but even there the number of members of the British Medical Association who attend the annual gatherings in the different towns is only a small fraction of the total membership of the

In

Association in Great Britain and Ireland. Australasia the long distances to be travelled would necessitate a medical man being absent from his practice for two or three weeks, and in these days of keen competition this is what very few medical men can afford. But a further strong argument against the proposal is that if such an Association were formed it

would practically mean the disruption of the

present State Branches of the British Medical

Association, and the severance of a very large number of members from the Association, with no corresponding benefit. We esteem it a high honor and privilege to belong to the great

British Medical Association, which has done so much for the welfare of the profession throughout Great and Greater Britain, and we should not appreciate severing our connection with such a world-wide and influential Association. Even the combination of all the Australasian Branches of the British Medical Association in one large Australian Branch, with sub-branches in the different States would, we think, be impracticable, and the best work and best results will be obtained by the different Branches continuing their steady work in their own States, and endeavouring to embrace every member of the profession in the Association, which is not the organisation of any party or clique, but whose sole object is the furtherance of professional brotherhood.

THE BOYCOTTING OF THE BRISBANE

MEDICAL INSTITUTE.

THE Queensland Branch of the British Medical Association is to be congratulated upon the results of the discussion which was held at its last meeting, particulars of which appear in another part of the present issue. The meeting was a representative and largely-attended one,

so that the resolutions are practically certain to be ratified at the February meeting, the clause requiring such ratification being a well considered addition to the main resolutions. After the February meeting, when it is hoped that the same unanimity will prevail, it will be quite impossible for any member of the Branch to plead ignorance as an excuse for his action in continuing to meet in consultation the medical men who serve the Brisbane Associated Friendly Societies' Medical Institute. It is also the intention of the Branch to acquaint by

circular every member of the profession in

Queensland of the stand taken by the practitioners of Brisbane, by doing which the hands institutes are in existence will be strengthened. of practitioners in other towns where medical Already there is a feeling of disquiet in the

minds of the executive officers of the Brisbane "Institute," they do not wish it to be known that by taking office in their service, medical men place themselves on a level which carries with it a sense of degradation. The Secretary of the "Institute" has expressed his unwillingness to give a copy of the agreement to a member of the Branch for the reason that a more satisfactory agreement is in course of preparation. The action of the Queensland Branch can have only a good effect upon the terms of the new agreement, unless the executive of the "Institute" blindly decide to take up the gauntlet in which the branch resolutions are enclosed. It is possible, also, that benefit may accrue to those medical men who hold club appointments unconnected with the " Institute," some at least of which are held under unsatisfactory conditionsguinea confinements, absence of wage limitation, inclusion of anæsthetics and of all operations, fee-less examination for admission to the lodge, insignificant mileage rates, the custom of calling for tenders for such appointments, and so on, all of which require modification in the interests of the profession and of the public. A word of

praise should be accorded to the senior members of the profession in Brisbane for the cordial manner in which they have supported this movement, since to many of them it is a matter of personal (monetary) indifference; from the point of view of the profession it is mainly to the advantage of its junior members that success is desired. It is not surprising that a young man, whose financial resources have been entirely exhausted by the prolonged and expensive education which he has necessarily undergone, and who finds that the beginning of his troubles is synchronous with the attainment of his degree or diploma, should accept an "Institute" appointment, in ignorance of the degrading nature of his service, and of the slur which he unwittingly places upon his name and the value of his work-a slur which a long life will with difficulty remove. That such a condition of ignorance may no longer exist it is desirable that during the fifth year of his career, the student should have an opportunity of attending a short course of lectures upon ethical and kindred subjects delivered by a practitioner whose motives were above all suspicion of prejudice. We congratulate the Queensland Branch on the firm position which they are taking up, and wish them success in the fulfilment of their laudable desires.

THE MONTH.

been to reduce the number of applicants, and to lower the standard of men who are applying for this lodge. The matter of fees to be paid for examinations for life insurance has also been under discussion, and it was resolved that no further action be taken at present in the matter of life insurance fees As regards burials without medical certificates the council forwarded the following recommendation to the Solicitor-General: "That no Deputy Registrar shall register a death or still-birth without medical certification, and that where the certificate is not filled in by a registered medical practitioner, the Deputy-Registrar must report to some such officer as may be held most desirable e.g., Coroner or police officer." The Council accepted the resignation of Dr. W. L. Mullen with regret, and recorded its high appreciation of the zeal and interest he had always shown in the Association and the sound legal advice he had given it.

The North Sydney Water Famine.

During the past few weeks the inhabitants of North Sydney have been suffering acutely from a water famine, but we are glad to note that the very serious state of matters as regards the water supply has been remedied, at any rate temporarily. It is not necessary to point out how serious from a sanitary point of view a shortage of water at this time of the year is to all classes. There has not only been a deficiency of water for the morning bath, but the amount available for food and drink has been very small; and what is of still more serious moment the water closets have been choked up in such a way as to render life anything but pleasant. The trouble appears to have arisen, not from the general shortage of rainfall but from a defect in the pumping arrangements and in the size of the water pipes. This can only have been due to a want of foresight on

Victoria, Ltd.

JUDGING from the last quarterly report of this Association, it would appear to be a most vigorous institution, and to do a large amount of work which in other States is done by the Branches of the British Medical Association. Amongst the subjects which have occupied its attention during the last quarter are, the matter of prescribing by chemists, the issuing of a "black list," the raising of the rates for women's lodges, etc. The profession in Bendigo is at war with the Bendigo United Friendly Society, and is endeavouring to raise the rate of remuneration of the medical officers. The result of the united efforts of the professsion has

control of the water supply and sewerage, for the rapid growth of the northern suburbs in recent years has been a matter of common knowledge and comment, and provision should have been made years ago for an efficient water supply. Now that matters have reached the present crisis, it is absolutely necessary that the whole of the water supply and sewerage systems of the city and suburbs be thoroughly investigated by some independent authority, for recent events have shaken the faith of the inhabitants in the present Water and Sewerage Board, and we know not when some similar serious break down may affect not only one suburb, but perhaps the whole of Sydney.

A New Morgue for Sydney. Up to a short time ago Sydney had two morgues, the South Sydney morgue in the Devonshire Street Cemetry overlooking Belmore Park; and the North Sydney morgue situated on the western side of the Circular Quay. The former, which was the most convenient and better of the two in every way, has been demolished in consequence of the site being required for the new city railway station, and the North Sydney morgue has had to do duty for the whole of the city and suburbs. This building is inconvenient in situation and construction, and quite unfit for the important work which has to be carried on in it. The need for a new and commodious morgue in the centre of the city has long been felt by those who are engaged in the medico-legal work of the Coroner's department. A short time ago a proposal was made that a morgue with all necessary appliances for pathological work should be erected in the north-west corner of the University grounds facing Parramatta Road. The Senate however refused to consent to this, and the matter is again in abeyance. A more central site and one which has much to commend it, is the south-east corner of the Domain in Woolloomooloo, which is in a quiet part of the city, and is convenient of access both by land and water. We hope that the Minister whose province it is to deal with this matter will lose no time in securing this or some equally central site, and in erecting a building fully equipped in every way for important medico-legal post mortem work, and providing for a suitable Coroner's Court and offices.

The Thomas Walker Convalescent

Hospital, Sydney.

Since this hospital was opened eight years ago 6491 patients have been received, and of these only seven have died. The number of patients treated during the year ending September 30th, 1901 was 979, which is an increase of 61 over that of the previous year. Of these, 791 were discharged cured, 109 relieved, and 5 unrelieved. There was one death, the patient being a man of 64, who died from suppuration and exhaustion following an operation for hydronephrosis. There were 72 remaining in the hospital on September 30th, 1900, and 73 on September 30th, 1901, the average daily resident being 75. During the recent epidemics of influenza and pneumonia large numbers of convalescents from these diseases were admitted to the hospital, and many convalescents from typhoid were rapidly restored to health. The hospital proves

a great boon to many also who have undergone some surgical operation, and to whom fresh air and good food are of the highest importance. The hospital has had to deplore the death of Dr. C. Dagnall Clark, of North Sydney, one of the honorary examining physicians since its establishment. Dr. Newmarch has succeeded Dr. Clark on the honorary medical staff. Dr. Spiers Kirkland, resigned his appointment as one of the visiting medical officers and Dr. Sydney Littlejohn, of Croydon, has been appointed to the vacant position.

The Coast Hospital, Little Bay, Sydney.

The report of the select committee appointed by the Legislative Assembly of New South "to inquire into and report upon all the circumstances connected with the removal from the public service of Mr Glynn, late assistant storekeeper at the Coast Hospital, and on the action of the Public Service Board and Chief Medical Officer to the Government in connection with the exposures made by Mr. Glynn contains some serious reflections on the officials of the Health Department. It would appear that there has been some laxity in the matter of supervision of the character of the food supplied to this institution, and that some confusion has arisen from the fact that the Board of Health officials in specifying in the contract dairy butter" and "fresh eggs," showed ignorance of their duties, as both of these are trade terms for second-grade articles, the firstgrade being designated "factory butter" and new laid eggs respectively. It is not a desirable state of things that what is, after all, now a general hospital should be under the control of the President of the Board of Health. The management of this hospital and of the Asylums for the destitute and infirm should be vested in a Board of Charity Commissioners, and detached altogether from the Board of Health.

This is the only public institution in Sydney where infirm and destitute women are received, and it is a matter of urgent necessity that some other institution or some modification in the present system of management of the Newington Asylum should be provided. Many very poor but respectable women positively refuse to enter the asylum in consequence of the prevailing conditions, and prefer to starve outside than accept the coldest charity of this institution. We sincerely hope that some attempt will be made at once to improve the lot of the destitute women at Newington.

THE FIGHT AGAINST TUBERCULOSIS IN AUSTRALASIA.

III.

South Australia.

THOUGH it is only during the last few years that the crusade against consumption has had a a definite and specific character, yet it has, in reality, been carried on ever since the early days of sanitary reform. A new colony begins with Arcadian simplicity, only to find, in a few years, that it is accumulating the evils of "Civilization " common to older countries. In time there comes a period of awakening, and an effort is made to get rid of evils which ought not to have been allowed to exist. Now all these efforts have been attacks directly or indirectly against tuberculosis. Whether it has been Parliamentary enactment or local byelaw, whether it has been to improve drainage, prevent overcrowding or cause the erection of healthier buildings, all have united in reducing the mortality from consumption. The study of the mortality returns from phthisis in South Australia are interesting. Instead of being reduced by the various sanitary reforms, the death-rate slowly mounted up till in the year 1888 it reach its climax of 119 per thousand, then for several years it oscillated till in 1895 it began to go steadily down, and last year with only 84 per thousand it reached the lowest point for a great many years. It might be a matter of surprise that in England the phthisis death-rate began to decline as early as 1838, when the first efforts for sanitary reform were made, reaching in that year the enormous figure of 3.8 per thousand, it gradually fell till in 1895 it was only 1.4. But it must be remembered that consumption is a disease of "Civilization," with its attendant evils of overcrowding. The effect of over-crowding had been fully felt in England as early as 1838, and as slowly but surely sanitary reforms were put into force the death rate fell. But here, the evils of civilization increased at a greater rate than legislation was able to cope with, and it is only within the last decade that it has been possible to turn the tide. It is difficult to say how far immigration affects the death rate from phthisis, but I would say that at least ten per cent. of the fatal cases are imported.

The year 1898 was a memorable one in South Australia, for then the new Health Act, with clauses bearing directly on the subject, was passed. Dr. Borthwick, Medical Officer of Health for the City of Adelaide, states:

"The Health Act of 1898 contains certain sections which have a direct bearing on

"It is compulsory on medical men to report every case of pulmonary tuberculosis coming under their notice to the local Board of the district in which the patient resides. The local Board has power to order and supervise the disinfection of the house, or part of the house, and also its contents, and it may defray the whole or part of the expenses as it sees fit. Articles may be removed from the house for disinfection elsewhere if necessary, and disinfecting apparatus may be provided by local Boards, acting singly or in combination; or, when such apparatus is otherwise available, its use may be arranged for. When a case of pulmonary consumption is certified by a medical man to exist in a building used for the storage of milk, or for the storage or manufacture of butter, cheese, or other article of human food, the local Board, with the sanction of the Central Board, may order the building to be closed if there is reason to believe that the milk or other products may be contaminated. The building remains closed until the patient is removed, and the Officer of Health certifies that all precautions have been taken to prevent contamination. Finally, local Boards have power to make arrangement with any laboratory to have the expectoration of patients examined for the tubercle bacilli. It should be noted that this disease is subjected to any of the other provisions in Part VIII., which refer to infectious diseases. That is, patients suffering from pulmonary consumption are not liable to isolation, nor are their movements in any sense restricted.

"While these powers are fairly comprehensive, their effectiveness must, of course, depend on the administration of the Act. It is impossible to speak for the State as a whole, but the following are the methods adopted in the City of Adelaide. When a case is reported, the first step taken is to enquire of the medical attendant whether he has any objection to the patient being visited by the Health Department's officer. This precaution was introduced to overcome any latent distrust in the policy of notification as leading to undue interference.

If the medical attendant expresses no objection to the routine methods, the city trained nurse proceeds to the house, taking with her a copy of the printed instructions relating to disinfection and other precautionary measures which she carefully explains to the patient or the patient's nurse. She also supplies poor persons with such disinfectants as are needed, and shows how to use them. Any insanitary condition of the premises is noted and dealt with. The nurse further maintains a more or less continuous supervision over the case from a public health standpoint, so as to secure effective observation of the necessary precautions. On the other hand, should the medical attendant desire that his patient should not be visited, he is supplied with the printed instructions and requested to deliver them to the patient or some suitable person in the house. Experience has shown that when a medical man undertakes this responsibility, he invariably carries it out faithfully. Medical men are encouraged by payment of a fee to notify removal of patients from one house to another; so that every house vacated on account of death or otherwise is disinfected by the Department before it (or it may be only the patient's room), is occupied by another person. The extent of disinfection depends on the measure of isolation of the patient in the house. It always includes the bedroom and frequently another room; and in the poorer classes of houses the opportunity is taken of thoroughly renovating them."

"The numbers of deaths for the two years ending 30th September, 1901, were respectively 70 and 67, and of notifications for the same periods 72 and 116. This may be taken to indicate that notification is increasing in favor; and it is gratifying to be able to record that no friction has occurred between the Department and the medical attendant or the patient. It need hardly be added that the work would be much facilitated by the provision of further isolation accommodation with power to remove the poorer patients from small and overcrowded houses.

"The meat and milk clauses are, of course, supplementary to the Campbell clauses.

"The diseases of animals specified include tuberculosis, and the following is a resumé of the powers and duties:

"It is compulsory on owners to give a written notice to the local Board as soon as they discover that their animals are diseased, and to isolate such diseased animals pending the action of the local Board. The officers who are charged with the execution of the work

under these sections are (1) a Chief Inspector of Cattle, who shall be a veterinary surgeon, appointed by the Governor; and (2) an Inspector of Cattle, who shall be approved of by the Central Board, appointed by the local Board. The appointment of the latter officer is optional on the part of the local Board. In order to satisfy himself as to the presence of disease an inspector of cattle has power to apply all necessary tests, not only to suspected animals, but to the whole herd. When he is satisfied that any animal is diseased, he shall order the owner to kill the animal and destroy its carcase. The owner has, however, power to demand that the inspector shall apply the necessary tests before the carcase is destroyed. If it be found to be free from disease its value may be recovered by the owner from the local Board, the value of the carcase being deducted from the compensation recoverable. In order to facilitate inspection of meat, public slaughterhouses may be erected by individual or combined local Boards, and provision is made whereby other meat may be prevented from being sold in the district. It is also rendered a penal offence to sell for food a diseased animal or any meat from it. In regard to milk, the same diseases apply to cows as to cattle, with the addition of ulcers or other diseases of the udders. The Act renders it illegal to supply milk to any person from a diseased animal, or to mix such milk with other milk either for consumption as milk or for butter or cheesemaking, or to give such milk to other animals for food unless it has been boiled for ten minutes, and the local Board notified of the intention so to use the milk. The local Board has power to provide for temporarily prohibiting the sale of milk if the Officer of Health certifies that there are reasonable grounds for believing that such milk is causing the spread of infectious disease. It has also power to make regulations for the protection of milk from contamination and adulteration, etc. Finally, it is illegal to keep milk in a room used for sleeping purposes, or in any place or manner likely to render the milk unwholesome.

"It must be admitted that very little has been done in the direction of the construction of abattoirs and the efficient inspection of meat. The city has a bill authorising the erection of abattoirs under consideration, and the various local bodies of the metropolitan area have combined with the city to place the milk trade on a satisfactory basis. A fully-qualified veterinary surgeon with special training in regard to milk processes has been appointed, and already he has done good work in improving