product of the most complete and scientific experimental work, one was thoroughly justified in being enthusiastic about its value. as a therapeutic agent.

The

Dr. JEFFREYS WOOD said the profession were much indebted to Drs. Cherry and Mollison for having presented this paper to the Society, and for the work they had done towards the introduction. of the antitoxin treatment of diphtheria in Melbourne. recent outbreak of diphtheria in the wards of the Children's Hospital had been referred to by the writers of the paper, unfortunately it was not the only outbreak that had occurred at this hospital. In the year 1889, eleven cases developed diphtheria in the wards and died; in 1890, four more cases died from the same cause; and in 1894, two cases of diphtheria occurred and died. This year we had eleven cases, with only one death, and this death was due to a bad broncho-pneumonia rather than to the intercurrent diphtheria, which latter was wonderfully improved by antitoxin injections. The facilities afforded to the authorities of the Children's Hospital by Dr. Cherry at the University enabled a definite diagnosis to be made in the case of every suspicious throat at the very commencement of the outbreak, and cases that in former epidemics would have been permitted to remain in the wards were promptly isolated. By this means, the

epidemic was taken in hand early, and the result was excellent compared with our previous experience of waiting for clinical diphtheria to manifest itself before isolation. Outbreaks of diphtheria in the wards of Children's Hospitals are not at all uncommon, and the recent experience of the Boston Children's Hospital is well worth noting. In 1894, this hospital was closed on three separate occasions on account of outbreaks of diphtheria. In January 1895, a fourth outbreak occurred, and immunising injections of antitoxin were used to check the spread of the disease, with excellent results. The injections were found to lose their effect in about thirteen days, and were repeated at that interval in the case of every inmate of the wards. Nearly every child admitted was injected, and no harmful effects occurred, even in children ill with pneumonia, typhoid, empyæma, &c. In the case of new patients applying for admission, it was found that no less than 20 per cent. presented the diphtheria bacillus in their throats, although no sign of clinical diphtheria was visible. The effect of antitoxin injections on cases presenting the diphtheria bacillus alone in their throats was found to be nil,

atomised strained lemon juice being the most effective means of getting rid of the bacilli. To know that in antitoxin we have a remedy by which we can certainly check the spread of diphtheria in the wards of a children's hospital is a most wonderful advance in our knowledge, and one that will be of immense benefit to the authorities in the future.

Dr. CHERRY, in reply, said that the value of the evidence furnished by this series of cases depended on the character of the present type of disease. No other series of fifty cases with the like mortality had ever been presented to the Society. If the present type of diphtheria were, as they held, somewhat more virulent than in 1893, then there was no other factor except the new treatment which could be pointed to as the cause of the improvement. More careful nursing and improved hygiene may have something to do with the result, but their importance may be easily overrated, for it is certain that they did not bring about any startling improvement in results until reinforced by bacteriological methods. The twofold nature of these methods should be borne in mind. In the first place, the diagnosis is usually no longer a matter of doubt, but one nearly approaching to certainty. Formerly, it depended largely upon the theoretical views held by the physician as to the local or constitutional origin of the disease. The demonstration of the bacilli in the throat changes our views of a case, just as a patient suffering from a slight pleuritic pain is suddenly transferred to a new category by the discovery of tubercle bacilli in his scanty expectoration. The bacteriological diagnosis of diphtheria is of itself a great step forward, because early local treatment will in many cases stop the disease. Then came the antitoxin-and here it was difficult to understand the doubts expressed as to its being a specific remedy in face of the countless laboratory experiments, and when it was admitted that one of the most striking clinical phenomena was the way in which it caused the false membrane to loosen and disappear. For how is this brought about? The false membrane is formed by the necrotic action of the toxins upon the epithelial cells, and these dead cells form the pabulum for the bacilli. The faster the toxins are secreted, the faster is new food supplied for the further multipliIcation of the bacilli. Now, the arrest of this process can only be explained by the antitoxin interfering with the nutrition of the epithelial cells in such a way as to counteract the effect of the toxins upon them, and hence the loosening of the membrane

affirms the specific nature of the remedy. To stand by and allow a case to become severe before using antitoxin indicates ignorance of the experimental results upon which the new treatment is based. Its failures should be reckoned, not by the deaths of patients moribund on admission, but by the number of cases which die after it has been used early in the disease. Fourteen years ago, there was a discussion in this Hall upon diphtheria. At that time the chief points in debate were the local or constitutional nature of the disease-whether it was contagious or not, and the value of local treatment of any kind. may now be given to each of these questions. no longer empirical, but rational; and there is every ground for the hope that before many years have gone a case of virulent diphtheria will be as great a curiosity as one of hospital gangrene is at the present time.

SPECIAL MEETING.

Definite answers

The treatment is

The PRESIDENT said that a deputation from the Medical Defence Association had recently waited upon the Chief Secretary, to urge upon him the necessity of introducing a Bill into Parliament to suppress the indecent advertisements that appear in our daily press. The Chief Secretary received the deputation very favourably, but said that he would like to have his hand strengthened by an expression of opinion on the subject from the several Medical Societies of Victoria. It certainly was a public scandal that our press published these advertisements, and it gave him much pleasure to move- "That in the opinion of this Society it is expedient that a Bill be introduced into Parliament in order to suppress indecent medical advertisements."

Dr. J. P. RYAN considered that it was a disgrace to us as a community that such advertisements should be allowed to appear, and had much pleasure in seconding the motion, which was carried.

EXHIBITS.

Dr. GARDNER showed the following pathological specimens:(1) Hydroceles and Testicles removed from a patient suffering from an enlarged prostate gland, which rectal examination showed to be of immense size. The urine was ammoniacal, and loaded with muco-pus. He was passing water every hour, and his condition was pitiable in the extreme. The operation was followed by an attack of acute mania, as in the cases reported by Mr. Faulds, of Glasgow, in the Lancet of May 4, 1895, who

quotes seven cases with six deaths, three deaths occurring in four cases under his own care, and two under a colleague. My patient recovered, and is now enjoying good health, micturating only about four times in twenty-four hours. The prostate was found to be reduced one-third in size when he was examined about three months after the operation, which took place on May 23, 1895.

(2) Tubes and Ovaries removed for pyo-salpinx, December 24, 1894. Both were as large as medium-sized oranges, and the right ruptured twelve hours before the operation. At the operation, pus was found free in the abdominal cavity, which was washed out with normal salt solution, and drained for forty-eight hours. Temp. 103° F. at the time of the operation, and steadily came down to normal in a week. The patient made an excellent recovery.

Dr. BALLS-HEADLEY showed a large Ovarian Cystoma, the notes of which appear in another part of this number.

Dr. DUNCAN showed two Calculi, one a large biliary calculus, and the other a vesical calculus, weighing 2 ozs. 20 grs.

The former was removed from a female patient, æt. 60, the subject of intense cholæmia for some months prior to the operation. The gall-bladder was much distended and full of pale mucoid fluid, without any appearance of bile. The patient made a good recovery.

The vesical calculus was removed from a gentleman, æt. 58, who for years had had symptoms of stone of the most pronounced kind. Although frequently sounded, no stone could be detected, except on the last occasion, when it was easily struck. Supra-pubic cystotomy was performed and the stone removed. A well-marked diverticulum accounted for the want of success in finding the stone earlier. The patient made a good recovery.

Dr. MOLLISON showed the following specimens:--

(1) An Infantile Uterus.-This was removed from a woman about 30 years of age. The organ was quite undeveloped, the cervix formed the greater portion, the body being almost absent, while the mouths of the Fallopian tubes were large and funnelshaped. The ovaries were not bigger than small peas. The vagina was considerably shorter than normal, the pelvis approximated to that of the male, and the breasts were small.

(2) A Cerebellar Abscess.—This specimen was obtained from a boy with necrosis of the mastoid cells. The inflammation had

spread to the dura mater, which on its inner surface was lined with a layer of lymph, and formed the outer boundary of a large abscess in the left lobe of the cerebellum.

(3) A Sarcoma of the Kidney, removed by operation by Mr. C. S. Ryan. The growth occupied the greater part of the substance of the organ, which was considerably enlarged. The tumour consisted principally of large cells, with a more or less abundant fibrous framework; the cells, however, were distinctly of connective tissue origin.

(4) Tuberculosis of the Fallopian Tubes, occurring in a young woman with lymphatic leucemia, who died from an attack of erysipelas. Both tubes were greatly swollen, contorted, and distended with soft cheesy tubercular matter. Their abdominal ends were sealed by inflammatory exudation. There was no other tubercular focus in the body.

(5) A Vermiform Appendix, removed from a boy about 15 by Mr. T. N. FitzGerald. The appendix was surrounded by a collection of foul-smelling pus, and was found to be gangrenous in two distinct places-at the base and at the tip. The patient recovered perfectly.

Dr. MOLLISON also showed Two Carcinomatous Uteri, successfully removed per vaginam by Dr. Dunbar Hooper.

Medical Defence Association of Victoria Limited.

A meeting of the Council was held on September 30. Present: Drs. Hamilton (in the chair), Brett, Howard, Jamieson, McAdam, Mullen, and Goodall.

Re orders of burial by J's. P. without inquest or medical certificate of cause of death, Hon. Sec. was instructed to write to Secretary of Crown Law Department in reference to ruling in the

matter.

Re Certification of Insanity.-Council decided to print and forward to members of the Association forms of indemnity, to be signed by responsible representative of insane person, protecting certifying medical man in case of legal action.

Re Medical Officers and Benefit Societies.--Draft form of agree. ment to be prepared and forwarded to members.

Re Unregistered Houses for Treatment of Women's Diseases. Referred to Indecent Advertisement Committee for action..

HH