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Three Symphysiotomies Upon One Patient.

L. Hirigoyen (Rev. mens de Gyn., Obst. et Ped. de Bordeaux, No. 10) reports three symphysiotomies upon the same patient, resulting in the birth of three living children. “After the last operation no enlargement of the pelvis, fibrous induration, adhesions of neighbouring organs, or vascular dilatations near the symphysis were found.

Victoria. The Lodge Court Friar Tuck, A.O.F., is recognised as one of the strongest lodges in the district of Carlton. It has 306 members on its roll, and the amount paid in for medical expenses is £l per annum for each member. It is pointed out that the court is not in a position to pay more than £1 per annum per member to its doctors and chemists without making special levies on the members. Some years ago it paid £1 per member to Dr. McInerney. Recently the amount paid was £1 3s per member, of which es went to the chemists and 15s to the doctors, but members objected to the latter figure on the ground that other lodges were paying only 13s, and others only 12s 6d, per annum per member.

At a special summoned meeting of the court it was therefore resolved that the doctors be given a month's notice to terminate the existing agreements. The doctors replied in a joint letter declining to accept less than the 15s per member they had been receiving. Matters were practically at a deadlock, when Dr. Lynch, a member of the Medical Defence Association, of which

court doctors

also members, agreed to see any of the lodge members professionally until such time as a permanent medical officer was elected. Dr. Lynch was subsequently unanimously appointed medical officer. Four other applicants were also elected, the whole agreeing to accept the reduced fee of 13s per annum per member. At the last meeting of the court the friends of the doctor to whom most of the trouble is attributed endeavoured to pass a resolution directing that a special meeting be held with the object of securing his reappointment, but the proposition was lost by 28 votes to 8.

The secretary considers that other friendly societies are indebted to Court Friar Tuck for its successful efforts to prevent an organised attempt at “raising” (!) the medical fees.

Perhaps the profession in Carlton will consider that Court Friar Tuck has taken the lead in reducing medical fees, and that its medical officers who have consented to accept the reduction in fees will be deserving of professional and social ostracism.




Indications for Rapid Induction of Labour.

G. Fieux (Rev, mens de Gyn., et Ped. de Bordeaux, Nos. 8, 9, and 10) discusses the indications for rapid induction of labour. In the case of hæmorrhage, he limits it to accidental hæmorrhage, rarely employing it in that due to placenta prævia. As regards severe dyspnea, the operation is not indicated if it be due to some mechanical condition, such as pneumonia, pleurisy, or ascitis, and in these cases treatment should be directed to the etiological condition. When of cardiac origin, medical measures should first be tried to relieve the heart, and, these failing, rapid induction of labour is favoured. Intrauterine putrefaction of the fætus, of course, demands the operation with rapidity. In eclampsia labour is usually initiated by the convulsions, and in the 10 per cent. of the cases in which this does not occur, rapidly induced labour not only produces no ill-effect, but often greatly improves the mother's condition. The fætal mortality of 80 per cent. in cases in which labour does not rapidly follow the convulsive attacks is reduced by the operation to 20 per cent. In cases of the apparent death of the mother near term, a Cæsarean section should only be done with all the usual precautions, as death has occasionally been found to be only apparent. If the fætus is in bad condition and the mother not so, partial dilatation of the cervix and insertion of Champetier de Ribes' bags may suffice; if not, rapid induction of labour is demanded. In cases of maternal anthrax he does not favour this operation, and in hydrophobia advises its use only after the onset of symptoms. He is uncertain as to the indications in tetanus. Among its contra-indications he includes a general sclerotic condition of the cervix, large fibroids, or cancer of the cervix or lower uterine segment.

Anesthesia by Subarachnoid Injections of Cocaine in the Lumbar Region.

Arnold W. W. Lea (Journal of Obstetrics and Gynacology of British Empire, January, 1902) contributes a very excellent and exhaustive paper on this subject, with reference to its use in obstetrics and gynecology. The literature of the subject is reviewed. The details of the method of Tuffier (who has done so much to bring this method forward) are briefly as follows:- The injection is made between the laminæ of the fourth and fifth lumbar vertebræ. For this purpose a needle sufficiently long and firm to penetrate the tissues is required. Tuffier's needle is four inches long, and is best made of platinum with an iridium point. The point of the needle must be short, to avoid injury to nerve structures. The skin is made thoroughly aseptic. The patient is placed in the sitting posture, with the back well arched forward. In this position the maximum amount of separation between the laminæ of the vertebræ is obtained. The spine of the fourth

Yersin's Curative for Plague.—The Acting Federal Prime Minister has received a despatch from the Secretary of State for the Colonies stating that it is proposed to manufacture Yersin's curative syrup for bubonic plague at the country branch of the Jenner Institute in England. £3,000 will be required to equip and work a new laboratory for two years. The local government boards of Great Britain have recommended that the Imperial authorities shonld subscribe two-thirds of £3,000, and the colonies which have suffered from the plague are now being appealed to to provide the balance. Hongkong has undertaken to vote £636 13s 4d of this £1,000, and Mr. Chamberlaia suggests that the Commonwealth should become responsible for the £333 6s 8d still required. Mr. Deakin intends to consult the State Premiers on the subject.

At a meeting of the subscribers to the Dr. Way Memorial Fund on uly 9th it wa decided that all funds be handed over to the council of the Adelaide University for the endowment of a chair of gynecology, to be called the Dr. Edward Willis Way Chair of Gynecology.



lumbar vertebræ is now sought for and clearly identified, is without influence on the condition of the fetus. This is usually easy to do, but in stout patients, or The definite influence of cocaine on the uterine conif the spinous process is not well developed, a line tractions limits its sphere of usefulness in obstetrie joining the highest points of the iliac crests, which practice, as when complete muscular relaxation is crosses the level of the fourth lumbar spine, may be required for podalic version or other intra-uterine adopted as a guide, and will be found to be reliable.

manipulations. Gueniot, in a communication to the The needle is now inserted one centimetre below and Academy of Medicine of Paris on January 22nd, 1901, outside the spinous process, and directed vertically lays down the following conditions as contra-indicating downwards and slightly inwards. It will enter the its use in labour: (1) Disease of the heart or great interval between the laminæ of the fourth and fifth vessels, (2) chronic disease of the respiratory organs. lumbar vertebræ, and penetrate the subarachnoid space, (3) chronic affections of the central nervous system, as is shown by the escape of clear cerebro-spinal fluid (4) the absence of facilities for securing complete through the needle. An ordinary Pravaz syringe is asepsis. The

writer admits the following now attached to the needle, and one centimetre of a conditions as suitable for the use of cocaine: (1) Any 2 % solution of hydrochlorate of cocaine ( grain) obstetrical operation requiring anæthesia, with the is very slowly injected. The needle is now with- exception of those in which it is necessary drawn, and the minute puncture sealed by collodion. introduce the hand into the uterine cavity ; (2) exThe strictest antiseptic precautions must be observed. cessive pain during labour ; (3) prolonged labour It is essential that the cocaine solution be freshly owing to feeble or irregular contractions of the uterus made. Difficulty may arise from several factors. in the absence of any obstruction; (4) in conditions (1.) The needle may impinge on the bony lamina, or tending to hæmorrhage, such as uterine inertia, placenta in cases of deformity of the vertebræ or ankylosis it ! prævia, etc. may be impossible to enter the subarachnoid space. (2.) The needle may be apparently in the subarachnoid

GYNECOLOGY. space, but as yet no fluid appears. This may be due to the point being entangled in the membranes, or the

Instrumental Perforation of the Uterus, needle may have penetrated too deeply. A slight movement of rotation or withdrawal is usually sufficient to

Wilmer Krusen (Amer. Med.) discusses briefly the cause the fluid to run freely. (3.) Blood may appear at

accidental perforation during operative procedure. The

uterus may be accidentally perforated by the sound, the end of the needle, due to injury to a vein. The needle must then be withdrawn and a fresh puncture

dilator, bougie, tent, or curette; or it may occur in the made. The analgesia commences almost immediately,

attempt to procure abortion by many other instruments

and unusual appliances such as may be conveniently at and is usually complete in five to ten minutes.

In rare

the hands of the abortionist. There are certain condicases fifteen to twenty minutes may be required.

tions of the organ which favour such injury and render The extent of the analgesia shows great variations, but

it more liable to occur. When the body of the uterus is it may be relied upon up to the level of the umbilicus,

the site of a carcinoma, the organ is more fragile, and and usually there is complete cutaneous anesthesia up to the ensiform cartilage. The duration of the analgesia

the effort to obtain material for microscopic examination is also somewhat uncertain. Usually it continues for

may prove disastrous. Atrophy, anæmia, and tubercu

losis are the usual causes of abnormal fragility of the an hour or a little more. It may, however, last for

uterus. An abnormal condition of the uterine muscle thirty minutes only, or up to three and a half hours.

may be attributed to frequently recurring pregnancies During analgesia the patient has a feeling of “malaise,'

in which there is a very brief time between successive respiratory anxiety, and weight at the epigastrium. Nausea occurs in 30 % of cases. In a considerable

labours. Any attempt to explore or curette the uterus proportion this is succeeded by vomiting. The pulse is

immediately after labour or abortion, when the uterus is

subinvoluted, must be made with unusual care because quickened and the tension lowered.

After analgesia

of the softened condition of the uterine muscle. A the patient usually feels very comfortable. Slight sickness may continne. Headache, which may be

failure to recognise by careful bimanual examination

the position of the uterus when it is either acutely antesevere, comes on six to eight hours after the injection.

flexed or retroflexed may lead to injury because the A rise of temperature, accompanied sometimes by a chill, or even a shiver, occurs in about half these cases

operator fails to properly direct his instrument. The

point of the instrument making pressure upon the within a few hours of the operation. It is usually

cervical wall near the flexure produces rupture. No one slight, it subsides rapidly, and is of no special signi

should attempt intrauterine manipulation until he is comficance. The cause of this rise of temperature is obscure.

petent to diagnose the uterine position, and the presence or If during the operation there is evidence of cardiac

absence of disease of the appendages. Much harm is depression or respiratory difficulty, injections of

done by the unwise dilatation and curettement of the strychnine should be given. Fowler, of New York,

uterus in cases of lateral disease.

Proximity to the gives a full dose of strychnine before the operation in each case. Certain details add much to the comfort

menstrual period, when the uterus is much congested

and softened, may contribute in a high degree to the of operating upon a conscious patient. Thus it is well to put cotton wool in the ears, and to place a hand

possibility of uterine injury. kerchief over the eyes of the patient. She should also

The perforation may be either partial or complete; be reassured at intervals during the operation. Silence

partial when the mucosa and muscular coat of the uterus should as far as possible be enjoined. This method of anæsthesia is not suitable for hysterical women, in

are involved without injury to the serous covering; whom the simple sensation of contact may suggest

complete when the instrument passes through the three painful sensations. Cases of heart disease or anterio

coats and enters the peritoneal cavity. The injury may

be cervical or fundal. sclerosis bear it well (Tuffier). Clinical experience has shown that the contractions of the uterus continue regularly under the influence of cocaine. Dupaigne

The result of such injury may be :found that the uterine contractions were increased in (1.) Infection : If unclean instruments have been force and frequency, and considered that the duration

passed through an unclean canal, there is the of labour was distinctly lessened. If the dose of

possibility of septic material being carried 1 centigramme (} grain) be not exceeded, the injection

directly into the peritoneal cavity.


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(2.) Hæmorrhage: The amount of blood lost de- cancer cells as well as around the cell nests, while in the

pending upon the position and extent of the normal epithelium or in benign growths, such as condyinjury and the contractile power of the uterus. lomata acuminata and tuberculous lesions, these fibres

stop at the edge of the epithelium, and are not found (3.) Visceral injury may occur, as when the intes

between the individual cells.
tine or omentum is injured by the instrument
or drawn into the uterine or vaginal canal.

Shortening the Round Ligaments through the (4.) There is the danger of the introduction toxic Vagina.

material into the peritoneal cavity when
chemical antiseptics are employed. Whenever C. J. Bucura (Zeitschr. für Geb. und Gyn., Bd. xlvi.,
there is a possibility of uterine injury, irriga- H. 2) warmly defends this operation as it is performed
tion should not be practised, or, at least, only by Wertheim. Of 86 cases so treated, only two had
saline solution employed.

recurrence of the retroversion at the time of discharge,
and these were complicated cases.

Seven had since had (5.) Pelvic peritonitis may result.

normal labours; three had aborted; three were preg

nant and comfortable at the time of writing. Of 48 When simple perforation of the uterus has occurred

cases in which this operation only was done, 10 had under aseptic conditions, without marked symptoms of

While vaginofixation and Alexander's shock or visceral injury, no operative interference is

operation give better results, the former may cause comindicated. In all cases in which there is visceral com

plications during subsequent pregnancies and the latter plication, cæliotomy should be immediately performed,

sometimes hernia. and the injury repaired.

OPHTHALMOLOGY. Ovarian Transplantation.

Older and Newer Mydriatics, Myotics, and William R. Nicholson (Univ. Penn. Ved. Bull., Jan.), in summing up the work which has been reported on

Anästhetics. this subject up to the present time, states that it is In the March number of the Archives of Ophthalmology possible to transplant ovaries either homo or hetero

H. Schultz has an article under the above heading. The plastically, and that pregnancy will follow in a small

mydriatics discussed are atropine, daturine, duboisine, proportion of cases; that there is without doubt an

hyoscyamine, hyoscine, scopalamine, atroscine, homainfluence inherent in the ovaries, beyond the mere

tropine, gelsemine, ephedrine, mydrine (a mixture of process of ovulation, which is very important for the

homatropine and ephedrine), euphthalmine and mydrol. development of the genitalia and also for their conserva

The myotics are physostigmine or eserine, pilocarpine tion. All the evidence adduced tends to strengthen the and arecaline. The anæsthetics are cocaine, apomorposition held by the so-called conservative school, that

phine, benzoltropine, stenocarpine, toad-poison, strothe whole ovary, or at least a portion of it, should be

phanthine, erytropleine, tropacocaine, eucaine, holocaine, left where possible.

anæsine and suprarenal extract. So far none of the

newer agents appear likely to displace atropine, homaPigmentation of the Linea Alba.

tropine, eserine or pilocarpine for general purposes.

Cocaine, however, has formidable rivals in tropacocaine The Thèse de Paris, 1901, of R. Lehman (Presse méd., and holocaine, both of which are less irritating than November 30) shows that pigmentation of the linea alba cocaine, have no action on the corneal epithelium, and occurs under other conditions than pregnancy. He little or no effect on pupil, accommodation or tension, found it in about 30 % of the little girls in one of the and both can be sterilised by boiling, and keep well. hospitals. In these cases it is usually pale yellow, Holocaine, in i % solution, is also powerfully antiseptic. sometimes darker, and generally associated with chronic

In the same number Macklin writes on the cycloplegia constipation or other intestinal lesion, such as typhoid,

and mydriatic action of atroscin and I-scopalamine general or localised tuberculosis, or the approach of

(which are probably identical in nature). He advocates puberty. In men it occurs under the same circum

their use (in oily solution) for the following reasonsstances. It is always between the umbilicus and pubes

(1) only one application is required; (2) more rapid and in girls, appearing before the first menstruation, and

certain action of the drug. Mydriasis begins in 10 persisting if the function is not regularly established,

minutes, and is complete in 20; cycloplegia begins in and always suggests the occurrence of amenorrhæa,

20 minutes, and is complete in about 50 (average); dysmenorrhea, menorrhagia, &c. Tumours of the genitals cause this pigmentation only when they cause

power of accommodation returns in about 5 days.

Schultz thinks, however, there is no reason for replacing amenorrhæa or dysmenorrhea. The writer considers a

atropine by scopalamine generally. Solutions stronger dark line pathognomonic of pregnancy. He believes

than % are not to be employed, since they may have a that a line of suficient length, breadth, and intensity toxic effect. conclusively proves, without other examination, that the woman has recently been pregnant. In the nullipara after puberty it nearly always indicates the existence of

Treatment of Suppurative Keratitis. amenorrhæa or dysmenorrhæa, while in a little girl it

In the Recueil d’Optalmologie, Perrin concludes his points to the near approach of puberty and the first

i observations on his series of 32 experiments on animals, menstruation.

of injections of antiseptics into the anterior chamber in

cases of suppurative keratitis (especially those due to Early Diagnosis of Carcinoina of the Uterus. staphylococcus) with iritis, hypopion or iridochoroditis,

and is so impressed with his results that he announces Abel (lich. für Gyn., Bd. lxiv., H. 2) claims that he his intention of employing the method in man. He has discovered a valuable diagnostic point between carci- recommends cyanide of mercury 1-5000. He says injec. noma arising from the squamous epithelium of the cervix ' tions into the anterior chamber are less painful, and and benign growths from the same cells. His illustra- more rapid and certain in their action than subconjunctions show the presence of elastic fibres between the i tival injections.



investigation of three brains of general paralytics. The article seems to have two chief points of interest. The first is that it brings pathological evidence in support of Flechsig's developmentally investigated association

Schaffer finds that it is just those areas which Flechsig indicates as association areas which are affected in general paralysis; he finds a constant immunity of the motor, visual, auditory, etc., areas. The second point of interest is the assertion that general paralysis is a disease of a definitely marked out area of cortex; he does not find that in one case the frontal convolutions are involved and in another the parietal, but he finds that in every case the whole of the association area is involved. Should these conclusions prove correct they will mark a distinct advance in our knowlege of the disease, and they appear to support the theory of primary nervous degeneration rather than the iheory of primary vascular disease. The paper further confirms the theory advanced by Cajal (histologically), Flechsig (developmentally), and Sherrington (experimentally) that the posterior central convolution is an association and not a motor area.

Protection of Cornea in Sightless Stumps.

In Knapp's Archives for March, Gifford has an article, and begins by saying, “ For all who believe that all sightless stumps should be enucleated, this paper can have no interest.” He does not propose his operations as substitutes for evisceration or enucleation in actively infected globes, but in the class of patients who come with a quiet stump, over which a glass eye cannot be worn on account of irritation of the cornea ; or on account of the danger of irritating and infecting exposed iris tissue; or when the stump is irritable solely from the degeneration of the corneal epithelium ; or in patients who refuse evisceration or enucleation.

When sufficient conjunctiva is available he excises the membrane around the lower border of the cornea for an area 7 of an inch wide at the sides, and below. Above this zone the membrane is dissected free from the globe as far as the upper fornix, where he makes a cross cut through the membrane to allow it to be slid down over thecornea without putting much tension on it. These sutures are inserted below, well into the episcleral tissue.

When the conjunctiva is atrophic or scanty he dissects the conjunctiva up for } inch around the cornea, scrapes the latter, and applies a thin flap shaved from the lip with a razor, or a Thiersch Aap. The flap is tucked under the conjunctiva on all sides, and both eyes bandaged for 24 hours. The lip flap is preferred to the Thiersch graft. Parascleral Tenotomy for Strabismus.

As a result of the disastrous secondary deviations that followed Diffenbach's operation of myotomy, it has since been strongly insisted upon that in tenotomy the tendon must be snipped as close as possible to the sclera. Delamare, of Rouen, in the Recueil d'Ophtalmologie for November, describes his operation, in which he leaves a tag of tendon about 2 um. long attached to the sclerotic. He claims by this method to overcome deviations of from 2 to 6 mm. (10 to 30 degrees) in adults, whereas even double tenotomy, done in the usual fashion, rarely corrects a squint of 4 mm. (20 degrees) in persons over fifteen. Tenotomy, with advancement of the antagonist, can produce as great an effect and the particular method he commends is that of de Wecker), of tenotomy with capsulo inuscular advancement by folding (plissement) of the antagonist (without cutting it); but, in addition to the objections that this operation necessitates two wounds instead of one, as well as the presence of a stitch, which is sometimes irritating, besides being more tedious and painful, there is the further consideration that it requires a considerable amount of skill and experience to get good results, whereas he claims that his operation of parascleral section can be performed by the average surgeon. The steps of his operation are similar to those of the usual tenotomy, with the exception of the position of the section of the tendon. Cocaine is used. The conjunctiva is divided over the position of insertion of the tendons, Tenon's capsule is snipped through, above, below, behind, and in front of the tendon, the attachment being carried behind and in front, back to the caruncle, above to midway between the internus and the superior rectus below to midway to the inferior rectus. The tendon is then hooked up and cut with one snip 2 mm. from the selera. The operation is applicable to divergent as well as to convergent squints, though in the divergent form the results are not so satisfactory.

NEUROLOGY. General Paralysis of the Insane.

Schaffer (Neurologisches Centralblatt, 1902, No. 2) has a very interesting article on the results obtained from the


Clark and Prout (The Medical Review, 1901) having examined 13 cases of epilepsy, and having found in all a nuclear degeneration of the second layer of the cortex, a condition of chromatolysis of the whole cortex, and an overgrowth of the neuroglia, Clark proceeds to criticise the usual modern surgical and medical treatment of epilepsy. He comes to the following conclusions :1. Idiopathic epilepsy with typical fits of the grand mal character should never be trephined with a view to improvement. 2. Idiopathic epilepsy with fits of the Jacksonian type should only be trephined if infantile cerebral paralysis is excluded, and if there is not a marked amount of family or individual degeneration. In the case of an operation the cornical area from which the fits origin:ite must be as freely as possible removed ; even when this is done only about 1 % of the cases are freed from fits. 3. Cases of traumatic epilepsy should only be trephined if the accident stands in direct causal relationship to the fits, and if the accident has occurred not more than two years previously. The prognosis, then, will depend on the amount of nervous predisposition present, and it is the more favourable the earlier the operation is performed. 4. All trephiued epileptics should be treated for at least a year with bromides. In regard to the hygienic, diutetic, and medicinal treatment of idiopathic epilepsy, the writer lays stress on the following points :1. The bromides give the best results when combined with correct diet, regular employment, and personal hygiene. 2. Bromide is our best drug for the status epilepticus. Yomg patients can undergo a lessening in the number of fits, and even eventually be cured thereby; the old will at least be benefited to the extent of a lessening in the number of fits and an increase in the feeling of bien être. 3. If the bromides are to do any good they must be given in such quantity that the number of the fits is decreased. Warm and cold baths are recommended, and attention paid to all the systems of the body.

The Posterior Columns of the Cord.

A publication from Bechterew's laboratory describing the results of an investigation on 14 dogs whose posterior columns were divided goes to show that only sensations connected with the muscle sense pass up these columns. The dogs showed marked inco-ordination, but there was no sign of anæsthesia, analgesia, etc.

It was only when the grey matter of the posterior horns was


injured that anesthesia was produced. If the posterior column of one side only was divided there resulted marked inco-ordination on the side of the lesion and slight inco-ordination on the other side. This the writer explains by supposing a decussation of a few fibres of the posterior columns. The Bath Treatment.

W. Alter, an assistant-physician at one of the provincial hospitals for the insane in Germany, has an article on

• The Bath Treatment of the Insane" (Centralblatt für Nervenheilkunde u. Psych, March, 1902). In bearing testimony to the efficacy of this method of treatment he confims what so many others have asserted who have used it. The writer seems to have been placed under rather unusually favourable conditions for the carrying out of his investigations since he had one nurse or attendant to every 2-4 patients, whereas in most hospitals the ratio is something like one to seven or eight. The temperature of the baths varied from 34° C.-36° C., and the patients were kept in for from 2 hours up to 24 hours, or longer. Usually the patients rested on a sheet suspended beneath the water, and another sheet covered the whole bath excepting at the head end. Their meals were served to them in the bath. It was found that on an average one attendant to every four patients in baths was required. The results described were such as are seldom obtained by any other method. At the commencement there were 54 patients almost all in single rooms, and after a few months none occupied single rooms; and whereas previously most were noisy, and restless the whole or part of the night in spite of the administration of drugs, after the institution of the bath treatment it was a rare thing to find a patient noisy at night. The baths also seemed to improve both the mental and physical condition of the patients. Dr. Alter is of the opinion that if the difficulty as regards number of attendants and sufficient bathing accoinmodation could be overcome, the bath treatment should be introduced into every hospital for the insane.

Forel (Zeitschrift für Hypnotismus) has an article in which he points out how the treatment of mental oases by means of gardening, etc. has degenerated into a method whereby only the physical condition of the patient is to some extent improved. He remarks that patients are very often set to do such simple work that they do it, as it were, automatically, at the same time directing practically their whole attention to their delusions. He insists that where the best results are obtained the patients are given work which requires a considerable amount of care and attention on their part, and by this means the patients' minds are trained to think and act along normal lines. Such work is not only a physical but a mental gymnastic.

LAURENCE GEORGE MALLAM, M.B., C.M. (Edın.), M.R.C.S. (Eng.).

The death of Dr. Mallam, which occurred at Armidale on 19th May, has robbed the profession of a worthy and highly esteemed member, and has caused a deplorable gap in a wide circle of friends and patients. The cause of death was pneumonia, followed by heart failure. For some weeks he had suffered from a cold, and had been working at high pressure, so that he could not lie up, as his friends begged him to do. He was out nearly every night. He intended resting on the Saturday night and Sunday, but had several urgent calls on Saturday night, including one to an aged paralytic club patient some miles out in the bleakest part of his district, and on this drive he caught the chill that resulted so disastrously. Drs. Little, Samuelsou, and Harris were unremitting in their attentions; and though at first little danger was apprehended, for he had a robust constitution and fine physique, alarming symptoms set in on Wednesday, and Drs. Walley, of Tamworth, and Scot Skirving, of Sydney, were telegraphed for. Before the latter could leave, however, he was stopped by a second wire saying the patent had died on Thursday afternoon. Born at Maitland in 1859, Mallam went with his parents to Armidale when four years old, and, except while away studying in the old country, his life was spent there. He received his primary education at the public school, and was afterwards at the Armidale Grammar School. In 1880 he went to Edinburgh, graduating in 1884, and in the same year took the M.R.C.S. diploma. He was a prominent member of the Australian Club in Edinburgh, and for some time acted as its honorary treasurer. As a student he was a diligent, honest worker, and had an excellent record. He took honours in several subjects, and was a demonstrator in anatomy at the University. For family reasons he had to decline Professor Turner's request that he should stay in that capacity, and returned to Armidale, where he immediately took up the practice of his profession; and by solid merit overcoming the suspicion with which a prophet is apt to be regarded in his own country, gradually but steadily built up one of the best country practices in the State, and relinquished the intention he had, before starting, of returning to anatomy teaching in Edinburgh.

Mallam was a fine type of man and practitioner, Straight and honourable in all his dealings, he was trusted by colleagnes and patients. He was an estimable husband and father, a genial companion, a good comrade, and a staunch friend. Along with a kind and gentle disposition he had a hearty, cheery manner, and an ever-ready joke and laugh. Cautious and careful in his judgment and expression of opinion, he was never known to say an evil word of anyone, though to one he would speak out with a manly candour, but yet in a way that could not be resented. He was a good, allround man at his work, and possessed of that resourcefulness that characterises the best of our country practitioners, who are so often called upon to act with skill and promptness and assume immense responsibilities under very adverse conditions. His fine sense of duty was remarkable, and though it is to be regretted that this led to his death, he died as he wished, in harness, and doing his duty to the last. Like most prudent and busy doctors, he found no time for active part in public affairs, though always interested and helpful in deserving local objects. He was for many years on the staff of the Armidale and New England Hospital, and gave a large share of his time to that institution. He was also a promient Freemason, a member


University of Sydney.—The following candidates were successful in the final examination for the degrees of Bachelor of Medicine and Master of Surgery, held in the commencement of Trinity Term :--Arthur Anderson, Gother R. C. Clarke, Wilfred B. Dight, Charles D. Halcomb, Rees F. Llewellyn, Walter L. Rees, Frank S. Tange, John W. Tarleton, Evan TudorJones.

University of Ade le.-The foundation stone of the Eider Anatomical and Pathological School was laid by the Governor on July 14th, in the presence of a large and representative attendance.


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