Speculum - Digitised Collections

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No. 39. NOVEMBER, 1897.

Si Speculum Piacet, Inspice.

T ke: Speculum.

THE JOURNAL OF THE

MELBOURNE MEDICAL STUDENTS' SOCIETY.

CONTENTS.

PAGE

EDITORIAL 73

SUCCESS IN LIFE .. 75

" SURGICAL PROGRESS " 78

A NEW OPERATION FOR SOME CHRONIC SKIN DISEASES 83

NOTES AND COMMENTS 85

THE MEDICAL DEFENCE ASSOCIATION 86

THE HISTORY OF A MORPHOMANIAC 88

PHARMACY NOTES • • 9 1

OUR LATE CORONER ⁹²

ROUND THE WARDS .. 93

CORRESPONDENCE .. 96

OLD BOYS 98

SPICULA 99

CLASS LISTS, 1897 .. 100

MIDWIFERY BALLOT .. I00

EDITORIAL NOTICES .. I00

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T he,Speeulum.

THE fOURNAL OF THE MELBOURNE MEDICAL STUDENTS' SOCIETY.

No. 39. NOVEMBER, 1897. ^PRICE,

Editorial.

AT one of the social functions of this year the Medical Students' Society was chided with having failed to take advantage of a very excellent opportunity, when some three years ago sug- gestions were invited by the Faculty of Medicine with a view to the revision of the curriculum of our Medical School.

Though the fault may not have rested with the then execu- tive of the M.S.S.,—and we do not think that it did—still it does seem of the nature of a misfortune that the well intentioned efforts of the Faculty should not have received more cordial support from the Students themselves, for the advent of years of financial embarrassment has up to the present precluded the possibility of any radical changes in the Medical Course, although it is generally recognised that such are necessary if our School is to maintain that lofty prestige of which we are all

so proud.

We realize at the outset, that difficulties of a very practical nature obstruct the way of reform—financial considerations and the question of " settled interests "—still we believe that on closer enquiry, these will be found to be surmountable.

In the first place we are sure that all who have graduated here within the past few years will agree that it would be altogether unfair to ask our Students to undertake more work than that at present prescribed, so that if new subjects are to be introduced, some of those now standing will require either to be dropped out entirely or materially reduced. It thus becomes a question of " the relative values of knowledges," and bearing in mind the limited time for acquisition, and the large range of choice, the framers of our Course require to be especially solicitous to employ that time to the best advantage, to settle those things which it concerns us most to know, and to weigh with great care the worth of various alternative results.

It will be admitted at once that each subject of our Course has its own intrinsic value, but the question is whether the

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74 THE SPECULUM. November, 1897.

degree of its importance justifies the expenditure of time necessary to acquire it and whether there are not things of more importance to which such time might be better devoted. The enquiry of the greatest moment is therefore, not whether this or that subject is of worth, but, what is its relative worth ?

To discuss the question in any specific detail is beyond the scope of our present intention, and we desire but to indicate the direction in which we think that reform is called for.

The first thing commanding attention is the congested state of the work of our present fourth and fifth years. To in some measure obviate this, examinations in Junior Medicine and Surgery might be instituted, Medicine possibly at the end of the third year, Surgery in the fourth year. This would also ensure improved clinical work in the earlier years, a circum- stance that at the present time is altogether desirable. With the same object in view and also to furnish fourth and fifth year men with the opportunity for attending the practice of our various metropolitan hospitals,—a desideratum which it is almost impossible to realize under present conditions--arrangements should be made that would admit of dissecting being finished by the end of the third year. To accomplish this without interfering with the existing anatomical course, it would be necessary to begin Junior Anatomy in the first year, as is done in many - other schools ; and to make an equivalent reduction in the standard now required of medical students, in the other subjects of that year. Several courses that now extend over a whole year might without disadvantage be curtailed to a single term, and the time thus saved devoted to other studies which at present are crowded out. Of these latter, Diseases of Children, Diseases of the Eye, Ear, etc. and Diseases of the Skin claim first consideration, and a short course of lectures in one of these important subjects could be undertaken in each of the third, fourth, and fifth years with accompanying practical work at the various hospitals.

The course of Operative Surgery, too, requires attention, and with a view to rendering it of more value than at present we would advocate its extension over the fourth and fifth years.

The shortage of subjects at present militates against anything like really satisfactory work being done in it, and we would in all seriousness ask of the authorities whether it is not possible to make such arrangements as will ensure a more adequate supply, both for the purposes of Operative Surgery and of the all-important Anatomy ; for if our men are to retain the high name that they have heretofore borne as skilled anatomists, it is imperative that the pernicious, but under present circumstances, necessi- tous, system of " double-banking " shall cease.

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November, 1897. THE SPECULUM. 75

Finally, among minor matters we wish again to direct attention to the absence of instruction at the Melbourne Hospital in the administration of anaesthetics, and in dentistry. The Students directly, and indirectly through the University, pay a handsome sum annually to the Honorary Staff at the Hospital, and it is surely not too much to ask that we shall at least receive some instruction in these minor branches of our art, without further fees. The demand for additional payment we think an altogether unfair one, and we look to the Faculty to protect us from any longer being the losers through the existing differences among the members of the Hospital Honorary Staff.

Success in Life.

IT is getting to be more and more the case that success in life is measured by its material rewards. This tendency, common to all classes and all countries, is specially marked in young and growing communities such as ours. But the mere fact ,of a tendency being strong, or a feeling dominant, supplies no sufficient reason for yielding to it. It may rather be that protest is the more needed, and resistance the more imperatively 'called for.

I do not say that the medical career is more affected than others by the temptation of making haste to be rich, and gauging success by that standard. Comparing ourselves, not merely with the mercantile calling, but with our brethren of the legal profession, we can safely say that it is not so. And if contempt of the world and its wealth is not constantly held before us, as with the members of the clergy, I am not at all sure that the average medical practitioner is not, in practice, as self-denying and devoted to the public weal as the average clergyman is. Though there may not be the same direct inculcation of these qualities, at least it is true that, in our profession, there is the established tradition that a medical man is not entitled to consult his own ease, or generally to think of himself first, when pain can be relieved or sickness averted. In many ways we may be criticised and found fault with, but that our profession as a whole is constantly seeking to promote public well- being, even at its own expense, is universally admitted.

Repudiating, then, the idea that we are worse than our neighbours, that our selfish and dngerous tendencies are stronger, or that we yield to them mo than others, confession must still be made that our temptatio s are sufficiently great, and that they are too often yielded to.

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Iy

I do not know that it is good for any man to attain success, of whatever kind, too easily. If it does nothing worse, it ministers to his vanity, making him think more highly of himself than he ought to think, and more highly than he is esteemed by those about him. Even success in the intellectual sphere has very readily this unsought-for result ; but there it is more pardonable than where success is limited to the attainment of professional notoriety and the earning of a large income.

It is unfortunately too often the case that these are quickly attained, in our profession, only by some sacrifice of self-respect, some dropping of youth's ideals, and loss of fitness for the honest labour and struggle which strengthen thews and sinews, mental as well as bodily. There is a noble saying of Lessing's, often quoted and very often misquoted : " If God held en- closed in His right hand all truth, and in His left hand simply the ever moving impulse towards truth, although with the condition that I do eternally err, and said to me, Choose,' I should humbly bow before His left hand and say, 'Father, give

—pure truth is for Thee alone.'" There are some, I know, who consider that saying as a grievous error, their view being, of course, that since truth is a good thing in itself, it cannot be too easily and quickly attained. But that was not Lessing's view, though there never was a more earnest truth-seeker than he.

The great German was right in the spirit of his contention, as I believe ; and, if even the best and purest of successes, the attainment of truth, is chiefly valuable for the training got in striving for it, what is to be said for the lower successes of place, position, and material wealth ? Now I do not pretend to despise these things. As man is constituted he needs some stimulus to exertion ; and Lessing, though he preferred truth obtained by striving to truth got without effort, was incited to labour by hope of his reward in attaining it.

Grinding poverty is always bad, but poverty is relative, like other things, and very many of our so-called needs are artificial.

Certainly we can say that many of the greatest names on the roll of the world's great men, are those who have lived laborious days, and done their best work, with material rewards few and small. John Milton held a prominent position under the Common- wealth, but the works which he did then were not those by which he is now famous. It was when he was almost in hiding, _and suffering from actual poverty, that his great poetical works were produced. Samuel Johnson for many years had the direst struggle for existence, and if he became in some ways soured, he was also strengthened in the process. Wordsworth never made more than trifling gains frDm his poems, and was content to live a life of retirement, cultivating the Muses " on a little

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oatmeal "—as Thackeray, I think, parodies Virgil's tenni arena.

Thomas Carlyle was many years before he obtained public recognition. Coleridge through a great part of his life had to depend on friends for his support. Keats died in Rome, his name as he thought, "writ in water," dependent on the kindness of his friend Severn, and of a member of our own profession, afterwards famous as Sir James Clarke. Tennyson for many years was laughed at ; Browning held up to ridicule. For Burns nothing Netter could be found that the post of exciseman, with, as has been said, the noble duty of measuring whisky casks. Emerson, the greatest name in American literature, was always poor, and quite content with his poverty. Lessing, whose name stands worthily beside those of Goethe and Schiller, had little popular recognition in his own day, and earned but a beggarly pittance by his writings. Cornelius, one of the greatest of German painters, toiled long and hard with little reward.

" I waited for twenty years," he said, " till the world came round to me." Patiently perhaps he waited, but the waiting was long, and must have had its moments of bitterness, and certainly of self-questioning.

If men like these, then, had to be content with small things, some at least of them willingly content, what are we, to be calling heaven and earth to witness our wrongs, because success and its accompaniments do not come at our call ? If success comes too early, it is almost certain to come undeserved, because not worked for ; and, having come, its very existence is apt to destroy any chance of deserving. It is those who have slowly climbed the ascent, who are best able to escape giddiness, and the danger of a heavier fall.

There is a common saying, " All things come to those who wait," and there is truth in it, but not the whole truth. As a matter of fact, it should run, " Everything comes to those who know how to wait." The Scripture maxim, "Watch and pray,"

corresponds, on the spiritual side, with the line from Milton,

"They also serve, who only stand and wait," or as it is according to Longfellow, " Learn to labour and to wait." Waiting is useful, only when it is in the attitude of readiness and expect- ancy, and when it alternates with strenuous endeavour. And it is in this view that I feel myself entitled to say to you, that comparative lateness of success may well be a real gain, and the condition of a higher and truer success. In Germany there has always been recognised a kind of double apprenticeship, what Goethe speaks of, in his " Wilhelm Meister," as the Lehrjahre and the Wanderjahre. The first period is that of the formal apprenticeship, during which the youth is under direct tuition and supervision ; and the other that, during which he

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goes out and learns, by independent observation, some of the wisdom and experience of a wider world. If you look about among the graduates of our own school who have done it most credit, and gained for themselves the most assured position, you will find that almost all of them did not hurry to enter on the routine work of the profession. If they had not, for any reason, their " Wanderjahre," in the stricter sense, at least they were content to keep up their studies, in positions which led rather to increased knowledge and skill than to direct money making. To more sordid souls it might have seemed that their method was chiefly a waste of time ; but, if the reward was deferred, it was the greater when it came.

It is not always easy to judge fairly of the use made by others of what seem to us opportunities. But for seeming invidious, I could give instances of men, leaving this University with a high reputation and failing to get more than the most common- place positions, because of their haste to settle in practice and make money.

It all comes back to the question, with which we started, of a man knowing how to wait, using his opportunities aright ; if necessary making his opportunities; neglecting paltry temporary gains, while labouring and waiting for some higher object of ambition. And let me say again that the mere attainment of large practice and proportionate income is not within the reach of every worker, however honest. There are persons illnatured enough to say, that no great, and certainly no rapid success is possible, in our profession, without a considerable spice of charlatanry.

Well, however rapid, and in appearance great the success got by the tricks of the charlatan may be, that success is far from being of the highest. The greatest of any man's achievements must be the formation of his own character ; and no degree of notoriety, no accumulation of wealth, will be compensation for the loss of self-respect.

JJ.

The Annual Le1ure, 1897.

"SURGICAL PROGRESS."

(Concluded.)

The dawn of the present century finds London the centre of the surgical teaching of the world, and though much had been done to raise surgery into a science, the surgeon of the beginning of our century had but few resources and little accurate knowledge as compared with the surgeon of to-day. He had a too close and unfortunate knowledge of the dangers, often fatal,

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which followed accidental and operation wounds, and yet living cheek by jowl with septicaemia and hospital gangrene, he knew little more of their exact causes than Hippocrates did. One can but pity the memory of a surgeon in these days when he had no anaesthetic, no clinical thermometer, no hyperdermic syringe, no antiseptics, when hemorrhage was, but very partly under his control, and when he knew by fearful experience that a frightful fiend did close behind him tread in the shape of pymmia, the more dreaded in that it was never seen except in its results. The progress of surgery in the first half of the century was mainly the accumulation of knowledge, rather than the production of wisdom, and actual advance was slow. As long as the ultimate cause of inflammation was unknown, the surgeon was very helpless in its presence, and his fixed idea that it was a disease, prevented any real advance, until its true nature was understood.

It is to the science of bacteriology that we owe the more than marvellous progress which has been made in surgery during the last twenty years. Before 1870 the result of our treatment depended mainly on chance. Now-a-days, when we look upon suppuration occurring in a wound made by the surgeon through unbroken skin as a stigma on his surgery, it is hard to believe that in 1870 a well-known text book alludes to the importance of promoting suppuration in all wounds.

The nearly universal existence of micro-organisms is now con- ceded. Not only do we encounter them in most of the external influences that affect mankind, but we find them in many of his tissues, thus his surroundings from his cradle to the grave are always potentialities of disease and death. His tissues wage war on the germs, even as the germs wage war upon him, and health is on the side of the strongest battalions. It is a warfare beside which the carnage of a Gravelotte, or a Plevna, pales into insig- nificance, and the main outlines of the war of nations are repro- duced in miniature in an inflamed part. After the declaration of war, which is a wound, and as amongst civilized nations invasion of territory sometimes precedes war, so we find germs invading the body even without a wound ; mobilization of the individual forces at once take place, and in obedience to a mys- terious influence, which though we have named, we do not understand, troops of cells hurry to the invaded point with more than German precision, every bloodvessel becomes a strategical railway and pours its masses of cells into the conflict. The battle of the cells is more than a fight between the individual and disease. It is an encounter between kingdoms ; the man represents the animal kingdom, the bacteria the vege- table kingdom. It goes back to first principles in its savagery,

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8o THE SPECULUM. November, 1897.

for the invaders are armed with poisoned weapons, while the defenders display most marked cannibal appetite. Like the Dutch of old, opening the dykes and submerging the intruding army, we find the organism bathing the battlefield with fluid, thus diluting the poison with which the enemy is endeavouring to paralyse the resistance. During the height of the fighting the individual gets constant telegraphic messages from the scene of the conflict ; his pain tells him how the fight is going, and the part throbs in unison. His whole being feels the fierce delight of battle, his eye brightens, his life burns more quickly, and the battlefield becomes actually hot with the ardour of the fight, and shows the dull and awful red of inflammation.

Now, as generally happens, the individual by his cells repels the invader, and under the microscope you can see on the battlefield victors and vanquished lying dead, so valiantly have the defenders fought to protect their parent organism, that inside their dead bodies can be seen one or more of the minute invaders. When the battle is over the flood waters are called in, and a separate army of cells sets to work to clean the battlefield and bury the dead, and soon according to the strength of this second army all is cleared away, and nutrition resumes its stately march, even as the corn waves over Waterloo. If, however, the invaders come in too great numbers, the defending army is paralysed by the poison excreted by the enemy, their resistance is overcome, the strategical railways are used by the oncoming host, the very citadels of the individual's being are captured, and be sleeps with his fathers. In other words the germs overpowering the resistance of the tissues gain access to the blood, by which they and their toxics products are borne to the heart and lungs, in time killing the individual by a general poison. As a rule no quarter is given by either side, but sometimes the organism imprisons some germs captured in small parties in the fortresses of the lymphatic glands. The imprisonment is often for life, in the case of tubercle bacilli, but they may escape and work harm in other parts when the individual's power of resistance has been weakened.

Now this picture has not been overdrawn, and while it may set you wondering upon the marvels by which we exist, it points a moral well worth remembering to our students. Any inflammation however small, any germ however insignificant, may become the starting-point of a fatal infection, and I believe that we are only just beginning to be aware of the possibilities of danger that lurk in such seemingly small lesions as a carious tooth, a festered hangnail, a sore throat, or an inflamed hairfollicle. If we could but read aright the pathological history of the numbers that die of pneumonia, pleurisy, and

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November, 1S97. THE SPECULUM.

inflammatory diseases, we should find that a small and almost unnoticed germ infection was often the first cause. A little fire is quickly trodden out, which being suffered, rivers will not quench.

It is better to treat the small inflammation with ordinary surgical skill than to minister with the highest physician's ability to the fatal pneumonia.

But a very few years germs held almost unlimited sway over our wounds ; it is dreadful to think that only twelve or thirteen years ago septic diseases were still rife in hospitals. Of course some wounds healed kindly because the germs present were few in number and mild in virulence, and the patient's tissues were strong in resistance, but more than half the cases of wounds of any sort in a Continental hospital died of some form of blood poisoning. To enter the hospital of Heidelberg, with even a small lacerated wound, was almost suicide, and in Paris sepsis had claimed so many victims after operations, that the French surgeons were actually giving up the knife and using caustics to make incisions in the skin. In England, fortunately, matters surgical never reached sech a fatal depth of sepsis, still pyzemia, septicemia, hospital gangrene, and erysipelas walked the hospitals with the surgeons and students. This terrible state of things was all changed, almost suddenly, by the genius of Lister, who had been working and pondering upon the causes which prevented the healing of wounds, for a long time.

" Healing and Healings's laws lay hid in night, God said, Let Lister be, and all was light."

For most assuredly Lister holds even a higher place in the history of the healing art than that assigned to Newton in Astronomy by Pope who wrote his Epitaph in Westminster Abbey.

Thus Lister, with the aid of anwsthesia has made possible most of the wonders of modern surgery. Progress since the general acceptance of his doctrine and practice has been nearly continuous ; here and there in surgery we find that small retrograde steps have been taken, but the backward direction is soon recognised, and no great lapse from progress in surgery, such as we have so often seen in the past, is, I believe, possible again.

The history of Lister's patient exhaustive and absolutely reliable work is full of interest to the student of any science, and the account of how he gradually won his way from the first crude dressings of impure carbolic acid undiluted, to the present ideal asepticism is worthy of all attention. His methods will always remain a model of what scientific research should be.

His original principles he has always been able to follow, but his actual practice has altered. Even the greatest of men

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are dependent upon contemporary work, and Lister was largely influenced by Davaine and Pasteur in France, and by Tyndall in England, but he was selected by Providence to be the greatest benefactor of the race that has lived, at all events in modern times.

Science has neither sex nor nationality, but it may be pardoned to us if we are gratified when we consider that the vast blessings of vaccination, of anmsthesia, and of antisepsis have been given to humanity by men speaking the English language. This gratification is somewhat lessened, when we remember that while Germany embraced and France welcomed Listerism, the main opposition to its spread was experienced in England.

Abdominal surgery, possibly the most marvellous of the developments of modern surgery, was started, as we know it, by Spencer Wells. Against much virulent opposition and what we think now, was a fearful mortality, he laboured on towards the perfection, which ovariotomy has now attained. The dangerous paths by which great surgeons have gained a perpetuity of fame should be known to all who essay to follow them. Thus Spencer Wells with the threat of trial for manslaughter before him, persevered though losing one case of ovariotomy in every three. Now-a-days, one death in 3o, one in 4o, one in 5o is one too many, when surgery records a succession of over 15o operations for the removal of ovarian tumour without a death.

The results of modern progress in surgery are best seen in three savings :-

i. Saving of human life.

2. Saving of human time.

3. Saving of human pain.

As Waterloo was won on the fields of Eton, so the victory of surgery over disease is often largely assured by the care of the surgeon before the actual operative work takes place. All the events of an operation are so carefully thought over and arranged for, or should be so, previously, that it is seldom we are in the position of Napoleon in Egypt, after the Battle of the Nile, when he said, " Great things are now required of us."

Thus the surgeon who meets with many operative emergencies, is the surgeon who has not thought out the campaign before engaging in it, although sudden decisions must at times be called for. It is this exactitude of surgical methods and surgical results that to my mind is the crowning glory of our work.

I would have you fellow-members of this Society remember that you may and will share in this glory. You may not indeed become a Lister or a Fitzgerald—the really first-class surgeon is compounded of many special qualities and requires oppor-

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tunity to cement them—but you all may become really good surgeons, and the watchword of the glorious fellowship of good surgeons is antisepsis, and the price of antisepsis is eternal

vigilance.

A New Operation for some Chronic Skin Diseases.

BY HERMAN LAWRENCE, M.R.C.P.E., &C.

Physician, for Skin Diseases, to the St. Vincent's Hospital, and to out- patients, Melbourne Hospital.

I will first of all describe the operation I refer to, and afterwards relate some of the cases successfully treated by such

• method.

The operation really consists in a mince-meating of the skin with its capillary vessels (which vessels are in a state of chronic dilation in the cases chosen for the operation). This procedure is then followed by hot boracic fomentations to increase the bleeding. When the bleeding has fairly stopped, powder with iodoform, and apply Zinc Icthyol glycerine jelly, and cotton wool. Upon this dressing, and placed well over the seat of the disease, a solid india-rubber pad is fixed by Mead's plaster, the strips of plaster being drawn fairly tense, in order to obtain the required amount of pressure upon the seat of the operation. The dressing and pads for pressure should be attended to daily for about three applications. Then some simple protective covering may be used if considered necessary.

The instrument I use for mince-meating—kindly sent to me by Dr. Louis Wickham, of St. Louis Hospital, Paris,—has six blades, which are r-loth inch apart, and so, with longitudinal and cross incisions, it divides each square inch of skin operated upon into some 400 sections. If instruments with numerous blades and more closely set, as most are, he used, many of the sections of the skin are carried away, being held between the blades on making the cross incisions.

CASES SUITABLE FOR OPERATION.

Chronic• patches of dry catarrhal inflamation of the skin, Lichen Planus patches, intractable patches of non-apparent catarrhal inflamation of the skin—as met with in patients who have had an eczema, but in spite of varied treatment, dating probably over some years, they have been unable to get rid of these patches of pathologically altered skin.

T.N., aft. 36.—Strong, healthy man. No history of general eczema. Two patches of chronic inflamation of the skin, situated upon inner side of left leg, with marked pruritus, never

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- 11

weeping, slightly scaling, somewhat reddened, furrows of the skin much exaggerated, papules irregular in shape and flattened

—not Lichen Planus papules. From history of case, probably in the first place, patches of traumatic dermatitis.

When he came to me for treatment, the pathological changes produced in the skin by chronic inflamation were well marked.

Patient stated his trouble had been a constant source of annoy- ance to him for the past i i years. Had used many applications, including chrysarobin traumaticin, jellies, pastes, lobs, &c., externally, and had taken KI and arsenic internally, from which he had only derived temporary relief from the irritation.

The patches were situated on the ir.ner side of the left leg, and near to the knee-joint, one patch being about 6 x 4 inches and the other 3 x 3 inches. The patches were strapped over night with Salicylic et Creasote plaster mull. (Fort—Biersdorf). Next morning the destroyed epidermis was removed, serum exuding here and there. This surface was then painted with cocaine solution, and operated upon as previously described, without chloroform. Patient states he has been free from his trouble since the operation, now about three months ago, but on examination a portion of the larger patch had not quite disappeared, owing no doubt to the proper application of pressure being interfered with, by the awkward situation of the patch.

Suitable cases of Lupus Erythematosus may be operated upon by this method, and the following history of a case of true Keloid (Alibert) is, to say the least, very encouraging. A strong healthy man consulted me at St. Vincent's Hospital, about two •

years ago, with a keloid upon his right forearm. The tumor was about the size of a man's thumb, situated upon the dorsal aspect, and in the longitudinal axis, with the usual processes extending from either side. The growth caused him so much pain, that I twice excised it freely for him, with the usual result, in these cases, that it returned soon after the healing of the wound, the pain re-occurring with the growth of the tumor. I then exhibited the case before the Victorian branch of the British Medical Association, and the surgeons present recom- mended the keloid to be left alone. But the pain annoyed the man so much that he requested me to try some further treatment. I then treated the keloid by my mince-meat and continuous pressure operation, with the result—and it is now six months since the operation—that the man has been completely free from pain, and has been able to work all this time, while in the place of the keloid there remains a tissue-paper scar.

As the text books admit of no successful operation for keloid, I thought the result of this operation upon a case could not fail to interest the readers of the Stecithint.

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Notes and Comments.

THE Medical Harriers annual cross-country race for Dr. Kent- Hughes' prize was held this year at Mentone. Dr. Balfour and Mr. Riddell, the hares, laid a good trail across country abound- ing in furze bushes and water, which seriously discomfited

several of the hounds. Mr. E. E. Webster, the scratch man, ran a magnificent race, and won as he liked in good time. The members of the club were afterwards the guests of Dr. Balls-

Headley to dinner at the Mentone Hotel. When ^thepunch was circulating, Dr. Balls-Headley proposed the toast of the club, coupled with the names of Mr. Fletcher—the secretary, and Mr. Rose—the captain. Mr. Fletcher responded for the club, and then proposed the toast of the evening—the health of Dr. Balls-Headley, congratulating him on his complete recovery from his recent accident. The toast was received and honoured in a most enthusiastic manner. Songs were rendered by various members during the evening, and the usual Auld Lang Syne concluded a most enjoyable afternoon and evening.

About forty members of the fourth and fifth years recently went with Mr. Bird for a stroll in the adjacent country. Taking train to Box Hill, we walked thence to Warrandyte. The country was gay in its spring costume, the delicately-tinted fruit blossoms, wild flowers of every hue in profusion, and the rich yellow gorse lining the roads, lending quite a holiday appearance to the otherwise sombre Australian landscape. Lunch was provided for us at Warrandyte—where Mrs. Bird joined the party—and with appetites sharpened by the fresh country air, the hungry band fell to. The gastronomic feats of the assemblage excited the admiration of the plethoric van-man, who vowed to one of the party that " he never seed such eatin' in his life before, blowed if he had." After several men had contrived to fall into the river, we started for Heidelberg, against the wind every inch of the way, and after a brief rest at Templestowe for liquidation, we arrived at the Heidelberg station. Thence by rail to Col- lingwood, and so into town by the homely trams of civilisation.

We offer Mr. and Mrs. Bird our sincere thanks for their kindness in providing such an enjoyable outing, which proved an excellent preparation for the impending examinations.

The annual fifth-year dinner, tendered by the successful men

—in the October exams.—to their less fortunate brethren, was held at the Vienna on Monday evening, 8th November, A most enjoyable evening was passed with songs, recitations, toasts, &c.

The event of the evening was, sine dubio, the song by a contingent of the Melbourne Hospital residents. Dr.Crowley accompanied, Dr.

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Officer being an efficient and energetic conductor, whilst Drs.

Williams, Ostermeyer, and Perry amply justified their already high reputation for concerted singing in the chorus. The only regret was that Marshall-Hall was not present to hear this number, for he would certainly never have suffered again from his diphtheritic neuritis. The singing of Auld Lang Syne brought the evening to a close—the last occasion on which _we would all meet together as a year.

At the close of another year we wish to tender the thanks of students to all those gentlemen who have befriended us in one way or another during the year. We would especially thank Dr. McCreery for his excellent lectures and demonstrations at Kew—Mr. Noyes for his valuable lectures and systematic teaching in the out-patient department—Mr. O'Hara for his clinics in surgery at the Alfred—Mr. Syme for demonstrations in Regional and Applied Anatomy and Surgery, and Dr. Nihill for lectures to third-year men. Last, but by no means least, we thank the residents of the Melbourne Hospital for the thorough work they have done with us this year, and to their systematic teaching in Medicine and Surgery we attribute in no small measure our success at the recent examinations.

The Medical Defence Association.

As time rolls on the course of study prescribed for the medical student is steadily becoming more difficult. If the remuneration of medical practitioners were being increased in similar proportion there would not he much to grumble at, but as the average medical income is steadily diminishing, the out- look for the junior practitioners is not at all a pleasant one.

Several causes are at work. First of all the number of practitioners is increasing out of all proportion to the increase in population. With this of course comes the inevitable excessive competition. Again, patients are not now the possessors of as much money as they were, say, ten years ago. Besides these important factors, there is the indubitable fact that meanness seems to he unfortunately so widespread as to threaten to become an essential feature of the national character. People who are perfectly well able to pay current fees simply swarm to the hospitals—in particular to the Women's, Children's, and Eye and Ear—and have not the slightest scruple about writing themselves down as paupers and accepting charity from the rest of the community.

A cut above these—but for all practical purposes just as bad

—is that large section of the Friendly Societies which is per-

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ovember, 1897. THE SPECULUM. 87

fectly well able to pay current rates, but prefers to pay twelve and sixpence (12/6) per annum for attendance on a family. In this particular section of the Friendly Societies is to be found that amusing set of people who declaim loudly about the iniquity of sweating " the worker ;" and the necessity for short hours and a living wage. But they take all sorts of care to sweat their own workers (doctors and chemists), and to see that they do not get either short hours or a living wage. Further, if one

•of their sweated employes ventures to indulge in the faintest suspicion of a grumble he is told very plainly by these preachers against sweating that if he doesn't like it they can get somebody else—who won't grumble—quick enough. The language of the sweater precisely, but it sounds strange from the lips of alleged apostles of peace and good will and fair platy to all mankind.

To stem the ever increasing tide of meanness, as far as possible, and to insist upon reasonable treatment to the medical profession are really the principal functions of the Medical Defence Association. Interviewing the Income Tax Commis- sioner, and obtaining small concessions—as the Association has done—is all very well in its way, but that and such like functions are practically nothing as compared with that of organising strong and determined opposition against those—and their number is legion—who are ever ready to take advantage of the weak. The necessity for such an organisation has year by year become more imperative, and now that it is not merely in existence but growing rapidly, it behoves every member of the profession to further its interests in every possible way. The influence which such an association wields varies almost directly as the number of its members ; if the list of members is small, it will be treated with contempt ; if large, with respect begotten of wholesome fear.

The medical men connected with that peculiar mixture of Friendly Society and political institution known as the Australian Natives' Association recently combined—under the aegis of the Medical Defence Association--for the purpose of securing some amelioration of the conditions under which they work at present.

The result has been satisfactory, first to the medical men con- cerned, because they have secured reasonable concessions, and in the next place to the Medical Defence Association, as its roll of membership has, because of this A.N.A. agitation, been doubled within a few months. This Medical Defence Associa- tion is one that should receive special support from recently qualified men and women, as they are the ones who need special protection from those who sweat—under various guises more or less transparent. They will be rather taken back at the cool audacity of some of the requests made to them, and if not backed

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up by some organisation such as this, will have to eat humble_: pie much more frequently than is either desirable or pleasant.

The office-bearers are :—President, Mr. G. A. Syme ; Vice- president, Dr. G. F. Howard ; Hon. Treasurer, Dr. F. J.

Owen ; Hon. Secretary, Dr. Eugene Anderson ; Committee—

Drs. Jamieson, Brett, Rothwell Adam, Hamilton, Daish, Hall Owen, and McAdam. Any of them, but in particular the indefatigable hon. sec., will always be found only too happy to give to intending members all necessary information about the Association.

The History of a Morphomaniac.

BY O.B.R.

ON the of — a case was admitted to the Melbourne Hospital, the circumstances surrounding which appear to me of so much medical and general interest that I venture to submit them for publication in the columns of your journal.

at the age of — successfully terminated his engineer- ing course in the London Universities, when, with that fickleness that too often accompanies high intelleaual power, he wearied of the theories that have come down from Watt and Stephenson, and treat of steel and iron and the mechanisms into which they are wrought and moulded. His ambitions then dire6ted towards the medical profession, and meeting with no opposition he immediately commenced in his new field of study, very successfully completing his first year, and looking at that time as if a brilliant career were awaiting him in the future. Now, however, came his stumbling-block, for with materia medica came discussions of Coleridge, De. Quincey, and the opium habit—

the elevating and inspiring influence of this drug being known then as to-day, though the taste of crude laudnaum as Coleridge gulphed it down preparatory to going into the leaure hall, or as De. Quincey sipped it at his writing table as squires did their port, was very different to the refined preparations of morphia which in the present-day pharmocopea stands somewhat as its successor.

" Mind is superior to matter !" was the boast of at this time, and his contention then was, as probably it always remained, that no conviction was so strong as experienced proof.

That " one cannot know the use without transgression into abuse " was a theory be laughed to scorn, and accordingly with a head full of Greek verbs, mathematics, and other tyro knowledge, he scoffed at the teaching of text books and seers, and set himself the task of proving the possibility of touching pitch

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without becoming defiled, or in other words, that morphia, like spirits, can be taken systematically without excess.

Now comes the period of retrogression, marked gradually by an increasing number of grains of morphia per diem, for, as with other men, so with him, that which to-day took his soul soaring above earth, seated him upon a throne of mundane superiority, lifted his aspirations even to the verge of heaven, filled his mind with themes of rare thought, and set him as it were in a city of impregnable peace, to-morrow wanted further pushing to pro- duce a like effect. Even at this stage, however, all seemed well ; brilliant flashes of intellectuality and originality occasionally called him into marked recognition, and it is an unquestionable fact that under the influence of morphia he conceived that which of himself could never have been born.

But by-and-bye the ethical nature of the man began to feel the effects of over-stimulation, and the finer senses of morality which guard self-respect, grew markedly attenuate. At this time he consumed daily by hypodermic injection ro grs. of morphia, and his family, alarmed at the hold the habit was taking of him, decided to send him for a trip to Australia, in the hope that new interests and fresh scenes might vanquish the fate that seemed inevitable. On board the s.s. "

was carefully looked after by a friend, a fourth year medical, and in the time that elapsed between leaving Liverpool and arriving at Port Phillip his daily quantity of the drug was brought down to ²grs.

Released, however, from ship-board restrictions, it soon became evident that though his consumption of the drug had been diminished, his desire for its stimulation, or rather its calm inducing influence, was by no means lessened, and with the facilities at hand to re-embrace his infatuation, he very soon retrograded into his old habits, until he became such a confirmed morphomaniac that even his best friends recognised the hope- lessness of his redemption.

With very little appetite for natural food, beyond a periodical and greedy craving for nourishment, he spent his days in a state of fictitious bliss, showing very evident signs of his habit, but still retaining a clear and keen intellect marked by aniple originality, no loss of memory, and suffering no organic disturb- ance. Reading, as all through his life, was still one of his chief enjoyments, and after plunging the insiduous needle into any available region of his anatomy, he would calmly settle himself down to his hooks, possibly with a sense of superiority and superhuman goodness. Or should his fancy turn to art he would seat himself on the kerb-stone with a handful of coloured chalks and pass an hour by amusing the urchins in the neigh-

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go THE SPECULUM. November, 1897.

bourhood with outlines of mythical forms, for which reason he was known in his suburb as " The Artist."

Now comes a new phase of the old disease — cocaine competes with morphia, and an evil and powerful competitor it was, for whereas morphia only acted as a sop to conscience and a temporary elevator of the ambitions and powers of the man, cocaine exercised an active inflammatory influence, debasing in tendency and degrading in result ; so that subsequent to its introduction every destinctive characteristic of the original man was very soon lost, and there was nothing left but a creature crying for its syringe and its drugs, which though they often had to be injected between sores and ulcerous wounds, gave his system a sense of stimulation that a healthy mind would shudder to suggest.

On one occasion about this period — had the misfortune to break the needle of his syringe, and not being able to obtain another, he used to make an incision in his arm, plunge the nose of the syringe into the wound, and so inject his morphia or cocaine, making, one would imagine, ample allowance for waste and overflow, as it is reported to the writer that the crudeness of his method did not lose him the result of his injection, the absence of which caused him such an exquisite sense of dissolution that it was no wonder he preferred going to any extremes rather than forego his serpent's fang. And perhaps no stronger proof of the power of the morphine habit could be given than the fact that he would voluntarily cut into the flesh of his own body, insert the metal cup of a hypodermic syringe into the incision, then inject so much of the drug as he conceived himself to require, and with pinching fingers hold together the part during the process of absorption.

It might he thought that this artificial and morbid existence could not be persisted in for any length of time without some actual organic disease resulting therefrom, or some active brain lesion asserting itself. Strange however as it may seem, though some years were passed in this manner with no change other than increasing doses of morphia and cocaine, neither one nor the other form of disease became apparent, and when the patient was admitted to the hospital suffering from acute pleurisy due to exposure, there was no evidence of any other trouble, and this opinion was substantiated post-mortem, though anyone seeing the haggard, fleshless face of the patient, his fixed and glassy eye staring as with a rigid gaze of mixed defiance and fear, with hair grown coarse and standing out from the scalp " like quills on the fretful porcupine," and knew his body to be emaciated and covered with innumer- able sores due to constant irritation from the puncturing point

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November, 1897. THE SPECULUM.

of the hypodermic needle, would have found it difficult to believe in the absence of any specific disease.

Like a puling infant crying for its mother's breast, this once fine mind lay craving for its torture toy, a patched and broken syringe ; and even though his soul was about to return to its Source, he had no higher aspiration, no other call than " Give me ten grains of cocaine—let me put it in myself!" Then while at his own request a cup of tea was being got for him by his nurse, with a gasping struggle he passed out of the flesh — whither and having served what purpose, who can say ?

The quantity of morphia and cocaine being consumed daily by — at the time of his death were respectively ninety grs.

and twenty grs.

Pharmacy Notes.

A case has recently been reported of poisoning by Pyrethrum powder. Vomiting, collapse, with very feeble pulse and respir- atory difficulty were the prominent symptoms. An emetic dose of Ipecac afforded immediate relief. Pyrethrum if inhaled may cause a reflex spasm of the glottis with all its concomitant alarming symptoms.

Oxygen water is the latest treatment for the vomiting of pregnancy. The oxygen water contains ro volumes of gas, and the dose is from one dram to an ounce, freely diluted.

" Scopolamine," which is stated by Schmidt to be merely impure Hyoscine, is now being used as a cerebral depressant in meningeal insanity, and, in fact, any case where a powerful sedative is thought desirable, in doses of gr. 1-2ooth hypo- dermically. Up to the present, however, Hyoscine in similar conditions, where milder measures fail, has amply justified its reputation, and we see no need for abandoning its use for a drug of which we as yet know comparatively little.

" Tetrallylamoniumalum " is being brought forward as an uric acid solvent. Time alone can tell whether it possesses all the virtues claimed for it.

"Guaiacol-Chloroform " is the name given to a preparation of guaiacol and chloroform in the proportion of six to ten. It possesses powerful local anxsthetic properties, and ten to thirty minims deeply injected in the course of the nerve, is said to relieve instantly the pain of sciatica.

"Orthoform " is a local anaesthetic with more lasting effects than most other agents of this class. Its chief value is stated to be in skin grafting. Unlike most anxsthetics it is a solid—a bulky white crystalline powder.

In one of the druggists' papers there recently appeared a

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letter bemoaning the poor prescriptions written by modern medical men. Inter alia it stated that druggists were positively insulted when a prescription directed them to dispense"some patent medicine. This statement reads rather curiously when one sees the advertisements in that very paper for every description of proprietary medicine, and finds druggists' shops crowded with every known registered and unregistered nostrum on the market, and when chemists constantly advertise and dispense their own patent abominations for all diseases from whatever cause arising.

Our Late Coroner.

The Sun would hover round the Morgue When Dicky Youl went in,

And Death itself put on a cloak A smile of his to win,

And Nature lent a genial glance From out her deep blue skies,

Making him gaze at death's grim trance With kind and fearless eyes.

Death noted how his cheerful voice The saddest case would greet, And memorised a fatal choice—

Death envied his heart beat ! No wonder in a world like this He did not let him stay,

We need it more, that smile of his, Than those he's with to-day.

He'll see those faces live and move That silent were, below—

For there's no morgue in heaven above—

At least we fancy so.

How will he lay his great skill by In that great world of blue, To live where sorrows never sigh—

With nothing kind to do ?

Earth's fevered lips must cry in vain His vacant place to fill.

The su

▪

n's crept from

▪

the morgue ag

•

He left it drear and chill ain

He joked upon the corpses grim, Nor was his heart of stone—

And whlle he lived all laughed with him ;-

Dying, he laughed alone ! A.B.O.

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Round the Wards.

G.M., aet ? Admitted 20/10/97. Brought in unconscious after -a fit (epileptiform ?). T. 99.

On Examination.—Patient semi-conscious ; can be roused by pressure on supra-orbitals. Pupils, equal and re-act to light.

Pulse 8o, regular, fair volume and tension. Heart and lungs clear. 21/10/97.—T. 99-10o. Patient very dull and stupid.

Breathing stertorous. Tongue dry and glazed. Skin moist.

Bowels not open. Passing a large amount of urine. Vomited several times since admission. Loss of power in left arm, and paresis and increased patellar reflex and ankle clonus in left leg.

Urine—pale amber color, 1015, acid, albumen 1/3. 22/10/97.—

Comatose all night and to-day. Stertorous breathing. Pulse, high tension. 23/I0/97.—Comatose. Cheyne-Stokes respiration, and tongue very dry. Pupils contracted and equal. Temperature rose rapidly to 105-109 in two or three hours. Died suddenly.

P.M. Brain.--No cedema. Small haemorrhage in the right side of Pons, rupturing into the 4th ventricle. Blood in both ventricles.

Kidneys.—Subgranular contracted cystic cortex, very narrow.

Heart.—Hypertrophy and dilatation of left ventricle. Flabby dilated right heart.

Lungs engorged. Pupils equal, and very contracted.

W.H., 39. Admitted 5/7/97, 2 p.m. Laborer. Unconscious on admission. T. 103.6. Pulse 120, regular, fair volume, poor tension. Respirations 24. Had been ill eight months with noises in the ears, and deafness in the right ear. Last four days had severe pain, chiefly in the right side of the head. Has been semi-conscious last three days. No history of spasms or con- vulsions, nor vomiting. Bowels constipated during last four days. No trouble with micturition. Heart and lungs clear.

3.3o p.m.—Breathing suddenly became rapid and distressed, though regular. Respirations 52. Patient became very cyanosed. Pulse 184, very feeble. Profuse drenching sweats.

T. 103.6 at 2 p.m.; 105 at 3.3o p.m.; io5.6 at 4.15 p.m.; io6.8 at 4.3o p.m. when patient died.

P.M.

p.m.,

was found to be suppurative basal meningitis accruing from chronic otitis media of the right ear. Heart.—The left auricle was enormously dilated, thin walled, and contained a large ante-mortem laminated clot, breaking down in the centre, and probably of some weeks' standing. Marked mitral stenosis.

The mitral valves and cords were very much thickened, and bound down the mitral orifice, only admitting the tip of the finger. Left ventricle rather hypertrophied and dilated. Other valves healthy.

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Kidneys.—Firm and sub-granular. Brain.--Plugging of left mid-cerebral artery, with extensive softening. An old blood clot of firm consistence in the middle of the softened area.

Intestines distended and their veins dilated. A little blood in the peritonial cavity. Plugging of the inferior and superior mesenteric arteries.

Lungs.—Tough and emphysematous. No distinct brown induration. Liver fairly normal, not nutmeg. No oedema or dropsy anywhere. There was a vague history of rheumatism.

M.L., 6o. Admitted 17/8/97. Patient complained of heart disease ; ailing for years. Very short of breath. Has cough and frothy expectoration. Small hmmoptysis. Orthopncea at night lately. Feet swell at times. Nocturnal micturition with large quantity urine, but noticed it getting less of late.

Examination.—T. 98.4. Pulse 84, regular, fair volume and tension, but tension not sustained. Lungs, clear. No adven- titious sounds. Expiration prolonged.

Heart.—Apex displaced down and out. Impulse increased.

1st. Sound in mitral area clear, and a long drawn soft bruit following immediately on the second sound. 2nd. Pulmonic sound accentuated. In aortic area sounds clear. Liver dulness increased. No swelling of feet. Urine—clear, amber, 1015 acid, no albumen. Patient went on satisfactorily till 30/8/97. At night after an attack of coughing, patient suddenly lost consciousness and was unable to move the right leg or arm.

Mouth was drawn to left side. Pupils, left larger than right.

Marked ankle clonus, and increased tendon reflex on right side.

Pulse, 52 full. Bowels very constipated. Urine-1o22 acid phosphates, no albumen. Patient made gradual improvement, the mental faculties becoming clearer, and the power of the limbs returning. 23/9/97.—Patient became suddenly worse, the abdomen became distended, patient was cyanosed and collapsed.

Died suddenly at 8.10 p.m.

E.C., 17. Patient walked into the Melbourne Hospital complaining of severe abdominal pain. The mother stated that the girl had been suffering from uterine hwmorrhage for the past week, and it was thought that she had had a miscarriage. The patient was in a very collapsed condition, with a T. 96.5, and a pulse 130, and very feeble. There was marked tenderness and dulness over the region of the right iliac fossa, also a sense of fulness over this part. Examination revealed a swelling in the region of the right broad ligament, and the, uterus felt much enlarged. An immediate operation was decided upon, and abdominal section performed. On opening the peritonial cavity a large quantity of blood escaped. The case proved to be a

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ruptured extra-uterine fcetation. The ovary and tube of the right side were removed.

Though the patient was almost pulseless when leaving the operating table, by the aid of saline enemata and hypodermics of strychnine she rallied considerably during the night, and on the following morning was comparatively out of danger. There was some little difficulty in getting the bowels to act, but this was attained by means of I-gr. doses of Hydrarg. Suhchlor, repeated at intervals of an hour. As soon as the bowels acted the patient's condition improved rapidly, and within a month from the date of operation she left the hospital thoroughly well and quite strong again.

M.S., xt 45. Patient complained of severe abdominal pain with vomiting and constipation. The attack came on suddenly. She had had two similar attacks during the past ¹² months.

On admission the patient was in a very collapsed condition.

There was no very marked abdominal distension. A large enema was given without result.

On enquiry the patient stated that she had had colicky pains for the past two days, and that she had not passed either wind or feces by the bowel since first seized with these pains. She was admitted about 7.3o p.m., and Mr. Stirling was telephoned for as soon as it was found that the enema had no effect. After examination, Mr. Stirling decided that the case was one of slow intestinal obstruction, probably as a result of a band. The woman was operated upon at the Women's Hospital some years ago, but though enquiries have been made, the nature of the operation has not been learnt. At 9 p.m. abdominal section was performed. It was very difficult at first to determine where the obstruction was, but after careful examination a band was found extending upward from the fundus of the uterus, and obstructing the smaller bowel just above the region of the ccum. The bowel was rather congested, but healthy enough to obviate the necessity of resecting any part of it. The patient did remarkably well, and left the hospital three weeks after the operation.

A.W., pEt ro. Patient had fallen down a sewer-hole. During descent he struck a bucket, the impulse being on the right side of the head. On admission the boy was semi-conscious, and on examination there was found a small punctured wound over the region of the right parietal bone, also a large hamatoma. Though it was difficult to be absolutely certain of the presence ^{of a} depressed fracture, it was thought that most probably there was one. The pupils were equal and re-acted to light. Pulse 70, regular, not full or bounding. Respirations 26, not stertorous.

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Within three-quarters of an hour of the receipt of the injury an operation was performed. A large flap was turned back, and nearly the whole of right half of skull was found depressed.

The part was thoroughly irrigated, and the depressed bone was raised by means of an elevator, but as it was impossible by this means to raise the whole bone, the trephine was also employed.

The patient progressed favorably, and was discharged in three weeks. The dressings were not changed for six days after the operation. Cyanide gauze was the dressing used.

Correspondence.

To the Editor of The Speculum.

DEAR SIR,—About six years ago a number of graduates of our Medical School, feeling the want of a Society which would occasionally reunite those who had been closely associated during their student days, formed the Melbourne Medical Association. This Association is composed of Melbourne Medical Graduates, or of Medical Students who passed several years of their course in Melbourne, but graduated elsewhere, and its objeas are to foster the spirit of unity among Melbourne Medical Graduates, and to advance the interests of the profession generally. The room of the Association is centrally situated, and is also tenanted by the Victorian Branch of the British Medical Association, whose library we have the privi- lege of using. Monthly meetings are held for social or scientific purposes, and a great deal of useful work has been done.

The Committee has, however, felt for some time past that the aims of the Association would be realised more fully if there were a more cordial feeling between the present students and the members of our Association, and if there were a larger accession to our ranks of recently qualified Melbourne Graduates ; and I have therefore been requested by the Com- mittee to bring the claims of the Association upon Melbourne Graduates under the notice of the present Medical Students, through the medium of your columns.

We should like it to be understood that our Association is in no way antagonistic to either of the other Medical Societies, to one or both of which nearly all of our members belong. Our meetings are somewhat informal, and the subjects of papers and discussions are those of every-day interest to the general practitioner.

It is felt that your journal may do much to bring about the good feeling which should exist between present and past

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Students of our Medical School, and we hope that some means of attaining this end may soon be found.

I am, Yours, &c.,

A. V. M. ANDERSON, M.D., B.S., Hon. Sec. Melbourne Medical Association.

DEAR SIR,—At the last M.S.S. social Mr. Syme made the remark that " Medical Students now-a-days seem to do nothing but work." This, sir, is a most pregnant remark, and well worthy of consideration, for of late years it has become noticeable that the attendance of medical students at the various funOcions connedied with the School has been steadily decreasing.

At the M.S.S. fortnightly meetings there is, I believe, an average attendance of about 4o—this from a membership roll of over 15o. Note the falling off in members at the Hare and Hounds dinners, and the paltry attendance at the Commence- ments and Sports. At one time there were three M.S.S. socials in the year: now, for lack of support, there are two, and I believe that the committee this year seriously considered the advisability of omitting the second.

I would also draw attention to the paucity of students at the Annual Lecture. This used to be the occasion on which medicals, both within and beyond the pale of the M.S.S., rolled up in force in honour of the le6turer, who was striving for their instruaion and amusement. These are only a few of the many ways in which the present generation of students proclaims its want of interest in matters conne6ted with the social life of the School.

While deprecating the lack of esprit-de-corps shown by students at the present time, I do not for a moment infer that the medical student has degenerated in other ways. On the contrary, there can be no doubt that the average student of the present day does more and better all round work than was done by students even a few years ago. But he should not consider that his duty to the Medical School and to himself ends with the perfunctory performance of the duties set out in the calendar.

The medical man is not created ; he is the product of a pro- gressive evolution which has its inception in the medical school.

If he wishes to be what the world calls a success, he must be a composite being : educated not only in matters pertaining directly to his profession, but able also to take his place—in he country often a prominent place—in every day, and especially social life. He must have all his " corners " rounded off, and be able to take an intelligent interest in current topics. If he can sing or perform on any instrument—nay, if he can make a