THE AUSTRALASIAN MEDICAL GAZETTE. SYDNEY, 20TH JUNE, 1902. A FEDERAL MEDICAL BILL. ONE of the important matters which must come sooner or later (and the sooner the better) before the Federal Parliament is the question of a Medical Bill to regulate the practice of medicine and surgery in the Commonwealth. At the present time each State has some sort of Medical Act, but no one is as complete or effectual as it should be; and when the Federal Medical Bill is drafted it is to be hoped that the Government will seek the assistance of medical men who have carefully studied this question, and who alone are competent to give advice and assistance. As a first essential of such a measure registration should be made necessary to enable any person to practice medicine or surgery. The registration should be made by a General Medical Council for Australasia, with branch registration offices in the different States. Registration should only be possible for those persons who can produce diplomas or certificates showing that the holders thereof have spent at least five years in medical study at a recognised school. It may be objected that as many of the recognised medical schools of America grant degrees in medicine after three or four years of study, it would not be fair to exclude the graduates of those schools from practising in Australasia. But the General Medical Council of Great Britain requires five years of medical study, and will not register anyone whose diploma has been gained after a shorter period of study; so that in requiring a five years' course of study we should not only be following the example of the highest authoritative body on medical education, but also conserving the interests of the medical authorities of the Australasian Universities, graduates of the Australasian Universities, all of whom are required to spend at least five years at their schools. It is manifestly unfair that persons should be able to come from abroad with degrees and diplomas obtained after a much shorter period of study, and compete with those who have been compelled to spend five years in medical study before they can be registered. Further, reciprocity must be secured, and only those medical men should be registered who hold diplomas or degrees obtained in countries where our Australasian graduates would be registered and allowed to practice without further examination. Provision must also be made against the registration of any unqualified persons unless they can show a lengthened term of medical study at a recognised school of medicine, as well as some years of reputable medical practice. Penalties must be enforced against medical practitioners guilty of "infamousconduct in a professional respect," and there must be a clear definition of what is included in this expression. Conditions of life and practice in Australasia are very different from those in the old country, and the strict rules. enforced by the General Medical Council of Great Britain can hardly be fully applied here. Nevertheless, the broad lines of the policy laid down by that body should be capable of being enforced by law, and any breach of the regulations of practice should be followed by the removal of the offender's name from the register. The assumption of titles by unqualified persons which suggest that they are legally qualified medical practitioners must by all means be prevented in the interests of the general public quite as much as in those of the profession. The regulation of medical education, which is one of the functions of the General Medical. Council, may safely be left in the hands of the for we feel sure that so long as these institutions are conducted on present lines there is no danger of their failing to require an adequate standard of general as well as strictly professional education. We sincerely hope that a comprehensive Medical Bill, founded on the broad lines above sketched, will be introduced at an early date into the Federal Parliament, and that the profession in the States will exert its fullest influence in assisting to secure such a bill becoming the law of the Commonwealth. MENTAL SYMPTOMS IN VISCERAL WE are all more or less familiar with the fact that the mind exercises a profound influence over the body, and that the condition of the mind is often largely dependent on the physical state of the body. Melancholy, which, of course, literally translated in plain English, means black bile, tells of mental depression, associated with disturbance of the hepatic functions; and we know how frequently this depression can be dispelled by a dose of blue pill and black draught. It has remained, however, for Dr. HENRY HEAD, F.R.S., whose name is associated with some very valuable work on the subject of referred pain in visceral disease, to enter fully into the question of mental changes associated with visceral disease in his recent disease (he deals more particularly with cases of chest disease) at certain periods suffer from definite hallucinations of vision, hearing, and smell, from moods of depression and exaltation and suspicion, and that these mental phenomena are always associated with referred pains. Of course, he carefully excludes all cases in which definite mental disease is present, and those in whom the condition can be definitely traced to the influence of alcohol or other drugs, such as quinine or salicylate of soda; also cases in which local disease in the ear, nose, or throat may be present. It is hardly necessary to point out what a wide field of speculation and research is thus opened up to the mind of the clinical investigator. As Dr. HEAD remarks, these symptoms are practically unknown to the general physician; but having had our attention directed to the subject, we shall be prepared to explain the occurrence of various states of mental depression and exaltation, and to understand how it is that sometimes patients, for no apparent cause, refuse food, or suddenly leave the hospital for some unexplained reason. 66 It appears somewhat remarkable that the, perhaps, best known mental state associated with pulmonary tuberculosis-namely, the condition of mental exaltation known as spes phthisica "-is explained by Dr. HEAD on the ground of the nescience of the patient of his true physical condition. He suffers practically no pain; he is ignorant of the significance and progress of the physical signs in his chest, and of the temperature chart. But when this Goulstonian lectures before the Royal College patient has been in hospital, and has learnt the of Physicians of London. This work is based on most careful observations on patients in the Victoria Park Hospital for the Diseases of the Chest, and also in the London Hospital, where he holds the position of assistant physician. In these lectures, which are well worth the study of all physicians, Dr. HEAD leads us on by the record of most careful and painstaking observations to the conclusion that a large number of patients who suffer from organic visceral gravity of his case from the remarks of the doctors and students, and the meaning of the fever and the night sweats, then the condition of exaltation gives place to one of less hopefulness, and possibly actual depression. This appears to us a very unsatisfactory explanation of "spes phthisica," and to be one of the weakest parts of the whole thesis. The statements are hardly warranted by facts, for not unfrequently the state of exaltation is maintained throughout a patient's stay in hospital, even up to the day of his death, although he must be quite familiar with his temperature chart and with the discussion on his physical signs by the doctors and students. Dr. HEAD dwells exclusively upon the nervous reflex theory, and does not refer to the influence on the cerebral cortex of the toxic substances formed in the bodies of patients suffering from pulmonary tuberculosis, which, we think, must be reckoned with in framing any theory to explain the facts. THE MONTH. The British Medical Association's As already announced, the President and Council of the New South Wales Branch of the British Medical Association have issued invitations to members of the profession throughout this State to a conversazione at the University of Sydney, on Tuesday evening, June 24, from 8.30 till 11 p.m. His Excellency Sir Harry Rawson (the State Governor), Lady Rawson, and party, His Excellency the Commander-inChief, Lady Beaumont and staff, BrigadierGeneral Finn and Mrs. Finn, the Hon. the Premier and Mrs. See, His Worship the Mayor of Sydney and Mrs. Hughes, and many others have signified their intention to be present. It is expected that there will be a very large gathering of the profession and the general public on the occasion. Recognition of the N.S.W. Branch of the British Medical Association as a Public Body. It has long been a matter of regret that the profession of medicine has not been officially recognised at the Governor's lerées and other State functions. We are pleased to be able to announce that, in reply to a request from the Council of the Branch, His Excellency Sir Harry Rawson has graciously consented to recognise the New South Wales Branch of the British Medical Association as the public body representing the profession of medicine at State functions. We feel sure that every member of the Branch will join with us in thanking His Excellency for so readily acceding to our request. Inquests Without Medical Evidence. A correspondent from a country town in New South Wales writes to us to say that the coroner of that district nearly always holds inquests without calling medical evidence of the cause of death. He states that on a recent occasion the coroner held an inquiry without a jury in the case of the death of a young married woman who died a few hours after confinement. Only the girl's mother was present at the confinement. The coroner, without calling medical evidence, found that "death resulted from exhaustion following confinement." It is scarcely necessary to point out how utterly inadequate such an inquiry is to ascertain the full facts bearing on the cause of death. It is clear that in this case a post-mortem examination should have been made; and if this is the sort of inquiry usually held by the coroner in question, we think our correspondent should communicate with the Department of Justice, otherwise serious crime may go unpunished. Civil Ambulance and Transport Brigade of New South Wales. From the sixth annual report of this institution we learn that during the year 1901 some 2,166 cases were dealt with by the Brigade Officers and Ambulances, travelling an aggregate of 9,249 miles. Of these 1,451 were medical and surgical transports on practitioners' certificates; 93 patients were conveyed to hospital or homes otherwise than in ambulances; 120 were accidents at sports' meetings; 394 were cases treated at the Brigade's Ambulance Stations according to first aid, and directed to a medical practitioner or to hospital for further treatment; and 58 were sundry minor accidents. The receipts from subscriptions and collections from all sources amounted to £1,186 19s. 5d., and the expenses for the year amounted to £1,125 4s. 4d., thus leaving a surplus of £61 15s. 1d. The receipts included £75 from the Hospital Saturday Fund, and £120 19s. 3d., being the proceeds of the Children's Fancy Dress Ball held in October last. We are glad to note that this institution is carefully controlled by the medical profession, the President being Professor Anderson Stuart, M.D.; the chairman of committees, Dr. R. H. Todd; and there is a medical committee composed of members of the New South Wales Branch of the British Medical Association, and all the lecturers and examiners are members of this Association. State Aid to Hospitals. When speaking at the opening of the Camden Hospital, N.S.W., Mr. See, the Premier, stated that the total revenue of the New South Wales hospitals during 1900 was £191,272, made up as follows:-Government was aid, £88,683; private contributions, £86,195; miscellaneous sources, £16,394. Those figures, however, only referred to hospitals in the strict sense of the word. In the widest acceptance of the term, including all asylums for the insane, the permanently incurable, the destitute, the aborigines, and so on, the gross expenditure of the Government during last year £353,909. To that must be added £42,422, the State's expenditure on the Children's Relief Department. The Government aid of £88,683 was distributed in 1900 as follows:-To country hospitals, £42,171; to metropolitan hospitals, £29,781; and to the Coast Hospital at Little Bay, £16,731. The Recent Gynaecological Appointments at the Adelaide Hospital. A correspondent has written to us complaining of what he calls a gross act of nepotism in the recent gynaecological appointments at the Adelaide hospital. If the facts are as stated by our correspondent, the hospital Board evidently considers that family and personal considerations are of more worth in deciding upon the fitness of candidates for hospital appointments than years of experience and proved merit. It is lamentable if such should be the case, and we hope that in future the appointments at the hospital will be given to men who have shown by their past work and experience that they are the best fitted to serve on the hospital staff. Country Hospitals and Old-Age Pensioners. At a recent meeting of the Bathurst hospital committee a communication was received from the secretary of the Hay hospital upon the subject of the Old-Age Pensions Act as regards its effects upon country hospitals. The letter stated that numbers of paupers were leaving the benevolent asylums and making their way back to the districts where they had lived in order to claim old age pensions, and that when these pensioners became infirm and decrepid they must resort, as they are doing in considerable numbers, to country hospitals, where they would probably stay the remainder of their lives, thereby throwing a serious additional burden on these institutions. To force the district hospitals to take on the functions of benevolent asylums was contrary to the spirit of the Hospital Act, and promised to become a serious source of embarrassment and expense. The letter sought the co-operation of the Bathurst hospital committee with a view to concerted action in the shape of a demand for additional subsidy for each pensioner admitted, or such other course as may be deemed advisable. The letter was received, and the committee recognised the necessity of doing something in the matter, and intimated a desire to co-operate with the Hay committee. Asylum for Destitute Children, Randwick,. Sydney. This institution has just attained its jubilee, The having been founded in the year 1852. meeting at which it was started took place at the house of the late Dr. Douglass, and the asylum was opened on June 1 of that year at Ormond House, Paddington. It was aided by a munificent legacy by the late Dr. Cuthill, the first medical officer of the institution, and by grants from the Governments, and in March, 1858, the buildings at Randwick, now in use, were opened. From the 50th annual report we learn that during the 50 years the asylum has been in existence, over 4,900 boys and girls under eight years of age have been admitted.. Of this number, over 2,000 have been apprenticed under indentures; 2,255 have been restored to their parents or otherwise discharged; 305 have been discharged to the boarding-out officer; and 213 have died. From the medical officer's report we learn that only one death has occurred during the past 14 years, and this took place last year, the cause of death being cerebro-spinal meningitis. Five cases of scarlet fever occurred during the year, and it speaks well for the care and attention bestowed on the inmates that no further spread of this disease occurred. Dr. Dick, the visiting medical officer, resumed his duties after his return from South Africa, Dr. James Reiach having acted as his locum tenens. The average cost for maintenance, education, and general management is £24 11s. 114d. per head. An institu-tion which does such valuable work is deserving of the generous support of the whole community. The Queensland Weather Bureau.-We much regret to learn that the Queensland Government has decided, as a part of its retrenchment scheme, to abolish the Weather Bureau in that State. Mr. Wragge has become widely known throughout Australasia as a weather prophet, and his forecasts have proved of immense benefit to all classes, so that the loss of his services will be felt throughout Australasia. It seems that with the advent of Federation ¡the Federal Government have charged Queensland with the expenses of telegrams, etc., in connection with the Weather Bureau, amounting to about £4,000 per annum. Previously the cost of maintenance was about £1,500 per annum, and this expense was borne entirely by Queensland, although all the States shared in the benefits of its work. Surely this is a department which should be taken over by the Federal Government at an early date, and we hope that Mr. Wragge's services will yet be retained. BRITISH MEDICAL ASSOCIATION NEWS. PROCEEDINGS OF AUSTRALASIAN BRANCHES. Ballarat. THE ordinary quarterly meeting was held at the Ballarat School of Mines on Thursday evening, April 24th. Present-Drs. Bennett, Courtney, Cussen, Gardiner, Hardy, Jordan, Martin, Mitchell, Morrison, Naylor, Palmer, Richards, Steel, G. Affleck Scott, and R. Scott. Apologies were received from the President (Dr. W. B. Smith), and Drs. Davies and McGowan. The HON. SECRETARY reported the sudden illness of the President, who had come from Melbourne to give his demonstration on the microphotography of diseased brain tissues. Dr. MITCHELL moved, and Dr. G. A. SCOTT seconded, "That Dr. Jordan take the chair." The minutes of the October quarterly meeting were read and confirmed. Accounts amounting to £1 6s. 6d. were passed for payment. The CHAIRMAN reported that, owing to the lamented death of Dr. R. D. Pinnock, a vacancy had occurred among the trustees, which, according to the by-laws, must be filled that evening. Dr. Wm. Morrison, M.A., was elected trustee. A letter of sympathy was ordered to be sent to Mrs. Pinnock. It was Correspondence was received from the Secretary of the Association and the Hon. R. T. Vale. resolved that Mr. Vale be thanked for his efforts to obtain a lunacy receiving ward at the Ballarat Asylum. NEW MEMBERS.-Dr. John Steell, of Ballarat, and Peter Hannah Cunningham, of Talbot, were unanimously elected members of the British Medical Association and of this Branch. On the motion of Drs. ROBERT SCOTT and NAYLOR, the members of the Branch were urged to join the Medical Defence Association of Victoria. It was resolved that in future the meetings of the Branch be held at the Ballarat District Hospital, the board-room of which had been courteously placed at our disposal. Dr. HAROLD A. BENNETT was appointed curator and librarian, and the Hon. Secretary handed over to him the pathological specimens and two framed engravings which had been bequeathed to the Branch by the late Dr. Pinnock. Dr. R. Scorr's notice of motion with reference to the appointment of specially qualified medical officers of health was ordered to be placed on the notice paper for the next meeting, but that the country members be invited to express their views this evening. Dr. NAYLOR (Smythesdale) was in favour of such appointments, as the local practitioners were not sufficiently independent. Dr. PALMER (Ararat) was also in sympathy, and thought the matter would become urgent in the near future, as the present system was undoubtedly bad. Dr. COURTNEY (Learmouth) thought that a central officer would be able to compel councils to move against vested interests. Dr. WILSON (Creswick) cordially approved of the suggestion. Dr. HARDY (Ballarat) pointed out many conditions at present unworkable, notably in regard to the by-laws. At this point, Drs. GUTHEIL and GRACE VALE, with a number of other visitors, were introduced by the Hon. Secretary. In the unavoidable absence of Dr. W. BEATTIE SMITH, his lantern slides, about forty in number, were exhibited by an expert lanternist, and were highly appreciated by the members and visitors present, the series being a most instructive and interesting one. The comparisons between the healthy and the diseased brain tissues added The greatly to a clearer understanding of the subject. brief notes on the slides were read by Dr. G. AFFLECK SCOTT, who voiced the regret of those present that the President was unable to describe his beautiful sections and preparations in detail. The meeting was then closed. Victoria. THE ordinary monthly meeting of the Branch was held at 178 Collins Street, Melbourne, on Wednesday evening, May 28th. Dr. McCANSH (President) took the chair, and a large number of members and visitors, including Colonel Williams, C.B., P.M.O., were present, on the invitation of the President and Council of the Branch, to hear Dr. W. Fox's paper on "The Cure of Rodent Cancer by Electrocution.' The minutes were taken as read, and signed. Letters of apology for not being present were received from Drs. Meyer, Officer, Weigall, Kennison, and J. T. Rudall. Dr. W. Fox then read his paper. (See page 308.) Dr. J. WEBB preferred to divide facial cancers into epithelial, non-epithelial, and rodent. During the last 24 years he had cured 4 rodent cancers and 2 epithelial cancers very quickly and effectively with injection of soap solution. Dr. Webb then proceeded to give his reasons for adopting this procedure, and also the results of treatment; but as this hardly applied to the subject matter under discussion, the Chairman asked him to confine his remarks to the paper, and that the Branch would be very pleased to have a paper from him on his cancer cure on some future occasion. Dr. Webb said he knew nothing about electrocution as a means of treatment of rodent cancer. Dr. CARNEGIE said that the scar resulting after the treatment seemed to show up as if it were rather large in the photograph which had been passed round. In America, Cohnheim's theory was the most accepted by the profession, viz., that cancer was simply misplaced epithelial cells, and if the circulation could be cut off rapidly and early this gave the best chance of destroying the new growth, and also preventing the disease spreading into the general system. This was quite possible by the means Dr. Fox had been describing to them. He noted that lately ligation of the internal carotid had been done in some cases of cancer, with the idea of cutting off the blood supply. So far, he had seen nothing better than the knife. Dr. LLOYD (North Melbourne) wished to thank the Committee for their kind invitation to hear the able and admirable paper which Dr. Fox had given them. He stated that he had no experience of this treatment of rodent cancer, but that it seemed to answer admirably. About 12 months ago he treated one of these cases with a mixture of mercury and zinc, and with three applications made a complete cure. Dr. BECKETT expressed the pleasure this paper had been to him, and the great interest he took in this method of treatment. He would like to hear it compared with other treatments by surgeons, viz., by the Röntgen rays, and the Finsen light. He thought this treatment was suitable for small growths, but would be of no use when the disease had eaten away the nose and a good part of the face and bone adjacent. He thought Dr. |