1450 AUSTRALIAN MEDICAL JOURNAL. February- 28, 1914.
The - second feature of the developing lympho- cytosis, .which also seems from the previous cases to he
-eventually controlled:
•However, the eighth case has shown it developing in the face of in- flammation, which should" call forth a polymorpho- nticlear neutrophilic leïzêocytosis. This would seem to show that removal "of-the spleen gives a stimulus to the lymphatic appatatits of the body, and causes
thereby a hyperlymiphocytosis.
-
It is interesting to note that in two cases of the
series .th'e lymphatic glands throughout the body
enlarged on the fourth or fifth day, and remained
so during stay in hospital. .'phis last case showed
no such enlargement; neither was the symptom em-
phasised by Mayo noted, viz., pain in the ends of
the long hones.
r February a8, 1914. AUSTRALIAN MEDICAL 'JOURNAL 1451 both in its afferent and efferent influence. Gradu-
ally during my post-graduate
•work in London (1881-3) I became more and more impressed with, and practised the light percussion and reliance upon the sense of resistance which .I learnt from the late Sir Douglas Powell. I next admired, though for long I did not understand, the wonderful results of certain experts—notably the late Sir Thomas Fitz- gerald—whose fingers gave them more and better information than most practitioners' combination of half-trained senses.. This led me to the systematic training of my own fingers, at first along the re- cognised lines so well described in Da Costa's
"Physical Diagnosis." Progressively I was pleased to find that I became able myself to recognise what I had previously only envied in others. I was coming Ito my own. Thus, without any knowledge of Montessori or Pottinger, I began experimenting wi th texture of clothing, bedding, etc., size and con- sistency of coins, keys, fragments of various objects, more or less enveloped, near or distant; proceeding through known objects and conditions to the diag- nosis of unknown objects and conditions. All this I -then applied to human anatomical conditions, beginning with the normal, and following up on the pathological, testing and, so far as possible, verify- ing by all other reliable clinical means; attempting to ascertain and correlate through touch what I knew through the other senses, and gradually ex- tending- all this from common to uncommon condi- tions. Surface conditions, from all tactile points of view, infiltrations, due to fat, fluid, gas, etc., in- flammations in time became diagnosable compara- tively easily, and with a greater certainty in many cases than I had attained through the eye. The state of some veins and lymphatics (with associate glands) and the size, state of walls, external pressure, and other conditions of vessels, especially the radial, furnished another exceedingly interesting and profitable study. It is a strange comment upon our neglect in this respect, that the physicians of com- paratively recent times used to recognise some hundred different kinds of pulse, as compared with the dozen or so with which our test-hooks still keep us in touch. It was this that first led me to dispute the manometric claim of the necessary danger of a high blood-pressure (vide my paper in the Inter- colonial Medical Congress, 1908), and led me to divide arterio-sclerosis into stages of velvety extra- muscular, distended, fibroid, and calcareous. A simi- lar testing of tactile impressions from bone led me to recognise ossification—even commencing—in the sterno-costal cartilages, variations in the thickness of synovia, as well as amount of effusion, infiltra- tions, rarification, etc., of bones and joints; so that frequently under the bed-clothes and without lead- ing questions, and apart from osteophytes or irregu- larities of outline, one could diagnose old gouty attacks, etc. I remember also the pleasure with which I found myself able to—generally—diagnose pleural effusion from lobar pneumonia (though much less certainly from pleura-pneumonia) by the feel and the res'is'tance of the part. I began, also, to rely upon picking up the outer border of the heart, the upper border of the liver, etc., in the same
way. For some time, also, I had been experiment- ing With the feel of muscles, poor, normal, degene- rated, slightly or acutely spastic, and the relation- ships, reflex or direct, with related structures or organs. Gradually I found that a large volume of very valuable evidence was thus forthcoming-, fre- quently of a sort that, under other procedures, I had previously missed.
I had found, also, that in reference to dulness and increased resistance, the best results were ob- tained by a mixture of palpation and percussion, drawing the percussed finger lightly towards, over and away from the surface, and at the same time percussing with a variable amount of strength ac- cording to the normal known conditions of the part
—but generally very light.
Most of this was, of course, over and above the usual procedures described by authorities such as Da Costa in the orthodox physical examination of pulmonary, cardio-vascular, abdominal, and other conditions by ordinary palpation, percussion and sense of resistance, and its inculcation has been part of my ordinary clinical teaching for some years past.
It was at this stage that I came to know Pot- tinger's work (Muscle Spasm and Degeneration in Intrathoracic Inflammations and Light Touch Pal- patation. He deserves the credit of maintaining and extending the practice and value of light-touch.
palpatation, coupled with the sense of resistance.
As already mentioned, I personally feel more at home with variable percussion of the finger. Light is kept lightly moving over the different areas. By this means he outlines the cardiac borders, the lungs and many of their lesions, differentiates heart from liver, outlines the stomach, spleen, and liver, many mediastinal tumours, etc.-, in a way and to any extent not generally attempted. He was, also, ap- parently the first to lay special stress on this means of diagnosing from degenerative and spastic con- ditions of the sterno-mastoid, levantor anguli sea puli trapezius, and rhomboid muscles, chronic and acute lesions respectively in the upper part of the same lung. Since reading his work I 'have paid some attention to his connection, but do not feel competent yet to give a definite opinion. -With most of 'his other views, however, I find myself in accord.
From my own
-experience, therefore, as well as from these general considerations and the experi- ences of others, I submit that much greater atten- tion than is at present given might well be shown both educationally and clinically to the sense of touch ; that its present haphazard clinical applica- tion should be replaced by thorough, systematic training; and that the tactus eruditus, which conies with experience through such training, may thus be made the means of obtaining always important, and at times, invaluable information in an ever-increas- ing number of diseased conditions—information which may not be procurable in any other manner.
What might not we achieve if we could but apply
fingers such as -those of Helen Keller to clinical
medicine and surgery?
115'
AUSTRALIAN MEDICAL JOURNAL. F'ebrulary 28, 1914.
JI3rtttgb
,^ ebtcar ZW50ciattOn.
AUSTRALAtia.i\ MEDICAL CONGRESS.
Abstract of Report of the Special Committee on Syphilis.
(From our own Correspondent.)
At a general meeting of the Congress held in Melbourne, October, 1908, it was resolved that the Executive of eaoh Congress be recommended to appoint a Committee to in- vestigate, tabulate and report the facts in regard to syphilis, which Committee may obtain. The Committee to report to the next meeting of Congress, and be given authority to publish its report prior to the .meeting of Congress if Its investngations should convince the members of the Com- mittee of the necessity for such urgent action.
The Executive of the Congress to be held at Auckland in 1914, appointed a Special Committee in accordance with the standing orders.
• The Committee consists of:—Dr. W. E. Collins (chair- man), Wellington; Professor L. E. Barnett and Professor D. Colquhoun (Secretary for Otago) ; Dr. W. J. Barclay, Invercargill; Dr. G. E. Gabites, Timaru; Dr. H. T. D. Ac- land, Christchurch; Dr. S. A. Gibbs, Nelson; Dr W. McKay, Westland; Dr. E. E. Porritt, Wanganui; Dr. H. D. Robert- son, Taranaki; Dr. J. W. Williams, Gisborne; Dr. E. A. W.
Henley, Napier; Dr. J. Hardie-Neil (General Secretary), Auckland. South Sea Islands: Hon. G. W. A. Lynch, Chief Medical Officer, Suva, Fiji.
The Committee met in Wanganui in February, 1913, and determined to circularise every practitioner in New Zea- land, and also institutions such as mental hospitals, gaols, general Hospitals, old men's homes, and Salvation Army homes. This has been done.
The Committee determined to obtain information as to the prevalence of syphilis in New Zealand, the South Sea Islands, and as to the outside source of 'infection.
With this end in view, the Hon. G. W. A. Lynch was asked to take charge of an investigation covering the ,preva- lence of syphilis in the Fiji Group, of which he is the prin- cipal Medical Officer, Dr. G. Pearce Baldwin was asked to report upon the Cook Islands, and Dr. Arnold Izard upon Tonga. The Committee has had to rely upon general in- formation as regards the islands of Tahiti and Samoa.
An investigation covering Australia would be much bet- ter conducted by a Committee working from one of the cities in the Commonwealth. This Committee has, there- fore, decided to limit its investigations to the condition of affairs in the Dominion and South Sea Islands. As the disease is of such Immense importance to humanity, the subject will no doubt be further considered at the next Congress.
The returns report 1,941 primary and secondary cases that were seen by private practitioners during the last two years. To these must be added cases met with in insti- tutions.
Auckland contributes 615 from the city and 138 from the outside districts. Wellington, 412 in the city and 23 from outside districts. Christchurch, 252 from the city and 24 from the outside districts. Dunedin, 44 from the city and 14 from the outside districts.
The returns from 301 practitioners, and from general and mental hospitals, showed a total of 1941 fresh infections during the last two years.
In speaking of the returns as a whole, the number re- corded in these returns cannot be taken as an indication of the absolute amount of syphilitic infection. So many cases do not come under the observation of medical men in the primary and secondary stages, when they are readily recog- nised. It is well known that cases which a re tided over in the early stages, may show no obvious signs of the disease for years.
It is safe to say that .if all the medical men in the Do- minion had replied, the amount of the disease reported would be at least double, and even then, there would not be shown anything concerning the number of diseases which have their origin In syphilitic infection, nor the number of congenital cases of which it is impossible to get anything like approximate reports even from medical men, although
many practitioners proffer the information that they see them frequently. •
The replies to the question as to the, frequency of syphi- litic infection, as compared with former years, is indefinite, brit, if anything, the evidence points to the fact of it being less frequent. The same remarks apply to the enquiry as to the severity. The evidence again being in favor of its being milder, though the majority report that they are un- able to see that there is any change.
The medical practitioners doing eye work are very in- sistent on the prevalence of Tertiary and Congenital syphi- lis, especially the congenital form. Recent work on the blood test shows that women who hear syphilitic offspring are themselves the subjects of a latent yet personal infec- tion. The detrimental influence on their health and vi- tality requires no elaboration.
Sources of Infection.—'The replies are practically unani- mous that the infection is sea borne. Australia, especially Sydney, being most commonly mentioned, then the South Sea Islands, with a proportion of cases coming from other over-sea routes. We must then ascertain from the informa- tion available, the extent of the disease in the places men- tioned.
With reference to Sydney, it must be recognised in the first place, that a great source of syphilis in Oceania, is undoubtedly the Indian Coolie population of the Islands.
There is said to be a fair amount of communication be- tween Sydney and the South Sea Islands by various trading schooners, and direct communication from Melbourne and Sydney to the Fiji Group. Medical Officers state that the East Indies, China, and Japan are also common channels of infection. Sydney has direct communication with these countries.
RECENT AUSTRALASIAN LEGISLATION.
A great advance has been made by the addition to the Statutes in New South Wales of the "Prisoners' Detention Act, 1908," which has had a distinct effect in reducing the amount of specific disease among the class of people affec- ted by the Act, and also among the sailors attached to the Naval Squadron when lying 'in Sydney Harbor.
In Queensland, the Public Health Act Consolidated 1911, Section 132 A, is as follows:—
"132a (2) provides for notification of these diseases.
"132a (3) reads:—"No person other than a medical practitioner or a person acting under the direct instructions of a medical practitioner shall attend upon or 'treat any person suffering from such disease."
The penalty Is not exceeding £50, or six months.
"This sub-section shall not apply to a registered phar- maceutical chemist who dispenses to the prescription of a medical practitioner, or to any pharmaceutical chemist, who under a permit in writing from the Com- missioner (of Health) (which 'permit the Commis- sioner is hereby empowered to grant) prescribes any medicine or drug for any person suffering from such disease, or to any person who under a permit in writ- ing from the Commissioner (which, etc.) sells any proprietary medicine or drug to any person suffering from such disease: provided always that the proprie- tary 'medicine or drug is approved of by the Com- missioner."
In New Zealand there is no special legislation, and ex- cept that in reference to the control of prostitution, there is no Act which affects this particular disease, but it is hoped that the important clause .19, introduced to the Hos- pitals and Charitable Institutions Amendment Act, 1913, No. 56, will be made use olf for the purpose of checking this among other contagious diseases. It is as follows:—
(1) The Governor may from time to time, by Order- In-Council gazetted, make regulations for the reception into any institution under the principal Act of persons suffering from any contagious or infectious disease, and for the detention of such persons in such institu- tion until they may be discharged without danger to the public health.
(2) Any person in respect of whom an order under this section is made may at any time while such order remains in force appeal therefrom to a Magistrate ex-
February 28, x914. AUSTRALIAN .MEDICAL JOURNAL. 1453
ercising jurisdiction to hear such appeal and to makesuch order in the matter as he thinks fit. An order of a Magistrate under this subsection shall be final and conclusive.
(3) Regulations under this section may be made to apply generally or to any specified institution or in- stitutions.
The Committee recommended:—
(1) That syphilis be declared a notifiable disease. That notification be encouraged, and discretionary but not com- polsory; and that the Chief Medical Officer of Health be the only person to whom the notification he made.
(2) That provision be
m
ade through the Hospital Boards to establish laboratories in the four centres where not already exiistent for the diagnosis of syphilis.(3) That free treatment in the public hos•pital.s and dis- pensaries be provided for syphilitics.
(4) That steps be taken to educate the Mercantile Marine as to the dangers of syphilis, and that provision be made for preventative treatment on the Intercolonial service.
(5) That legislation be enacted against the treatment of syphilitics by unqualified persons.
The following memorandum and resolutions were sub- mitted at the meeting of 'Congress on 'Thursday, at 2 p.m., by Dr. J. W. Barrett, seconded by Mr. G. A. [Syme, and supported by Dr. Worrell and Dr. P. Fiaschi, after consulta- tion with members of the New Zealand committee.
This Congress desires to submit to 'the various Govern- ments of Australasia the following summarised observa- tions and recommendations:—
Venereal diseases
are
proved to be responsible for a vast amount of damage to mankind, The damage is expressed by ios.s of life (frequently at its prime), insanity, sterility, destruction of family life, inefficiency, and economic waste.The monetary loss to the nation is enormous. The exact distribution of these diseases is unknown, but it is esti- mated by excellentauthority that one twenty-fifth of the population of Berlin, Paris, and New York are 'annually infected. It is fairly certain that 12 to 15 per cent. of the population of London, Paris, and Berlin are .syphilitic, and in addition a much larger number are gonorrhœic. There is good reason for thinking that Australasian cities are affected to much the same extent. 'There are no other dis- eases which cause so much loss to the community.
By the adoption of suitable measures these diseases can be greatly reduced in frequency, and may be wholly sup- pressed. The steps which should be taken are:-
1, The provision, after consultation with the educa- tional authorities, of education for all adults and ado- lescents in the nature, causes, consequences, and mode of prevention of venereal diseases.
2. Provision !of free scientific facilities for effecting the early
and
accurate diagnosis of venereal diseases, and for testing the results of treatment.3. The provision of free treatment both in and
out
door at times convenient to the patient for all those who are unable to make their own arrangements.4. The passage of legislation providing for—
(a) The
detention of any prisoners suffering from vene- real disease until by treatment he or she is rendered in- nocuous. The Prisoners' Detention Act of New South Wales already makes this provision.(b) The severe punishment of anyone who wilfully or negligently communicates venereal diseases to other peo- ple.
(c) The severe punishment of any one not being a quali- fied medical practitioner who undertakes to treat sufferers from venereal diseases.
This provision is very necessary because of the danger to innocent persons consequent on the unsuitable treatment.
of the •infected.
The monetary cost of effecting the eradication of venereal diseases would not be very great; in fact, the expenditure would be very small by comparison with the expenditure resulting from the present wholesale infection of the popu- lace. There is no form of public expenditure which might so truly be described as national and reproductive.
If the steps indicated are taken with wisdom, the results will be:
Diminution of mortality.
Diminution of insanity.
Diminution in the expenditure in hospitals and asylums.
Increased human efficiency, and better and healthier en- joyment of life.
Note.—The resolutions quoted above embody principles.
Their mode of applioatien would properly be a subject of discussion between the respective 'Governments
and
the branches of - the British Medical Association.It has been reported in the daily press that Congress agreed to notification, but this does not appear from our account, kindly forwarded by Dr. J. W. Barrett.
A very successful dinner, tendered to the overseas mem- bers of the congress by the New Zealandmembers, took place at !Cargen on February 12th. The president of the congress (Dr. A. Challinor Purchas) presided over a large attendance.
"The Government
of
New Zealand" was proposed by Dr.J. W. .Barrett, C.M.G. (Melbourne). Dr. Vaiíntine, Chief Health Officer, in responding, apologised for the absence of the Minister for Public Health (the Hon. R. H. Rhodes).
The toast of "The Visitors" was proposed by Dr. W. C. W.
McDowell (Auckland). He expressed pleasure at the pre- sence of Dr. ,T. B. Macdonald (chairman of the Central Council of the British Medical Association in England) and the Hon. W. A. Holman (Premier of !New South Wales).
The Hon. W. A. Holman replied in a humourous speech.
He spoke of the pleasure that he had derived from this, his second, visit to New Zealand, which, he said, was favoured by Nature to a degree that aroused the envy of Austra- lians. He said that during the time that he had been in New !South Wales he had endeavoured to establish a co- operation between the medical profession and the Govern- ment in conserving the interests of the public.
Mr. Hamilton Russell (Melbourne) also responded and acknowledged the hospitality extended by the people of Auckland to the members of the congress.
Dr. F. Antill Pockley (Sydney) proposed "The British Medical .Association," which, he said, was the most .potent factor for good in
the
British Empire. He spoke of the kind hospitality extended to the visiting members of the congress whilst in Auckland, 'and specially mentioned the part that had been taken by Mrs. W. H. Parkes in the en- tertainment of the visitors. -Mr. J.
B.
Macdonald (chairman of the Central Council of the British Medical Association in England) and Dr. W. H.Parkes (president of the New Zealand branch of the British Medical Association) replied to the toast.
The Mayor of Auckland (Mr. C. J. Parr) 'proposed
the
"Austs:alasian 'Medical Congress." The president (Dr.Porches), in responding, acknowledged
the
cordial assist- ance that he had received from his confreres in carrying the congress to a successful issue. He expressed regret that illness had prevented Dr. McKay Grant from dis- charging the duuties of treasurer. He proposed the health of Dr. Grant, which was enthusiastically honoured.Mr. Hamilton (Adelaide) gave 'the 'toast of the secretary of the congress (,Dr. Dudley) and on behalf of the mem- bers of the congress presented him with a purse of sove- reigns in recognition of the excellent manner in which he had discharged his duties. Dr. Dudley suitably replied.
The toast of "The Ladies" was proposed by Mr. Harvey Sutton (Melbourne) and acknowledged by Dr. R. H. Makgili (Auckland). The concluding toast was that of "New Zea- landers," proposed by Dr•..Hornabrook (Melbourne).
A very pleasant and. successful function was brought to a close shortly before 1 a.m. by
the
singing of "Auld Lang Syne" and the National Anthem.The ladies visiting Auckland with the delegates to the congress were entertained at a 'theatre party at His Ma- jesty's Theatre.
B.M.A. VICTORIAN BRANCH.
A special meeting of the Branch was held at the Medical Society's Hall on Wednesday, February 18th, the Vice- President, Dr. Honman, in the chair. There was an at- tendance of about 45 members.
Business: -1. Presentation of Treasurer's Annual Re- port; 2. Address by Dr. Fetherston on the work done in