belt after the lines of the notorious Harness. A patient of mine paid £9 for one of these belts, the result of the treatment was to make him a wiser man, and keep a tighter hold of his money, in fact, he now keeps too tight a hold. Under the Proclamation relating to our profession issued by the High Commissioner anyone practising as a physician, surgeon, or dentist without being registered as such, is liable to a fine not exceeding £100. I contend that anyone who pretends to be able to cure disease, or sells anythings- that claims to do so, or prescribes drugs for the cure of disease, or does any surgical procedure (with the exception of first aid) or visits or sees a sick person with the object of giving him drugs to cure him, comes under the penal clause in the Proclamation, and therefore consider that we should be able to free ourselves of some of those around us who are making fortunes at the expense of the pocket of our profession.

Health Report, Southern Rhodesia.

We have to thank the Medical Director for a copy of the Health Report for the year ending March 31st, 1903. During the absence of the Medical Director, A. M. Fleming, C.M.G., M.B., it was compiled by Dr. P. L. Moore, Acting Medical Director. It is a clear and lucid document, although the compiler warns us at the outset that the statistical deductions are based purely on hospital returns, owing to the fact of the Ordinance for the compulsory registration of birth and deaths not having come into operation. It is therefore impossible to give any population percentages.

The prevalent diseases appear to be malarial fever, dysentery, enteric and pneumonia, whilst small pox and scurvy are stated to have been prevalent amongst the natives. It would be interesting to know how far this last affection is true scurvy, or the new affection on which Dr. Gregory read his interesting paper at the last Congress. It will be remembered that Dr. Gregory referred to Dr. Loir's deductions in his paper. The Report also comments on this French scientist's investigation. He states that it is dietetic, and that only the natives working on the mines are attacked. Dr. Eaton of Hartley, has done experimental work on this scurvy. He has cultivated a fungus from the organs of affected persons, and he believes that infection takes place through some article of food. He mentions that in some of the cases symptoms closely resembling beri-beri are present. Out of 46 natives treated in the Government Hospitals, 13 died. Two cases classified as true beri-beri are recorded, both at Salisbury. One died. With regard to small pox, there is the satisfactory report that systematic vaccination has been carried out, with the result that only sporadic cases have occurred.

A steady decrease in malarial fever is reported, and we are pleased to note that one of the Hospitals, that at Hartley, has been made absolutely mosquito proof, and that some of the public bodies have constructed mosquito proof dwellings for their employees. The prevalent form of organism is reported to be the small malignant pig

mented parasite, but the mortality is none the less small, only 1.82 per cent.

Blackwater fever seems to bulk rather largely, 38 cases having been treated during the year, with a mortality of 26 31, as against 30.9 in the previous year and 38.6 in 1901. The Hartley District has had an abnormal number of cases, ten per cent. of the total admissions into the Hospital.

The Report states that, although enteric was unknown in Rhodesia ten years ago, it is now fairly prevalent, and the Medical Director thinks, probably quite correctly, that many cases spoken of as low fever" and the like, are really enteric.

The Report mentions that the native, although fairly immune to lobar pneumonia in his kraal, suffers from it in the clothing and surroundings of civilisation, and also incidentally points out that he is beginning to suffer from phthisis.

The sanitary condition of the chief towns is reported as far from what it should be, but the Medical Director points out the enormous difficulties which the local Municipalities have to contend with, and expresses his conviction that they are doing their best. Dust and shallow well water supply are the greatest dangers.

Attached to the Report are a very interesting series of the reports from the various District Surgeons and Hospital Surgeons. At the date of the Report there were 11 District Surgeons in the Territory.

Correspondence.

We do not hold ourselves responsible for the opinions of our correspondents.

"IN RE ELLIOTT."

To The Editor, SOUTH AFRICAN MEDICAL RECORD. DEAR SIR,

It is thus in true legal phraseology worthy of a better cause that the scribe-whoever he be? who records the proceedings of the Natal Medical Council headlines his Report in your December issue, of a matter in which I am particularly interested, not so much personally as professionally.

I will outline briefly the facts which led up to the result as reported of a resolution being passed by the Natal Medical Council with exclusive reference to the issuing passes. for stimulant by medical men to their free Indian patients in this Colony (Natal.)

Early in this year, a Police Sergeant (who died almost immediately afterwards,) actuated by some extraordinary sense of duty, or otherwise, entered the local canteen at Tongaat and without a warrant seized five orders of mine that I had issued to free Indian patients during a period of fiveand-a-half months.

I had for over three years occupied the position of Indian Medical Officer in Tongaat and when I came to Verulam some eight miles distant a large number of my old patients frequently sought my advice and attendance and I was very often in my old district.

In the month of September (1902) I issued three orders for stimulant to patients actually under my care.

And in December I issued two passes.

As these patients to whom I gave these medical orders for necessary stimulant were living at distances of 8, 10, 12 and 15 miles from Verulam and as they obviously could not be visited frequently I had to look ahead in the treatment and I necessarily had to give medicine to last some time. On the same system I ordered stimulant sufficient to last a little longer than a day or two.

In one case, that of an old woman (since dead) suffering from chronic bronchitis and debility, I ordered a bottle of rum each week for six weeks. It must be considered before coming to a hasty conclusion regarding the amount that the rum used by Indians and supplied by canteens in Natal is what is known as coolie rum a spirit distilled from sugar cane and diluted many times before it reaches the consumer.

In another similar case I ordered a bottle once a week for a month.

As also again in another instance. In December in the case of a dying woman suffering from debility and who died shortly afterwards I issued a pass for a bottle of whisky. And again, in the case of an old woman of over 70 with a weak and failing heart I ordered a bottle of brandy.

In all cases I had visited and given medicine to each of these patients and I considered the stimulant a necessary adjunct to my treatment and I had personal acquaintance with all the families for four years.

These cases represent all the orders issued by me from September to February in which month, absolutely without authority or warrant, the local Police Sergeant took upon him to seize and convey away from the custody of the publichouse keeper my medical orders issued in all good faith and in strict accordance with the laws of the Colony of Natal.

I looked upon the question as one affecting the general principle of my profession and immediately reported the matter, but getting no "forrarder," and after some months of fruitless correspondence, I wrote a full account to the Natal Medical Council dwelling particularly upon the interference with professional rights and privileges and asking them to establish my position and render me independent of police. criticism and insult.

The result is as published in your December issue "That while admitting that Dr. Elliott may have been acting in good faith in issuing orders for stimulant in the way he has done," etc., etc. (The italics are mine), with I may further add as communicated to me a few days ago resolutions arrived at, at the last meeting of the Council :—

"The Medical Council regrets it cannot interfere in the matter of the action of the Police as it is a question between Dr. Elliott and the Police."

Unfortunately (for me) the Police Sergeant who acted in so unauthorised a fashion died immediately after having asserted his authority, or I need hardly say, I would have sought satisfaction in another and more decisive way, but as it is, when I was in London in July last I saw the Secretary of the British Medical Association and obtained his advice upon the subject, advice which I intend to follow. Of which how

ever more anon.

Yours truly,

JOHN F. ELLIOTT, L.R.C.S. C.P. Ireland. Indian Medical Officer, Verulam District, Natal.

P.S.—I will give an instance to illustrate the position which I at present occupy. A few days ago wishing to prescribe a bottle of port wine for a little girl with tuberculosis I wired to the Colonial Secretary at Maritzburg for permission and received answer to "act in conformity with the resolution of the Natal Medical Council." Previous to this I had asked the Secretary of the Council whether it was intended to publish their decision for the guidance of my professional brethren but received answer that "The Council does not propose to ask the Government to send a copy of the

resolution in question to the medical men of the Colony at present."

It therefore follows that I am at present the only medical man in Natal to be favoured with a copy of the resolution. The only one in the Colony who has to keep off the grass. I naturally ask you and your readers "What have I done that this infliction should fall upon me? as far as I can see it is the direct result of my having reported a Police Sergeant for gross interference with legitimate professional rights. Needless to remark I will tread another path to glory next time. J.F.E.

UNCERTIFIED DEATHS.

To The Editor, SOUTH AFRICAN MEDICAL RECORD. DEAR SIR,

Your opinion on the following vexed question would be of great value to the District Surgeons in the territories :Are post-mortem examinations only made when there is suspicion of foul play?

The following is a case in point:

nurse

as

Five days after birth a male infant-bottle fed-is noticed to cry continually, and to be seized with some form of spasm, which is diagnosed by the coloured female "convulsions." The child was seen about twenty-four hours after birth by the District Surgeon, and found to be a typically healthy child in every respect. The crying and spasmis continued till the morning of the seventh day, when death occurred. The death was reported to the District Surgeon, who refused to give a certificate on the grounds that he had not seen the child during its illness, nor could he state the cause of death. On approaching the Magistrate to ascertain whether a postmortem examination was necessary or not, the District Surgeon was informed that the death had already been registered by deceased's uncle, the "cause" of death being "convulsions," and "that post-mortem examinations were only made where there was suspicion of foul play." In opposition to this statement, it may be remarked that the same District Surgeon held a post-mortem examination on a coloured illegitimate child, whom he had previously attended, and where there was no suspicion whatever of foul play; and, this, too, on the very day that the white child above mentioned died. I would ask, sir, if the course pursued in this instance is the usual one, and whether it is lawful to bury any white person--unattended medically-without either a death certificate or a post-mortem examination?

I am, Sir,
Yours faithfully,

THOMAS QUERNEY.

[There is no obligation upon a Resident Magistrate to order post-mortem examinations in uncertified death cases. He is only supposed to do so when he has some suspicion of foul play, neglect, or obscure epidemic disease. The matter is entirely within his discretion, subject, of course, to a direct appeal to the Attorney-General. It is, of course, regrettable that any death not medically certified should escape investigation of some sort; but, inasmuch as Great Britain has not got beyond the stage of leaving the whole matter in the discretion of an official, it is perhaps hardly to be expected that we should go so much in advance, with our far greater difficulties. But it is certain that deaths not medically certified should not be certified at all. Unskilled certification is worse than useless for statistical purposes.-ED. S.A.M.R.]

Reviews.

Squint occuring in Children. An Essay by Edgar A. Browne, F.R.C.S. Ed., Lecturer on Ophthalmology, and Edgar Stevenson, M.D., M. Ch. Aber., Demonstrator of Ophthalmology, University of Liverpool, pp. 74, with 5 illustrations. 28. 6d. nett. Bailliere, Tindall & Cox, London, 1903.

In the preface to this excellent little book, Mr. Browne states that it represents his teaching for some years, and is really an expansion of an address delivered before the Medical Society of Liverpool in 1902. He further remarks that it deals only with the concomitant convergent squint of childhood, and, omitting the varieties of muscular abnormalities that are to be met with in practice, may be regarded as an account of squint reduced to its simplest expression. Therefore the ground covered is limited. The chapters are well selected, and written in a clear and simple way. In the Chapter "Obstacles to Success." Mr. Browne deals at some length with the difficulties in the way of treatment experienced at the hands of parents and medical practitioners, and how they may be overcome by judicious co-operation with the oculist. In London Board Schools nowadays, there are competent medical officers able to properly supervise and control the education of squinting children, thereby preventing much injury to eyes and associated parts, Great emphasis is placed on the recognition of the fact that squinting children are very curable up to a certain stage. If treatment were generally carried out without delay, squint would almost vanish. In the chapter on treatment many useful hints are given, and methods for training the squinting eye by means of screens, bar reading, stereoscope, black board, bimanual drawing, and other exercises, are carefully enumerated.

The Appendix by Mr. Stevenson on "The After History of Squint treatment without Operation is very interesting, and shews what may be done when the cases can be kept under observation for a long period some of the examples given extending to close on twenty years' supervision. The book is a very valuable help to the medical practitioner, giving him much useful information in the physical development and education of squinting children. If the advice given be carried out, much suffering may be avoided, and many comparatively useless eyes restored, if not to normal vision, at any rate to a very satisfactory degree of usefulness.

W.E.S.

"Systems like the Twentieth Century and Allbutt. Consequently, it may be strongly recommended to the general practitioner who, whilst relying on a small book for his hurried every day reading requires a larger one for reference, and yet has not time to wade through the big Systems, which, after all, are more suitable for the man who specialises in medicine than for the average South African general practitioner. The volumes are of handy size, amply illustrated and well printed. W. D-H.

Notes on New Preparations, etc.

THE B.W. & CO., ALL-GLASS ASEPTIC HYPODERMIC SYRINGE.

Messrs. Burroughes, Wellcome & Co., have submitted to us this syringe. With the exception of a detachable finger-grip, which is not necessary, and not supplied unless desired, it is entirely glass, and in three parts, barrel, piston, and nozzle, all detachable in a moment, thus allowing, not only of perfect and easy sterilization, but also of the insertion of tabloids to be dissolved in situ. Every piston is specially ground to the individual barrel, and fits it with absolute precision, thus obviating the use of any washer or packing. This is an important advantage, apart altogether from the obvious asepticity. We must all have noticed in this climate, how annoying it is to find that, after not using a syringe for some days, and then perhaps, wanting to use it in a hurry, the packing has contracted, and in consequence, the injection, even if we can draw it into the barrel, returns behind the plunger on attempting to inject. A prolonged soaking is necessary to put matters right. Nothing of the kind can happen with a glass piston. No lubricant is required, and the glass nozzle takes a needle of the usual pattern. We have tested it fully, and can unhesitatingly say that it is the best hypodermic syringe we have yet seen. The firm makes a serum syringe on a similar plan.

W. D.H.

Manual of Medicine. Edited by W. H. Allchin, M.D.,
F.R.C.P., F.R.S., Ed. Vol. 5, Pp. 679. Macmillan &
Co., Ltd.
Price 10/- nett.

This is the concluding volume of this excellent manual, and covers diseases of the digestive system, liver, kidneys, peritoneum, abdominal vessels, and ductless glands, articles being written by ten contributors, in addition to the editor. The volume is quite up to the standard of the previous ones, and exhibits the same characteristic of a singularly successful harmonising of the various contributions, which are of more even merit than in any similar book we know. Perhaps specially deserving of praise are Dr. Lazarus-Barlow's article on "The Bacteria of the Alimentary Canal" a singularly succinct and clear account of a subject most important for every practitioner to understand: Dr. Hale White's" Diseases of the Peritoneum": Dr. Robert Hutchison's " Food and Diet," and Dr. Bertrand Dawson's " Physical Examination of the Stomach and Intestines and Analysis of Gastric Contents."

Dr. Allchin's Manual occupies an unique position, even in these days of much book making on medicine, in being the only book of moderate size written by a large number of contributors. It stands, therefore, intermediate between such single author books as Taylor, Osler and Monro, and the big

METHYLOIDS.

This recent specialty of Messrs. F. Stearns & Co. is an elegant, and so far as we can judge, effective mode of exhibiting Methylene Blue in combination with some other well-known drugs acting on the urinary tract.

A good many reports have been published substantiating the claims of Methylene Blue as a bactericide in the urine, and its therapeutical efficiency seems greatest in the very troublesome chronic gleet cases. The American practitioners speak enthusiastically about it. The name of Stearns is a guarantee that the drug is what it professes to be, a most important consideration in this case. W.D.H.

ASSISTANCY WANTED.-Lady M.B., Ch. B. as Assistant in a first-class practice. Experienced in dispensing and private practice.

Apply, Editor, "S.A.M.R."

VOL. II.-No. 2.

Index.

After some introductory remarks, Dr. Mackenzie went on to say :

Any notes upon Surgery in Natal must naturally be corfined to the last fifty years or so, beginning from the time when the early settlers found the country in a state of barbarism, from which, by their pluck and their colonising instinct, they have brought it up to a position in which we may say that we enjoy much of the best that civilisation and industry can do for us, and have gained facilities and advantages which make our little Colony and its towns places of attraction to many.

I should like to pay a well-deserved tribute to the pioneers of our profession who settled in Natal in those early days and who hand in hand with the progress of the Colony, applied their art to the relief of suffering and

A

PRICE 1/6

to the saving of life and limb amongst their fellow colonists. In those early days, before towns and villages had sprung up, when small settlements and scattered farm houses were widely separated and travelling was full of danger, they did their work under the most trying conditions with a devotion to duty which we are proud to remember. The knowledge of antiseptics, by the introduction of which the great Lister has rendered himself immortal, was not thought out in those earlier days and all the advantages in bacteriology which we now enjoy and with which the name of Pasteur will be associated throughout the ages, were not even dreamed of. There were no hospitals where the present day arrangements for operative work were available, and often there was no assistance to be got, no matter how complicated or difficult the surgical problem which the surgeon had to face. The great blessings of chloroform were hardly understood, and it was only slowly coming into use. It was used in fear and trembling, as well it might be, for we now know all too well its terrible dangers and can watch for them and successfully guard against them. But in those days the knowledge of them was wrapped up in the future, and the way to combat them was little understood, and to the older men it was something quite new of which they had heard little in their student days.

Notwithstanding the difficulties which these pioneers of Surgery had to encounter, they have left an honourable record of useful work behind them, and will always be remembered with appreciation. How much the whole condition of things has changed, it is difficult for one to realise who comes to settle and practise amongst us at the present day. The surgeon now finds that in almost any part of the Colony he can get what assistance he requires for any operation, and the help of an anæsthetist and a well-trained nurse. Even outside of our towns and villages he can at short notice summon aid to assist him in a difficult case, or he may send his patient to Durban, Pietermaritzburg or Ladysmith, where there are hospitals, nursing homes and sanatoria in which he can obtain proper care and treatment for the case. You are to be congratulated in Cape Town in that no one can drive from your Docks into the City without seeing the statue of one who, as far as I know, stands quite unchallenged as the first surgeon and man of any note on record who settled in South Africa. It is over 250 years since Jan van Riebeek landed here and took possession of the land on which Cape Town stands. When, therefore, the late Mr. Rhodes erected the statue which will for ever commemorate the first Governor of the first settlement of white men in South Africa, he also did a graceful act of remembrance to the profession of surgery, Mr. Jan van Riebeek was a surgeon. In Natal we cannot go back so far in the interesting way that you can, but

we like to recall the names, amongst others, of Dr. P. C. Sutherland, who practised in the Colony in its earliest days and from 1857 until a few years before the time of his death held the office of Surveyor-General, and to do honour to the memory of Dr. Lyle of Durban and to remember with an ever fresh recollection the kind sympathy in suffering, the sage advice in trouble, the sure and skilful hand as a surgeon, of John Gordon, M.B. and C.M. of Edinburgh, known to every young man who began practice in Durban when he was alive as a good and true friend and wise professional counsellor. Addison, too, who has now retired in advanced years, many of which he has spent with the best of records for the good not only of his private patients, but also of the inmates of the Government Hospital in Durban over which for many years he had professional control, must be mentioned amongst those who, along with Dr. Scott and Dr. Allen of Pietermaritzburg, people in Natal delight to honour.

The Government of Natal has well equipped Hospitals in Durban and Maritzburg and is arranging for the establishment of others throughout the Colony. An evil, however, lurks in the fact that our Government is inclined to accept in all our hospitals under the present methods of admission, anyone and everyone, and runs a grave risk of admitting and treating in them at the expense of the tax payer those who are quite able to afford to pay for their own surgeon and nurse in their own homes, or to go to a Nursing Home and be treated there, and Natives and Indians are to a great extent treated free. Notwithstanding this however, it is a comfort to be able to say that anyone entering one of our Government Hospitals in Natal to-day will find the means necessary for the saving of life and limb, and the general treatment of surgical cases in a very high state of thoroughness and efficiency. In Durban we have three Nursing Homes and a Roman Catholic Sanatorium, in addition to the Government Hospital. The Berea Nursing Home, with which I am associated and where I have had the able and helpful co-operation of my old fellow-student and present partner in practice-Dr. Campbell-is a model little place for surgical work. It is equipped with an excellent staff of nurses under the management of a Matron of great energy and ability, and possessing a long experience in surgical work under Professor MacEwen of Glasgow. The central block of the building has an upper story devoted to comfortable apartments for accommodating the nursing staff, whilst the ground floor has at the back a splendidly lighted operating theatre, with its walls and floor tiled and easily kept clean and as nearly as possible sterile. There is an excellent supply of steam from a steam boiler, which supplies hot water and steam to the fine baths, and the operating theatre, and also to a large steriliser through which all our dressings are made to pass before use. There are two wings, connected by covered ways with the central block and easily accessible from the operating theatre. Here the patients have comfortable and well ventilated accommodation, consisting of separate rooms, all opening out on to a wide verandah which admits of the beds-which are fitted with rubber wheels-being run out and in from the rooms, the floors of which are on the same level as that of the verandah.

During the past few years the kind of work which has

drifted into our hands has borne upon it the unmistakeable mark of the influence of the war which started a little over four years ago, and many of the cases have been so interesting in some of the features they have presented, that I think it would be a mistake were I at our first Meeting of Congress after the war not to refer

some of the teachings and experience in military surgery of which we had a fair share in Natal. As a Natal Volunteer I had the privilege of doing duty for my country, either personally or through a substitute, during the whole of the time that the Natal Volunteers were on active service. A great deal has been written on the subject of military surgery in the light of the experience gained during this war, so that whilst I will have little that is new to tell you I feel sure that it will interest you to hear of some of the work that passed through our hands in Natal, and it will also help to associate the Natal Volunteer Medical Corps directly with that work. Every Surgeon should take a pride in the military surgery of his country. Even the old Romans had their medicus legionis. The great French surgeon who substituted the ligature for the horrors of the cautery and boiling pitch to control hæmorrhage, Ambroise Parè, followed the wars of his country for over thirty years, and we may well be proud to claim a deep interest in a branch of surgery associated with which history records many other and many most illustrious names. Compared with previous wars the differences in the injuries have been very great, chiefly on account of the modern bullet which was employed for the most part on both sides. This bullet is long and narrow, and enclosed in a hard, polished nickel jacket, and is about 3/10ths of an inch in diameter, that of the Mauser being slightly less. This missile, when compared with the round bullet of the old flintlock, which was made of soft lead and was 7/10ths of an inch in diameter, or the Minie Rifle bullet, which was 6/10ths of an inch in diameter, and the Enfield which was 5/10ths of an inch in diameter, has an entirely different effect upon the tissues of the body when passing through it. The older soft, large bullets were easily flattened out when they struck a bone in the injured man, or a stone or other hard substance, before reaching and wounding him. They caused awful lacerated wounds and a great deal of tearing and destruction of tissue and the patients often died on account of this terrible destruction of parts that were not in themselves vital.

The modern bullet, on the other hand, we found, in our wounded and in those of the enemy who fell into our hands, frequently passed through the body with a very fine puncture-like track and did not tear or destroy the tissues in the way that the older bullet used to do. In cases of ricochet however, where the bullet had struck a stone or some hard body and become broadened and flattened out before wounding the combatant, the wound was more like that of the older style of bullet. In connection with the injury of bone, too, this hard bullet with its immense velocity, on striking the hard shaft of a long bone shattered it into a mass of splinters at the part struck and then passed rapidly onwards, sometimes carrying portions of bone some distance along its track. These modern bullets do not readily carry portions of clothing or foreign matter of any sort with them, as was often done with the large, blunt, old style of bullet,