CHEMISTS

and IMPORTERS of Surgical Instruments and Appliances, Antiseptic Bandages, Dressings.

and Medical & Surgical Requisites generallY SERA, VACCINES, TUBERCULINS

(Human, Bovine, Beranek's, etc.).

N.B.—Any required dose supplied in sterile glass capsules.

280 BOURKE STREET

Branch Pharmacy, 111' Collins Street Bacteriological Speoiniens for Dr. Bull to be lett at

Ill Collins Street.

Oct., 1919. THE SPECULUM. 77 Then a sleepy trip to put stitches into the head and "white house" by the half-pint into the stomach of the buck larrikin, with the help, when necessary, to soothe the patient, of Hoskins turning the old galvanic battery with zest. Then the decision as to whether to admit or send to the cells, with the chance of death from fractured base. Visions of inquest and Youl's heavy eyebrows glowering at a coronial enquiry, kept me in the way of caution, and the patient in hospital, on many occasions when really the elimination of alcohol was the only necessary treatment.

In those days, too, or a year or so earlier, we welcomed back from New Guinea Ernest Morrison, with several spear-heads embedded in him, to lose him soon when he went to qualify in Edinburgh, and later proceeded to run China and its mil- lions. I think it was in '84 that the M.S.S. first took the gallery at the Opera House, hung its flag over the rail and gave a concert "on its own" during the intervals. They were great days, but several things have happened since, and I must get to my monthly bills instead of retrospecting further.

FIRST YEAR HUMOUR

First year med.'s humour is an extraordinary and inexplic- able thing. To the lay mind it would appear utterly incon- sequential ; but some sort of idea or system must underlie it, for, curing the course of lectures which would appear to the outsider utterly devoid of humour, certain parts will cause the students (with the exception,—bien entendre,—of the good little shes in the front rows) to break out into harsh guffaws and heavy stampings with a unanimity that is marvellous.

The sensation equivalent to a joke seems to be received in certain rudimentary organs,—some of them situated in or near the face, but most of them in the feet, where any stimulus causes them to set up convulsive movements of the boots. These organs or ganglia are obviously quite unlike brains, in the ordinary sense of the word ; and they can receive

1

^Jilior

stimuli by other means than the sense of hearing ; for the other day a weak-eyed, lop-eared young gentleman, on recover- ing from a severe attack of bellowing and boot-banging, was asked by his neighbour "wot the prof. 'ad said, anyway." He

78 THE SPECULUM. Oct., 1919.

seemed surprised at the question, but, on thinking it over, admitted that he did not know.

There seems to be a certain sense of duty or obligation con- nected with it. At prac. chem. some of the students, while Dr. Riyett is talking, sprawl on their ventral surfaces along the benches, and gaze fondly at the lighted gas burners, with a rapt, almost blithered, expression. Others hang themselves up dorsally by their elbows. They fix a glassy stare on nothing in particular, and rapidly assume the expressions of dead fish.

Suddenly, a mild professorial remark about the behaviour of hydroxides, or something equally innocuous, stimulates the humour ganglia of one or two students, and they emit a few howls. Immediately the rest, who have obviously not heard the remark in question, laboriously heave themselves upright, and, still with quite vacant faces, give a few heavy kicks to the nearest waste-tin. Then they relapse again into a comatose state.

Each trade or profession has its stock jokes. What would the vaudeville stage be without the missus, the lodger, the kipper? And any would-be professorial comedian can always be sure of a prolonged and hearty welcome for such old familiar favourites as dirt, fleas, and alcohol ; especially the last, though most of the children present are not hard drinkers themselves, and are merely at the age when they admire beer immensely in the abstract. But, granted these conventional humours, why should the mention of such mild commonplace things as butter or golden syrup evoke such a frenzy? No one ever got

"blithered" on butter; but Prof. Spencer has only to mention that flies carry disease germs on to butter, or Prof. Laby _to state its heat of combustion, and Bedlam breaks loose; and not until our bright little laddies have kicked and screamed themselves into a semi-exhausted state can the lecture pro- ceed. . . . Does the presence of butter on the club-house tables cause roars of laughter? It does not. . . . When Bill's father mentions butter during a family meal, does Bill break into screams and howls, and try and kick the legs off the table? Certainly not. Should his father suggest his doing anything of the sort, Bill would gloomily reckon that 'th' ol' man was goin' dippy."

One only finds this first year humour in full blast when a large number of students are gathered together at a lecture or meeting. Possibly this is a last remnant of the University spirit, the lack of which is being deplored in the press; but, in that case, why worry?

Oct., 1919. THE SPECULUM. 79' It is very strange and difficult to understand. No research has been done on the subject ; and as Prof. Ossy says: "There is a new field waiting for some of your bright young minds!"

After all, though, perhaps it isn't worth it.

—R. Arthur Boared.

COMMENTARIES.

The first prize, given by Dr. Norris, for the best solution of his medical commentary published in the last issue, was won by

C. W. Adey.

Dr. Lambert has not yet corrected those for the Surgical ; we hope to announce the results in our next number.

N.B.—All answers to the following commentaries must be left with the Editor before the 31st October.

Commentary in Obstetrics.

DR. (11. V. Doyi.E D.G., female, married, aet 30.

Family History.—Good.

Past History.—Good.

Obstetric History.—Two children, aged 4 and 1 years, re- spectively.

At 1 p.m. on the 22/4/17 patient admitted in a collapsed condition. Temp. 96, pulse too fast to be counted, skin sweat- ing, color bluish-white, mucosa pale.

Patient had been confined of a normal infant nine days pre- vious to admission. Owing to some symptoms of sapraemia occurring during the previous three or four days, it was de- cided to douche and curette the uterus.

This operation was performed at 11 a.m. on 22/4/17. After the operation had been completed patient was noticed to be in a collapsed condition, and her removal to the hospital was decided on.

O.E.—The abdomen was slightly full, not tender. The uterus could be felt about two inches below the umbilicus, firm and hard. There was a rounded mass, tender, to be felt to the side of the uterus. It was fixed, dull on percussion, but appa-, rently not connected with the uterus. There was dullness on Percussion in the flanks.

ra

SO THE SPECULUM. Oct., 1919.

2 p.m.—Patient having revived slightly, operation was de- cided on.

How would you proceed with the diagnosis of this case?

What operative treatment would be necessary.

Commentary in Gynaecology.

DR. G. V. DOYLE

M.E., aet 32, female, married 10 years. Was admitted at 8,30 p.m. on 29/12/16.

Family History.—Negative.

Previous History.---Suffered from anaemia when a girl. No previous operations.

Obstetric History.—Two children, 8 and 6 years old re- spectively.

Menstrual History.—Amenorrhea for the previous four months. Before that date menses were regular, lasting four or five days, and were painless. Patient gave no history of leucor- rhea or of intermenstrual pain.

Bowels were regular.

Urine.—Some frequency, otherwise normal.

Present Complaint.—In September the menses were normal in amount, etc. In October and November the menses were practically absent. During December several clots were passed p.v., and for some days previous to admission there was a discharge of non-offensive blood.

For the past fourteen days has had severe pains in the lower abdomen. Has had attacks of vomiting on several occasions lately.

0.E.—Patient thin, anaemic, elderly woman, lying fairly quietly in bed. Has rather an anxious expression. Temp.

103.6, pulse 128, resp. 32. General condition fair.

Heart and lungs normal.

Abdomen.—Full--moves fairly well on respiration. There is a softish rounded mass in the right iliac fossa, and a firm round hard mass in the left iliac fossa. Both were dull on percussion. Both were palpable as high as the umbilicus, and were both tender. There was no dullness in the flanks, and no free fluid to be detected.

P.V.—The cervix could only be felt with great difficulty.

It was displaced upwards to about the upper edge of the spiv' physis pubis. The whole of the posterior fornix was filled up by a rounded tumor, firm and only moderately tender. it was apparently continuous with the mass felt in the abdomen on the

Oct., 1919. THE SPECULUM. 8t left side. It could be traced outwards to the inguinal ligament.

The os was small and regular.

30/12/16.-3 a.m., patient in great pain. On exarrf.. p.v. a piece of decidual tissue found in the vagina.

9.30 a.m.—Operation decided on.

Give your opinion as to the diagnosis. Describe the opera tive treatment necessary in this case.

Surgical Commentary.

DR. HAMILTON RUSSELL

A woman, about 40, who had always enjoyed good health,.

swallowed by mistake some iodine liniment. She recovered, but suffered for some days from pain, vomiting and symptoms ,

of gastritis. For the next two years she suffered from chronic dyspepsia, and on one occasion during that period had haematemesis. Eventually she came into the hands of a gynaecologist, with pain in the lower abdomen radiating down the thighs, especially the left thigh. The abdomen was opened . and the ovaries and tubes removed ; this operation failed to restore her to health. Four months later a swelling formed in the left ischio-rectal fossa; this was opened and a quantity of stinking purulent .matter evacuated. This wound refused to heal, but constantly discharged a moderate quantity of some- what watery pus. The abdomen was again opened and the uterus removed. Recovery from this operation was uneventful, but the condition of the opening in the ischio-rectal fossa was not affected by it. She was later admitted to a general hospital' for treatment.

On admission, she was a thin woman, but not emaciated.

There was no discoverable disease in any organ ; the urine was• healthy. Treatment was directed solely to the discharging wound in the ischio-rectal fossa; several attempts were made to cope with this condition by surgical methods, and after one such attempt the patient died. The total length of the history of her illness was four years.

Discuss possible causes.

he following two solutions of the "Bendigo" commentary Published in our last number have been sent in. Though both ingenious, the diagnoses are so very different, that we cannot consider the case in any way settled. In the meanwhile, as our honoraries say, "J.B." is slowly dying of his obscure malady.

82 THE SPECULUM. Oct., 1919 M 1".

Dear Sir,—

Seeing your ade in truth i have some think the matter with me so i am going to see if you can fix me up i get a nasty weak sickly shirvey feling runs righ throw me it comes on at all times some times in Bed and aney time of the day theare is no Pain and it only just runs throw me for the minet then i an write again I can eat and sleep like a top i have tried all kinds of stuf But it dos me no good it not worms nor indegeston i have been taking Pill to coat the stomack and theare no good so if you think you can cure me Let me know i am only a Poor man Batling for a crust But if you think you can fix me up send me the Price of one week tretment and i will send you the money every week i am 57 years of age i dont work hard i just do od Jobs hear and thear I am giving )ou full pitklers of whot I do i dont Drink i youst to drink 3 ',ears ago the feling is going throw me while i set writing this.

Your Fiathfull,

J. B—.

i am weell known in Bendigo and if you do fix me up i wont for get to Let the Pepple know who did it.

Bindigo, Oct. 26.

A hasty scrutiny of the communication received would show _an apparent absence of sufficient data for a solution of the

case. Such a conclusion, however, would be eminently super- ficial and misleading. A more careful examination discloses many facts upon which a diagnosis may be based.

J.B., a male, aet. 57, complains of a "nasty, weak, sickly.

shivery feeling," momentarily permeating the very interstice- of his being. A reference to French's "Differential Diagnosis' gives, as possible causes of such periodical manifestations:—

(1) Indigestion, (2) chlorosis, (3) alcohol (over-indulgence).

(4) gestation.

To consider these in order.—

1. In,ligeslion.

This suggestion may be at once dismissed. No anorexia, pain, no flatulence, no distension. Moreover, a reference in the letter, which is,the basis of our scientific structure, disclose' a direct denial from the patient that this is the correct solution.

"It is not," he writes, "worms nor indigestion." We agree.

THE SPECULUM. 83 bi

'Oct., 1919.

2.—Chlorosis,

Very rare in the male. No anorexia, no palpitation, no gas- troptosis.

3.—Alcoholic Indulgence.

Patient denies the possibility in toto. "I used to drink, 3 years ago." C'est la guerre! No restlessness, no insomnia, no lucre. Atrophy of the exchequer may be assumed.

We are, therefore, left with the fourth alternative—gesta- tion—and an unbiassed consultant will confirm the truth of this diagnosis. By those of the older school it will be urged, we know, that such a condition is, in the male, exceedingly rare, but ever since one of our own domestic pets, whose masculinity had been until then unquestioned, deposited six kittens on the drawing-room sofa, we have felt that the accepted view might be revised. In support of this contention, we may refer to that eminent Italian authority, Boccaccio, who, in his "De- Cameron" (novel 3, day 9) gives details of the onset of the condition in the male.

Evidence of further symptoms may be extracted from this illuminating epistle:—

The patient has been taking pills to coat the stomach, and they are now no good. Why this dogmatic assurance? Obvi- 'ously, though a lay sensitiveness would hide it, they have re- turned to view—morning vomiting.

Again, "it comes on at all times, sometimes in bed and at any time of the day"—frequency of micturition.

C.W.A.

.Discussion—Diagnosis.

At our first general survey of the case we are struck by the Prominence of nervous symptoms—Foremost of these is a gen- eral lack of tone.

The three chief causes of hypotonicity are 1. Sclerosis Trouseri.

2. Aspondulix.

3. Interference with the path of cerebellar impulses.

I. Sclerosis Trouseri, more often attacking males, is charac- terised by the formation of ulcers, which, on healing, leave Patches of repair tissue of varying size at the seat of infection.

Accompanied by necrosis of the lower extremities and lowering 'of the temperature—only comes on with old age and chronic

irritation. This condition, which necessitates complete re-

looval, may safely be excluded from the absence of the above

local signs.

I

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16+f1 it

84 THE SPECULUM. Oct., 1919.

2. Aspondulix.—Due to a failure of metabolism, the body being unable to produce sponds — an external secretion, very unstable, but necessary to life. The patient is commonly subject to remissions, with acute exacerbations. This cannot yet be excluded.

3. Cerebellar Disease.—He says he reads "Truth"—presum- ably his own copy, i.e., he has a degenerate tract. Further, he- has small "i's" where they should be large. This may be I. Ptosis. 2. Contracted pupils.

Presumably the latter, for he also says that he Battles (with a ^. capital B) for a crust—nothing less than sweating.

So far, then, we have J.B., act 57,—Hypotonicity,—a de- generate tract—contracted pupils—sweating.

The two latter suggest pressure on the sympathetic. The usual cause of this is constant "bending of the elbow," but this- is contraindicated, for he states that he has not drunk for three years.

'This raises the question, "How, then, does he get his neces- sary fluids?" Presumably, he takes them P.R. Here lies the whole solution of the case. He has in some moment of extreme thirst used the tube carelessly, and with too much force, per- forating the cerebellum, and so causing the lesions described above. This has precipitated the onset of a latent .C.B.I. (con- genital B. idiocy).

We can disregard his statement that he "has tried all kinds^• of stuff" as a gross exaggeration, for if it was true he would have been sure by this time to have struck something that was specific.

Further Examination.—None necessary. Diagnosis is un- disputable.

Treatment.—Essentially surgical. Unscrew the umbilicus and drain the fourth ventricle through the foramen of Winslow.

—E.M.E.

ANSWERS TO CORRESPONDENTS

"Ole Black Joe."—Your paralysing parody on the paltry pay at present prevailing in professional precincts is pretty painful (if you'll excuse being "alliterated" on from a great 'height) .

"Ramus."—In trying to digest your wretched notes, our as- sistant editor's first wife (who is really the brains of the party), got a partial volvulus and intestinal obstruction- She is not well vet. Do be careful.

"Bertie the BolsheVik."-4J -seudOnym appropriate; your story has hairs on it.

"Ole Black Joe" (again).—Your idea of stealing the anatomy papers is so feasible that we are afraid to •publish it. You're a second William le Queux. Only worse.

"Ellipticle."—Your beautiful proem in • poes is so—so—so

indescribably ,ethereal, so effusively effeminate, such a - frail exotic plant, such -rot, in other words, that.. we .publish it as a warning :,--

"The Art of Osculation.--M any people kiss; but not one in a thousand knows how to extract bliss from lovely lips more than he knows how to extract diamonds. In going to kiss, never kiss on any other part but the lips. The gentleman should be a little taller than the • lady. , He should have a clean face and a mouth full of expression.

Take the left hand of the lady .in your right (don't think of your hat), and place your left over her shoulder. Let it fall gently towards her waist, and don't be in •a hurry.

Gently but lovingly draw heart to your heart. •• Her head Will fall gently on your shoulder, which causes your heart to flutter. Don't be in a hurry. Now you . are ready, heart to heart, but don't .squeeze her. - Look down lovingly into her eyes. Gently but firmly press her to your bosom.

Stand firm.' Now her lips are almost open. ]Don't shiver.

Take good aim. , Press your lips to•hers; Your eyes close, your• heart opens. 1)6 not take your lips away at once, but press them to hers. • Your nerves dance -

(I have lost • the finish, . but you can guess it without thinking)."

It is terrifying to think that we have , these all-embracing mashers, these osculatory octopi, doing first year. (Any lad y wishing further partidulars Miust. applyin writing be- fore the expiry of seven days.) •

I We hope that these apparently .scathing rebukes will not

increase the natural timidity of students-in forwarding con-

tributions. As a matter of fact, our gratitude to those who do try and keep this journal up to standard is immense, though. it

n14lel• seem a curious way -of showing it. If 'these answers to doves sound unduly harsh, they are 4S the cooing of those to what the editor , thinks, and not uncommonly says, of who evidently believe the Specuilum •to toe autegeneous,

a l

nd • can only assist- in the-production by asking•When it's com- in g out.]

IN

Oct., 1919. THE SPE( 85