MARCH, 1892.
No. 27.
Si Speculum Placet, Inspice.
The Speectican
A JOURNAL OF THE
Melbourne Medical Students.
CONTENTS:
EDITORIAL : PAGE
DENTISTRY ... 145
NOTES AND COMMENTS 146
INAUGURAL LECTURE 148
A TRIP UP THE WANGANUI RIVER, N.Z. 159
THE BLOOD 164
WANTED A GALVANIST 165
A. VISIT TO THE LEPERS' CAMP 167
A. CASE FROM THE COUNTRY 169
THREE MEN AND A MOKE 170
THE SYDNEY MATCH ... 173
PATHOLOGY NOTES ... 178
ATHLETICS :
CRICKET ... 180
TENNIS NOTES ... 184
ROWING NOTES ... 184
THE UNIVERSITY OF MELBOURNE:
PASS AND HONOUR LISTS, &C. ••• 185
PASS PAPERS (OCTOBER) ••• 186
HONOUR PAPERS ... ••. 189
SPICULA ••• 192
EDITORIAL NOTICES ... ••• 192
titelbaurne :
PUBLISHED BY MELVILLE, MULLEN & SLADE, COLLINS STREET.
PRINTED BY FORD & SON, DRUMMOND STREET, CARLTON.
WORTH NOTING.
Ant
-acid "TABLOIDS"
are often thus prescribed :—R:
CalciumCarb. Prcecip , 32 gr. ; 1VIagnes. Carb., 2 gr. ; Sodium Chloride, 1 gr., in Tabloids. (B., W. & Co.).
Anti
-Constipation " TABLOIDS "
thus :—R : Aloin, gr. ; Belladonna Ext., * gr. ; Strychnine,Tabloids. (B., W. & Co.).
AT gr. ; Ipecac., -1-- gr. in
Cascara Compound " TABLOIDS "
thus :—R:
Cascara Pry.Ext., 1 gr. ; Euonymin,; Hyoscyamus, *S gr. ; Nux Vomica,
I:1w
gr., in Tabloids. (B., W. & Co.)Cathartic " TABLOIDS"
thus :—R:
Ext. Coloc Co. Pulv., 1 gr.Ext. Jalapa Pulv., 1 gr. ; Hyd. Subchlor., 1 gr. ; Cambogite Pulv., 34 gr., in Tabloids. (B., W. & Co.).
Hydrastia Compound " TABLOIDS "
thus :—R: HydrastiaMur., a gr. ; Ergotin, ,1- gr. ; Cannabin Tannate, s gr., in Tabloids.
(B., W. & Co.).
Iron and Arsenic " TABLOIDS "
thus :—R:
Quinine Bisulph• , 1 gr. ; Iron Hvpophosph., 2 gr. ; Arsenic, Strychnine Sulph.,as
-5..1, gr., in Tabloids. (B., W. & Co.).Laxative Vegetable "TABLOIDS "
thus :—
R: Res. Podoph•;Ext. Hyoscy., Ext. Tarax., as
+
gr. ; Ext. Coloc. Pulv., 1 gr.Jalapfe Pulv., Res Leptand, as gr. ; 01 Meath Pip, in Tabloids.
(B., W. & Co.).
Peptonic " TABLOIDS "
thus :—R:
Pepsin, Pancreatin, Lacto - Phosphate Lime, equal quantities, in Tabloids. (B., W. & Co,).Rhubarb Compound " TABLOIDS "
thus :—R: Rhei. Pule., 1 gr. ; Aloes Soc. Pulv., 1 gr. ; Saponis Pulv., -a gr. ; Myrrhie Pulv., -a gr. ; 01. Month Pip., in Tabloids. (B., W. and Co.).Rhubarb and Soda " TABLOIDS "
thus :—R :--Rhei., :3 gr. ; Soda, 2 gr. ; Zingiber, ?I gr., in Tabloids. (B., W. and Co.).Soda Mint "TABLOIDS"
thus :—R: Soda Bicarb., 4grs.; Ammon.Carb., gr. ; 01. Menth Pip., gr., in Tabloids. (B., W. & Co.)•
Sulphur Compound "TABLOIDS "
thus Sulph.5 gr. ; Potass. Bitart., 1 gr., in Tabloids. (B., W. & Co.).
Tonic Compound "TABLOIDS"
thus :—R: Iron Pyrophos., 2 gr., Quinine, 1 gr.; Strychnine, -. { -6 gr., in Tabloids. (B., W. & Co.)•Trinitrine Compound "TABLOIDS "
thus : Trinitrine' A-o- gr. ; Nitrite of A myl., 4 gr. ; Capsicum, %gr. ; Menthol.in Tabloids. (B., W. & Co. ).
Zymine Compound " TABLOIDS "
thus—
R : Zymine, 2gr. ,
Bismuth Subnit., 3 grs. ; Pulv. Ipecac. Tlb- gr., in Tabloids. ( 13 ' W. & Co.)
BURROUGHS, WELT COME & CO.,
Snow Hil Buildin lgs,LONDON ;
Austrnli,, 456 COLLINS STREET, MELBOURNE.
_
The + Speculum.
A .OURNAL OF THE MELBOURNE MEDICAL STUDENTS.
No. 27. MARCH, 1892. SINGLE COPY, 1/6
Dentistry.
THERE is one department in our hospital which many students con- stantly neglect, and to which very few pay any great amount of atten- tion, although it is one which would well repay careful attendance for a few months. We refer to the department of dentistry.
That a man should obtain his degree and license to practise without ever having pulled a tooth is extremely undesirable, and yet we are certain that with us such cases occur every year. Students may imagine that it is a very simple thing to draw a tooth, and needs no previous training or great amount of knowledge, but they will soon find that it is not nearly so easy as it seems, and that the chanCes of really doing damage, instead of giving relief, are much increased if the requisite skill and science be wanting to the operator.
Dentistry, it is true, is a branch of surgery which is usually left almost entirely to the hands of specialists, but cases not infrequently happen, and are easily conceivable, where the surgeon will be called upon to do the dentist's work. In the country districts, where, very probably, no small proportion of our members will spend a greater or less part of their time, dentists are not nearly so plentiful as in towns, and so part of that work will necessarily fall upon the surgeon, in which case how acceptable would be the results of a little previous experience ? There is no need to expatiate on the mishaps which might happen to a beginner, but a tyro unacquainted with tne art of using the forceps, or ignorant of the amount of pressure to apply, might readily spoil the record of his first few cases by a splintered jaw or a broken tooth whose fangs are still firmly and immovably embedded.
Further, the teeth play such an important part in the digestive system, and by means of dyspepsia and other ailments have such an influence on the general heath, that it is certainly to our advantage to know as much as possible about them, and of the means of rectifying faults which are glaringly apparent—the less troublesome defects of Course are not included in ordinary hospital practice, but are left to the private practice of dentists.
Tuesdays and Fridays are not inconvenient days for students at the hospital, and early birds could easy find a little time while waiting for honorary or resident ; and we feel sure that some time spent regularly thus in the earlier part of the year would entail very little trouble on the student, and would bring in a stock of experience well worth the slight amount of exertion necessary to procure it.
Notes and Comments.
THE Inaugural Lecture of- the Clinical series was delivered . at the Melbourne Hospital on the evening of 3rd March by Dr. J. Robertson, the chairman of the hospital medical staff, before an audience consisting of members of the hospital staff (honorary and resident), of the Committee, and professors of the university, and about half the students who attend the hospital. The lecture itself was very interesting and instructive, and was much appreciated by all who heard it. After the lecture, Mr. Syme presented a case of instruments, his prize for bandaging, to Mr. W. W. Hearne, one of his dressers during the past year. Dr. Williams moved a vote of thanks to Dr. Robertson for his lecture, which was seconded by Mr. Baxter on behalf of the Committee, and carried by great acclamation. Dr. Halford also said a few words, impressing upon students the value of a knowledge of physiology. A vote of thanks was proposed and carried to the chairman, Mr. Marks, and the meeting then terminated. It may he mentioned that Dr.
Robertson deprecated a vote of thanks being tendered to him, on the grounds that " this is the lecture-room," a theory which may perhaps be correct, but one with which we do not agree ; for surely, if it were correct, we ought to receive credit for attendance at the lecture, and a roll should be called ; but such is certainly not the case, attendance at the Inaugural Lecture being voluntary, and rather a matter of courtesy to the lecturer than a part of our clinical course.
On Saturday afternoon the 30th January, our old friend and esteemed honorary secretary for the first two years, Mr. J. K. Freyer, M.A.
' left for London in the s.s.
Gull of Lyons,
to which steamer he had been appointed medical officer. A number of medical students and private friends went down to Port Melbourne by the two p.m. train, and took a sailing boat out to the steamer, which was lying a mile and a half from the pier, so as to see the last of their old pal and pleasant com- panion. After a parting glass or two had been partaken of, and heart- felt wishes forbon voyage,
&c., expressed by all, at four p.m. the ship's roll was called, and then the shore bell rung, and as the visitors left, three ringing cheers and a tiger were given for J. K., which were at once responded to by those on board the steamer, and before the Port Melbourne pier was again reached the steamer was well under way for London, where the captain hoped to arrive in forty-five days' time.Dr. Robertson's lecture suggests some reflections which are not of the pleasantest nature. Quoting from the English Medical Acts, he says—" All medical students commencing their professional studies after 1st January, 1892, are required to pass through a curriculum of study of at least five years' duration, the fifth year being entirely devoted to clinical work," and he goes on to say that he apprehends some change in our course will be necessary. If that is true, the sooner it comes the better, as, otherwise, those medical students who are so unfortunate as to begin their course this year will be unable, spite of the recognition of colonial degrees, which Professor Allen was instrumental in procuring, to secure registration in the United
Kingdom, and will be in as unsatisfactory a state as colonial men were Previous to 1890, if not in a still worse condition.
Dr. Allen, our professor of pathology, means to make a determined effort to improve his course now that he has a demonstrator (Dr. Cherry) to assist him. He means to start classes in practical bacteriology, and in the practical preparation of pathological specimens for the microscope.
The latter class will be somewhat on the lines of the second year histology classes, and will occupy four hours a week during the second term, probably on Tuesday and Thursday afternoons. The practical bacteriology is to occupy four hours a week, but students will only have a course of four weeks, either in the first or third term, since, owing to
the scantiness
of space, the pathology class will have to be divided into smaller groups (probably of six students each). Attendance at these classes is to beoptioned
this year, but compulsory afterwards. The only question which arises is " Where do dissections and operations come in?"At last a distinct and definite arrangement has been made with respect to students doing lunacy at the Yarra Bend Asylum. The chief medical officer has determined that none but fifth year men shall
be
taken round the wards, and from other sources we hear that only four of those will be taken round at a time. We have every reason to believe that such students, who choose to avail themselves of this offer and who will attend regularly, will have no more difficulty about getting their certificates signed. We confess we cannot exactly see why the privilege should be limited to fifth year men only, when the university allows lunacy to be done in either the fourth or fifth year. It is said that Kew is still open to us if we choose to go there regularly.This year is marked by a change in the distribution of the medical clerks at the Melbourne Hospital. Instead of the fifth year men (and women) being placed under Drs. Williams and Moloney, and the third
Year
men under Drs. Springthorpe and McInerney, the fifth year menare
about equally distributed between Drs. Williams and Moloney, and ,urs. Springthorpe and McInerney, and are the only ones who have beds allotted to them, while the third year is distributed in two sets, la a like manner, but without beds. This change will be a great relief to the fifth year, which has of late years been growing rather large, and if the senior men will only give some attention to the junior men who
°last go round with them, the latter will find at the end of the year
that
they will have no cause to grumble. Another change which is to be commended is the appointment of an assistant pathologist in the person Of Dr. Mollison. The presence of a nurse in the surgical out-patient department is also a great improvement, and has long been needed, and ifone
could also be assigned to the medical out-patient department, even for only a few hours each morning, it would be an innovation Which would be much relished by all.Messrs. Burroughs, Wellcome & Co. send us the following, which will, no doubt, be of general interest :—"It is of interest to your readers to know that tubes,
have a case specially devised for use in cases of snake-bite, containing two Pbes, strychnine is and
A
gr., a syringe and two needles. Many of the pro- fession are asked about such cases. No danger or alarm is caused to patients, as each tabloid is a dose and no more."B2
148 THE SPECULUM. March, 1892.
Inaugural Lecture.
BY JAMES ROBERTSON, M.A., M.D.
IN accepting office as chairman of the medical staff of the Melbourn e Hospital, to which I had the honour of being appointed last year, it became my duty, in accordance with the standing orders adopted
by
that body, to deliver an address introductory to the clinical course in this hospital. I have great pleasure in doing so, and highly appreciate the opportunity of addressing such a large assemblage of medical students.
Before proceeding to notice that very interesting and importan t branch of study, which now claims your attention at this hospital, I desire to set befell e you the changes recently effected in the curricular' ) of professional education in the United Kingdom. The General Council of Medical Education and Registration of the United Kingdom has issued new regulations, which came into force at the beginning of this year. All medical students .commencing their professional studies after 1st January, 1892, are required to pass through a curriculum of study of at least five years' duration, the fifth being entirely devoted to clinical work. In our own university, the period of study for a degree in Medicine or Surgery has always extended to five years, but I apprehend some alterations will now be necessary , so as to conform to the resolutions of the General Medical Council, in regard to practical work.
It is required by the Medical Council that :
The regulations of the examining bodies, and of the schools, should be 0 framed, that attendance on systematic courses may be concluded at the end of the fourth year of study, so as to permit of the student devoting the fifth year
to clinical work.
The fifth year should be devoted to clinical work at one or more of 500 1 public hospitals or dispensaries, British or foreign, as may be recognised b3/ any of the medical authorities mentioned in Schedule A of the Medical Act, 1858, provided that of this year six months may be passed as a pupil to a registered practitioner holding a public appointment, or possessing such oppor- tunities of imparting practical knowledge as shall be satisfactory to the Medical authorities.
The regulations requiring attendance on systematic courses of lectures ought not to require attendance on more than three lectures weekly in any one course .
It is provided that the first year may be passed at a university or teaching institution, recognised by any of the licencing bodies, where the Subjects of Physics, Chemistry, and Biology are taught. Graduates in arts or science of any university recognised by the Medical Council, who shall have spent a year in the study of Physics, Chemistry, and Biology, and have passed an exams' nation in these subjects for the degrees in question, should be held to have completed the first of the five years of medical study.
Due time should be set aside for practical work in the various subjects . Attendance on a practical course should be carefully ascertained and certified' By a practical course is understood one in which work is done by the studen t himself, under the direction of a duly qualified teacher. In order to promote a practical system of clinical teaching, the regulation s should specify, " Hospital Practice with Clinical Instruction." Ample time should be set aside for hospital work, and means should be taken to ascertain regularity of attendance in the wards and outpatient department s.
Every candidate for the final professional examination at the end of the fifth VI
Year, should be required to give evidence that he has had sufficent oppor- tunities of practical study.
This resolution relates to such offices as the following: Clinical Medical Clerkship, and Surgical Dressership (either for in or out patients), Obstetrical Clerkship, post-mortem Clerkship.
No qualification in Medicine ought to be granted without evidence of clinical instruction in infectious diseases.
With the view of securing attention to practical work in Education, the time devoted to the practical part of the examinations in all the subjects should be extended.
All examinations, except the final examinations in Medicine, Surgery, and Midwifery, should be passsed before the final year intended for clinical work.
The marks for the written and oral examinations in Medicine and Surgery at the final examination should not exceed those for the clinical and practical Portions of the examination.
These extracts contain the conditions obligatory on universities and schools of medicine, and on medical students commencing their studies, and serve to show the great importance now attached to practical work.
They are evidence of a recoil from the system so long pursued, that of cramming the memory with minute theoretical knowledge to the neglect of practical work.
Many years ago, before I commenced my medical studies, apprentice, ship to duly qualified physicians and surgeons for a period of five years, constituted the initial step to the medical profession, and theoretical lectures on certain subjects completed the curriculum of study, the examinations at that time not being very severe or strict. Afterwards, apprenticeship became obsolete, and attendance on lectures at a recog- nised school more imperative. The stringency of the examinations was increased, and more minute knowledge of the subjects entering into the theoretical course was demanded. Latterly, the subjects of study were so extended and so increased in number, that they became a tax on the memory, and claimed the whole time and attention of students. The result was that students left the schools, loaded with theoretical know- ledge soon to be forgotten, but knowing very little of the practical part of their profession, having in fact to pick up that most essential part, the art of practice, in the daily routine of active duty. The necessity of a change in the method of tuition has now been acknowledged by the highest authorities ; a reaction has taken place, and practical instruction in Medicine has been advanced to the position it ought to occupy. It is not to be regarded as of inferior importance to theoretical lectures, it merits an equal recognition, indeed it ought to occupy the position of Primary consideration, as beinu
°
the most approved and only means of acquiring a real and lasting knowledge of medicine. The practical work in the wards is complementary to the theoretical details of the class-room, it is the application of the knowledge you have already gained, so as to qualify you for the active and responsible duties of the profession.
A rather anomalous state of affairs prevails in the course of study Prescribed for students in our university, to which my attention was recently drawn by a discussion at a meeting of the medical staff of the hospital. In the British medical schools, students are permitted a certain latitude of choice ; the subjects to be attended in the respective
THE SPECULUM. March, 1892.
years are not as a rule so definitely arranged as in our
University Calendar.
It is however understood that such a sequence shall be followed in their medical studies, as will tend to advance them step by step, the earlier branches of their education necessary to a proper understanding of the more advanced, being first mastered. The inverse course is adopted here in regard to clinical medicine. Although a student may profit by attending the surgical practice of the hospital, after having gained a knowledge of the bones, joints and muscles, he cannot possibly derive much benfit by attendance on the medical practice, before he has studied not only the anatomy of the whole body but also Physiology and knows something of Pathology. But it i5 certainly " putting the cart before the horse," to require a student to attend the medical practice in the third year, while lectures on the theory of medicine are not commenced till the fourth year of the course.This change has been made since I had the honor to be associated with the hospital and medical school, as physician and lecturer in medicine.
I cannot but regard it as subversive of natural or rational order, adverse or inimical to the progress of students, and requiring the immediate attention of the Faculty of Medicine.
Another anomalous condition, which very intimately affects the interests of students, is the relationship existing between the university and hospital, or rather, I should say, the want of any relationship
or
connecting link between them. In British universities and medical schools, the respective professors and lecturers in Surgery and Medicine are also clinical teachers. Having access to the wards of the hospitals attached to their respective schools, they are enabled to illustrate the subjects of lectures by referring to cases in the wards, a great advantage to clinical students. Here, the Council of the University appoints the systematic lecturers in Surgery and Medicine, the most competent being chosen from the applicants invited by advertisement, and selected by the Medical Faculty. But, although they are selected and appointed university lecturers, on account of their special knowledge and ability, they may fail to be favourably regarded by the subscribers to the hospital and to be appointed on the hospital staff. It is desirable
that
some definite arrangement should be made, constituting the. lecturers in Surgery and Medicine in the university
ex officio
members of the hospital staff.The value of clinical instruction, and the unsatisfactory manner in which it is given in our hospitals, formed subjects of comment
by
Dr. Shields, president of the Victorian Branch of the British Medical Association, in a recent address to that body, and certainly his remarks are fully justified by the existing state of matters. The most important part of the students' training, practical instruction, to which increased attention is now called by the General Council of Medical Education of the United Kingdom, is entrusted in a haphazard way to those who may be appointed medical officers at the Melbourne and Alfred hospitals. It is assumed that all are alike qualified and competent to teach, the tyro just commencing practice, and the veteran of ripe experience. I have always maintained that clinical lecturers should be selected with as much care as other professors and lecturers
in the university, and should be equally well remunerated, so that they may devote the necessary time and attention to their duties.
At present, all surgeons and physicians elected by the popular vote to the Melbourne Hospital, are accepted as competent clinical lecturers, become in fact ex officio lecturers to the university. Now, it cannot be asserted that all the best qualified candidates for election as surgeons and physicians to the Melbourne Hospital were elected by the popular vote as now cast, or that all elected are alike competent to give practical instruction. A man may have a very good theoretical knowledge of medicine, but if he has not had time and opportunity to gain practical knowledge and experience, he cannot satisfactorily teach clinical Medicine. Indeed, it is an acknowledged fact, that many years of practice and diligent study are required as a preparation for efficient practical tuition. There are attached to the hospital both physicians and surgeons well qualified to undertake the duties of clinical lecturers, While others are fitted for tutorial work, and may by special study and training become in time expert clinical teachers. But, granting that all engaged in giving clinical instruction in the wards of the Melbourne Hospital, as now arranged, are alike competent, it is not possible that any connected, methodical, and well-arranged course of clinical lectures Can be given. The patients occupying the beds necessarily afford the subject-matter for examination and remark, so that, at certain seasons, all the teachers on the medical staff may and probably would be lecturing on the same diseases. From my experience in the medical wards, typhoid is the most prevalent disease in the summer and autumn months, all would naturally be directing the attention of students to that disease, and again in winter, to diseases of the respiratory organs Common to that season. Students would certainly have an opportunity of hearing diverse methods of treatment of a few diseases, but it is desirable that clinical lectures should embrace as wide a field as possible. • The main objects of clinical teaching are, however, to point out the Means and different methods of examining patients to direct students how to educate their senses, more particularly, their powers of observa- tion, in order to detect the symptoms and signs of disease, and to lead them to use their reasoning faculties, so as to be able to form a diag-
n
osis or judgment as to the nature of a disease. The best clinical instruction has been quaintly described by some writer, whose name I Cannot now recollect, as " thinking aloud," so that students may follow the mental processes of the surgeon or physician in arriving at the diagnosis of a case, and in suggesting the treatment.It is presumed that, in entering on the practical study of Surgery and Medicine at the hospital, you have already gained a knowledge of Anatomy and Physiology, and know the principia of Pathology, that You have studied the body and its functions in a state of health, so as to be able to detect any departure from the normal healthy condition, that you have attended lectures on Surgery, and on the theory and Practice of Medicine, and are thus enabled to profit by practical tuition.
Lectures
and books are useful aids to study, in enabling you to read and understand the book of nature as it is unfolded in the hospital wards.152
You may acquire a theoretical knowledge of Surgery and Medicine by listening to lectures and reading class-books, but that real, true, practical learning, which will fit you for the discharge of the onerous duties of your profession, can only be acquired at the bedside, by the exercise and training of your own senses and reasoning faculties. In studying cases at the bedside, your teachers may direct your attention to the symptoms and physical signs manifested, but in order to profit by their teaching, you, yourselves, require to exercise your powers of observation and examination. The eye must be educated, so as to observe accurately the objective phenomena of disease, and the minute changes that constitute the physiognomy of disease. The ear and touch must also be trained, the ear to appreciate and distinguish minute variations of sound, the fingers to acquire that
tachts erudilus,
so essential to the accomplished surgeon. In examining patients, first use your eyes : not infrequently the nature of the disease may be revealed by simple inspection, as in surgical cases, by deformity resulting from fractures and dislocations. In medical cases, the physiognomy of disease is evidenced by the expression of the face, complexion, colour of the lips and skin, general appearance or condition, as to wasting, posture, gait, tremor or twitching of muscles, &c. Inspection of the chest may discover want of symmetry of the thorax, impaired mobility, flattening, prominency or bulging, increased cardiac impulse, quickened or laboured respiration, abdominal breathing, &c. Of course there are certain variations in form and figure of the bodily frame within the limits of health, such as rounded shoulders, pigeon-breast, flat chest, want of symmetry of both sides to a certain extent, and other abnormalities not inconsistent with health.The information gained by simple inspection, is of incalculable value in the case of children, who annot answer questions, and also in the case of adults unable to express their feelings, perhaps unconscious. It also aids you by indicating the direction in which inquiries and subsequent examination may be made. It is of the utmost importance in studying the characteristics indicative of the different temperaments and diatheses of patients, and in recognising the various morbid consti - tutional states, such as the strumous, the rheumatic, the gouty, the syphilitic cachexire.
Having noted the information derived from inspection, you may then have recourse to other methods of examination, such as palpation, percussion, auscultation, mensuration, &c., according to indications. It is often necessary to supplement the knowledge derived from the unaided senses by the employment of instruments of precision, such as the thermometer, laryngoscope, ophthalmoscope, and various specula, spirometer, sphygmograph, urinometer, various tests and re-agents, and last, but not least useful, the microscope. Students are therefore required to use their eyes, ears, and hands, and such aids to the senses as are required, and are available in the circumstances of particular cases.
It is desirable that you should first practice percussion and ausculta - tion on healthy subjects, men, women, and children, so that the ear may be educated to detect variations in sound. You will thus become III
acquainted with the percussion note, its intensity and pitch in different regions of the chest, the healthy vesicular murmur during inspiration and expiration, the voice sounds at different points of the chest, the area of cardiac dulness, the rhythm of the heart's action, and normal valvular sounds in the different sexes and at different ages.
In examining patients, it is therefore imperative to cultivate the habit of minute observation and careful examination, to note accurately th e symptoms and physical signs of disease. It is only when you undertake the duties of clinical clerks, and commence to write out the history of a case, that difficulties present themselves. If the investiga- tion be conducted in some definite order or plan, the way will be
-smoothed or rendered easy.
What to observe, and how to observe 7 Where to commence is the student's first dilemma ? Different methods of clinical inquiry have
b
een recommended, but the simpler and more natural the order adopted in recording the observations made at the bedside, so that nothing of importance may be omitted, the result will be the more satisfactory.You may commence your history of a case by recording :
1. Personal appearance, or general condition of patient. [Age, sex, tempera- ment, physical development, occupation, or condition in life, country of birth, &c.]
2. History of commencement and progress of illness.
(a) The mode and time of attack, symptoms first experienced.
(b) Any symptoms that may have disappeared.
3. Symptoms under which patient at present labours —
(a) Objective symptoms present, expression of countenance, con- dition of body, state of nutrition, colour and state of skin, &c.
(b) Subjective symptoms, or those complained of by patient.
(c) Physical signs of part affected, if any.
(d) State of the different functions, as pulse, temperature, respiration, digestion, secretions, excretions, if necessary.
Intellect, sensation, motion.
4. Causes of the disease—
(a) Conjectures of patient, causes, real or supposed.
(b) Previous state of health, habits of life, family history, &c.
5. Record of medicine prescribed and general regimen.
Again, a definite arrangement may be followed in the daily reports of medical cases :
(a) The obvious effects of medicines prescribed.
(b) Condition of the symptoms and physical signs.
(c) New symptoms, if any.
(d) State of the principal functions.
(e) Prescription of medicines, diet, and regimen.
The above arrangement may be followed, or any regular systematic order calculated to unravel the phenomena of disease, and facilitate the labour of the student.
You must not expect to find the synitoms and signs of disease so minutely and clearly described in lectures, and in text books, equally Well marked or expressed in patients, even in so called typical cases.
If the case under examination is a typical one, and the nature of the disease is so far disclosed that the student knows what he has to
I
01
THE SPECULUM. March, 1892.
investigate, then the symtoms and signs are more easily interpretatecl, and referred to their causes. Time and patience are necessary in investigating cases at first ; afterwards, the experience gained from previous examinations, if carefully conducted, will aid in smoothing the way, and assist the ,judgment in forming a diagnosis. Sometimes ' difficulties are surmounted by interrogating patients, so as to gain some indication of the nature of the disease from the subjective symptoms. You are not, however, always aided by answers of patients to questions proposed. Not infrequently, a case is rendered even more complex or obscure by the answers, and the relations between the subjective symptoms and physical signs even more mystified. Be assured, that, if you have acquired a good theoretical knowledge Of disease, and have devoted due attention to cases at the bedside, all difficulties will speedily vanish, and the diagnosis of even obscure and complicated cases will become so easy, as to appear almost intuitive.
Only the salient points or leading features of a case will arrest attention, and serve the purpose of enabling the judgment to form a diagnosis • with increased celerity, ease and accuracy. Your observation of facts must be careful and accurate, and not less care must be taken in accurately recording them, if satisfactory work is done, such as will prove of permanent value in the future. In interpreting the symptoms and signs of disease, and connecting them with the pathological changes taking place in the sy.tem, you are called on to exercise your reasoning faculties and your judgment. The facts or phenomena constituting the symptoms and signs of disease are to be collated, compared, reasoned on, submitted to judgment, and referred to their causes, in order to form an opinion or diagnosis. You must not jump at conclusions, or form a preconceived opinion in regard to the nature of a disease, and then search for data or facts to support it, ignoring the Baconian method of induction. One is peculiarly liable to be influenced by a preconceived opinion or theory, and in that case naturally seeks for evidence in support of it. This is esrecially true in regard to therapeutics. The hunt after specifics is now-a-days very keen, and when the mind is'
intent on discovery, the search for facts in evidence or proof of a theory seldom fails. If facts do not support the preconceived opinion, so much the worse for the facts.
Such fallacies or sources of error are included under Bacon's
Idola Specus.
Facts, seemingly favourable, are accepted, while those adverse . are minimised, little valued, or altogether ignored. But I am digressing in anticipating remarks more applicable to the subject of treatment.In writing out the histories of cases, state facts, relate what you see or hear, or feel, and not the inferences you yourselves are disposed to draw from them. For instance, describe the character of the sounds heard over the chest on percussion or auscultation and their position, instead of writing—consolidation, softening, cavities ; the sounds audible over'
the region of the heart, situation, intensity, rhythm, &e., instead of valvular disease, hypertrophy, dilatation. Students are liable to state their diagnosis of the disease and not the facts or physical signs, which should be stated, to enable others to form a diagnosis. It has been well observed by Cullen, author of
_First Lines of the Practice of Physic,
andMarch, 1892.
Synopsis Nosologica Methodica,
so long in repute, "there are more false facts than false theories in Medicine." Though uttered upwards of a century ago, this apothegm holds good at the present day, if applied to statements not infrequently met with in medical literature, especially in reports of cases in the medical journals. The expression, "false fact," is a contradiction of terms, a perversion of language, inasmuch as a fact is a thing done, a reality, an actual existence or object of know- ledge, and consequently true. Medical facts are however often mere assertions, statements of things believed, and accepted as facts by the narrator, yet not fully verified. See that your facts are not fallacies, but veritable scientific data, so that any theory founded on them, the superstructure may not fall to the ground. Observe accurately, and record with precision in case-taking, so that the reader may have a true and well defined sketch presented to his mind, such a report as will enable him to clearly comprehend the particulars of a case, to interpret the data, to weigh the evidence, and draw his own conclusions.The remarks I am now about to offer on the diagnosis and treatment of disease, are intended for the more advanced students, for those of you about to quit the university, and engage in the active duties of the Profession. Cast on your own resources, and called to the bedside of a Patient, you are required to diagnose the disease. To enable you to do that, an intimate knowledge of the distinguishing characteristics of the various diseases liable to be confounded, is essential. In the early stages of acute febrile disorders, diagnosis may prove a difficult task ; time may be required to watch the further development of a case, before any positive opinion can be expressed. The febrile disturbance may be clue to some specific fever, or may prove symptomatic of inflammation in some organ or part of the body. Not infrequently, young doctors find themselves placed in a difficult position. They are expected not only to give a name to the disease, but also to state the course, duration, and mode of termination of it, to in fact form a prognosis as well as a diagnosis. Anxious friends may be urgent in pressing their questions, and young practitioners unwilling to seem ignorant or even in doubt, and thus to create a bad impression, are led to venture an opinion, which they may find it necessary to alter or retract at next visit. If in doubt as to the nature of the fever, it is far better to delay expressing any positive opinion until the symptoms have become more fully developed.
I have heard of cases of fever being reported to the Board of Health rather prematurely as typhoid, the supposed victims becoming conval- escent after the lapse of a few days, and even of a case of chronic disease with so-called typhoid or asthenic symptoms being so reported. Cases of fever are not always typical at the onset, the symptoms may be obscure, or not well marked, so that it is wise to defer forming a diagnosis until further developments have supplied the necessary premises.
Having decided on the diagnosis of a disease, and as far as possible ascertained its cause, you are then in a position to adopt a plan of treatment. Of course, I do not infer that you are to do nothing in the Way of treatment until you have completed your diagnosis. You must be guided by indications in individual cases, and prescribe so as to
11
dll
f.
THE SPECULUM. March, 1892.
relieve pain, fever, or other prominent symptom. You may give directions as to diet and general regimen, taking care that the patient is placed under conditions favourable to recovery, as far as accommoda - tion, ventilation, nursing, &c., are concerned. To enable you to conduct the treatment satisfactorily, you must study the natural history of the disease, the pathological changes and complications liable to supervene in its course and the usual modes of its termination. You are then in in a position to lay down a definite course of treatment, which should be steadily carried out. Do not be disconcerted by the patient's dislike of the medicine, or discontent at being restricted to certain articles of diet, or at being confined to the recumbent position. A simple
explanation of the necessity of the measures enjoined, will in most cases secure a ready compliance. Carry out the treatment deliberately adopted, do not make frequent changes in the medicine prescribed ; at all events allow sufficient time to elapse to test its efficacy before making a change, unless any decided alteration in the state of the patient necessitates it.
A frequent change of medicine is liable to complicate the symptoms, and excite distrust in the patient.
Nihil ita sanitatem impeclit at remediorum crebra mutatio
(Seneca) is a trite and true maxim of ancient date. Avoid over-medication ; there are many cases where active treat- ment is not required, and in which it might even prove detrimental.Remember that many diseases run a certain natural course and terminate favourably if patients are placed under conditions conducive to recovery. The highest aim of the physician is to assist nature, to be
" minister et interpres naturae,"
to follow nature. The treatment should not be too active or perturbative, but judiciously adapted to fulfil the indications in each individual case. Medical men sometimes claim too much credit in the successful issue of cases, and the younger and more inexperienced are most liable to err in that direction. They ascribe recovery to some special medicine employed, ignoring the concomitant measures adopted, and forgetting that many diseases, such as the specific fevers, and other acute diseases tend to run a certain definite course, and as a rule terminate favourably.To Homoeopathy, as practised according to the tenets of its founder, the medical profession owes a deep obligation. The medication employed was powerless for good or evil, it did not affect or in any way influence the natural course of the morbid process. The disease
was
allowed to run its natural course to its termination, under favourable con- ditions, the diet being regulated, and general hygienic measures enjoined.
The useful lesson inculcated by this practice was not without its effect on the system of medication at one time in vogue' The apothe - caries who were the general practitioners in England, w re prone to a system of over-medication, inasmuch as their fees were de 'ved from the medicines prescribed and compounded, rather than from the visits made.
Not only the medical profession, but humanity at large was benefited by the teachings of a system, the practice of which has now fallen into disuse, but not into oblivion, for yet the name remains.
As au illustration of hyper or hazardous medication, and consequent speedy reaction, it is instructive to be able to refer to a very recent
instance. " The old method," as it is now termed, of administering tuberculin has been already superseded by a new method. The want of success following the use of tuberculin as at first recommended by its discoverer, and the demonstrations of the post-mortem room, have led many to discontinue it altogether, and others to subject it to trial in greatly diminished doses. No longer is it considered necessary to cause severe reaction by using gradually increasing doses. High temperatures are not now regarded as indications of the success of the treatment. . Better results are found to follow the administration of small doses, and the avoidance of strong reactions. Such is the new mode of treatment;, it is found advantageous to administer tenths of a milligramme, and to increase the dose very cautiously and tentatively. The remedy is.
evidently a very potent blood and tissue poison, and is likely to ;Ave better results if used in infinitesimal doses.
Students of the present day possess many advantages to which students of thirty or forty years ago were entire strangers. It has been said, "there is no royal road to learning," but now-a-days the road is made easy by text-books being well illustrated, by beautiful anatomical preparations, frozen sections, and exquisite models being used in teaching Anatomy, by Physiology being expounded as far as possible by practical experiments, by the great advances made in Histology, and by Pathological demonstrations in the museum and post-mortem room.
The Pathological museum will furnish you with the means of studying preparations of morbid structures, but the most valuable knowledge of the changes effected by disease, is to be sought for in the hospital mortuary. Having studied the phenomena of disease in the living subject, having formed a diagnosis, and watched the treatment, it is interesting and most instructive, when opportunity offers, to be able to verify your diagnosis, to refer symptoms to their causes and to see the morbid changes brought about by disease. Seize every opportunity of attending post-morten examinations, for they are full of interest and information. Often in an individual corpus you will find a complete museum of morbid anatomy, and the question will recur, not as to the cause of death, but, how was life so long maintained under conditions of such extensive organic disease ?
Objects presented to the eyes make a more vivid and lasting impression on the mind than sounds (lectures) entering by the ears. This fact is very elegantly expressed by the Latin poet :
Segnius irritant animos demissa per aurem, Quam quae sunt oculis subjecta fidelibus, et quae 1pse sibi tradit Spectator.—(Horace)
With the advantages you possess, and with industry and application, the difficulties attending your studies will be easily surmounted. Just as the vigour of the body is increased by exercise, in like manner, the capacity of the mind is expanded, and its faculties enlarged and strengthened by study. The task becomes easier, confidence and self- reliance are inspired by a regular and systematic course of study, and a feeling of satisfaction is experienced in the acquisition of knowledge.
In the discharge of your duties at the hospital I would bespeak your sympathy on behalf of the suffering patients. Bear in mind that the
THE SPECULUM. March, 1892.
primary or chief object of a hospital is undoubtedly the treatment of the sick poor. • The practical education of medical students is scarcely less important, as it tends to develop and maintain the highest professional skill in the treatment of the sick. The two objects are however not incompatible, indeed they are mutually advantageous and auxiliary. The attendance of students at hospital secures for the patients a more careful and methodical examination of their cases, and the employment of the best means for their treatment. I would only observe that in examining patients, it is due to them, that students should keep in remembrance their weakness and suffering, exercise gentleness and kindness, and avoid any thing likely to irritate or excite their sensibilities or depress their spirits. In some cases, more especially in pulmonary and cardiac diseases, the exposure necessary for the examination of the chest might prove hurtful in the cold season of the year, unless care is taken that the exposure be so slight as not to seriously disturb the patient or occasion any risk.
I have only a few words to add by way of advice to students.—
Y our duty to yourselves, to your parents, and to the general community is to apply your minds to your studies with all diligence, earnestness and zeal, so that you may become fitted for an intelligent and conscientious discharge of the onerous and responsible duties of your profession. You have adopted an honourable and learned profession, the pursuit of which is sufficient to engage the highest powers of the mind. The preliminary subjects of study embrace the whole domain of the physical sciences, and are not complete without mental and moral philosophy. And now a new world revealed by bacteriology, remains to be conquered. Remember, therefore, that your studies do not terminate when you have passsed your final examinations for a degree, but continue throughout life. If you determine to succeed, your spare time must be devoted to study. You must keep yourselves au courant with the ever increasing literature of the profession. The practice of the profession will prove a source of ennobling pleasure to those actuated by high resolves, by a desire to benefit suffering humanity, and advance the knowledge of Medicine. Do not forget the grave responsibility that rests upon you ; not only is the well-being of your fellow-creatures confided to your care, but even their lives.
To those entering the profession, and practising it as a trade with a view to gain the means of living, to those fond of ease and pleasure, or bent on making money, I would say, choose some other walk in life.
On one occasion, I heard a member of our profession express himself to the effect, that he disliked practice so much, that, if he could live by any other means he would cut the profession. Truly, the practice of it, in his case must have been utter drudgery—a bitter pill. If you entertain a true estimate of the dignity of the profession, you will be jealous of its honour, and strive to conserve its fair fame and repute.
Place before you a high ideal of your profession ; and endeavour to maintain it in your intercourse with your colleagues, compeers, your patients, and the general public. Be courteous and inoffensive to your professional brethren, and avoid disparaging remarks in regard to their knowledge and qualifications. Trust to your own ability and special
knowledge to gain a status in the profession; do not condescend to any thing improper or mean ; do not have recourse to advertising your superior talents and credentials, the discovery of some new remedy, the recovery of some patient from some usual or very unusual accident or disease in the daily press. Such practices are only resorted to with a view to gain notoriety. Medical journals are available for medical subjects and afford a legitimate channel for all medical reports. The life of a medical man in active practice is one of constant labour, he is expected to be at the call of all who may send for him, to be ready to attend at a moment's notice, whether the case be one of urgency or Otherwise. There in no limitation to his hours of labour : he is summoned at all hours, day and night, in all seasons, and in all weathers. He does not rest on a bed of roses if expectant of the midnight summons. The only consolation he has, is, that the more actively he works, the more speedily will he gain a sufficiency to enable to relinquish some of his practice, or make it more select. Do your duty to the best of your ability ; deserve success, and you will not go unrewarded. You will reap the gratitude of your patients and of their friends, a feeling of inward satisfaction arising from a conscientious discharge of duty, and from being able to relieve suffering humanity, and in time, a competency of the good things of this life.
A Trip up the Wanganui River, N.Z.
BY PONEKE.
EARLY in 1889, the writer and a party of four gentlemen took a canoe journey up the far-famed Wanganui river, going over ninety miles from
•the town of Wanganui, and reaching the confines of the King country, and thinking it might be of interest to those of our students, who, during the long vac., take a delight in seeing other lands, I append a 'Very meagre description of the journey.
On leaving the empire city (Wellington) in the 6.50 a.m. train, it rained very hard, but not sufficient to damp the ardour of the party Who had made up their minds to spend about ten days on the river, and We were in hopes that it would clear off long before Wanganui was reached, and pleasing to record, our wishes were gratified. Duly arriving at Wanganui in the afternoon, and having put up for the Right at Laird's Commercial Hotel, so as to be near the river, we made Preparations for a departure early the next morning. A week before all arrangements had been made, provisions forwarded from Wellington, and the canoe, with a guide and men, engaged. These latter consisted of Captain itIarshall, late of the river steamer Tuhua, which had broken down, and three natives, at whose tender mercies we were to be for the next eight days or so.
Having spent the remaining hour or two of the afternoon in seeing everything safely aboard our craft, we arranged that it should leave at four o'clock next morning, and proceed with the crew to Parakino, twenty-five miles up the river, while we could drive to Kennedy's, seven
miles, and walk four more over a very steep hill. On the way out our urban eyes were delighted with the sight of rows of luscious looking blackberries growing by the roadside, and it is needless to say We stopped and buckled-to with a will. The day was terribly hot, and glasses of soda and milk, dm, were freely partaken of at Kennedy's Hotel.
Safely negotiating the up-hill walk, the sight which met our gaze at the top was grand, as emerging suddenly from the bush through a small cutting at the top we beheld a magnificent stretch of country, and a glorious panorama. Away as far as eye could reach were to be seen homesteads , plains and plantations backed up by such forest-clad mountains, as only New Zealand can show, while below it all ran the river, like a huge serpent, winding and twisting its tortuous course in all directions, on the bosom of which we had chosen to spend, at least eight days of our existence. We joined cur car.oe at the appointed spot, and here We had our first camp experience of this journey. Captain Marshall having boiled the " billy," tea was ready, and was partaken of with a relish seldom experienced by townspeople. This done, we embarked to properly begin our journey, and also become better acquainted with the members of our crew.
First, there was Captain Marshall (Matara), our attentive skipper, a half-caste, and small giant of six feet three inches, built proportionately , as strong as a lion, and full of information about the river and its people. He told us he was one of a family of ten, six boys and four girls, each one of whom was over six feet in height. He seemed very popular amongst the natives, and all the way up was treated with the highest respect. He had married a full-blooded native, and resided about fifty miles up the river. It is impossible to say whether there was a chief officer amongst our crew, but if " cheek " and a capacity for talk constitute any title, the palm should most unquestionably be awarded to Katera, who, besides being a first rate hand in a canoe, was"
certainly a great masher among the Maori ladies, for very often while endeavouring to push our way along, some pretty little female voice, from the bush on the bank would salute him with " Tena koe Katera, and he would remark to us " Kapai to wahine," and at every landing he was the centre of attraction to the dusky belles. He recounted with a feeling of horror, how that, during the Maori war, he was for fourteen days without tasting food. With the exception of one or two lazy fits, he, however, did his work well.
Next was an interesting specimen of Maoridom named Panneta.
This individual has seen active service on behalf of the New Zealand Government, and claims the honour of having killed his own brother.
Just after, and emboldened by, the Poverty Bay massacre on the East coast, the Hau Haus made an attempt to come down the river and surprise and massacre the whole of the Pakehas in Wanganui, but the friendly natives met them at the island of Moutoa in the river, and gave them battle and defeated them, and thus saved the township of Wanganui. Panneta stated that his brother joined the rebels, and on meeting him in battle, at the island of Moutoa, fraternal affection was so strong that he instantly despatched him, lest (as he said) he should be killed by anybody else, which would have been a disgrace—so ranch
March, 1892. THE SPECULUM.
for the native idea of brotherly love. This man had been in several engagements and told us enough to engender in our manly breasts a feeling of respect for the old fellow. The last, but by no means least important, of our crew was an ancient warrior named Taki Taki, his face was tattoed all over and he looked every inch a chief, although his rank may not be high. A previous tourist party took his photograph as a specimen, which pleased him very much, but he expressed great dis- appointment that he had been unable to secure a copy for himself, although promised one. He, too, had taken a prominent part in several sanguinary conflicts years ago, when the Wanganui River was the scene of war and bloodshed. We had our doubts as to his having been a cannibal in his younger days, and when taxed with it, lie said that he him- self had never tasted human flesh, but he had been present when it was being consumed. Verbum sap. This completes the personnel of our crew.
On this, our first day, we only travelled three miles further, to a place called Te Rumu, twenty-eight miles, where we camped for the night. The camping process was a source of great fun, landing things, lighting the fire, pitching the tent, discussion over bill of fare, cooking, and the method of washing the potatoes by an old Maori woman who placed them in a " kit " and then rubbed them together with her bare feet, &c., all being productive of considerable merriment, and on this occasion all being tired, early under the blankets was the word and it was gladly obeyed. All through the trip it was agreed to start every morning at daylight, to break up our camp, and travel as far as possible before breakfast, this of course necessitating early retirement the previous evening. Next morning everyone was astir in good time, so we got off early, but every few miles some distracting element intervened, here it would be a deserted native plantation with fruit trees in full bearing, e.g., peaches, plums and apples ; and there wild Pigeons and ducks would come round to be shot—all the tourists, save one, being good marksmen. Our second evening we got to Ranana (London), forty-seven miles, having passed through Athens (Atene), Corinth (Koriniti), Galatia (Karatia), en route. Here we were received with great hospitality, this being a large settlement, and the spot where the whole of our crew resided. We arrived late at night, and were evidently expected, as a prominent native named Ford, related to Major Kemp, a friendly chief, who distinguished himself in the Maori War, vacated his newly-built wooden house and placed it at our disposal for the night. The natives also assisted in carrying our things op from the canoe, and generally saved us a lot of trouble. Men and women were bathing promiscuously in the river as we came along, and on the pakeha being espied there was a general scramble by the latter.
At this place there is a large "Whore Runaage" or meeting-house, where Many people seem to live. Divine service was conducted by a native preacher during this evening, and numbers of Maories had come from the adjoining pahs, so when it was concluded there were some matters discussed connected with the well-being of the community, after which, the hour being late, they rolled their blankets round them and endeav- oured to go to sleep. Both sexes do this indiscriminately and appear to take no notice of the presence of the pakeha, or anybody else.
162 THE SPECULUM. March, 1892.
At this place we changed our canoe for a larger one, the new " waka "
being fully sixty feet long, and celebrated in history as being the one in which the dead were carried away from the great battle at the island of Moutoa.
The following account of the battle was supplied to us by one of the Maori chiefs who took part in it. It appears that about twenty-eight years ago, the rebel Maoris (Hau Haus) contemplated an attack upon the town of Wanganui, and came down the river for that purpose, but first they had to pass Ranana, where the friendlies were ready to give them battle, and the engagement took place on the island, a small place, about four or five acres in extent. From all accounts it was sanguinary conflict, and the friendlies were partly driven into the river, when they were rallied by the old warrior chief, Mete Kingi, who, holding a sabre aloft, rushed forward and turned defeat into victory, which resulted in the complete annihilation of the rebels. This is supposed to have saved Wanganui, as there were then no means Of communication, and the rebel force would have been down before word could be sent.
Our party landed on the island and gravely conversed over the incidents as related to us by several of the actors in the scene who still live. They tell the Europeans now of these matters with great pride, which is, doubtless, pardonable. We breakfasted this morning at Jerusalem (Hiruharama), where there is a Roman Catholic Mission station. The priest, Father Selly, together with the Sister Mary Joseph, and the members of the mission being held in the highest esteem by the natives. Sister Mary Joseph belonged to the ambulance corps during the Franco-Prussian War and gratuitously attends the natives around during sickness or when they have obtained injuries, and is very highly spoken of. Whether it is due to their influence or not it is impossible to say, but this village is the cleanest and neatest of all the up-river settlements, a number of the houses being built of wood and painted in approved European fashion Here we had some swimming and diving matches for children under ten years of age while resting after breakfast, and which resulted in some very close contests.
This place is fifty and a half miles up, and we felt very pleased at having accomplished more than the half century before breakfast on the third day ; but our troubles were only just beginning, for rapids had now to be faced in quick succession, impeding our progress and tiring our crew ; so much so, that it was late in the afternoon when we arrived at Pipiriki, fifty-six miles. Here we found a store, and took the opportunity to replenish our stock, some particular items having run.
short. This is the furthest point reached by the river steamer, and then only in the winter months when there is more water, and the people who have travelled beyond are very few. We found the store- keeper out, but by dint of good lung-power and the Australian "coo-ee,"
he was induced to come from his plantation over the river and attend to us. Meantime the members of our party had not been idle—names were carved on the shop door, and one gentleman ransacked a neigh- bouring garden and returned laden with a hatful of Cape gooseberries, which we all assisted in consuming.
it
ili
After leaving Pipiriki we encountered the biggest rapids yet faced (Ngaporo, No. 1 and No. 2), the navigation of which so knocked up the crew, who alone remained, in the canoe in going up the rapids, that about a mile further up we were glad to camp for the night under the shelter of an immense apple tree full of fruit, some of which we cooked for supper. This apple tree was, we afterwards found, planted by the Rev. Mr. Kish, of Blackbridge, Lower Hull (about eight miles from Wellington), who lived in that exact spot over forty years ago, conducting a mission. We felt very grateful to the reverend gentleman When we heard of it. On the fourth day we passed over a great number of rapids and explored a large cave, " Waitai," in the side of the hills, and about mid-day reached the river Manganui-te-au, which afforded a lovely bit of scenery, the banks on each side being very precipitous, and clothed with New Zealand's finest scenes to the water's edge. Here we lunched, and afterwards passed some distance up the river. We arrived at the Ti Eke late in the evening, all pretty well tired out. The natives here also were very hospitable, and gave us a supply of potatoes and wanted us to have some roast pig, but we preferred our own victuals. We made them a present of several bottles of English ale, which was a luxury to them, and were not long in disappearing, as they were very fond of the " waipera." At breakfast time the next morning (fifth day) we reached Utupu, about seventy miles, where only a few months before the warlike M aori chief, Taumati, tried to prevent some well-known Wanganui gentlemen from proceeding further up the river. He and a party came down to the river bank and fired across the river, and told those in the canoe if they passed over that line of fire he would shoot them down. The Europeans wanted to turn back, but the Maories manning the boat said that he was only bullying and dare not fire and pushed on, and Taumati did nothing but swear. Since then the pakehas can go beyond without fear of molestation.
After leaving Utupu we encountered a great number of rapids, and the banks of the river were so precipitous that we could not get a large enough space to pitch our tents, so we decided to pitch ours on a bed of shingle in the middle of the river not more than a foot above the level of the water. A week before, the captain told us, the river was in flood, and was at least fifteen feet above the present level, so you can Imagine we watched the weather very carefully before turning in. The Maories slept in the canoe, as they said it was too risky on the shingle.
We covered the shingle on the floor of the tent with a good thickness of the fronds of tree fern, which was growing in great abundance along the banks, and were thus enabled to lie down comfortably, and were soon in the land of dreams. The next day (sixth) we passed over some very stiff rapids and reached almost to Kiri Kiriroa, a further distance up the river than any tourist had ventured previously. We met Taumati and some of his followers, men, women and children, about mid-day, in a dozen canoes, and it was a very pretty sight, although he was very surly to us when we spoke to him. About three o'clock in the afternoon we turned round and faced for home, and came down much quicker than we went up, it being great sport shooting the rapids,
c2
THE SPECULUM. March, 1892.
which were, at the same time, invested with a certain amount of danger.
Altogether we shot about one hundred and fifty rapids, and reached Wanganui late on the evening of the eighth day, after having spent a most enjoyable holiday, and feasted our eyes on scenery, the magnifi- cence of which requires to be seen to be admired, and is altogether beyond description. The banks of the river near the rapids are composed in many instances of Papa rock, which look like large white retaining walls. In this rock are impressions of the poles which are used in lifting the canoes over the rapids. Some of them are at least fifty feet above the present level of the river, and makes one wonder at the time when the river was thronging with war canoes.
Interesting anecdotes were recounted of fights which took place amongst the different tribes at various places along the line of route, when the Maori tribes were much more numerous than they are at present, and the deserted Maori pahs along the banks of the river, make one reflect on the great falling of of what was once a very powerful and intelligent race of people.
Some few months ago a new steamer was placed on the river, and is now making trips about sixty miles up the river, returning to Wanganui the next day. The trip is not a very expensive one, after reaching Wellington, N.Z., and I should strongly recommend these who intend paying New Zealand a visit in the future, not to f orget amongst the other sights of this Wonder Land " A trip up the Wanganui River."
The Blood.
Six thousand years after his era began, The astonishing fact was discovered by man, That the blood in his body does not remain still, But rushes along like the race from a mill.
Certain vessels call'd arteries, hidden within The body, conduct from the heart to the skin ; While others called veins, throughout every part Of the system, conduct from the skin to the heart.
The heart every instant gets fill'd with new blood, Prepaid, as you'll see, from the air and the food ; And this new blood is driven throughout the whole frame As from a force-pump by the force of the same.
The blood in its passage leaves everywhere Some of what it has got from the food and the air, Which is all taken up, ere a moment be gone, To replenish the tissue, the fat and the bone.
Throughout the whole structure—bone, muscle, or skin—
Where the arteries end and the veins begin, And changing its colour from red blood to black, The blood enters the veins and is so carried back.
When the old blood arrives by the veins at the heart It is mixed and churned up, in a chamber apart, With a thick milky fluid, nutritious and good,
Which the stomach and bowels have drawn from the food.
