MIRROR OF HOSPITAL PRACTICE IN AUSTRALASIA. PRINCE ALFRED HOSPITAL, CASE OF CIRRHOSIS OF THE LIVER IN A CHILD. E.S., female, cet. 12 years, was admitted to Prince Alfred Hospital, Sydney, November 23rd, 1901, complaining of swelling of abdomen. She had noticed the abdomen gradually becoming more and more prominent for the last nine months, but the swelling had increased much more rapidly lately. She had never had any abdominal pain and only very occasional irregular vomiting. Bowels were constipated and the appetite poor. She had been getting gradually weaker. She had no cough, nor any swelling of feet or legs. Past History. She never had scarlet fever, and never had alcohol given her in any form. She never suffered from an illness which might have required alcohol, and was not accustomed to take spices or condiments. Family History. Good, no phthisis. Brother said to have an enlarged liver. Parents teetotallers and very plain-living people. Present State.-Patient is enemic; no sign of icterus. Face full and puffy. Digestive System.-Appetite poor. Tongue highly furred. Bowels constipated-no pain on defecation. Abdomen uniformly distended, tense, umbilicus everted. Superficial veins very prominent. Well-marked fluid thrill. Extensive dulness in flanks and lower part of abdomen, varying with position of patient; not to be felt on palpation. Liver Dulness. From fifth rib in nipple line and sixth rib in axilla. Heart.-Apex beat in fourth space in nipple line. Sounds clear. Lungs.-Impaired percussion note at bases. Crepitant notes at both both bases, but clear elsewhere. Urine is acid, one-eighth albumin, and contains granular casts. Some oedema of feet and legs. Subsequent Examination of the Urine.-The amount always scanty, never more than 25 ounces in 24 hours--usually less. Specific gravity varied between 1015 and 1030; only twice contained albumin, then only a trace. November 27th, 1901.-The abdomen was tapped. Ten pints of clear fluid withdrawn (specific gravity 1004, acid, heavy cloud albumin, no T.B.). Spleen could now be felt lin. below costal margin. Liver margin smooth, regular, firm and sharp at level of costal margin. December 10th, 1901.-Paracentesis abdominis again performed. Fifteen pints of fluid drawn off. December 15th, 1901.-Eleven pints withdrawn. January 2nd 1902.-Laparotomy performed. Five pints of fluid let out. Peritoneum healthy. Nothing to be made out. Drainage tube left in. Patient became very restless; later became delirious, and on January 6th, 1902, sank into a state of coma and died. Before death she emitted several times a short sharp cry like that of meningitis, the respirations became very slow (about ten minute), and the pulse remarkably quick. The temperature lay between 98.4° and 100°. Post-mortem Examination, Jan. 7th, 1902.— The bodily nutrition was good, but the subcutaneous fat deficient; rigor mortis was passing off. The lungs were congested at their bases; here and there were some small purple blood extravasations. The heart weighed 8 oz.; its valves and coronary vessels were healthy; some petechiae and vibices appeared under the visceral pericardium, and a few smaller ones in the parietal pericardium; the blood in the vessels was fluid. The liver weighed 30 oz. ; it was uniformly contracted with some small bossy projections in places; the surface was of a pale whitish colour; the consistence exceedingly tough; on section, thick bands of pale pinkish or white fibrous tissue invaded the whole organ isolating numerous small yellow lobules or groups of lobules which projected markedly above it; in some places this fibrous tissue was alone left; the capsule of the liver was not appreciably thickened. Microscopically, the liver presented the typical appearance of a multilobular cirrhosis; the portal systems were surrounded by a very great increase in the connective tissues, this being in general fibrous, though in places more cellular; the larger branches of the portal veins traversing these areas were held widely dilated by the dense fibrous nature of their walls, which prevented any contraction; the contour of numerous bile ducts could also be seen in this stroma, occupying positions formerly taken by hepatic cells; rounded isolated hepatic lobules could be seen in various stages of diminution, almost to obliteration, though their remaining cells exhibited no great fatty changes. The gall bladder was contracted, small, and thickened. spleen was large, firm, and weighed 11 oz. ; it The was dark red in colour, and showed prominent Malpighian bodies; under the microscope, there was no decided increase in its stroma, but the rounded cells of the lymphoid tissues were noticeably prominent. The pancreas was very firm; microscopically appeared an increase in its interacinous stroma consisting chiefly of rounded and spindled cells which tended here and there to enter between the peripheral cells of the acini so as to separate and isolate them; in the centres of some acini, collections of small rounded or irregular or spindle-shaped cells could be seen. The kidneys were deeply congested; the capsules peeled; the left weighed 5 oz., the right 6 oz ; there was a scattered infiltration of small rounded cells in the stroma between the tubes, and in the Malpighian capsules, but this was not very marked; the renal cells were granular and their nuclei indistinct. The suprarenals were unaffected; the stomach showed some slight old slaty pigmentation; the intestines were healthy; the peritoneum was not thickened; it was discoloured and of a greenish hue (p. m. changes) close to the suprapubic wound. The brain exhibited no changes. The urine removed p. m. contained a few blood cells, an occasional blood or hyaline cast, and many bladder cells, but no crystals. was The following attempts at establishing the collateral circulation were noticeable. The vein accompanying the phrenic nerve enlarged, the veins in the falciform ligament of the liver were marked, as were all the retroperitoneal veins which connected with small veins running into the mesentery; a deep purple varicose condition of veins connected the mesentery, binding down the cœcum and adjacent parts with the deep pelvic veins and those around the iliac bone. Remarks. The following points may be dwelt upon. The youth of the patient; the entire absence of alcoholic history either personal or parental; the rapid re-accumulation of fluid after tapping; and the fact that though this had to be repeated several times chronic peritonitis was quite absent; the presence of pancreatic as well as hepatic cirrhosis; the sudden supervention of auto-intoxication symptoms (from defective hepatic action) shortly after exploratory laparatomy and draining, which supervention may be merely a coincidence or directly due either to the loss of fluid by draining with increased absorption in consequence from the alimentary canal, thus increasing the work of the liver cells, or to the reparative changes and increased metabolism originating in the area of the wound; and the history of liver enlargement in the patient's brother. REVIEWS AND NOTICES OF BOOKS, MENSTRUATION AND ITS DISORDERS. By Arthur E. Giles, M. D., B.SC., F. R.C.S., etc.; Surgeon to the Out-patients, Chelsea Hospital for Women ; Gynecologist to the Tottenham Hospital, etc. Crown 8vo., 2s. 6d. net. London Bailliére, Tindall and Cox, Sydney: L. Bruck. The writer of this monograph aims at presenting a concise and practical exposition of normal and diseased menstruation. Within the space of 100 pages, he has successfully carried out his object. Too fre quently brochures of this kind are a weak and unsatisfying dilution of the standard treatises. In the present case this cannot be charged, and Dr. Giles has done his work so well that the larger treatise which he promises on the same subject will be expected with interest. About one-third of the volume is given to a consideration of the physiology of menstruation. Its anatomical and physiological characteristics, and its relation to the "estrus" in animals in the light of Heape's investigations are discussed; next we have an account of its clinical characters, and chapters on its relation to conception, ovulation, and pregnancy, and on the menopause. The disorders of menstruation receive fuller atten tion, and they are treated simply and clearly, in a manner that will make this little book practically useful to the practitioner. Dr. Giles emphasises the fact that these disorders are but symptoms, suggesting a cause to be investigated, "and not separate diseases, for the cure of which an empiric therapeutic formula suffices." To the practitioner of medicine the subject is one of every day interest, and this little book can be recommended for perusal as being, though its scope is circumscribed, both scientific and practical. A.W.M. OBSTETRIC AND GYNECOLOGIC NURSING. By E. P. Davis, A.M., M.D., Professor of Obstetrics in This book, which was prepared for the Training Schools of the Jefferson and Philadelphia Hospitals, in both of which the author teaches, is designed to furnish instruction as to the various duties of the obstetric and gynecologic nurse. Obstetric nursing demands some knowledge of natural pregnancy, and of the signs of accidents and diseases which may occur during pregnancy. It also requires knowledge and experience in the care of the patients during the labour, and her complete recovery, with the needs of the child. Gynecologic nursing requires special instruction and nursing, and a thorough knowledge and drill in asepsis and antisepsis to supply in a clear and concise manner all the details are absolutely indispensable. This bok will be found necessary to enable any fairly educated woman to become proficient in these branches of nursing, provided that she receive at the same time proper practical nearly past, and women are beginning to fully recognise training. Fortunately the days of "Sairey Gamp" are the necessity of having properly trained nurses attend to them in their accouchments. The work is to very freely illustrated, and can be safely recommended as a text-book for the two branches of nursing that it deals with. W.H.C. A TEXT-BOOK OF THE PRACTICE OF MEDICINE. By Dr. Hermann Eichhorst, Professor of Special Pathology and Therapeutics, and Director of the Medical Clinic in the University of Zurich. Authorised translation from the German. Edited by Augustus A. Eshner, M.D., Professor of Clinical Medicine in the Philadelphia Policlinic, &c. Philadelphia and London: W. B. Saunders and Co. Melbourne: Jas. Little. 2 vols. Price, £1 10s. This is a translation from the German of Professor Eichhorst's "Practice of Medicine," which, the author says in the preface, was written at special request as an elementary text-book for students. streptococci, eponymic; tables of diseases, operations, signs and symptoms, stains, tests, methods of treatment, etc. The author has sought a middle course between the large, unwieldy lexicon and the abridged student's dictionary, avoiding the disadvantages of both. Special attention has been paid to the wording of definitions, with the intention of making them clear, concise, and yet sufficiently complete. The important features of pronunciation and derivations have received careful attention. The illustrations have been chosen for their value in aiding the text rather than for their artistic value. The work has been admirably designed and carried out, and the type is so arranged and varied that the eye is not confused and wearied in scanning a page in search of the required information. The Dictionary is a valuable addition to a library, and it is certain to be popular with the profession. SEXUAL INVERSION. By Havelock Ellis, L.S.A. England. Sold only to physicians, lawyers, advanced teachers, and scientists. Philadelphia, Pa.: F. A. Davis Co. 66 Not much criticism need be directed to the book itself, though one cannot help being struck with its in equality. One of its best features is an excellent account of the different modes of investigation of the functions of the stomach. The author gives a full account of the processes for ascertaining the absorptive power, the motor activity, and the digestive power of the stomach. This is given much more fully than in any English text-book of the same class, and is undoubtedly of real practical value. On the other hand, This work deals with a subject which may be of the account given of "Appendicitis" is confused and some interest to alienists and of some assistance to unsatisfactory. The author really believes in an oc- medical jurists, and that is about all that can be said casional primary typhlitis, as apart from an appen- of it. A record of a number of cases of sexual dicitis. Although he is not alone in his belief, it is inversion in the two sexes, with a description of their contrary to all recent pathological experience, which experiences in various abnormal ways of gratifying the is derived chiefly from the examination of specimens sexual appetite is not edifying reading to any pureobtained from the operating theatre, and not the post-minded person, whether he be a physician or lawyer, mortem room. The treatment recommended is antiquated, to say the least; e.g. (we quote the exact words) : "An ice-bag that is not too heavy should be applied over the right iliac fossa. When the acute inflammatory manifestations have subsided, and the exudate has been well circumscribed, the ice-bag should be replaced by a hot cataplasm, which will better favour the absorption of pus. Severe pain will frequently be relieved speedily by the application of from 6 to 10 leeches. Treatment with opium should be persisted in till all pain in the right iliac fossa has disappeared, even if many weeks should be required." One can hardly believe that such treatment should be recommended in a modern text-book. Perhaps no more dangerous advice could be given to a student. In the same way the author does not recommend the antitoxine treatment of diphtheria with absolute confidence; he recommends that 1,000 units be injected immediately, and 1,000 more next day, in a severe case. He does not seem aware of the great value, and even necessity, of giving much larger doses. Evidently the book cannot be recommended as a text-book for students. With regard to the translation, it is fairly well done; the English is always clear, and German idioms are, as a rule, absent. The illustrations are not numerous, and are poorly executed; the majority are of very little help to the text. J.M.G. THE AMERICAN ILLUSTRATED MEDICAL DICTIONARY. By W. A. N. Dorland, A.M., M.D. Second edition, revised, large octavo, nearly 800 pages, bound in flexible leather. Price, 22s. 6d. Philadelphia and London: W. B. Saunders and Co., 1901; Melbourne: J. Little. This is a complete dictionary of the terms employed in medicine, surgery, dentistry, pharmacy, chemistry, and all the kindred branches; containing also much collateral information of an encyclopædic character; also new and elaborate tables of arteries, muscles, nerves, veins, etc.; of bacilli, bacteria, micrococci, or scientist. To speak of such a work as scientific is, in our opinion, to use a misnomer. A BRIEF MANUAL OF PRESCRIPTION WRITING IN -LATIN OR ENGLISH FOR THE USE OF PHYSICIANS, PHARMACISTS, AND MEDICAL AND PHARMACAL STUDENTS. By M. L. Neff, A.M., M.D., Cedar Rapids, Ia. Philadelphia, Pa.: F. A. Davis Co. The first part of this small work is devoted to a brief account of Latin grammar, sufficient to enable one unfamiliar with the language to write an intelligible and correct Latin prescription. As every medical student is, or ought to be, familiar with the rudiments of Latin, we fail to see the use of this part of the book. The remaining portions of the work, which are devoted to a description of the method of prescription writing, with illustrations of model prescriptions, tables of doses and incompatibles, are useful, and should tend to keep up the art of prescription writing, which, with the great increase in these days of tabloids and "elegant preparations," we fear is fast decaying. DEATH FROM TETANUS.-The death of Mrs. Emily Pearson, who died recently in the Melbourne Hospital from the effects of an injury to her hand, was inquired into at the Morgue by Dr. Cole, Acting City Coroner. The evidence of deceased's husband was that on the 13th ultimo his wife, while climbing over a neighbouring fence after a tablecloth, slipped and hung suspended on a nail which had entered her hand. The flesh eventually gave way and released her, and as she fell a piece of paling entered the wound. She went to Dr. Reid, who dressed the wound, and attended deceased every day. On the 20th, deceased complained of pains and a peculiar feeling around her jaw. Deceased was sent to the Melbourne Hospital, where her case was diagnosed as a severe form of tetanus. Dr. Bonnin evidenced that deceased died from that disease. A verdict of death from tetanus was returned. THE AUSTRALASIAN MEDICAL GAZETTE. SYDNEY, 21ST APRIL, 1902. THE POLICY OF THE NEW SOUTH WALES BRANCH OF THE BRITISH MEDICAL ASSOCIATION. In the excellent address delivered at the Annual Meeting of the New South Wales Branch of the British Medical Association, by the retiring President, Dr. FOREMAN, we had laid down in clear and emphatic language the past policy of the Branch, and some good advice as to our future action. We hope that his sanguine expectation will be realised, and that by the end of the year we shall have enrolled in our membership all the members of Branch. But we shall certainly wage war upon a society which is political in aim, but tries to carefully disguise this fact under the masquerade of a medical benefit society. In so doing we do no injury to a single individual who is deserving of the help and consideration of medical men. We are acting also in the best interests of the legitimate friendly societies, whose field for recruiting new members is being damaged by the invasion of the Australian Natives' Association, which appears to threaten, judging by the figures put forth by the officials of that organisation, to destroy their progress and efficiency. We are glad to know that some of the officers of these Orders in Sydney and other centres are alive to this fact, and regard the Australian Natives' Association with no the profession in the State who are eligible for officials to impress upon them and the public friendly eye, in spite of the efforts of the membership. We are passing through troublous times, and we need to emphasize again the importance of unanimity of action in preventing encroachments upon our rights as professional men and citizens. Our policy is a defensive one, and not offensive; we seek to act not in the interest of any one section or clique, but in the interests of the profession throughout Australasia. Dr. FOREMAN has put very clearly the case we have against the Australian Natives' Association, and no policy of compromise or mediation can be tolerated. We have no war to wage against the legitimate friendly societies; we have always recognised the immense influence for good they exert upon the industrial population, and the great assistance they are to a large section of the profession, and any action which would tend to destroy the usefulness of these societies, or to "smash them up" (to use the language which has been put into our mouths by the officials of the Australian Natives' Association), would be strenuously opposed by the Council of this that the sole aim and object of the British Medical Association is to deal a death blow to all friendly societies. The President of the United Friendly Societies' Association was recently reported to have said that "they had had no trouble with their doctors until the advent of the Australian Natives' Association"; so that to be consistent he must regard this association as a thorn in their sides rather than the bosom friend that the officials would have them believe them to be. We know, further, that if the Council of the New South Wales Branch of the British Medical Association had only taken. the bait held out to them by the Australian Natives' Association, the friendly societies would have found themselves actively opposed by the Australian Natives' Association. Now, having failed to secure the benefits they want from us, the Australian Natives' Association seeks an alliance with the friendly societies of an offensive nature against us. But we are mistaken if the latter will not see that such an alliance is not in their own interests, and that they will act wisely in not taking up the cudgels for a rival association, and precipitating an unnecessary quarrel with the profession. THE DISCUSSION ON CANCER. THE discussion on cancer at the recent Intercolonial Congress at Hobart seems, on the whole, to have been disappointing. With all due deference to Professor ALLEN, we think that nothing has been gained by it, and no new facts bearing on the etiology, pathology or treatment of the disease have been forthcoming. We regret that the suggestion made in the editorial in our January issue was not acted upon, and a Collective Investigation Committee appointed to collect evidence and report to a subsequent Congress. Professor ALLEN's introductory address, of which we give an abstract in another column, was the result of an immense amount of labour in collating statistics, and dealt with the subject from various points of view; but we must confess our inability to accept his conclusions in toto. His inference that the increase in cancer was largely only an apparent one because of the relative increase in the potential cancer patients, is not borne out by Mr. COGHLAN'S statistics for this State, and cannot be taken to explain the relatively larger increase in cancer in England in recent years. While, of course, the parasitic theory so far lacks actual demonstrative proof, we think that the tendency of recent investigations, as well as a study of the clinical history and course of cancer patients all point strongly in favour of this theory. On no other hypothesis can all the facts be harmonised, and here we would remark that in speaking of "Cancer," we should restrict our attention to "carcinoma " as distinct from "sarcoma." The two forms of malignant tumour are distinct in their mode of development, their age incidence, and mode of secondary dissemination, and no one etiological factor can reasonably be assigned to the two forms of disease. No theory of perversion of nutrition of the tissue or loss of federal control will, surely, explain the cancerous cachexia, which so strongly suggests a poisoning of the tissues by the products of the growth of some parasite, or the introduction into the system of some foreign substance; and further, we think that on no other hypothesis can the occasional spontaneous disappearance of the disease be explained. But we must await the results of further experimental and clinical investigation, and hope that much good will ensue from the large amount of attention and research now being given to this subject by the pathologists of Europe and America. Many points of interest in Professor ALLEN's address were not touched upon by subsequent speakers, and the discussion practically resolved itself into a series of papers on various aspects of the question. Dr. VERCO's statistics of the disease in South Australia are very interesting, and the fact brought out by him—that women in South Australia are relatively less frequently attacked by the disease--is difficult of explanation. THE MONTH. The Victorian Sanatorium for Consumptives. THE Victorian Sanatorium for Consumptives has now been in existence for eleven years, and it is a matter for regret that this institution, and which is always full to overflowing with which appears to be doing such excellent work, patients, should lack widespread support from the community. The patients spend the summer in the sanatorium at Mount Macedon, and the winter at Echuca. During the last summer season at Mount Macedon, the average weight gained by each patient was a stone. Accommodation is provided for fifty patients, and over fifty more who have been medically certified as suitable cases are awaiting admission. During the year, owing to great increase in the demand for admission, temporary additions in the shape of tents were used to accommodate twenty-two more patients; but the committee having recently received a donation of £2,300 from a |