Speculum : The Journal of the Melbourne Medical Students' Society ...

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CONTENTSPage.Page.The Obstetric Forceps : Their Uses Working the Oracle .. 58and Abuses .. Dissertation on a Baby .. 60A Few Old-Time Quacks 16An Early Amputation .. 62Annual Meeting of the M.S.S. 19"Fame" 63Editorial .. 20 Going Up .. 63Business Page .. 23 On Being Born 65Inaugural Address to Medical Stu- An Alphabet 68dents . 24The Cynic .. 68Obituary—Dr. R. J. Bull 27Ladies' Letter 70Infant Feeding 27Concerning Women 71The Green Hat 33A Story .. 72Students of the Past 34Surgery and Medicine 73Treatment of Established RheumaticCarditis 36 "Orchidectomy" 75"Medicopassion" 41 The Wilfred Grenf ell Club .. 75Clinic from Satan . 42 Correspondence .. 76The Study of Anatomy .. 44 Prominent Personalities 80The Vicarious Elopement 48 Spicula 81The Good Old Days .. 50 Duds and Derelicts 84In Korea There Is No Chorea 52 Announcement—Essay Prize .. 85Hydrargyrum 55 Hospital and Year Notes 87To-day's Tonic Talk 55 Old Boys' Notes .. 92

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Si Speculum, Placet, Inspice.tbe ZpecuturnTHE .JOURXAL OF THEMELBOURNE MEDICAL STUDENTS' SOCIETY.16oarb of Management:11;EditorSub-Editor ..Business Manager..E. K. RODDA... P. G. REYNOLDS...J. L. GROVE.The Faculty of MedicineGraduates1Representatives :..PROFESSOR R. J. A. BERRY... DR. F. L. APPERLY.MR. H. R. DEW.Melbourne Hospital Clinical School . P. W. FARMER.St. Vincent's „ .M. J. McNAMARA.Alfred 1,.E. A. EDDY.Women Students3rd Year2nd Year ....1st Year ....MISS J. WHITE.M. 0. KENT HUGHES.1 C. N. RAPHAEL.R. I. GREENHAM.G. M. OXER... J. R. WATERMAN.

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the %peculumNo. 120 JULY, 1927Ebe Obstetric 'forceps: Ebeir Vlso anb Abuses.BY ARTHUR M. WILSON, D.S.O., M.D., B.S."Saul has slain his thousands, and David his ten thousands."—(I. Samuel 18!7.). . . and the Obstetric forceps their hundred thousands.Of the instruments in the armamentarium of the general practitioner, probablynone is used more frequently than the obstetric forceps. Familiarity is aptto breed contempt, and sometimes the busy or impatient practitioner may betempted to regard his lack of time or his convenience as the indication for theiruse.The word "obstetrics" is derived from the Latin "obstare," to stand by andprotect, and this should be the function of the obstetrician, viz., to stand by andprotect the mother and her offspring from all sources of danger, and ill-health,not only immediate, but also remote, and to alleviate the mother's sufferings asfar as possible during her hours of trial.The dangers associated with forceps operations should never be forgotten,and the further the obstetrician departs from the operative principles to be presentlyenumerated, the greater are the maternal and foetal risks. The motheris exposed to a greater risk of infection, especially if the cervix is not fullydilated and drawn up over the fcetal head. The lower part of the vagina isneither sterile nor sterilizable, and by the mere introduction of the forceps (andalso by the concomitant manipulations) pathogenic organisms may be introduced,or at any rate carried higher up in the genital tract. It must be admitted thatthe maternal risk of infection is not very great, provided that the head is outsidethe uterus, yet the risk is definitely much greater when the forceps are actuallyinserted into the uterine cavity—a condition which applies if they are usedbefore the cervix is fully dilated, and also even if it is fully dilated but not yetdrawn up over the fcetal head (a fact which is often not properly appreciated).With forceps operations there is also an increased risk of maternal lacerations.To think that the perineum can more frequently be saved by a forceps operation(other than a head-on-perineum operation) is hopeless optimism. The cervix,unless it is fully dilated and pulled up out of harm's way, is extremely likely tohe torn. Also, apart from any lacerations whatsoever, the rapid forcible extractionof the child may loosen the attachments of the vagina and the uterus, andmay result in the subsequent development of a prolapse of the uterus, a relaxedvaginal outlet, a cvstoccele and a rectoceele.Maternal lacerations and relaxations are undoubtedly the greatest factorsin the causation of remote maternal morbidity (the most frequent and mostserious maternal result of the abuse of forceps), and when it is considered that9

10 THE SPECULUM.• there are more gynaecological than obstetrical beds in the metropolitan hospitals,and also that a large proportion of the patients occupying these beds date theirdisability back to a confinement, we must admit that our obstetrical results arefar from perfect. It would be quite wrong to say that all the remote maternalmorbidity is due to the abuse of forceps, because 'it is an undoubted fact thatextensive lacerations of the cervix, vagina and perineum may occur in a spontaneousdelivery, and also in many cases the obstetrician cannot be blamed, ashe may be compelled, owing to the exigencies of the situation, into performingan operation which he would have preferred to delay a few hours.The fcetal risk is also, definitely increased by the use of forceps.- Three percent. of all babies are dead-born, another three per cent. die within the firstmonth. Birth injuries (especially cerebral haemorrhage) cause at least twentyfiveper cent. of these fcetal and neo-natal deaths, and also are responsible for afair proportion of the epileptics and mental deficients amongst the survivors.Here again it would be incorrect to state that all of these birth injuries are dueto the use of forceps; as a fatal cerebral haemorrhage may occur even in a spontaneousdelivery in a multigravida, but, nevertheless, many must be definitelyascribed to this cause. The further the obstetrician departs from the correctmethods of procedure, the greater will be his fcetal mortality rate. The lowerthe head has descended into the pelvis, the less is the fcetal risk, and this riskis very slight indeed with a H.O.P. operation, where the handles of the forcepsneed not be screwed together, and consequently there is no compression of thefcetal skull. It is astonishing how a head will mould and descend if given time,whereas the premature application of forceps (especially if incorrectly applied)subjects the foetus to a very real risk of a cerebral haemorrhage. A most unfortunatetenet is sometimes held that a few lacerations, more or less, do notmatter, provided that they are repaired at once, and certain exponents of theart of meddlesome midwifery, maintaining that their immediate maternal andfcetal results are satisfactory, quote in defence of their methods the proverb,"The proof of the pudding is in the eating thereof." This proverb is only ahalf-truth. The proof of any pudding is not only in the eating but also in theafter-effects. The pudding, though it provided excellent eating on ChristmasDay, cannot still be considered an unequivocal success if all the eaters are inthe throes of intestinal colic on Boxing Day. Similarly with meddlesome midwifery.The torn perineum is the least serious of the maternal injuries, as itcan be easily repaired at the time, and it is the only injury likely to occur ifthe obstetrician has performed a H.O.P. operation. The relaxation of thevaginal and uterine supports and the lacerations of the cervix are much moreserious, as they cannot be effectually treated immediately after the birth, andthese conditions are the great causes of the remote maternal morbidity whichcauses so many women to seek relief at the very numerous gynaecological clinicsin Melbourne. The late Lord Rosebery is reputed to have said : "There arethree kinds of liars—`Ordinary liars, damned liars, and statisticians' "—and it isquite true that statistics can be made to prove anything. Nevertheless, if maternalmortality statistics be investigated, it is most disquieting that the highestmaternal mortality rates (and maternal morbidity, immediate and remote, wouldundoubtedly run in a parallel curve) oecur in those countries in which thegreatest proportion of the women are attended by doctors. During the years1924, 1925, the United States (the home of operative obstetrics) led with amortality rate of 6.5 per 1000 confinements ; Scotland, next, 6; Prus,sia, Belgiumand Canada, 5.75; Australia, 5.6. At the other end of the list, Holland,

THE SPECULUM. 11Sweden and Italy are regularly under 3 per 1000 births, and in these countriesthe cases attended by midwives predominate. It is to be hoped that the statisticsare wrong, but it is quite certain that a woman is far better of without a doctorat all than with one that interferes unnecessarily.The indications for the use of forceps are :-1. Threatening or actual maternal distress (as gauged by the obstetrician,not by the patient, the husband, the nurse or the relatives).2. Threatening or actual fcetal distress.It must be noted that whilst the passage of meconium with any presentationother than a breech is an important sign, yet the fcetal heart rate below 120 orover 160 is much more important, and the diagnosis of fcetal distress should bemade more on the foetal heart rate than on the presence of meconium. Incidentally,if forceps are applied because of fcetal distress, the relatives should bewarned of the fcetal risk, as otherwise if the foetus is dead-born the obstetricianmay be quite unjustifiably blamed.3. Delay in the second stage of labour (actually this factor is a causeof 1 or 2, or of both, but as it is the most frequent indication for theuse of forceps, it perhaps deserves a special mention).4. As an adjuvant in guiding the head over the perineum when chloroformanaesthesia has been given to alleviate the intense pain of thepatient when the head is bulging the perineum.This fourth indication requires some special consideration. In the caseof a primigravida, the obstetrician has, by the administration of various narcotics,carried the patient along until she is in the second stage of labour. Henow is standing by to protect, the narcosis may have worn off, and she may becomplaining of severe pains as the head is descending. This pain is beingalleviated by light chloroform anaesthesia, and the head continues to descend andbulges the perineum. The pains have now become very severe, and a deeperdegree of anaesthesia is required. As more anaesthetic is given, the pains becomeweaker and no further advance is made, and if delivery is not soon effected, thecase becomes one with delay in the second stage of labour with all the attendantrisks. In order to effect delivery the obstetrician has three alternatives :-(a) To allow the patient to come out of the anaesthetic and suffer somemore pain—not a very satisfactory procedure.(b) To perform a H.O.P. operation (to be described later).(c) To give -& c.c. of Pituitrin if the maximum diameter of the head ispast the bony outlet of the pelvis and if the head is in good position(i.e., a vertex with the ocCiput in front). This procedure is notaltogether satisfactory, as very violent uterine contractions may followand result in severe lacerations of the perineum and vagina. It alsomay result in some retention of the membranes and difficulty in the thirdstage of labour.In primigravidae; if the patient will not deliver herself, personally, I prefera H.O.P. forceps operation—with multigravidae, on the other hand, I prefer afew minims of pituitrin, and this injection will usually result in a spontaneousdelivery, though the obstetrician should always be prepared to follow up witha forceps operation, if delivery does not occur within half an hour.In applying these indications for the use of forceps in your private practice,you will sometimes be sorely tempted to act contrary to your conscience and yourjudgment .

12 THE SPECULUM.To illustrate the first temptation, a hypothetical case will be quoted.You are called to see a primigravida at 6.30 p.m. On examination you findthat the cervix is about three-quarters dilated and well taken up and the headis about the mid-plane of the pelvis. You know that she is coming on well, andin the ordinary course of events will be head on perineum between 9 and 10o'clock. Unfortunately, you have promised your wife to take her to the operathe same evening. By breaking the rules you could deliver the patient at 7 o'clock.The cervix would undoubtedly be torn, the vaginal and uterine attachmentsprobably loosened, the perineum perhaps lacerated, and the baby perhaps injured.Your attitude in managing such a case must be guided by the principle enunciatedin the concluding paragraph in this article.The second temptation must also be resisted. In many cases you will beasked to terminate the labour in order to relieve the patient's sufferings. If thepatient is still in the first stage of labour and will not be ready to be deliveredfor about four to eight hours, the pain is best relieved by morphia, with orwithout scopolamine If the patient is in the second stage and will be ready inan hour, obstetric anaesthesia with chloroform or ether is the correct' treatment.The greatest difficulty arises in those patients whom you judge to be too faradvanced to be given any morphia and not far enough to be given any chloroform.The great majority of these patients will hang on for another hourif you point out that it is both in their own and the baby's interests, and alsoif you can give the patient a definite assurance that the labour can be terminatedat the end of that time.Quite candidly, by being conscientious and conducting your cases in thisway you may lose a few patients, especially if you are in opposition to someconscienceless practitioner who is quite prepared to break all the rules anddeliver the patient as soon as he arrives. Nevertheless, you will gain in theend, as the people will ultimately realise that your final results are very muchbetter than his.Above all, be very careful of the management of primigravidae, as at leastninety per cent. of the cases of remote maternal morbidity are caused at the firstconfinement.The sine qua nons are, of course, well known, but will be mentioned :-1. Bladder and rectum empty.2. Cervix fully dilated and drawn up, so that the head is now completelylying in the vagina.3. Membranes ruptured.4. Uterus contracting.5. Favourable position of a suitable presentation.(a) Vertex with occiput toward the front.(b) Face with chin toward the front.(c) After-coming head in a breech presentation with occiput towardthe front.6. No insuperable obstruction.The second necessity (i.e., full dilatation of the cervix) is too often disregarded,and it must be accepted that the forceps should never be applied untilfull dilatation has occurred unless some obstetrical emergency is present. Manualdilatation of the cervix is mentioned only to be condemned. To attempt amanual dilatation is to look for trouble. It may occasionally be justified in afew cases, where some severe emergency exists, and the cervix is already

THE SPECULUM. 13partly dilated, but it is well to remember that the cervix cannot be manuallydilated to more than three-quarters ; any further dilatation occurs only bylacerations. Those that favour manual dilatation would have their ideas changedby making pelvic examinations of their cases one month after delivery. Inaddition, it is always better to wait until the cervix is pulled out of harm's way,as otherwise it may be caught by the forceps, even though it is fully dilated.In the consideration of the fifth necessity it must be noted that the commonestcause of a "failed forceps" operation met with in consultant and hospital practiceis the failure to recognise an unfavourable position, especially a P.O.P. Ifthe position cannot be diagnosed with two fingers in the vagina, use the halfhand,if still undiagnosable insert the whole hand. The location marks to besought for—apart from the fontanelles—are the ears, the ext. occipital protruberance,and the nape of the neck. If the position is unfavourable ; it shouldhe corrected.Four types of forceps operations may be described :-1. The high forceps (the maximum diameter of the head not having,or only just having, entered the brim).2. The mid-forceps (the maximum diameter in the mid-pelvic plane).3. The low forceps (the maximum diameter at the bony outlet).4. The head-on-perineum forceps (the maximum diameter beyond thebony outlet and the only obstruction to delivery now being theresistance of the maternal soft parts, i.e., the perineum).47The high forceps should never he lightly undertaken, as it is risky to themother and extremely dangerous to the child. The obstetrician should he ableto recognise between a labour that is proceeding slowly and one that has definitelyfailed. The signs of a "failure-of-labour" may be briefly enumerated. Thepatient is presumed to have been in labour for some hours (during thelast three to four of which the membranes have been ruptured). By abdominalpalpation the head is still over-ridinc , the pubis and the anterior shoulder has notdescended. By pelvic examination the cervix is not taken up and is not dilating,and is hanging loosely as a curtain in front of the head, and also asynclitism andextension of the head are occurring. In such a case the attendant is ill-advisedto attempt delivery with forceps, unless he is quite prepared to go, on and deliverby other means if he fails. A failed-forceps operation has a maternal mortalityof ten per cent. and a foetal mortality of fifty per cent. On the other hand, ifthe labour is progressing and the advance of the head is proceeding, howeverslowly, it is infinitely better for both mother and child to wait until furthermoulding and descent has occured before using the forceps.The mid-forceps is also not devoid of risk, and once the maximum diameterof the head has got past the brim into the mid-pelvi4, another hour's wait usuallymeans a low-forceps or a H.O.P. operation, provided that the occiput is rotatingto the front.The risks of a low-forceps are very slight—those of a H.O.P. operation almostnegligible. Consequently, the very large proportion of forceps operations inpractice should be of the third and fourth variety, and the more patient theobstetrician the larger proportion of H.O.P. operations.These types of operations are not sufficiently well differentiated by somepractitioners, and the lecturer on the subject of Obstetrical Forceps: Thew Usesand Abuses, is very often asked what proportion of primigravidae lie deliverswith forceps in his own practice. If he answers about seventy-five to eighty.1

14 THE SPECULUM.per cent . and goes on to say that of these, eighty per cent. were of the H.O.P.type, it means that he has had enough patience to stand by and allow nearlyeighty-five per cent. of his primigravidae to practically deliver themselves. Hisresults should be ever so much better than those of the man who does eightyper cent. forceps operations, amongst which the incidence of mid-forceps andlow-forceps is unduly high. The incidence of forceps operation in privatepractice (including H.O.P. operations) should not be more than fifteen per cent.in multigravidae.The modes of action of the obstetric forceps are enumerated in the varioustext-books. The following are commonly described :-Traction, Rotation, Lateral Lever Action, Compression of the Head,Dilatation of the Perineum, and Excitation of the Uterine Contractions.The last three modes are quite contrary to the principles already enumerated.Using the forceps as levers is apt to cause extensive lacerations inside thevagina. It is well to rely only on the following modes of action :—Traction,a small amount of rotation (rarely more than forty-five degrees, never morethan ninety degrees) and guidance of the head over the perineum as in theH.O.P. operation.Two methods of application are described :-1. Pelvic (i.e., in relation to the mother's pelvis).2. Cephalic (i.e., in relation to the foetal head).The obstetric forceps have been mechanically designed to fit on a definiteposition on the fcetal skull. The tip of the blades should be on the fcetal cheek,the anterior (as it 'lies in the mother's pelvis) margin of the blade should beon or very close to the foetal ear. The fenestrum (or window) of the bladeshould be over the parietal eminence of the fcetal skull. If the forceps areapplied accurately in this position, there is a minimum of compression on thefcetal skull when traction is applied, and also a minimum of trauma will be madeon the fcetal soft parts. The further the forceps are from the site of election,the greater is the risk of injury to the foetus. It is quite obvious, therefore, thatthe forceps should always be put on with a cephalic application. It is certainlyharder to do, and requires more practice, but the results are very much better.Always inspect the fatal head after birth and note where your forceps have beenapplied. You will be surprised how often a difficult pull is associated with afaulty application of the forceps. The tip of one blade, instead of being on thecheek, is over one eye or on the forehead, and the tip of the other blade is downon the mandible or even on the neck. If the occiput is not quite to the front,and the forceps are put on with a cephalic application, as traction is applied thefcetal head and the forceps will rotate into the correct pelvic position. In theH.O.P. operation, of course,. the pelvic and cephalic applications will coincide.A few hints on the actual use of the forceps may be of value. Be surethat your interference is not too early—a few hours longer in labour will oftenconvert what would have been an extremely difficult forceps into what becomesa spontaneous delivery or a H.O.P. operation. Get your patient into goodposition, i.e., with her body at right angles to the long axis of the bed. Makeabsolutely sure of the fcetal position and presentation. If the fcetal positionand presentation are not favourable, correct them. Use the cephalic applicationby the following means :-Get your lower (or first) blade into good position by trying to arrange thatthe tip of the blade is on the fcetal cheek (if necessary, the whole hand may

THE SPECULUM. 5have to be inserted into the vagina alongside the foetal head, though this is unnecessaryin the low and H.O.P. operations, as it can be accomplished by thehalf-hand or even two fingers). Then note the position of the handle of theblade outside the vagina. Then insert the second blade and lock it on to the first,having kept the first blade in its original position. If the handles do not lockeasily—almost certainly you have the forceps on incorrectly. Take them off andstart over again.When you are satisfied that the blades are correctly applied, traction maybe used. Pull with one hand only, keeping the other hand in the vagina withthe fingers in the angle between the blade of the forceps and the fcetal skull, inorder to recognise any sudden advance of the head, or any slipping of theforceps. If the forceps slip it means either that they are incorrectly appliedor there is some very marked obstruction. In either case take them off andre-apply them. Remember the motto the old obstetricians had engraved on theirforceps : Non vi, sed arte. Please never pull with both hands and your footagainst the bed or the patient's buttock. In the words of Napoleon, C'est magnifique,nzais ce n'est pas la guerre. It is quite legitimate to use your foot (wrappedin a towel) to steady the patient if you have only one nurse to help you and ifyou are pulling with one hand only. If you do pull with both hands you maycause frightful injuries to your patient, either by the head suddenly being born,or by your forceps slipping off.Space does not admit of the detailed description of the management of P.O.P.positions.Always be chary of the application of forceps to premature infants. Theyare extremely susceptible to birth injuries. Also beware of the foetus in whichcalcification of the fcetal skulWs deficient and the bones are still quite soft.Always make a P.V. examination of your cases two to three weeks afterdelivery ; you will thus keep a check on your work.Take a pride in your art and do not speak disrespectfully or disparagingly ofyour craftsmanship or of your tools of trade. The use of such an expressionas "I stuck on the tongs and heaved out the kid" conjures up a mental visionof a helpless babe being forcibly dragged into the world with the gentleness onewould expect from a coal-heaver.Finally, always ask yourself would you apply the forceps if the patient concernedwere one of your own women-folk. Your conscientious answer to thisinterrogation must be the line of treatment to be adopted for that particularpatient.A WORD OF ADVICE.Ah, student at the Kids' O.P.—Like indeed the busy bee,If you, in search of learning's joy,Should soil your hands on "hoi polloi,"Of course, to wash them you will hasten—Never use the left hand basin!We're medical students all,Lads in the early twenties,And the impulse trueRuns through and throughOur nervi eriqentes!

16 THE SPECULUM.Fl few CDIOEtinc e11ach9.The history of quackery is the history of the human race. It is only inrecent years that medicine and surgery have been placed on a scientific footing,and have become divorced from the charms, the elixirs, the oracles and all theother paraphernalia of the charlatan. In the feudal ages medicine and quackerywere the same, so far as any scientific principles were concerned. The onlydifference in those days between the physician and the charlatan was that theformer was a fool and the latter a rogue. Men did not meddle with the healingart. A few clerks applied themselves to it, and so, by the exercise of bothspiritual and medical functions, obtained a double fee at the one sitting, so tospeak.In the Quacks' Academy, or the Dunce's Directory, a priceless gem of abook published in 1678, is the following list of a charlatan's qualifications :---"Your outward requisites are a decent black suit and (if your credit willstretch so far in Long Lane) a plush jacket ; not a pin the worse, though threadbareas a tailor's cloak—it shows the more reverend antiquity."Secondly, like Mercury, you must always carry a caduceus or conjuringjapan in your hand, capt with a civet box ; with which you must walk withSpanish gravity, as in deep contemplation upon an arbitrament between life anddeath."Thirdly, a convenient lodging, not forgetting a hatch at the door ; a chamberhung with Dutch pictures, belittered with empty bottles, gallipots, and vialsfilled with tap-droppings, or fair water, coloured with saunders. Any sextonwill furnish your window with a skull, in hope of your custom; over which hangup the skeleton of a monkey, to proclaim your skill in anatomy."Fourthly, let your table be never without some old musty Greek or Arabicauthor, and the fourth book of Cornelius Agrippa's Occult Philosophy, wide opento amuse spectators ; with half a dozen of gilt shillings, as so many guineasreceived that morning as fees."Fifthly, fail not to oblige neighbouring ale-houses, to recommend you toinquirers ; and hold correspondence with all the nurses and midwives near you,to applaud your skill at gossipings."The directions go on to advise loquacity and impudence, qualities whichquacks of all times have found most useful. In cases where the practitioner hasan impediment in his speech, he is instructed to observe a mien of strictestsilence, and a look of great profundity.When Queen Anne's weak eyes caused her to pass from one empiric toanother, searching for the relief which never came, the quack oculists of theday were in clover. One brilliant gentleman was William Reade, originally ashoddy tailor. He was knighted by the Queen for his services as an oculist,while he was himself incapable of reading the book on diseases of the eyewhich he had written (by means of an amanuensis). After he was knighted hehired a poet to sing his praises in decasyllabic verse, and distributed the atrociousresult throughout the town.Richard Steele, in the Spectator, has given posterity not a few anecdotesabout the empirics of his day. One doctor proclaimed his power to cure cataracts,because he had lost an eye in the emperor's service ! Another man professedto treat ruptured children. because his father and grandfather had congenitalhernias. Another friend of Sir Richard's announced that "from eight to twelve,

THE SPECULUM. 17and from two to six, he attended for the good of the public to bleed for threepence."The famous French quack, Villars, in 1723, confided to his friends that hisuncle, who had recently been killed by accident at the age of a hundred, hadbequeathed to him the recipe of a nostrum which would prolong the life of anywho used it to a hundred and fifty. Whenever a funeral passed, he used to say :"Ah! if that unfortunate creature had taken my nostrum, he might be carryingthat coffin, instead of being carried in it." This nostrum was composed of nitreand Seine water, and was sold at the ridiculously cheap rate of five francs perbottle. His was not pure quackery, for, with the draught, he required good, plainliving, and so indirectly did much good to the nation he duped. But he wasfound out and died forgotten.The most daring of the later quacks was James Graham, an M.D. of Edinburgh,who introduced into England the juggleries of Mesmer. His "Templeof Health" quickly became a place of fashionable resort. Its spacious roomswere supplied with furniture made to be stared at—sphinxes, dragons breathingflame, marble statues, paintings, medico-electric apparatus, rich curtains anddraperies, stained glass windows, stands of armour, immense pillars and globesof glass, Luxurious couches were everywhere for the languid visitors thereonto rest, while the senses were fascinated with strains of gentle music, and theperfumes of spices burnt in swinging censers. The most sacred shrine of theedifice stood in the centre of "The Great Apollo Apartment." The magicianhimself describes it thus :—"This room is upwards of thirty feet long, by twentywide, and full fifteen feet high in the ceiling; on entering which, words can conveyno adequate idea of the astonishment and awful sublimity which seizes themind of every spectator. The first object which strikes the eye, astonishes,expands, and ennobles the soul of the beholder, is a magnificent temple, sacredto health, and dedicated to Apollo. In this tremendous edifice are combined orsingly dispensed the irresistible and salubrious influences of electricity, or theelementary fire, air, and magnetism ; three of the greatest of those agents oruniversal principles, which pervading all created things, connect, animate andkeep together all nature, etc., etc." The woman who officiated in this sanctumsanctorum was the fair and frail Emma, later Lady Hamilton, the goddess ofNelson. Graham vended an "Elixir of Life," for a constant supply of whichhe asked i1000 and got it. His writings were a string of blasphemous vaporingsof a most insane type, and yet this man attended George the Third during hisfirst mental disturbance.In the entire history of charlatanism, it would be hard to find a career moreextraordinary than that of St. John Long, who practised about a century ago.Though a pretender and consummate quack, he was distinguished from thevulgar herd of cheats by the possession of enviable personal endowments, a goodaddress and a considerable quantity of intellect. He was the son of a Limerickbasket maker, but early set out to carve a career by painting portraits. Hissuccess was slight, and he found it hard to live on his impudence. His mindwas directed to medicine when he took on the task of colouring anatomicalsketches, by which he acquired a good knowledge of the human frame.He invented a lotion, or liniment, endowed with the remarkable faculty ofdistinguishing between sound and unsound tissues. To a healthy part it was asinnocuous as water, but when applied to a surface under which seeds of diseasewere lurking, it became a violent irritant, creating a sore over the seat of themischief and stimulating nature to throw off the morbid virus. He also instructed

18 THE SPECULUM.his patients to inhale a vapour which arose from a preparation which he compoundedand placed in the interior of a large mahogany case, which resembledvery much an upright grand piano. In the sides of this piece of furniture wereapertures, into which pipe-stalks were screwed for the benefit of the afflictedmortals who came to him, and sat on easy lounges, smoking away like a partyof Turkish elders.With these two remedies, Long promised to cure every ailment from goutto consumption. His success was miraculous. Harley Street was often blockedwith the carriages outside his door. He h ad so many patients that he simplyhad to turn them away. Once he was called to see a man in the last stagesof consumption. Long briefly examined him, and said :"Sir, you are so ill that I cannot take you under my charge at present.You want stamina. Take hearty meals of beef steak and strong beer, and if youare better in ten days, I'll do my best for you and cure you." It was a safeoffer to make, for the patient was dead in forty-eight hours.When he was on trial for manslaughter, because one of his patients diedfrom a suppurating ulcer over the whole back after application of his lotion,several patients testified for him. One said Long had reduced a dislocated hipwith a liniment. Another said that the lotion, on being applied to the stumpof an amputated thigh, produced a great toe !Even the stick of the physician that was, until recently, a characteristic ofthe profession is a relic of quackery. It was formerly part of the stock-in-tradeof the "healer" in ignorant and superstitious times, who with it worked on thewonder and imagination of the credulous by endowing it with magical powers.In more sedate practitioners, the head of the cane was hollow and contained avinaigrette, which the great man held to his nose when he approached a sickpatient, so that its fumes might protect him from the noxious exhalations. So,just as the Rx, which all our modern science has not succeeded in wiping offour prescriptions, is a badly drawn astrological sign of Jupiter, so, in the sameway, the cane is descended from Hermes and Mercurius.The pole formerly used by surgeons in place of the modern brass plate wasa symbol of their much-beloved operation of blood-letting. The pole representedthe stout staff the patient clenched, the blue spiral was the venous, and the redthe arterial blood, while the white was the bandage subsequently applied. Probablyboth the surgeon's pole and the physician's staff could be useful as well asornamental. For centuries, fustigation was believed to be a sovereign remedy forbodily, as well as for moral, ailings. Galen used it for fattening his patients.The routine treatment for ague was a beating, while in country districts to-day,mothers still flog the feet of their children to cure them of chilblains.With prescriptions, medicine and quackery walked arm in arm. Onewonders how the sincere physician of former days believed in the efficacy ofhis wonderful drugs. One of the sedatest men of Carolean days gave calomelin twenty grain doses, and mixed sugar of lead freely in his conserves, but canone understand him when one of his favourite ointments for hypochondriacswas a compound of adders, bats, suckling whelps, earth worms, hog's grease,the marrow of a stag, and the thigh bone of an ox?—"JACKSON."Women may be divided into three classes—acute, sub-acute, and chronic.

THE SPECULUM. 19Annual nnceting.The Annual General Meeting of the M.S.S. was held on the 21st April ofthis year. The Anatomy School was by no means overtaxed in accommodatingthose who attended, and on seeing the scanty numbers present, one regretfullycalled to mind the stories of the "good old days," when an Annual Meeting wasattended in force by the students.The first business before the meeting was the election of office-bearers, andProfessor Osborne having been elected to the chair and the Presidency for1927, this was duly carried out. With a commendable dispatch the report andbalance-sheet were disposed of—details of both of these having been published,it is unnecessary to discuss them further. We congratulate the President andoffice-bearers for 1927, most of whom are old and valued friends of the Society.The customary formality of proposing and seconding the admission of FirstYear Students to membership was enlivened this year by Mr. Farran's motionthat only those First Year Students present at the meeting should be admitted.Despite this opposition, First Year were en masse admitted to the fold.Messrs. Gault, Fox and Body were elected life members of the Societyin recognition of the valuable services they have performed in connection withtheir official positions in the M.S.S. This well-deserved mark of appreciationwas heartily applauded.The official side of proceedings having 'been concluded, Professor Osborneintroduced Dr. Mackeddie, who had very kindly consented to give a lectureillustrated by films and slides.Our President, in a typically enjoyable little speech, made some interestingstatements regarding the use of films in connection with medical instruction.One remark apropos of the lighter side of the motion picture industry gaverise to much amusement—it was to the effect that Australian censors laid downas a basic rule "that no kiss shall exceed ten feet in length."Dr. Mackeddie, in an interesting introductory speech, enlightened us as tothe extent of the possibilities of the motion picture film as a teaching and descriptivemedium.He spoke entertainingly, and with a personal touch of great names knownto us only through the cold distance of text-book and journal.We heard some interesting anecdotes of Gordon Holmes and Purves Stewart,and the mention of the human side of these celebrities brings home the factof the youth of neurology as a true science.Films were shown exemplifying the main points in connection with thestudy and surgery of cerebellar tumours, cisterna puncture, and pneumothorax.At the conclusion of the evening the vote of thanks accorded to Dr. Mackeddiewas certainly deserved, and we are fortunate that this gentleman shouldhave spared the time to instruct us in such an entertaining way.Front a medico comes the following as a fact:—"A lady told me that she didn'twant the position of her uterus rectified, because a doctor operated on a friend of herswho had a prolapse who used to have 'bearing down' pains. After operation she becameworse, because the pains changed to 'bearing up' pains, and nearly choked her."

20 THE SPECULUM.The M.S.S.There seems to be a growing tendency on the part of students to regardtheir Society with the apathetic air of tolerance the ultra-modern maid adoptstowards an uncle from the bush—not a "rich uncle."The M.S.S. has made possible the attainment of the well-ordered state ofthings in regard to clinical and academic study which now exists. It is to thestudent, as his Union is to the labourer, and because it is not actively militantnow, let it not be forgotten that there were times of conflict and stress, when thestudents' battles were fought by an organization entitled to the respect it received.The skies are clear now, and will remain so, because the powers that be areever ready to meet a representative body. There were times when no suchbody existed, and chaos was the outcome of the clamourings of a disorganizedherd of discontented individuals vainly trying to perform systematised clinicalwork.Five shillings per annum is hardly an exorbitant sum to pay for this privilegealone, yet many seem, to want more obvious and tangible return for their outlay.Others, and from these the cry in the wilderness so readily comes, do not eventrouble themselves with the payment of the annual subscription. There seemsto be something decidedly rotten in the state of Denmark when steps have tobe taken to debar unfinancial members from doing Extern. work at the Women'sHospital.Quite apart from these more obvious aspects of the attitude of the studenttowards the M.S.S. are others none the less disturbing. Attendance at allofficial functions for the past few years has been disgracefully inadequate.We have heard all the various excuses and explanations put forward, rangingfrom the financial to the problem of lack of time, but it is a duty of membersto attend, if necessary, to the exclusion of other engagements. The minority whodo go to these functions will testify that it is no hardship to be present.The student to-day is letting his whole horizon be limited by his ownprivate little schemes ; it is certain that he is industrious, but the future medicalmen of Melbourne should be more than mere technicians.Where are the appreciative audiences who listened to the delightful speechesof their professors and honoraries at dinners and smoke nights in the past?Fraternization seems to be a foreign word to the majority to-day.The Speculum, has its own particular plaint in the lack of response to theappeal for contributions. The teaching staff of the Medical School respondgenerously year after year, and largely endow the journal with whatever meritit possesses.The great majority remain inarticulate, whether from apathy or sheerinability to express anything not dealing with lipiodol or livers.It is a great pity that those engaged in an important life work cannotmanifest a little more interest in the Society and in their fellow members, whowill be, of necessity, their more or less intimate associates for many years.

THE SPECULUM. 21For the most part, sheer disinterestedness prevails, but should specialsclash, for instance, or a lecture be listed for Cup Day, there is an uproar.By now, it will have become plain that we have a grievance, and if we havesomewhat incoherently dipped our pen into gall and wormwood to write ofit, it is because it is a serious problem and we feel seriously disturbed by it.The M.S.S. appeals to all students, in their own interests, to manifest alittle concern regarding the activities of their Society. There is more in medicinethan the wielding of a knife or the giving of a drug, and it can be foundin the corporate social and intellectual activities of the M.S.S.Medicine is an Art and not a Trade—let us keep it such.The Business Side of the Profession.Dr. Kent Hughes, the Chairman of Directors of Messrs. Ramsay, ReabyPty. Ltd., attended a meeting of the Executive Council of the M.S.S. sometime ago, and put forward certain proposals outlined in a letter we have received.The problem of equipment is by no means a small one to the young practitionerand the student, and the co-operation of the Society and Messrs. Ramsay,Reaby will do much towards its solution.We reprint Dr. Kent Hughes' letter:—The Editor,Speculum,Melbourne Hospital.While the ideal and aim of the medical profession is altruistic, thereis no reason why we should not be as practical as is possible in our everydayaffairs. From a financial point of view, the most successful men arethose who began their work after a business training.There are several agencies at work to help and protect the interests ofthe profession, such as the British Medical Insurance Company and theMedical Agency.After consultation with the Committee of the M.S.S., it has been determinedto bring a close co-operation between the surgical instrument firm ofRamsay, Reaby Pty. Ltd. and the Society.When I first entered into the business of surgical instruments, I didso because I realized that the profession were paying extortionate pricesfor inferior material. It has taken a long time to obtain sufficient knowledgeto place the business on a sound basis. We can now claim to havedone this, and we want the profession and the M.S.S. to have the benefit ofour experience.• May I give two instances of purchase to show how we have beenrobbed. We bought sets of Bronchoscopes from a London wholesale firm.They charged us £45 each and we had to sell them at a loss. We boughtfrontal mirrors from another' London firm, guaranteed best English, or Continentalmake ; they were Japanese, and we were charged more than doublewhat the Japanese firm would have charged had they imported direct to us.Electric ophthalmoscopes afford another instance of extortion, andwe can now sell for 75/- what we had to charge £6/10/- on our previousbuying.Besides apportioning a certain amount of our profits to the M.S.S., weintend to set up any young graduate or student with equipment on an easysystem of payment, without extortionate rate of interest such as prevails inthe fashionable cash order system. A member of the M.S.S. Committee has

–22 THE SPECULUM.been made Assistant Secretary to the firm, and one of your members willbe elected a Director at the ensuing general meeting, so that every facilitywill be afforded the Society to make full enquiries into the actual workingof the business. It has taken seven years to accomplish success, but we cannow claim that we have done so.W. KENT HUGHES, Chairman of Directors.Commencement.A remark was made the other day, in the course of a conversation, whichbrings to mind a problem in connection with Commencement. The author ofthe remark, a city business man, expressed the opinion that while he thoroughlyenjoyed the activities on the "Block," he thought it a pity that the students shouldsell buttons for the gala.To him, it seemed rather an undignified thing, and while we do not altogetherconcur with this, it is certainly to be regretted that the money-making aspect ofCommencement is becoming increasingly apparent.While we have every sympathy with the project to build a new Clubhouse,and realise that Commencement affords an ideal opportunity for raising funds,yet it will go dangerously far in converting our one day of fun into a glorifiedcharity bazaar. It is hardly fair to criticise thus, however, for we can suggestno alternative to meet the undoubted necessity.Commencement should be a time for whole-hearted enjoyment—one carnivalday in the year when the city and the sedate academic University are givenover to frolic unmarred by any thought of money other than that to meet actualexpenditure.We accept the fact that it is another manifestation of the impecunious stateof our University, yet we record our regret. Mammon will soon put Harlequinto rout.Appreciation.We desire to express our appreciation of the kindness shown by thosehonoraries and members of the teaching staff who have contributed to this issue.These gentlemen devote much of their valuable time to The Speculum each year.No small amount of work is required in the preparation of the articles theycontribute. They form the basis of the matter for each issue, and are of permanentvalue and interest to students. Especially so is this the case at present,in view of the propinquity of Finals.The Wilfred Grenfell Club.The above title is that of a University Social Settlement organized by MedicalStudents. A short article appears elsewhere, describing the aims and activitiesof the Club.We wish it every success in carrying out its useful work.The Alfred.Earlier in the year we received a copy of The Alfred. This publication isa tribute to the enthusiasm of it producers and to the keen interest that is takenin the Hospital. Statistics and reports of hospital activities show the extentof interested co-operation that exists at the Alfred Hospital, and the resultantattaining of a high standard of efficiency.Commentaries.Commentaries are not yet to hand, but will be printed separately and distributedas soon as possible.

THE SPECULUM.BUSINESSPACE.OLD BOYS-1927 SUBSCRIPTION NOW DUE.YOU OWEYEAR'S SUBSCRIPTION.RECENT GRADUATES—JOIN UP !Subscription, 5/- a year.Five Guineas makes you a LIFE MEMBER.Save yourself time and trouble by sending along your subscriptions for twoor three years. Better still, why not become a Life Member? Join the ranks ofthe immortals by doing so, and at the same time place the finances of The Speculumon a sounder basis.Any news of interest regarding yourself or Old Boys in your particular partof the world would be appreciated by the Editor.Send all Contributions to—BUSINESS MANAGER,STUDENTS' ROOM,MELBOURNE HOSPITAL.

2-1- THE SPECULUM.Inaugural Abbress to fneOicat Stubents.Melbourne lbospital Clinical %cbool, 16tb februarp, 1927.BY. B. T. ZWAR, Dean of Clinical School.Through this address, it is intended to extend a welcome to those of youho, quite recently, have completed the preparatory training and are about to beintroduced to the real issues of your work in the wards of this Hospital.In your study of chemistry, physics and biology, you have been taught theimportance of certain great natural laws and have been trained to observe andto prove by experiment the truth of some of these laws. It has been one of theobjects of these studies to develop in you a scientific mind, one which will seekcontinually for natural revelations.The time has now come when you may apply the result of this training tothe problems which will present themselves in the field which you have chosenfor your life work.It is such application of the early scientific training in the study of medicinewhich has led to many of the epoch-making discoveries in its fields. Let meremind you of the important work of Sir Ronald Ross in connection with malaria,a disease which, in India alone, has been responsible for an annual death rate ofmore than a million.When Ross commenced his work, malaria was generally believed to becaused by some kind of vapour or "miasma" which rose from the swampy ormarshy land. Ross was then a major in the I.M.S., and in a small Indianmilitary hospital, under conditions which we would now regard as most primitive,he carried out investigations which established the relationship of the mosquitoto the spread of the parasite of malaria. Ross' experiments were characterisedby resourcefulness and perseverance rarely excelled. It is interesting to recallhis recorded thoughts at two stages of his work. The first, whilst carrying outresearches at Bangalore, he penned the following lines :—"In this, 0 Nature, yield, I pray, to me,I pace and pace, and think and takeThe fever'd hands and note down all I see,That some dim, distant light may haply break.The painful faces ask, can we not cure?We answer, No, not yet; we seek the laws,0 God, reveal through all this thing obscureThe unseen, small, but million-murdering cause."In your future work you will find many problems similar to the one whichconfronted Ross, problems which will demand that you should think and applyall your knowledge and resources to their solution.The second occasion was at the eve of making known his discovery, whenRoss offered up the following prayer of thanks :-"This day relenting GodHath placed within my handsA wondrous thing; and GodBe praised. At His command,Seeking His secret deedsWith tears and toiling breath,I find thy cunning seeds,0 million-murdering Death.I know this little thingA myriad men will save.0 Death, where is thy sting?Thy Victory, 0 Grave?"

THE SPECULUM.SZThe history of medicine abounds with achievements similar to that of Ross,and all emphasise the importance of the application of the scientific training inthe medical course to the study of medicine and disease. The reason why Ihave specially referred to the work of Ross is that only the other day, on the2nd February, 1927, Ross, now in his seventieth year, received from the CalcuttaCorporation an address, which contained the f ollowing"By your life-long researches and epoch-making discoveries you have laidthe people of Bengal under a deep debt of obligation by suggesting the possibility-of eradicating malaria, which claims as its victims more than 1,000,000 ofour people annually.""ti'd'e recall the dingy little military hospital, the old cracked microscope andthe medicine bottles, which constituted all the laboratory and apparatus whichyou possessed for the purpose of attacking one of the most redoubtable scientificproblems."In addition to developing a scientific attitude of mind, these early subjectsof your curriculum help in exercising powers of observation, in drawing conclusionsfrom facts observed and in bringing your judgment to bear on the solutionof various problems.They have, moreover, trained you in the use of certain scientific instruments,and have furnished you with technical knowledge essential to carry out yourclinical work ; it is important that you should properly assess the value of thisearly training and make full use of the same in your hospital work.A step further advanced in your curriculum, the study of Anatomy andPhysiology has taught you the normal constitution and. functioning of the humanbody.In the study of Pathology you will learn something of that body and itsfunctions gone wrong ; whilst a study of Pharmacology and Therapeutics willteach you some of the means by which disordered functions may be correctedor checked in their progress.Whilst it has always seemed to me that students should possess some knowledgeof Pathology and Pharmacology at the time when they commence theirhospital work, there can be no doubt as to the importance of continuing thestudy of Pathology right through your medical career. It is equally importantthat you should keep yourself well informed in the subjects of Anatomy andPhysiology, and apply your knowledge to the study and correction of abnormalconditions in the human body. In your hospital work you will find that thepractice of medicine and of surgery resolves itself in a logical application ofAnatomy, Physiology, Pathology, Pharmocology and various therapeutic measures.In order to assist you to determine the nature or degree of abnormal ordisordered functions, you will be taught the application of various chemicaland hio-chemical methods. In assessing the value of the results of thesemethods, you must learn 'to give (the closest consideration to the clinical signsand symptoms of disease. The work in the wards and in the out-patients' departmentof the hospital will give you ample opportunity to learn to appreciate thegreat importance of clinical signs and symptoms. You should give this aspectof your subject your closest attention. You should make it a practice never tointerpret a disordered or abnormal condition on the mere results of a chemicalor hio-chemical investigation. Every such result should be critically reviewed inthe light of the clinical phenomena.

26 THE SPECULUM.• In your hospital work it is your duty to learn to observe signs and symptoms; to use methods of precision; to interpret the results and to record thefindings correctly. Everyone of these duties is important. Experience will teachyou that observation, the use of laboratory or other methods of precision, shouldsupplement each other.To sum up this part of my address, I desire to impress upon you the importanceof the subjects in the early portion of your curriculum, your study of• these subjects should not end with the passing of the examinations in the same ;you will find the necessity for the application of the knowledge of them rightthrough your clinical work.As an introduction to your hospital work, the Medical Staff has drawn upand issued a handbook, which is intended to help you in your early observations.It will intimate to you what to look for and how this should be done. Youmust, however, learn to observe and to think for yourselves, and to form yourown judgments.Turning now to some other aspects of the career which you have chosen,it is, in the first place, desirable that you should all realize that the professionfor which you are preparing demands of its members the observance of veryhigh ideals. To quote from the late Sir William Osler : "No other professioncan boast of the same unbroken continuity of methods and ideals." "The practiceof medicine is an art, not a trade ; a calling, not a business ; a calling inwhich your heart will be exercised equally with your head."It is important, indeed essential, that all of you should inform yourselvesof those ideals and always live up to the same. I know of no book that dealsmore happily with this subject than the addresses of the late Sir William Oslerin 7Equanimitas and Other Addresses. It is a hook that should be in the possessionof every medical student, to be read and re-read.In your work in the wards and in the out-patients' department of the hospital,you must give the greatest consideration to patients, in your dealing withthem. The authorities of the hospital allow you to work within its walls oncondition that you submit to certain rules ; it is your duty to acquaint yourselveswith these rules and to conform to the same.The study and practice of medicine entails much and exacting labour. Youmust, above all things, continue to keep careful guard over your health andphysical fitness.Do not allow yourselves to neglect your interests in literature, art andsport. Time properly devoted to these will prove to be well spent and helpfulto you in carrying out the responsibilities of the practice of the profession ofmedicine.In conclusion, I desire to wish you the greatest happiness and success inyour work in this Clinical School.The latest story about the illegibility of doctors' handwriting comes from a townin western N.S.W. One of the local physicians dispensed with the services of hischauffeur, and gave him a reference on leaving. The recipient, after ruefully scanningthe crabbed hieroglyphics, made a bet that if the document were sent to the local chemistit would be taken for a prescription. He won. Squills duly made up the medicineand labelled it: "A tablespoonful every four hours."

THE SPECULUM. 27Obituary.DR. R. J. BULL.On May 8, 1927, there occurred with tragic suddenness the death of Dr.Richard Joseph Bull, the Director of the Bacteriological Laboratory of the Universityand President of the Victorian Branch of the B.N.A.Medical students had but little opportunity, of latter years, of coming intopersonal contact with Dr. Bull, but throughout the whole of their course someidea of the importance of his work was apparent to them. Far more so was itrealised by those who understood in full the extent and value of the activitiesof this earnest and brilliant worker.Dr. Bull was a graduate of the Melbourne University, and his academicrecord is a distinguished one. Through his course he obtained honours, andgraduated with honours in all his final examination subjects. From that timeonward his work was characterized by the true scientific outlook of individualinvestigation. His subsequent appointment to the post he held with such distinctiontill the time of his death entailed a vast amount of routine work : in additionto this, there was the responsibility of controlling the bacteriological work ofmany of the University courses,Despite the onus of this conscientiously conducted task, largely the result ofthe inadequate finances of the University, Dr. Bull engaged in a considerableamount of research work and published many papers, which were always clearand lucid expositions of the careful, rational and sound investigations he hadundertaken.Though running largely in academic and scientific channels, his mind wasby no means devoid of the broader outlook. He was ever an interested studentof general medical problems, and in the several crises, as well as in the moreplacid times, of Public Health affairs, during his lifetime, he rendered invaluableassistance. In his private life, despite the demands made upon histime by his duties, he found time to engage in the recreations and hobbies onewould deem fitting of his cultured and appreciative mind. He had none of thealoofness traditionally associated with a scientist of his undoubted eminence, anda peculiarly likeable personality that is sadly missed by all who knew him.To his family we tender our sincere sympathy. The medical profession haslost one of its ablest and most well-loved members.(lOobification of Cow's (I1)iII in infant jfeebing.BY STEWART FERGUSON.For the intelligent modification of cows' milk for infant feeding, one hasto have some ideas of the essential differences between it and human milk ;cows' milk being designed by nature as specific for the calf and not for thebaby. We have marked quantitative, qualitative, and physiological differences.Considering it first from the two former points of view, the main elementsin both cow's and human milk are the proteids, fats, carbohydrates, and salts.The last item is rather complex, and we will leave it out of consideration in suchan elementary article as this proposes to be, except to point out one thing— thatcows' milk is deficient in iron as compared to mothers'.

28 THE SPECULUM.• As regards proteid. Speaking only in round numbers, cows' milk contains,roughly, four per cent., and human, two per cent., but qualitatively there is alsoa marked difference, as cows' milk contains 3.25 per cent. of casein and about.75 per cent. lactalbumen. Breast milk is composed of 1.4 per cent. lactalbumenand .6 per cent. casein. Thus no simple dilution of cows' milk can make it in anyway resemble human milk.Thirdly, the fat. Both contain, roughly, about 3.5 per cent., but there is avast difference in the character of the two. There is a different melting point,different fatty acids, and a marked difference in digestibility.Carbohydrate.—Cows' milk contains 4 per cent., human 2 per cent., bothlactose, and as far as we know it is the same in both. Let us now consider some ofthe physiological differences. Human milk when swallowed is acted on by therennin and forms a fine flocculent curd, which readily passes through the pylorusinto the duodenum. Cows' milk, when swallowed, is converted by the rennininto hard, tough curds, but not only that, as these curds tend to coalesce theyform hard, solid masses in the infant's stomach. We thus have increasedmechanical difficulty in the food leaving the stomach, a much smaller surface areafor ferment action, and also an entanglement of fats in the curd substance increasingthe difficulty of its digestion. This hard, tough curd formation is aprovision of nature to quickly accustom the calf's stomach to its subsequent hardherbivorous diet. This, however, does not apply to the baby. Cows' milk is aunique food, in that it is swallowed in the liquid condition but rapidly becomessolid.Thus. in our modification of cows' milk for babies, we are faced with theproblem of overcoming these qualitative, quantitative and physiological differences.Next, for a moment let us consider the uses of these various food elements.Carbohydrate is used as fuel and energy for the body furnace, and is essentialto life. Fat is used for the same purpose. It has the added advantage of havinga higher caloric value, but it, unlike sugar, is not absolutely essential to life, andthough highly desirable, its place can, for a time, be replaced by sugar.Proteid is used for the purpose of body-building and repairing tissue waste,but it can also be used for fuel and energy purposes. If there is insufficient fatand sugar in the diet. the main use of the proteid is diverted and it is burnt asfuel or used as energy, and under these circumstances growth and developmentmust suffer. From these facts it can be inferred that our food mixture must beproperly balanced so that each element can be used for its main purpose and bein adequate amounts.At this stage one may point out the marked adaptability of the ordinary babyto changes from its natural feeding, and in the vast majority of cases all that isnecessary is a very simple modification. I will not stress in this article thenecessity of regularity of feedings, the supervision of the size of the feedings,the proper measurements of the additions by medical measures. It is by attentionto such details that one gets success. I will only deal with principles.The most commonly used, and the simplest modification of milk, is simpledilution with water. We may order the baby to start with so many ozs. of equalparts of milk and water. This gives us, roughly, P., 2 per cent. ; C., 2 per cent. ;F., 1.75 per cent. ; i.e., fairly adequate proteid, fat, quite enough to start with,but sugar very low, as compared to our breast standard of 7 per cent. If sucha mixture is given, the child will not thrive, as the combined fat and sugar willnot supply adequate calories for fuel and energy, and the main use of the proteid

THE SPECULUM. 29will be diverted. It may be dangerous to raise the fat much higher, as its digestionis the most difficult of all, and hence the main essential in this simple modificationof milk is to supply adequate carbohydrate, and one aims at bringing its percentageup to near to the 7 per cent. present in breast milk. The following is asimple method of calculation :—One medical teaspoon, by volume, of sugaradded to every 3 ozs. of the mixture raises the sugar percentage 3 per cent.By such a simple method as this, increasing the strength of milk gradually,so that in six months the child is getting milk 2, water 1, and at nine months,milk 3, water 1, always adding adequate carbohydrate, the majority of babies maybe easily and simply fed.However, matters are not always quite so simple, and if the milk mixturesare not agreeing with the child it is necessary to determine the cause of thetrouble in each individual case. It may be due to too large feedings, or irregularityof feeding, or may be due to proteid, fat or sugar disturbance. It is tooarbitrary to make all milk disturbances fall under one or other of these headings,as there is an interdependence between all three, but for purposes of explanationsuch subdivision makes matters easier.Proteid Indigestion.— This can easily be recognized. Characteristic proteincurds are passed in the stool. They are hard and firm, and cheesy in appearance,about the size of haricot beans, and can easily be separated from the rest of thestool. Their passage along the intestine is usually accompanied by colicky pains.The massive curd formation in the stomach means delay in passing through thepylorus, hence there is undue retention of food in the stomach, and consequentlyvomiting is often present ; but not necessarily of curds. The latter may be toomassive to be ejected, and vomitus may consist only of whey.The indications for treatment are obvious. These curds are only formedin the stomach. They are not formed lower down. Treatment is therefore toprevent or lessen this massive curd formation. The simplest method is furtherdilution with water. This has the disadvantage of cutting down the proteidpercentage too much, and the child will not thrive. There is a physiologicalreason for this. The amino-acids, which are most concerned in the growth anddevelopment of the human child, are mainly present in the lactalbumen. Cows'milk proteid is mainly casein, and if sufficient amounts of these amino-acids areto be given, the percentage of proteid to be given in a cows' milk mixture mustbe higher than that in breast milk. Personally, I never use for any baby, at anyage, a dilution of more than equal parts.There are numerous other ways of rendering the proteid more digestible :-(a) Dilution with barley water. Barley water, by virtue of its colloid action,delays and hinders rennin action. Hence a mixture of barley water andmilk remains more fluid in the stomach, and consequently more readilypasses through the pylorus. It also tends to prevent the coalescence ofthe curds by covering them with a sort of slimy coating.(b) Addition of sodium citrate. Here a chemical action occurs, the sodiumtaking the place of calcium in the curd, resulting in a finer and moreflocculent curd.(c) Addition of alkalies. These act by delaying rennin action. Lime waterhas a further action of markedly increasing the porosity of the curd.(d) Peptonisation or Bengerisation. This is, of course, partial pre-digestion.(e) Simmering of Milk. If milk be pasteurised or just brought to theboil, the same curd formation occurs when swallowed as with raw

30 THE SPECULUM.milk. If milk be simmered, preferably in a double boiler, for tenminutes, a very considerable difference is noted in the curd formationin the stomach. It is much finer and more flocculent. In the babies'ward at the Children's Hospital all the milk used is simmered, and forthe last three to four years, during which time this method of treatmenthas been in vogue, no proteid curd has ever been seen in thestools. The advantages of this method of treatment far outweigh itsdisadvantages. Practically the only disadvantage caused is the lesseningof its anti-scorbutic vitamin, and this is remedied many times bythe giving of an adequate amount of orange juice. Its advantages arethe prevention of massive curd formation, the increased surface areafor ferment action, the more ready passage of such a food throughthe duodenum, and also, by making the proteid more digestible, the fatis more easily managed. Certainly less fat is entangled in the meshesof the curd.Fat Indigestion.—Fat is swallowed in the form of neutral fat. Little or nochange occurs in the stomach. In the intestine it is split into fatty acids andglycerine. The fatty acids combine with the alkalies present to form soaps, andin this form fat is absorbed.Trouble with fat may manifest itself in various ways. The more fat present ina meal the longer it is retained in the stomach, hence vomiting is a common symptom.As fat is present in the intestine in three forms, naturally the nature ofthe stools vary with which form is in excess. The stools of a baby fed onstrippings may be full of unaltered fat and appear fatty and greasy to the nakedeye.The usual manifestation of fat indigestion in the baby fed on cows' milkis an excess of soaps in the stools. These may vary in appearance. Constipationmay be present and the stools hard, white and dry, or they may be frequent,of an ointment-like consistency, but of the characteristic white or grey colour.If this is allowed to go on for any length of time there is a mineral drain fromthe body and the child will steadily lose weight and go down-hill.Fat indigestion may also be diagnosed by the presence of an excess of fattyacids in the stools. This recognised by the appearance in the stools of numeroussoft white curds, easily distinguished from the characteristic hard, toughcurds of proteid origin. This form of fat indigestion is not common in babiesfed on cows' milk unless sugars are added in excess. It is characteristicallyseen in breast-fed babies, where we have a food of high fat, high sugar, and lowproteid content.The high percentage of proteid in cows' milk supplies plenty of mineralbases for the conversion of the fatty acids into soaps, so that soapy stools arethe usual feature of at indigestion in babies fed on cows' milk.As regards treatment of . condition. It is obvious that one must reducethe percentage of fat by various degrees of skimming. It must be recognizedthat milk, as a whole, must not be condemned merely because of trouble withone of its constituents. It can be taken as a definite rule that the more digestibleone renders the curd the more readily is the fat managed. A child can oftendigest the fat of simmered milk when it is quite incapable of managing that ofraw milk.It is my own practice, when starting to feed very young babies, to useskimmed milk, making it more readily digestible, and so preventing trouble.The skimming can easily be lessened as tolerance grows.

THE SPECULUM. 31It must also be recognized that skimmed milk is, not fat free milk. Our bestnursery methods of skimming leave 1.75 per cent. of fat in the undiluted milk,Quite enough for the very young infant to start off with.This fact must also be remembered. If fat indigestion has lasted for anylength of time, then the more efficiently fat is eliminated from the diet thequicker will the infant be got to thrive. In these cases we must eliminate milkfrom the diet altogether and fall back on a patent food with a negligible fatcontent. After a time we may very gradually add milk in small quantities, andat a rate varying with each individual case, the child being slowly educated tore-establish a fat tolerance.Carbolivdrate Indigestion.— This is rarely seen in infants fed on cows' milkunless sugar is added in excess, or if, as sometimes happens, the particular childhas an intolerance. As a matter of fact, it is usually not added in sufficient quantity.When added in excess, or if intolerance is present, it causes a watery diarrhoeaof acid stools, excoriating the buttocks. This may hurry the fat through beforeit has time to be converted into soaps, and fatty acid curds may be present.This is often mistaken for a fatty acid diarrhoea, but it is not so. The fatty acidsare simply hurried through by the increased peristalsis produced by the irritationof the excessive sugar acids. As far as the fat is concerned, it is more anon-digestion of fats. Lactose is the sugar normally present in both cows' andhuman milk, and seems in theory to be the natural sugar to add to cows' milkto bring the percentage up to the desired quota. As a matter of fact, it doesnot give the best results. Experience has shown that when given in a cows'milk medium, lactose is the most readily fermentable of all the sugars, and theone most liable to cause trouble. Cane sugar is almost at the same level.In my experience, dextrin maltose, obtained commercially, as Mellin'sFood or Maltogen, is the least fermentable and most readily tolerated of allthe sugars when given in a cows' milk medium. Babies tolerate carbohydratesmuch better when given in a mixed form.The dilution of milk with barley water, in addition to its value in proteiddigestion, also varies the carbohydrate. It, however, does more than this, for insome unexplained way the addition of small quantities of starch definitely aidsfat digestion and sugar metabolism. One must be careful in giving directionsas to the proper method of making barley water. When prepared according toformula it contains 1.5 per cent. of starch, so that if milk is diluted with, equalparts, such mixture contains .75 per cent. of starch, which is the optimum percentageto give the best results.Summing Up. — My more or less routine method of feeding normal babiesis to use simmered milk diluted with barley water, and dextrin maltose addedto bring the total carbohydrate content up to the neighbourhood of 7 per cent.I never reduce my proteid content of the mixture to less than 2 per cent.,and in the very young babies start with partially skimmed milk.Orange juice, i to 1 oz. per diem, given as a routine, and the addition ofostelin is, I think, of very definite value.Uncle Tom is much improvedSince he had those glands removed;And now, bereft of all desire,He sings soprano in the choir.

32 THE SPECULUM.

THE SPECULUM. 33Abe Orem ibat.IN ONE ACT.Scene: Room adjoining bedroom in an hotel in France.Gerald. Why did Boy die? Why did he die? I ask you again, why did Boy die?Sir Maurice. I'll be the mug—Why did he die?Dr. Masters. Gentlemen, I suggest that the answer be put in a sealed envelopeand that a prize be offered.Gerald. Iris—I ask you again, why did .Boy die? Men don't fall out of bedroomwindows They climb in sometimes, but they don't fall out. Why didBoy--. Was he pushed, or did he fall— .Sir Maurice. Quiet, Gerald !Gerald. I can smell lies ! Lies, do you hear? I can smell them!Dr. Masters. Young man, what you can smell is not lies, it isIris. Dr. Masters, what you have to say concerns me alone—.• Dr. Masters. "Fish!"Iris. Boy died for Purity.Gerald. I don't believe it, but say it again, say it again, say it again!Prompt (in loud voice). Purity.Iris. Yes, Purity ! 0 ! can't you see, any of you? Why do you look at me withsuch cruel eyes. Boy died for PurityHilary. Be careful, Iris!Iris. I. tell vou again, he died for Purity. If he had died before this play commencedhe might have been one of the characters, so he died—threw himselfout that window—for Purity.Dr. Masters. Mrs. Fenwick, it is imperative that I see you alone at once.Iris. My God! So soon, Doctor?Dr. Masters. At once !Iris. You must, all of you, go now. Go, please—I am not well—a touch of ptomaine—tinnedfish at the wedding. Go now, please.Napier. Good-bye, Iris. You have made my love dirty as Sodom and Gomorrah,and the dry cleaners are closed till Monday. I will never forgive you.Iris. Good-bye, Napier. Some day you will be the man you might have been ifyou hadn't been the man your father made you.Napier. I must go to Venice. She is going to have another little Gondola, and sheneeds me.Sir Maurice Come, Napier!Hilary. Shall we come back, Iris.Iris. Dear Hilary, dear drear hilarious Hilary. Give Gerald a couple of beers—he has no one to shout for him now, he has lost Bov.Gerald. God, I'm thirsty! Who'll shout? Good-bye, you''re a hard lot.[All exit except Masters and Iris.]Dr. Masters. Mrs. Fenwick, why have you lied?Iris. Doctor, you know?Dr. Masters. Yes, I examined--.Iris. Then, hush, for God's sake don't let the audience know. We have tokeep them here for four acts.CURTAIN.

34 THE SPECULUM.$ibelights on $tubents of the past.A Specuhtm notice last year reminded us that Hippocrates, Galen andCelsus were students in their time and that wine, women and horses intriguedthem, too, implying that we are also interested. Which is quite true.Although I claim some little acquaintance with Hippocrates, Galen andCelsus are no more than names, and so determined to carry out a little researchand see what their courses consisted of—in addition to the distractions mentioned.The results were disappointing, as the only volume available at the timewhich dealt with the subject was as ultra-modern as A.D. 1000. Thoughgaining nothing in the way of enlightenment regarding the more antique gentlemen,the book disclosed much of interest.In the year A.D. 800 the would-be surgeon commenced a seven years'course. During that seven years he was examined in Hippocrates, Galen andthe Arabists. (Text books being few in those days, they were classified bythe names of the authors rather than the subject matter contained in them.)In addition to being required to pass examinations in the above, otherrequirements included the study of anatomy, symptoms of diseases, dieteticsand pharmacy.The actual surgery was not extensive and was mainly confined to "suturing,bleeding and suppurative healing." In later times there developed a beliefthat the practice of surgery was too much akin to rough manual labour andwas not fitting to be engaged upon by refined and cultured men. Surgery fellto the lot of illiterate apprentices, with occasional remissions, when a doctorof greater skill engaged in a little undignified phlebotomy.The study of anatomy was for many years neglected by the student, whodid but little, although the subject was compulsory. Dissections were not doneby students, but in A.D. 1200 it was made compulsory for him to see at leastone carried out.Subsequent to this there is a nominal continuance of the seven years'course, which is, however, rather involved, as the student now has to study"logic" for three years, medicine and surgery for five years and anatomy inaddition. Hippocrates, Galen and Avicenna were also to be studied in thistime, after which one year's 'work' in practice under an "expert" was necessaryfor qualification.The path to fame as a surgeon was not, however, confined to the coursedescribed. There were military surgeons, barber surgeons, and ordinarysurgeons, a separate qualifying system for each existed.The system of the Military Surgeons was simple but rather drastic tothose of slower wit. A student is apprenticed to a Military Surgeon forsix years. He then sat for - his "final" examination. In the event of his failing,he is apprenticed for another six years and tries again. Should he fail, heis never allowed to sit again.Each of these various groups of surgeons united to form their separateguilds and each continued its system with slight changes, owing to differencesand amalgamations, up to the eighteenth century. It was then that the practicaldissection of the human body became increasingly popular, both with surgeonsand students. The difficulty was to obtain bodies, despite the fact that thelaw allowed by grant a few of the bodies of criminals after execution andindigent hospital patients. The supply was totally inadequate for the demandand the custom of "body-snatching" rapidly developed.

THE SPECULUM. 35The favourite method of obtaining a body was to exhume one immediatelyafter burial, and the activities of the "snatchers" became so widespread thatgraves were protected with iron railings and spikes, a remnant of which customcan be seen in our cemeteries to-day.Some enthusiastic surgeons did their own "body-snatching," though mostpreferred to pay on the "i12 and no questions asked" basis of the gangs ofprofessionals.Many actual murders were carried out by gangs of body-snatchers, theunfortunate inebriate being an easy type of victim on a dark night. So thatthe body might be suitable for dissection, the murder was often accomplishedby asphyxiating the victim by blocking up nose and mouth with plaster. Beforebeing caught many of the "snatchers" made up to £50 a day by their ghoulishindustry.Gradually after the weeding out Of the Barbers from the Guilds, a definitebody was formed in 1800, The Royal College of Surgeons. Under a charter,the College was founded as a recognized institution. From this time on, theadvanceiCient of medical knowledge and the collateral development of hospitalsand universities, with facilities for clinical and academic construction, readilyprogressed. This rapidly made possible the establishment of medical teachingon the firm basis on which it now stands."FARRANEE.""CAS."The wide, bare street where quiet cars slide byThroughout the night, is still and desolate,And at its farther end there hangs on highA blood-red lamp behind an iron gate.There is a room ablaze with searching light;The air within its cleanly compass hasA heavy smell of phenol. Stiffly whiteGleam bench and bowl and bandage. This is "Cas."The casualty room, where come the sick,The broken and the drunken and the sad,The victims of the bottle or the brick;Neatly or flashily or poorly clad.A swarthy foreigner, with bloody shirt;Victor or vanquished in a ghetto brawl;A grimy dead-beat, pale beneath his dirt;His shoulder broken in a drunken fall.Here a belated labourer who sawToo late the headlights of the rushing car;And there a boxer with a broken jaw,Limp and dejected, now a fallen "star."A white-clad doctor works to ease their pain,Reporters wait to search each case for "news.""A busy time in Cas. to-night again,There must be something here that we can use."—From Smith's Weekly.

36 THE SPECULUM.• Cbe Creattnent of Eztablisbeb 1Rbeumatic Carbitio.BY H. HUME TURN B ULL.This term is employed because in the heart affected by rheumatism thereis usually involvement of all or most of the structures of the heart. The endocardiallesions are the most obvious and the myocardial damage is frequentlyoverlooked, though it is really the most important.One of the main difficulties is diagnosis, and it is very hard to determinewhether mitral systolic murmurs, which occur during the acute disease, areindicative of valvulitis or are merely due to mitral leakage from temporarydamage to the muscle surrounding the mitral ring. The accurate diagnosis isin many cases impossible, for it is most probable that whether there is avalvulitis or not, the earlier murmurs are always due to muscular weakness.It seems best, therefore, to disregard this question in deciding on the methodof treatment. Probably the extent of the valve lesion is not affected by theactivities of the patient, provided these activities do not increase the rate ofthe heart, so that if the rate remains slow there need be no hesitation inallowing movement even if the valves are inflamed.If this view be accepted, the problem is simplified, for the only essentialis to be sure that the heart is not beating at more than a normal rate, thatthe temperature is normal, and there is no recognisable dilatation. If allthese are satisfactory, the patient can safely commence exertion.If we do not accept this proposition we must keep the patient at resttill we are sure that there is no active valvulitis, which will certainly mean along period of rest in bed ; and as there is no accurate method of determiningwhen the acute stage is passed, there would always be great doubt, and probablymuch unnecessary delay.I have always adopted the first plan, and let the patient up when the febrilestage is clearly passed, the heart is not dilated, or is obviously not going toget smaller and the pulse is below 80; even if a valvulitis seems probable. Atthe same time, the position is explained to the parents, who are warned thatsome months may elapse, perhaps a year, before a definite opinion can begiven as to the state of the valves, but that the more important question ofthe condition of the muscle will probably be clear by that time. If the musclehas largely escaped damage or the damage is recovered from, it is doubtlessnot only unnecessary but harmful to prevent the patient from taking exercise,which would certainly be beneficial to his general musculature and probably tocardiac muscle as well.It is generally impossible to keep a child quiet in bed unless he is veryill, and I think that he is a good judge of the amount of movement whichhe should have. Of course, in very severe pancarditis with extreme dilatationand orthopnoea he must be kept rigidly at rest, and spoon-fed. etc., but in thiscondition the child will adopt this attitude himself without restraint, and anyrestlessness is an index of the severity of the disease and may require evenmorphia for its control.In milder cases no good is done by worrying the child in an endeavourto keep him still, but he may be frightened into a state of apprehension, whichis very hard to treat afterwards. His gradual resumption of normal activityis a good mark of improvement. In this stage drugs are of little use.Sodium salicylate in good doses should be continued, as the disease maybe smouldering in some focus and ready to break out again. Exacerbations are

THE SPECULUM. 37common even while in hospital ; but it is unlikely that it has any effect onestablished valve lesions. How long it should be continued is a matter ofopinion, but there can be no harm in giving it so long as the child is kepttinder close observation, and it often seems to be of value in maintaining healtheven in convalescence. If any tonic is to be used, arsenic seems much moreeffective than iron ; indeed, the latter appears to do more harm than good.It has been claimed that digitalis will aid the production of muscular hypertrophyand so diminish the harmful effects of such lesions as aortic stenosis,but the evidence is slight and unconvincing, and cases in which it is not usedappear to reach an efficient level as soon as those who take it.Sutherland showed, that in some cases, digitalis slowed the rate of rheumatichearts whose rhythm was normal, and maintained this slow rate evenwhen they were going about, and he ascribed this to a specific action on thepacemaker, but his results have not been obtained by other observers.Digitalis is of undoubted value where congestive heart failure threatens,but in other cases the results of its administration are disappointing. Care isnecessary to be sure that the slowing produced by digitalis is not due to heartblock, as the drug will exaggerate a defective conductivity due to myocardialdamages, and may thus cause partial block with ventricular slowing, but notrue slowing of the sinus rhythm.Broadly speaking, we may divide cases which survive the acute periodinto three classes, of which the special features of the first two may be rapidlyreviewed, the third being the commoner and important one.(1) Those with an obviously hopeless outlook, in whom failure is definite,or in whom short periods of moderate comfort are followed by failure Withoedema, etc. Here it seems unkind to insist on full rest in bed over longperiods, as this can not be expected to do more than prolong a miserableexistence, and if the child can -enjoy himself out of bed, it is better to lethim up. He will not be inclined to attempt any active exercise, but may beable to potter about happily for a few weeks, before increasing failure sendshim back to bed for a period. A year or two of miserable existence is all thatcan be expected, and one's efforts should be spent in making him as happyas possible, even if the inevitable end be hurried a little.(2) Those in whom the outlook is uncertain, and in whom there are signsof serious damage and definite inefficiency is very easily induced. Such patientsshould be given long rest in bed, three or even six months may be desirable,though, of course, in the later months a fair amount of latitude is allowed.If there is a history of tonsillitis at the beginning of the attack or if the patienthas had frequent sore throats or the tonsils are infected, they should be removedat an early date. Anaesthesia at this stage entails no risk. There is plentyof sound muscle left to provide a reserve which will be found more than adequateto combat any slight extra strain, and no harm results to the patient,while the removal of a definite focus, from which toxines may be absorbed,is probably of real value. In these children moderate doses of digitalis maybe useful ; and if sleep is disturbed or the child is excitable, bromide mayhelp, combined with arsenic. When the pulse rate has fallen to about 80, andespecially if sinus arrhythmia is definite, the heart's size is fixed and the temperaturenormal, the patient may be allowed up. If after a long rest the pulseis still rapid, but other signs have for long been stationary and the temperaturenormal, it is wise to let the child up, carefully noting the result. In a goodproportion of cases it will be found that the pulse rate falls when the child

38 THE SPECULUM.goes about, and provided there is no definite rise careful progress in exertionmay be continued. If the temperature rises again, if the heart dilates, or ifthe pulse rate increases, he should return to bed for a further term. Also ifhe complains of fatigue and shows no inclination to run about, there is probablystill an active infection and rest must be continued. Apart from this fatigue,which results from infection and is not a true cardiac symptom, very littlehelp will be got from symptoms. If shortness of breath, pain, omlema, etc.,are apparent the state of the heart is really bad, for they are quite unusualat this stage in children who make a satisfactory recovery, though in adultsfair recovery is sometimes seen where such symptoms have appeared.These cases from this point tend to range themselves definitely in one ofthe other two groups. If symptoms continue, failure progresses and life is notprolonged more than a few rather miserable years ; but in many cases a fairdegree of efficiency is reached and the patient grows to adult life. Probablyin most of these, continued restrictions are necessary, and final failure setsin before 35 years of age, but in others the damage remains stationary and agood deal of effort may be possible.Patients, who are seen in middle life with efficient hearts in spite ofvalvular lesions, will usually be found to have shown no symptoms after theacute attack, and will often have been capable of normal exertion during youth,the failure, if any, setting in about the middle or end of the fourth decadewhen arterial and muscular damage normally begins to make itself felt, oras a result of auricular fibrillation.If the child is quite comfortable when he sits out of bed, temperature andpulse are normal, and he feels well,. he should be allowed to run about anddo what he likes in a quiet way, but for the first week or two it is betterthat he should not be allowed to romp with healthy children. The pulse ratewill, of course, rise if he hurries, and often when he is examined by thedoctor, but if the routine counts by nurse or mother are normal and he showsno discomfort this can be neglected. In these circumstances he will not overexerthimself, in fact he will usually want to do more than his nurses allow.After a week or two of restraint he can be allowed to play with other children,under a promise to stop when he is the least tired, but must not be allowedto take part in any team game, or any competition which would tempt himto go on in spite of •symptoms. If all is well, he will do all this easily, andif he is found to avoid such exertion it is certain that he finds it distressingor that he is afraid of the consequences. This fear is, of course, due to suggestion,usually from the parents but sometimes from the physician, whoseanxiety may be accepted by the child as a bad omen. Children are verysensitive to such suggestions and are usually very intelligent, so that it is wiseto explain the position to the patient before he is allowed out of bed. Tellhim that the disease has affected his heart, but that it has become stationaryand has left plenty of good heart muscle to carry him through life if he isreally careful now. Insist On the fact, and it is a fact, that nothing dramaticwill happen even if he does exceed, but that it will delay his full recovery andmay mean a longer rest. Tell him, if the condition is hopeful, that we expecthim to be able to play all or most games and to be able to forget his heart,but that he must "play safe" at first. If this is pointed out, the child will behappy and confident, and is then a first rate witness. He will play hard ifhe feels fit and any shirking of games which he used to enjoy is very significant.

THE SPECULUM. 39The parents are often a more difficult problem, but their education is perhapsthe most important part of the whole treatment of the case. They arenaturally very anxious, and they have the usual idea that any heart conditionmust mean invalidity with the prospect of sudden death. They also thinkthat examination will at once reveal the presence of a lesion, and that itsimportance will be evident. Therefore, the practitioner should take them intohis confidence from the beginning, and a few careful clinics to the parentswill not only be appreciated by them and give them confidence, but will savethe physician much trouble, and frequently prevent mistrust and misunderstanding.It is wise to start by showing how the early systolic murmur arises, andpointing out that it occurs just as freely in cases where endocarditis is absentas where it is present. Show them how all murmurs may be absent and yetthe valves may be affected, though this lesion may take months to reach adegree of deformation which will produce a murmur. Many excellent illustrationsare seen in chorea. Point out to them that hearts which show dilatation,loud murmur, and even pericarditis in the acute stage, do sometimes recoverwith no trace of permanent damage, and that an early prognosis in them wouldbe entirely erroneous. Mention, but do not insist on, the opposite type of case.where an apparently mild infection continues for months in an almost subacuteway and causes irreparable damage in a case which seemed slight atfirst.Finally let them know that about twelve months must elapse before areally reliable diagnosis and prognosis can be given, but that a fair guess canbe given earlier ; and many people do ask for such a guess.I would stress the importance of not letting them think that the firstopinion is more than that, as if it turns out to be false the physician will beblamed, whereas if it be true they will suppose the problem was simple. Fewpeople, in my experience, ,will refuse to wait for a correct forecast if the problemis explained to them, and the explanation helps them to understand thesafety and necessity of gradually increased activity even before the whole truthis determined. If the parents do not understand, they arc usually excessivelyworried at first, and worry and frighten the child by constant over-control,and then they gradually get used to it, and allow uncontrolled exertion, orforbid all sports and pleasures, though many, unpleasant tasks are allowedor even forced on the patient. In hospital out-patient practice one often findsthat the child is forbidden to play, but is frequently sent messages. If thechild can play with his fellows with enjoyment and without any undue fatigue,he may he allowed to extend his activities, until he is playing all ordinarygames, but if a definite lesion is present it is wise to forbid the more strenuous,such as rowing, football and running. The objection to these games is that,once embarked on a contest, the boy feels that he must continue to the end,and even if distress is quite evident to him he will probably push on, knowingthat any shirking on his part may cost his side the match, and in this wayhe is quite likely to do damage to the heart muscle which will leave permanentweakening. Also these games are of no interest apart from competition, andare unlikely to be of lasting value to him, so that no great hardship is entailedby their omission. It is of the utmost importance, however, that he shouldnot be deprived of all games, and nearly all patients who have sufficient cardiacefficiency to allow them to lead useful lives, will be found able to play the

40 THE SPECULUM.less exhausting games with both pleasure and profit. Many children are forbiddenall active interests, who could quite well be allowed some relaxation,and it will usually be found that they indulge in considerable exertion withouttheir parents' knowledge and are therefore more likely to conceal any symptomsuntil these are quite severe. Of course, in a few cases the damage isso slight that all restrictions could well be lifted, the efficiency being normal ;but so little is lost by omitting really severe strains that this safer policy isadvisable, and the boy will usually acquiesce quite readily, if the position isexplained to him.The parents should be advised in every case to have the child trained forsdme sedentary or at least physically light Occupation. Even when he is ableto indulge in really vigorous games, he is ill advised to deliberately undertakea hard or rough mode of life. Such a life probably entails risks of exposure .and, therefore, recurrences of rheumatism, and further, it is important thatphysical exertion should be lightened if any symptoms appear or if the patientis suffering from any poisoning, e.g., a cold, and this cannot be done if hardwork is inseparable from his means of livelihood. If, on the other hand, hecan obtain great decrease in exertion by merely stopping his amusements, heis in a much sounder position.In the case of girls an important question is whether marriage and pregnancyshould be permitted. We can clearly state that it should not be forbidden,for the only risk is that harm may be done to the patient's heart,and if she or her husband know this, and are prepared to take the risk, thereis no more to be said, for rhetiinatisin is not a disease which will necessarilyaffect the offspring. If the girl has symptoms of cardiac inadequacy beforemarriage she will most probably find that pregnancy will increase them andthat each pregnancy will diminish her cardiac reserve and hasten the finalfailure.If auricular fibrillation is already present, pregnancy is inadvisable, thoughinduction is not necessarily essential, for many cases can be piloted through safely ;usually they are damaged by the strain. If pregnancy has occurred, the questionof induction of labour or abortion is difficult and is a fresh problem ineach individual case. In the earlier months, there is little risk in induction,acid if symptoms are appearing and the patient is anxious for termination, Ithink her Wishes should be studied, as the risk to her is undeniable. If sheis anxious to go to term this 'can usually he safely accomplished, even inquite severe cases, though in these she has to live very much the life of aninvalid. In cases where symptoms were absent or only mild before pregnancy,this is usually carried through easily.Iri the late months it will usually be found that little is gained by prematuredelivery. Having passed through so much, the heart can stand the little extrastrain required to produce a full tine child, though the patient may have tolie up altogether. If the condition is very bad Caesarian section with generalanaesthesia; or if this appears dangerous, as it rarely will, with spinal anaesthesia,is probably the safest, and the opportunity may be taken to sterilisethe patient if she desires it, for such a case would probably be quite unableto survive another pregnancy.It is well to remember that heart failure in children and young adults withrheuniatic carditiS is nearly always due to a fresh rheumatic infection, evenif this is not evident clinically, and the case should be treated accordingly.Digitalis 18of great value while the tedema is present and the failure severe,but later salicylates should be used freely.

THE SPECULUM. 41I have not discussed the diet in such cases, because, so far as our knowledgegoes, it does not merit discussion. A full, ordinary, commonsense, dietis all that is required; the chief fault to guard against is overloading of thestomach with fluid and carbohydrates. The parents feel that a light diet shouldbe given and so will often fall into this error. During the febrile stage, ofcourse, small light meals are needed, but after this is over any reasonable dietis satisfactory and no restriction of meat should be permitted. The bowelsshould he kept open, and straining at stool avoided.fnebiCOPFISZi011.The awful result of an attempt to combine Medicine and the Muse.I am dreaming of you, my long lost love,(For reference to asthMa, see above.)When we roamed together 'neath desert skies.(For treatment start to desensitize) .Your white throat throbbed your passion song(Initial injections must not be strong)Of an Arabic love that never wanes.(13e sure to avoid the smaller Veins)Your lips met mine—a scarlet thread—(If reaction starts the skin goes red),And yOur eyes held mine in steadfast lock(In cases of anaphylactic shock) -as they hold me still, our souls are kin;(Minims five of adrenalin)Though you are lost, rethenlber shall I,(Always keep some handily by)Though memory now is a hitter delight.(Speedily puts the patient right)."K."The cabled report that a Californian scientist has succeeded in fertilising seaurchins'eggs by means of a substance discovered by Dr. T. B. Robertson, of AdelaideUniversity, recalls that similar experiments several years ago caused considerableexcitement along the Pacific coast. In fact, one spinster, on reading that biologistSwere pouring oocytin into sea water to fertilise sea-urchins, wrote to a newspaperinquiring if she incurred any risk in taking her daily swim.

42 THE SPECULUM.Clinic from %atan.(All the names mentioned in this story are purely fictitious. Should any person'sactual name occur, it is purely coincidental.)He must have moved with unusual silence, as I was unaware of his presencetill he touched my shoulder. I looked up from my work with a start, andsurveyed him in silence. I did not like him much, I decided. His nose wasover-developed and his ears somewhat pointed, while in his eyes was a lookof diabolical cunning. I have seen such a look in only one other place—theface of the Resident as he says : "Would you like to do a lumbar puncturethis morning ?""Oh, delighted," you blushingly reply."Splendid, old man," says he, with an exacerbation of the facies. "Andlook ! If you have time there's a couple of blood counts and a bladderwashout upstairs."But I have deserted my visitor."What the devil " I began, trying to think of something crushing andwishing I'd been more attentive in Sid's"Your humble servant," he replied, with a graceful bow."The devil you are," said I, using my M. caninus strongly."I am the Devil," said he, seeing my misapprehension. "I was wonderingif you would like to see over Hell.""Well," I replied, with suitable hesitation. "You're very kind, I'm sure.But it's putting you to too much trouble.""Not at all. You're very welcome.""Righto," I said. "I'd love to come. How do we proceed ?""It will be a little difficult," said he. "But you can do it if you try. First,read Infant Feeding in Hutchison and in Still. Then read it in Eden andcompare and contrast it with the views of the In-patient and Out-patientHonoraries and with those of Ian Wood. Then you will find yourself in Hell."And he was right."Now," said the Devil, "I was thinking that this morning we might runover some of the methods of punishing the members of your profession. Now,if you will look over there you will see a splendid specimen."I looked in the direction indicated and saw a hospital ward. Every bedwas filled. The Honorary was doing his round and with him the Residentand Sister. As I watched he raised his face to the sky, and beat his fistsupon his temples."Who is he?" I asked."He," replied the Devil, "is .the Honorary Who Lectures till One p.m.As you see, in Hell he has no Students whatever to clinic to, yet every casein the ward could be cliniqued on for hours. In the first bed, for example.is a man showing Rach's sign, Bamberger's sign, •Broadbent's sign, and Friedreich'ssign. In the second bed is a man with hwmaturia, melaena, luematemesis,heemoptyis and epistaxis. And so on."At this moment the Honorary gave a strangled groan and fell across thebed. His shoulders shook with convulsive sobs."What is that?" I asked."That," said the Devil, "is a case just admitted and no special testshave yet been done."

THE SPECULUM. 43"What does it show ?""Splenomegaly."We passed on and left him to his grief."Now," said the Devil, as we approached a group. "These should interestyou. They are Students. There, for example, is the False Passage King.""And what is his punishment?""Every morning he is filled with fish hooks through a suprapubic cystostomywound. This is closed with catgut and S.W.G., and by evening all must beevacuated per urethram.""It would appear," I remarked, "that in Hell, the punishment does notfit the crime.""How do you mean?" asked the Devil."Well," I replied. "According to the Mikado's views the Honorary WhoLectures till One p.m. should have to listen to Neville Wilson at a ClinicalMeeting, while the False Passage king should be catheterized by Arch Aitken.""I see your point," said the Devil, kindly. "But it could not be uniformlyapplied. What punishment, for example. would fit the crime of the HonoraryWho Commences at 8.30 Sharp?""Well, what do you do with him?"I asked. "Surely he is here.""He has a special location," said the Devil. "Would you like to see him?Or would you rather see the Concussive Percussor, or the Man with ColdHands ?""I think I'd rather see the Honorary.""Just as you wish," said the Devil. "I will explain as we go along. Thisparticular shade has to get 75 per cent. attendances. There are 9 gone, ofwhich he has missed 2. Therefore he must get the tenth and last. Ah! herewe are!"I looked and saw dimly (for it was early morning in this location) ahaggard form hastily bolting food. Before him, as he ate, lay a Choyce anda Price, and both he feverishly scanned. An alarum rang and, dropping hisknife and fork, he dashed from the house. A little later he returned for his"hat, then again for his book and yet again to fill his pen. Then, by a suspensionof Nature's laws, I was enabled to see him running to the stationand arrive there shortly after his train., I saw him get his name taken,because he had forgotten his ticket ; I heard him groan as he viewed the vastexpanse of road at Prince's Bridge, innocent of trams ; I watched him collidewith a bicycle (Teddy Gault in the saddle) as he tried to beat the trafficat Bourke Street.Breathlessly he arrived at the deserted students' room. It was empty ! Nohats nor coats ! With fear burying its fangs in his vitals he was able todrag himself to the Notice Board. Then, having ,read the scrap of paper,he collapsed, insensible, on the floor.I, also, was able to read the message. It said :"Dr. McMeekin will not be able to lecture this morning."I turned to the Devil, tears springing from my eyes."Poor fellow !" I sobbed. "Alas ! poor fellow ! His punishment is hardto bear.""PSORIASIS."

44 THE SPECULUM.Ebe $tuby of Anatomy.By A. E. COATES, M.S., Acting Professor of Anatomy, Univ. Melb.In commencing the study of Anatomy the student is often bewildered bythe nomenclature. An entirely new language would appear to he necessary.This, however,. is not the case. Any student with a passina knowledge of Latinand Greek derivations will easily understand the terms which, 6 fortunately, nearlyalways give some indication of the function of the part, e.g., Serratus Anterior,a muscle with a serrated edge lying anteriorly. This suggests at once thedigitations or finger-like processes by which it takes its origin from the ribs.Deltoid, Triceps, Sacrospinalis, Sternocleidomastoideus, Quadriceps Femoris,Trapezius, Risorius, are all names which indicate either the shape, bony attachmentor function of the particular muscle. Hepato-duodenal Ligament, PhrenicocostalSinus and such like terms further exemplify the manner in which theattachment or general arrangement of the part is indicated by the name. Everystudent of Anatomy, especially in his early years, should attempt to make thebest use of terminology. Let every name mean something to him.The study of Anatomy is undertaken by two methods. First, we maydescribe the various systems of the body in detail independent of their relationsto other structures. This is Systematic Anatomy, and is the method adoptedin the text-books such as Cunningham and Gray. Second, We may study thestructures in relation to their neighbours, so-called Topographical Anatomy.This method of studying structures and their relations is necessary to thesurgeon, who must be able to identify everything he sees in his dissection.He is often enabled to do so by noting the relation of one part to another.In disease, symptoms are often produced by the interference of a diseasedorgan with the correct functioning of another adjacent to it. This is wellillustrated in an Aneurysm of the Arch of the Aorta—a swelling of the vesselstretching and distorting various nerves and other structures in association withit, and producing syniptoins remote from the actual site of the disease.The study of the relations of the organs one to another is therefore offundamental importance in the practice of Medicirie, as well as iii the operationsof Surgery.In the second year of the course students are well advised to become conversantwith Systematic Anatomy and to learn as much of the Topographicalas possible. The topography of the Limbs must be known in detail. In thethird year great stress is laid on topography of the Abdomen, Thorax, Head,and Neck. Do not neglect the Macroscopic appearances and Relations of theCentral Nervous Systeni in the study of the intricate complexities of tractsand nuclei.The essential Method of studying topographical Anatomy is Dissection.This cannot he emphasised too much. It is impossible to visualise a structurein three dimensions. HenCe, although atlases, diagrams, museum preparations,etc., are very useful as an aid, they can never take the place of carefuldissection. It ought to be remembered that probably for rhany, this will bethe last opportunity for years for thoroughly dissecting the hotly. For manyit will be the only chance ever presented for exploring every nook arid crannyof the structure the diseases of which will be their chief concern. Then dissectcarefully and learn to observe. At this stage one must emphasise the Junctionalregions of the body. Too frequently each part is dissected separatelyfrom the other, and the regions which are of very great importance in Medicine

THE SPECULUM. 45and Surgery are only understood in a hazy manner. The junction of the Neckand Thorax, Pelvis and Thigh should be studied in the dissecting room bythe dissectors on the respective parts co-operating as freely as possible. Anotherhabit to be commended is that of constantly referring to the bones aseach structure is exposed, noting impressions produced on the latter by thesoft parts. One learns to identify bone markings in an intelligent mannerand the haphazard cram before examinations is dispensed with. The impressionsone receives in the dissecting room will live in the memory long afterthose from books have faded. Vision is aided by other senses, hence the ritorelasting impressions.Embry'ology is a branch of Anatomy which cannot be too closely studied.The origins of the various parts, their development to the fully formed organprovide a very interesting story and throw a flood of light on the many congenitalabnormalities later met with in practice. Also much topography canonly be understood by a correct appreciation of Development. The descentof the Testis and Hernia, the Peritoneal folds and relations of abdominalviscera are well-known examples. Good Anatomists THINK EMBRYO-LOGICALLY.Histology should receive careful attention. The function of an organcan frequently be inferred from its microscopic structure. The similarity instructure of the Prostate and Mammary glands suggests a like function. Theformer produces a milky secretion as a vehicle for the spermatozoa. Thereis some similarity in the histological appearances of most secretory organs.Osteology. In studying the bony framework of the body one must notforget the ligaments which hold the bones together and the cartilages takingpart in the formation of the joints. Dissections cannot be appreciated withouta thorough knowledge of the Skeleton.Bony landmarks are of great value in mapping out on the surface of thebody the structures which lie beneath. They are the key to Surface Anatomy.In fractures and dislocations the surgeon recognises certain bony pointsand, knowing their normal relationships, he can by observation and measurementascertain the presence of any abnormality.As examples of the importance of the same to the physician, there arethe relations of the angle of the sternum to the second costal cartilage, theangles of the scapula to the ribs enabling him to count the ribs even in afat subject. In mapping out the lungs and heart, in lumbar puncture, inparacentesis thoracis and abclontinis, the physician requires some knowledge ofbony landmarks.Certain mechanical principles observed in engineering are found in theskeleton. Consider the lattice-shaped arrangement of the bone lamellae in thevertebrae and the neck of the femur. In the former the strong lamellae arelaid on edge and are comparable to a series of beams laid edge ways. It iswell known that they are more resistent to strain in that way than if laidon the flat. The layers of bone in the head and neck of the femur form arches.The arch is a recognised device for supporting weight. Why does the neckof the femur not crack under the body weight? Struts and ties of bone lamelloeattached to the inner wall of the cylindrical shaft receive the chief pressureson the head of the thigh-bone. Interlacing layers act as supports one to theother, and no better mechanical appliance could be devised. The ordinary jibcrane is designed on that principle. This remarkable contrivance supports thebody weight year in and year out, and more astounding still is the fact that

46 THE SPECULUM.the army of osteoblasts, which are present in the bony layers, are continually,during the growing period, laying down new bone on the upper surface, andan army of excavators are cutting away old bone from the under surface ofthe head and neck. In other words, it is continually being remodelled duringthe growing period. The same standing army of osteoblasts are reinforcedby many thousands of similar workers should the bone break accidentally. Thesemaster builders very quickly repair the breach and remove the debris. Here,however, we are in the domain of Pathology. Again the tubular structure oflong bones is that best calculated to combine strength with lightness, c.f., theiron tubes used in the framework of a bicycle. The levers in the. body, suchas the limb bones, are strong enough to withstand a load ten times heavierthan they are called upon to bear in their usual work. Note the arrangementof the pelvic bones. The Ilium lies in a plane at right angles to the Ischiumand Pubis and thus a bracket is formed. In the centre of the bracket theAcetabulum is situated and at the inner side of the junction of the two setsof bones there is a thick strut, the Ilio-pectineal line. The tendency of thebox-like arrangement of the pelvic bones to fall in by the weight of the bodybeing transmitted to the thigh bones is thus resisted. Again note the mannerin which strong ligaments sling the sacrum between the two iliac bones, tendingto draw them together when the weight of the body pushes the sacrum downwards.The shock resisting mechanism of the body as represented in the archesof the foot and the cartilaginous buffers of the spine provides a system whichis not to be equalled in any modern engineering device.The lubricating system is well illustrated in ' the joints. Why do not theapposed surfaces of the Tibia and Talus wear" each other away in the act ofwalking? Friction is constant with every step we take and the weight ofthe body presses the lower end of the Tibia on the upper surface of the Talus.The explanation is easy. Each bone is covered by a layer of cartilage. Thismaterial is elastic, if flattened out it springs back to its original shape. Pressureof a similar kind elsewhere in the body causes atrophy or death oftissue from stoppage of its blood supply. But cartilage has no blood vesselsin . it, so that pressure does not so damage it. Tt derives its nourishmentfrom the vessels in the neighbouring tissue.The fibrous tissue around a joint, i.e., the capsule. is lined by a smoothlayer, the synovial membrane, which has the power of secreting a lubricatingfilm of fluid, constantly keeping down the effects of friction. The whole ofthe interior of the joint is thus admirably adapted to reduce friction. Fringesof tissue seen in the knee-joint, for example, serve as absorbers returning theused "oil" into the body. No drain pipe is needed in a joint."Seizing" does not occur in a healthy joint, but should disease attack thejoint and the lubricating mechanism break down, then the parts "seize" in thesame way as an unlubricated motor engine. A similar lubricating system isfound in the Pleural, Pericardial, and Peritoneal cavities, movements of theorgans proceeding without friction.Enough has been written to show that there is room for imagination inthe study of Anatomy. One can proCeed always by comparison and analogyfrom the known to the unknown, the essential method of learning anything.The student would do well to look for laws and generalisations in the body.Such a law as that of Hilton prepares us for the clinical phenomena met with

THE SPECULUM. 47in disease. C.f., the wasting of the Vastus medialis in lesions of the kneejoint.A good exercise is to apply the rule to all joints and see how it worksout. Lymphatics follow great veins and the superficial course of lymphvessels can be marked on the surface with ease if one bears in mind that fact.Sympathetic nerves follow arteries as a rule. These nerves belong to anetwork which have to do with the automatic system in the body. It is thesystem for routine and emergencies, in which there is not time for the issueof instructions from General Headquarters in the brain. It acts then largelyreflexly. It is responsible for the adequate safeguarding of the individual inemergencies such as flight or fight. What more natural than that it shouldstimulate the pupils to dilate in order to increase the vision, accelerate theheart, raise the blood pressure ensuring a free supply to the brain, inhibit thewalls of the gut and contract the sphincters retaining food in the bowel asfurther supplies are precarious ; stimulate the sweat glands to enable eliminationof heat, increasing the exchange of CO, and oxygen.It will now be realised that the study of Anatomy implies the study ofstructure, an appreciation of which can only come through a knowledge of thefunction of the part. Anatomy and Physiology are no longer subjects to bekept in water-tight compartments. All structure must be interpreted as faras possible in terms of function. It is only by this means that reason is calledinto play. The picture of two students standing by a cadaver, one vociferouslyreading from the text-book while the other scratches away with a blunt scalpel,at intervals glancing at the clock, will become a relic of the past.Form is determined by function. Study the body, not the book. Usethe latter as a guide only. -For senior students and graduates much help can be derived from thestudy of Comparative Anatomy.Finally it cannot be emphasised too strongly that the student should drawhis dissections. Much may be learnt by committing to paper or to the blackboardwhat one has seen with the eye. Difficult points will be cleared up andstimulus be given to further dissection. An aid.to the memory is also developedby the act of drawing the part dissected.Space does not permit one to dilate on the marvellous telegraphic systemrepresented by the nerves and the telephone exchange in the skull, the ventilatingbellows in the chest, the assimilating and digesting factories in the abdomen;but enough has been stated to remind students that Anatomy is nota dry-as-dust subject to he crammed for examinations and then put aside, butthat even the unclothed skeleton is full of interest and meaning and furnishesa basis for the sound study of the function of the human machine.(c; 71ti,DcWhen Tommy was a little boyHe contracted tonsillitis.Later there came rheumatism—And with it some nephritis.When Tommy grew to man's estate,Much to his consternation,The lining membrane of his heartShowed signs of inflammation.

48 THE SPECULUM.Cbe LDtcarious YElopement.This is the tale of the Senor Don Rodriguez De Santiago y Marta, Intendantof Royal Property in the Indies ; of the Dona Clara his wife; and of youngRamon de Soto of the Garrison. Being a tale of old Spain, it is full ofthe limelight of Romance ; it also goes to prove that because a man is ahusband, he is not necessarily a fool. Now, listen :-The Lord had blessed Don Rodriguez with many blessings. He hadbestowed on him rank, wealth, and honours, and more than the usual lengthof days : but lest he grow vain of such good fortune, had granted him for awife the veriest shrew in all Castile. Wherefore, though Don Rodriguez'sdays were roses, his nights were Purgatory itself.Now, it befell that the King gave a ball, and among the guests were theIntendant and his amiable spouse. Also a guest was our young friend, ElCapitan Ramon de Soto, in garrison in Madrid after the fatigues of theEnglish war. Of the latter gentleman, history records little save a good presence,an empty purse and a susceptible heart.This same susceptible heart of the Captain's received a more than usuallysevere shock at the Court Ball. Moving among the dancers (alas ! in thearms of another) he perceived the fairest woman on whom his eyes had everrested. Senor de Soto lost his heart upon the spot. Turning to a bystander,he demanded the name of the ravishing fair one. "Oh," was the careless reply,"do you mean the charming Dona de Marta, whose graces are the talk ofMadrid?" The casual words seemed to sound the knell of de Soto's newbornromance, for he knew none in Madrid from whom he could seek anintroduction, and a penniless infantry captain could scarce force himself.unpresented, on one of the great ladies of the land. Hurriedly quitting theball, he went to ruminate on his passion in secret, and to devise the next move.Denied the opportunity for direct approach, the infatuated young manventured to write of his adoration to the lady of his heart. This might havehad serious consequences for himself, for in that century injured husbandswere wont to exact satisfaction in no half-hearted fashion. But fate waskind to Capitan de Soto. If there was one thing the Intendant's wife craved.it was admiration. The letter of her new adorer filled her with utmost delight.Only to fancy, here was a whole intrigue, all to herself ! So she hastenedto reply in encouraging terms, and as such were beyond her powers of originalcomposition, the works of some good dramatic authors were Myoked to supplythe adequate phraseology.As the summer ended, the correspondence increased in tenderness andfrequency. Debarred from actual association with his lady. Ramon pouredout his whole passion upon paper, and surely was lady never so wooed andwon before. At last, her constant laments on the harshness and tyranny ofher elderly husband had the effect of driving de Soto to undreamt-of lengths.He proposed—and what he risked in so proposing she did not guess—thatthey should flee together. The mundane problems of what they should flee upon.and whither they should flee, were beneath the notice of the ardent wooer. ButDona Clara was less impetuous, and had no mind to desert rank and comfortfor the great unknown. Her terms, in fact, were : no money, no elopement.For a while Ramon was in despair, and the romance languished.Then fate was again kind to the Senor Capitan, and it was by an oddlyPuckish turn of chance that the sinews of war were indirectly supplied by the

THE SPECULUM. 49good Intendant himself. An officer being detailed to treat with the departmentof the Indies in the matter of some rationing returns, it was so ordained thatthis duty fell to Capitan de Soto. At once, as it seemed, an affection grew uuon the part of the .elder man for the younger. It was at the instigation of theIntendant that Ramon was appointed to the highly lucrative post of Commandantof Hispaniola in the Indies, receiving at the same time a quarter's payin advance.All was now clear for the project. The Intendant's household had withdrawnto Malaga for the winter season, and thither de Soto betook himselfupon some trivial official concerns. Dining with the Intendant, he had thesupreme felicity of seeing a mantilla fluttered from a closely shuttered windowas he quitted the house.It was Ramon's desire that, when flee he did, the Intendant should neverguess with whom he had flown. This was mere prudence, for in such cases,husbands often prove vindictive, and Commandants of Hispaniola are unmadeas easily as made. He therefore planned that his fair inamorata, attendedonly by her duenna, should slip out of her husband's mansion on the very nightof the sailing of the Indies fleet, which bore Ramon to his new command. Atrusy servant of his own would convey her to the port ; he himself wouldmeet her there, and a plausible story would be concocted to explain her presenceon board ship. In Hispaniola, across three thousand miles of sea, it was extremelyunlikely that news of the abduction of the Intendant's wife shouldever arrive. Even if it did, there was nothing to connect Capitan and Donade Soto with the event, for the Capitan had never met his lady in personsince the night of the ball, when not a glance had passed between them.It was a dark, overcast night when a trusted agent of the Capitan ushereda closely wrapped female figure into a closed carriage, and drove furiouslyout of the Intendant's park on to the Malaga road. Clattering through thetown, they arrived at last at the quays, where . a north-east wind was tearingat the houses and whipping the harbour into foam. The Indies fleet, tuggingat its cables, was moored in a dark mass, which every while gave forth asilvery cloud of canvas, as ship by ship lifted its anchors and stood out tosea, before the freshening gale. A rocking skiff waited at the spray-sweptharbour steps, and in the skiff Ramon. Silently, but hand in hand, they wereferried out to the looming black wall of the flagship, last of all to sail. Amoment later they stood upon the deck, to meet the greeting of the shipmasterat the gangway. "A letter for you, Senor Commandant," quoth he, "deliveredthis hour past by a Government launch." Ramon broke the seal. The missivewas signed, "Santiago y Marta," and read :-"Dear Ramon,—I feared you would never screw your courage to an elopement,but it has come. I make you a present of my wife, whom you willdoutbless find as amiable as I did. Incidentally, she is ten years older thanyourself. The lady, by the bye, whom you saw at the ball was not my wife,though now I may try my luck with her myself."G.A.K."A clean shirt every day and an easy second stage constitute the two essentialrequirements of a successful obstetrician."

50 THE SPECULUM.Ebe Goob GIO Maps.The following extracts arc taken from a small book entitled -The Diseases ofFemales: A Treatise Illustrating Their Symptoms, Causes, Variety and Treatment,Including the Diseases and Management of Pregnancy and Lying-In.Containing Also an Appendix of the Proper Treatment of Epilepsy and an Accountof the Symptoms and Treatment of Diseases of the Heart.The entire book totals some two hundred and fifty pages, and as it is writtenin a very florid style, it will be readily appreciated that the author has "out-tidied"tidy and is a master of synopsis at least.The author is an M.R.C.S. and the date of his work is given as 1850.Concerning sterility :—"A female was barren for fifteen years. She displayed no obvious ailmentfor the first twelve, but during the last three years suffered from a complaintwhich reduced her to a condition of extreme debility. She visited the waters ofVichey in the spring and again that autumn, and drank that celebrated tonicand aperient. Her health was suprisingly improved, and six months later conceptionfollowed."And again :—respectable lady, who has resided for many years in New South Wales,informed the author that she had known many instances of females who hadnever borne children in Europe, becoming the mothers of children subsequentlyto their emigration to Botany Bay. The fact was so notorious that before sheleft that country it had become the subject of current observation at Sydney."The worthy author apparently realises the psychic, climatic and generalsystemic factors that may convert sterility into fertility, though in these days of"believing the worst," many would find a different explanation, despite the factthat the second lady is definitely stated to be "respectable."Writing on ovarian tumours, the author has definite ideas on a ratherpeculiar method of treatment :-"Patting, tickling, or the occasional application of the hair brush two orthree times daily, over the diseased organ, is a plan, though apparently trifling,which has been known completely to arrest the progress of. cases of long standing.In one instance which, for the last eighteen years, has made little progress,I ascribe the suspension completely to this practice."Quoting Abernethy's Lectures in the Lancet, he says, concerning a problemmuch discussed to-day :-`'Stays, you know, are good things to let a person slip aside, without thatslipping being seen; and that went so far that I remember the time when it wasa bet, that upon examination in an assembly of well-brought-up girls, you wouldnot find one girl among them straight."Concerning the diagnosis of pregnancy, the following quaint extract isgiven from a contemporary work :-"Some years ago, I was engaged to attend the lady of a military officer, who,during the preceding pregnancy, had been considered as labouring under ovariandisease, for which, in the words of her husband, she had been unmercifully salivated,oftener than once, and made to swallow such a quantity of solution of themuriate of lime as would have filled a fish-pond."The foetus, however, proved a true son of Mars, for he would not quit hisfortress until the proper period."

THE SPECULUM. 51The hook is full of oddities, but there is in it a sentiment expressed that isbeing widely realised to-day as being one the student should keep before himlest he should consider every labour an occasion for complicated interference."We see that in labour a great deal is to be done, and still more is to beleft alone. Nature is to be regarded as the sole guide ; and where any persondescribes numberless difficulties that he has met with in practice, we may eithersuppose he created the difficulties himself by mismanagement, or manufacturedthem while telling the story."All this only some seventy years ago, and though times and methods aremuch altered—are our results ?So that while we may smile at tickling ovarian tumours—and salivation withmuriate of lime—it were best we did not laugh too openly. Then, perhaps,2000 A.D. will not be too unkind in their ridicule of 1927.Awkward moment in O.P. of a mild student whohas suggested to the gentleman that his Wassermannmight not be negative.

J52 THE SPECULUM.In Itorea tbere to no Cborea.At a very interesting and entertaining lecture on the 4th May, we learnt theabove from Dr. I. J. McClaren, who has spent the last fifteen years in Korea.He belongs to the Severance Union Medical School at Seoul.Korea, one is surprised to learn, is a little larger than Victoria, and yet hasa population of seventeen millions.Among the Koreans there is a very small percentage of wealthy people,most of the natives living on the simplest and the scantiest. Where, in Victoria,the average yearly income is about i500, in Korea, reckoning on a like basis, itis more like i50. Bearing these facts in mind, it is not hard to understand thatsuch a country, blest with only one small medical school, should give that schoolwork in plenty.A brief resume of some of the diseases to which Koreans are, or are not,subject is most interesting.Diseases associated with arteriosclerosis are very much less common thanamong Occidentals. The blood pressure is about 10 mm. lower ; this is probablybrought about by the small protein diet.Varicose veins and chronic ulcers on the legs are rare, this probably beingdue to the way the people squat, and also to the absence of lower garments.There is very little evidence of gross over-eating, for an obvious reason.Gonorrhoea is very prevalent, yet one rarely meets with a case of stricture.Tabes is never seen, and general paralysis is rare. This is not satisfactorilyexplained by the treatment given or by a different degree of resistance, but itis significant that the only places at which these are at all prevalent are ports.Acute rheumatism, chorea, gout and arthritis deformans are never seen.In spite of the general poverty, there is no prevalence of rickets. Probablyaccounted for by the fact that the children are taken off the breast at a latestage.Diabetes, appendicitis, and the occurrence of stones, are infrequent.Amongst the worst scourges are tuberculosis, syphilis and gonorrhoea.Scarlet fever is very virulent, and trachoma is common.There is a considerable amount of malaria, not very severe in type. andprobably tertian. It responds readily to quinine.Dysentery is very prevalent in both amoebic and bacillary types. The formeris found to respond well to emetine (Rogers). It is interesting to note thatfor the treatment of chronic dysentery, which will not respond to emetine, aGerman firm has produced a synthetic iodine preparation, "Yartrin," which isvery useful.There is sometimes quite a lot of relapsing fever, and at one time thisdisease was quite a bane. However, the blood always shows the spirillum, andresponds immediately to salvarsan.The Japanese have cholera under very strict control, and great care is takenthat it should not be exchanged between Korea and Japan. Between the twothere is a twelve-hourly ferry service, and each steamer carries about 500 passengers.During each voyage passengers are enforced to submit a sample oftheir excreta for examination, and occasionally drastic measures are necessitatedto bring this about.Smallpox has been stamped out recently by the use of vaccine.Beri-beri is largely present in Japan and Korea among the student classesand those living in dormitories. In this connection the Japanese have shown a

THE SPECULUM. 53lot of industry, and in particular, Dr. Shiga, who verified his belief that it is dueto lack of Vitamin B. By working on this hypothesis the Japanese navy wasfreed of Beri-beri.Leprosy is common in the southern parts of Korea, and till recently nothingwas done for it. It is very common in Japan. In the western countries it waswiped out by isolation. For a number of years 01. gynocardix was known to beof benefit, but was too nauseating. It is now administered hypodermically.Amongst the intestinal diseases, hookworm and tapeworm are prominent.Carbon tetrachloride is recommended for the former, but may lead to seriousresults. 01. chenopodium may also be harmful, and affects the hearing.Medical Practice in the Far East.Medicine is a very old practice in China. It was in China that the uses ofopium were first exploited, and the Chinese discovered the effect of mercury insyphilis. Talking of which, the Chinese, like people of all countries, insist thatV.D. was brought into their country by foreigners.The Pekin Medical School is very largely endowed by the Rockefeller Institute,but, as a whole, medical research in China has fallen into evil days, chieflyowing to the bane of authority, lack of experimentation, and instead, victimisation.Latterly, in Korea, anyone can set up as a "doctor" if they have a literaryeducation good or bad! Once a Korean literary gentleman of this type toldDr. McClaren that he had discovered the causes of melancholia : Melancholy isoften caused by jealousy, and this is due to the fact that the arrangement of theartery, vein and ureter on the left kidney differs from that on the right. Askedhow he found this out, he enlightened Dr. McClaren with the words " 'Yung°hesso' (I have thought about it) and it must be so."It is only during the last twenty-five years that the Koreans have had hospitals,and these are sef up by Christian Missions. Later on came the JapaneseGovernment Hospitals.When Dr. McClaren first went to Korea it was necessary for them to buildthe hospitals themselves, and at the same time to carefully keep an eye on thecontractor to see that he didn't put too much sand in the mixture. Apart fromthis trifling difficulty, Dr. McClaren had to train all his own nurses and staff,and having won through it necessarily reflects great credit on him. At first, owingto the prevailing social conditions, it was found necessary to have male "nurses"for the men's wards.Dr. McClaren trained men for giving anwsthetics, for chemical routine,pathology and in taking Wassermains, etc. He also had to train the patients inconnection with carelessness with refuse. It is a curious thing that in Japanesetrains refuse is never thrown out the windows, but if one wants such cleanedup, one calls for the "Boy." The "Boy" has such (adopted from the English)on his cap, and to be summoned must be addressed as "Mr. Boy."Frequently Dr. McClaren has had trouble with the patient's friends, by theirbringing into the wards huge bowls of rice for the patient immediately after heor she has had an operation.Financial trouble is often experienced, and soon after the Doctor openedhis hospital a very wealthy Korean woman came in for a fortnight and wascharged at 10/- a day. When presented with the bill she expostulated angrily,and the Doctor, thinking to shame her, asked her if she would like to be "treatedas a pauper and charged nothing." The invitation was accepted.

54 THE SPECULUM.• The natives have curious obstetrical methods. For instance, women withprolapsed uteri submit, without anesthetic, to cauterisation of the vagina withnitric acid. The subsequent scarring up is usually efficacious ; however, if asubsequent pregnancy occurs, a Caesarian delivery is necessary. If too late,crucial incisions must be made in the vagina. The patients usually die underthese conditions, but they have been known to survive.Dr. McClaren has seen a case where a Caesarian delivery has occurrednaturally, by the foetus' sloughing through the abdominal wall.On one occasion, the lecturer was called to a hovel and was confronted witha case of breach presentation. On attempt at delivery the foetus' head remained—it was rotted. A Caesarian was performed—on the floor—and the woman recovered!On another occasion, Dr. McClaren was summoned to a woman who hadbeen in labour a few days ; he delivered a child, and the father was delighted.He delivered another, and the father was more delighted, and ran round hisfamily to beg more clothes. The delivery of a third was too much for the poorman, and in a great rage he was forced to scour the village for clothes for theunwelcome one.In Seoul (the capital), Dr. Abrahamson (Physician to the Emperor) andDr. McClaren started a medical school, mainly by the financial aid of a wealthyAmerican. The hospital attached is small, averaging about 100 beds, and treatsabout 70,000 out-patients per annum. The teaching staff numbers about 20, ofwhich some 10 are graduates, and includes some very able men. In addition to"foreigners," the staff includes some of the school's own graduates and postgraduates.The number of students is limited to about 20 a year, owing to the smallaccommodation. The students must matriculate and then pass an entrance exam.,which includes the Japanese, English and Chinese languages. The best arechosen, physical fitness and moral character being well considered.The medical course is only four years, but the students can get excellentpractical work and plenty of beds for good medical and clinical experience.Dr. McClaren is in charge of the Neurological Clinic.The Language.Difficulty is frequently met in connection with the different languages. Forinstance, on one occasion a Chinese wanted to speak to Dr. McClaren, and to doso he had to speak to a Jap., who translated into Korean and a Korean translatedinto English, and then, in the end, the Doctor obtained the history by the man'spointing to his stomach.At a clinical meeting, on one occasion, Shiga had come over from Japan togive an address, and a Korean (a D.P.H., John Hopkins) translated the addressinto English as fast as it was delivered—a remarkable feat.Of English, German, etc., text-books, anything of scientific interest is translatedinto Japanese, while English is being learnt increasedly, especially in medicaland scientific matter. This is probably due to the proximity and influence ofU.S.A. German used to be the popular foreign language.In concluding his address, Dr. McClaren pointed out that the Koreans arenot to be despised, and, if given opportunity, are in no way an inferior race.The three ages of man—Primary, Secondary, Tertiary.

fHE SPECULUM. 55lbvbrargprum.When I, exulting in my lusty youth,Assailed the ambient air with pierced screams,Hydrarg. subchlor. was given me by mouth—To purge my duodenum, soothe my dreams.When I, too eager in my manhood's prime,Received into my blood the spirochaete,Hydrarg. again did blue my limbs each timeAnd drenched my soul from occiput to feet.As when the swimmer, careless in his strength,Defies the wave that later lays him low,So innocence seems ignorance at length,For mercury's two uses now I know.'Tis sad, indeed, that manhood's ills should heCured by the drug of blameless infancy."AR FUF."to-map's tonic taln.BY "DR. BLANK BRAIN."I knew a man once who called himself "Simon-Who-Seeth-Afar-Off,"and who said he was a sage. One day he said to me, "Desirest thou a milliondollar parable ?" There was a strange, uncanny gleam in his glittering eye. Ihad not made my will. Therefore, I made haste to say, "Let me hear your milliondollar parable." He told it to me thus :—"There cometh one day to a hamlet by the sea one Knivem, a youth, havingsome renown in the school wherd they do teach the art of healing. Much versedwas he in the ossifications of the sulci and of the gyri, and 'tis said that he hadgreat skill in percussing and palpating neurones. But of late he felt that helacked some of his mastery over his ossifications, and that his hand faltered alittle as he mapped out his neurones. Therefore, he said unto himself, 'I willgo down to the sea-side, where the air hath not so many dust particles, diseasemicro-organisms, and poisonous gases. There, surely, my Nissl granules willtake new life unto themselves.'"Now it chanced that there came thither also one Teutopia, who was of thesame seat of learning as was Knivem. But Teutopia was of a rival fraternity.Not a little prestige was his amongst those who had steeped themselves in theintelligence tests of ancient mythology, which Macdougall and Stout record sonobly. Many dissertations had he given on the place of colour vision in theRepublic of Plato. He had studied history even from the time when the SpencerStreet Bridge was first promised unto the present day. Moreover, was it nothe who, after weeks of arduous investigation in the Storehouse of the Books,had first established beyond dispute how many books might be placed with safetyone upon the other before the pile would o'er-topple? But of late many of theE.

56 THE SPECULUM.youths of his clan had said one to another : 'Teutopia loseth somewhat of hisstyle.' Thrice had the tower of books o'er-toppled before he had added theuttermost volume. Saddened, Teutopia said unto himself. 'Of a truth, my formlacketh me.. I will hie me straight to the great open spaces. Lulled by the rockingbillows, inhaling the pure ozone of the ocean, I will find the balm my feveredspirit craves. 'Twill be an excellent atmosphere, too, for composing my essayon "The South Sea Bubble." '"Now it soon befell that Knivem and Teutopia, meeting one day by the seashore,did fall to talk. There be some among the fisher folk of that place who dosay that they for ten minutes did converse in peace ; but many affirm that theydid not talk with quietness so long. Be that as it may, full soon they fell tofierce disputation. 'Tis said that Knivem covered much of the shore there withstrange, uncouth figures, which he did draw with his stick on the sand, loudlydebating the while ; and that Teutopia, planting himself upon a nearby rock, didperform the most marvellous movements with his arms, that his face was wonderfulto look upon, and that likened to his voice, the roar of the breakers wasbut an undertone."Multitudes drawing near did listen in wonderment to the mighty disputation.They tell how, that Knivem spoke much of his beloved neurones, proclaimingoftentimes that 'Neurones cannot be manufactured.' They tell how, towardsthe middle of the afternoon, he did write upon the sand, inscribing many linesthereunder, 'Acquired characteristics cannot be inherited' ; and that he did forciblydraw Teutopia from his rostrum to gaze upon the inscription. He spokeoften, too, with admiration of the royal line of Edwards, and poured scorn andcontumely on the scurvy tribe of Jukes. Much time they did dispute concerningone of the figures which Knivem had drawn upon the sand, and which hedid say was an 'Andalusian fowl.' The fisher folk do say that the half-hourwhich followed is a blot upon the history of their town. Their guileless youthdid then learn many new and strange, but degrading, oaths. Even to this day,when the night is black and stormy, and a cat-fish has got into the lobster pot,the beauty of the homely fisher dialect is tainted by such depraved words as`Mendel, dominance. and recessive.'"Teutopia, on the other hand, is said to have spoken with much passionconcerning such things as 'Instinct, the power of example, reformatories, and thetreatment of the insane.' For many moments, 'tis said, he did talk concerning theevils of 'Repression,' and he did tell , many a tale concerning a strange fish called`Eugenics.' Towards the declining of the day he is said to have flung at Knivemthe words, 'How knoweth thou what a baby is born with ?' one time after another,even unto six times, and that 'twixt the saying of them Knivem did full earnestlyset forth divers figures which he had drawn upon the sands. Many, when folksdid talk with them in after days, did say how that they had heard the word`Psychology' ; and they that be great do tell how that it he plain that the fisherfolk did first hear it among the words of Teutopia. No man can give truewitness concerning the number of times Teutopia did say 'If thou puttest anindividual in an environment . . .' The fisher folk do all stoutly affirm thatthey did lose count of them."The fisher folk do say that towards the setting of the sun there was apiteous scene upon the sea-shore. Knivem, having drawn many fine figures, beganto walk around upon the shore in aimless circles, and many who were therefeared greatly for him. He did walk ever more fast, and did stagger mostdazedly, and from no seeming account. In the end, he did sit heavily upon the

THE SPECULUM. 57sand. Those who were near him do say how that he used strange words like'equilibrium' and 'semi-circular canals.' Teutopia, too, became wearied and didsit upon his rock. No longer did he wax loud in his disputing, but did onlymurmur one time after another, 'Environment counteth for most' ; and men dotell how Knivem would turn each time, and in his exceeding weakness mutter,`Heredity doth predominate.'"Now, it chanced that there cometh at this time a man of gray beard andvenerable mien, bearing the weight of many years upon his shoulders. He didspeak with those that stood by, and then, approaching the two youths, he addressedthem thus : 'Observe,' said he, 'that barque which you fisherman rowstowards us. He propelleth it by two oars and it goeth ahead. You have disputed'twixt yourselves concerning Heredity and Environment. I tell you thateach is an oar. Together they propel the boat of Personality onward. Strivenot 'twixt yourselves concerning which doeth most. But the rather, go ye andhelp to make both the better, that all Personalities may go ahead the farther.'"At these words Knivem and Teutopia did fall silent. Then they did botharise and, shaking each the other's hand, did together thank the ancient man.'Tis said that Teutopia's last words to him were concerning his 'writing a hook';and that, as they parted from him, Knivem was heard to murmur some wordsof halting sequence about `. . . doing one for the Museum.'"Not many days thereafter Knivem and Teutopia journeyed back to theirseat, of learning; and Knivem once more became lost in the worship of hisneurones, and Teutopia delved even deeper into the works of the scribes, Macdowialland Stout. But Teutopia did not inquire concerning neurones, nordid b Knivem bethink himself to seek the scrolls of Macdougall and Stout. Thenext year, at a like time, once more each journeyed to the hamlet by the sea.And once more, meeting by the sea-shore, they did fall to disputation. Sad is itto tell that once more Teutopia did say, 'Environment counteth for most,' thatonce more Knivem did answer, 'Heredity doth predominate.' No ancient mancame to make straight their differences. They bade farewell still in disputation."Many, many years after, Knivem and Teutopia came once again to thehamlet by the sea. Long white beards had they, and the tops of their heads weremarvellous bright to look upon ; and each did bring with him many flocks andherds, which he had gotten unto himself. By the fire, smoking their old blackpipes, they did talk far into the night. But, alas ! even once again did Teutopiasay, 'Environment counteth for most,' and Knivem, 'Heredity doth predominate. "I had heard him out, and so I said to my friend, the sage, "Simon-Who-Seeth-A far-Off" : "What is the meaning of your parable?""Art thou a medical man?" said he."Assuredly," I answered him.He took a deep breath. "Hast read Macdougall's Outlines of Psychology,Wells' Outline of History, Walter de la Mare's Poems?" he flung at me."Of course not," I laughed. "I've got no time to read such things, andbesides, a doctor doesn't need them.""In thy answer is the meaning of my parable," said he."MONO."An optimist is a man who persists in believing he's got eczema.

58 THE SPECULUM.LIXElorhing the Oracle.In these sadly logical, materialistic days, the noble art of fortune telling,with other similar once dignified pursuits, has fallen into low repute. Despitethis, there are few who do not harbour illegal convictions anent the number thirteen,nor the possibilities of a future of roseate hue, outlined before them permedium the chance assorted display of cards, or the creases of the skin of thepalm. The witlessness of the individual certainly aids acceptance of the seer'sprognostications, for he has usually but the vaguest idea of what he wishes toaccomplish in life, and therefore any comfortable prospect sounds probable andfeasible. Anyhow, when fulfilment of the prophecy is due, he will have forgottenthe details.The foretelling of the future, however, is a vital part of all the constructiveactivities of life. Often it is manifested indirectly, as when one proposes thata certain end is necessary and desirable, and then projects a course of actionwhich is calculated to have the wished-fon consummation.There are three requisites for a successful prophecy : a knowledge of thepresent state of the subject of the prophecy ; a knowledge of the laws whichexpress the relationship and reaction of that subject to external conditions ; anda knowledge either of the particular end which it is desired to attain, or of theexternal changes which will, in the future, be made.The physician, in the treatment of disease, has as his aim the restorationto a so--called normal of a tissue or function prevented by injury or disease.He establishes the present state of the patient by diagnosis ; experience and thescience of medicine provide the rules whereby the reaction of the patient totherapeutic measures and the processes of his disease may be deduced ; andhence either the treatment of the case may be predicated, or the prognosis moreor less accurately foretold. Unfortunately, prophecies vary widely in accuracy,both as to the nature of the end that will result, and when and in what degreeit will come about. He whose prophecies are most often correct is said to bepossessed of the greater luck or the greater knowledge, the regrettable failings ofhuman nature tending to cause one to ascribe success in the case of others tothe former ; to the latter, in the case of oneself.It is the province of natural science to determine the inter-relationship betweenthe various forms of matter and energy, and by means of which mathematicallycorrect forecasts of the future may be made. In the present imperfectstate of knowledge, those rules are by no means exact, and prophecies basedupon them suffer from a varying degree of inaccuracy. The sciences groupedunder the term "Engineering" have a remarkably small margin of error, butthose of Medicine are woefully generalised.Fortunately, there comes to our aid a subtle something termed "Art." Adictionary defines "Art" as the practise of the rules of a science in order to procuresome desired end, a definition which, in effect, states that Art is merelypractical Science. Rather should one consider it as an unknown quality superaddedupon the rules of science by, and peculiar to, the individual, wherebydeductions and prophecies based upon those rules reach a much higher degreeof accuracy (or inaccuracy !) than would otherwise be attained. Where thelaws of a science are absolutely exact in their statements, the production of someend by their use becomes merely a matter of rule of thumb; the personality ofhe who uses them does not affect the final result. Thus, in the performance ofmathematical computations, Art cannot be manifested. If knowledge of the

THE SPECULUM. 59material universe and of natural laws was precise and complete, it would be possible,with a reservation, to predict' the future of mankind in toto by the performanceof a series of more or less complicated mathematical calculations.Indeed, at that dim, far distant date, when all knowledge is perfect, andthere are no more mysteries to justify the legalised starvation of scientistsdevoted to their solution, the professional fortune teller will be cast upon thetender mercies of a sophisticated world, the members of which may become, byapplication to a text-book, their own pocket astrologers. Auto-predictionism maythen be as . fascinating an entertainment to the enlightened damosels of theperiod as psycho-analysis is to-day. And think what potentialities for gossipwill be opened up !A few observations, and a trifling physiological calculation, for example, wouldlay bare the domestic affairs of the next-door neighbour, with interesting sidelightsupon his mode of death, and principles of business. Unfortunately, hecould retaliate.One is consoled by the thought that perfect knowledge ranks with perpetual. motion, true socialism, and the millenium, in regard to its possibilities of achievement.Until, therefore, those war-cries of cranks express the facts of life,one may resign oneself to the existence of such as "Madam X., Clairvoyant andCrystal Gazer," who differs only in methods and repute from those excellentgentlemen who once, from observation of the flight of birds, or the whistling ofthe wind through a crack in a rock, determined the fate of nations."AR FUF."LAMENT?Oh, once I was pure and the world and its waysAnd its wickedness meant naught to me;But since I've engaged on this course I'm enragedWhen I think this has all ceased to be.Wine, women, and song I regarded, alas,As little above a mere fable;But now I'm enlightened, and, if I weren't frightened,Could say more than most men are able.In gambling and racing I never indulgedTill I took up the study of med.But now about courses and fast and slow horsesI'm one of the most deeply read.I'll gladly admit I've experience gained,Though Virtue's a high price for the prudent,And though every yard of the sinner's way's hard—Yet I'm glad I'm a medical student.—"WUNOVUM."!,7

60 THE SPECULUM.Dissertation on a Vabv.[The writer has apparently composed his article in a mood of bitterness—whether. this is born of personal experience or probability, we cannot say. Certainit is that his views must be modified if he is to become a successful practitioner.We hope that added years and his three months at the "Kid's" may desensitizehim against the anaphylactoid reactions babies produce. We have felt much thesame ourselves at times, however, but it is necessary to develop a tolerance, because,after all's said and done : "Weren't we all ?"—Ed.]Years ago, when I went to school, we always commenced our weekly compositionsby a short, but more or less comprehensive, definition of our subject.In my more mature years I still find this an eminently satisfactory procedure, sohere goes :—A baby is a small blob or mass of protoplasm, which has, in additionto a very powerful pair of lungs and an almost insatiable appetite, a most lamentablelack of control over the chief sphincter muscles of its body.To my mind, the above definition embraces to an all sufficing degree, everyphenomenon which it is possible to observe in a baby. And I am sure allexperienced persons will agree with me, for what else does a baby do, except eat,cry, and —, but you had better look up the definition.There is a common belief, in poorly informed quarters, that babies sleep.If any deluded people try to tell you that such is the case, don't you believe them.It is a lie. Babies never sleep—they merely close their eyes to think and plotdevilry. On rare occasions they may stop their savage howlings, but this isonly to regain lost breath, for the crafty little wretches fully realize that respirationis an essential function.Perhaps the most noticeable property of a baby is the aforementioneddeficiency in muscular control. It is the characteristic which is responsible, atone and the same time, for the keenest amusement and the most abject misery.It all depends, you see, on who happens to be holding the mite at the criticalmoment.I don't think there is anything in the world I hate quite so much as a baby.Perhaps at first sight this seems to stamp me as a most bitter woman hater.But don't you believe it—I like 'em.The fact of a man disliking boiled eggs is surely not a bar to a passionateweakness for poultry.But to return to my muttons. It is already fairly clear, I think, that Ipossess a seemingly unnatural aversion to human babies. No, I am not a spoilsport, and I want you to thoroughly understand that I have not the slightestdesire in the world to curtail the birthrate. What do I mean ? you say.Anyway, let me be quite clear about this point at once. It is the baby assuch, not the quite necessary introductory phases, which I dislike. Eh! What'sthat? Good Lord, some people should read Truth! I merely meant that I haveno distaste for courting and marriage ceremonies, and all that.I suppose, dear readers and fellow students, that most of you, in your profoundignorance, are wondering why I am so bitter towards such an insignificantaffair as a baby. The ones who are not wondering know, for they, too, havesuffered at the hands—but no, perhaps not the hands—of these small tyrants.Let us consider the various emotions which the sight of a baby is liable toconjure up in the breasts of different types of human beings.

THE SPECULUM. 61To most of the readers of this very fine article, the sight of a grubby andsqualling baby means nothing at all. If it happens to he in the soft arms of ayoung and pretty woman, however, the above statement must be modified somewhat,for in this case there will probably be experienced a momentary, yetnevertheless very strong, feeling of envy towards the doubtless loving husband.Others again experience a sudden and lifting sense of ease and contentmentas they gaze upon a child in its mother's arms. They suddenly realize howlucky they are, not because they have achieved a child of their own (Oh, dear,no !), but because they have escaped having fatherhood thrust upon them—sofar. This sudden flood of happiness has probably been experienced by all gayyoung bachelors in their time.To mere females, the word "baby" is singularly expressive. It typifiespersonal industry and production—the "fruits of labour," so to speak.We are told there is no love more noble, more sacrificing, more enduring,than the love of a mother for her child. Perhaps there is something in this,but for a sample of real depths of feeling, try to steal. a medical student's sundaeon Commencement morning.We now come to the most important point of all, that is, my own personalviews on a baby. I certainly cannot be included in the first class, my chastityand pure life makes the second impossible, and my sex excludes the last.Therefore, there must clearly be another class to which I, as a logical conclusion,must belong.What, then, does a baby mean to me ?To me a baby means everything that is dirty and smelly, everything that istreacherous, everything that is embarrassing and dreadful, everything that is—.In fine, everything that is not nice. It is my experience that a baby cunninglysaves up everything, yes everything, till it is my turn to hold it, and then crowswith malicious and savage glee as it watches the effects of its ghastly pranks.Have you ever been forced to hold a baby, to be exposed to its slobberings, itssticky clutchings, its regurgitations ?I tell vou, a baby is a hideous, loathsome thing. It has no manners, nomorals, no ḏelicacy ; not the slightest idea that there is a time and place, especiallyplace, for all things.Have you ever seen a baby blush with shame ? I haven't, and I bet youhaven't either. because a baby has no shame.Babies are ushered into this world at least sixteen years before theirtime, and yet most people apparently simply adore them. Well, I don't, andwhat's more, I don't care who knows it.Why should I? They are common enough, surely? Almost anyone canhave a baby if the right course is pursued, and thousands of them are bornevery day, I suppose.All the strong, silent, thinking men tell us that what Australia really needsis a plentiful supply of babies to help fill up those vast open spaces we hear somuch about. Now, if, when they are born, they would only go and fill up thoseopen spaces, I wouldn't care. But what do they, in reality, fill, apart from theirwhat-d'ye-call-ems ? It is the trams and trains, and shops, and theatres they fill,so that they can slobber and clutch and scream at anyone who happens to benear.But, you ask, if all this is true, why are babies so popular?In my own private opinion, they are not nearly so popular as it may appear,and the wealth of love usually lavished upon them is one of the world's greatestdeceits.

62 THE SPECULUM.Have you ever seen the father of seven walking the floor at three o'clockin the morning with the youngest but one in his arms, and trying to silence roarsof such magnitude that in comparison the fall of Jerusalem was only a faintecho?What does that man feel like, I ask you? Does he feel like petting it, callingit daddy's ickle toodlums, and all the rest of the slap-doodle that is usuallyindulged in on such occasions? No, decidedly no. He feels like taking a firmgrip just above its ankles and dashing out its brains on the bed-post, I warrant.But he doesn't. Oh, no ! He restrains his just, though infanticidal impulse, becausehe is supposed to love the child dearly. It is the custom for fathers tolove their children dearly. If it were the custom to knock them on the head, hewould soon be back in his warm bed, I tell you that.Women, of course, like to have a baby or so around the place becauseother women have them and they don't want to feel out of it. Just as they gettheir hair Eton cropped, because it is the fashion to have one's hair Etoncropped.In conclusion I would like to draw your attention to the fact that H.R.H.the Duke of York left his baby at home. Doubtless you will think of any numberof perfectly sound reasons, but you are all wrong.Why, then?Because a baby is a plain, ordinary, damn nuisance.JACQUES..7.-An Early Amputation.(Taken from The Early History of Surgery in Great Britain.)"About twenty years ago, returning from the Bath, in Somersetshire, to theHolt, about five miles from Chester, where then 1 remained, having lodged inNewport, in Shropshire, by the way, I was called by this Lord Gerard's grandfather,to Gerard's Bromley."This, to take a view of his tailor, who had fractured both the facils ofthe leg a little below the knee, about thek breadth of a palm. When I did beholdthe fracture, with a wound, and the extenuation of the body (for the accidentfell out ten months before), neither were the bones united, and, beside, therewas a great tumour in the knee, I pronounced a lingering death to the part unlesshe were out of hand dismembered above the knee."Being entreated by the sick party and the Earl to perform the operation,I yielded to their request ; but having by me neither instrument nor medicament,I supplied the place of both. I made a medicament with umber and unslakedlime, taking equal parts of each, which I found there (the house being inreparation). I used a joiner's toothed saw—newly toothed—and in the presenceof two chirurgeons I dismembered the Lord's tailor, unto whom the Lordallowed DO a year during his lifetime, who lived many years afterwards."When I dressed the wound on the fourth day I found the mouths of allvessels shut by incarnation, so powerful was the restrictive medicament madeby equal parts of umber and unslaked lime reduced to the form of liniment bythe addition of whites of eggs beaten and the hair of a hare."

THE SPECULUM. 63fame.For Fame I yearned with an increased yearning,To dizzy heights my thoughts were ever turning,But somehow all my daring plans miscarried:And Fame, the cruel, heartless minx, still tarried.In vain upon the stage I raved and ranted,I sought to write, yet still my wish remained ungranted."Fame's son," I cried, "I'll be some day or other"—Alas ! she only proved a harsh step-mother.Yet stay ! my name far down the ages yet may go,For since I had that last bad turn of lumbago,And used to cure it Lixall's Lightning Lotion,My exploits all have stirred up) a great commotion.Yes, Fame is mine in measure quite unstinted,My photo. in each lotion "ad." is printed.•CECIL N. R." going lap.""Going up, going up, like a rocket gone insane,Sailing in an aeroplane. . . ."I think that, almost without exception, my most enjoyable flips were madein company with Alfred Frith, in his inimitable rendering of the play bearingthe above title. Never, I think, have I enjoyed a theatrical performance morethan I did this one. But without wishing to detract in the least from AlfredFrith's splendid achievement, one must admit that in point of fact there is notmuch of the "rocket gone insane" about flying ; and as my first experiences of itare still fresh in mind, I shall try and recall exactly what it is like at variousstages.I will recall my first flip It was in the nature of a joy-ride, to show mewhat it was like. To begin with, I might mention that never have I "had thebreeze up" whilst in the air, my good angel—or chance—having endowed me withentire confidence in the ability of the pilot with whom I was a passenger, or ofmyself, as the case might he. That was doubtless an inestimable boon. They saythat over-confidence is an airman's• greatest danger. At the same time, lack ofit would surely be his greatest handicap.Interest in everything that is done is naturally great during a novel experience.Nevertheless, future experience showed the that I had noticed very littleof the actual procedure gone through. But I was not concerned with that at thetime, and just permitted' myself to enjoy whatever of sensation and novelty therewas. My two outstanding impressions of .the flip were, firstly, an apparent lackof motion ; and secondly, the most unusual appearance of the ground. Theformer statement may appear strange, but it must be remembered that all motion

64- THE SPECULUM.is relative, and it is only when flying close to the ground that one experiencesany sense of speed. I recollect flying one day as a passenger and watching, asI had leisure to do, another plane flying alongside. Both were travelling at some70 miles per hour; yet, when, as occasionally happened, our speed slightlyexceeded that of the other 'plane, it actually had the appearance of flying backwards,we being motionless. The whole thing had the appearance of a very ridiculousfantasy.The ground presents a very remarkable appearance from above, such as Ihad never before seen, except, on occasions, from high and precipitous mountains.Neatness and precision are the impressions left on one's mind. A largeobject seen clearly, yet reduced in size, retains its beauty while losing its blemishes,as when an object is viewed through the bottom of a tumbler—no, not througha "long one." A house and its surroundings look like a toy model at an agriculturalexhibition. Cows have an appearance all their own, and men, working on ahaystack, look like ants on a piece of cheese.The flip terminated Nv ith a few aerobatics. The loop is a most remarkableevolution the first time one experiences it. As the nose is first pulled up, one's reactionon the seat is about three times normal, and the feeling is just like that whenrushing to the side of a ship as it heaves up in a rough sea. At the top ofa loop the reaction may become zero, so that it is as well to be strapped in.have felt myself to be just on the point of leaving the seat, and realising that Iwas not tied in. A peculiar feeling.A half roll is also rather disconcerting for the first time. The sky and thelandscape seem to swerve round rapidly in several directions all at once, andone entirely loses one's idea of position for a while. I remember that itoccurred to me, as we did a, couple of turns of a spin, what a good thing it wasthat I was not in charge, as I felt at the moment incapable of either thought oraction. But that very quickly passed, and when doing any acrobatics now Ithink only of my position at different stages of the evolution and the actionnecessary in consequence. The fact that one is spinning round or upside downseems to have very little effect.Cloud flying is a very disconcerting procedure, and though I passed withoutdifficulty the tests laid down, I am by no means sufficiently expert to fly anydistance in a complete fog. A real pilot can do steep turns in a cloud and comeout facing in any previously selected direction—a feat which I cannot helpregarding with great admiration. It conies with the "air sense," however, andthat is a matter of continual practice in gauging correctly the feel of everything.It must be realized that when up in an aeroplane one's semi-circular canals ceaseto convey to one the usual impressions, and one is therefore deprived of thatfaculty which gives the usual indication of relative position. The canals functionas a result of forces acting, and when one is on the ground almost the sole forceacting is gravity. But in an aeroplane gravity is merely one of the componentsof a resultant force, and the normal reaction (i.e., on the seat) takes the place ofgravity so far as the airman's senses are concerned. If, therefore, the resultantof the forces acting happens—as in correct flying—to coincide with the normalreaction, the pilot will feel that he is in the usual "upright" position, even if,in fact, his head is directed towards the earth, as in a loop, or his sagittal planesare almost parallel with the earth's surface, as in a steep turn. It will'thus beseen that the semi-circular canals indicate only correct or incorrect flying, and notrelative position. In cloud flying, therefore, the pilot has to rely on other senses,the functioning of which have to be developed by practice.

THE SPECULUM. 65Racing or labouring of the engine, for example, indicate descent and ascentrespectively. The instruments, and the sound and feel of the wind, are otherindications ; hut, as I have already remarked, the best of them all is that indefinablesomething known as the "air sense."As to flying in general, it is becoming more and more apparent that it isdestined to be one of the most important methods of keeping the British Empireunited in the face of modern conditions. It is certainly helping greatly to developAustralia, and is doing more than anything else to make habitable the vast spacesas yet untouched by the older methods of inter-communication ; and in spite ofoccasional Air Force crashes, due to stunting, or the use of more or less unstablemachines especially designed for war service, I do not think that anyonewho has learned to fly can regard it as unsafe. There is practically no dangerto life so long as the pilot exercises normal (and, of course, unceasing) care,and one can safely predict a great future for aviation, especially in this Continentof ours, ideally adapted as it is to flying. But for excitement ! Don't look toflying. Do as I did during my training, and vary the monotony with a fewexhilarating rounds on the Big Dipper, down at Luna Park.G. M. OXER.On liking Born.Parturition is a functional phenomenon exhibited exclusively by the femalemammalia. To the student of medicine, in the purely practical sense, a womanhas two uses, dissection post mortem and parturition, while alive. From hispoint of view these special functions form an almighty service of providing textbookinformation to be psychologically packed into an all too inadequate nervoussystem. Parturition of itself is an interesting event in three stages, with a highlycommendable purpose, which is liable—owing, as Metchinkoff points out, to acertain imperfection in Nature's arrangements—to many more or less fatal, andcertainly inconvenient, accidents, which it is the physician's inestimable privilegeto frustrate or to repair. To this end he spends the best years of his life instudy.There are few aspects of parturition which afford to the inquiring minda welcome relief from the monotony of continual physiological and pathologicalmethods of thought, and certain of these that occurred to me during the courseof a recent delivery (of course, not my own) might, with the excuse of anynovelty they possess, be set down here.The physical aspect of parturition, I must confess, I found at first extremelydiscomforting to behold. I was pained, if not quite appalled. The whole businesssavoured of a fundamental grimness—an sanguinary indelicacy which rattledone. That protecting influence—consisting partly of bourgeois conventionalityof ideas, partly of ignorance, with which one clothe's one's sensibilities fromthe minor assaults of one's environment—was rudely and violently strippedoff, leaving a sensation similar to that with which one dreams of walking downCollins Street clad merely in a dress stud or so.This sensation I recognised later as being common to uninitiated spectatorsat most of the major accidents of this life. I have experienced it before, notablyE

56 THE SPECULUM.on the occasion of seeing a fellow-man's skull stove in by the hoof of a 'bushorse. It resembles fear, without the paralysing effect on the viscera thatcharacterizes that major emotion. It may be produced by any sudden confrontationwith naked, unimpeachable Truth—ever a stranger in our midst. Itis a fair conjecture that the celebrated were inhabitated by Truth in either, assome say, the open grave, or as is more likely, in that strait way through whichit is customary that each new individual shall arrive among us. Certain it is,man passes from the latter to the former—naked beginning, naked ending—having done little more than grow to twenty times his original size in the interim.Birth is a subject which, among British people, is simply not 'discussed. Itis a strange custom of our race that they take 90 per cent. of the cold, solidfacts of life and keep them bottled on a high shelf, labelled "Truth—Poisonous.""Simplicitas " in the' Arcadians, bashfully remarks that when he found Truth,she pinched his trousers. The reason most people dislike. Truth is that at herapproach off fly their comfortable, figurative mental trousers, and uncommonlycold and discomforted they feel. Some relieve their feelings by throwing stonesat her introducer—for instance, Lister and Jenner, who had quite a bad time—others try to Clothe and powder her into their own standards of decency. Afew have curiosity and philosophy enough to feel at their ease—trousers orno trousers.At the same time, from the purely perSonal viewpoint, it is rather disturbingto recall that one's own self has necessarily and fairly recently been concernedin this parturition process—tempered by the feeling that, for once in alifetime, someone else did all the work, or, rather, labour—all that was expectedof one was to be on the spot—figuratively speaking. It should be an excellentspecific for pride, vain-glory and hypocrisy to imagine oneself being bundledthrough an inadequate passage under the urgent and 'combined stress of vis atergo and axis traction forceps. In this way birth, even more than death, may bespoken of as the great leveller—for a great man may possibly die in the grandmanner, but even Under the most favourable circumstances—one's mode of entryto life hardly lends itself to dignity; let alone comfort. Neck twisted through allimaginable angles—head contorted into peculiar shapes.' But I digress.From the above I would not have you impute to me any illusions that man'sglorious presence on earth is worthy of a less primitive method of jumping off.Arnold Bennett, in one of his books, complains of this absence of dignity—he deplores the groans, the discomfort, the dirty linen. I am sure he prefersthe "stork" or "found in a flower" theories. Cabell, in one of his' fantasticworks, makes his hero, a 17th century French noble, 'complain of a world, "intowhich we are voided like urine, and from which depart as ordure." It is surprisingthat in the most intelligent there occurs this artificial drudgery of thoughtresolving into a pure, unmitigated snobbery at the expense of man's bodilymembers. This is indeed worshipping false gods—from whence does it spring?Partly, I think, from the mid-Victorian confusion of innocence, ignorance andpurity as synonyms ; partly from mental sloth that would sooner sneer thaninquire. Mainly, I know it is a primitive instinct—the instinct that makes theAustralian native segregate women at times as being unclean, that makes themore civilized damn the .newly born with sin for being born of the flesh—theinstinct that causes fear of the unknown and hatred of the not understood. Itis comforting to predict that since man's mind, and not the Deity's handiwork,is at fault, this feeling will disappear with wider outlook.

THE SPECULUM.67,:'I realized some days after the event described that parturition is a physiologicalprocess. The fact comes home hard—it is not pathological. One becomesso impressed with the learned doctors, the hospital treatment, the instruments,the ergot, and the antisepsis, that it is only later one realises that one has beenwatching—not a stage in the course of some peculiar and painful disease—buta natural event which antedates humanity itself, let alone surgery. One istempted to wonder how long it will be before defiecation and micturition comeunder the immediate supervision of the practitioner.The student at hospital forms an early and fairly extensive acquaintance withbirth and death; and he soon reaches a state of indifference, or, rather, impersonality,as far as they are concerned. One fact that has always impressed myunworthy self is that, whereas the methods and means of quitting this vale oftears are legion—their names and evil omen being written in many great volumes—the path of entry is unduplicated. It is, moreover, narrow, with many anawkward twist and curve between the traveller and daylight. I heard a fellowstudent remark once, when a craniotomy became necessary : "There, but forthe grace of God—God !" A sober and seemly thought.Being born admits one to membership of the society of humanity. Thereis only one rule of entry, and that was made a sine qua non by our Founder manyyears ago. It implies that any new member can be admitted only by the jointcollaboration and approval of two existing members of the society. Moreover,these must go to a deal of trouble and pains about the matter. This, I presume,vouches for their disinterested motives.ROMA.AT THE PLAY.I weep at the playWhen the villain pursues the fair maid,Or honour is lost or betrayed,I weep at the play.At life's mighty heart-breaks I standDry-eyed, nerves stretching like tightening bands,Teeth shut, muscles set, with interlocked hands,And breath that comes gasping.Death, love, loss and failure,Small cares that are petty and rasping,All find me defiant, at bay.Yet I weep at the play.From The Argosy, 1926.cA little nurse at one of the Brisbane maternity hospitals was off duty till midnightand spending the flying hours with her "boy." "Heavens!" she said, glancing at herwatch, "it's five to twelve—whatever shall I do ?" The young man promptly hailed ataxi. "To the — Maternity Hospital as quick as you can," he directed, and startedto bundle the lady inside. But the driver didn't want that sort of fare, and firmly kepta grip on the handle of the door. "No, Missis, not in my car!" he objected gruffly.

68 THE SPECULUM.lin Alphabet.A stands for Alphabets I write for fun,B for the Balls that the M.S.S. run.C stands for Clinics, the ones we don't miss,[Casinos, too.—Ed.]D for the Doctors, who maybe read this.E stands for Exams, not far away,F for the FINALS, and work night and day.G stands for Golf, that I'd like to play,H for the Honoraries, who keep me all day.I stands for Increase in length of our course,j for the Joy that this gives us, perforce !K stands for Kudos, the rummy school's pool,L for the Lectures, 8.30's the rule.M stands for Man, and the maid that he has,N for the Nurses who like ( ?) us on Cas.O for the Old days over again,P for Present days, Prescriptions, and Pain.Q stands for Quart, two full pints, you bet,R for the Rolls that we have to get.S for our Students, long may they reign,T stands for Tidy, they all obtain.U is the Unknown till honours, you say ;✓ for VERY different thoughts on the day !W stands for Walter, and Eliza, too,X for 'Xceptions, and X-Rays true.Y for the question we ask when we flop,Z stands for Zero, where we often stop !L. L. S.Zhe Cynic.Back in those days which we term, with a certain air of superiority, childhood,I held the conviction that the cynic was an unfortunate individual who expectedthe world to be constructed upon a plan that existed solely in the vapouringsof his own imagination, and discovered by experience that he was sadlyin error. The shock produced the typical symptoms. That, as I say, was achildish definition. Having reached the age when castles in the air begin to fallwith a sickening thud, from which there is little, or delayed, rebound, anotherforces itself to consciousness. It requires merely the substitution of "oneself"for "the world" in the former.The dictionary disposes summarily of the definition : "A morose, sarcastic,surly person; a misanthrope"; and adds as a rider, with precessive three dotsthat indicate "Philosophy, Logic," "One of a rigid sect of Greek philosophersfounded at Athens by Autisthenes, a pupil of Socrates. He insisted on the renunciationof all luxury, and the subjugation of sensual desires."

THE SPECULUM. 69"Morose, sarcastic, surly ; a misanthrope." Short shrift, methinks. Cynicalto a degree are many, yet' by no means morose, sarcastic, or surly, nor even withmore than a slight touch of misanthropy.There are, for example, those excellent souls who are comparatively freefrom trifles of mannerism, the foibles that are the heritage of most of us. Freeare they from the perils of impulse, from decisive likes and equally decisive hates ;easily pleased, unobtrusive, neutral.Yet they have the saving grace, and no mean one it is, of Humour. Comfortablyensconced in their own impeccability, they pick our weak spots, our enthusiasms,our pet theories and our dogmas, with all the facility of the passive onlooker,hold us and them up to a gentle, good-natured ridicule, and then set usdown, abashed and once more reduced to the dimensions of the average citizen,chiding with a lazy smile of amusement as one does the pranks of children. Andwe like it, for perhaps there filters through to our egotistical consciousness therealisation that Burns' prayer, is answered, that "some Power" has—"the giftie gi'en us,To see ourselves as ithers see us !"This is the function, I verily believe, of that class of cynic ; to reduce usevery now and again to the common level of our fellow-men, smooth out our conceits,and rid us of the priggishness that a too-lively sense of individuality is aptto bring in its train.Far different; indeed, is a cynic of the second order. Here is the unfortunateindividual who is cursed with desires too powerful for his will to curb, withaspirations too high for his will to achieve. Intensely imaginative, probably,and idealistic in nature, the contrast between that which he longs for and thatwhich he is able to do, is absolute. Small wonder, then, that he merits the. nameof cynic. The contrast between the real and the ideal (which is the meaningwhich some grim humourist has attached to humour), of his immediateworld, and the knowledge that, however he may strive, there can be no appreciablerelative alterations in these values, rapidly confirms the definition, "Surly,sarcastic, morose; a misanthrope !"He is a walking exposition of the verse :—We please our fancy with ideal websOf innovation, but oui life meanwhileIs in the loom, where busy passion fliesThe shuttle too and fro, and gives our deedsThe accustomed pattern.A self-defensive mechanism develops. Lacking self-control, the professionof a belief in the fundamental iniquity of mankind is fatally easy to acquire,providing, as it does, a species of moral narcosis, A truly uncomfortable person.There are cynics, and cynics, but to one type most of us will approximatewhen the hot blood of youth has cooled, and the habit of work, early and late,with but little return, has stilled the longing' for those luxuries which at one timeseemed so desirable.Cynics of Athens most will become, not by any virtue in themselves, but byforce of circumstance. Could a more desirable state be imagined than that inwhich one's body is disciplined to reason, and ethical perfection and reality approachto close acquaintance? Then may we sit back and criticise the erring ofour fellows, pedantically, comparing their defections, belittling their achievements,secure from retaliation, and with a serene sense of our own superiority.A goodly company ! AR FUF.

70 THE SPECULUM.Ma chere Yvonne,—I hope you have not forgotten to pay your M.S.S. subscription. If you have,pay at once, or your doom is sealed, at least, so the notice-board assured us afew weeks ago. Our notice-board is a masterpiece, all and sundry combiningto produce a state of affairs which makes one wonder whether some people arenot right when they say that the end of the world is at hand.I didn't see you at Stunt Night, but perhaps you were disguised as a dashingyoung gentleman. But take heed and beware, my child ! On dit that last weeka girl with an Eton crop was brought into the ward—not in our Hospital. Aftera short conversation between the girl and the nurse, , the ambulance man quicklyremoved the patient. Girls haven't the monopoly of the Eton crop, at least,not yet. And, dearie, one of our women received a letter, this year, asking "him"to call at the office as soon as possible. She went, to discover that the Sub-Dean and the Secretary merely wanted to know whether she were a man or awoman, since they had had an argument on the subject. Keep your hair on,dearie, whatever happens.I believe you had rather a bright and busy time at .the Women's. Don'tforget to tell us the whereabouts of that pie-shop. We have a vague idea, butI've heard it said, not so very long ago, that vague ideas are an abomination anda stumbling-block.Our Fifth years are busy at the Children's now. We miss their sisterlyadvice. They were so useful when the Dean of the Clinical School told us, atthe beginning of the year, to cultivate our House-Surgeon. But for them, wemight have cultivated the wrong person. One of our number was looking forthe House-Surgeon of the Hospital with a view to presenting him with a boxof cigarettes or some such thing. We have been taking good advice and reading2Equanimitas. We have been striving to emulate Osler, but the education ofnerve centres is a labourious process, and the maintenance of an inscrutable faceis rather difficult at times, as when an irrepressible interrupts the honorary with,"They'll be making a doctor of you yet."One virtue we will soon possess—the priceless patience. We have notachieved it, rather, it has been thrust upon us. By the bye, why should a manwho is invariably three-quarters of an hour late, keep his watch half an hourahead of Mean Solar Time? We are beginning to feel quite at home at hospital

THE SPECULUM. 71now. I fancy that bears some relation to the fact that we do not nowadays tellthe honorary that our patient has a "rumbling heart" or a, "gastric stomach." Itseems to be wiser to word it differently.Even P.M.'s can be• quite bright at times, as when the Pathologist tells usthat, as far as he can remember, the medium in which the ameba found itselfwas acid. Such feats of memory are rare. Even the most stolid sit up andtake notice when Dr. X. throws straight, and, rewarded with a "good shot, sir,"from a quiet member of the class, acknowledges the compliment with "Thankyou ; such praise is praise indeed, when it comes from such a source." The skybrightens considerably when he, whose Sunday-go-meeting name is Heart's-ease,on being asked what he has done with the slide of sputum, informs the Pathologistthat he has left it with the Registrar to show him what good Tb. bugs reallylook like.One of our number has turned Prohibitionist since viewing cirrhosed liversand such like. It has manifested itself in rather a strange way, for she nowfills the Absolute Alcohol bottle with water. Those using the Absolute Alcoholhave wished that her energies could be diverted into other channels of thecause.I suppose you are rather busy. I'm afraid we may have to do a little workthis term. It's looking rather like it. Possibly some of us will be journeyingalong to Cas. for the Resident to strap our wrists, and no our ankles, as heretofore.Our brethren in Second and Third Years seem to be having a right royaltime. They haven't put up the curtains in the Women's Room yet, but they haveshifted the table. The energy of youth is remarkable. I have not heard of anynew engagements, but, of course, that does not signify. You never can tell.Vera has changed her name quite recently. I'm sure she has the good wishes ofall of us. ,Well, dearie, best of luck for Finals. Gbod-bye till we meet. Don't forgetthe Medical Women's Dinner some time soon.Tou amie devoue,CORINNE.W WConcerning igioinan.The Sayings of Salpiax the Sage.An occasional indiscretion is good for all. The bow must not be too tightlystrung.Love never knocks at the door of a woman's heart ; he goes in, drives philosophyout, shows wisdom the door, and then rules supreme.A man has no business to marry a woman who can't make him miserable :it means that she can't make him happy.Had Venus realized the power of a little aloofness in her flirtation withAdonis, her reputation as a tactician, at least, might have been saved.If people look bad, they are ; if they look good, they may be.Being temperamentally interested in a woman is what the average man callsloving her.

7 3 THE SPECULUM.There are two kinds of women--the experimenting and the experienced.Until temptation has come to a woman in every form, she should neverdeclare herself immune.You don't know a woman till you have had a letter from her.God forgives, man forgets, but woman remembers for ever.I know of no more terrible weapon than a lorgnette in the hands of theenemy.When a woman is pretty she's charming ; when clever, fascinating ; but whenshe is sympathetic, she is adorable.The smart woman divides her time between pampering the flesh, astoundingthe world, and amusing the devil.When Discontent wears her smartest creation and goes into society, she callsherself—Ennui.Can there be a more distressing exhibition than a superlatively plain womanboasting of her virtue ?The woman of the world is most discreet ; it is her understudy who isdangerous.Wives are wonderful things. Every man should have at least one, as amatter of education.As a woman's waist increases, her faith in man decreases.To two parts earthly add one part spiritual and we have a fascinatingwoman.There is always one woman who teaches a man everything.A %tomThere was once a medical student who never failed in a single exam. Healways was five minutes early for all his lectures, clinics, and specials, and nevermissed a single attendance, even at a post mortem. He always knew the rightanswers to the questions he was asked—even in Ward 24.He didn't know anything about spirochetes and gonococci, except the thingshe learnt in Pathology. His knowledge of women was confined to that gainedfrom his anatomy book and the gyno. clinic.He had never had a drink of beer in his life, except once, when he mistookit for cold tea. He only once said "damn," and that was away back in secondyear, when some boiling nitric acid fell over his trousers. He had never smoked,except once, when he was nine, he put some pine needles in his grandfather'spipe. He certainly did play cards, but only Animal Grab—he was once temptedto play "Strip Jack Naked," but the name shocked him, so that he withstood thecoaxing of the wicked clergyman who asked him to play.He passed his final exams. with honours and won all the exhibitions.Then unfortunately the angels came and took him away, so we can't go onwith this fairy story any longer."N.A.B."

THE SPECULUM. 73ttrcierp anb f11)ebicine.From an article in The Bulletin by T.C.In May, 1665, the Great Plague, incubated in the crowded and insanitaryquarter of St. Giles, swept through the streets of London, and in six monthsclaimed 100,000 lives—nearly a fifth of the city's population—not sparing rank,sex• or age. To English readers the authoritative historical record of the visitationis by Defoe. There is, however, an extensive bibliography on the subject,giving a connected account of its spread from the East in the earlier part ofthe fourteenth century along the main commercial arteries of India, Persia andRussia into Europe. The gist of these records has now been compiled byJohannes Mohl under the title, The Black Death, a Chronicle of the Plague(Allen and Unwin). Incidentally, the work contains much interesting informationon the curative methods of the allied professions of surgery and medicinein those days."On the whole," says the author, "the physicians were quite helpless inthe face of the plague. The most eminent among them confessed it frankly."For the most part they restricted themselves to defensive or prophylactic measures,and for the rest fell back upon the spiritual resources of the Church.It was agreed in the face of professional ignorance that the most efficaciouspreventive means was the fear of God, "for by this the venomous astral arrowsmay be averted." To-day, thanks to the achievements of Yersin and Koch,the bacteriological character of the plague has been established. "In a littleanonymous primer for the doctors of the period," says the author, "we findthat it was the first duty of the physician on entering the house to ask therelations of the patient if he had confessed and received the holy sacrament,as upon this, in the first instance, his salvation depended," it being held thatmost frequently the sickness was the consequence of sins. If by any chance—and chance appeared to have been the dominant factor—the physician attaineda cure he was immediately deprived of any personal merit in the case, therecovery being attributed to the intercession of the saints or the prayers ofthe priests. If, on the other hand, the attempted cure was a failure, he wasregarded as responsible for the death of the patient, through lack of trust inthe divine power.Among the people physicians were not, on the whole, popular. They thoughtmore healing virtue was to be found among alchemists and magicians untrammelledby the Church. Anatomy was in its infancy, but some dissections hadbeen made on the continent which led to the reported discovery of a smallboil in the vicinity of the heart. This so-called "boil" was said to be filledwith poison, and the medical science of the day attributed the miserable deathof young and old to its toxic effect on the blood. It is related that in thisyear of gloom one Henrico Sayer, throwing aside all the fantastic tricks andtrappings with which the general practitioner of the day invested himself whenentering a plague-house, fearlessly attended all patients, daily administeringtheir medicines, and with his own hands binding up their boils, plague glandsand spots, thus saving the lives of many. Indiscreetly he went to bed with anoble lord suffering from the epidemic, and, having saved many, was unableto save himself. In the course of this physician's practice he took no othermeans of self-preservation than a long draught of good strong wine beforeentering the houses of the infected.

74 THE SPECULUM.It was about this time that-;a Jesuit Father Q11 the Continent announcedthat he had solved the mystery of the plague. "The 'plague," he announced,"is nothing but a multitude of small animals and diminutive worms which flyabout in the air, and when drawn into the body by the action of breathing,vitiate the blood, impair, the spirits and finally gnaw into the flesh and glands."The cure he proposed was that of lighting large and flaming fires, by meansof which the wings, feet or probosces of the animalculx would be burnt offso that they could no longer fly and menace the health of the people. An opinionvery prevalent was that the air became stiff in times of plague, and that itwas necessary to set it in motion artificially, and thus break it up. ,To do thisbells were rung and cannons and fire-arms discharged. Many people had little'birds flying about their rooms so that they might absorb the poison and keepthe air in motion. As spiders were considered specially endowed with powersof poison absorption, they were encouraged to spin their webs in the homes,of the afflicted. Flocks of oxen and cows were also driven through the streetsso that their breath might improve the atmosphere. It was even thought thatthe infected air might be beneficially changed by stinks, and billygoats were keptfor this purpose in living apartments and bedrooms. Some of the cures recommendedby quacks and even prescribed by physicians are too filthy to mention.Amulets, heart-bags, spells, dried toads and other weird means of protection,were not only sold by quacks but prescribed by physicians. One of the mostsuccessful cures was a surgical operation in which the boils were cut openand burnt out with hot irons.. On the medical side the boils of the dead werecut out, dried, powdered and given to the sick as a .preventive medicine. Afeeble attempt to isolate the infected was made .by marking all houses containingplague cases by a red, cross. Essences and aromatic oils expressed from variousherbs were used as preventives, and homes were fumigated by the smoke fromvarious leaves, berries and woods.How slowly the physician and the surgeon progressed is illustrated by anarticle written by the late Sir Frederick Treves. Only 50 years ago quitemediaeval methods were still in use in British hospitals. A dislocated limb,for example, was reduced by compound pulleys worked by man-haulage. Inthe operating theatre a fire was kept constantly burning to heat the searing ironsfor arresting the flow of blood under the surgeon's knife.. In the wards of thehospital sepsis was "the prevailing condition." It was considered finickingto be clean. "The surgeon operating in a slaughter-house-suggesting frockcoatof black cloth. It was stiff with the blood and the filth of years." Thewounds of the unfortunate who lay in these institutions were dressed, with akind of cotton waste—"It would probably now be discarded by a motor mechanicas being too dirty for a car." A whole ward would be decimated by hospitalgangrene.In terms of surgical and medical progress the past 50 years represent anadvance far in excess of anything attained during the preceding five centuries.Now Bonzo is a boggeragogue,A laxative, you see,And I take it every morningComplete with morning tea;For the dread of constipationIs innate in every man,From Adam and the Devil,Since peristalsis first began.

THE SPECULUM. 75Orcbibectomv.In a distant eastern harem,Miles across the sea,The Sultan's brow was cloudedAs he sipped his Turkish tea.He'd had trouble with his ladies—Other sultans had as much—With the sprightly harem ladies,As to how, to keep them such.For he'd ten score male attendants,And the wily Nubian churlsMade him feel a bit uneasyAbout his fair Circassian girls.But he , had an inspiration,Called his barber bold, and heFirst devised the operationOf orchidectomy.EbeWeb. Grenfell Club.Patrons: Sir Aaron Danks, Professor Woodruff, Thomas Baker, Esq., Dr.A. E. Coates, Dr. R R. Stawell. President: Rae W. Dungan. Vice -President:P. R. Slater. Secretary: T. D. Hagger. Asst. Secretary: N. Haney.Treasurer: Professor Payne.During the last few months there has been a good deal of talk in Universitycircles about a University Social Settlement, but it has remained for the Meds.to take the first practical step towards its attainment.On May 9th last, there came into existence a medical students' organisationknown as the Wilfred Grenf ell Club, the activities of which are to be directedtowards "the promotion of the spiritual, mental, and physical improvement ofthe people, especially the younger boys, living in the poorer districts of Melbourne."The Club is under, distinguished patronage, there being a general,realisation among the public that there is a great need for such work as it isgoing to carry out, and those who are already directly interested in it hopethat the Club will come to take a place of first importance among medical students.Permission has been obtained to make use of a hall in Bouverie Street(within a stone's throw of the University ,grounds) and activities have alreadybeen commenced with a Sunday evening meeting for boys. Before this appearsin print, what will probably come to be the most important part of the Club'swork will have been commenced in the form of a Tuesday night club for boysunder 18 years of age. On the premises which we are using (kindly lent bythe •Bouverie Street Baptist Mission) there are facilities for gymnasium, ballgames, billiards, ping-pang, etc., for the older boys, and board games, puzzles,and word games for those just past the kindergarten stage. In addition to

76 THE SPECULUM.this we have plans for the formation of Scout troops in the near future. Thepossibilities for the extension of such plans as these are almost limitless, andwe look forward to the time when the work which the medical students andgraduates do through the Wilfred Grenfell Club will raise them much higherin the estimation of the general public.Membership in the Club is open to any Med. who is willing to take anactive part in the work by turning up on Sunday or Tuesday nights. If you feelthat you cannot spare a night every week, come once a fortnight, or have yourname placed on the list of those who will be willing to relieve on nights whensome of the regular members cannot be present. The vacations will be timeswhen help is particularly needed, and that will provide an opening for some whohave their time very over-crowded during term, But come every week if at allpossible, and you will be amply repaid for the time you spend at the work inthe coin of that personal touch with humanity which is so necessary to asuccessful medical career, and that satisfaction which comes of having done agood job well.It is up to us to make a great success of this work, so come along and doyour bit. Everyone willing to help, be it only in a small way, please get intouch with the secretary of the Club, T. D. Hagger, either at Queen's Collegeor, if you are at the shop, in the dissecting room.Correeponbence.The Editor of The Speculum.Dear Sir,—May I, through the columns of your powerful journal, entera protest anent the disgraceful state of the heating arrangements in theStudents' Room at the Women's Hospital ?During my period of residence there, last December, I noted that behindthe radiator in the students' room is a bye-pass pipe. When, therefore, theheating system is in operation the greater part of the water, instead of passingthrough the radiator, passes along the bye-pass, with the result that not eventhe tenderest glutxus is scorched by being seated upon the heater in question.From earliest boyhood I have been of a strictly practical nature, and hencemade an attempt to rectify the above glaring anomaly. As luck would haveit, at the time of our stay at the Women's Hospital, the plumbing on the newbuildings was being performed. Accordingly, one afternoon I borrowed asuitable number of tools from the workmen and proceeded to attack the byepass,with a view to inserting therein a block of wood, or other suitable obstructivematerial. On detaching the union, however, I was immediatelydrenched by a quantity of cold water which happened to be flowing in the pipe.All attempts to stop this flow, while the obstructive agent was being inserted,were futile, and I was compelled to abandon the project. It was with greatdifficulty that I was able to recouple the union at all, and not until many cubiccentimetres of water had flowed away.Consequently, the heating arrangements are no better now than before,despite the attempt by the Hospital Authorities at forfeiture of my 13/3/-,only averted by strenuous opposition upon my part.

THE SPECULUM: 77May I suggest that your journal make a determined attempt to block thatbye-pass ?Which reminds me that the nursing staff probably does not now reach thestandard of excellence to which it attained in my day.Trusting that you will plumb the matter fin-then—Yours, etc.,AR PRO PATRIA FUF.The Editor of The Speculum.Dear Sir,—I wish to take this opportunity of dealing a blow at thoseobnoxious people who glory in what they term Commonsense, and at the sametime to congratulate the far-seeing intelligence of one of the modern genii ofmedicine.I note, in a recent article in the A.M.J., that hiccough may be effectuallycured by extreme flexion of the sufferer's head upon his (the sufferer's) chest.Superficially, that may appear a matter of little moment, but when one probesdeeper one realises that it is one of the magnificent achievements of modernmedical science.You doubtless will remember that from time immemorial we have held tothe opinion that to sip a little water from a glass is a certain cure for hiccough,and we also know that it is entirely ineffectual. 'Whence, then, came the tradition? The daring investigator in question, who shall be nameless, but whomI wish to congratulate, has discovered that originally the water was sippedwith the lips applied to they opposite rim of the glass, in which case it is obviousthat the head must be very fully flexed in order to sip any water at all. Hefurther boldly states that the essential factor in the process is not the sippingof water, but the flexion of the head that is required. He has further provedhis contention by showing that hiccough may indubitably be cured merely byflexion of the head alone.We are now in a position to understand the cycle of events which hasoccurred through the ages.Originally, as I remarked earlier in this communication, hiccough wascured by sipping water from the far edge of a tumbler. On some occasion,however, doubtless some commonsense medical man was shown this method,and, in his fatuity, jeered at what he considered was a piece of pure ritual,namely the sipping from the far edge. "Aw, g'wan," he probably remarked,"sipping the water's all you want. Why make yourself ridiculous and do itfrom the wrong side. Why don't you sip it properly ?" Shamed into obediencehis listeners commenced to sip it in the usual manner, and passed the worddown to the subsequent generations, with the utter failure to cure what weonly too dreadfully know.At last, however, Truth has triumphed, and with it the scourge of hiccough,so long dreaded, has been trampled underfoot, even as typhoid, small-pox, anddiphtheria.—Yours, etc.,FATHEAD.To the Editor, Speculum.Sir,—I have often wondered why your journal has not investigated theexamination system in vogue in second year. The system of picking the honourclasses seems to me to be grossly unfair. The test in anatomy is a pure gamble

78 THE SPECULUM.and a test of speed. Even if a man does very well in the written examinationthat follows, he is absolutely debarred from even going to the honours lectures.The position in physiology is a subject which ought to form good materialf or .your humorous column. The idea of choosing the sacred twelve evidentlyappealed to some saintly spirit of bygone ages, and in the general interests ofthe students this holy body has remained singularly celibate.Other faculties have realized that by giving the student the choice ofdoing honours they stimulate the general interest of students in their work.As the position now stands the faculty seem to be doing their best to encouragethe student to be a 50 per cent: pass man.—Yours, etc.,VOX STUD ENTIUM.The Editor of The Speculuin.Dear Sir,—Yesterday, in the confines of the Medical. School, I was publiclyrebuked for swearing !! Not for long-continued, monotonous mouthing of brutaloaths such as delight the soul of the illiterate, but merely on account of theinclusion, in a short tirade which I was conducting at the time, of a certainword which was intended purely for accentuation purposes.It would interest me to know what every right-minded medical studentthinks about this mealy-mouthed, cringing, bible-banging prudery.Surely a man can swear if he so desires; always providing, of course, thatno female ears are near enough to turn shell pink with shame—or pity for ourpoor efforts. All my life I have retained the right, prerogative and privilegeto swear how, why, when or where I pleased, always recognising the rights ofothers and listening eagerly to the glorious flights of the great masters, who,though unfortunately rare, are still to be found in the Faculty. But—well,yesterday, I was rebuked for swearing!I can assure you the case is desperate. These infernal busybodies, notcontent with spoiling all our public functions by their cursed respectability, arenow threatening even our personal liberty. As a medical student and Britishsubject I protest most strongly against this dull and rigid moral code whichis beginning to be accepted by the entire faculty. It is too gentlemanly altogether.How the leaders of the movement bear, on their ugly shoulders, sucha burden of virtue, righteousness and piety I, for one, do not know.There was a time, it is true, when the typical medical student fairlystaggered under his load of sin and depravity, but that, of course, was onlyright and proper. In the old days, I understand, the medical student was adreadful fellow who drank a cupful of blood every day, two large flasks ofneat rum every night, and who wore a black beard and a red nose in betweentimes.He always passed his exams. though, and Melbourne at this very day isfilled with smug and respectable, though eminently capable, practitioners whotwenty years ago staggered home in the dawn, joyously drunk and having passedthe night the Good Lord knows where. But now—well, yesterday, I wasreproved for swearing !Surely, as the walrus is commonly reputed to have said, the time has cometo speak of many things. Let us, however, on this occasion, confine ourselvesstrictly to things medical. For a start it is evident, even to the meanest intelligence,that the medical faculty is absolutely decadent ; indeed it is putrid, rotten.There is not one jot of originality, dash, drunkenness or sin to be found in

THE SPECULUM. 79the entire administrative forces. The only decent thing left is our Spec/I/urn(no, Editor, don't thank me) which, please God, will be kept impure anddefiled throughout the years to come. (Order, please.—Ed.) Take a glanceat the advertisement for the M S.S. ball. "All sorts of novelties, with 'just aof mauve'." To think I lived to see such hackneyed drivel on anadvertisement at one time deservedly famous for originality and daring. . . .Come, gods, with all your thunderbolts, dash me to pieces. Another trulydreadful example can. be cited in the masterly opening words of the addressof welcome read to the bogus Duke and Duchess at. the Bijou Theatre. Itran : thus : "Unaccustomed as I am to public speaking,' I have spoken beforethe Prince of Wales, the Duke, of York and other, leading hotels in Melbourne."Ye gods—Originality, hide thy head. Talking of crimes, perhaps a little commenton the Commencement Show would not be out of place.The incorporation of the Medleys with the Legal Lyrics (or whatever theyare) when first suggested struck me as being wretched in the extreme. Thedear old Medical Medleys, famed for their , ribaldry, and utter lack of decency,to be sunk in comparative oblivion—ah,. well; it smacked of prostitution.However, it turned out all for the best, as it must be admitted that thelaw people, although it rives my heart to say so, made the show. It is nowsmugly claimed that the Medico-Legal performance was one of the most successfulon Gala Night. There is no doubt, that it was, seeing the quality ofthe Goats' Train and -other farces, but it cannot be claimed that the medicalpart made it so.If only jokes were like wine, the otherwise excellent skit on Beau Gestewould have been witty in the extreme. As it was, most of us can rememberdropping the papilla and laughing till all our sphincters relaxed when first weheard some of the chestnuts resurrected by Sergeant-Major Lejaune and hisminions. The turn perpetrated, I understand, by some of the college people, wouldno doubt have been very enjoyable if one .had only known what it was all about.It had a good, taking name on the programme, though, and indeed was ratherlaughable. The ballets and other items were right enough, I suppose, but fartoo good and respectable for a students' commencement show.That famous "dash of mauve" we hear so much about seemed to bequite lacking. The one saving grace was the untiring energy and enthusiasmdisplayed by the Manager, who cheerfully sacrificed time, work, meals, everything,for the sake of the cause. It seems a pity that such Titanic effortswere rewarded by only a mediocre show.It is fully realized that all this is purely destructive criticism of the firstorder, but I, and no doubt many others, feel that the medical students shouldbe able to give a performance which would be the talk and envy of the wholeUniversity: Also, there has been much adverse criticism of last year's MedicalDerby. Admittedly it was a failure, but it, at least, had the merit of beingoriginal, and could easily have been a very great success, which was a manifestimpossibility in this year's show. Do the medical students realize that otherstudents are beginning to call them "the Salvos"? It is true and it is dreadful.The fact must be faced that the faculty traditions and aspirations aredying out very rapidly. We have done nothing of note for years. Who capturedthe Duke and led him in triumph through the streets of the University ?Certainly not us, despite the fact that nearly all the men in the mock presentationof the degree were projectors.

80 THE SPECULUM.The Medical Faculty has, like somebody or something at sonic time orother, fallen upon evil days. Perhaps the old times will come again. Whocan tell ? But—well, yesterday, I was publicly reprimanded for swearing!J ACQUES.(The writer has adopted rather a sweeping style wherewith to conveyhis grievance to the world—and perhaps overstates the aims of the "good olddays." He writes, however, with the emphasis of sincerity, and there is a lotin what he says—quite a lot. In Faculty affairs generally there is a tendencyof late toward the "dash of mauve," instead of the Complete frankness ofunabashed purple. Though we still have hopes that we may be on the sideof the angels, we agree with the writer in recognising the fact that there iscause to make him melancholy, even as another of his name.—Editor.)prominctit personalities."Bung" Hill, A.H. —At present in retirement with an eye to Exes. in Finals.A student of the psychology of the Nurse. Also a student of Medicine ofno mean calibre. Tennis and short stories, preferably Leonard Merrick's,constitute his main diversions.Ray Fox, A.H. — Always a great help in brightening the reflecting surfaceof The Speculum. Editor 1926. Exhibits rather a tendency towards the exoticin his literary leanings, but otherwise the only stain on his character is thathe did a year's Engineering before embarking on the noble art of Medicine."Divertissements" unknown, but it is safe to assume his Barling goes withhim like Mary's lamb.Tom Reynolds, M.H. — One of the best known identities at the Melbourne.Can solve any problem re hospitals. Has a marvellous repertoire of old plantationsongs. Reported to be preparing—avec coach—for a determined attackon that formidable body, the Board of Examiners, in August."Joe" Reed, M.H. — Or should we have said A. J. Clinton Reed? Wieldsa winning racquet for the Shop and is, as the pink paper puts it, "a brightstar in the tennis firmament." Has lately developed such a state of sartorialperfection that the psychologists suspect tendencies of "narcissism."Jack Turner, M.H.--Also an exponent of "top spin." Seems to find bridge,or his partners, very interesting. The possessor of a repressed complex fornurses. Won' the Pathology exhibition last year, so we can forgive all the rest.Bill Rawlings, M.H. — The strong silent man of Parkville. A former "star"iii the Medical Medleys. Packs a wicked punch and his opponent in the IntervarsityBoxing Champs. was in Ward 18 for two days after the fight. We'dbetter not say any more, but if you want to find him—look for "Pick."

THE SPECULUM. 81%picuta.Jack : "I couldn't get to sleep for a long time last night on account of theblinds being up."Jill : "Why didn't you pull them down?"Jack : "My arm wouldn't reach across the street !"0 0 0 El M ElLady : "Conductor, do you stop at Ritz Mansions ?"Conductor : "No, madam, it's too expensive."O M 0 0 El 0Garage Scandal.--It is reported that a man who was in the habit of garaginghis "Lizzie" with the "Dodge Brothers," found a Baby Austin in the garageas well one morning2 2 CI CI El 0Honorary : "Good heavens, man, don't you know anyStoodent : "No, sir, I've been too busy working for exams."•• 0 0 0 0Scene at the G.P.O.Fair Young Thing : "A parcel of medicine was posted to me a month ago.and I haven't received it yet."Clerk : "Fill in this form and state your complaint."F.Y.T : "Oh! won't bother about it, then."0 0 0A man once consulted a Chinese herbalist. The herbalist felt his patient'spulse and said, "You have to stop smoking.""But don't smoke."On hearing this, the Chinaman again felt the pulse. "You have to giveup drinking.""Never had a drink—teetotaller."The Chinaman then felt the pulse on the other wrist, and said : "You giveup women.""Never been out with a woman in my life."The herbalist was obviously puzzled. "How long you want to live?" heasked."Oh! for years and years. Till I'm very old.""Whaffor?-" said Ah Kim.

82 THE SPECULUM.Honorary : "What is the most frequent cause of polyuria?"• Stoodent : "Alcohol, sir."Honorary : "I want medical experience—not reminiscence."CIFond Parent : "Hallo! Is that the University ? I want to speak to WillieStoppit, please."Switchboard: "What course is he doing ?"F.P.: "Medicine."Switchboard : "I'll put you through to the billiard room."• 0 C] 0 0 0Lunatic, on grounds of um ( to new superintendent) : "Who are you?"Super. : "I'm the new superintendent."Lunatic : "Oh, it won't take them long to knock that out of you. I wasNapoleon when I first came here."CI 0 CI CI CI 0Teacher : "Henry, why are you not writing?"Henry : "I ain't got no pen."Teacher : "`Where's your grammar ?"Henry : "She's dead."El El CI CI CI 0He (petulantly) : "You are hiding something from me."She (coyly) : "Of course, silly. I'm no Salome."O M CI CI 0 0Strange to say, a dead motor always adds life to the party.Ca 0 0 0 13 0An illiterate candidate was interrupted in the course of his speech oneducạtion and asked:"Are you in favour of castigation in our State Schools?"Wishing to be very diplomatic, his reply was : Well, not entirely—I'dremove one and leave the other."El El 0 0 El ElHeard the difference between a politician, and a lady defined rather cleverly :When a politician says "yes," he means "perhaps." When he says "perhaps,"he means "no." But if he says "no," he's no politician.On the other hand if a lady says "no," she means "perhaps." If she says'perhaps," she means "yes." But if she says "yes" she's no lady !El 0 0 El El 0Extract from a nurse's exam. paper.—"The words p.r.n. written after a prescriptionmean it is to he used per rectum now and again."El El 0 CI 0 0A: "What is the last thing a girl takes off before going to bed?"B: "Her legs off the floor, of course."

THE SPECULUM. 83This month's funny story.—Once upon a nine a honeymoon couple, arrivingat a hotel, asked to be called early, as they wanted to go for a walk beforebreakfast.•O 0 0 0. Two students of anatomy were passing a house one night in which oneof the occupants had forgotten the conventional use of the window blind.First Student : "That girl's not a bit shy, is she?"Second ditto : "Well, not exactly. But she's certainly retiring."CI CI 0 CI 0 0Honorary : "How would you prepare a patient for a prostatectomy ?"Nurse : "Well, sir, I'd begin by plaiting the hair."El 0 0 lj 0 IDSome P.H. points :-"Water from dams should be regarded with suspicion."Surely this is encroaching on the provinces of veterinary science !a 0 O El 0 0Lecturer : "I am not going into the various types of water closets.can do that together on our practical demonstration day."CI CI 0 CI CI • CIFrom a P.H. text-book : "Of 3000 latrines inspected, less than 100 werefound to be safe."This may account for so much wiring of the patella.CI CI CI 0 CI 0Eve : "Is it true that a lot of whisky makes you see double?"Adam: "Don't know., but it certainly makes me feel single."El CI CI 0 O CIEqual to the occasion.—One day a well known . physician was hurrying toan urgent case when .a lady of his rather vague acquaintance stopped him."I know your time is valuable, doctor, so I won't keep you long. Just alittle consultation, please."The man of medicine stopped. "Certainly, madam." Then with a gravehow—"Will vou be so kind as to undress ?"CI CI 0 0 CI 0Patient (who has had a toe amputated) : "I say, nurse, I'm rather worriedat letting my fiancee know there's a part of me missing."Nurse : "Take my advice. Don't keep her in suspense. Write and tellher just what it is."O 0 0 0 0 CIThe meanest man in the world has been discovered. He is a Scotch fishermanwho married a woman suffering from ascariasis.asO El CI CI 0 CIjosie : "I'm going to the Ball as Venus."Jessie : "You can't.. Your feet are too big. Anyway, what are you goingosie : "As 'September Morn'."Jessie : "You can't. Your hands are too small !"We

84 THE SPECULUM.Abelard : "What nice ankles you have. Are those stockings all silk ?"Heloise: "I'm a school teacher."a L3 a a aMrs. Wiggs : "So the doctor wouldn't give you a certificate for your latehusband?"Mrs. Biggs : "No—'e says they want to 'old a post partum examinationon 'im."a a a a a aAnne: "Do you let men kiss you ?"Annabel : "No, but I'm not very strong."Dubs an *Derelicts.H.A.P —We could almost taste the vodka when we read your RussianTragedy. Can't use it, though, because there are sonic words in it that don'tlook too well in cold print ; anyway, our censors aren't educated up to Turgenevvet. Thanks all the same.G.A.K.—Many thanks.Ian.—Holding it over till next issue, by which tinle we hope to have sortedout the tragedy a bit.Decam.—You might whisper that story into a naughty young thing's earone dark night, but you forget The Spec-it/urn is respectably middle aged. Fortythree,in fact."Wunovem."—A bit obvious. Have another go along the same lines.Corona.—They say an ounce of humour will redeem a ton of innuendo.We looked in vain for the ounce.." We can't even print your noni-de-plume. Your effusion causeda hemiplegia to afflict our Religious Editor, so that he's only half as usefulas he used to be. Curse you.Spiro.—We know it's all in the cause of science, but one must draw theline somewhere. We don't think you've a chance, seeing that they stopped HenryHead when he —. Oh, well, ask any Third Year physiologist what they stoppedhim doing.Synapse.—Thanks. We have done so for our next issue.I. G. Swinburne.—The subject had been written up and sent to press beforeyour article came along. Sorry we can't use it. Many thanks for sending italong.Furor.—Have you ever heard of libel?Johnstone Cleve.-3.B M.A. just fails to get there for two reasons. One—30.L. Melbourne as a record. Two—our record of friendship with thephysiology department, which we fear publicati1.1 0on of your article would sever.Thanks for the others.1101P

THE SPECULUM. 85e438aPiSt9Here is an opportunity for you to disclose your latent talents. The Speculumoffers a prize of One Guinea for an essay on some humorous subject of medicalinterest.Articles should be about 1800 words in length, and should be legibly written,or preferably typed, on one side of the paper only.These latter conditions apply to all contributions to The Speculum. Disregardof them has been the cause of much obscenity in the Editorial Office.Noms-de-plume will be respected. Hand your MSS. to the Editor, Students'Room, Melbourne Hospital, not later than October 1st.Ebe %peculum 'Moult) Zile to iltnowWhat the questions in Finals will be.Whether ten bob would square the examiners.If there is a "super-synopsis" of Medicine, Surgery, Gyno. and Obstets.Why man was born to trouble. (We blame Eve!—Ed.)If there is something better than A.P.C.What the attraction is about Senior Cas.How little Red Riding Hood managed it.If "meteorism" means seeing stars.Where the flies go in the winter time.If pituitrin is better than ergot.Where the boys of the old brigade are.Who is the silly fool who alters all the notices at the M.H.What to do when two "specials" are listed for the same time.How to be in two places at once.How to be pure.How, failing that, to be careful.The winner of the Grand National.If there is a decent classification of nephritis.If there is a decent cause of it less than 1/- per glass (Old Court barred).If the evil that men do lives after them.Whether a positive Wasserman or a negative character is the greater evil.Why we ever took up Med.What is to become of us all.ZOOLOGICAL LOVE DITTY.Little parameciumHow I envy you,I was like you in the ArchonAnd not far removed in the Palwogene.Time stacked the cards against me,So I evolved into a man.I am envious of your fateWhen you conjugateBody and soulWith .r little protozoan mate—How .derful to beWithol intelligence,Withou decency.(Shades of Walt Whitman!– tEd.)G—CECIL N.R.

86 THE SPECULUM.Ott mit.That Finals are rapidly approaching.That even the "chronics" are aware of the fact.That the Casino is deserted.That generally things are pretty quiet.That one can have too much work.That, in fact, work is a —!!That "finis coronat opus."That we don't like the sound of "finis."That a week's growth and spats are incompatible.That radical removal of both is indicated.That wine, women and song are "the goods."That "that way madness lies."That it's "a mad world, my masters."That love is a neurosis.That there are many neurotic students.That a rather popular O.P. clinic has repudiated "hots."That the clinician is not so popular now.That silver gets a man out of trouble often.That notes get him into it more often.That there is a "suggestion box" at the M.H.That we know a few we're afraid to put in.That letters have a habit of disappearing.That there are all kinds of letters.vb.That these were important ones.That it's a punishable offence to cause a letter to disappear.That life is a "strange, eventful history."That we're historical students.That we're depressed.That a glass of water will go well after Finals.That a glass of beer will go much better.That we mean to try both—with the accent on the latter.That we wish all students freedom from cares and positives.That we wish ourselves success in Finals.That it, like all the rest, is on the knees of the gods."THE THERAPOET."Someone has suggested that, if window boxes are encouraged in Collins Street,doctors may become poets.Hail, smiling morn! The passing tramcar's bellSounds to mine ear like love songs sweetly sung.The sunlit pavement glows, and all is well—Put out your tongue.Without my window salpiglossis blooms,Nasturtium nods to laughing columbine.Sweet odours waft thro' my consulting rooms—Say ninety-nine.Tra-la, tra-la! Let's troll a merry lay!See how my maiden-hair bends to the breeze!Who could be sad on such a golden day ?One guinea, please.—By C. J. DENNIS.

THE SPECULUM. 87lboopital an rear 'Rotes.(Melbourne bospital 'Rotes.July! The hour has come when we no longer reckon the time till the fateful dayof Finals in months or weeks. It is computed in days, and now even the most hardenedsinners have scorned delights, and are living laborious days—and, what is more to thepoint, laborious nights as well. The Casino accordingly bears a deserted aspectnowadays, and it will be some time before "rummy," "pont," and "ups" come into theirown again. Speaking of "rummy," we would like to know what has become of Walter,whose devotion to the game was, for a time, truly remarkable.However, we were speaking of sterner things. - The wards present an inspiringpicture of activity from an early hour. New patients with anything at all interestinginside or outside are pounced upon by the earliest birds. The later ones usually finda rather short-tempered object for clinical study.There are some few spare moments, though, when we go down and support theweary flesh with morning tea in our new tea room—a peculiar architectural structure,apparently the offspring of the ill-assorted union of a bird cage and an aquarium tank.Were it not so obvious, we would remark that there are some queer birds and strangefish to be seen in it, too.Certificate books are strongly in evidence, too, around the institution—especiallyat one O.P. Clinic, where proficiency in vaccination is attained in a remarkably shortspace of time.All the boys look a little worried except "Bern," but some say that's just irresponsibility.Ian is still muttering dogmatic statements anent the nourishment of theyoung, but not quite so decidedly as before. Harold and Eric still hold learned discourse,and Teddy still manages to keep a firm grip on the handlebars despite theapproaching trials.We know how many will be called, but just how many will be chosen in August isa different matter—anyhow, best of luck to us all.Fifth Year are learning the sorrows of eight-thirty lectures. With chilled extremitiesand profound cerebral anemia, resulting from lack of sleep, they painfully toilto the P.M. room every morning. In their spare time, when not in clinics, they go toFairfield, Royal Park, or other far-flung outposts of clinical teaching. Some are learningat the Kids that D.V. doesn't mean God willing, and others are at. the Women'sdealing with the raw product.Speaking of Royal Park recalls a case seen there of more than usual interest tostudents. The individual in question had been drinking sarsaparilla in Young & Jackson'swhen the delightful form of Chloe met his gaze. He threw a glass at the lady,inflicting such damage as necessitated the removal of the masterpiece from the gazeof the Bacchic esthetes for a few days. Personally, we never drink sarsaparilla, andas for throwing things at anything or anyone as charming as Chloe ! In fact, wefeel quite the reverse.Fourth Year have by now become desensitized to the Hospital, and show few ofthe symptoms of the shock we so vividly remember. They now know where the wardsare, and what D.O.L.P. means, and where the A.P.C. bottle is on the Cas. shelf, andlots of little useful odds and ends like that.

88 THE SPECULUM.There is still much for them to learn; a time of suffering and mental travail liesbefore them, its consummation being experienced by the unhappy Sixth Year now.There is really very little of interest to recount—at least, most of the interestingthings that happen here can't be told. Discretion is our middle name, and TheSpeculum must not be sullied by other than that which is meet and proper. Not thatanything very dreadful happens, but there are some bright spots in our otherwisedull lives.When we get through Finals we'll tell them to you over a celebrating pot ofglorious beer. Till then with our parched throats we'll just say "Cheerio."IttfreD lbospital 'notes.Very little of moment has occurred since last publication. Life has been veryuneventful, and it is only now, with a few weeks remaining before Finals, that weawake from our lethargy, and wonder, some of us, how we are ever going to getthrough; others, how we will feel twelve months from now; and yet others, blissful intheir early days at hospital, wonder what all the flurry is about.So far this year there has only been one dance, at which the students may see thenurses, fresh from their labours, and discover unsuspected charms. Truly, as Shelleyor Hill—for the moment I forget which—puts it, "Eve escaped from her cave, and,without her leopard skin, is a very different maiden." However, the students intendholding their own dance in August, and then there is also the Nurses' and the Honoraries'.Truly purple spots on the horizon.To several of our number we advise the greatest caution. We know that all of usat some time or other had a nurse, but we have left those years of indiscretion farbehind. Not wishing to be personal, we will say no more, but hope that these littleincidents will not be repeated. Brandy may be 200% proof spirit, and ammonia aliquid with plenty of kick in it, but they will not mix to advantage.Tonsillectomy has become the fad of the moment. Why John, Bill and Dave wishedto have theirs removed we do not know, but if the staff in War d 4 were changed,perhaps the incidence of septic tonsils would be greatly lowered. And also, John, thatwas no time to retire to your bed, on the night of your admission.A motor bike club has been formed at the A.H. Already seven prospective membershave promised their support, on condition that week-end trips are arranged toBalnarring and Chelsea.Two of our number, Phipps and Buchanan, upheld the traditions of the A.H. bytheir performances at danberra. Just what those performances were we cannot getthem to disclose, but we hope that the honour of medical students has not been tarnishedin any way.Several of our students have been distinguishing themselves in the academicworld of late. Very soon publications in the A.M.J. are expected on the Use ofLipoiodol for Intrauterine Injection, coupled with X-ray. Vast fields will be openedby the perfection of these researches. But perhaps the greatest feat of all was madeby one of our number, who diagnosed that rare condition of Pillagra in a patient, afterall the honoraries had lived in a quandary for weeks, and Sixth Year students stoodround and gazed with awe and admiration, tempered with envy and derision. Trulya case of "pearls."In the realm of sport little progress has been made. After decisively defeatingthe Residents at cricket, they have been most unwilling to participate in any otherform of sport. After the way they showed us to play hockey, some years ago, we hadlooked forward to many a spirited contest. It is rumoured, though, that they aretraining Harry as a wrestler, but we will be ready.Whilst talking of sport, our heartiest congratulations to Eddy on his performancein Inter-'Varsity in the High Jump, and his Victorian record in the Discus.Here's one heard in an S.O.P. clinic:—Doctor, recognising elderly woman, a formerpatient of his: "Oh, yes, you are Mrs. X. I remember operating on you in the frontpassage years ago." To which she replied, "Oh, no, doctor, you operated on me in thetop theatre."In memoriam, we wish to insert an epitaph to the Cas. Students' Radiator. Forthe benefit of those who did not know the inspiring words engraved on it we attachthe following:—"A catheter is the invention of Satan, through which the patientfinally gets cystitis and the Cas. Student no sleep." And on the other side: "A circumcisionis the only thing which makes enjoyable the life of the Cas. Student. When we

THE SPECULUM. 89are R.M.O's. we will do all the dressings, catheters and kid's histories ourselves, andgive the students all the decent jobs. Yes, we will, like h-1."Before concluding, we wish all those doing Finals every success and the best ofluck, and feel sure that they will emulate the records of previous Alfred students.In conclusion, we express our gratitude to those members of the Hospital Staffwho have so generously fortified the soda of our academic existence with the whiskyof social intercourse.%t. Vincent's 'notes.The most important event to chronicle this time is the invasion of the Women'sHospital by the St. Vincent's contingent. We got a warm welcome there, and were aspopular when we left as we were at the beginning.Whilst there, Rick, with a wonderful effort, defeated Jack Bryan hands down, in astirring contest in which every point was vouched for. Rick says he even had to wakethe boys up at 3 a.m. to see that all his points should be counted. Anyhow, Jack, don'tworry, you are in all probability well ahead of any third man. Leo Geraghty, to thegreat delight of all present, rendered his masterpiece, "Oyez, Oyez, Oyez, Soliman."To be appreciated this effort should be heard. Leo Loorham came home one nightwith two of the City Council flags, which now adorn the St. Vincent's students' room.He won't tell us how he got them without being pinched, but they say the devil looksafter fools and others.Jack B reckons he knows all about doing a P.V. or P.R. now, since Mac taughthim the right way. Breezy had a bed down in the L.W., we think, as he spent mostof the night and day there, and Sol. says he holds the record for P.V's. with 82 tohis credit.Our late Registrar, Dr. Con. Ley, the ever-popular, has left the fold, carrying ourbest wishes with him. Dave is on the job now. A late arrival at St. V's. is Lou.Phillips, the inimitable, who, with his toothbrush and cute grin, got the boys sized upall right.The Sixth Year, whose Finals are so near, are getting that pale, nervous expressionwhich is pathognomic of medical examinees. They say that Crop finds another whitehair every morning, while Bill Bailey has become a wraith, spoken of, but never seen.How carefree and happy seem the little Fourth Year men in comparison, whoselife for the next few months is one sweet dream; who can sit back and view the hurriedstrife and efforts of their fellow-men with perfect sang-froid. Ah me, those happydays of Fourth Year never to return.For the Fifth Yea r at present life is one long round of Specials at Royal Park,Fairfield or St. Vincent's, and, to cap it all, we've got to start going to the Alfredfor another one. They say that Mat. Mac. feels goosey all over when he thinks of thetime he has got to be the Resident Student. Examine everything very closely, Mac.,before abandoning yourself to the arms of Morpheus. One of our most promisingyouths nearly joined the defunct lately, as he tried to see what aeroplane flying waslike, leaving a motor car somewhat suddenly while it was doing 50 miles an hour.He arrived back with a few scalp wounds and quite a respectable gash on the upper lip.We have got a new clinician in the hospital, or, rather, a pseudo-clinician, for,although he doesn't claim to be M.B., B.S., he knows everything there is to be known,whether in specials, outdoors, or in the wards. Only sublime ignorance or the utmostcheek can have allowed him to carry on so far without realising what a damned nuisancehe is to everybody except himself. Also clinical botts are hereby advised that, althoughthey may like to air their knowledge, they can keep it for their own clinicians infuture, and not loose it upon clinics other than their own. If speaking out of turn willget some people through exams., there are a couple of certs. with us.There has been an outcrop of long veils amongst the nursing staff, and herewithcongrats. are extended to those who tricked 'em. Well, I think I've been burling longenough now, so, like the Arab, I will fold my tent—or, rather, my fountain pen—andcreep silently away to books and other things.tbirb near 'dotes.First term. Busy, as usual, with frivolities. Work in our spare time. We arepleased to announce that on Commencement Thursday their "Royal Highnesses" gracedus with their presence at a dinner, and afterwards the theatre—this being the first

90 THE SPECULUM.occasion on which they appeared in Melbourne. The theatre was the Bijou, and, needlessto say, the Bijou was full. The manager of the theatre appreciated the honourthat was being done to him, and reciprocated by having an escort of police in attendance.The crowds were so threatening that they had to be held back till the arrivalof their "Highnesses," in case room should not be left in the theatre for them. Themanager of the Bijou was delighted with the whole evening, and has desired me tothank everyone for the success they made of his show, and apologised profusely forthe shocking ventilation of his theatre, saying that he would see to it that a bettersystem was installed before this time next year.Let me now tell you "How we out-Did the Duke by Doing Duty to the Duchess."We all remember how angered we were, and how incensed, when we heard our "Darling"Duchess had been left off the list of official guests on the occasion of the Royal visitto this University. I am now going to remind you of how Third Year rectified thisunchivalrous omission. Firstly we invited her; secondly (so that she would not belonely or frightened with unusual company), we set up a "puppet" Duke, dressed akinto "Albert," and bearing this same name. Then a degree. This was a hitch, but weconsidered it absolutely necessary and only fair that she should have one as well asher husband.A degree meant chancellor, professors, and what-nots, and we had to waste anawful lot of time filling these positions, as no one had full qualifications. We foundwe had a B.Sc., so he promptly became chancellor.We added a true touch of dignity to our procession to the Wilson Hall by havinghorse-drawn vehicles throughout. The pilot police officer was the one exception, as herode a primitive machine with the word "Triumphant" inscribed thereon. Our bandwas unique in Australia, not only by its music, but also its garb—bearing the nearestpossible resemblance to the King's "Heralds."Well, to conclude this episode. We got in first. The Duchess received her degreeof "Spinster of Domestic Economy" before the Duke got his. She made a stirringspeech, that was printed in all the daily papers before that of the Duke. She wasspared the pain of having to inspect a Guard of Honour, and she was quietly shownround our grounds•to examine our precious antiques without having a yelling populacetrailing at her heels. The only painful incident that we feel compelled to report wasbrought about by the Duke himself, and was a result of the Duchess' charming sympathy.Outside the Path. School she saw a seething, struggling mass of humanitywith her beloved in the centre of it. Fearing for his safety, she rushed to be at hisside. Cries of "Make way for the Duchess!" arose, and came to the ears of the Duke,whereon he immediately inquired, "Where is she ?" "Squashed in the crowd," cried avoice. "No matter, then," said the Duke, and with this unchivalrous remark passedon. Insulted! We stood aghast for the moment, but, on reading The Argus the nextmorning, we were content; we felt we had won, and that the honour of the Duchesshad been retrieved, for this is what we read:—"The fact the Duke's public welcomeoutside the gates was not so enthusiastic as usual, was accounted for by the fact thatthe burlesque Royal party (evidently referring to our puppet Duke and to fact thatthe Duchess was unofficially present), a moment before, had driven through and hadstolen the applause."Thinking backwards, we come again to "Commencement." Unable to obtain aroom of our own for our stunt, the Law Students generously invited us to join up withthem, and run a combined Medico-Legal stunt. We accepted. You know the result,and we feel our efforts were justified.We could have filled the vaudeville show to at least three times its capacity, andthe Palais de Danse was just comfortably crowded.Of other matters we have little room to tell. Dr. McLaren, from Korea, verykindly troubled to come up one evening, and gave us an interesting account of medicinein Korea. We're expecting to have a few more addresses this term.We entered a relay team for the Relay Race in the Freshers' Sports, and pulledoff a good second place. Re matters Inter-Varsity, congrats. to W. Fenton Bowen forhis win in the 880 Champ.; to R. G. C. de Crespigny for inclusion in the crew thatcame second to W.A.Re matters of work. Congrats. to all who did any last term.2nb Dear 14otes.In the first edition of The Speculum last year, the Editor was compelled to makethis cryptic comment anent the Second Year notes—or lack of them—"We regret tostate that these brethren are inarticulate!" By the time he has perused these notes,he will probably be regretting that this Second Year is not inarticulate, for we havequite a mouthful to tell the world.

"-rtozrziZZLITHE SPECULUM:To begin with, there was a comparatively small nucleus from last year's SecondYear, but the new members soon got into the swing of things, and from then on wehave not looked back.The first function to attract our attention this year was the M.S.S. Theatre Night.which was perforce held at the illustrious and far-famed Bijou Theatre. (It may bementioned that an ex-Second Year man has quite a high opinion of the Bijou, andfrequented it on more nights than one. We would like to know why ? However, thisis beside the point.) It is a strange thing, but theatre managers here in Melbourneseem to be quite chary of our honourable patronage, and, although we are quite broadmindedin the matter, we cannot see why this should be so at all. The entertainmentwas up to the standard of the usual Bijou performance—we will not praise it any more,as this is quite sufficient—and things were very quiet on the whole. The Duke andDuchess "slipped up" the governors of their tour, and joined us for the evening—indisguise. Unless any doubt should exist as to who were responsible for the offensiveodour which spread through the theatre during the performance, we would like to statequite definitely that the people responsible were not medical students.Commencement saw us well to the fore, and the Second Year, or part of it, canrest assured that they "did their bit" to make the Law-Med. show the success it was.So popular did the show prove to be that the room that was available for our use inthe new Arts Building was wholly inadequate, and many people had to wander offto inferior shows disappointed. After the vaudeville show was over, the room wascleared for dancing, and an enjoyable time was spent there until midnight. The profits,although hardly colossal, showed that the entertainment was well received, andwe hope that next year the Med. students will not only run a show on their own, butalso have a much larger room at their disposal.The other big event during the term was the Duke's visit to the "Shop." Someof the members of the Second and Third Years joined together in putting on a verygood entertainment in Wilson Hall just prior to the Duke's entry. We would be verygrateful if the chemist who prepared the NI, for the occasion would write a treatiseon "Why Home-made NI, Will Not Function."Before closing these notes we would all like to congratulate Fenton-Bowen on hisexcellent performance in the Inter-'Varsity 880 yds.Now something for the Bio-Chem. heads—Would anyone like to explain briefly,for the sake of a budding Apostle, whether saccharose is soluble in water or not?Finally, does everyone in the dissecting room know the inimitable Peri ? Heturned up for dissection on five occasions at least during first term. Can he keep itup is what we would like to know ?first near 'dotes.The old axiom about Freshers working the First Term has been applicable to themajority of our fellows.And because of this our social activities began and ended with the Med. theatrenight and the Commencement rumpus.The little coterie of men who knew the ropes, and who by the narrowest of marginsfailed to go on into their second year, was regarded with something of amazementas it leisurely lounged away hours in the sun, or gathered about Van Pelt and hisukelele.There is a growing antagonism to the system that allows little if any appreciablecredit to men who may pass excellently in two of the three First Year subjects, butby a very few marks fail to get the third.We have recovered from our nausea at first confronting our enemy, the rabbit;done our "damdest" to liberate vast quantities of H 2S in the Chem. Lab.• and sweatedwith fear over the small number of experiments carried out and initialled ' at Nat. Phil.At sport and athletics we have a merry tale to tell. Temple is doing good workwith the racquet in the Shop second tennis four; Flynn rowed for Newman; Quinnran well in the sports; Williams, of Queen's, won the Intercollegiate High Jump;Everard acquits himself nobly with the Shop First XVIII.; Gorman batted for Newmanearlier in the year; a number have sacrificed themselves on the callous altar of Rugby,and so on.But, although we have appreciated with suitable stamping the arrival of the latecomerand the bewhiskered jokes of the "Profs.," we have not so far entered as wholeheartedlyas we might into Shop activities.There are many exceptions to this—especially among the men doing the year again—and one is inclined to think that the desire to do well at the end of the year isresponsible for this apathy. Even so, it would be well for a few to remember thatthere is more in University life than the particular course for which one has entered.

92, THE SPECULUM.Alfred Jacobs —State Sanatorium, Wooroloo, W.A.Walter. Seed, John Day, Colin Anderson, Gerald Moss, and Staff. Sutherland.—Perth Hospital. The last named, with a commission gazetted in the A.M.C.Roger Dunkley.—Private Fremantle and Hon. Radiographer to the Hospital.Les Le Soeuf.—England. Passed F.R.C.S. primary.Jack Hasker.—Back again. Gyno side. W.H."Boggy" Grounds.—Gloves, stick and Tasmania. Broken leg—recovered by this."Toot" Taylor.—Somewhere in the Apple Isle."Inky" Way.—(Ormond 1908). Kalgoorlie, W.A.Tom Tyser.—The Hannan's Club, Kalgoorlie, W.A.Alan Tate.—Hampton. Married with son and heir.Noel Box.—E.N.T., Ballarat.F. W. Williams.—Clunes.John Barnaby.—Married. Private at Learmonth.Wilbur Joynt.—Private at Birchip. ? Married.J. M. Buchanan.—Gone to England.John Tate.—Black Rock.Max Kreitmayer.—Finishing course at Barts, and playing in the rugby team.Married Mab Beauchamp."Ginger" Andrews.--Still married. In the bush at Neerim.Don Shiel.—Private, Brisbane. Married.Lionel Loughnan.—Broa if ord.Bert. Hiller.—Super. Bendigo Hospital.George Moore.—London.Wilf. Brady and Elphinstone.—Both about town.Lionel Lockwood.—A life on the "ocean wave" with the R.A.N. Married.Lyal Lovell.—Bendigo Hospital.Harry Ham.—Ditto.Gaston Taylor.—Amongst the phosphate at Ocean Island.Vic. Coulon.—Geelong."Snow" Courtney.—Jervis Bay.

THE SPECULUM. 93Henry Maling.—Millicent, S.A.Keith Hill and Reg. Adamson.—Queensland.George Jamieson.—Ditto, further north.Ken Hope.—Big noise at Ballarat Hospital.Alec. Lincoln.—As above.Doug. Mitchell.—With Vic. Coulon at Geelong Hospital.Bill Freeman.—Returning from Singapore.Alec. Swain.—Kvneton.Les Westacott.—Assisting at Mackay.George Bearham.—Has ceased to tear 'em. Now Pathologist at the Women's.Harry Masel.—Women's.Jim Pannell.—Perth Kids. Just rowed in the winning interstate eight.Bert Nairn.—Perth.ree ",#.4 ."7;"Ebe ibippocratic Oath."This is the oath which Hippocrates, the Father of Medicine, is supposed to havemade all his followers take. In the older Universities of the United Kingdom, eachstudent is made to subscribe to a Latin translation of it before being admitted topractice. The English translation reads thus:—By Apollo the Healer, JEsculapiusand Hygeia and Panacea, do I sware, calling to witness every god and goddess, that Iwill perform to the best of my power and judgment this oath and bond following:—I hereby promise to account him that hath taught me this art as though he were aparent unto me. I will divide my living with him, and if he have need of aught, withhim will I share my substance. His offspring, even as my own very brothers, will Iesteem, and I will teach them this craft, if so be they desire to learn it, without feeor bond. All manner of instruction, whether by word of mouth or by other means, willI impart unto my sons and unto the sons of him that hath taught me; yea, and untoall disciples that are under bond and oath after the custom of our craft, but to noneother. The use of my art will I use for the well being of the sick to the best of mypower and judgment, but naughtiness and iniquity will I eschew. To no man for hisasking will. I give a deathly potion, nor will I devise counsel to that end. In likemanner, to no woman will I give a pessary that shall slay the fruit of her womb. Inholiness and purity will I keep watch over mine life and mine art, and I hereby swareto cut the stone from no man, nor will I attend in the way of them that are wont todo this thing. Into whatsoever house I come I will enter that I may aid the sick, andI will have no willing part in iniquity and wickedness, nor yet in lasciviousness, whetherto man or woman, bond or free.And whatsoever in the way of my craft I do see or hear, yea, even otherwise inthe common life of men, if it be not meet to spread it abroad, I will keep silence,counting such things as mysteries that none may divulge. In fine, if I do keep thisoath inviolate, nor break it at all, then may I have the profit of my life and mine art,being esteemed of all men for all time. But if I break the same, and forswear myself,may the contrary thereof be my lot.

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The Melbourne University PressProposed Circulating LibraryThe University Press proposes to extend the Circulating Libraryit now maintains for students taking courses in Education, so as togive lending facilities to members of staff and their connections andstudents in all faculties. The decision to do this turns to some extenton the needs of country students as well as students attending courses,on the possibility of linking up with a proposed Circulating Libraryunder the Extension Board, of supplementing and assisting theGeneral Library, and of providing quick and cheap methods of obtainingbooks.It is proposed that the library should contain in the mainsupplementary and reference books for courses, new contributions toknowledge specially asked for, and, as funds become available, somevolumes of general literature, including novels.It is proposed to conduct thelibrary on a deposit and payment bytime basis. A subscriber will pay,say, a deposit of 10/- when takinghis first book, a hiring fee of 3d. to6d. for the first week, and a furtherfee on return for any additional time.All members of the University andtheir connections are invited to , jointhe library, and, if it is their intentionto do so, are requested to advise theundersigned. The result in returnswill determine whether or not thelibrary will be instituted.STANLEY S. ADDISON,Managing Director.NEW PUBLICATIONSBYThe Cambridge University PressFetter Lane, London, E.C. 4.PRACTICAL PHARMACOLOGY. For the use ofStudents of Medicine. By W. E. Dixon, M.A., M.D.,F.R.S. Price 8/6. This work is intended for laboratoryuse, but enough is said in the text to impress onthe student the significance and practical bearingof the experiments he performs. The experimentshave been chosen as far as possible to illustratewell recognised actions of common drugs in everydayuse and, with a few exceptions, because theyrequire little technical skill.THE RESPIRATORY FUNCTION OF THEBLOOD. By J. Barcroft. Price 12/6.LECTURES ON THE HISTORY OF PHYSI-OLOGY DURING THE SIXTEENTH, SEVEN-TEENTH AND EIGHTEENTH CENTURIES.By Sir M. Foster. Price 16/-.BLOOD IMMUNITY AND BLOOD RELA-TIONSHIP. By G. H. F. Nuttall, M.D., Sc.D.,F.R.S. Price 25/-.Owing to import charges, the above English Catalogueprices are increased by the Australasian BooksellerSend for a complete Catalogue of bookspublished by the Cambridge University Press.AUSTRALASIAN REPRESENTATIVES:THOMAS C. LOTHIAN PTY. LTD.,' 497 Collins Street, Melbourne.95

309-11 and 82 BOURKESTREET, MELBOURNEFOR those much appreciatedgifts yousave by shopping atEdments.WE have a most comprehensivestock ofsuitable presentationgoods, including Pens,Watches, Beauty Aids,and Smoker's Requisites.Smith St., CollingwoodChapel St., PrahranSydney Rd., BrunswickNicholson St., Footscrayand Moorabool St., GeelongSwan St., RichmondBridge Rd., RichmondPuckle St., Moonee PondsErrol St., Nth. MelbourneCIGARETTE HOLDER, made of Amberold, andmounted with Silver Bands. Complete in highlyfinished Case, making an ideal gift - - - 7/6EVERSHARP PENCILS, in Plain Silver-plated Case. These Pencils are always ready for use, and neverneed sharpening. Eraser under cup on top. Each pencil is fitted with Pocket Clip, 9/6 and 13/6. Engraved,13/6; Sterling Silver, 25/-; Gold Cased, 27/6; Engine Turned 31/6. The Pencils are ntwo sizes, Short 4 1 4, in., Long 5'A in. We stock refits in H.B., Indelible, also Rubbers 1/6 box.STATE SAVINGS BANKOF VICTORIAINTEREST-4 Per Cent. on balances up to 11,000Per Cent. on Deposit Stock up to11,000Head Office-139-153 ELIZABETH ST.MELBOURNE.GEO. E. EMERY,General Manager96

University Men !WE SPECIALISE IN THE FOLLOWING:—We are looking forYOUR Business ::MiCrOSCOrles.—By Baker, Leitz, Watson, Zeiss, Spencer, Beck, Bausch& Lomb, and others. from &II/10/- to £20.Microscope Accessories. —Objectives, Oil Immersion Lenses, Eyepieces,Slides and Slips, Cabinets, Stains, Books, and DissectingInstruments.Surveying Instruments.—sole Agent for Watts, London : Theodolites,Precise Levels, Quickset Levels, Staves, Compasses, AbneyLevels, Steel Tapes, etc.Drawing and Mathematical Instruments.--Large selection ofall descriptions.OUR ILLUSTRATED CATALOGUES FREE ON REQUESTN. H. SEWARD"OPTICAL HOUSE"457 Bourke Street, MelbourneTel. Cent. 9439(Near Queen Street)Academic GownsDOCTORS, MASTERSBACHELORS' GownsUNDERGRADUATES'Gowns00.00All Gowns correct in shade and shapeas per University regulations—Madein Woollen Persian Cord.Successois goLINCOLN STUART & CIATRENCHERS---Christy'sEnglish Madeand HoodsSPECIAL PRICEUndergraduates'Gowns52/6Prices of otherGowns on request16/697

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THEMelbourne University Press.Board of Directors :Dr. J. C. V. BEHAN (Chairman).Professor E. SCOTT.Professor A. J. GUNN.Mr. LEIGH SCOTT.B. C. D. JONES.Mr. A. E. WINTER.Mr. S. S. ADDISON (Managing Director).The following Services for Students arenow maintained :-I. A Second-hand Book Exchange.2. A Postal, Telegraph, and Money Order Office.3. Supplies of Specially designed Notebooks, Loose LeafCovers and Stationery requisites.4. A Circulating Library for Education Students(M.Ed.).5. A Publishing department which has issued sometwenty-five volumes on various subjects. Fortitles and prices see catalogue.6. A System of Discounts with booksellers who supplyTextbooks to Students.Address all communications toThe Managing Director, Melbourne University Press,University, Carlton.99

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ESTABLISHED 1888Telephone Central 4298After Business Hours, Windsor 1531JAMES LITTLEMEDICAL PUBLISHERIMPORTER of MEDICAL and SURGICALWORKSMedical Agent for the sale and purchase of PracticesAssistants and Locum Tenentes supplied" CENTREWAY," COLLINS STREET, MELBOURNE(Take Elevator to 3rd Floor)STETHOSCOPES FROM 10/6A CHOICE COLLECTION OF THE LATEST BOOKS ON MEDICINE,SURGERY AND NURSING ALWAYS ON HAND. ALSOStudents' Text Books:DISEASES OF THE CHEST AND PHYSICAL DIAGNOSIS. By Norri#and Landis. Third Edition, Revised, 1924.YOUNG'S PRACTICE OF UROLOGY, based on a Study of 12,500 cases.THE MAYO CLINIC. One Volume. Annually.THE SURGICAL CLINICS OF NORTH AMERICA. Every other month,February to December each year.THE MEDICAL CLINICS OF NORTH AMERICA. Every other month.Clinic year, July to June each year. (Equal to a Post-graduate Course.)SURGICAL PATHOLOGY. By William Boyd, M.D., M.R.C.P.Ed.,F.R.S.C. 1925. The latest and best on the subject.MacCALLUM'S PATHOLOGY. New Third Edition. September, 1924.The recognised standard.SPECIALTIES IN GENERAL PRACTICE. Nine Specialties by NineSpecialists. Edited by F. W. Palfrey, M.B. Price, 32/6.SCUDDER'S FRACTURES. New 10th Edition. Price, 60/-.TEXT BOOK OF BACTERIOLOGY. By W. W. Ford, M.D., Professor ofBacteriology, John Hopkins University.DISEASES IN INFANTS AND CHILDREN. By J. B. Crozer Griffith,M.D., and A. Graeme Mitchell, M.D., Professors of Pediatrics. Twovols. £5. New Second Edition, thoroughly revised (1927.)A COMPLETE STOCK OF SURGICAL INSTRUMENTSBrown, Prior & Co. Pty. Ltd., Printcraft House, 430 Little Bourke Street, Melbourne.No,