University of New Zealand.

THE University of New Zealand is an examining body only, and is modelled on the lines of the University of London, with affiliated Colleges. The University of Otago in Dunedin is the only institution in which a complete medical education can be obtained, but preliminary education in Arts and Science can be obtained also at Auckland College, University College, Victoria College at Wellington, and Canterbury College.

Medical students, unless they are already graduates in Arts or Science, must pass a preliminary examination in English, Latin, Elements of Mathematics, and either Greek, French or German. No candidate is admitted to the final examinations for Degrees in Medicine unless he has been registered as a medical student for at least fifty-seven months previously.

Three Degrees in Medicine are conferred, viz.: Bachelor of Medicine, Bachelor of Surgery, and Doctor of Medicine.

Degree of M.B. and Ch.B.-There are an intermediate examination and three professional examinations. These are conducted by written questions and viva voce. Excellence in one or more subjects at an examination does not compensate for failure in others. Intermediate examination.-This is held not earlier than November in the student's first year, and includes biology, physics, and inorganic chemistry. The subjects of this examination may be taken together or separately, at the option of the candidate.

First Professional Examination.-This is held not earlier than November in the student's third year, and includes organic chemistry, practical chemistry, and anatomy. Before admission to this examination the student must furnish certificates :

1. Of having attended not less than one hundred lectures on chemistry, including organic chemistry. 2. Of having received six months' instruction in practical chemistry.

3. Of having attended a course of not less than one hundred lectures on human anatomy.

4. Of having dissected the human body during two periods of six months each.

Second Professional Examination.-This is held in November, in the student's fourth year, and includes physiology, pathology and morbid anatomy, and materia medica. Before admission to this examination, the student must furnish certificates :

1. Of having attended a course of lectures of not less than sixty lectures, and gone through a course of practical work in physiology.

2. Of having attended a course of not less than sixty lectures, and gone through a course of practical work in pathology.

3. Of having attended a course of not less than sixty lectures on materia medica.

4. Of having practised the dispensing of medicine for three months.

5. Of having attended the post mortem examinations of a hospital containing not less than one hundred beds, for two periods of six months each.

Third Professional Examination.-The third professional examination is held in November in the student's fifth year, and includes surgery, clinical surgery, medicine (including therapeutics and insanity), clinical medicine, surgical and medical anatomy, midwifery and diseases of women, medical jurisprudence and public health. The following certificates are necessary to admit the student to this examination :

1. Of having been registered as a medical student at least fifty-seven months previously.

2. Of being 21 years of age.

3. Of having attended a course of not less than one hundred lectures in surgery.

4. Of having attended a course of not less than fifty lectures in clinical surgery.

5. Of having attended a course of instruction in practical and operative surgery.

6. Of having attended a course of not less than one hundred lectures in medicine.

7. Of having attended a course of not less than fifty lectures in clinical medicine.

8. Of having attended a course of not less than one hundred lectures in medical jurisprudence and public health.

9. Of having attended a course of not less than sixty lectures on midwifery and diseases of women.

10. Of having received practical instruction in diseases of women.

11. Of having received a three years' course of regular clinical instruction in the medical and surgical practice of a hospital containing not less than 100 beds. This certificate must state that the student has acted for six months as clinical clerk in the medical wards, and six months as dresser in the surgical wards. Six months of this hospital practice may be taken at a lunatic asylum containing not less than one hundred beds. 12. Of having attended six midwifery cases.

13. Of dispensary practice for six months, either in the out-patient department or at a public dispensary, or with a qualified practitioner.

14. Of having had instruction and practice in vacci

nation.

15. Of having had clinical instruction in insanity at an asylum containing not less than two hundred beds.

Degree of M.D.-A candidate for the degree of Doctor of Medicine must be a graduate of a University in Arts or Science, and not less than 24 years of age. He must have obtained the degree of M.B. at least two years previously, and must have been engaged during the interval in the practice or study of his profession.

Candidates must send in a thesis on some subject of the medical curriculum, and be examined both in writing and orally on any one of the following groups of subjects:-1. Anatomy and physiology. 2. Surgery and anatomy. 3. Medicine and pathology. 4. Public health and medical jurisprudence.

There are about 120 students in all the year in the Faculty of Medicine, and the total fees for graduation as M.B. and Ch. B. amount to about £110.

The following are the lecturers in the subjects of the medical curriculum at the University of Otago :Anatomy and Physiology.-J. H. Scott, M. D. Edin., M.R.C.S. Eng., F.K.S.E.

Surgery.-L. E. Barnett, M.B., C.M. Edin., F.R.C.S. Eng.

Practice of Medicine.-D. Colquhoun, M.D. Lond., M.R.C.P. Lond., M. R.C.S. Eng.

Pathology.-W. S. Roberts, M.R.C.S. Eng. Midwifery and Diseases of Women.-F. C. Batchelor, M.D. Durh., M. R.C.S. Eng., L.R.C. P. et L.M. Edin., L.S.A.

Materia Medica.-J. Macdonald, L.R.C.P. et S. Edin., M.R.C.S. Eng.

Medical Jurisprudence and Public Health.-F. Ogston, M.D., C.M. Aberd.

Ophthalmology.-H. L. Ferguson, M.A., M.D. Dublin, F.R.C.S. Irel., L. K.Q.C. P. Irel.

Mental Diseases.-F. T. King, M.B., C. M., B.Sc. Edin.

Clinical Medicine and Surgery.-The Honorary Staff of the Dunedin Hospital.

REVIEW OF CURREnt mediCAL

LITERATURE.

PEDIATRICS.

Congenital Absence of the Abdominal Muscles with Distended and Hypertrophied Urinary Bladder.

Osler (Bulletin of the Johns Hopkins Hospital, November, 1901), records a case of this extremely rare condition. The author could only find reports of two similar cases-one in the Clinical Society's Transactions (Vol. 28, 1895), by R. W. Parker, and one in the Transactions of the Pathological Society of London (Vol. 47), by Dr. Leonard Guthrie. The author's case was that of a boy aged six years, who was admitted to the hospital in 1897, complaining_of stomach trouble, and difficulty in passing urine. His family history was good. His chest had been deformed from birth, but he appeared to have had good health till the second summer, when he had severe stomach trouble. There had been recurrences of these attacks each year, some of these had been gastric attacks, but others, and apparently the chief troubles, had been with the urine. The attacks lasted four or five weeks, and had been getting more frequent lately. On examination the patient was found to be a poorly nourished child, somewhat anæmic, and complaining of pain chiefly in the hypogastric and lower umbilical regions. There was a remarkable fulness in these regions, which were occupied by an ovoid mass corresponding to a dilated bladder. The urine obtained by catheter was free from albumin, and contained a good many leucocytes. In the erect posture the attitude was remarkable. It was not quite symmetrical, being fuller on the right side than on the left.

was

The navel was stretched and distended. Above it there was seen on either side the attachment of the recti to the sternum and costal margin. The skin over the abdomen was thin; the veins a little prominent. When recumbent the belly flattened out in front, and extended at the flanks. Coils of intestine could be seen in peristalsis. There was extreme relaxation of the abdominal walls so that the finger could be passed everywhere to the spine. The liver, spleen and kidneys could be felt easily. The bladder could be felt as a firm ovoid body reaching almost to the navel. He could not raise himself off the bed without turning over. As he made the attempt the abdomen thrust forward and slight contraction was seen of the expanded abdominal muscles and recti. The deformity of the thorax was also remarkable. The lower part of the sternum was thrust forward, forming almost a right angle with the xiphoid cartilage. There was also a condition of cryptorchidismus. The testes could not be felt in the groins. Osler states that the deficiency in the abdominal muscles and the high position of the bladder are associated conditions due to arrest of development. He was not able to say whether the bladder was adherent to the umbilical scar. Guthrie regarded the hypertrophy of the bladder and the dilatation of the ureters in his case as secondary, due to the fact that being firmly connected with the umbilical scar, it

was unable to contract downward and to empty itself completely. In its effort to do so it became hypertrophied and dilated, and the accumulation of urine caused backward pressure and dilatation of the ureters.

Treatment of Scarlatinal Nephritis.

Saundby (Birmingham Medical Review, September, 1901), approves of the treatment of this condition advocated by Kerley, namely, irrigation of the colon with hot water as the best means of restoring the functions of the kidneys in scarlatinal nephritis. It should be employed whenever the quantity of urine is diminished or when convulsions occur. In a child aged three years, 500 to 750 cubic centimetres of water at a temperature of 43° C. should be introduced by means of a rectal tube passed into the rectum for a distance of 2.5 centimetres. If the water is returned at once it must be repeated, and irrigation should be continued every six or eight hours. After three or four administrations, the kidneys generally commence to act, and abundant diuresis takes place.

Acute Fatty Degeneration of the Liver.

Lister (Scottish Medical and Surgical Journal, July, 1901), reports the case of a girl aged six years, who was suddenly taken ill with slight jaundice, severe vomiting, pain, hæmorrhages, fits. coma, and death, the whole illness only lasting twelve days. The liver was felt to be enlarged throughout, and leucin was found in the urine. Post-mortem the liver was found to be considerably enlarged. It was in an advanced stage of fatty degeneration, fragments floating readily in water. When cut, the surface was of a canary-yellow colour. There was also an increase in the connective tissue The author considers that the condition was due to the entrance of some poison into the system, and one naturally thinks of phosphorus, but no history could be obtained of there being the least probability of the child having taken phosphorus in any form; further, the urine showed no trace of this poison, and no sign of it was found in the liver. It was possibly a case of acute yellow atrophy, but the fact that the liver remained enlarged throughout is against this diagnosis.

elements of the interlobular tissue.

General Edema without Albuminuria in Children.

F. L. Batten (Pediatrics, September, 1901), describes a case of this nature, which he considers a typical one of Herringham's toxæmic drop-y. A boy, aged four years, had an attack of dropsy similar to the present one a year ago. He was then ill for a month, but completely recovered. His present illness began a week before he was seen by Batten, with swelling of the legs, face, and abdomen. He had never had scarlet fever, and was a well-nourished boy. The eyes were puffy, the abdomen cedematous with free fluid in it, and there was cedema of the legs. The heart was normal, and there was no albumin in the urine; the average quantity of urine for the 24 hours was 10 ounces, and the specific gravity was always high-1028 to 1035. The oedema rapidly diminished, and the boy left hospital in fourteen days, quite well. General œdema in children without albuminuria is seen in marasmic infants, in congenital syphilis, in the later stages of tuberculosis, and in association with diarrhoea and anæmic conditions.

MEDICINE.

The Temperature of Phthisis Treated by Open Air Methods.

Dr. D. Lawson, senior physician Nordrach-on-Dee Sanatorium, describes (Medical Press and Circular, December 18th, 1901) a new graphic method of showing the temperature. The temperature is taken four

hourly, and the highest and lowest readings of each series of four days are averaged and marked on a chart, each space of which therefore represents a period of 96 hours. The space between the highest and lowest curves on the chart so obtained is blackened in, and the irregular band of ink thus got gives a better idea of the course of the case than the usual temperature curve, On the same chart the amount of sputum and the body weight are graphically represented. In the case of an active lesion undergoing arrest, the black band is at first broad and especially on its upper margin, irregular ; as improvement takes place, the breadth of the band diminishes, showing less diurnal variation in the temperature and the band, as a whole, falls. With this character of the temperature the weight curve rises and the sputum curve falls. Dr. Lawson puts forward a strong plea for the rectal method of taking temperatures, claiming for it greater accuracy, and also that it gives indications of a rise twelve hours before such could be detected in the axilla or mouth.

that below was not collapsed. During life the presence of volvulus was not suspected. The patient was admitted as an ordinary case of colica ab ingesta, and later the diagnosis of thrombosis or embolism of the mesenteric vessels was inclined to. The author thinks the mass of damson skins played an important part in the formation of the volvulus, as gall-stones in the intestine may cause rotation. The red fluid was proved to be blood by the guaiacum test, and by microscopical examination.

Pulmonary Incompetence in Mitral Stenosis.

He

Bryant (Guy's Hospital Reports, Vol. 55), gives records of 16 cases of functional pulmonary incompetence from his own experience at Guy's Hospital, and the results of post-mortems in nine cases. states that in all the post-mortems on cases of advanced mitral stenosis he has seen, there have always been thickening, dilatation, and atheroma of the branches of the pulmonary arteries in the lungs. These marked structural changes in the branches of the pulmonary

The

J. H. Bryant (Clinical Society's Transactions, Vol. xxxiv., 1901) reports the above on account of the great rarity of hæmorrhage per anum with any form of acute intestinal obstruction except intussusception. patient, a male at. 21, was admitted to Guy's Hospital September 18th, 1900, for pain in the abdomen. He had always enjoyed good health, and felt quite well until an hour or two after his supper on the previous night, at which he ate a large amount of damson pudding. He was suddenly seized with severe pain in the umbilical and hypogastric regions about 10 p.m. on September 17th, and was admitted to the hospital soon after midnight. On admission he appeared to be in great pain, and rolled about from side to side and groaned. Temperature, 99°; pulse, 80; respiration, 24. The pain was paroxysmal in character, and the abdomen was not distended. The lower part was rigid. Two ill-defined masses could be felt, one just below and to lett of umbilicus, and the other in the hypogastric region. The pain continued throughout the day, and in the evening, about 8 o'clock, he became very collapsed and passed about a pint of bright red blood, and a large mass of undigested damson skins, about the size of a tennis ball. He became very blanched, and his pulse went up to 160, being feeble and running in character. The abdominal wall was very rigid, especially in the hypogastric region, and appeared to be extremely tender, out no tumour could be made out after the motion. Nothing abnormal was felt per rectum. In spite of hypodermic injections of strychnine and infusions of normal saline solution, he became more and more collapsed, and died at 5.30 a.m. September 20th. Just before death a quantity of fæculent liquid poured from his mouth and nostrils. A post-mortem examination was made nine hours after death. With the exception of some thickening of the aortic valves, the heart, lungs, liver and kidneys were normal. The abdomen was distended. On opening the peritoneal cavity, several coils of ileum of a deep dull red colour were found lying in and just above the pelvic cavity. Large flakes and patches of recent lymph loosely bound the coils of intestine together. One hundred cms. of the ileum, the lowest portion being 10.5 cms. from the ileo-cocal valve, were involved. This portion of the gut was found to be attached to a long piece of mesentery, which had become twisted one and a half complete turns in its longitudinal axis. The intestine above the volvulus was distended, but

increased tension produced in the pulmonary circulation by the obstruction at the mitral valve. Syphilis probably does not play any important part in producing pulmonary artery degeneration. The most important physical sign of functional pulmonary incompetence is the presence of an early diastolic murmur, which is most frequently heard in the third left intercostal space, midway between the left sternal line and the left nipple line, but it may be heard in the second or fourth spaces in the same line. Some physicians think that this early diastolic murmur heard in the above-mentioned situations is created at the mitral valve itself. Bryant, however, considers this interpretation to be most unlikely, for he has never heard the crescendo or mid-diastolic bruits produced at the mitral valve in these spaces, and he cannot see how a stenosed mitral valve could produce an early diastolic murmur in this position. There is no doubt that an early diastolic murmur can be heard in cases of mitral stenosis at the point of cardiac impulse, and between the impulse and the left border of the sternum ; but the author does not consider that there is any justification for interpreting the early diastolic murmur audible most frequently in the third left space midway between the left border of the sternum and the left nipple line, as being the direct result of the mitral He considers the theory of this murmur being due to dilatation of the pulmonary artery and functional incompetence more satisfactory, and supported by the very definite morbid changes found in the pulmonary artery and its branches in autopsies on advanced cases of mitral stenosis.

lesion.

Functional Incompetence of the Pulmonary Valve.

Brockbank (Medical Chronicle, October, 1901) reports a case of this nature. A female, aged 19 years, was admitted to the Ancoats Hospital complaining of shortness of breath and palpitation. She had had no antecedent cause for heart trouble, such as rheumatism, chorea, etc., and had been quite well until three years previous to admission to hospital. On examination of the chest the apex beat was found to be in the fifth interspace, 34 inches from the midsternal line. Cardiac dulness extended as far as this to the left, and threequarters of an inch to the right of the midsternal line. Un auscultation, at the apex there is a short, pre-systolic murmur terminated by an accentuated first sound, and followed by a double accentuated second sound. No diastolic murmur was audible. At the tricuspid area

the sounds were very accentuated, and the first sound was prolonged into a faint systolic murmur. This murmur was limited to the tricuspid area, and was not conducted away from it. At the aortic cartilage no murmur was heard, but both sounds were accentuated. Over the pulmonary area in the third left space, the heart sounds were very accentuated and " parchmentlike" in tone, the second being double. There is also a distinct early diastolic murmur running off from the double second sound. This murmur is smooth and "whiffy," and suggestive of a leakage resulting from the high pressure in the pulmonary circulation. It is not conducted from one spot, and is scarcely audible at the left edge of the sternum in the same interspace. There are no signs of back pressure in the systemic vencus circulation. This case is one of pulmonary regurgitation from functional incompetence of the valve, resulting from the high pressure in the pulmonary artery. The mitral valve is stenosed, and the right ventricle is hypertrophied. The systolic murmur over the tricuspid area is suggestive of dilatation.

Beri-Beri.

A. Stanley, Health Officer of Shanghai (Journal of Tropical Medicine, November, 1901) arrives at the following conclusions after having made observations on a series of 341 cases of beri-beri. (1) Beri-beri has a marked degenerative action on heart muscle, which frequently causes fatal circulatory failure. (2) In this respect beri-beri resembles other toxæmic diseases such as diphtheria. influenza, and alcohol and arsenic poisoning, which often cause peripheral neuritis, and also other toxæmic diseases, such as typhoid fever, plague, and acute rheumatism, which do not, or rarely, give rise to peripheral neuritis. (3) Beri-beri and diphtheria are the diseases par excellence in which sudden fatal heart failure occurs. (4) The heart muscle degeneration is not a secondary result of neuritis of the vagus. (5) The heart muscle degeneration takes place as a rule before skeletal muscle degeneration, and is the result probably of direct action of the toxin, and not a secondary result of nerve change. (6) Sudden heart failure does not indicate a sudden lesion, but rather is the result of a gradually increasing heart weakness from cardiac muscle degeneration, which may be precipitated by any sudden exertion, but more frequently is the result of the principle of "all or nothing"-the transition from "all" to "nothing being necessarily rapid. (7) The cardiac physical signs in beri-beri closely resemble those found in diphtheria, and are of paramount importance in prognosis and treatment.

Gastric Ulcer.

Attention has been drawn recently on several occasions to the fact that in some cases where laparotomy has been performed for the purpose of excision of a gastric ulcer in patients presenting the usual clinical symptoms of this disease, no ulcer has been found; and it has also been remarked that the number of cases met with in the post mortem room presenting the signs of past or recent gastric ulcer seems to be much smaller than one would expect, judging from the comparative frequency with which gastric ulcer is diagnosed during life. In a recent lecture at Guy's Hospital, London (Guy's Hospital Gazette, August and September, 1901) Hale White answers in the affirmative the question: Are not many patients, supposed to be suffering from gastric ulcer, really suffering from some other disease? According to statistics gastric ulcer is very much more common

in women than in men, while post mortem records show usually that the excess is much larger in men than in women; and this fact would seem to point to the conclusion that gastric ulcer is either much more favourable as regards its prognosis in women than in men, or else that frequently the clinical diagnosis of gastric ulcer is incorrect. Hale White has often suggested at the bedside that there is a disease, not ulcer, met with chiefly in women between twenty and forty years old, and that its chief symptoms are gastric pain, sickness and hæmatemesis. If there is any ulcer it is probably quite superficial and secondary to the hæmorrhage. A diagnosis between this condition and true gastric ulcer is extremely difficult, but White emphasises the following points: first, these patients may show serious gastric symptoms for many years, even as long as 15 years, and yet not show any great wasting, such as is seen commonly in many cases of gastric ulcer; second, they nearly always have intervals of good health, while patients suffering from gastric ulcer do not nearly so often get intervals of good health; third, these cases of hæmatemesis in young women are very frequently associated with chlorosis, there being no special association between chlorosis and genuine gastric ulcer, for genuine gastric ulcer occurs in men in whom chlorosis is unknown. distinguished from true ulcer, occurs in women from Another point is that this condition, which is to be 20 to 40 years of age; and, further, it is not followed by any of the organic or mechanical results of ulceration of the stomach. The prognosis is different in the two conditions. That of true gastric ulcer, in view of good in the condition characterised by pain, sickness, the possible grave complications, is not good; but it is and hæmatemesis occurring in young women. author suggests that chlorotic dyspepsia, which is so common, is nothing but an early stage of the condition which he describes. He cites several cases of hæmatemesis supposed to be due to ulcer of the stomach, in which autopsy or operation has revealed no evidence of ulceration. While no one doubts the accuracy of Hale White's statements, in view of the admitted difficulty of certainty in diagnosis of gastric ulcer, one is certainly justified as regarding, for the purposes of treatment, any case presenting clinically the symptoms of gastric pain, sickness, and hæmatemesis, as one of gastric ulcer.

PATHOLOGY.

Primary Endothelioma of Pleura.

The

Adler (Journal of Medical Research, July, 1901) reports a case of this nature and describes and illustrates the microscopical appearances presented by the growth. A man, aged 26 years, with no previous history of any chest trouble, and whose father died of cancer of the stomach, died in the German Hospital, New York, after an illness of nine weeks. The diagnosis of a rapidly growing malignant neoplasm of the right pleura was made, and the autopsy confirmed this diagnosis. On microscopical examination of sections of the neoplasm, it was seen to consist of alveolar spaces bounded by tracts of connective tissue interlacing in different directions. The central portion of these alveolar spaces was crowded with cells with hardly any interstitial tissue; but towards the periphery the cells were seen to be arranged in parallel layers supported by bands of fibrous tissue. At the very edge of the alveoli there are numerous tubules and wider cyst-like spaces lined with cuboidal cells, these latter are either arranged in single rows, or one or more layers of flattened, round, or polymorphous cells are super-imposed above them. Between the