September, 1918. THE SPECULUM. 67
THE SPECULUM. September, 1918.
in him," consequently we have little warrant for enrolling him among the band of royal patrons.
The subjects of Materia Medica and Therapeutics must have been rather fearsome in those days, as can be seen from a cursory examination of Dr. Willis' "Pharmaceutice Rationalis." One is rather thankful that Willis bequeathed us the "Circle of Willis" and not this work. The subject of anatomy was more enticing. After struggling to work out the course of the Fasciculus Longitudinalis Medialis, one looks back with pained tonging to the entertaining works of anatomy used in those spacious times. They combined the then known facts of anatomy with all the breeziness of the "Memoires" of Casanova de Seingaet.
A good specimen of this is contained in "Samuel Collins' Anatomy," published in London in 1685, wherein a detailed account may be found of the amourous pursuits of a certain gentleman of the period, which, unfortunately, re- stilted in traumatic rupture •of the Urethra and much loss of blood, and so on, ad neuseam.
Later writers indulged in far less romance, as can be seen from "Munro's 'Anatomy," published in Edinburgh in 1780, one passage in which begins :—
" To determine the velocity of blood at its entrance into the aorta, modern writers proceed op the following data:—
They suppose that two ounces are expelled by each systole, that each systole is the third part of each pulsation, and is performed in 1-225th of a minute, that the area of the aorta is 0.4187 of an inch, and that 2 ounces of blood occupy a space of 3.318 cubic inches; or, in other words, that a cylinder of blood whose solidity is 3.318 ins., and base 0.4187, is expelled in I-225ths of a minute. Since the solidity of a cylinder is , the product of the area of its base into its length, its length will be equal to the solidity divided by the base, therefore, in this case, 3.318 divided by .4187 gives 7.9245 for the length which the blood runs in I-225ths of a minute; that is, 148 feet 1 inch in a minute, etc., etc.
This weakness for details, this thirst for accuracy, al- ways instructive and sometimes boring, tends to increase with the passing of the years.
There was a time when meadow, grove and stream, The earth and every common sight
To me did seem
Apparelled in celestial light,
The glory and the freshness of a dream.
September, 1918. THE SPECULUM. 69 But, alas! that time for each of us has fled ;; percentage mor- talities haunt us, the possibility of the deviation of our com- plement disturbs our sweetest dreams, and the fear of exams lies upon us with a weight—
"Heavy as frost and, deep almost as life."
By Dr. T. P. Noonan.
Mr. J.B., Aet. 55, horse trainer, on December 12th had a rigor lasting about 15 minutes. This was followed (in his own words) by generalised pains and headache, with feverishness, loss of appetite, and of energy. He was ill for about five days, and remained in bed for that time. Although feeling weak he resumed his occupation. Two days later he again felt very ill, took to his bed, and sent for the doctor. He complained of considerable weakness, and had a troublesome cough with yellowish expectorations, but no pain. There was some frontal headache.
Patient had always been of good habits, and there was no history of venereal disease. On examination the patient was very flushed and was drowsy. T. 103°, P. 110, R. 30. Pupils equal and reacting normally. No strabismus, no neck-stiffness.
Tongue furred and brown 111 centre. Both sides of chest moved equally without pain. Heart showed no alteration of dulness, and the sounds were clear. There was some dulness at each base, with rise of pitch of respiratory sounds, scat- tered crepitations and increase of vocal resonance in parts.
These changes were more marked at the right base. Abdomen was clear, except for some tenderness in the right kidney region.
No abnormalities could be made out of examination of the nervous system. Urine, clear ; Sp. Gr. 1014 ; trace albumen ; no sugar ; no pus cells.
Bowels had been open each day since onset of illness.
For seven days the patient's condition showed little altera- tion, the evening temperature reaching 1.03° with intermis- sions. Pulse varied from Ho to 126, and the respiratory rate from 28 to 34. There were some sweats.
Thereafter, until the fourteenth clay, the temperature pulse and respirations gradually fell until the evening tempera- ture reached 99.8°, the pulse loo, and the respirations 22.
THE SPECULUM. September, 1918.
There was corresponding improvement in the lung signs.
Two days later the temperature again rose to 103° and the pulse to 13o, the respiratory rate remaining at 26.
The lung signs showed little change except that, at the angle of the left scapula. there was a somewhat circumscribed patch about the size of the palm of the hand, showing some dulness, diminution of breath sounds, and of resonance and fremitus, nothing abnormal detected elsewhere. Comment upon the case with a view to diagnosis, further methods of examination, and progressive treatment.
[Dr. Noonan has offered a prize of £2/2/- for the best solution of this commentary. Solutions should be sent to the Editor or Dr. Noonan before Nov. 1st. The best solution will be published in the next issue, together with suggestions
and comments by Dr. Noonan.]
Owing to confusion in placing the paragraphs in the last issue this commentary has been reprinted. The above condi- tions will hold for commentaries already or yet to be handed in.
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September. 1918. THE SPECULUM. 7r SURGICAL COMMENTARY.
(I) Male, aet. 23.
In 1915, while with the A.I.F. in Egypt, began to suffer from pains in the front of both legs and thighs. Was sent into hospital for rheumatism. After two weeks was discharged to his unit. About a month later was again sent to hospital for rheumatism, which improved with rest. Rejoined unit, and was twelve days on Gallipoli, when the pains in the legs became so severe that he was invalided to Australia. After arrival here early in 1916 had spasmodic attacks of pain, but ,was working in an office and leading an ordinary life. In June, 1917, had a bad cold, and the pains recurred in the legs.
The pains were ascribed to neuritis, and the patientAgdered to Queensland. While in Queensland began to notice pains and some stiffness in the back, but worked on a station at horsebreaking and ordinary station work. During this time he noticed a soft lump about half way down the anterior sur- face of the left thigh. This lump was not tender or painful, was soft to palpation, and gradually increased in size. A local surgeon diagnosed it as a cyst, and endeavoured to aspirate the swelling, but obtained only a little blood. As the stiffness in the back persisted, and the lump in the thigh was steadily becoming, larger, he returned to Melbourne. When seen two months ago the condition was as follows :—Strongly healthy looking young man, presenting a large rounded swelling nearly as big as a football on the inner and anterior surfaces of the left thigh, and extending from the lower margin of Scarpa's triangle to the junction of the middle and lower thirds of the thigh. The swelling was perfectly smooth and even in consistency, non-lobulated, tensely elastic and fluctuat- ing. It appeared to stop short at the upper third of the thigh, and there was no swelling to be found above Poupart's liga- ment. Hip movements were free and painless. On examining the spine it was found to be held rigid, while there was a slight prominence over the second lumbar vertebra.
(2) Male, aet. 56, Farmer ;
For over twelve months had noticed pain in the back and left side made worse by movement. The sypmtoms gradually increased, and on examination he was found to have a large swelling in the left iliac fossa extending back to the, left loin and medially 'under the edge of the left rectus muscle.
Its upper margin extended to the costal margin, while below it was continuous under Poupart's ligament external to the
THE SPECULUM. September, 1918.
femOral vessels, with a distinct swelling in the upper third of the thigh. The whole mass was fluctuant on palpation, but was not very tender or painful. The spinal movements were much restricted, as were, to a lesser degree, those of the left hip. No prominence of the vertebral column dorsally could be detected.
Discuss diagnosis and treatment of these two cases.
Prize of two guineas for best commentary.
T. E. L. Lambert.
" IGNORANCE IS BLISS."
(To the Editor of Speculum.)
Now that it is all over we are at liberty to speak, which we may do with comparative safety, thanks to the ornament of Society—"Freedom of Speech"—which broadly means that one can air one's ideas to the populace without stopping a bottle, brick, or postmature ovum, provided that—their ideas and yours are coincident.
Lately we have heard much from "those who sit in high places" about the poor standard of our clinical knowledge ; we learnt with regret that our "knowledge of clinical medicine was of the most meagre quality."
Of course we sadly admit the case of the innocent student, about to sit for finals, who unblushingly told his clinician "that he heard one small rhoncus," but this is not a fair example. ' We were warned before the November Special "that we must pay special attention to our clinical medicine," or else—Be- ware!!
Now, admitting that our clinical sense is not of the acutest, let us look deep into the well of Truth, and try to see what is at the bottom.
Does the onus lie on us? Is it at the student end of the stick that the fault lies, or is it that the stick is not handled properly from the clinician's end ?
Surely the student of to-day is no thicker cranially than the student of former clays.
Bluntly, we maintain that the lack of clinical knowledge is due to the lack of adequate clinical teaching. The clinical material is there, the student is there, but it is the capable clinical teaching that is lackink. Of course, due allOwance must be made for those of the staff that are bellicose ; we realise that we live in abnormal times.
September., 19a& THE SPECULUM. 73 What clinical teaching do we get? Here is a typical case of three terms' clinical medicine :-
1st Terni.—The honorary arrives five times, on two occa- sions he is late.
and Term.—Honorary comes regularly with the sole pur- pose seemingly to simulate the proverbial oyster.
3rd Terra.—Honorary is regular, but his pearls are honestly not worth the gleaning.
Enough of destructive criticism, we will attempt some constructive criticism.
We would suggest that several of our capable clinicians—
and of course there are excellent ones in our midst—should be paid a sufficient remuneration from the 'Varsity coffers, so that they could afford to neglect their practices and devote, say, two mornings a week to systematic clinical teaching, so that students would get competent clinical teaching in medicine as soon as they reach the hospital, so that their eyes are opened early, instead of stumbling blindly through the darkness of ignorance right through the fourth year, only getting a glimpse of light when their finals are hard upon them.
—" De Crev.
(To the Editor of Specutton.)
Since Hippocrates scattered the mists of superstition which had for so long encumbered the Science of Medicine—
down through the ages to the present time—all unbiassed spec- tators have granted the premier place in every respect to the
This University boasts that its Medical School is amongst the first in the world—a statement borne out by authorities everywhere.
In the face of these facts, it seems scarcely reconcilable that any person having reached Matriculation standard in cer- tain fixed subjects should be allowed to enter the School pro- vided that there is nothing bad enough in his record to debar him from entering any course at all at the University.
How popular the Medical course has become of late is witnessed by the size of the first year, which is at present of most unwieldly dimensions, while there seems to be nothing to prevent it becoming even larger in future years.
Some of the results of this unwieldiness are apparent in the recent "affairs" at the Nat. Phil. School, which also serve to emphasise the fact that the material entering the Medical course is decidedly mixed.
Would it not be more in keeping with a profession with such wonderful traditions and such a pregnant future if, in- stead of an unrestricted entry, there should be some representa- tive organisation to consider the character of the entries;
eliminating undesirables and choosing a fixed number in pro- portion to requirements to have the privilege of studying for the finest profession Society has produced.
ANSWERS TO CORRESPONDENTS.
Semi-Somnis.—Of course you are, but it's nothing to what we are.
Stiffus et Moeus.--Thanks. Kindly continue your labour of love; but do not send in jokes merely because they are vulgar ; in fact, (though some people would hardly believe it), it is just possible that a story may be humorous without being vulgar at all.
Axilla.—As Mr. Hughes said, "You have the mind of a toad in a cesspool."
Bill.—Poets are born. Try a change to the country. The following verse was almost good:—
Billy Hughes is our uncrowned king, With place of power and pride.
Bluffing along on his little fling Over the other side.
He's going to be the soldiers' friend, Their sorrows heal and troubles mend, He's going to build a merchant fleet, And lower the present price of meat;
In fact, he'll put us in Easy Street- -Perhaps.
Your other effort on " 'Ops" gave us the 'orrors.
Coma.—Your touching reference to the gentleman with traumatic rupture of the urethra we thought best to keep to
September, 1918. THE SPECULUM. 75 ourselves. After all, his relatives might'nt like it to get into print. Congratulations on the nom-de-plume.
Weary Will.—Not too bad. Keep trying.
Rup.—Try something where a likeness is not essential.
Your sketch of Prof. Osborne lacks conviction—in fact, it might almost be someone else. Furthermore, professors are
W.—"A bit thin, a bit thin," as the Dean of Faculty is wont to remark. "But it will do."
Barney.—No, Wasserman's Test was not named after the Wassah in Cairo. There really was a man, Wassermann, you know.
"Tho' violet eyes may melt in liquid bliss, And fonns enchanting kneel in touching plea, Though Helena the wondrous came to me, And smiling offered a heaven-bribing kiss;
Yet could I stand unmoved with soul as cold As an old marble monument . . . "
You heartless wretch!
A.C.P.—Not funny enough. Try the Bulletin.
Appendix.—We were reading your article the other after- noon, when unfortunately it came in contact with the fire. It seemed almost too good to publish.
Mat.—At present I sleep with " Ulysses" under my pillow.
If I wake I read a few lines. Thanks.
Tunga.—This was quite good :—
The motto of the first year med., As on his careless way he goes?
Tho' in a year joys may be fled, Who knows ?"
The air of impending tragedy is well sustained. I repeat:
"Who knows ?"
THE SPECULUM. September, 1918.
That some things are too good to be true.
That with a desperate effort and the aid of an appendix Crawk bluffed the examiners.
That he then went to QUEENS cliff to recuperate.
That "we doctors" was last seen disguised as an officer
—some disguise too.
That furthermore Long has been shifted to Fairfield.
• That though we hope for the best, probably the Austin would have been better.
That the following appears in Dr. Noyes' - Dermatology,"
"a man under my care in the Melbourne Hospital ultimately committed suicide."
That of two evils even outpatients have the presence of mind to choose the lesser.
That Jos has enlisted in the Jordan Highlanders.
That they never make an advance without previous good security.
That only three persons can refer to themselves as "we"
—the King, the editor of a paper, and a gentleman with a tape- worm.
That Snakes had good reasons.
That some people are pressed for time and some for pleasure.
That talking of ladies reminds us that 1A'innie came third in Pathology and survived it.
That you should never jump into the water on a full stomach—the owner might object.
That at last we've got the keys to our lockers.
That the difficulty now is to get lockers.
That if you do get lockers its impossible to get near them;
so it's best not to have anything—just take what you want.
That God helps those who help themselves.
That the exzematous cow who took my white coat will certainly need divine intervention if I see him wearing it.
That the study of medicine is a snare and a delusion, the voice of lecturers but a sounding brass and a tinkling cymbal, and life in general just one damn thing after another.
Thaf its time for bed.
September, 1918. TT-TE SPECULUM. 77