THE SPECULUM
Medical Services
To the Student
University and Oqedical Text Books
Surgical Instruments and (Diagnostic Apparatus . .
To the Doctor
Locum Tenens and .. . Assistants (Provided • • . 'Practices Transferred . . (Partnerships Arranged .
Alian graft Orbital cAgent
54 COLLINS STREET, ‘714ELBOI_JRNE, C.1
(.NEAR EXHIBITION STREET)
Phone : Cent. 4171, (After Hours, Haw. 3992) 'Telegrams Cr Cables: ",Allgra, Melbourne
AGENTS IN ALL STATES
' 1,-1— I'S- 1
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Time Marches On
and HENRY A. SPINKS
The Engitsf) Tailor
Marches with the Times -
IF it is a Spinks Suit, it may be different; but it is correct.
You feel dressed as well as look dressed, and there is the secret of Good Tailoring.
HENRY A. SPINKS
The English Tailor
MANCHESTER UNITY BUILDINGS
COLLINS STREET MELBOURNE
'Phone: Central 3755.
2
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- V I o V.
"For him that may not slepe for sickness set this herb in water, and at even let him soke well hys fete in water to the ancles. When
he goeth to bed bind of this herbe to his temples, and he shal slepe wel by the grace of God."
Anthony Ascham (from "A Little Herbal," 1550)
RDSONERYI
MARKTHE SAFE AND EFFECTIVE BRITISH HYPNOTIC
Containers of 12 and 25 tablets and boxes of suppositories
MAY & BAKER (AUSTRALIA) PTY. LTD., 5 PHILLIP STREET, SYDNEY
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3For the Medical Student ..
FROM FIRST YEAR TO LAST YEAR, AND FOR THE GRADUATE THROUGHOUT ALL HIS YEARS OF PRACTICE HIS EVERY REQUISITE CAN BE SUPPLIED BY-
FELTON GRIM WADE DUERDINS Pty. Ltd.
INSTRUMENT DEPARTMENT,
21 ALFRED PLACE, MELBOURNE
Telephone F1638 (3 lines)
Pioneers Needed!
When an explorer leaves the beaten path, he never knows what lies ahead.
He may find only barren, worthless wastes. Or he may come upon rich deposits of minerals, or great, stands of timber—completely unsuspected.
So it is with the explorer in medical research. Leaving familiar scientific landmarks behind, he never knows whether he will find disappointment, or some new funda- mental principle which may greatly benefit mankind.
But in any case, his pioneering has set up significent guideposts for those who follow.
PARKE, DAVIS & COMPANY
Divisions of Parke-Davis Research Laboratories: Pharmacy.
Pharmacology, Botany. Organic Chemistry, Nutritional Chemistry, Analytical Chemistry, Microanalytical Chemistry, Physical Chemistry, Biochemistry, Immunochemistry, Endocrino- logy, Physiology, Histology, Haematology, Allergy, Bacteriology, Pathology, Immunology, Serology, Mycology.
We shall be pleased to welcome Medical Students at our Sydney Laboratories.
4
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Students' Microscopes
Slides : : Cover Glasses Bacteriological Apparatus and Laboratory Glassware
at Cheapest Rates
FROM
H. B. Selby & Co. Pty. Ltd.
393 SWANSTON STREET, MELBOURNE, C.1.
AND AT SYDNEY
Telephone: F3661.
t New Mono-Binocular Stereo
Microscope
Larcher's Safe Milk
LARCHER'S Milk is treated by the most hygienic methods, which includes pas- teurising and bottling for safety. Always insist on Larcher's Pasteurised Bottled Milk.
H. Larcher & Son
(Fitzroy) PTY. LTD.
45 Moor Street, Fitzroy
Established Over 50 Years.
Telephone: J2197, J2198.
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5W. RAMSAY (SURGICAL) PTY. LTD.
MEDICAL BOOKSELLER TO THE UNIVERSITY
A large assortment of all Medical, Surgical, and Dental Books
HIGHEST STANDARD
ill
Surgical Instrument Manufacture
Half-Sets of Bones Dissecting Sets
"Leitz" Famous Microscopes SURGICAL CUTLERY
Forceps work of all descriptions.
Individual ideas carried out in any instrument.
Alterations and Repairs receive our strictest supervision.
Students' Requisites, T r u s s e s, Belts, Artificial Limbs, Rubber Gloves, Orthopaedic Appliances, Splints, etc., on hand.
INSPECTION INVITED
340 SWANSTON STREET, MELBOURNE, C.1.
6
THE SPECULUM
Gangway for
a great "brass-plate"
Whether the stork is hovering overhead or there's an epidemic of athletes' ankle afoot, this is the man of the hour! And he owes it all to his "HB" shirt! What a disaster it would be if the inopportune popping of a button should shatter that monumental dignity, or the anguish of a shrunken collar band mar the graceful ease of his bedside manner! No wonder the profession appre- ciate "HB" shirts. Lesser mortals can profit by the experience of the great, and for once there's no fee for advice!
HENRY 6U or SWANSTON STREET C KS
IM•11111•1
■
11 ..._._SI SPECULUM PLACET, INSPICE
The Speculum
THE JOURNAL OF THE
Melbourne Medical Students' Society
"The Speculum" is published for private circulation among members of the M.S.S. Copies are not supplied to non-members of the Society.
BOARD OF Editors
Sub-Editor
Business Managers
MANAGEMENT
1, A. S. FERGUSON J. H. CLOKE R. J. BALDWIN 5 R. J. BALDWIN ( R. J. LOVE REPRESENTATIVES Medical Graduates:
Dr. C. H. DICKSON Royal Melbourne Hosp. Clin.
School:
I. H. CHENOWETH
Alfred Hosp. Clin. School:
A. S. FERGUSON St. Vincent's Hosp. Clin. School:
J. MONK University . R. K. SMYTHE Women .. . EFFIE M. ROSS
Medical Officers in Wartime .. 25 Odd Odes .. ... .. 35 Some Aspects of Muscle Physiology . 40 Clinical Uses of the Sulphanilamides 13 Physiological Problems
Caloric
of the .. 45 M r. W. H. V. Preston .. .. • • • • 18 Year Notes .. .. 51
Editorial .. .. 19 Spicula .. 59
One of Our Mentors—Lord Moynihan 21 Old Boys' Column 62 Frontispiece: To face • • • • • • .. 9
The Medical Wing of the M.U.R. . • 9
M.S.S. Notes .. .. 12
PROFESSOR PETER MacCALLUM Dean of the Faculty of Medicine,
President of the M.S.S.
The portrait is by Dr. Julian Smith, Senior, through whose kindness it is published.
The Speculum
o. 145. OCTOBER, 1941.
The Medical Wing of the M.U.R.
By PROFESSOR P. MaCCALLUM.
The formation of a Medical Military Unit of Melbourne University Students has often been mooted, but it has proved difficult to arouse enthusiasm for such a project in times of peace. A spontaneous surge of desire to be up and doing (which it did one's heart good to see) followed the news of the collapse, of France. The men to give that desire voice and action were found in Wakefield, Ireland and kindred spirits of t
he
M.S.S., and at a meeting of students called by Ireland (himself a fourth year student and a captain in the artillery) it was decided to form a volunteer training unit of Medical students forthwith.Over 100 students enrolled within a fortnight, and from the middle of July gave UP their Saturday afternoons to three-hour parades for instruction in squad and stretcher drill and the elements of the work of the A.M.C. In this the volunteers had th e generous assistance of the D.D.M.S. himself, Major Atkins and other officers, and Of Warrant officers and non-commissioned officers of the 3rd Division, A.A.M.C.
The volunteers were, naturally, keenly desirous that their effort should receive So me official sanction. The spontaneity, practical action and sustained enthusiasm carried conviction, and the D.D.M.S. (Colonel Shaw, D.S.O.), after conversations with Captain Ireland) and the Dean of thq Faculty of Medicine took the matter up with the Aruty, and authority for the formation of a Medical Wing of the Melbourne University Rifles was given in December, just in time for the unit to go under canvas with the M ' U•R• at Mount Martha.
v.
One hundred and thirty-seven students, of whom 37 per cent. had had some pre- have military training, enrolled and went into camp for 35 days. The number would holidaysbeen greater had more warning been possible, for many had commitments for the which they could not forego. Arrangements were made with the Commanding
o
Meer (C
Balfe),
for an advance party of 20 to go into camp ten days ahead of the 111._ alit body to be trained in the work of the N.C.O.'s. They did invaluable work under telle enthusiastic leadership of Brodrick, who had already a good deal of such experi- no with the M.U.R. As a result the unit on arrival slipped into its place without a hitch—other
than a slight difference (amicably adjusted) with the neighbouring corn- D i
anY over the mysterious disappearance of their laboriously assembled floor boards.
The Medical wing was organised as two companies, under the command of a 0_ —Derary major. The administration was under the M.U.R. The establishment of :cells and N.C.O.'s was never fully realised during the period of the camp. The Dean th the Faculty of Medicine commanded the unit, and he had the good fortune to have
e assistance of a captain of artillery (Ireland) and a lieutenant of infantry (Ley,
10
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M.U.R.), both fourth year medical students, whose keenness, military knowledge and personality contributed very largely to the practical success of the training. The N.C.O.'s held acting rank during the greater part of the camp, the unit ultimately possessing an acting C.S.M., 11 sergeant, 7 corporals and 1 acting corporal. The establishment provides for a major, 2 captains, 3 lieutenants, 12 W.O.'s, staff sergeants and sergeants, and 8 corporals. Two A.A.M.C. N.C.O.'s (Q.M.S. Nicholson, of the Instructional Corps, and Sergeant Barker, of the Hygiene Section) were attached, and in addition to rendering most valuable service earned the high respect of all members of the unit for their practical efficiency and personal quality. Q.M.S. Nicholson specialty was the care of Stores and Equipment, and Sergeant Barker directed Field Sanitary construction and gave practical instruction in Water Duties and Field Sanitation.
For the work of lecturing we had the willing assistance of officers both within and outside the unit. We would record the thanks due to the C.O., the Adjutant, the Intelli- gence Officer, the Quartermaster, the M.O. and the Sergeant-Cook within the unit; and outside the unit to Captain Hanson, officer in charge of an Intelligence School attached to the M.U.R., to Colonel Holmes (D.G.II.), Major Atkins (A.D. of H. Southern Com- mand), Colonel Merrillees, Captain Lowe (115th A.G.H.), Captain Bristow (now A.I.F.) and Captain Leffers (Hygiene Section), and to the proprietor of Mount Martha Guest House.
The training carried out was comprehensive—in retrospect, surprisingly so—and the very high standard of performance in all branches extremely gratifying to those who set the tasks. It is, of course, what one would expect of a keen, intelligent group.
A University regiment should be a "crack" regiment. We aimed to be the "crack"
unit of such a regiment, and by the time it came out of camp it was certainly a unit that could confidently invite comparison.
We took our full share in the life and work of the battalion, taking turns as Duty Company and, though a non-combatant unit, mounting guard. Indeed it is (unofficially) alleged that one of our more pacific members with delicate and hypodermic accuracy drew blood with his bayonet on two occasions from those who had the temerity to try him out.
Though the form of the unit was that of a Field Ambulance, it would have been a waste of time and opportunity to train medical students to be A.A.M.C. privates. ThoPe who joined the unit did not waste their time.
The aim of the course was to train men who were shortly to be officers of the medical services. They had to learn both to serve and to command. An endeavour was, therefore, made to give them an understanding of the organisation of the military machine as a whole; of the place of the medical services in it, and of the duties and responsibilities of the medical officer. Practical experience of the working details and their direction and control formed the basis of the exercises of the unit.
The men not only earned high praise for their smartness and bearing on the parade ground and on the march, and held the best record in the regiment for the condition of their lines, but they showed the same quality in all phases of their work.
They learnt to use a compass, move and find their way at night, to read maps and make field sketches, and to pitch tents and marquees of various types. They learnt the con- tents of the panniers, haversacks and companions, tested water, built rafts (which floated), did some hard digging in the construction of aid posts (complete with camou- flage), gas shelters, field kitchens, incinerators, latrines, grease traps, and drains.
On four occasions they carried out field exercises on the collection, disposal and transport of wounded; carried wounded in trenches (and found it hard work); dressed wounds, improvised splints, carriage and shelter. They displayed much ingenuity in the establishment of Regimental Aid Posts, Field Ambulance Bearer Posts, Relay Posts
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11and Walking Wounded Collecting Posta, Advanced Dressing Stations, Main Dressing Stations (complete with heating apparatus and operating theatre). They learnt how to handle wounded and minimise shock, to label their patients, to keep records and to keep a wary eye on stretcher and blanket dumps and supplies, and had brought home to them the importance of calculating time, space and transport.
They were taught the whole duty and armamentarium of the Regimental Medical Officer, assisted in the conduct of sick parades, and groups of them accompanied the M.O. of the M.U.R. daily on the camp inspection. They were lectured on army and battalion organisation, on orders, military law and procedure, supply and communica- tion. They had corresponding but more detailed lectures on the whole plan of medical organisation and the function of medical units.
Other instruction covered the choice of camp sites, the hygiene of the camp and the march, sanitation in camp and in the field, the working of a septic tank system, the control of epidemics, meat inspection, flies, the nature of war wounds and prin- ciples of treatment and transport, war gases (precautions, decontamination and respira- tor drill), tactics and appreciation of the military situation, the psychology of the fight- ing soldier and points in leadership.
Few phases of the problems that face the medical services in the disposal of sick attention.
We
and of hygiene, as practically applied to military conditions, escaped We shall not easily forget the 17i-mile route march (at least I shan't), or the three-day trek on Mornington Peninsula, away from the motherly care of the regiment (nobody will). There were commendably few casualties '(of the flesh or of the spirit) 04 the route march. The clerk of the weather provided as severe a test of stamina and steadiness as the hardest disciplinarian could have desired. It was distinctly the weather for not bivouacking. But the unit carried out its programme with little modi- triumphant,
and arrived back in camp at the scheduled time, dry, cheerful and a little u
inPhant, for we were the first of the companies to undertake the exercise, and the camp having been itself in danger from the deluge all preparations had been made to bring us in out of the wet.
The, work of the unit was inspected on three occasions—by the D.G.M.S. (Major- General Downes), who braved the perils of the raft ferry; the D.D.M.S. (Southern
(311-1/nand) (Colonel Shaw) and the D.D.G.M.S. (Colonel Walsh), and they pronounced it What with a flattering unanimity. They thought it was a "good show," and with Watormk odesty we can summon we may concur. We had lots , of fun, as well as lots of
There was a young lady from Crewer, Who incited a bull to pursue 'er;
She vaulted the gate, A moment too late,
Now, when she sits down, she says "ooer!"
12 THE SPECULUM
M.S.S. Notes
The Anhual General Meeting was held on the evening of April 28 in the Anatomy School. The following office bearers were elected:—President: Professor MacCallum;
Vice-Presidents: Sir James Barrett, Emeritus Professor Osborne, Professors Marshall- Allan, Woodruff, Wright, Sunderland, Young, Doctors Balcombe-Quick, O'Sullivan, Maxwell, Hailes (abroad) and Coates !(abroad); Honorary General Secretary, Mr. R.
K. Smyth; Honorary General Treasurer, Mr. W. R. Gordon.
Professor MacCallum outlined the proposed shortening of the course, the most vitally affected at the present time being those in the later clinical years. Condensa- tion of earlier years would probably be necessary, but it was desired to minimise dis- turbances as much as possible.
Professor Sunderland then honoured us with an illustrated address on "Medical Schools Abroad." Although it is very difficult to make a contrast between the various Medical Schools it seems that the standard of the Medical graduate as turned out by the Melbourne University is very high.
Owing to war demands teaching staffs have suffered much change, but in most cases we have been fortunate in the choice of tutors. The temporary loss of the Anatomy Museum has had its repercussions, but the new one when opened should amply compensate for any inconvenience.
A combined meeting with Law students was held early in the year,, when Mr. J.
V. Barry addressed the meeting on the "Problem of Sexual Delinquents." It was a pity that so few Medical students attended such an important discussion.
Once again this year second and third year students aided the medical staff in the examination of recruits at Royal Park, namely, by the testing of urine.
Sir James Barrett, who incidentally was the first Secretary' of the Society, kindly delivered an illustrated address on the "Role of the Medical Officer in War Time"
early in the second term. He certainly made us realise the enormous number and variety of problems confronting a medical officer.
The Medical Medleys in all its traditional glamour was held on Rine 27 at the Caulfield Town Hall. A most enjoyable envening was had by all, and the success of this venture should inspire first year students to hold a ball.
Once again the Faculty distinguished itself on the sports field by winning both the athletic and the football contests. The Baldwin-Spencer trophy cup has now graced the Anatomy School for several years.
Several surgical films were screened, and judging from attendances were certainly appreciated. Our thanks are due to Doctors Trethewie and Watsford for their lucid commentaries.
The Society wishes to thank Professor Sunderland for his donation towards M.S.S.
funds.
Finally, our deepest sympathy go to Professor MacCallum in his recent bereavement.
Mistress: Well, Mary, and how do you like being married ?
Mary: Well, to tell you the truth, mum, it's just the same only more regular.
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13Clinical Uses of Sulphanilamides
By Dr. F. BLOIS LAWTON
Drugs of the sulphanilamide group have been in use for about six years, and dur- ing that time, the value and limitations of the better known members of the group have become fairly clear.
The drug first used was sulphonamido-chrysoidin or Prontosil, and in the early work on streptococcal infections it or the related prontosil soluble was used Many still Prescribe it, considering that it has certain advantages over sulphanilamide.
It was soon found that the active agent in this drug was sulphanilamide, and numerous preparations of this appeared, and special names were given to many by the manufacturers.
Its value in many infections was soon established, and, in infections in which its value has been proved, it should be the drug of choice. Recognition of this is im- portant now, because the supply of some of the newer allied drugs is limited, and, by trhregulation, egisw use is restricted to certain infections. Some have not yet reached Sulphanilamide has been tried in almost every infection, and in many it is use- d" , and for this reason it has been said that a bacteriological as well as a clinical diagnosis should be made before the drug is prescribed. Even where facilities exist this involves a waste of time which may bd dangerous, and treatment, as a rule should begin at once if the drug seems to be indicated. On the other hand, it should not be Pr
escribed if a diagnosis is made of some condition in which it is known to be useless.
The frequent occurrence of toxic symptoms led to the use of a benzyl derivative called Proseptasine, which is effective against streptococci and meningococci, and which is claimed to be less toxic than sulphanilamide. It appears to be available in barge quantities, and its extensive use seems to substantiate the claims made for it, but it does cause toxic symptoms in some patients.
In 1 937-38 several new compounds were synthesised. In these an H atom of the sulphonamide (S02.NI-1 2 ) was replaced by various substitutes. Four of these are 1:
leron, Albucid, Sulphapyridine and Sulphathiazole.
g Meron was introduced as an antistaphylococcal agent, and it has been used for ono rrhoea, but it has proved disappointing in early infection. Severe peripheral neuritis has followed its use, and outside Germany it is little used now.
Albucid selaom causes unpleasant side effects, but it is less powerful against nococci than other sulphanilamides.
of Sul
Phapyridine is the most important of this group, and so far the most valuable all the sulphanilamides, for it is effective in the infections which respond to sulph
anilamide, and in many which sulphanilamide does not affect. Unfortunately it ca uses many toxic symptoms.
Sulphathiazole is more active than any of the others against staphylococcal in- rec
,. ti i
°ns. It has only recently become available here, and there have been few oppor- L
nn ties of trying it. It and sulphapyridine will be referred to again later.
bef The search for new compounds is going on, and it is not unlikely that drugs will druzs
use at present. None is effective against virus diseases except lymphogranu- 'ulna inguinale.
One of the new drugs is sulphadiazine (2 sulphanilamidopyrimidine), and it is ound which will be successful in infections which are not touched by any of the
described
as a promising new sulphanilamide. It has been studied at Johns Hopkins lutal, but its use has been insufficient for conclusions to be drawn as to its ultimate
14
THE SPECULUM
place in therapeutics. One feature is the high concentration obtained in the blood even after a single dose by mouth.
In the treatment of streptococcal and pneumococcal infections in mice sulphadia- zine gave results comparable with those given by sulphanilamide and sulphapyridine.
The results in staphylococcal infections were similar to those of sulphathiazole.
Against Friedlander's bacillus B. sulphadiazine was more effective than any other.
Sulphanilylguanidine, which has been used in bacillary dysentery, will be referred to later.
Although this article does not deal with the mode of action of the sulphanila- mides, a reference to the relationship of some of these drugs to certain vitamins is included by request. It is described by Paul Fildes in the "Lancet" (May 25th, 1941);
but description of the experimental work and the conclusions drawn from it would make this article too long, so a summary is given.
"An essential metabolite is a substance or chemical group which takes an essen- tial part in a chain of syntheses necessary for bacterial growth. A growth factor which must be supplied in the nutrients is an essential metabolite which the cell can- not synthesise. Nicotinic acid, for instance, is an essential metabolite for all bacteria, but a growth factor for only a few. Antibacterial substances function by interfering with an essential metabolite, and thus inhibit growth.
"An interference may be—(1) by oxidising a substance which requires to be reduced; (2) by molecular combination forming an inactive product, or (3) by com- petition for an enzyme associated with the essential metabolite.
"It is claimed that sulphanilamide acts as in (3), the essential metabolite being aminobenzoic acid.
"Class (3) inhibitions require an inhibitor so closely related in formula to the essential metabolite that it can fit the same emzyme, and sufficiently unrelated to be devoid of essential metabolic activity. It is suggested that research in chemotherapy might reasonably be directed to making such modifications of known essential meta- bolites as will have these characters. Chemists are already proceeding on these lines.
In sulphapyridine, for example, the base attached to sulphapyridine is related to nicotinic acid, and that to sulphathiazole to vitamin Bl."
SULPHANILAMIDE.
This is indicated in streptococcal infections of all kinds, even though some will fail to respond. As indicated earlier, bacteriological examinations are desirable and would be likely to show if the infecting streptococcus was likely to respond to the drug, but to wait for these might allow a favourable condition to pass before treat- ment began. In scarlet fever it is without effect, but it is claimed to reduce the incidence of complications. It should be given in otitis media and mastoiditis, but it does not replace surgical treatment, which should be carried out without delay. In intracranial extension it has proved most valuable. Puerperal fever is the condition in which it was used first and the results are well known. B. Colt infections of the urinary tract respond well to the drug, which is effective in an alkaline medium.
Although numerous reports of successful treatment of Brucella abortus infection have been publishd, there is some doubt of its value. However, it seems to be worth trying. It has been used with success in trachoma and lymphogranuloma inguinale.
Erysipelas is another streptococcal infection in which it has become the routine treatment.
ADMINISTRATION: Once treatment is begun it should be continued until the infection is cured or toxic symptoms cause treatment to be stopped. It is wrong to stop treatment as soon as symptoms disappear. The initial dose should be
large,
THE SPECULUM 15
8.00 to 6.00 grms., according to weight and age, and should be followed by 0.5 to 1.00 gin. 4 hourly. Four-hourly doses are essential to maintain a sufficient concentration in the blood, because excretion is rapid. Doses should be continued at 4-hourly inter- vals for 72 hours after the fever has abated, and then maintained at a lower level till cure is effected. The blood level should be 15.00 mgm. per 100 cc. In milder infec- tions small doses may be used, e.g., 4-5 gms. in 24 hours, the duration of administra- tion and gradual reduction being as in the higher dosage. Sodium bicarbonate, 3.00 gni. in 24 hours, is often given to counteract acidosis and to lessen the tendency to nausea and vomiting.
SULPHAPYRIDINE.
This drug is indicated in pneumococcal infections wherever found. It is unneces- sary to stress its value in pneumonia, but experimental work suggests that even better results may be obtained by using the appropriate serum as well.
Possibly vaccine may also enhance the effect of the drug. In pneumococcal meningitis recovery was very rare before this drug was used, while now the prognosis is reasonably good. Sulpahanilamide is comparatively feeble against the pneumococcus, but a recovery occurred in a case of pneumococcal meningitis treated with massive doses of this drug. (R.M.H. Clinical Reports, Thne, 1938.) Dosage is discussed else - where, but it may be stated again that it is essential to obtain a good concentration in the blood at the outset and to maintain this not merely till the temperature falls but until there is evidence of recovery. In gonococcal infections the results are excellent, but ambulatory treatment is often prescribed, and this may cause unsatisfactory results as well as toxic symptoms.
Sulphanilamide gave fair results in meningococcal meningitis, but with sulpha- PYridine results are much better, and during the war the use of the latter drug is reserved for meningococcal, pneumococcal and gonococcal infections.
Experimental work suggests that this drug should be useful in enterica infections, but the leucopenia of these infections has discouraged its use. One case of agra.nulocytosis has occurred among the few cases treated.
io. A. small series of cases was reported by Harries, Swyer and Thompson ("Lancet,"
6 : 4 1). The doses were small and there was no striking effect on temperature, but there e re was improvement in the physical and mental condition. They concluded that it doses
reasonable to say that massive doses for the first two or three days, with smaller the for ten days or so, would give better results, especially if treatment began in 'lie first week. These observers did not attempt to treat any of their later cases on these lines.
T3Thoid carriers have been treated successfully with this drug. In the B.M.J., l'eb• 24, 1941, the result of treatment of twenty cases of acute bacillary dysentery is reported. The infecting organisms were Shiga, 4 cases; Flexner -Y, 13; Strong, 1;
s
un e E, 1, and Schmitz, 1; and the results were uniformly good even in the severe cauu8 • In all cases cultures of the faeces were negative after treatment, and there Were no relapses.
These results are excellent, but it would be wise to await reports in a much elarger
number of cases before reaching any conclusions. Doubt is raised about in1I' llaPyrictine by the use of sulphanilylguanidine in U.S.A., and it is also being used in Egypt and Palestine. In U.S.N. Medical Bulletin, April 1, 1941, Lt.-Commdr. G. M.
reports that it is effective for acute bacillary dysentery because a high concen- trYa ir. on of the drug in the bowel can be obtained easily.
Recently reports of satisfactory results in actinomycosis, a condition in which hitherto treatment was unsatisfactory have been reported. The plan of treatment ad-
16 THE SPECULUM
vised is unusual, for it consists of two or three courses, each of one week, with an interval of one week between courses. As in many other conditions further observa- tions are necessary before its value can be assessed.
ADMINISTRATION: It is usually given by mouth, but if for any reason this route is not available one or more intramuscular or intravenous injections of the soluble preparation well diluted may be given. In severe infections the initial dose should be 4.00-6.00 gram, followed 4 hourly by 1.00 gram till fever has been con- trolled completely for 48 hours. The dose is then reduced to 0.5 gram, and this dose should be continued until there are no symptoms. The dose is varied according to need. Usually the total dosage is 20.00 to 25.00 gram.
SULPHATHIAZOLE.
This drug is recommended for the treatment of staphylococcal infections, and good results have been recorded. Many cases of this infection have been cured with sulphapyridine, but it has also failed in many cases, and sulphathiazole seems to be more reliable.
Sulphathiazole is useful in other conditions► in which sulphapyridine has been used successfully. Banks ("Lancet," 25:1:41) treated 96 cases of cerebrospinal meningitis with 94 recoveries, but 52 had one or more doses of sulphapyridine and 44 had sulphathiazole only.
It has not been tested in epidemic conditions, but it has cured some very acute cases. It was stated to be equivalent in potency to sulphapyridine and less toxic.
It has also been used in pneumonia. At present it seems safer to use sulphapyridine in meningitis and pneumonia.
Toxic symptoms are common with all the sulphanilamides, and are commonest and most severe with sulphapyridine. The toxicity of sulphapyridine has led to the adoption of several measures aimed at prevention.
The tablets may be crushed and given in milk. Sodium bicarbonate may be given to combat acidosis as well as to prevent nausea and vomiting. The dose advised is 1.00 gram three times daily. Also to prevent vomiting dilute hydrochloric acid has been used. Nicotinic acid, 50.00 mgm. with every dose of sulphapyridine, is in many cases effective in preventing toxic symptoms and in treating them.
Sulphaemoglobinaemia is very frequent, but it is of little importance, and the restriction of sulphur-containing food and drugs which was enjoined is now thought by many to be unnecessary. Methaemoglobinaemia occurs occasionally, and is said to be relieved by methylene blue, gr. i. t.i.d.
Fever is most important. It may be the first toxic symptom, and if it occurs the drug should be stopped and fluid forced. The drug should cause a fall of temperature within thirty-six hours; and a sharp rise then, in spite of clinical improvement, is probably due to the drug. A. fall of temperature within thirty-six hours of the with- drawal of the drug will establish the diagnosis of drug fever.
Acute haemolytic anaemia is infrequent. It is met by stopping the drug, forcing fluid and giving transfusions of blood. Chronic progressive anaemia may occur with prolonged treatment, and if treatment IS prolonged frequent blood examinations should be made. If the haemoglobin falls to 50% a transfusion should be given.
Agranulocytosis is the most serious complication. A. few cases have occurred early in the courses of treatment, but most have occurred when administration has been con- tinued longer than ten days. It is wise to do leucocyte counts from time to time in all cases. Treatment consists in stopping the drug, forcing fluid, giving pentanucleo- tide, bone marrow and blood transfusions. Injections of liver and vitamin C have also been used. Crystallisation of the acetyl salt of sulphapyridine in the renal
THE SPECULUM 17
tubules may cause haematuria and decreased output of urine, and occasionally even suppression of urine. These complications are treated by stopping the drug and giving fluids and alkali.
Rashes are fairly common, and if severe cause the cessation of treatment. A generalised morbilliform rash is an example. Jaundice, due to hepatitis, is unusual and requires free fluid, calcium gluconate intravenously and a high carbohydrate
IS
THE SPECULUM
Mr. W. H. V. PRESTON
A Tribute by Professor Sydney Sunderland
With the death of Mr. W. H. V. Preston on August 14, in his 73rd year, there passed away one of the greatest and most remarkable personalities in the history of this Medical School.
At the same time the Anatomy Department lost a splendid technician and a grand protagonist, and the students a very real friend. All who knew him join in mourning his death, and extend to his family their deepest sympathy.
To write the full story of Mr. Preston's life and work
during his association with this Medical School would be in-
deed to write the history of the School itself. This obituary is
but a brief tribute to the memory of a romantic and now almost
legendary figure, who endeared himself to all who came in
contact with him. If we attempt to assess those qualities which
endeared him to generation of students we will especially
recall his kind and efficient help, and his passionate devotion,
loyalty and enthusiasm to the department which he so faith-
fully served. His remarkably attractive and arresting per-
sonality, his straightforward, simple, sincere and kind attitude
to everybody around him evoked a feeling of warm affection
and admiration in all who knew him. Only those, however,
who have been responsible for the administration of the de-
partment's business know its full debt to the man whose life
was devoted to it. During his 45 years' association with the
University he rendered conspicuous service in the fulfilment
of his duties. He was a staunch champion of the Medical
School and the medical profession ; enthusiastically loyal to its
traditions, jealous for its prestige and quick to suspect en-
croachments on its rights. To criticise the School was to risk
his enmity. It can honestly be said that Mr. W. H. V. Preston
more than any other strove to maintain and transmit the great
traditions of our School. Those who knew him intimately will
always find singular comfort in looking back on the pleasures
of his acquaintance. We deeply regret that he was not spared
to remain longer with us, but it is heartening to know that it
was given to him to retain his faculties and his sense of
splendid endeavour right up to the end of a long and active
life. The name of W. H. V. Preston is assured an honoured
place in the history of this Medical School.
THE SPECULUM
19Recently there has been spoken and written a great deal on a number
!'‘
-
I subjects of vital interest to the Medical student, both as a student and
as a future practioner.
v
Such widely differing subjects as the recently instituted faculty sur-
e Y as a prelude to faculty reform, and the question of refugee doctors have been given considerable and probably too much publicity. The result is too many unqualified and hasty opinions from persons with little or no direct connection with the Medical profession have been given too
much credence and brought forth a trumpeting which cannot fail to leave an unpleasant jangle in the ears of those who take notice.
The impression so gained of the Medical faculty and profession, though quite a wrong one, is similar to one that can be and has been formed of Australian life to-day. That is, we are too interested in our own imm e- cilate personal life and effects and insufficiently awake to the dangers which Such an outlook engenders. Surely the tragedy of France should have
ta _ ught, better than any inspiring oratory or photography, the folly and suici de of sacrificing a national outlook for that of the individual or group.
feeling ,.Yet, in our community, and the University in particular, one has the
Li
eu-11g that a cancer of false or unreal ideas has gripped so many and blinded them to the one thing that really matters. Unless this war ends in a British triumph there will be no University or even Medical profession as live now know it.
, Thus ideas for reform, admirable and necessary though they be, must Pe placed in storage for the duration of this war, and also because nothing but total energy will bring victory. Unnecessary argument and research into the reforms will only dissipate vital force which could well be spent, and in fact absolutely must be spent, on combating an enemy which is so employing his resources.
particular, to Thus it is the duty of all University students, and Medical students in refrain from abusing the privileges they now possess by allowing
their anything so to dissipate their energy, particularly pleas to reform eir faculty emanating from the blind followers of creeds born of dangerously blind members of non-scientific faculties.
These blind people should realise that their energies, so spent on
20 THE SPECULUM
reforms, may be admirable in their proper perspective—and in times of peace; and also should not attempt to persuade other students, particularly those of scientific faculties, to do anything which will mitigate against their efforts to reach a stage when they cm help directly to eliminate the threat to the way of life in which the reformers can press their claims in many cases for the betterment of the nation without damaging its integrity.
This outlook is all too rare in our University, a place where it should be a shining beacon. The tragedy is that if the University is so lacking the less fortunate people of this country will be also, and even more so.
May the Melbourne Medical students be the last to succumb to this cancer of false ideas, but rather let them prove the surgeons to eliminate it from this University and then this land.
THE HOSPITAL RESIDENTS GROUP OF B.M.A. (VIC. DIV.)
This year a Hospital Residents' Group of the Victorian Branch of the British Medical Association has been formed.
The objects of the group are:—
∎11. To form a group within the scope of the Victorian Branch of the. B.M.A.
which will bring to the notice of the younger members of the medical profession the medical problems of the future.
2. To form a liaison betw'een the resident medical officers and the rest of the medical profession, and to link up student bodies to the B.M.A.
3. To discuss clinical material between the different metropolitan hospitals.
4. To promote the welfare of resident medical officers and the junior members of the profession.
The membership is restricted to junior members of the B M.A. and those members who have in the preceding two years acted as resident medical officers. In addition, fifth and sixth-year students are honorary associate members, with the right to attend and speak at meetings of the group.
The group proposes to conduct a series of clinical discussions, particularly on prac- tical aspects of medicine. Students are invited to attend these meetings. It also hopes to enlist the services of the B.M.A. in an attempt to secure a more rational system of hospital appointments, and to secure better conditions for residents.
Mary had a little waist,
Where waists were meant to grow, And everywhere the fashions went
Her waist was sure to go.
THE SPECULUM
21One of Our Mentors
By D. GAVAN FLANAGAN.
Berkeley George Andrew Moynihan, the son of Captain Andrew Moynihan, V.C., was
born at Malta in 1865. His father did of Malta fever shortly after the birth of 1119 8011,
and the family, consisting of Mrs. Moynihan, her two daughters and the baby son, went back to England to live with Mrs. Moynihan's married sister at Leeds.
Young Moynihan went through his preliminary education at a preparatory school in Leeds from six to nine; from nine to fifteen, at Christ's Hospital Bluecoat School, and from fifteen to eighteen, at the Royal Naval School at New Cross, where he showed
or the first time both athletic and scholastic ability.
He had grown up determined to continue in the military tradition, of his family, put one day overhead his beloved mother telling a friend, of his that it was her desire that he should do medicine and her dread that he would enter the army, so he changed his
h
n R
UM, and in 1883 entered the Yorkshire College at the age of eighteen, and quail- ed four years later, having taken honours in every subject during his course.He had no difficulty of comprehension or remembrance, and read rapidly with Dower and concentration. But that was not the whole secret of his success, for he
eXa
imed in later years that his normal working day was fourteen hours and in pre- afnination periods sixteen hours.One of his contemporaries, Dr. John Fraser, later described his appearance.
"Moynihan at this time was rather a tall, thin young man, with a pale, serious Lace and a shock of red hair. He did not strike me in the first years of our course as a than of outstanding brilliancy."
He graduated in 1887, and passed his primary fellowship at the same time, and he was very fond in later years of telling his students of an incident that occurred with Michael Foster, the examiner in Physiology.
Michael Foster was giving Moynihan an oral in physiology, and his text book on a
ll:: subject was the standard one. On asking Moynihan a question and receiving an w that he considered incorrect, he said: "What is the authority for your Cr answer?"
"Michael Foster's text book."
"But I am Michael Foster."
, "Then you are my authority, sir. If you will have your text book sent for you will u My answer is the right one."
Arherl he related the story afterwards and was asked how he managed to have the
eon
book
ndence to give such an answer, he replied: "Ah, but you see—I knew the whole by heart."
_ l
ie was very fond in later years of relating this story to his students to bear out his 13
,0a wnatirodns.that no student has an excuse for failing, as he should know his text books one After 1,
-e qualified he intended to gratify his original desire and join the army, but e again he was thwarted. McGill, of the Leeds General Infirmary, appointed him house
surgeon of Mayo-Robson without consulting Moynihan first.
It was at this time that he discovered his love for surgery.
1889 he finished at the infirmary and went to Berlin to further his clinical ttudies. as was the custom at that time. Hie returned and successfully 189 position applied for of R.S.O. at the Leeds General Infirmary, where he took up his duties in for
three years. He then engaged consulting rooms in Leeds, and while sitting
22 THE SPECULUM
and waiting for patients he also sat for and obtained his M.S. He applied for the posi- tion of assistant surgeon to the infirmary, but was refused.
In 1895 he married the daughter of Dr. Jessop, who was head of the Leeds General Infirmary, and in 1896 again applied for the position of assistant surgeon, and this time was accepted.
From 1896 to 1900 he published papers on appendicitis, T.B. of the skin, mesenteric cysts, strangulated hernia in infancy, ruptured kidney, dermoid cysts, excision of the scapula for sarcoma, subclavian aneurism, the operation of gastronaphy, prevention or anticipation of shock in surgical operations and the surgery of chronic ulcer of the stomach. He continued with a steady output of papers till 1914 on a variety of sub- jects, but was focussing more and more on the diseases of the gall bladder, stomach and duodenum.
In 1901-02 he published in conjunction with Mayo-Robson a book on "Diseases of the Pancreas and their Surgical Treatment," and another, "Diseases of the Stomach and their Surgical Treatment," which remained the standard works for a decade, and through them he became known throughout America.
In 1902 he was invited to America by the American Surgical Association, who had had a very favourable report of him from Dr. Lobrugier, who had been visiting European clinics.
He went and brought back with him several pairs of rubber operating gloves, and their introduction into the operating theatre of the infirmary induced one of the students to break into ridiculing but strangely prophetic verse:—
We see the surgeons turn aside to test the latest germicide, To stop the wily microbes' least infection;
They've sterile clothes from top to toe—moustaches now have had to go.
And even just to speak will bring correction!
But not content their hair to hide, when on the nurses fair they've spied, They'll order caps too hideous to mention!
Lest when they're on a mighty list their doings may be slightly missed And you should claim the gallery's attention.
There's no doubt it must impress To thus cover up each tress;
But I think its cutting things a bit too tine .. . Ah!
For quite soon they'll want to veil Every face from gaze of male.
You'd be better far in convents out in China.
At this period of his life he rose at six and worked till eight, during which time he prepared a book on abdominal surgery which, in the words of his biographer,
"threw open the abdomen to all surgeons."
In 1903 he published a book on the "Surgical Treatment of Gastric and Duodenal Ulcers."
He was the first man to notice the difference between the symptons of duodenal and gastric ulcers, and this because he compared his operative findings with his physical symptoms and signs, and observed that the duodenal ulcer patients had a rather different set of symptoms from the gastric ulcer patients; and thus was able to lead the way to diagnosis of duodenal ulcer without the necessity of an operation.
In 1910 he published another book on duodenal ulcers, with his case notes and proofs of his theory, and in it ho preached the "pathology of the living"; and in his own words: "It is, I submit, by' a close study of the animism, followed by a careful
THE SPECULUM 28
investigation of Ole parts implicated in the disease,
during the life of the
patient, that the surest foundation for accurate diagnostic power can be built. . . . At the time when the symptoms are being caused the pathological changes are open to examination;that is
the advantage which comes from the study of the pathology of the living."ti When in the operating theatre he worked in complete silence, with a calm con- (lance and lack of haste and flurry that impressed the observer with a feeling that everything was under control and would never be anything else—and It never was.
I
any of the theatre sisters or nurses made a slip the rebuke was administered later axid not in public.
doing was very proud of his hands, and took very good care of them, not any rough work with them that might spoil their appearance, and had them Manicured once a week.
He was just as careful concerning his dress and personal appearance, and his Clothes were always well brushed and pressed; his linen spotless, and he himself kevenynses:."eared as if he were fresh out of a bath, radiating rniental and physical – In 19 06 he was made a full surgeon at the Leeds General Infirmary, and in 1909 Professor of Surgery at the Leeds University, and in the same year was responsible for the formation and establishment of the Chirurgical Club, from which sprang the Alsoelation of Surgeons of Great Britain and Ireland. In 1912 he was knighted.
h At the outbreak of war in 1914 he offered to go to France with a fully equipped :Iasi and his own staff, and in due course he was made a major, and at last fulfilled
al Wish to enter the army.
Moynihan
was
an excellent orator and was much in demand at patriotic meetings,arid
t following is an extract from one of his speeches, which at the moment happens a be topical:—
"We could not deny that the Germans had fought with great bravery, and at the e'er
•
time we knew they fought with great brutality and the utmost bestiality. . . . since the time of Frederick the Great the Germans had looked on war as
• rtanI
sed Pillage. They had cast covetous eyes on their neighbour's vineyards, and they had raided them when they thought they were strong enough. They had derided the decencies of war and mocked at the restrictions that humanity had placed upon it."
• thoracic surge ry,
gewar Moynihan studied and became a great advocate for and exponent rY, and led the way in this form of surgery.
In 1917 the King appointed him a Companion of the Bath.
tratZetzt: now at the zenith of his career. He possessed a mental clarity and pone- Perpetually amazed his close associates.
Towards the end of 1917 he went to America on a tour to advise the U.S.A. Medical cor
p! in its preparations, and by special request made a number of patriotic speeches which
were heard by a vast and very enthusiastic public.
BY 1919 Moynihan possessed the reputation of being the greatest abdominal aur-
et°
al
_ n Of the day, and the great ones in the land flocked to his door. At this time hei
began to expand socially, reading widely, and with his natural facility for rapidacq
i uisition of knowledge could discuss with intelligence a multitude of subjects cover-48' art,
literature, science, politics and sundry other subjects.
He had, however, no knowledge of the dead languages, but when this was used against
h im would in self defence quote the words of John Hunter, the famous anatomist, who, when taunted with his lack of knowledge of the classics by Dr. Foot, replied: "Jesse Foot accuses me of not understanding the dead languages, but I could teach e h
him that on the dead body which he never knee in any language, dead or Living .,
24
THE SPECULUM
In 1922 he was made a baronet.
In 1927 he fell a victim to the disease for the sufferers of which he had done so much—a duodenal ulcer. He underwent medical treatment on professional advice and recovered.
In 1929 the King made him a peer.
Lord Moynihan died on November 5, 1936, six days after the death of his wife, and I think it fitting to conclude this article with Moynihan's own expression of his surgical faith:—
-11sTo training of the surgeon can be too arduous, no discipline too stern, and none of us may measure our devotion to our cause. For us an operation is an incident in the day's work, but for our patients it may be and no doubt it often is the sternest and most dreaded of all trials; for the mysteries of life and death surround it, and it must be faced alone. Those who submit to operation are confronted, perhaps after long and weary days or months of suffering, with the gravest issues, and far more often than many of us suppose they pass into the valley of the shadow of death, and in stark dismay, wonder with Beatrice in her aching solitude and panic what will come to pass—
If there should be
No God, no Heaven, no Earth in the evil world;
The wide, grey, lampless, deep unpeopled world.
"To give courage to those who need it, to restore desire for life to those who have abandoned it, with our skill to heal disease or check its course. This is our great privilege. Ours are not the mild concerns of ordinary life. We, who, like the Happy Warrior, are doomed to go in company with pain and blood shed, have a higher mission than other men, and it is for us to see that we are not unworthy."
THE M.O. IN THE TROPICS.
THE SPECULUM 25
The Duty of a Medical Officer in War Time
An Address by SIR JAMES BARRETT to Members of the Medical Students' Society.
Thursday, June 19, 1941.
The object of this address is to show what is required from a medical officer in the army, d 371; The popular idea that his work consists solely of attending to the sick and quite incorrect. It is, of course, an essential part of his work, and in my experience during the Great War was well done, and from it much indeed was learned. 1 lit it is only a part of his work. If the war continues, as General Smuts predicts, each
and every one of you will be wanted for medical service of some kind.
arnI 1) ropose to tell you what I personally had to do, and from that the lesson can be le t. I enlisted at the age of fifty-two, and was sent to Egypt, where I was oculist and t aurist to the entire British force in Egypt, as there were no other specialists! at I d was secretary to the first General Hospital and executive officer! of the Austra- lian • Re
l _ Oh arrival in Egypt at the first General Hospital I was instructed to convert a very large hotel de luxe at Heliopolis, ten miles from Cairo, with a tram line, into a Base t4108Pital, and the second A.G.H. had to perform a similar service at Mena House under
„II: Pyramids, where nearby the first Australian division was encamped. Two stationary n Einitals and a casualty clearing station were distriouted throughout the Delta.
_ The steamer which conveyed these units was a coastal steamer, the Kyarra; quite the
ufncierlt, not even being provided with a refrigerator. During the voyage 22 cases
" 1 Dtorn ..4,.._
Poisoning occurred during one night—two being serious.
the The hotel was taken over and gradually developed into a 1000-bed hospital. As vi eacc ommodation soon became insufficient, some buildings were taken over in the eleini1Y as nurses' homes. The work became very great. At a much later stage one idtrenistcheanrtgereei from os entered intohospital
he
which no one forsesaw. When a convalescent ital he was soft and unfit for duty. An American doctor of physical education arranged for training them by gentle exercises with music, and in 19 to
14 days they were fit for resumption of army work and duty.
No dentists had been provided. Dentists who had enlisted were withdrawn from the
army and dental units were provided in the hospital.
ery soon auxiliary units became essential. Measles can be a very serious disease adults, and venereal disease was extensive. A canvas camp was erected near the
sefaosrest.he treatment of these cases. Another building was taken for other con- ,...,agi
,
before But We soon learned that cases of measles did better in tents than in a building extensiver,o0apn:lin
heir best to
a special hospital was created to! accommodate the cases. The arrival d an Eastern ertn country led to many complications, and the medical officers i armies the whole war 400,000 cases were reported in the British and Dominion en and 3 40,000 in the American army, i.e., 740,000 cases in all, apart from those who'
did not report and managed to conceal it. The gravity of the condition was recognised gbised
and earnest efforts to control it were made; not only by medical methods by
the provision of social amenities, which will be described later, and by lectures and the di
ssemination of information.
General Sir William Birdwood, who commanded the Anzacs, i.e., Australians and 11" Zealanders, made every effort possible, and sent me to meet the incoming second
26
THE SPECULUM
division, which soon arrived, and other transports to warn the officers what their men must avoid.
You will realise, therefore, that even at this stage the medical officers had much more to do than the treatment of the sick. They had to turn a huge hotel into a hospital, to provide auxiliaries for contagious cases, to see that the nurses were properly housed, and to pay some attention to the social requirements of the men on leave.
This took place in the cool weather, but with the approach of summer other problems had to be considered. I was sent down to Suez at a later date to meet a Medical General from India and to transport 20 medical officers, 80 nurses and about 350 men to Cairo. Fortunately I was able to secure a refreshment car for the train. I boarded the ship at 7 a.m., when the temperature was 95° F., and with the usual kindly aid of a British officer got the party onto the train and left for Cairo. By mid-day it was blowing a gale and the temperature was 115° F. With the supply of water and the refreshment car all were transported without loss, but at a parade in Cairo on that day some 20 cases of heat stroke were recorded, with two deaths due to the heat and kidney disease.
A conference was called next day, and it was decided to abandon the heavy Austra- lian tunic and to disregard appearances and parade men in their singlets.
Before describing the next set of events it must be stated that on arrival in Egypt medical officers and nurses were taken from the hospital in large numbers and distri- buted in various places where they were urgently needed, and the staff was greatly reduced. There were about 24 ambulances from Australia and New Zealand, and they were formed into a unit under medical direction and used as required.
In addition inoculation against typhoid, vaccination against small pox and against cholera were necessary, and a small cholera unit was created, though happily never used. You will realise, therefore, that at this stage the medical officers were occupied with much more than the treatment of disease or accident; for up to this point men wounded in battle had not appeared.
But now occurred the most remarkable incident in my life. General Birdwood is a very kindly man, and sent for me to dine with him. He was very depressed, and spoke freely to me about the decision that had been reached to attack the Dardanelles. He said that the forces at his disposal, whilst very good, were not sufficient to make such a difficult operation certain. By the time dinner was finished I was myself much depressed, as there was no preparation ready from the medical point of view for any such large-scale activity. I asked one of the staff what number of casualties could be expected. He said, guessing, 10,000; a number which was later very much exceeded. I accordingly saw my chief, the late General Sir William Williams, and discussed the matter with him. We then saw the late General Sellheim and put the case to him. He asked what we wanted. We told him the taking over of a number of buildings, the expenditure of a large sum on drugs and equipment, that if nothing occurred some money would be wasted, but if it did we could only say that an effort had been made. General Selheim was a fine soldier, and said: "If I cable Australia there must be delay and the information might leak out. See the Com- mander in Chief (General Sir John Maxwell), and whatever he authorises I will pay for on behalf of the Commonwealth."
We did so, and as Egypt was under martial law obtained an order to take over buildings with the sanction of the British medical staff. We thought we had eight weeks' grace, but it proved to be much less. General Williams went to London to deal with Australian affairs and left me in charge, expecting to return in time. I examined
50 buildings and took over 17, ordered an ample supply of drugs from London and cabled Australia for medical officers, nurses and orderlies.
THE SPECULUM 27
Then the practical difficulties began. There were no beds purchaseable in quantity, but a contractor made thousands of serviceable beds of palm wood at a cost of 1/6 Per bed. Egypt is a cotton country and rainless, and we soon piled up thousands of
b
edding supplies and stored bed and bedding in huge stores, and gradually placed them in readiness as the buildings were taken over.
Then arose the question of food, and, confidentially, we arranged with the leading hotels that on notice being given they would supply at once cooking utensils, cooks, table requisites and waiters to convey the food to diningrooms for those who could walk, and that the orderlies and nurses would supply those in bed, and so it happened that if a. telephone message was sent to the manager of an hotel that 500 men must be Provided for on the next day it was done. But whatever precautions were taken it was i
mpossible to entirely conceal these activities from spies.
Then Sir Henry Maudsley raised the question of the method of conveying the twounded from the Cairo Station to the hospital. By the prompt arrangement with the rasaWaY authorities a trial tram was run at midnight on that day, and found that to the foresight of Lord Kitchener the tram line had been built to carry trains.
The following afternoon, without warning, the wounded began to pour in, the trains 14 nhing almost to the hospital, and this continued for months.
,, The 10
00-bed hospital had been expanded to 11,000 beds in various buildings, and
`se demand was just met. One day we had only a margin of 200 beds available.
ti As the reinforcements from Australia had not arrived the entire English popula- 2 1: of Cairo volunteered, and by one means or another the want was met; whilst the it
authorities were organising their own hospitals.
th You will see, then, even at this stage what was required of medical officers. Whilst
8 W. as taking place the excellent Y.M.C.A. organisation stepped in and with Aus- 0
11i
s money began to create clubs and hostels for convalescents and soldiers on leave.
Australian of the largest, the Esbekieh, covered 2b acres, and was staffed by English and A
ch stralian ladies, who had begun to arrive. At these clubs everything could be pur- ch as
ed at cost. Cables, magazines, writing materials were supplied, and thousands of wePs
of tea or chocolate were served daily. Entertainments, both here and privately, e abundant. Concerts, lectures, &c., were arranged.
Any man who knows an army realises how important these healthy activities are.
about The l
0_ ut argest number of wounded admitted in any one day to the main hospital was 0, followed by 400 the next day. The management of these 17 buildings and br: nurses' rest home tit Alexandria, at Aboukir Bay, the site of Nelson's victory, were
"nlig impossible, and we cut them up into units under separate commands.
I
BY the end of 1915 I was knocked up, the crisis was over) and I was invalided to 11g.
and, where in February, 1916, I transferred to the British Army and went back to u
t
Pt to take up new work with the same rank and plenty of work. The Australian of s had left for France, except the Light Horse, who made an imperishable record
service in the advance on Palestine.
t r
eturned to Egypt in 1916 and took up a new phase of medical officer's work.
these oI shall
1sPosihnotrtmly refer.
On
been done, but certain things had not been done, and to
„_ stated, MY return to Egypt I found the Australian and New Zealand hospitals had left, as but there was a large and growing British army, and the Anzac mounted divi- en e
to which were added British mounted men, and all placed under the command of ral Sir Harry Chauvel, who made an enduring record in the way he used them.
There
ere were now many specialists and dental units and hospitals in the British Se , and I was offered the post of consultant in charge of the Ear, Nose and Throat On, and ultimately had the help of some 30 odd specialists. I was instructed to
