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remedy needed. To the charge about guaranteeing that no
questions would be set^ outside my lectures, I have already given
a positive contradiction. To the further statement that these
lectures * appear to be of a limited nature,' I can only say, that I
put as much as I can into a course of about seventy lectures ; and
that it is simply impossible, in the time, adequately to discuss all

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516 Audralian Medical JaumaL Not. 15, 1884

subjects in connection with obstetrics and the diseases of women.
Some I am compeUed to consider rather shortly^ and I hare even
to omit some altogether. In this respect I believe myself to be in
the same position as every other teacher in the University. I tzy
to give prominence to the subjects which it is important that yonng.
medical men should know; and I also try to vary my lectures
from year to year, as it is only in that way that a teacher who has
the same course year after year, can hope to keep the attention of
students, among whom it is the habit to hand on notes of lectures
from year to year.

'^ 13. The Examinations are a safeguard to the public, if they
are sufficiently strict, and if the theoretical knowledge is supple-
mented by right practical instruction.

" 14. I will be pleased if the Council accedes to the request of
the oo^xaminers, and makes full inquiry into the subject. I
would willingly have joined them in making the request, if they
had asked me to do so ; and, as a matter of fact, I would prefer
having the examination in obstetrics at the end of the fifth year,
instead of at the end of the fourth. It seems, however, that,
mingled with the desire for reform, there was a wish to injure me
in the eyes of the Council and of the public. The best proof of this
is that their letter was received by the Council, at the meeting on
July 7th, and was not dealt with till the 14th, when it was simply
referred to the Medical Faculty for report Before it was in any
way considered by those to whom it was addressed, a copy was sent
to the Argus, and appeared on the morning of 9th July. I must
complain of, and protest against this unjustifiable step of hastily
publishing statements, exaggerated and in part untrue; and in
particular that a tale, carried by a plucked student, should have
been put first into writing and then into print, without any inquiry
from me as to its correctness. I may fairly ask the Council to
inquire how a document, which had not been dealt with, came to
be publidied in one of the daily papers."

After reading the letter, and considering the various points
raised, the Faculty adopted a report which was brought up at
the meeting of the Council on 20th October.

''Gentlemen, — I am directed by the Dean of the Faculty of
Medicine to acknowledge the receipt of a letter from Dr. Balls-
Headley and Dr. Bowan in reference to the examinations in



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Nov. 15, 1884 Atutralian Medical Journal. 517

obstetric medicine and diseases of women and children, which the
Council have ralerred to the Medical Faculty tor their consider-
ation and report.

**The Faculty has considered the matters referred to in the letter
of Drs. Headley and Bowan, and has resolved to report to the
Council—

*' 1. In reference to the letter signed by Dr. Balls-Headley and
Dr. Bowan, the Faculty requested Dr. Jamieson, the lecturer and
examiner in obstetric medicine and diseases of women and children,
to report to the Faculty on the subject.

"2. The Faculty has received a report from Dr. Jamieson,
which is now enclosed, and which the Faculty considers perfectly
satisfactory.

*' 3. The Faculty would draw the special attention of the Council
to the fact that the letter in question was published in the ArguM on
the 9th July, whereas it seems not to have been read by the Council
till the 14th July. In the opinion of the Faculty, the publication
of such a letter of complaint, before it was dealt with by the proper
authority, was grossly improper, unfair to the person charged, and
disgraceful to those who caused its publication.

" In the opinion of the Faculty, the writers of the letter display
such an amount of personal feeling, and make such unfounded and
unjustifiable statements, that they ought no longer to be permitted
to act as examiners in the University. — I have the honour to be,
gentlemen, your obedient servant,

"E. F. a'Beckbtt, R^istrar.



ON TUMOURS OF THE BLADDER : THEIR NATURE,
SYMPTOMS, AND SURGICAL TREATMENT.*
The last contribution of Sir Henry Thompson to the surgery of
the urinary organs is formed principally by the matter of two
lectures, delivered at the Boyal College of Surgeons in June this
year ; it sei-ves to introduce first of all a new mode of exploratory
diagnosis — digital examination of the bladder by an external

* On Tumours of the Bladder : Their nature, symptoms, and snrgioal
treatment. By Sir Henry Thomson, F.B.C.S., M.B., Lond. London,
J. and A Chnrohill.



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518 Australian Medical Journal, Koy. 15, 1884

urethrotomy, and afterwards to trace the history of the varionp
operations for vesical tumours in the male^ to give an account of
their intimate structure and physical characters, along with the
symptoms and signs of their presence. It is almost needless to
state at the outset — when one recollects what this master-hand
has wrought for special surgery — ^that the work is elaborately
written, and with much care as to clinical and histological de(;aiL
The first chapter relates entirely to diagnosis, and a systematic
mode of inquiry is presented, by which to localise very precisely
those derangements of the urinary function which are to be re-
garded either as signs or symptoms of disease affecting any part,
at least, of the bladder and urethra. As however a great part of
this section is merely a reiteration of the teachings of the author
in former works {vide Diseases of the Urinary Organs.), we
will pass on to the consideration of the more novel part of the
work, viz., that which treats of the operation of digital explora-
tion of the bladder. This surgical proceeding — as the author him-
self admits, a circumstance too which his critics have not over-
looked — is an old one put to a new use. It consists, in few
words, in opening up the shortest, easiest, and safest route by
which a finger may be made to enter the bladder. It is the
external urethrotomy of English writers, and the bauionnih'e of
Tolet, Oolot, and other French surgeons. Prior to its employ-
ment in a fresh field of investigation it was used as a relieving
operation for impassable stricture, and for urethral calculus. It is
almost without risk. The mere section of parts from the perineal
surface in the median line, down to any part of the urethra
anterior to the prostate, is one of the simplest and least dangerous
of surgical operations.

There are three morbid conditions in which this exploration ia
indicated, and will afford permanent relief :

L In cases of impacted calculus, associated as it usually is with
painful and frequent micturition, and mucopurulent or blood-
stained urine.

II. A growth (not cancerous) within the bladder, such growth
being usually associated with long-continued or repeated bleeding,
and sooner or later depositing in the urine organic debris.

m. And, we think the most usually met with of them all, is
that distressing cystitis which occurs in old men who have already
spent some time in *' catheter life.** '* This cystitis is rarely amenaUe



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Nov. 15, 1884 Australian Medical Journal. 519

to relief by ordinary treatment, because the cystitis itself is main-
tained by the very agency — the catheter, without which the
patient's existence is impossible.''

£very one will agree with the author that in these three
conditions the patient's fate is sealed, and that with severe and
protracted suffering. The only means of escape is the operation.

The steps of the operation are shortly as follow — Complete
anaesthesia, with the patient in the lithotomy position; a grooved
staff in the urethra; with a long, narrow, straight-backed bistoury
the operator cuts upon the staff, guided by a finger placed in the
rectum on the apex of the prostate ; the incisions need only be
large enough for the finger to enter. He now inserts in the
groove of the staff a tapering director (gorget-like), which passes
inwards along the urethra to the bladder ; the staff is then with-
drawn, and the finger insinuated along the director, through the
vesical neck, the director being withdrawn, the tip of the
exploring finger is now felt free in the cavity of the bladder, and
can recognise the morbid condition for whi«h the exploration was
undertaken.

If the commonest state of chronic cystitis be present, and it be
intended to keep the bladder and urethra at rest for a few days,
a free exit to the urine is secured by passing a stout indiarubber
tube, with a clear calibre of a fourth of an inch, having a lateral
as well as a terminal opening, just within* the bladder ; the tube
may remain a week or sa We can quite endorse the remark
that '* to a man who has for some months before never enjoyed
two consecutive hours of sleep, the ability to lie unmoved and
undisturbed has the happiest effect on his digestion, his spirits,
and his strength." To this proceeding, finally, enlarged prostate
<^ers no impediment.

Space will not permit us to criticise the results of the various
cases quoted, but on the whole it may be stated that they are
satis&ctory.

The remainder of the work is given up to bladder tumours,
with a full history of the various operations for their cure.

These tumours, which are said to be not so rare as is generally
supposed, are divided into— 1. fimbriated papilloma. 2. Fibro-
papilloma. 8. Tumours of a transitional type ; all of which are
homoplastic and innocent.

The heteroplastic growths are in order of frequency, epithe-
liomata, and sarcomata (rare.) Scirrhus occurs as a deposit.



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520 AuBtralian Medical Jowmal. Not. 15, 1884

in the walls of the bladder, and usually affects the base and sides
sufficiently to admit of indentification by rectal examination.
Lastly, dermoid tumour has been found in the bladder.

All these structures are described much more fully and
completely than by any other English author, and the method of
detecting their presence by examination of the urine is given.

The concluding chapter is taken up with a description of the
operations for the removal of tumours and their results.

The general get-up of this valuable little work reflects the
highest credit on the publishers. R. A. S.



MARTINDALE'S EXTRA PHARMACOPCEIA *
This most useful little book is one which we can heartily re-
commend every member of the profession to keep beside him for
reference. So many new remedies and new preparations have
been introduced within the last few years, that a hiuidy guide to a
knowledge of them and their uses was needed. That this book
has been felt to supply the need is shown by the fact that it came
to its third edition in less than a year. The main body of the
work is taken up with a list, in alphabetical order, of new drugs, or
of old drugs which have been put to new uses, with just enough
description to allow of identification, while the modes of preparing
and using, with doses, <S:c., are carefully given. For those wha
desire further details references are given to the most important
articles in the medical journals and other works of reference. To
the second edition there was added a therapeutic index, a list in
which, under the heading of the Disease or Symptom, the more
definite remedies now in use are given. This has been further
added to in the third edition, and a number of other additions
made throughout, with the view of keeping the book fully up to
the times. Space is saved, and convenience of reference increased^
by making the index serve also as a posological table, and though
the book contains a large mass of valuable material it is of so
small a size that it can easily be carried in the pocket. To those^
therefore, who have not already made acquaintance with this
Extra Pharmacopoeia, we can give it very unreserved commends*
tion. J. J.

* The Extra Phftrmaoopoeia of Unofficial Drags. By W. BCartrndale, F.0.8.
and W. Wjmn Westoott, M.B. Thixd edition. London, H. E. Lewis, 1884.



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Nov. 15, 1884 AttUraKan Medical Journal. 521

€ttxnctB itam t^e SJjebkal ^mxnulB,

Fibrfxyttic Tumwur of the Uterus.

The poBsibility of mistaking a tumour, springing from the fundus
of the uterus, for one of ovarian origin is well illustrated in the
following case, reported by M. Schwartz. There is a history of a
two years' growth of an abdominal tumour, in a lady »t. 54,
married, whose courses left her in January 1882. She was
admitted to the hospital on September 3, 1883. This tumour
developed itself first on the right side, then invading the left
side, and finally showing itself uniformly on both sides. As
the belly enlarged it became painful, the pains recurring at certain
times with greater acuteness. Coincident with the growth of the
tumour her general condition became feeble, loss of flesh, bad
digestion, and embarrassment of the respiration supervening.

On inspection, the patient's frame is large, very emaciated, and
the belly round, with abundant venous networks. She maintains
the dorsal decubitus. Palpation shows a fluctuating mass extend*
ing from the xiphoid cartilage to the pubes, and from one flank to
the other. The hand can discover no separate bosses or inequalities
of surface, and there is no difference in resistance on percussion^
which gives dulness all over the abdomen, except at the flanks,
where ^e note becomes clear. No alteration follows change in
position. By vaginal examination the cervix is found to be
drawn up but accessible, the uterus is mobile, and movements
impressed on the abdominal mass are not transmitted to it*
(Edema of the lower extremities exists only on assuming the erect
position. Other organs normal. Ovarian cyst was diagnosed^
and an aspiratory puncture made to confirm the diagnosis, and to
ease the patient of her enormous distension, resulting in the
evacuation of about 17 pints of chocolate-coloured liquid. This
gave great relief to all the pressure symptoms in the heart,
stomach, and lungs. The patient picked up strength and healthy
but the belly gradually re-filled, so ovariotomy was performed on
September 25, with the patient in very good general condition.
An incision four inches long revealed a C3rstic pouch closely
adherent to the parietal peritoneum. The large trocar gave issue
to about 27 pints of fluid, but was soon choked by membranes, so
the incision was enlarged upwards to the umbilicus. The task of
separating the cyst from the peritoneum was one of great difficulty*



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522 AuUralian Medieal Jonmal. Not. 16. 1384



and during attempts to free it the tumour burst, and about 17
pints more of fluid ran out. The tumour then appeared to oonsist
of two large cysts, separated by a Uiin partition, and adherent not
only to the abdominal wall but also to the small intestine, omentum,
and the sides of the true pelvis. The tumour was eventually
detached, leaving a pedicle as thick as one's wrist, which proved
to be the fundus of the uterus. Being assured of the integrity of
the uterine cavity, the first idea was to return the pedicle, but its
nature and volume induced the fear of consecutive evils, as
hemorrhage and septicemia ; so it was fixed externally in the
inferior angle of the incision, where it could be maintained without
any tension. Lister's precautions were exercised throughout. .
After recovery from the chloroform great pain in the belly was
complained of, which was eased by morphia, and with the
exception of some vomiting and intercurrent retention of urine,
with mild cystitis, the case proceeded steadily to a cure.

The points of this case, upon which M. Schwartz would insist,
are the difficulty of diagnosis, the great benefit of the preliminary
puncture, and the gradual but sure progress to a successful termi-
nation. The absence of transmission of movements from the
tumour to the uterus in this case (which somewhat negatives the
value of this test) he believes to be due to the enormous size of the
cysia and ^h^ intimate adhesions, especially those to the pelvis.
M. Schwartz affirms that the pedicle, as in hysterectomy, and
contrary to its management in ovariotomy, should not be returned
to the abdominal cavity, except in cases where its shortness would
cause it to drag dangerously and encourage it to fedl back into the
abdomen if fixed outside. — Bevue de Chirurgie, AjhtiI 1884.

F. D. B.



At the meeting of the Council on the 20th ult, on the motion
of Dr. Morrison, a committee was appointed to consider the whole
question of the extension of University teaching, and of the
improvement of buildings, with the view of submitting a claim to
Ck>vemment for an increased grant.

The registrar brought up a report from the Faculty of Medicine,
in reference to certain chai^^ces formulated against Dr. Jamiesoni
the lecturer on obstetric medicine and the diseases of women and
children, by Drs. Balls-Headley and Rowan. On the motion of

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Kov. 15, 1884 Australian Medical JoumaL 523

Dr. Heam, the report^ so far as it related to the exoneration of
Dr. Jamieson, was adopted, and copies of it were ordered to be
sent to Drs. Balls-Headlej, Rowaa, 4uid Jamieson. (The report,
with the letters which led to its adoption, will be found
elsewhere.) The members of the various Boards of Examiners
were re-appointed.

At the meeting on the 3rd inst., it was unanimously decided to
appoint Dr. J. P. Byan co-examiner in surgery, in the room of
Mr. Fitzgerald (absent from the colony), and Dr. Springthorpe
<x)-examiner in pathology in the place of Professor Halford, who
desired to be relieved from this particular work. It was resolved
to ask Mr. C. B. Blackett to take the examinership in chemistry,
vacated by Mr. Newbery. Dr. Fulton was appointed co-examiner
in medicine vice Dr. James Robertson, resigned. A recommenda-
tion from the Medical Faculty, to the effect that attendance at a
recognised hospital as in-dresser should be counted as attendance
at University lectures, was unanimously rejected. After some
iurther discussion, in the course of which objection was taken to
Dr. Williams holding two lectureships, the present lecturers were
reappointed for 1885, with the exception of the clinical lecturers,
whose appointment was deferred, pending the receipt of the
report of the committee appointed to confer with the hospital
Authorities. The registarar read correspondence which had passed
between him and the editor of The Argue relative to the
recent publication of certain letters by Drs. Balls-Headley and
Bowan, in which the r^;istrar was shown to have had no
connexion wiUi the publication of the letters. (Dr. Balls-Headley
■and Dr. Bowan had separately written to The Argue^ stating
that they had no part in the publication, the latter adding that
he did not keep a copy of the letter, which was written by
Dr. Headley.)

At a meeting of the Senate on the 21st ult., the regulation
^iwarding two scholarships at the fifth honour examination in
medicine was finaUy adopted. Dr. Springthorpe proposed certain
•changes in the regulations, which would give medical students
i;reater facilities for presenting themselves for the degree of
Bachelor of Arts. After some discussion the motion was rejected.
For the ordinary examinations which commence on the 17th insti
165 students of medicine have entered. At this examination the
new regulation, requiring the candidates to give in numbers
instead of their names, will come into force.



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624 Atutralian Medical Journal. Nor. 15, 1884



MELBOURNE HOSPrTAL.

The committee, at its ordinary fortnightlj meeting on the 2l8t
nit., received a letter from Dr. Harbiaon, drawing attention to the
fact that the friends and relations of the patients in the infections-
wards were allowed to visit them, and that nurses and attendants,
engaged in the infections wards were not restricted from going into-
the surgical wards. He pointed out tiiat great danger was likely
to accrue from the practice. Dr. Llewellin, the medical superin-
tendent, stated that the passage of persons from the infectious ta
the surgical wards might have taken place, but it was against his-
orders, and he was ignorant of the fact. The matter was left in
his hands, on the understanding that he would report at the next
meeting of the committee.

At the meeting on Uie 11th inst. Dr. Llewellin reported fulljr
on the rules which had been adopted for restricting communication
between the erysipelas wards and other parts of the hospital. It
appeared that the number of persons, known to have gone even inta
the medical wards after visiting the isolation wards, must have beea
very smalL The matron was the only person who had of necessity
to visit both places r^^ularly.

A letter from the secretary of the Operative Masons' Society
was read, complaining that a member of that society had been
refused continuous attendance on the ground that he was able to
pay. The letter continued : — " As the trades contribute largely ta
the Hospital Sunday Fund, and also to the annual benefit for the^
Melbourne Hospital in particular, we do not consider it just that
a tradesman (even supposing he is well able to pay for attendance)
should be refused treatment, especially in case of accident" It
was shown that, by the rules, when persons were able, they must
pay after receiving temporary assistance, A reply was oidered to
be forwarded to that effect.

Professor Elkington brought up the amended rules. He said
the chief alteration was in r^ard to clinical lectures. Provision
had been made in order that the fees for clinical instruction might
be collected by the University authorities instead of by the
hospital, as at present

The consideration of the rules was deferred.



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Hov. 15. 1884 Atutralian Medical Jm/nrnaL 626

ADELAIDE HOSPITAL.

The drcumstances connected witE the death (^ patient, while
under the anaesthetic influence of ether, having been made the
sabject of unfair comment in the Begkter newspaper, Dr. Poulton,
the junior house surgeon, wrote a long letter to the committee,
supplying full details. Several of the medical members having
expressed themselves strongly to the effect that no blame attached,
to the medical officers treating the case, it was decided to enter the
letter on the minutes and allow the matter to drop, no inveetigar
tioH being needed. (An account of the case is given elsewhere, in
a commtmication from Dr. Poulton.)

A letter was received from Dr. Ellison, stating that the dis-
agreement between himself and the rest of the medical staff had
reached a dimaz, and he had no other alternative but to resign.
The resignation was accepted.



VITAL STATISTICS.

The monthly report of the Victorian Qovemment Statist shows
that the births of 1,001 children — ^viz., 474 boys and 527 girls —
were r^^istered in Melbourne and suburbs during the month of
September. In the month of August 954 births were registered,
or 47 fewer than in the month under review. The births were
237 above the average of the previous ten years, but only 128
above that average if allowance be made for the increase of
population.

The deaths registered in September numbered 520 — ^viz., 270
of males and 250 of females. The births thus exceeded the deaths
by 481. The deaths were fewer than those in August by 71, but
exceeded the average of September during the previous ten years
by 150. If, however, allowance be made for the increase of popu-
lation, they will be found to have exceeded that average by 97 only*

To every 1,000 of the population of the district the proportion
of births registered was 3*29, and of deaths registered 1*71.

The highest temperature in the shade recorded at Melbourne
Observatory during the month was 79-0'' on the 9th, and the
lowest was 35*0* on the 17tlu

Males contributed 52 per cent., and females 48 per cent, to the
mortality of the month. Children under 6 years of age contri-
buted 38 per cent, to that mortality, as against 32 per cent, in
September, 1883.



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iiturrclNem Midieal Jourwal.



Hoy. 15, 1894



Twenty deaths wen aserH^ed to eztenial oauses during the



Online LibraryReale accademia delle scienze di TorinoThe Australian medical journal, Volume 6 → online text (page 52 of 58)