Last tapping five months previously.

On

Under chloroform the right swelling was opened On compressing sac over the external ring the lower part readily emptied. relaxing pressure the sac filled at once from the abdomen. Efforts were made to collect and measure the fluid, and over 150 ounces of fluid were collected; probably nearer a pint than half-a-pint escaped, so that the hydrocele contained fully a gallon of fluid. The sac was

stitched to the edges of scrotal wound and a drainage tube inserted. The left sac was tapped and found to contain some fourteen ounces fluid. Recovery was uneventful; after a few days the contracted sac on right side could be readily made out through the abdominal walls.

Subsequently the left sac was subjected to The sac, which was enormously operation. thickened, and of wash leather consistence, being freely excised.

Remarks. Large hydroceles in old people are not unfrequently met with, and also double

Figure II. shows the tension existing when in the upright position; also the rounded outline of the abdomen with the protruding navel, so characteristic of fluid in abdomen. At the bottom of the scrotum the outline of the right testis is very clearly to be seen.

REVIEWS AND NOTICES OF BOOKS.

ATLAS AND EPITOME OF OBSTETRIC DIAGNOSIS AND TREATMENT. By Dr. O. Shaeffer, of Heidelberg. From the Second Revised German Edition. Edited by J. Clifton Edgar, M. D., Professor of Obstetrics and Clinical Midwifery, Cornell University Medical School. With 122 coloured figures and other illustrations. Philadelphia and London: W. B. Saunders and Co., 1901. Cloth, 15s. Melbourne : J. Little.

This volume contains in the compass of some 300 pages a goodly collection of interesting facts, but not much that is new. Its special recommendation lies in its presenting the subject to the eye in a pictorial manner. semi-diagrammatic, are very good. It is rich in lithographic plates, all of which, though

There is a text, as a current comment on the illustrations, covering a large part of the subject. This is written in good style; but the promise of the title page "Special reference to treatment"-is hardly justified, for the space given to treatment is

often brief and, it must be said, not always satisfactory. We do not, for example, like the bald counsel given under Eclampsia (the treatment of which is disposed of in some twenty-five lines), that three grains of morphine may be given in "four to seven hours," the weighty name of G. Veit notwithstanding. It is better to give this and other important drugs "with brains," after the manner of the artist, and watch physiological results, than thus to measure them out in the style of the apothecary. Again one finds with surprise, under" The Treatment of Tubal Gestation," the statement that a patient with "severe hæmorrhage," or where the shock is "too profound, must not be deprived of the extravasated blood." This is a hard saying.

Apart from these slips, however, the book can be recommended as a very good atlas of midwifery, the technique of the art being copiously illustrated, and the text full of important clinical information.

A. W. M.

ATLAS AND EPITOME OF LABOR AND OPERATIVE OBSTETRICS. By Dr. O. Shaeffer, of Heidelberg. From the Fifth revised German edition. Edited by J. Clifton Edgar, M. D., Professor of Obstetrics and Clinical Midwifery. Cornell University Medical School. With 14 plates in colours, and other illustrations. Philadelphia and London: W. B. Saunders & Co., 1901. Cloth, 10s. Melbourne J. Little.

This is an excellent atlas of operative obstetrics. It is unfortunate that the present regime of study affords all too little opportunity to the average medical student of acquiring a practical knowledge of obstetric operations; and therefore such assistance as this atlacan give will be specially welcome to the young prac titioner, who frequently has to bear alone the burden of the most important emergencies. It can be heartily recommended.

The text in explanation of the plates is fairly good and clearly put, as far as it goes. It deals first with the act of parturition, from the standpoint of the practical obstetrician, and secondly with the operations of midwifery. A good index renders the volume readily available for reference. A.W.M.

A TEXT-BOOK OF PHARMOCOLOGY AND THERAPEUTICS. Edited by W. Hale White, M.D., F.R.C.P., Physician to and Lecturer on Medicine at Guy's Hospital, London. Edinburgh and London: Young J. Pentland, 1901.

The editor of this text-book, in his preface, tells his readers that it is not a book on Materia Medica; doses, prescriptions, the composition of drugs, etc, are generally omitted, because it was felt that every one likely to make use of the book would be sure to possess a Pharmacopeia or a book on Materia Medica. Further, no attempt has been made to deal with purely surgical therapeutics. We must say that we think the editor has done wisely in making these omissions, and has succeeded, with the help of his well-known colleagues, in producing the best book on the subject in the English language.

The arrangement of the contents is somewhat different from that usually followed in this class of work. The work opens with an introductory chapter on the relation between chemical constitution and physiological action, from the pen of Mr. Hopkins, the lecturer on chemical physiology at Cambridge, and gives in a concise but clear manner the most important of the ascertained facts in this line of chemical research. A

chapter on Organotherapy, by Dr. Hector Mackenzie, includes, of course, all that is prac tically important in the action on the human body, of preparations of the following organs of the lower animals Thyroid body, suprarenal, thymus, spleen, pituitary body, ovary, testicle, and bone marrow. Dr. Washbourne deals with the subject of growing importance in recent times, included under the term "Serum Therapy." He gives a good account of the diphtheria antitoxine, discussing its mode of preparation and standardisation, and its therapeutics. He also treats fully the direct effects of its administration, and the ill effects which have at times followed upon its use. The treatment of tetanus, hydrophobia, plague, typhoid fever, tuberculosis, and general septic conditions by means of sera, is dealt with in a brief but satisfactory

manner.

Perhaps one of the most striking features of this work is the inclusion of some very useful though concise articles on special branches of therapeutics. Thus a chapter on massage, by the editor, gives the methods usually adopted, and the indications for and against this mode of treatment. The subject of venesection, too, which, we think, has been allowed to fall too largely into disuse is treated of in a very clear manner, and the many conditions in which this treatment is beneficial are explained. Dr. G. V. Poore contributes a special article on the treatment of heart disease by rest, exercise and baths. The chapter on climate and health resorts in Europe is written by Dr. Michael Foster, and an additional chapter on the health resorts of America is by Dr. Solly, of Colorado Springs, U.S.A. The work concludes with a summary of the uses of electricity in medical and surgical diseases.

We can confidently recommend this work as one of special usefulness to the student of medicine, as well as the general practitioner, as the information is well up to date, and includes references to all the best methods of treatment. G.E.R.

MANUAL OF SYPHILIS AND THE VENEREAL DISEASES. By J. N. Hyde, M.D., Prof. Skin and Venereal Diseases, Rush Medical College, Chicago, and F. H. Montgomery, M.D. Philadelphia: W. B. Saunders and Co.; Melbourne: J. Little.

This book very well bears out what is indicated in the preface. It, in many places, cursorily, but yet with sufficient detail for the general reader, compresses most of theessentials of syphilis and venereal diseases in the volume before us. A few of the minor details might be open to controversy. One would hardly think that it is necessary to sterilise the skin before applying mercurial inunction. However, the suggestion is probably in sympathy with the sterilising fashion which pervades medical and surgical practice, and is not to be taken too seriously. The treatment of cowperitis with abscess makes mention of external incision, a method likely to be followed by urethral fistule. Free incision through the floor of the urethra, with the assistance of a urethroscopic tube is infinitely preferable. It is worthy of note that the authors place particular stress on the part taken by toxins and organisms in the production of catheter fever. The treatment of the urethral abrasion by means of which the toxins gain an entrance to the general circulation is of importance, inasmuch, as abrasion is unavoidable, and the treatment of the abrasion, immediately after catherization, with a solution of silver nitrate is in many cases possible, and productive of excellent results. The book is a good book of its kind, and to be recommended. H.C.H.

THE AUSTRALASIAN

MEDICAL GAZETTE.

SYDNEY, 20TH MAY, 1902.

FEDERAL MEDICAL DEFENCE.

ALTHOUGH the motion brought forward at the recent congress at Hobart advocating the formation of an Australian Medical Association was lost, we are glad to note that the spirit of federal medical defence is growing stronger throughout the States of the Commonwealth, The profession is beginning to realise that concerted action and reciprocal relations between the medical societies in the different States is becoming a matter of urgent necessity. We are threatened by various evils, and it will matter of necessity for the profession throughout Australasia to stand together if we are to maintain our professional status and right of "freedom of contract,"

In Tasmania the establishment of a strong Branch of the British Medical Association will, we hope, soon be accomplished, and as a preliminary step in the direction of unity of action amongst the medical men of that State, the Medical Defence Union of Tasmania has been formed, and already has made very satisfactory progress. In Hobart there is a medical section of the Royal Society of Tasmania, which em braces the Hobart practitioners, but this is not in organic union with any other professional association. In Launceston there is a subbranch of the Victorian Branch of the British Medical Association, but the long distance between Launceston and Melbourne renders the connection between the two centres practically useless. The organisation of the profession throughout Tasmania in one Branch of the British Medical Association would be of great benefit to all the practitioners in that State, and would bring them into direct line with the profession in the other States. This

becomes the more necessary in view of the recent attempt to resuscitate the Australian Natives' Association, and the formation of new branches of that society in Tasmania.

In Victoria the old established Medical Society, which has hitherto restricted its attention almost exclusively to purely scientific matters, is beginning to realise that ethical questions cannot be entirely excluded, and, though it bears a different name, we believe that every member of that society is in full sympathy with the Branches of the British Medical Association in Australia in their endeavours to defend the profession from the attacks made upon it from different quarters. The Medical Defence Association of Victoria is a vigorous body which is binding together all the members of the profession in that State, and we know that it has already rendered useful assistance to the New South Wales Branch of the British Medical Association in their action against the Australian Natives' Association. In the other States the Branches of the British Medical Association are strong and active organisations, which are gaining in influence every day. But for successful organisation and reciprocal relations between the different States, it is essential that there should be one journal, recognised as the official representative organ of all the medical societies in the States, a medium for the dissemination of information on all questions of professional interest, and for the making and guidance of medical policy in the Commonwealth. With certain necessary modifications, we think, the Australasian Medical Gazette could be made to fulfil these requirements, as it has now the largest circulation of any medical journal in the Southern Hemisphere. To this end we shall be pleased to receive and consider any suggestions offered; and in the meantime it will be the aim of this journal, as far as possible, to further the organisation and consolidation of the profession in Australia.

PESTIS MINOR.

AT the recent Congress at Hobart, on the motion of Dr. BURNETT HAM, a resolution was passed that the term "Pestis Minor" should not be applied to non-plague cases. This resolution, apparently so obvious, was necessary in view of the reported statement of SIR JAMES GRAHAM, late Mayor of Sydney, that the disease known as "Pestis Minor" was not true plague; and on the strength of this statement, the public of Queensland were at first disinclined to believe that the disease which was prevalent in Brisbane and some other towns in that State, was true bubonic plague. The origin of this confusion of terms would appear to have

been in an article in the British Medical Journal,

of November 23rd, 1901, giving an account of a case of suspected plague at the West London Hospital. This case was examined by several experts, who all agreed in its being a most suspicious case of true bubonic plague, but the bacteriological investigation by Dr. KLEIN negatived this view. The reporter proceeds to state"The diagnosis of pestis minor was probably the correct one, the expression 'pestis minor' being understood to mean not a mild case of true plague or pestis ambulans, but a specific form of glandular enlargement, which occurs when plague either threatens or is actually about." It is true that cases of glandular enlargement with slight fever and constitutional symptoms do occur coincidently with, or as fore-runners of, epidemics of plague, but there can be little doubt that these are cases of true plague of a mild type. We have an analogy to this in the prevalence of very mild cases of scarlet fever presenting only the symptoms of tonsillitis during an epidemic of that disease; and we know how frequently under these circumstances an attack of scarlet fever may be overlooked at first, and only recognised on the occurrence of post-scarlatinal dropsy.

Clearly, the term "pestis minor," if used at all, must be applied only to mild cases of true bubonic plague, and not used to describe any form of non-venereal glandular enlargement, which is proved by bacteriological examination not to be due to the bacillus pestis. But we think the term should be abandoned altogether

if it lead the public to view the occurrence of mild cases of plague as not of much importance, and to consequently neglect to use those sanitary precautions, and to adopt such preventive measures as bitter experience has taught us, to be absolutely essential in successfully dealing with an epidemic of such a serious disease as bubonic plague. "Familiarity breeds contempt" is an old proverb, and judging by the revelations recently made in Sydney and suburbs, it would seem to hold good as regards the present epidemic of plague in this city, and as if all the experience of the past epidemic has, to a great extent, been lost. The general panic has subsided, and in spite of the warnings repeatedly made by the Health Authorities, many householders remain supine and indifferent. The general public must be aroused more and more, and kept alive to the dangers of an even more severe epidemic than the previous one, and the use of any term which is calculated to lull house-holders to sleep over rat-infested premises is to be earnestly deprecated.

THE MONTH. Travelling Expenses for Medical Wit

nesses at Coroners' Inquests. In consequence of the frequent complaints of country practitioners as to the inadequacy of the allowance

for travelling to Coroners' inquests, the honorary secretary of the New South Wales Branch of the British Medical Association has had an interview with Dr. Ashburton Thompson, the medical adviser to the Government, whom he found to be quite in sympathy with the medical profession in the matter. Dr. Thompson has promised, on receiving a statement of the case from the | Council of the British Medical Association, together with some specific instances of the harsh incidence of the Act of Parliament, to

make a recommendation to the Government that the remuneration for attending the Coroners' courts should be somewhat on a similar scale to that allowed for attendance on police cases. Medical practitioners residing in the country are requested to furnish the honorary secretary of this Branch, without delay, with instances where the remuneration has been felt to be inadequate.

The British Medical Association's

Conversazione.

As announced at the last meeting of the New South Wales Branch of the British Medical Association, the Council have decided to hold a public conversazione some time next month. The Senate of the University have graciously granted the use of the University buildings for the occasion, and arrangements are now in progress to make this an occasion for all the members of the Branch, their wives and friends, to meet together for social intercourse. It is hoped that the new State Governor and suite will be present. The arrangements will be carried out by the Council, and invitations will be issued in due course by the President and Council of the Branch. Any

member who does not receive an invitation in due course should notify the hon. secretary, 121 Bathurst Street, Sydney.

Sanatoria for Consumptives in Victoria. A deputation representing the executive committee of the Association for the Prevention of Tuberculosis asked the Minister of Public Health recently to help the association in getting sites for the establishment of sanatoria for the treatment of consumptives. Sir Samuel Gillott said it was understood that the Public Health Department had undertaken to inquire into this matter, and the deputation wanted the department to hurry the business on. The association expected the Government to provide sufficient land for the purposes. Dr. Jamieson said tuberculosis caused 1,800 deaths a year in Victoria. The existing sanatoria, at Echuca and Macedon, could accommodate only 1 per cent. of the patients. Mr. Morrissey promised to discuss the subject with Dr. Greswell, and in the meantime the committee could assist by suggesting suitable localities.

The Adelaide Medical School. We are glad to notice that after the troublous times through which the medical school at Adelaide, South Australia, has passed in recent years, it shows signs of taking on a new lease

of life, and already work has commenced at the new building about to be erected in connection with it. The building is to be constructed at the northern end of the present site, and should be completed at the beginning of next year. It will be of a plain character, with cut stone and brick dressings. The suite of rooms include a dissecting room, 80 ft. x 32 ft. x 17 ft., having an open timbered roof and lantern lights, surrounded by a 6 ft. dado and opalite tiles; a mortuary, 34 ft. x 22 ft. and pathological museum, 96ft x 32 ft. x 17 ft., with glass cupboards running the whole length of one side, while provision is made for additional apartments if required. There is also an articulating room 21 ft. x 14 ft. 6 in. In addition there will be erected rooms for the professors and students and the necessary lavatory accommodation. The walls will be sufficiently strong and stable to allow of the building of another story should it be wanted. Mr. C. Martin is the contractor, and Mr. F. J. The school is to cost Naish the architect. £5,300.

The Medical Profession and the A.N.A.

The

A pamphlet, issued some months ago, by authority of the Western Australian Medical Defence Union," evoked an animated discussion at the sitting of the A.N.A. Conference at Perth last month. The pamphlet, it was stated, contained allegations to the effect that the A.N.A. was an Association of "sweaters," and that it was endeavouring to bring down the status of the medical profession. board of management of the Association had consulted Mr. F. W. Moorehead, solicitor, who had given the opinion that portions of the pamphlet was distinctly libellous. Several members of the Conference urged that an action at law should be taken against the Medical Defence Union if it were found that that body was incorporated, and hard words were used against those few doctors who were believed to be the authors of the pamphlet. On the other hand, it was urged that the reputation of the A.N.A. was capable of withstanding the allegations of a few medical men, and that the objection to the A.N.A. by the medical profession was in itself a recommendation for that body to the generality of the public! One member of the Conference defended the right

of the doctors to unite for their mutual benefit and protection. Ultimately the Conference decided not to risk the costs of a Supreme Court action, and to allow the matter to drop. At Burnie, Tasmania, over forty names were enrolled for the formation of a branch of the A.N.A., but the doctors of the town