also acted as medical officer to the Adelaide Gaol for several years. He was for several years a prominent member of the Central Board of Health and of the Medical Board. He has left a widow, five daughters, and two sons.

Dr. D. J. Williams, one of the oldest medical practitioners in Victoria, died at Queenscliff on Saturday, 18th January, 1902, after a long illness, in his 84th year. Deceased was one of the oldest justices of the peace in Victoria. He was one of the first councillors of Queenscliff, and had filled the office of mayor.

they are at present constituted, are suitable public bodies to be entrusted to the prosecution of the new campaign against phthisis and other forms of tubercular disease.

On December 3rd, the Prince of Wales was ceremoniously installed as President of St. Bartholomew's Hospital. Sir Trevor Lawrence introduced the new President, and, in speaking of the past history of the Hospital, referred to the fact that the foundation had always maintained an unbroken connection with the Crown. He reminded his audience of the exceeding interest which their late President, now His Majesty the King, had always taken in their work, and congratulated them on the prospect of having that Royal interest upheld by the King's successor in their presidential chair.

leaves a widow and two children.

CORRESPONDENCE.

London.

(FROM OUR OWN CORRESPONDENT.) The Army Medical Service-The Prevention of Tuberculosis-St. Bartholomew's Hospital-Smallpox in London-The General Medical Council―The rapeutic Institutions.

IT is rumoured that a Royal Warrant is about to be issued for the carrying into effect of Mr. Brodrick's scheme for the reform of the medical services of the army. Unless this scheme as originally promulgated has been subjected to very considerable modifications it will ignominiously fail in its object. There has been abundant evidence that it has been received by the Royal Army Medical Corps itself with a feeling of disappointment, and it is almost universally condemned as unworkable by those outside the service who are best qualified to judge of its merits.

The system, on which it is based, of promotion by examination is one of the worst conceivable and will almost inevitably ultimately result in the highest posts being occupied by officers who, however expert in book knowledge and laboratory technique will not necessarily possess either administrative capacity or executive skill for the solution of problems concerned with the sanitary and general medical management of armies in the field. There are, moreover, so many anomalies in the matter of pay and promotion that, apart from the examination test which is to be supreme and is of itself enough to wreck the scheme, the conditions of service will in no sense be improved, and will fail to attract either the class or number of men who are so urgently needed.

The Council of the National Association for the Prevention of Consumption held a meeting on November 11th, at which the following resolution, brought forward by Dr. Nathan Raw, was unanimously adopted: "That, in the light of our present knowledge, the time has now come, when the whole question of tuberculosis, including treatment of suitable cases in municipal sanatoria, should be undertaken by the municipal corporations and county councils throughout the country."

It is doubtful whether the times are propitious for the general adoption throughout the country of a scheme which would necessarily involve serious additions to the rates; and it also may be questioned whether municipal corporations and county councils, as

under treatment in the hospitals of the Metropolitan Asylums Board having on the 2nd December reached a maximum of 459. The advent of cold weather has not brought about the expected decrease in the notifications, the number of which have been 16, 31, 28, and 33 for the 1st, 2nd, 3rd, and 4th of December respectively. This epidemic has abundantly verified the experience of former outbreaks that the protection of vaccination lasts only for a few years, and that if the immunity from the disease acquired in infancy is to be maintained revaccination is imperative.

Though the people of London have sought the protection of revaccination in large numbers, it is to be feared that their still remains a considerable residuum of the population who, either from carelessness, "conscientious scruples," or 66 cussedness" has omitted to range itself on the side of safety. This non-compliance with the only, and now-a-days absolutely safe means of prevention, constitutes a serious menace to the community at large, and is a painful testimony to the legislative un-wisdom which sanctioned a repeal of the compulsory clause in the Vaccination Acts. Owing to the difficulty often experienced in recognising the early stages of the disease, and the disastrous consequences which are apt to ensue from errors in diagnosis, the Borough Council of St. Pancras have recently adopted two commendable safeguards. They have made chicken-pox a notifiable disease within the Borough, and they have appointed, to act as medical referee in each ward, a practitioner whose services may be requisitioned by the ordinary medical attendant on any suspicious case. It will be interesting to observe how this plan works out in practice.

The proceedings of the W nter Session of the General Medical Council came to an end on Tuesday, the 3rd December. Sir William Turner, whose term of office expires this month, was unanimously re-elected to the Presidency for a further term of five years.

The business was not, on the whole, of great consequence, but none the less, seven days were occupied in its transaction. One of the leading items on the agenda was the case against Mr. Robert Rendall, M.B., C.M., Edin, of Great Yarmouth, against whom the following charge was formulated: "That you have been guilty of infamous conduct in a professional respect, particulars of which are that you accepted and continue to hold the appointment of medical officer to the Liverpool Victoria Friendly Society at Great Yarmouth, a society which systematically practises canvassing for the purpose of procuring patients, and that you have approved or acquiesced in such canvassing."

The prosecution was conducted by Dr. R. G. Bateman on behalf of the Medical Defence Union, while Dr. Rendall was represented by Mr. Lawson Walton, K.C.

M.P., and Mr. Charles Matthews. The Council, after deliberating in camerá, decided that the facts alleged against the respondent had been proved, and, while admonishing him, gave him until next session to consider his position. This decision is, in the interests of the profession, heartily to be approved, and has a far-reaching importance. If Dr. Kendall, between now and next May, severs his connection with the Liverpool Victoria Friendly Society, no further steps will be taken against him, but the Council's decision establishes a precedent which must in the future deter practitioners from associating themselves with that class of Medical Aid Association, whose modus operandi is such that the difference between the income acquired from the weekly pittances collected from the poor, and the miserably insufficient salary paid to the unfortunate medical man who consents to do their work means revenue to the Association and percentage profits to those who run it. As commercial speculations, such institutions may be legitimate enough, but much of their success is attributable to the philanthropic flag under which they sail, and the position of their medical officers, who are little more than business assets on which the profit and loss account has entirely to depend, is obviously one which is inimical to the veriest rudiments of professional ethics. The Medical Defence Union is to be congratulated upon this successful issue to a case involving such important principles.

Another case of some interest in which certain practitioners were charged with employing as assistants for the sale of scheduled poisons, persons unqualified as pharmaceutical chemists, fell to the ground in virtue of an apology offered on the part of those charged with a breach of the Pharmacy Act, which they had committed unwittingly.

How far medical men should be allowed to compete with chemists in the sale of ordinary drugs is still an unsettled point and one which must in great measure be decided by every man for himself according to his views and circumstances, but there can be no question as to legality of poisons being sold except by those who are duly licensea.

The subject of the powers of the Council with regard to courses of study and the recognition of institutions in which such courses may be taken gave rise to animated discussion, and was ultimately referred to a special committee to consider and report.

Dr. Dawson Williams, the Editor of The British Medical Journal, recently delivered to the Reading Pathological Society, on he occasion of its sixtieth anniversary, a striking ad prophetic address on the subject of Sanatoria. He called attention to the fact that the recent extraordinary multiplication of institutions in this country for the cure of consumption was a vivid illustration of the response which had been afforded by the public to the system of disease-treatment away from home in well-appointed houses, where a disciplinary method of management is adopted and intelligently directed to every detail of the patient's daily life by skilled medical supervision. Such institutions, though long existing abroad, have only recently caught on here, and though there is some reason to fear that the recently awakened enthusiasm for the open-air method of treatment of phthisis may lead to a supply in excess of any legitimate demand, the fact that they have been so extensively patronised gives point to the force of Dr. Williams' prognostication that the day is rapidly coming when "more poor-law patients will be treated in institutions, more persons of the artisan and lower middle class will be treated in sanatoria at low rates, and

more people of the wealthier class will go for the treatment of chronic disease to sanatoria, where at various rates of payment they will obtain the quiet or society, the rest from household anxieties, and the systematic treatment by diet, exercise, physical methods, and by drugs which they need." There can be no doubt in the minds of medical men that not only tuberculosis but every other variety of disease would be better managed and yield a higher and more speedy recovery ratio if such a system of sanatorium treatment were to become the fashion, but it may be doubted whether any extensive development in such a direction would be to the benefit of our profession. It would have superlative advantages for persons of limited means, whose home circumstances and financial resources are ill adapted to the strain of long illness; it would also ensure obedience to orders and immunity from the irresponsible interference of the fond, though foolish, friends and relatives of every patient whether of high or low degree: but were it to be widely adopted by all classes of society the aggregate loss to the general knowledge and yearly revenue of the general practitioner might more than ever seriously handicap him from the point of view both of experience and of the necessary wherewithal to live. Dr. Williams does not think that the effect need necessarily be injurious, but that, on the contrary, such a movement, if well directed and carefully guarded from the avaricious ambition of the company promoter and capitalist, will redound not only to the greater benefit of suffering humanity, but also to the ultimate greater influence and power for good of both medicine and surgery. Whether public opinion either at home or in the Colonies is yet ripe for such a development, the day is foreshadowed in this suggestive address when the advantages of treatment for all kinds of ailment in a well equipped "home" will command the attention of the public and leave the profession no choice but to progress with the times. London, December 13th, 1901.

Victoria

(FROM OUR OWN CORRESPONDENT.) Deaths under Chloroform-Case of Brain InjuryLodge Matters at Williamstown-Expenditure at Melbourne Hospital.

THE prevalence of deaths during the administration of chloroform still continues, and since my last letter ether has been blamed for the death of one case. Apparently, the medical man who made the autopsy did not agree with this opinion, for his evidence made it appear that the death was due to shock following upon a serious and dangerous operation.

Another death occurred whilst chloroform was being administered, and this time at the St. Vincent's Hospital. In this case the sufferer was a farmer, aged 45 years, who had been suffering from diseased bone in the arm. The symptoms were of the usual type recorded, viz., after the administration of a certain amount of anæsthetic the patient began to struggle violently, and then after the administration of a little more he suddenly ceased to breathe. The usual remedies were unsuccessfully tried to revive the patient, whose heart, according to the evidence, continued to beat for nearly one hour and 20 minutes. The cause of death, in the opinion of Dr. Stawell, who made the autopsy, was dilatation of the heart and heart failure.

The feeling of insecurity such cases as these give the public must have a highly prejudicial effect upon patients who may have to undergo operations, and it is a great pity that the publication of every death under big headings in the daily journals should be countenanced, as it does no good to the profession or to the public. Many times operations are only undertaken "in extremis in the forlorn hope of saving life, and death, under such circumstances, should hardly be ascribed to the anesthetic. There is no doubt that the administration of chloroform should only be undertaken under the direction of an experienced anæsthetist, and no cases, in hospitals particularly, should be operated upon without this direction except in great emergencies.

Mr. Agar Wynne, Solicitor-General for Victoria seems (?) to understand the whole matter, and puts it in a nutshell, viz., "That the patients are smothered by the mask." According to the Herald, dated 20th January, 1902, Mr. Wynne states that he has studied this question of chloroform administration, and the result of his studies was the opinion given in the preceding paragraph. He also states in the same paper that he has given instructions that, in future, at all inquests on persons who have died under chloroform, the Government shall be represented by a 66 competent man," who will endeavour to ascertain if anyone was to blame in connection with the fatality.

The Solicitor-General further informed the Herald representative that he had some little experience of the use of chloroform himself, and that it was perfectly safe when applied intermittently on a handkerchief. He had used it many times in this way, and had seen it used for a great number of years without accident, and, he observed in conclusion, that it was only in hospitals"-where mask inhalers were usedthat one ever heard of a death under chloroform.

Mr. Agar Wynne apparently understands more about medical matters than the profession itself, and the poor, long-suffering practitioners are again being taught by a layman how to carry on their business.

If Mr. Agar Wynne were to appoint a medical commission to consider the question of the administration of anæsthetics, he would be doing better work than by giving his own opinions on these matters.

In private practice mixed anæsthesia is coming much more into vogue, and certainly seems, so far, to have proved very successful, for no deaths have been reported under such circumstances, to the best of my belief, for the last few years.

An extraordinary case of brain injury occurred recently to a boy aged five years. He accidentally fell from a railway carriage on the Gippsland line, and was picked up in an unconscious state, and conveyed to the Children's Hospital, Carlton, where he remained unconscious for 67 days, and then died.

No settlement has been arrived at between the medical practitioners at Williamstown and the Rechabite Lodge so far, and the matter has been postponed for another three months in order to give time for unanimity and friendly arrangement on both sides.

The expenditure per bed per year in the Melbourne Hospital was stated to be £74 11s. 5d., or £10 4s. 3d. more than the average of the six hospitals which had been selected for comparison, viz., the Sydney, Prince Alfred (Sydney), Brisbane, Adelaide, Alfred (Melbourne), and the Melbourne. At a meeting of the committee of the Melbourne Hospital, the Argus proprietors were complimented for having, at their own expense, conducted an investigation into the expenditure of this Hospital. This seems a peculiar position for a committee of a hospital, who are

supposed to manage and control its expenses, to take up. To an outsider, it would naturally appear as if the committee were not capable of conducting its own affairs, when it has to look for outside help for such a purpose as this.

Mr. Andrews, the Secretary of the Melbourne Hospital, stated that the expenditure was greater in the Melbourne Hospital than in others, because the number of in-patients per bed occupied is greater in the Melbourne than in any other institution. The higher expenditure for provisions is due to the higher prices of groceries and meat.

South Australia.

(FROM OUR OWN CORRESPONDENT.) Adelaide Hospital-Dentists' Bill-Amendment of the Vaccination Act-Administration of the Public Health Act-Medical Defence Union.

THE history of the past year here can hardly give unqualified satisfaction to those interested in medical progress. It is true that there is food for thankfulness in some directions. The return of the old staff to the Adelaide Hospital early in the year has, as was hoped, gone a long way towards closing the breach that has existed for so long, and has enabled medical students once more to complete their course here. With the appointment of a medical superintendent and five house surgeons during the past week a further step has been taken toward a return of the old order of things.

The introduction of a Dental Bill into the local House of Assembly last session was also a step forward. This State has long been the happy hunting ground of unqualified dentists, and the proposed Bill, based as it was on similar Acts in the other States, would have gone a long way towards bringing about a better condition of affairs in the future, while duly conserving the rights of those already in the field here. The "anaesthetic clauses" in particular were a praiseworthy effort to bring the administration of anaesthetics under proper and qualified supervision. Unfortunately the Bill was introduced too late in the session to be carried through, but better success may be hoped for during the coming year.

On the other hand, the Compulsory Vaccination Act has been amended by the introduction of the conscience clauses of the English Act, without, however, any limit being placed on the period for which the experiment is to be tried. This in itself is not so serious a matter as the sentiment at the back of the change; the daily papers openly term it the abolition of compulsory vaccination, and the letters of the general public prior to the introduction of the Bill and the speeches of legislators during its passage through Parliament both revealed a very strong feeling against vaccination, combined in most cases with a very imperfect knowledge of facts concerning it.

A similar unhealthy state of public opinion was revealed in the public discussion that ensued, on Dr. Borthwick's attempt to secure the better administration of the present Health Act. It was clearly shown that the vital clauses of the Act were not being enforced, and that the hoped-for benefits had not been realized through the administrative bodies spending their time searching for grievances and difficulties instead of attempting to carry out the spirit of the Act. But it was just as clearly shown that many of the local bodies were determined to resist any attempt to enforce the Act, and that a section of the community were much more impressed with the grievances of individuals than with the welfare of the many. For a time it looked as if

the only result of the discussion would be to cause the repeal of the Act altogether!

These facts clearly show that the prime necessity in the immediate future. is to educate the public more thoroughly in public health matters. It becomes a serious question whether an attempt must not be made to do this through the daily press. At present, practically the only medical information the lay public get in their papers is sensational paragraphs on the cure of cancer by Röngten rays or violets; or the experiences of a man with a gastric fistula, or some such supposed wonder of surgery. A number of cases of individual hardships, whether it be from quarantine or vaccination, or the cleaning of a dirty milkshed, have full publicity given them, and sooner or later an agitation arises on one of these subjects. Any facts put forth at such times by medical men carry little weight. Their evidence is regarded as biassed and is discounted accordingly. Yet, these are about the only occasions at present when we attempt to put the facts on these matters before the public. The periodical contribution of a column of notes and authoritative facts would do much in the way of improving matters.

The Medical Defence Union of this State held its second annual meeting in December, and by its report showed it is accomplishing useful work in a quiet way. Membership has been well maintained, and there is now a substantial bank balance. Both in the report and at the meeting stress was laid on the decision of the council that £1 18. should be the minimum fee for insurance examinations. The necessity for this was shown by a circular issued the next week by the Temperance and General Mutual Life Assurance Society asking medical men to examine those insuring for a small sum for 10s. 6d. A great show was made of a less complete form to be filled in, but a casual inspection revealed that the answers for this form required just as complete an examination as ever. It is to be hoped that a united effort will be made to defeat this

move.

The Proposed Australian Medical Association.

(To the Editor of the Australasian Medical Gazette.) SIR,-As the member dissenting from the resolution passed at the meeting of the New South Wales Branch of the British Medical Association, which condemned the proposal to discuss the formation of an Australian Medical Association, I would ask leave to state my reasons for doing so. It is probably true that selfinterest governs all our actions, and the members of the Branch have jumped to the conclusion that their interests were best served by the maintenance of the status quo. And the parochial spirit, which views with distrust any suggestion of change coming from an outside source, was not wanting. I am convinced that an attitude which refuses even to discuss in open court any subject, and prejudges it in ignorance, is an altogether unreasonable one, and one not calculated to gain for us the intellectual respect of the medical profession in the other States.

It would appear from the discussion at the meeting that there were no arguments to be adduced in favour of such an Australian Medical Association. The Executive Committee of the Inter-State Congress evidently think differently, and it would only have been courteous to have withheld an expression of opinion until their proposals were made public. And this all the more because any abstract resolutions

passed at the Congress could only have an academic value. As in the case of political federation, I opine that any resolutions passed at the Congress would be submitted to the various State Medical Associations, and that the final appeal would be by plebiscite to the medical profession in the different States, and that only by majorities in each and all of the States could such resolutions become binding. By such a procedure absolute liberty would be accorded to the medical profession in each State. And are there no arguments in support of medical federation in Australia? It is seemingly held that this federation would necessarily be antagonistic to the connection with the British Medical Association. This has not been proved. Anyone is at liberty to propose that the federation should be a union of all the State Branches of the British Medical Association, this to form an Australian Branch of the British Medical Association, with State Branches retaining a certain amount of autonomy.

And if this be impracticable, it remains for us seriously to discuss whether the connection with the parent Association is of sufficient value to outweigh the advantages arising from an Australian federation. The connection with the British Medical Association is, after all, mostly one of sentiment. Let it be granted that the parent Association is a great and powerful body, but let us also realise that it can do little or nothing for us in Australia. It provides us with the Journal, it extends a courteous welcome to Australian delegates at the annual meetings; beyond this, I do not know what it can do. But the profession in Australia has to work out its own destiny, and no outside influence can avail it in the least.

My desire is to see an Australian Medical Association, not a mere dilettante body meeting occasionally for discussion and recreation, but an organised fighting union presenting an unbroken front to all attacks upon its rights and privileges, and, on occasion, carrying the war into the enemy's country.

The condition of medical men in Australia is, in many ways, deplorable; in the not far distant future it looks as if it would be worse. One need not be a pessimist to predict this. The ranks of the medical profession are being increased every day, the general population is practically at a standstill. It follows from this that incomes all round must be decreased. But the true inwardness of the situation is this-that the increase in the number of medical men offers the opportunity to the Friendly Societies, and other sweating organizations to seek to make their own terms with their medical attendants. Heaven knows the position is bad enough already. What will it be if a sauve qui peut sets in, and every man finds himself competing against his fellow for bare existence? And we are the trustees of the future, and owe an account of our stewardship to those who will follow in our footsteps. We have no right to act on the principle that as long as things suit us at present the deluge can come after us for all we care.

The question of contract practice requires to be gone into all over Australia. We have no General Medical Council, whose pronouncements carry legal effect. Our own salvation must be worked out by ourselves, and this can only be done by strenuous organisation; the accumulatton of what we not need hesitate to call "strike funds," and the rigid application of the boycott. This is the only weapon the medical profession possesses, but it is a very effective one. Under an

Australasian Medical Association its arm should reach from Port Darwin to Hobart, from Sydney to Fremantle. If the stories which reach us about the bondage in which many of our Victorian brethren are

held be true, we, in happier lands, should be prepared to make considerable sacrifices to come to their aid.

There are other questions of great importance-such as hospital abuse, the necessity for a supreme court of appeal for medical ethics, and many others, but I cannot deal with them. Have we not some power of looking before and after? In solidarity lies our safety. If the wharf-labourers, the miners, the seamen on our boats can strive and suffer for what they hold a principle, surely we, with our advantages of education, of resources, of belonging to what is practically a close corporation, can so baad ourselves together that we may face our future with confidence and unafraid With apologies for a verbosity, the sincerity of which should discount a charge of "high-falutin."-Yours, etc., RICHARD ARTHUR.

Sydney, 10th January, 1902.

THE cause of this unfortunate trouble appears to have been a want of confidence in the honorary staff by the committee of the hospital.

The facts are as follows:-A death from septicemia occurred at the end of December, and a number of cases were running a high temperature.

A meeting of the honorary staff was held, and it was decided to make certain changes, viz., to isolate all septic cases, and to have the ward disinfected with formaline. (This latter had actually been done).

Dr. Cuscaden, on behalf of the staff, reported this to the committee, and informed them that all danger was passed, and that the staff saw no necessity to close the wards. He was asked the following question:-"Would the staff take all responsibility if the hospital remained open?" and he replied "Yes,"

He was then asked if he would guarantee that no further outbreak of sepsis would occur, and he replied that he would give no such guarantee. It was then moved and seconded that a sub-committee be appointed to inquire into the matter.

Nothing further did Dr. Cuscaden, as representative of the staff, hear, until he received a telephone message that the committee had decided to close the hospital, and that they were carrying out his wishes.

Dr. Cuscaden asked the secretary to kindly take a message from him to the committee, and to say (fearing any mistake) that the honorary staff did not wish the hospital closed.

The secretary's reply to this was that the committee had decided to close the hospital.

On the 25th January, it was reported at a committee meeting that Messrs. J. B. Lewis and J. Sandison Yule (the medical staff for the midwifery department) refused to follow out the instructions of the committee, and they sent a letter to the committee, in which they stated that they had not defied the instructions of the committee out of mere bravado, but that their "consciences as medical men in a position of trust would not allow them to send away patients, who might be within a few minutes of confinement, to a private institution half-a-mile away, when they had behind them a hospital pronounced clean by the unanimous voice of the honorary medical staff."

The honorary medical staff of the infirmary and obstetric departments sent the following letter to the committee:-"At a meeting of the united staffs of the infirmary and obstetric departments, held at the hos pital on the 20th inst, it was unanimously resolved that the action of the committee in closing the obstetric department, contrary to the expressed wish and advice of the honorary obstetric staff, was, under existing conditions, unnecessary and uncalled for, inflicting a severe and needless hardship on the suffering and indigent women of this city, and so calculated to place many of them in a dangerous and desperate position at a most critical time.

'We therefore urge that the obstetric department be re-opened for the reception of cases, without further delay."

The committee then catechised members of the honorary medical staff who were present, trying to justify their own position, and making use of medical terms. One member wished to know the meaning of sapræmia, and was informed by a member of the staff that terms were used probably with which the committee was not familiar; the inference being that they were not a committee of medical practitioners, but ordinary individuals not supposed to understand such matters.

The committee gave the resident medical officers a month's notice, and dismissed the secretary and superintendent (Mr. Gibson) at once for disobeying their orders.

There can be no doubt that the officials of the Hospital made a mistake in disobeying the orders of the committee, and they ought certainly to have left the matter in the hands of the honorary staff. The committee, on the other hand, should not have taken upon itself medical duties, and should have been guided by its honorary staff, who have quite as much at stake in any matter pertaining to the well-being or otherwise of the Hospital.

The medical staff may well consider that they have been unjustifiably snubbed by the committee, and such treatment could not be passed over by them without vigorous protest. Their opinions have been flouted, and their medical knowledge ignored, and, according to the resident medical officers, the interference of two members of the committee in the medical department of the Hospital has been a source of great annoyance. They have been accused of patrolling the wards weekly, bursting into labour wards during confinements, entering the residents and students rooms without knocking, and turning away an urgent case to get a reference without the resident medical officer seeing the case at all.

It is to be hoped that some new system of manage ment will be inaugurated, and that such a worthy and useful institution as the Women's Hospital should not suffer by mismanagement.