admitted, it has never been scientifically proved, for although bacilli are present in all cases of leprosy, yet all culture and inoculation experiments have failed. The final chapter deals with treatment, from the time when the fat of panthers and lions, and the flesh of crocodiles and serpents was used, up to the present. The therapeutic value of the so-called specific remedies as Chaulmoogra, Gurjan oil, Cashen-nut oil, tuberculin, ichthyol, &c., have all been tested, and as a result, in nearly every case, one finds the disappointing nil. Since all efforts to destroy the bacillus have failed with drugs, the treatment may be summed up in two words--cleanliness and isolation-put the patient under the best possible hygienic conditions for his own sake, and isolate him for the sake of his fellow countrymen. Tables showing the frequent complication of nodular leprosy with tuberculosis; the proportion of tuberculosis in maculo anaesthetic leprosy; the proportions of the two forms of leprosy ; and the results of isolation in Norway, together with thirteen admirably executed plates complete this excellent work, the careful perusal of which can be thoroughly recommended to any interested in the subject. A. W. F. N. Vital Statistics. The births of 1032 children, viz., 539 boys and 493 girls, were registered in Greater Melbourne during the month of July. In the month of June, 1272 births were registered, or 240 more than in the month under review. The births were 262 below the average of the month during the previous ten years, and 283 below that average if allowance be made for the increase of population. The deaths registered in July numbered 621, viz., 338 of males and 283 of females; the births thus exceeded the deaths by 411, or 66 per cent. The deaths exceeded those in June by 36; but were below the average of July during the previous ten years by 22. If, however, allowance be made for the increase of population, they will be found to have been less than that average by 32. To every 1000 of the population of the district, the proportion of births registered was equivalent to 27·68, and of deaths registered to 16.66 per annum. In the month under review, as compared with the previous one, there was a increase of 8 deaths under the head of zymotic diseases, 3 under dietic diseases-due to intemperance, 13 under developmental diseases, 14 under local diseases, and 6 under ill-defined or indefinite causes; but a decrease of 6 2. deaths under constitutional causes, and of 3 in the number of violent deaths. The increase in the zymotic class was contributed to by whooping cough, which proved fatal in 2 cases in July as against nil in June; diphtheria in 4 as against 2; syphilis in 7 as against 3; and puerperal fever in 4 as against Under the head of constitutional diseases, deaths from cancer fell from 41 to 33, and those from phthisis from 71 to 68. The increased mortality of children—especially infants, took place under the diseases of premature birth and malformations, which caused 26 deaths as compared with 16 in the previous month, atrophy and debility 18 as against 11; as well as under other heads. Under local diseases, the principal increase was in deaths from diseases of the respiratory system (chiefly bronchitis and pneumonia), which rose from 94 to 125; deaths from enteritis also rose from 9 to 16, but under most other diseases there was a decrease-deaths from diseases of the nervous system having fallen off by 5, those of special sense by 4, of heart diseases by 5, of the generative organs by 4, of parturition by 3, and of the integumentary system by 4. One death in the month under review, and one in the previous one, were ascribed to septicemia after vaccination. The following is a statement of the deaths set down to typhoid fever and diphtheria in each month of the years 1890 to 1894, and the first seven months of 1895. It will be noticed that in the last two months, the mortality from both causes was exceptionally low : DEATHS FROM TYPHOID FEVER AND DIPHTHERIA, 1890 to 1895. TYPHOID FEVER. DIPHTHERIA. MONTH. 1890 1891 1892 1893 1894 1895 1890 1891 1892 1893 1894 1895 Total 403 192 154 120 155 114 400 145 88 33 48 31 Local Subjects. MEDICAL BOARD OF VICTORIA.-The following gentleman has registered his qualification:-Horace Grattan Kelly, L. et L. Mid. R.C.P. et R.C.S. Edin. 1895, L.F.P.S. Glas. 1895. Additional qualifications registered.James Wilson Bett, M.D. Aberd. 1892; Henry O'Halloran Giles, M.B. et Ch. B. Adelaide, 1891. Names of deceased practitioners erased from the Register. Horatio St. John Clarke, F.R.C.S. Eng.; Paul Howard MacGillivray, M.R.C.S. Eng.; Henry Crossen, L.F.P.S. Glas.; Robert Hodgson Anderson, M.B. Melb. Name restored to the Register under the provisions of section 7 of the "Medical Act 1890."-William Henry Lang, Corowa, N.S.W., M.B. et Ch. M. Edin. 1882. HEALTH OFFICERS.-The following appointments have been confirmed :— Town of Williamstown-Andrew Honman, M.R.C.S., vice John Johnston, M.B., resigned; Shire of Dunmunkle, North Riding-Arthur George Eyre Naylor, L.R.C.P., vice George Joseph Ley, M.B., resigned; Shire of Narracan - Robert John Fullerton, L.R.C.P., vice Paul Guinand, M.B., resigned; Shire of Numurkah, Central and East Ridings-John McGinness, L.K.Q.C.P., re-appointed: Numurkah, West and Moira Ridings-John Ellison, M.D., re-appointed. PUBLIC VACCINATORS.-The following appointments have been made :East Erighton-Alfred Fleming Joyce, M.B., vice C. N. Simmons, L.R.C. S., resigned; Richmond-James Amess, M.B., vice H. St. John Clarke, M.R.C. S., deceased; Coalville-Robert John Fullerton, L.R.C.P., vice C. W. Laver, L.R. C.P., resigned; Heywood-Thomas Shanasy, L.R.C.P.; Kensington— William Joseph Alleine Moss, M.B., vice G. E. Cussen, M.B., resigned; Minyip-Arthur George Eyre Naylor, L.R.C.P., vice G. J. Ley, M.B., resigned; Richmond-Godfrey Howitt, M.B., acting from the 1st April, 1895, until the 22nd August, 1895; Serviceton-John Murray Gibbes, M.D., from the 1st April, 1895, vice E. G. Erson, L.R.C.P., who has left the district; Werribee -Henry O'Halloran Giles, M.R.C.S., vice C. de Wolfe Heard, resigned. BIRTHS. BROWN.--On the 7th September, at Colac, the wife of W. H. Brown, M.R.C.S. of a daughter. MORTON.-On the 19th August, at 39 Brunswick-street Fitzroy, the wife of Dr. F. W. W. Morton, of a son. OWEN-On the 25th August, at "Corio," Brunswick-street, North Fitzroy, the wife of F. J. Owen, M.D., of a daughter. MARRIAGES. HALFORD-IRVINE.-On the 14th August, at the Presbyterian Church, Armadale, by the Rev. A. C. Smith, George Billing Halford, M.D., of "Corowa," Wattle-tree-road, eldest son of Professor Halford, of the University of Melbourne, to Helen Francis (Nelly), third daughter of the late Major-General Alexander Irvine. M'INERNY-BRAYSHAY.-On the 31st July, at the residence of the bride's mother, 66 Lilygleu," Studley-park, by the Rev. W. G. Hindley, John M'Inerny, M.D., of Nicholsonstreet, North Carlton, to Margaratta Wright, eldest daughter of the late D. W. Brayshay, formerly of Hamilton. Contributors of Papers to the Australian Medical Journal can have copies re-printed in pamphlet form by communicating with the Publishers before the issue of the Journal. THE Australian Medical Journal OCTOBER 20, 1895. Original Article. THE USE OF COCAINE IN MINOR SURGERY. [Read before the Melbourne Medical Association.] It is remarkable, with all the wonderful activity on the part of pharmacists and others, how few drugs of really great and lasting value have been introduced of late years. Among this small number, cocaine undoubtedly occupies a high place; and it is because I think that its value is not sufficiently recognised, and that its beneficent powers are not nearly often enough availed of, that I venture to make these few remarks to you to night. The alkaloid cocaine was first obtained by Niemann in 1860 from the erythroxylon coca; but it was not until 1884 that it came into use as a local anesthetic, and at first it was employed almost exclusively for operations on the eye, anæsthesia being produced by introducing a few drops of solution. Its use was then extended to various mucous surfaces, more particularly the laryngeal, but also to the nasal, pharyngeal, rectal, and even urethral. Before long, too, it began to be employed in the minor operations of general surgery, anesthesia being produced by the injection into or under the skin, which was to be the seat of the incision, of a varying quantity of a watery solution of cocaine of varying strength. It is my intention to confine my remarks to minor operations in general surgery, to such cases in fact as come under the care of the out-patient surgeon at a general hospital, and as are met with in the practice of the general practitioner. Its beneficial action is well seen in the removal of small tumours, such as sebaceous cysts and fatty tumours, in excision of epithelioma of the lip or other growths about the mouth, and in the opening of cold abscesses. It may be used in performing circumcision in adults, but I scarcely feel disposed to recommend it for that purpose. In the casualty room at the Melbourne Hospital it is used a great deal in the trimming or removal of injured fingers, but here, in my opinion, its use is not quite satisfactory, and general VOL. XVII. No. 10. GG anesthesia should as a rule be adopted, at any rate, in the more severe of these injuries. But I am sure that the range of its usefulness might be greatly extended. For instance, three times this week I have employed it at the hospital. On Monday, the skin over distended bursa patilla was injected with a 2 per cent. solution of cocaine. An incision was made allowing the fluid to escape. The cavity was then thoroughly washed with a solution of chloride of zinc, emptied, and closed with catgut suture. The patient took no notice of the whole procedure. Yesterday, a patient required an opening for a large pyæmic collection of pus in the bursa patillæ. This was opened in the same way, much to the patient's satisfaction, as she had on a former occasion tasted the undisguised knife. The third case was that of a woman in a very low condition, with a collection of fluid in the right pleura, subsequent to an operation for hydatid of the liver. The skin was injected, then a small incision was made, without pain, and the trochar and cannula of an aspirator introduced. She appeared to suffer a good deal later on, while the fluid was being withdrawn. In all cases of tapping the chest or abdomen, cocaine should be used. In one patient whose abdomen required to be tapped every four to six weeks, and where a large trochar was used, the cocaine proved a great boon. She was a very intelligent and a very good patient, and on one occasion something was wanting so that the cocaine could not be used. I said to her, "Now, this will be what is called an experiment; we'll see if it hurts much more without than with the cocaine." It hurt very much more, and the cocaine was never omitted again. In no cases is its action better seen than in the removal of even large epitheliomata of the lower lip. All simple cases that have not been previously operated upon, I deal with by means of cocaine, injecting a small quantity along the lines of incision, whilst a piece of wool soaked in lotion is placed between the lip and the gum. After excision of a large growth on one occasion, the patient did not know that anything had been done. With fatty tumours and, as a rule, with sebaceous cysts there is no trouble at all. Some time ago, in the case of a patient with an abdominal tumour and a large amount of ascitic fluid, it seemed scarcely safe to commence giving chloroform. A small quantity of cocaine solution was therefore injected into the skin, and then the abdomen was opened sufficiently to permit of the introduction of the |