-called science, I was knocked out of " time " in more senses than one ; " ideality " damaged ; "ludicrousness " excited ; and I presume the phrenologist would say that " constructiveness " blundered along with " ideality " in the unreality of its imaginings.

In the above sketch, which is as nearly a narration of facts as I can give them, you will use your own judgment as to whether you use the whole, a portion, or any.

Faithfully yours, Warrnambool, Feb. 17, 1876. THOMAS E. RAWLINSON.

LOCAL TOPICS.

At the meeting of the Medical Board on the 4th February, the following qualifications were registered : James Duncan, Sale, M.B. et Ch. M. Aberd. 1875 ; Frederick Homan, Bairnsdale, L.F.P.S.G. 1855. Name erased from the register : Stewart Cowper, deceased.

Dr. Reynolds has been appointed officer of health for the shire of Mansfield.

At the annual meeting of the subscribers to the Eye and Ear Hospital, held on February 1, it was stated that, during the year 1875, the number of in-patients had been 171; out-patients, 2347 ; and attendances of out-patients 14,272, which was an increase of 17 patients and 17 attendances over the previous year. The number of capital operations performed was 161, as against 256 in the previous year. Mr. Gray was elected surgeon for life, Dr. Bowen for 10 years, and Dr. Ryan assistant-surgeon for 5 years.

The report of the committee at the annual meeting of the Lying-in Hospital on January 31, included the following description of the changes lately effected in that institution during the period of its closure, on account of the occurrence of scarlet fever. " In November last, owing to the prevalence of scarlet fever in Melbourne and its suburbs, and to the fact of three cases having appeared in the hospital itself, it was judged advisable to close the institution for a short time. In taking this step, the committee were not unmindful of the responsibilities which rested on them, and at a special meeting of the General Corn-mitee, it was arranged that assistance, both medical and pecuniary, should be given by them at the houses of the applicants, who, it was intimated, could obtain tickets in the usual way by attending at

1876.] Local Topics. 63

St. Enoch's Assembly-hall, instead of at the hospital, every Friday morning. Offers of assistance from surgeons in various districts were thankfully received, and in any critical case the patient was cared for with as much attention, as she would have received had she been in the hospital itself. The closing of the hospital, although in itself an evil, has been productive of good, since, while it has been vacant, opportunity has been taken to thoroughly look over the premises, with a view to carrying out beneficial alterations. By the advice of the medical staff, many improvements have been effected. The system of drainage bus been altered, the operation-room has been enlarged, and the whole of the worn-out wooden flooring of the verandah, has been replaced by asphalte. Mr. Davison's contract for these works was accepted for the sum of £581 19s., and although there is no building fund to fall back 'Upon, it is hoped that the strong representations of the committee will induce the Government to grant a sum this year for building purposes which will enable them to defray the cost of these very necessary works. Nearly an acre of the hospital ground has been well trenched and manured during the past year. Three sides of the square have been planted with trees of various kinds, and walks have been laid out with a view to making pleasure-grounds for the patients."

The following return was submitted at the annual meeting of the subscribers of the Alfred Hospital : -Return of the number of In-patients, Out-patients, and Casualties

treated annually at the Alfred Hospital from the year 1871 to 1875, both inclusive, and also of the number of deaths en each year.

Years. -t>

Ai A - r, .

'FIERvo

a

quo° le a

•

evio -pp3d -In

°

•

sa piguire o

'B re 10I

1871 . . . 1872 ... 1873 ... 1874 ... 1875 ...

354 710 875

1023 1110

37 75 97 83

104

103 10 4-7 101-12 8 1-9 93

917 1679 2162 2213 2465

978 2229 2653 2285 3033

2249 4618 5690 5521 6537

Dr. Wehl, of Mount Gambier, died on the 11th of February from 'hydatids of the lungs. He had practised in South Australia since 1849, and had been closely identified with the social progress of that colony. He was widely and deservedly respected, and his death in the prime of life is a source of general and profound regret.

An inquest was held on the 27th of February upon a patient who .died in the Melbourne Hospital, after having been operated upon by Dr. Webb, acting for Mr. Beaney. Mr. Lawton, acting-resident surgeon, deposed that deceased was admitted on the 23rd inst., suffering from a compound fracture of the lower part of the right leg, with great lacera-tion of the soft parts, and the end of the upper fragment of the tibia protruding. The back of the left knee was greatly bruised, with swelling of the whole limb above and below the injury. A consultation was held, and it was decided to amputate both legs, which was done. Deceased gradually sank, and died on the 24th inst. The operations were performed by Dr. Webb. One leg was taken off above the knee. It was found after the operation was performed that the bone protruded most, the muscles next, and the skin least, and it was necessary to perform the operation again, in order to leave a flap large enough to cover the bone. Dr. Youl, in addressing the jury, made some

64 Notices to Correspondents. [Feb.

remarks upon the way in which operations have been recently performed at the hospital, and intimated that he should communicate with the committee of the institution upon the subject.

A correspondent sends us the following handbill : " Dr. Johnston begs to inform the inhabitants of Beaufort and surrounding district, that he has reduced the price of the following articles from ls. 6d. to ls. Holloway's pills and ointment, Cockle's pills, Bristol's pills, Ayer's pills, Blair's pills, Jayne's pills, Steadman's teething powders, Winslow's soothing syrup, Atkinson's infants' preservative, balsam of aniseed, fluid magnesia, Perry Davis's pain killer, Collis Browne's chlorodyne, Keating's cough lozenges, seidlitz powders, baby bottles, and other articles at the same reduced rates."

The man Greathead, who obtained notoriety some two years ago for prescribing sulphuric acid as a specific for diphtheria, now announces his remedy in the following advertisement : " Greathead's new mixture cures diphtheria, scarlet fever, neuralgia, rheumatic pains. It kills animalculce and parisitical life in the blood. Is one of the best medicines to assist and strengthen the digestive organs. It is the finest drink in the world when hot and thirsty. Ask those that have tried it for proof of it as a specific remedy for nearly all complaints. See bills with each bottle. Wanted storekeepers as agents all over the colony.—RoBT. GREATHEAD, 33 Chetwynd-street, Hotham."

The Microscopical Society of Victoria held its monthly meeting on February 24. Mr. Ralph, the president, described and exhibited a supposed new conferva found in a stagnant pool at Bulleen. Mr. F. Barnard exhibited and read some observations on a fungus infesting the leaves of one of the eucalypti, and not known to have been des-cribed. Mr. Sydney Gibbons addressed the meeting on " Methods of Modifying Light, for the relief of the eyes in microscopic observations," and showed some simple and effective contrivances for the purpose. He recommended the use of very pale cold blue glass, not purple, applied to the diaphragm and as a removable cap over the eye-piece.

BIRTH. STARKE.—On the 11th February, at Inglewood, the wife of Hayden Starke, M.D., of a

daughter. DEATH.

WARWOCK.—On the 8th February, at Church-street, Richmond, Eliza Ellen, wife of John Warnock, L.K.Q.C.P.I., &c., aged 49 years.

NOTICES TO CORRESPONDENTS. Communications have been received from Mr. Ford, Mr. Gunning,

The Librarian of the British Museum, Mr. Rawlinson. The following publications have been received ; The Lancet for Nov.

20, 27, Dec. 4, 11, 18, 25 ; The British Medical Journal for Nov. 20, 27, Dec. 4, 18, 25 ; The Medical Press and Circular for Nov. 17, 24, Dec. 1, 8, 15 ; The London Medical Record for December ; The Student's Journal for Nov. 20, Dec. 4, 15 ; The New York Medical Record for Nov. 11, 18, Dec. 4, 25, Jan. 1 ; New York Medical Journal for Decem-ber; The Pacific Medical and Surgical Journal for December ; The Canada Medical and Surgical Journal for December ; Dobell's Annual Reports of Diseases of the Chest, Vol. I. ; Victorian Government Gazette, current numbers; Parliamentary Papers.

Library Digitised Collections

Title:Australian Medical Journal 1876

Date:1876

Persistent Link:http://hdl.handle.net/11343/23140

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