British Medical Association.

PRESIDENT'S ADDRESS.

At the Annual Meeting of the Victorian Branch of the British Medical Association, held at the Austral Salon on Wednesday the 18th inst., the following address was delivered by Dr. Snowball, the retiring president :

Dr. SNOWBALL said the most important change that had taken place in the politics of the Branch was the establishment of the Australian Medical Gazette, which was of a federal character. Their ranks had been recruited by the addition of 41 new members, consisting principally of country practitioners. The medical science of the day was in a transitory state, and the union of physician and surgeon in one individual was becoming day by day more evident. Especially was this shown by the manner in which, in many cases, scientific surgical interference was supplanting the more empiric treatment by drugs. A short time ago, if the medical man was fairly cognisant of the objective symptoms of his patients, he was considered fairly well educated, but now he must have a personal acquaintance with the more commonly known bacteria that were recognised as the cause of so many diseases. The work of the latter day healer was endless, his industry must be untiring, and his mind many-faceted. If ten years ago a prophet had dared to foretell this change in the spirit of medicine and surgery-the hope that was in store for their apparently hopeless cases-it would have been looked upon as the raving of an optimistic visionary. It was fair to say that all their progress had been due to the advance of antiseptics, or, to be more honest, cleanly precautions. Directly that was realised, it became evident that almost any organ could be handled surgically with impunity, and that the risks to patients depended more upon the possible introduction of filth germs than upon shock to the system.

Stepping closely on this advance, came the knowledge that secretions from various organs could be introduced, provided they were scrupulously clean, into other parts, and perform functions on behalf of tissues already played out. Hence came the magical part played in the introduction of thyroid juice in myxedema, of supra-renal juice in Addison's disease, and, as he hoped shortly to be able to show, of fresh bile feeding in cases of bile starvation, as

in hydatid cases. And here he could not help noting the improved position of a hydatid patient within the last few years. Immediate evacuation of the cyst had taken the place of slow drainage, and it was extremely probable that in suitable cases the time of suffering for the patient would be still further shortened by the return to the cavity of the opened exo-cyst, instead of the long process of filling-up by tube drainage. Antiseptics, and a knowledge of bacteriology had made possible Mace wan's magnificent operations in pyogenic diseases of brain and cord, and in abdominal work, the removal of large portions of incapacitated bowel, whether from accident or disease.

With all this advance, there was in some quarters an uneasy feeling that the surgeon was nowadays too prone to resort to radical measures, but he was loth to think so. No conscientious surgeon would treat or speak of a surgical operation as devoid of risk. Exactness of diagnosis was all important, and of late he feared there had been a slight tendency to allow observation in the laboratory and mortuary to walk past keen attention at the bedside. It was the living symptoms of a suffering patient they were called upon to treat-not to make nicely-mounted collections of morbid specimens. The bacteriological chemist had been doing good work, for following on the partial success obtained by tuberculin, had come the triumph gained by antitoxin in the treatment of diphtheria. But here, again, there was a tendency to forget that antitoxin was only put forward as an antagonist to diphtheritic virus in the human system, and that where, as a result of that virus, absolute change had taken place in the tissues and structures, it was cruel and futile to promise benefit from its use. It certainly seemed that in antitoxin they had a remedy which put what up to lately had been one of the bugbears of the profession in the position of an easily treated disease. The supply of antitoxin in the colony was small, and it should be a public duty to increase and maintain it. It was too much to demand such a service of the overworked and underpaid pathological laboratory of the University, for though the men there are able and willing, they were crippled both for time and money. This was an additional reason for the speedy appointment of an institute of public health, a department quite distinct from that of the Board of Public Health which was at present doing such yeoman service. The preparation of this and other toxin remedies could be carried out at the Model Farm, where vaccine virus was being cultivated. They must all

have been struck with the appositeness of some satirical lines by the Professor of Pathology at the Melbourne University in the Argus anent the contemplated appointment of a veterinary inspector. The foundation of such an institute would prevent any such difficulty arising in the future.

Already there was before both Houses a bill for the better inspection of food supply. A step further, and the endowment of such an institute would meet all requirements. The drainage of the metropolis was now within measurable distance of completion, but experience showed that possibilities of danger trod on the steps of the sanitary engineer to the very end of his work. It was to be hoped that a mild despotism would be exercised in the supervision of all house connections, and that a definite system be insisted upon and not left to individual caprice and possible ignorance. If there had been any doubt as to the necessity of draining the subsoil, it must have been dissipated by noting how rapidly an outbreak of divers zymotic disorders followed the upstirring of the soil and the dormant microbes. It was to be hoped that increased health to the city would be as marked after satisfactory drainage, as had followed the closer supervision of the water supply under the régime of the present President of the Board of Health.

He might now be pardoned if he dealt for a few minutes with a subject to which he had devoted most of his professional lifethe treatment of disease amongst children. The change that had taken place of late years in therapeutics had in no class been more noticeable than here, and particularly in the treatment of intestinal trouble in child life, the keynote of which might be expressed in attempted asepsis of the intestinal tract and absence of hurtful germs in the food supply. Apparently absolute sterilisation was hurtful, benign germs being necessary for the process of digestion. At the present moment they were threatened with an outbreak of that scourge of infant life, gastro-enteritis, and in no class of case was it more the absolute duty of those in charge of the patient to insist upon cleanliness, both of the bowel, the food, and the environ ment of the patient. The advantages of so simple a proceeding as lavage of the bowel and stomach were marked, while the predigestion of foods, which could be thoroughly and palatably performed, was a great adjuvant in the present management of this malady. Unfortunately, the fact remained that during the first twelve or fifteen months of child life, while the breast-fed babe was almost

immune from this intestinal complaint, it was still the scourge of the artificially reared. It was imperative, where possible and suitable, to obtain the natural nourishment directly it seemed likely that the child would absorb it. It was worth remembering that attention to dietetic details was of more value than drugging, and without decrying the value of the use of special drugs for special symptoms, he was strongly of opinion that more amelioration of medical disease in childhood was effected in the kitchen than in the laboratory of the pharmacist. The reverse obtained in dealing with the surgical ailments of young sufferers, and nowhere in the province of surgery was the result of wise and cautious interference more evident or more successful. This must be so when they reflected on the rapidity with which growth and absorption were going on in the young tissues. In operating on joints in children, the argument of expectancy that would hold good in the adult was not admissible, for erasion was here the operation of election, just as excision would be in adults. An exception must be made of disease of the hip, a joint whose structure was unique, and where the advantages to be derived from timely and properly applied mechanical aids were particularly well seen. The application of the splint had been greatly improved by the industry of Dr. Bennie at the Children's Hospital. The tolerance of quite young infants to active surgical interference was well exemplified in the many cases that were now recorded of successful operation for the relief of "intussusception." Another common abdominal disease, though not easily recognisable, was tubercular peritonitis, and there could be no doubt of the gain here of laparotomy and protracted drainage. As to operations for stone in the bladder in children, supra-pubic cystotomy bade fair to become the fashionable operation, but as yet in his work he had not had sufficient evidence of its worth to forsake the "lateral" method. There were a number of children in this community whose interests had perhaps been somewhat neglected, namely, the mentally feeble-those who had not passed the border line of idiocy. Till within a short time ago, when, thanks to the endeavours of Dr. M'Creery, some attempts were made at their teaching, absolutely nothing was done for them, and even yet there was room for the establishment of a proper school, where these children could be sufficiently educated to become, if not useful members of society, at any rate tolerable to themselves and others.

Melbourne Medical Association.

CHLORIDE OF ETHYL.

By W. C. DAISH, M.D., Ch. B.

Hon. Physician to Out-Patients, Melbourne Hospital.

I have put together a few notes on chloride of ethyl because, as a local anesthetic and analgesic, it seems to me to fill a gap in the equipment of the general practitioner.

It is a safe, rapid, and reliable local anesthetic, and as now supplied, convenient to carry about, and not expensive. By its means we can often give immediate relief in severe pain and gain time for internal remedies to act, and we can perform many little operations without any necessity for chloroform or a second medical man, and without having recourse to cocaine with the use of a hypodermic needle and its possible dangers, immediate and

remote.

The morphia and cocaine habits are largely on the increase and constitute a most serious danger, and the less we accustom patients to the use of the hypodermic syringe the better, and for this reason I would urge the use of ethyl chloride, where possible, in place of cocaine. There is small danger of anyone dosing himself with chloride of ethyl for its pleasurable effect.

Chloride of ethyl or hydrochloric ether is formed by the action of hydrochloric acid on alcohol, or of phosphorus chloride on alcohol. Its formula is C2H,Cl. It is a colourless mobile liquid, with a sweetish chloroform-like odour, and a sweet burning taste. Its boiling point is 52° F., so that it rapidly evaporates at ordinary temperatures, and can only be kept in hermetically sealed vessels. It is inflammable, burning with a green-edged flame. It can and has been used as a general anesthetic, and it acts very rapidly, but besides its volability, it has the following disadvantages:-

(1) It is eliminated very quickly from the system, the effect lasting a very short time.

(2) It causes a marked fall in the blood pressure, by depressing the heart, and in this respect is much more dangerous than chloroform.

For local uses it is supplied in glass tubes containing about an ounce of the fluid, sufficient for ten or twelve minor operations such as teeth extractions, or in large metal flasks enclosing about