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FEBRUARY 20, 1902.] THE AUSTRALASIAN MEDICAL GAZETTE.
M.P., and Mr. Charles Matthews. The Council, after more people of the wealthier class will go for
from the avaricious ambition of the company promoter
or in the Colonies is yet ripe for such a development, with a breach of the Pharmacy Act, which they had
the day is foreshadowed in this suggestive address committed unwittingly.
when the advantages of treatment for all kinds of
attention of the public and leave the profession no
London, December 13tb, 1901.
(FROM OUR OWN CORRESPONDENT.)
caught on" here, and though there is some reason to recorded, viz., after the administration of a certain
The feeling of insecurity such cases as these give the supposed to manage and control its expenses, to take public must have a highly prejudicial effect upon up. To an outsider, it would naturally appear as if the patients who may have to undergo operations, and it is committee were not capable of conducting its own a great pity that the publication of every death under affairs, when it has to look for outside help for such big headings in the daily journals should be counten. a purpose as this. anced, as it does no good to the profession or to the Mr. Andrews, the Secretary of the Melbourne Hos. public. Many times operations are only undertaken pital, stated that the expenditure was greater in the " in extremis” in the forlorn hope of saving life, and Melbourne Hospital than in others, because the number death, under such circumstances, should hardly be of in-patients per bed occupied is greater in the ascribed to the apæsthetic. There is no doubt that the Melbourne than in any other institution. The higher administration of chloroform should only be undertaken expenditure for provisions is due to the higher prices under the direction of an experienced anæsthetist, and of groceries and meat. no cases, in hospitals particularly, should be operated upon without this direction except in great emergencies.
South Australia. Mr. Agar Wynne, Solicitor-General for Victoria
(FROM OUR OWN CORRESPONDENT.) seems (?) to understand the whole matter, and puts it in a nutshell, viz., " That the patients are smothered by
Adelaide Hospital-Dentists' Bill— Amendment of the the mask.” According to the Herald, dated 20th
Vaccination Act- Administration of the Public January, 1902, Mr. Wynne states that he has studied
Health Act-Medical Defence Union. this question of chloroform administration, and the The history of the past year here can hardly give un: result of his studies was the opinion given in the qualified satisfaction to those interested in medical preceding paragraph. He also states in the same paper progress. It is true that there is food for thankfulness that he has given instructions that, in future, at all in some directions. The return of the old staff to the inquests on persons who have died under chloroform, Adelaide Hospital early in the year has, as was hoped, the Government shall be represented by a “competent gone a long way towards closing the breach that has man,” who will endeavour to ascertain if anyone existed for so long, and has enabled medical students was to blame in connection with the fatality.
once more to complete their course here. With the The Solicitor-General further informed the Herald appointment of a medical superintendent and five house representative that he had some little experience of surgeons during the past week a further step has been the use of chloroform himself, and that it was per- taken toward a return of the old order of things. fectly safe when applied intermittently on a bandker. The introduction of a Dental Bill into the local chief. He bad used it many times in this way, and House of Assembly last session was also a step forward. had seen it used for a great number of years without This State has long been the happy hunting ground accident, and, he observed in conclusion, that it was of unqualified dentists, and the proposed Bill, based as “only in hospitals”—where mask inhalers were used it was on similar Acts in the other States, would have that one ever heard of a death under chloroform. gone a long way towards bringing about a better con.
Mr. Agar Wynne apparently understands more dition of affairs in the future, while duly conserving about medical matters than the profession itself, and the rights of those already in the field here. The the poor, long-suffering practitioners are again being "anæsthetic clauses " in particular were a praise worthy taught by a layman how to carry on their business. effort to bring the administration of anæesthetics
If Mr. Agar Wynne were to appoint a medical under proper and qualified supervision. Unfortu. commission to consider the question of the administra- nately the Bill was introduced too late in the session to tion of anæstheti he would be doing better work than be carried through, but better success may be hoped for by giving his own opinions on these matters.
during the coming year. In private practice mixed anæsthesia is coming much On the other hand, the Compulsory Vaccination Act more into vogue, and certainly seems, so far, to have has been amended by the introduction of the conscience proved very successful, for no deaths have been clauses of the English Act, without, however, any limit reported under such circumstances, to the best of my being placed on the period for which the experiment is belief, for the last few years.
to be tried. This is itself is not so serious a matter as An extraordinary case of brain injury occurred the sentiment at the back of the change ; the daily recently to a boy aged five years. He accidentally fell papers openly term it the abolition of compulsory vacfrom a railway carriage on the Gippsland line, and was cination, and the letters of the general public prior to picked up in an unconscious state, and conveyed to the introduction of the Bill and the speeches of legis. the Children's Hospital, Carlton, where he remained | lators during its passage througb Parliament both unconscious for 67 days, and then died.
revealed a very strong feeling against vaccination, No settlement has been arrived at between the combined in most cases with a very imperfect know. medical practitioners at Williamstown and the Recha ledge of facts concerning it. bite Lodge so far, and the matter has been postponed A similar unhealthy state of public opinion was refor another three months in order to give time for vealed in the public discussion that ensued, on Dr. unanimity and friendly arrangement on both sides. Borthwick's attempt to secure the better administration
The expenditure per bed per year in the Melbourne of the present Health Act. It was clearly shown that the Hospital was stated to be £74 l/s. 5d., or £10 4s, 3d. vital clauses of the Act were not being enforced, and that more than the average of the six hospitals which had the hoped-for benefits had not been realized through been selected for comparison, viz., the Sydney, Prince the administrative bodies spending their time searching Alfred (Sydney), Brisbane, Adelaide, Alfred (Mel- for grievances and difficulties instead of attempting to bourne), and the Melbourne. At a meeting of the carry out the spirit of the Act. But it was just as committee of the Melbourne Hospital, the Argus clearly shown that many of the local bodies were proprietors were complimented for having, at their determined to resist any attempt to enforce the Act, own expense, conducted an investigation into the and that a section of the community were much more expenditure of this Hospital. This seems a peculiar impressed with the grievances of individuals than with position for a committee of a hospital, who are the welfare of the many.
For a time it looked as if
the only result of the discussion would be to cause the passed at the Congress could only have an academic repeal of the Act altogether!
valne. As in the case of political federation, I opine These facts clearly show that the prime necessity in that any resolutions passed at the Congress would be the immediate future. is to educate the public more submitted to the various State Medical Associations, thoroughly in public health matters. It becomes a and that the final appeal would be by plebiscite to the serious question whether an attempt must not be made medical profession in the different states, and that to do this through the daily press. At present, practi- only by majorities in each and all of the States could cally the only medical information the lay public get such resolutions become binding. By such a proin their papers is sensational paragraphs on the cure of cedure absolute liberty would be accorded to the cancer by Röngten rays or violets; or the experiences medical profession in each State. And are there no of a man with a gastric fistula, or some such supposed arguments in support of medical federation in Auswonder of surgery.
A number of cases of individual tralia ? It is seemingly beld that this federation would hardships, whether it be from quarantine or vaccina- necessarily be antagonistic to the connection with the tion, or the cleaning of a dirty milkshed, have full British Medical Association. This has not been proved. publicity given them, and sooner or later an agitation Anyone is at liberty to propose that the federation arises on one of these subjects. Any facts put forth at should be a union of all the State Branches of the such times by medical men carry little weight. Their British Medical Association, this to form an Australian evidence is regarded as biassed and is discounted Branch of the British Medical Association, with State accordingly. Yet, these are about the only occasions Branches retaining a certain amount of autonomy. at present when we attempt to put the facts on these
And if this be impracticable, it remains for us matters before the public. The periodical contribution seriously to discuss whether the connection with the of a column of notes and authoritative facts would do
parent Association is of sufficient value to outweigh much in the way of improving matters.
the advantages arising from an Australian federation. The Medical Defence Union of this State held its
The connection with the British Medical Association is, second annual meeting in December, and by its report after all, mostly one of sentiment. Let it be granted showed it is accomplishing useful work in a quiet way. that the parent Association is a great and powerful Membership has been well maintained, and there is now body, but let us also realise that it can do little or a substantial bank balance. Both in the report and at nothing for us in Australia. It provides us with the the meeting stress was laid on the decision of the Journal, it extends a courteous welcome to Australian council that £1 18. should be the minimum fee for delegates at the annual meetings ; beyond this, I do insurance examinations, The necessity for this was not know what it can do. But the profession in shown by a circular issued the next week by the Tem. Australia has to work out its own destiny, and no perance and General Mutual Life Assurance Society outside influence can avail it in the least. asking medical men to examine those insuring for a
My desire is to see an Australian Medical Associasmall sum for 10s, 6d. A great show was made of a
tion, not a mere dilettante body meeting occasionally less complete form to be filled in, but a casual inspec. for discussion and recreation, but an organised fighting tion revealed that the answers for this form required
union presenting an unbroken front to all attacks just as complete an examination as ever. It is to be
upon its rights and privileges, and, on occasion, carry. hoped that a united effort will be made to defeat this ing the war into the enemy's country. move.
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 The Proposed Australian Medical
pessimist to predict this. The ranks of the medical Association.
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. (To the Editor of the Australasian Medical Gazette.)
But the true inwardness of the situation is this-that SIR, – As the member dissenting from the resolution the increase in the number of medical men offers the passed at the meeting of the New South Wales Branch opportunity to the Friendly Societies, and other sweat. of the British Medical Association, which condemned | ing organizations to seek to make their own terms with the proposal to discuss the formation of an Australian their medical attendants. Heaven knows the position Medical Association, I would ask leave to state my is bad enough already. What will it be if a sauve qui reasons for doing so. It is probably true that self. peut sets in, and every man finds himself competing interest governs all our actions, and the members of against his fellow for bare existence? And we are the the Branch have jumped to the conclusion that their trustees of the future, and owe an account of our interests were best served by the maintenance of the stewardship to those who will follow in our footsteps. status quo. And the parochial spirit, which views with We have no right to act on the principle that as long distrust any suggestion of change coming from an as things suit us at present the deluge can come after outside source, was not wanting. I am convinced that us for all we care. an attitude which refuses even to discuss in open court The question of contract practice requires to be gone any subject, and prejudges it in ignorance, is an alto- into all over Australia. We have no General Medical gether unreasonable one, and one not calculated to Council, whose pronouncements carry legal effect. gain for us the intellectual respect of the medical | Our own salvation must be worked out by ourselves, profession in the other States.
and this can only be done by strenuous organisation ; It would appear from the discussion at the meeting the accumulatton of what we not need hesitate to call that there were no arguments to be adduced in favour “ strike funds," and the rigid application of the boycott. of such an Australian Medical Association. The This is the only weapon the medical profession possExecutive Committee of the Inter-State Congress esses, but it is a very effective one. Under an evidently think differently, and it would only have Australasian Medical Association its arm should reach been courteous to have withheld an expression of from Port Darwin to Hobart, from Sydney to Freopinion until their proposals were made public. And mantle. If the stories which reach us about the this all the more because any abstract resolutions | bondage in which many of our Victorian brethren are held be true, we, in happier lands, should be prepared The secretary's reply to this was that the committee to make considerable sacrifices to come to their aid. had decided to close the hospital.
There are other questions of great importance—such On the 25th January, it was reported at a committee as hospital abuse, the necessity for a supreme court of meeting that Messrs. J. B. Lewis and J. Sandison Yule appeal for medical ethics, and many others, but I cannot (the medical staff for the midwifery department) redeal with them. Have we not some power of looking fused to follow out the instructions of the committee, before and after ? In solidarity lies our safety. If and they sent a letter to the committee, in which they the wharf-labourers, the miners, the seamen on our stated that they had not defied the iostructions of the boats can strive and suffer for what they hold & committee out of mere bravado, but that their “con. principle, surely we, with our advantages of education, sciences as medical men in a position of trust would of resources, of belonging to what is practically a close not allow them to send away patients, who might be corporation, can so ba od ourselves together that we within a few minutes of confinement, to a private may face our future with confidence and unafraid
institution half-a-mile away, when they had behind With apologies for a vervosity, the sincerity of which
them a hospital pronounced clean by the unanimous should discount a charge of " high-falutin."-Yours, etc., voice of the honorary medical staff.'
RICHARD ARTHUR. The honorary medical staff of the infirmary and Sydney, 10th January, 1902.
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 ANISOMETROPIA.
that the action of the committee in closing the obstetric ( To the Editor of the Australasian Medical Gazette.) department, contrary to the expressed wish and advice
of the honorary obstetric staff, was, under existing conSIR, -In your resumé of ophthalmology, Dr. Douane's ditions, unnecessary and uncalled for, inflicting a severe treatment of correcting each eye in anisometropia is
and needless hardship on the suffering and indigent referred to with approval. For the last 12 years, [
women of this city, and so calculated to place many of have always treated cases in this manner, and Mr. F.
them in a dangerous and desperate position at a most B. Archer, senior surgeon at the Central London
critical time. Ophthalmic Hospital, who taught and practised this
“We therefore urge that the obstetric department be method, had done so for fifteen years, that is, from re-opened for the reception of cases, without further 1885, with unvarying success.
The committee then catechised members of the W. KENT HUGHES,
honorary medical staff who were present, trying to 21 Collins Street,
justify their own position, and making use of medical Melbourne,
terms. One member wished to know the meaning of
sapræmia, and was informed by a member of the staff THE DISPUTE AT THE WOMEN'S HOSPITAL,
that terms were used probably with which the com
mittee was not familiar; the inference being that they MELBOURNE.
were not a committee of medical practitioners, but
ordinary individuals not supposed to understand such (BY OUR SPECIAL REPORTER).
The committee gave the resident medical officers &
month's notice, and dismissed the secretary and The cause of this unfortunate trouble appears to have superintendent (Mr. (iibson) at once for disobeying been a want of confidence in the honorary staff by the their orders. committee of the hospital.
There can be no doubt that the officials of the The facts are as follows:-A death from septicæmia Hospital made a mistake in disobeying the orders of the occurred at the end of December, and a number of committee, and they ought certainly to have left the cases were running a high temperature.
matter in the hands of the honorary staff. The A meeting of the honorary staff was held, and it was committee, on the other hand, should not have taken decided to make certain changes, viz., to isolate all upon itself medical duties, and should have been septic cases, and to have the ward disinfected with guided by its honorary staff, who have quite as much at formaline. (This latter had actually been done). stake in any matter pertaining to the well-being or
Dr. Cuscaden, on behalf of the staff, reported this to otherwise of the Hospital. the committee, and informed them that all danger was The medical staff may well consider that they have passed, and that the staff saw no necessity to close the been unjustifiably snubbed by the committee, and such wards. He was asked the following question :-"Would treatment could not be passed over by them without the staff take all responsibility if the hospital remained vigorous protest. Their opinions have been flouted, open? "and he replied “ Yes.”
and their medical knowledge ignored, and, according He was then asked if he would guarantee that no to the resident medical officers, the interference of further outbreak of vepsis would occur, and he replied two members of the committee in the medical departthat he would give no such guarantee. It was then ment of the Hospital has been a source of great moved and seconded that a sub-committee be appointed annoyance. They have been accused of patrolling the to inquire into the matter.
wards weekly, bursting into labour wards during Nothing further did Dr. Cuscaden, as representative confinements, entering the residents and students of the staff, hear, until he received a telephone message rooms without knocking, and turning away an urgent that the committee had decided to close the hospital, case to get a reference without the resident medical and that they were carrying out his wishes.
officer seeing the case at all. Dr. Cuscaden asked the secretary to kindly take a It is to be hoped that some new system of managemessage from him to the committee, and to say (fearing ment will be inaugurated, and that such a worthy and any mistake) that the honorary staff did not wish the useful institution as the Women's Hospital should not hospital closed.
suffer by mismanagement,
“ It is to be noted that no less than four produce stores have been implicated in the present series of cases,
viz., Hay Street, city, George Street West, Rushcutters' New South Wales.
Bay, Alexandria. Inquiries show that the produce Vital Statistics. --The Government Statis- sold at these stores was obtained in each instance from tician reports on the vital statistics of the metropolis for Tasmanian, New Zealand, North Coast, and Howard
several places; the railway station, the Adelaide, the month of December, 1901, as follows :The births during the month of December likely that the railway station is infected, but some
Smith's wharves being usually mentioned. It is not numbered 1,005, being 70 greater than the average for suspicion naturally attaches to the wharves. NeverDecember for the past five years. The deaths for the
theless the absence of any cases attributable to infection month were 574,or 52 greater than the quinquennial ave.
acquired at or near the wharves and the negative rage for December. Balance of births over deaths, 131, 1 result of their recent sanitary inspection, makes it The birth rate being 2.06 per 1,000 of population, and impossible to determine on any one of them as a the death rate 1:18 per 1,000. True infantile mortality, possible centre. The City Council has already taken under one year, compared with the births for the
action to require the owners to provide rat-proof month, at the rate of 244 per 1,000 for the city, and
cement basements to produce stores, and no further 176 for the suburbs. For the metropolis, as a whole,
measure with respect to them appears to be indicated the rate was 189 per 1,000. Zymotic diseases caused
at the present time. 104 deaths, or 18 per cent. ; typhoid fever, 9;
“ Certain rats taken in the south and west of the scarlet fever, 3; whooping cough, 37; and bubonic plague, 1. Constitutional diseases were responsible for city in November last were found to be infected with 94 deaths, or 16o4 per cent ; those from phthisis being plague. Among the 844 rats examined in the Board's 50 ; cancer, 30. The deaths from phthisis comprised 8.7 | laboratory since that date, all were clearly free from per cent. of all deaths. Local diseases numbered 284
the disease until the past week or 10 days (January deaths, or 49.5 per cent. of the death list ; of these, 76 28th-February 8th), during which some suspicious speciwere from enteritis, and 21 from heart disease.
mens have been received from two places in the city at For the quarter ended 31st December, 1901, from these places have been bacteriologically examined,
which rats were said to be dying. Several specimens the births numbered 3,195, and the deaths, 1,605 ; which
and although the results are obscured by mixed are respectively 245 and 101 more than the average
infections there is a certain amount of evidence that numbers registered for this quarter during the previous the rats have plague. five years, equivalent to an increase of 8} per cent, on
“On the evidence furnished by the foregoing data the average of births, and of 6% on the average of deaths. In the zymotic group, the death rate increased by 29
there can be little doubt that the plague is still existent per cent. above the average of the December quarter amongst the rats in this city. Nevertheless, it does not for the last five years, caused mainly by the deaths appear, on the one hand, to be generally prevalent from whooping cough. There were satisfactory de- amongst them, nor on the other hand, to be maintained creases in deaths from influenza, typhoid, and diarrhea,
at any specific centre which can be dealt with by but an increase in the number of deaths from measles, ticable measure of a general character is rat destruction
cleansing operations. Consequently the only pracscarlet fever, diphtheria (with 18 deaths), and the septic diseases. In constitutional diseases, with the exception be mentioned that since November, 1901, 24,269 rats
on the lines already in operation. On this point it may of phthisis, which shows an excess of 14 per cent. above the five years' average, there is little variation have been burnt in the board's furnaces, and that Developmental diseases show a slight advance. The additional large but uncounted numbers were killed
It is most material divergence from the normal in local during the fumigation of vessels and sewers. diseases is found in the respiratory group, wherein there reasonable to conclude that these measures have
hitherto averted the more serious possibilities of the were 185 deaths, as against an average of 146 for the previous five years, being an increase of 27 per cent. epidemic which has threatened and still threatens the The main complaint in this group was pneumonia, city. But in view of recent developments it may now
be deemed desirable to make use of every possible which brought about 124 deaths, as compared with the
means to induce increased destruction of the rats. For average of 73, thus increasing the rate from this disease by 71 per cent. Enteritis, the great cause of
this purpose householders should be enjoined to lay mortality among children during the hot months, poison freely, and to clear away accumulations which caused 151 deaths; about the average number. The
may afford food or harbourage for rats.
“In the meantime the occurrence of cases can only birth rate for the quarter under review, was 6:54, that for the previous five years being 6:31 per 1,000. The
be met by the usual measures of isolation and disinfec
tion. death rate for the quarter is 3.29 per 1,000, being
These are vigourously carried out by the almost identical with 3.22 per 1,000 the quinquennial department with respect to all actual cases of plague rate.
wherever occurring, and with respect of suspicious THE BUBONIC PLAGUE.
premises in the suburbs. With regard to suspicious
premises in the city, an arrangement has been made We regret to report that since our last issue with the Medical Officer of Health (Dr. W. G. several cases of bubonic plague have occurred in Armstrong) that they shall be dealt with by the city
local authorities to the full extent of their powers. Sydney. The following is an abstract of a
immediate reference to this department to be made report on the subject to the Government by Dr.
when anything further is necessary.” F. Tidswell, the Acting-President of the Board
At a meeting of the Sydney Municipal of Health :
Council held on February 11th, it was resolved “After a period of quiescence lasting about 15 " that as produce stores were apparently plague months, plague re-appeared in Sydney on November
centres where outbreaks occurred, the whole of 14th, 1901. From this time to date there have occurred 17 cases.
the produce in infected stores should be