general description of the clinical features of leprosy under the title "forme complete," and briefly notices described varieties under the title of "formes incomplete.' A chapter is devoted to the consideration of Morvan's disease, aneheim, morphœa, scleroderma, etc., in relation to leprosy. For the author these are not morbid entities, but conditions which sometimes, at least, are met with in leprosy. The whole work constitutes a valuable addition to our knowledge of leprosy.

F.T.

THE FOUR EPOCHS OF WOMAN'S LIFE: A STUDY IN HYGIENE. By Anna M. Galbraith, M.D. W. B. Saunders & Co., Philadelphia and London; James Little, Melbourne.

The work before us has been most disappointing reading. From the title and owing to the fact that the author was dealing with her own sex, we looked forward with great expectations " for a treat in store, but a careful perusal failed to discover the aim or object the author could have had in view. If meant for members of the medical profession it is useless, as many of its statements are not, in our opinion, correct; if for the general public, it is quite unsuitable, as some of its teaching is diametrically opposed to the moral instincts of many, we hope the majority, of civilised people. Fearing that we might have missed the mark, and that, perchance, its truths were to be found between the lines,' we read it a second time, but even then the verdict had to be given that it was not a book to be recommended. H.C.T.Y.

LUNGS. By Alfred Austin Lendon, M.D. (Lond.).
London: Baillière, Tindall & Cox. Sydney: L.
Bruck. 1902.

This is a timely publication. As far as we know no monograph on hydatid disease of the lungs has appeared since the publication of Dr. Davies Thomas' little book in 1884. Owing to the greater prevalence of the disease in Victoria and South Australia, practitioners in those States enjoy unusual opportunities of observing it, and we look to them for guidance in its treatment. Dr. Lendon has made good use of his advantages, and in this book gives us the results of his observations. From a clinical point of view he recognises seven stages of the disease-1. The unsuspected cyst. 2. The suspected cyst. 3. The ruptured cyst. 4. The stage of quiescence. 5. Expectoration of the cyst membrane. 6. Septic infection of the adventitious sac. 7. The empty cavity from which the cyst has been entirely expelled. He tells us that of these stages "some may be well marked in one case but absent in another; some may be of prolonged duration in one instance and of momentary duration in another. Occasionally several stages may be passed through in the course of a few

moments.

The symptoms, physical signs, diagnosis, prognosis, and treatment in each stage are discussed and illustrated by the record of cases. A chapter is devoted to the consideration of the complications of pulmonary hydatids, bronchitis, pneumonia, pleurisy, pneumothorax, phthisis, and gangrene. Another chapter, and not the least important, deals with the treatment of cysts, which, although originating in the abdominal viscera, have encroached upon the thoracic cavity. In these cases the diagnosis is often difficult, and the results of treatment as shown by statistics are much less favourable than those of lung hydatids. The book closes with a chapter on the anatomy, pathology, and etiology of the disease, and another on causation and prevention.

The interest of the work centres, of course, upon the treatment of the affection in its various stages. In the case of the ruptured and suppurating cysts with profuse expectoration, hectic and wasting, there is no room for doubt that the radical operation should be performed without unnecessary delay, and in these cases we have usually no difficulty in inducing the patient to submit to operation. It is in instances of non-ruptured cyst (which, however, rarely fall under our observation) and in those of ruptured cyst which have not yet suppurated that differences of opinion as to the propriety of operative treatment are found. Dr. Lendon thinks that the radical operation should be performed on both the unruptured and the ruptured cyst as soon as recognised, and he supports this view by the following considerations:-(a) The probability of the cyst dying spontaneously is very remote; (b) the probability of its growing to a large size if left untouched, bursting and perhaps smothering the patient; (c) the fact that the dangers of operation are increased in direct ratio to the size of the unruptured cyst; (d) the risk of profuse and even fatal hæmoptysis; (e) the dangers of sepsis. These are sound reasons for recommending the radical operation, but in our experience, unless the patient's general health has suffered very much, he is usually unwilling to submit to it. Treatment by simple tapping or aspiration is only mentioned by the writer to be condemned, and in this all who have had experience in the treatment of hydatid disease of the lung will agree. The book is well got up, is very readable, and will be found valuable by both students and practitioners. It has no index, a fault which Dr. Lendon will, no doubt, correct in a future issue. P.S.J.

DISEASES OF THE DIGESTIVE ORGANS IN INFANCY AND CHILDHOOD. By Louis Starr, M.D., late Clinical Professor of Diseases of Children in the Hospital of the University of Pennsylvania, etc. Third edition. Rewritten and enlarged. Philadelphia: P. Blakiston, Son & Co. Sydney: L. Bruck. 1901.

Ten years have elapsed since the last edition of this work was published, and the author has taken the opportunity of a new edition to add some new chapters, and to omit some that were obsolete. Some important additions have been made to the sections dealing with the subjects of simple atrophy, infantile scurvy, rickets, lithæmia, infective follicular tonsillitis, naso-pharyngeal adenoid hypertrophy, proctitis and appendicitis. These alterations have brought the book well up to date. A valuable part of the book is the introduction on the general management of children, which deals with the important subjects of feeding, bathing, clothing, sleep, exercise, and the management of weak and immature infants. The work is illustrated and interspersed with numerous prescriptions suitable for the treatment of the various digestive disorders of children. We can thoroughly recommend this edition of the book.

G.E.R.

CONTRIBUTIONS TO PRACTICAL MEDICINE. By Sir James Sawyer, M.D., F.R.C.P. (Lond.), F.R.S. (Edin.), Senior Consulting Physician, Queen's Hospital, Birmingham, etc. Third edition, revised and enlarged. Birmingham: Cornish Brothers. 1902. This small volume includes a lecture on Insomnia, recently delivered by the author, as well as lectures on other matters of practical interest. Sir James Sawyer is not a voluminous writer, but his work is always good and sound, and a perusal of these lectures will prove both interesting and instructive.

THE AUSTRALASIAN

MEDICAL GAZETTE.

SYDNEY, 20TH SEPTEMBER, 1902.

A PROPOSED MEDICAL DEFENCE FUND.

WITH the increasing number of gentlemen entering the medical profession from year to year, the conditions of medical practice have altered somewhat from what they were in bygone days. It has become necessary for the organised ranks of the profession represented by the State Branches of the British Medical Association and allied societies to take steps to prevent the degradation of the profession in the eyes of the general public, and to defend themselves against the encroachments of societies whose aim is to get as much out of the medical man for as little payment as possible. In these days we have to contend with proprietary lodges and organisations such as the Australian Natives' Association, whose contempt for the simple rights of medical men is not concealed.

It is a matter of regret that, in the prosecution of this policy of maintaining the best interests of the profession at large, it has been necessary to ostracise some medical men, who, from a short-sighted policy of self interest, have decided to ignore the wishes of the majority of their fellow practitioners. We should much prefer that such a course of ostracism had never become necessary, and that the profession had become a thoroughly united body. It is also to be regretted that some medical men who have loyally abided by the decision of the majority of the profession, even though they may have held opposite views, have suffered financially as a result of their loyalty to the profession. It has been recognised that while these medical men have made considerable financial sacrifices to meet the

wishes of their fellow practitioners, and to maintain their rights, nothing has been done practically by the profession as a whole to compensate these men for their loss. To this it may be replied that nothing can be done in this direction. But if we are to continue a policy of ostracism of objectionable societies and their medical officers, it must be seriously considered whether we can in future ask medical men to resign from these organisations without offering them something in return. The apparent injustice of such a demand was, we believe, keenly felt by some medical men who, at the request of the New South Wales Branch of the British Medical Association, recently resigned their appointments as medical officers to a medical institute in Sydney.

At a special meeting of this Branch, held last month, a resolution was passed on the motion of Dr. FURNIVAL appointing a committee to elaborate a scheme for the establishment of a medical defence fund to be submitted to a subsequent meeting for further discussion. It is, of course, realised that it would be practically impossible to raise a fund sufficient to fully recoup a medical man who might resign from a medical benefit society at the instigation of the Branch, but it is thought that if a fund of this kind were in existence some temporary assistance might be given to him on resigning any objectionable appointment. It has been suggested that a fund for this purpose might be raised by annual subscription and donations from medical men whether engaged in lodge practice or not. Multiplication of medical societies with their necessary annual subscriptions is not desirable, and we think that if the establishment of a Lodge Practitioners' Defence Fund is not considered practicable, possibly some modification of the constitution of the New South Wales Medical Union might be secured to meet this object. In the meantime we hope medical men will carefully consider the proposal, so that when the matter comes up for discussion we may have the results of matured thought upon it.

THE ADULTERATION OF MILK.

WITH the approach of summer weather, and the accompanying large amount of gastric and intestinal disorders in children, it is a matter of great importance that the milk, which forms so large a part of the dietary of infants and young children, should be quite pure. From the annual report of the Medical Officer of Health for the Sydney metropolitan combined districts, we learn with regret that there is an immense amount of adulteration practised on the milk supplied to Sydney, not only by the addition of water often in large quantities, but by the addition of chemical preservatives, both in summer and winter. This statement is supported by the fact that out of 212 samples of milk taken and submitted to analysis, no less than 134, or 63 per cent., were found to be adulterated. Quite recently some milk purveyors in the Glebe district of Sydney were fined for having sold milk which was found to contain added water to the extent of over 3 per cent. and boracic acid to the extent in one case of 5 grains per gallon. In another case at the same court the report of the Government Analyst showed the presence of added water to the extent of 3 per cent., the fat being only 2.9 per cent. and the other solids only 8.2 per cent. This analysis was disputed by another analyst, who stated that the milk in question was a pure milk, but of poor quality, and contained 3.53 per cent. of fat. There is no standard for milk in New South Wales, but the Association of Public Analysts in England have adopted a standard which is universally recognised, and it is not apparent how such a variation in the results of the two analysts, who professed to adopt the same standard, is to be explained.

In a paper on the "Importance of Milk Analysis in Infant Feeding," in a recent issue of the Boston Medical and Surgical Journal, Dr. WENTWORTH reports the analysis of several samples of milk obtained from the milk vendors

in Boston. The examinations were made in the Pharmacological Laboratory of the Harvard Medical School, and the Chemical Laboratory of the Massachusetts General Hospital. The estimation of the percentage of fat was made by the Babcock method; the percentage of sugar by polariscopy; and that of the total solids, proteid and mineral matter, by incineration. These gave the following results :-Fat varied from 8 to 15.20 per cent.; sugar and proteids from 8:30 to 9:64 per cent.; and the ash from 0.47 to 0.65 per cent. These figures serve to show only what might be expected, that the nutritional quality of milk must vary within considerably wide limits consistent with purity. But there can be no excuse for the addition of chemical preservatives which have been proved to be detrimental to health, and the Departmental Committee of the English Local Government Board, appointed in 1899 to enquire into the use of preservatives and colouring matters in foods, have recommended, in their report, that the use of any preservative or colouring matter whatever in milk offered for sale should be constituted an offence under the Sale of Food and Drugs Act. As Dr. ARMSTRONG remarks, "this decision is a most valuable one, as it will strengthen the hands of sanitary authorities throughout the Englishspeaking world in suppressing the adulteration of milk, which was certainly assuming, in this country at all events, alarming proportions."

The machinery of the New South Wales Public Health Act, in respect to the prevention of adulteration of food, works well, and every assistance in the way of analysis of all foods is undertaken by the Department of Public Health free of charge. We hope that the efforts of this department to secure a pure milk supply will be vigorously supported by the profession at large, and that in the next annual report by Dr. ARMSTRONG we shall read of a great advance having been made towards this very necessary object.

THE MONTH.

Medical Men and the Lay Press.

It will be seen from a report in another column of the special meeting of the New South Wales Branch of the British Medical Association held last month that the motion proposed by Dr. Fiaschi for the appointment of a special committee to draw up some resolution on the relations between medical men and the lay press was negatived. Two amendments to the motion were also negatived, so that the question still remains undecided. It is a pity that some finality on this question was not reached, but it would appear that in the present state of feeling amongst the members of the Branch this is not to be attained just yet.

Meeting of the N.S.W. Branch of the British

Medical Association at Newcastle.

It has been remarked that medical men residing in the country profit but little by membership of the Branch of the British Medical Association, beyond getting the British Medical Journal and the Australasian Medical Gazette. It has, accordingly, been suggested that country members might be brought more directly into touch with the Association if some meetings were held in the country towns. From the report of the meeting of the Council of the Branch, published in our last issue, it will be seen that it has been decided to hold a meeting of the Branch in Newcastle during the month of October next, the exact date to be announced later. We hope that as many members as possible, living within easy access of Newcastle, will attend this meeting; and we would remind our friends that medical men who may not be members of the Branch may be introduced to the meeting by any member.

The Conduct of Medical Meetings. At the recent very successful meeting of the American Surgical Association it was decided that only eight minutes should be allowed for the reading of each paper, and as a result 30 papers were presented, and considerably more than 100 discussions were possible. Eight minutes would seem a very short time to allow to an author to present even the barest results of any medical research. But, as the Boston Medical and Surgical Journal points out, "it is unquestionably possible to condense into this time the salient features either of a clinical or a scientific report, leaving out all the extraneous

and usually unessential details which are so apt to creep into the ordinary medical contribution." Very lengthy communications only weary the audience, the salient points are often overlooked, and really profitable discussions cannot take place upon them unless summaries of the papers be printed and placed in the hands of the audience. The executive committee of the next Australian Congress may seriously consider the arrangements for the conduct of the business of the sections, and we would suggest that instead of there being a number of papers. on diverse subjects some attempt should be made to select definite subjects for each day's sectional work, a time limit being placed on each reader of a paper or speaker at a discussion.

The Treatment of Neglected Children.

We are glad to know that the AttorneyGeneral of New South Wales has prepared a bill for presentation to the State Parliament dealing with the treatment of neglected children. It is proposed to establish day industrial schools to which children found wandering about the streets might be sent by a magistrate. The child would be taught there in the ordinary course, and would be fed at a nominal cost to the parents. If the child could not be managed by its parents it could be left at the school entirely. There is no intention to interfere with existing arrangements for dealing with neglected children such as the N.S.S. "Sobraon" and the Reformatory, but they would probably be graded as industrial schools. Captain Neitenstein, the Comptroller-General of Prisons, has for several years past advocated a measure of this kind in his annual reports, and he states that the way in which children are allowed to wander about the streets can only be regarded as a great evil, since it has been proved beyond all doubt that truancy is the most prolific cause of juvenile crime, and if the growth of the criminal population is to be checked the children must be kept out of the

streets.

Fees to Medical Witnesses.

In reply to a question by Mr. J. C. L. Fitzpatrick as to fees and travelling expenses to medical men, Sir John See said that fees paid to medical witnesses compelled to attend the coroner's courts are prescribed by Act of Parliament, but by Executive regulation power is given to the chief medical officer of the Government to pay in addition to a special mileage rate, on recommendation of the coroner, when the distance travelled to the scene of inquest has exceeded 20 miles. The inequality

of this regulation, as compared with the mileage rate allowed to Government medical officers whose services are requisitioned by the police, has been recognised, and a fresh regulation, under which the special allowance may be paid when the distance travelled has exceeded three miles, has been made the subject of a recommendation by the chief medical officer of the Government.

Australian Child Study Association.

At a meeting of this association, held in Sydney on August 26th, a lecture was delivered by Dr. W. F. Quaife on "The Mind of the Child." He compared the plans of teaching adopted in the State schools here and in America, and said that an intellectual want of interest was visible in young Australians, and was due to the faulty methods adopted in their schools. The true school was not a workshop for the teachers, but an expression of the child's own life, and it was by studying the -child that the master learnt how to teach him. On the following day, upon the invitation of Lady See, a meeting was held at Randwick for the purpose of hearing addresses from Drs. Flashman and Brennand, and representatives of the Child Study Association, with the view to the formation of a branch at Randwick. Miss McClelland (general hon. secretary) explained that the Child Study Association had been formed about four years ago, and was endeavouring to awaken a wider interest in the study of the young. To discover the peculiarities of children it was necessary to establish a laboratory, in which all could be scientifically investigated and physically and psychologically tested, so that they might be classed and graded according to their physical and mental capabilities, and trained into habits which would produce a lasting benefit to themselves, and a future good to their country.

The

Drs. Flashman and Brennand delivered two addresses upon the subject, both from a scientific and practical point of view. subject of child study could be approached from many different directions, according to the view of the student, whether he be a parent, teacher or anthropologist, a psychologist, a physician, or simply a lover of young humanity in the abstract. In England and in most of the -Continental countries and America there were strong associations established for the sole purpose of studying child life in all its aspects. Such was, to a very great extent, due to the impetus given to such inquiries by the works of "Froebel" and others on the Continent, and the development of the kindergarten system in -consequence. Child study was producing an

enormous literature of its own.

OBITUARY.

Death of Professor Virchow.

A CABLEGRAM has been received announcing the death of the veteran pathologist, Professor Rudolph Virchow, in his 82nd year. In our London correspondent's letter, published in April last, there is an account of the accident which befell the distinguished scientist. As he was alighting from an electric car he fell on the asphalt roadway and fractured his femur. He was the recipient of an immense amount of sympathy from all classes in Germany, as well as from scientific workers all over the world. The Berliner Klinische Wochenschrift at that time announced that the fracture was beginning to mend, and that his general health was good, except for some want of refreshing sleep at night. In our last issue our London correspondent, referring to the accident, stated that the Professor's recovery was all that could be desired, and that he had left Berlin for the country for some months. His assistants were to carry on his work at the University during the summer term. He had resigned the presidency of the Berlin Medical Society. This is the latest news we have, and we must await the arrival of the English mail for full details of the cause of death.

Rudolph Virchow was born in Pomerania in 1821. At the age of 22 years he graduated doctor of medicine at Berlin, and four years later he became a member of the teaching staff. A year later he was appointed a member of the Government Commission to inquire into an outbreak of typhus fever among the weavers in Silesia. He was subsequently appointed professor of pathological anatomy at Wurzburg, and while there he published his work on "Cellular Pathology." He was then recalled to Berlin University, from which he had been expelled for political reasons.

Entering the Chamber of Deputies in 1860, he rapidly rose to the leadership of the Liberal Opposition, and as such made a firm stand against the encroachments of the reactionaries under the guise of the royal prerogative. In 1878 Virchow retired from political life. During the last illness of the Emperor Frederick he was constantly consulted. At the International Congress on Tuberculosis he attended in his capacity as director of the Pathological Institute of Berlin, a position he had held for 45 years, and was prominent in antagonism to the theory of Professor Koch that consumption is not transmissible by tuberculosis germs from cattle in food to human beings. In October last, when Professor Virchow celebrated his 80th birthday, the Emperor William of Germany presented him with the gold medal awarded periodically for eminent research in science.

The following extract is from an editorial article from the pen of Professor Wilson in our issue of July, 1901, on the celebration of Virchow's 80th birthday :

It is probably not too much to say that the period of Virchow's active scientific career has been the most fruitful epoch in the history of the medical sciences. Of the illustrious band of European observers and investigators who made the middle period of the nineteenth century what it was, Rudolph Virchow is now one of the very few, and also one of the most distinguished, surviving representatives. In a very real sense, every one who follows up the science and practice of rational medicine may be said to be the pupil of one who, if not the sole founder, was the most celebrated exponent of that cellular pathology' upon which is based practically all our interpretations of morbid structure and process."