John M. (John Milton) Niles.

The Australian medical journal, Volume 5 online

. (page 33 of 58)
Online LibraryJohn M. (John Milton) NilesThe Australian medical journal, Volume 5 → online text (page 33 of 58)
Font size
QR-code for this ebook


Closely related to the same subject was a pamphlet on " The
Histo-chemistry and Pathogeny of Tubercle,'' published in 1876.
The modem doctrines concerning the structure of tubercle were
then fairly complete. The existence of giant cells amidst a
lymphoid tissue was recognised by most original observei's. The
presence of peculiar granular bodies had been noted, and it had been
questioned whether or not they were true micrococci The infective
power of tubercle within the body was well known, and even the
most common students' text book of pathology said it was possible
that this power in products apparently inflammatory might
possibly **he determined by atmospheric influence, or by the
presence of minute organisms." Villemin, Klebs, Waldenburg,
Wilson Fox, and others, had shown that when animals were
inoculated with tuberculoiis matter they developed a disease
which these observers considered identical with human tuberculosia.
Dr. William Budd had allied tuberculosis causatively to the acute
specific fevers. Mr. Thomson, reasoning fix>m these facts, argued
that the granular bodies noticed in tubercle must be true micro*
zymes, and the true exciting or proximate cause of the disease.
He described these germs as withdrawing nitrogen from nascent
epithelial cells, the blighted cells accumulating in the air vesicles
as a nodular mass, and the microzymes remaining " buried as it
were in the ruins they produced." " The action thus set up by
micrococci would constitute tuberculosis a true mycosis. ....
If the explanation here offered be found true, it will fully account
for the febrile symptoms occurring on every fresh swarming or
multiple of the parasites; also for the consecutive anatomical
lesions in the trabeculse, inter-alveolar growths," &c, Mr. Thomson .
further brought this germ theory into relation with the doctnnes
of caseation of Buhl, Niemeyer, and others in the following way :
" While the caseous centre remains encapsuled, the external air
is excluded ; but a breach in it, caused by ulcerative absorption,
allows access by the germs of micrococci .... These germs, by
developing and multiplying, naturally migrate through the



Digitized by VjOOQIC



"318 Atutralian Medical Journal. July 15, 1883



afferent channels of the lymphatics to the lymphatic glands

There the parasites will operate, .... the resulting morbid

products being of precisely the same nature If, on the

other hand, the micrococci be taken up by the venous radicals,
they will equally readily be conveyed thence through the capillaries
•of the pulmonary artery, and thus finally reach the alveolar walls
of the air vesicles, where they will operate agaua upon the

freshly exuded protoplasm By their nature these plastid

particles of hyaline will possess the power of amoeboid
movement."

It was not till March 24th, 1882, that Dr. Robert Koch, at a
meeting of the Berlin Physiological Society, described the bacilli
which have now become famous. These bacilli probably differ
altogether from the granular bodies referred to by Mr. Thomson,
and it is still uncertain what rdle they play in the tubercular
process. But, so far as we know, Mr. Thomson was the first, not
merely to maintain without limitation that phthisis was a conta-
gious disease caused by germs, but to attempt a coherent explanation
of the phenomena of phthisis in accordance with this theory.

In 1874 Mr. Thomson was invited by the Central Board of
Health to inquire into the causes which led to the unusual
prevalence of typhoid fever during the preceding autumn. At
ihat time the most varied titles were given to the endemic fever
of this colony, as for example — typhoid, typhus, continued fever,
gastric fever, enteric fever, colonial fever, low fever, relapsing
fever, bilious fever, «tc. ; all these names then figured among the
causes of death set forth in ofiicial certificates, and no little
uncertainty seemed to prevail among both the public and a large
section of the profession concerning the true nature of the
disease. At the leading Hospitals it was fully I'ecognized that
there was only one form of fatal continued fever known in
the colony, namely typhoid or enteric fever ; and the Lecturer on
Medicine at the University, Dr. James Robertson, had for about
ten yeai-s been teaching that according to the weight of authority
this fever never arises cle tiovo, but always spreads from the sick
to the healthy, the specific iK)ison being contained in the stools of
the patients. These were the doctrines of William Budd, of
Bi-istol, first enunciated by him in the Lancet for Nov. lotli, 1856.

In 1873, Dr. Budd published his masterly work on Typhoid
Fever, its nature, mode of spreading, and prevention ; and by the
liistoiy of the North Taw ton and other outbreaks, he clearly

Digitized by VjOOQIC



JxTLT 15, 1888 Australian Medical JoumaL 319

brought typhoid within the group of specific contagious fevers, and
showed that it did spread from person to person, and from
village to village; and last, but not least, he drew up a set of rules
for popular use, whereby through due attention to disinfectant
measures the diffusion of the disease might be prevented.

However, in the same year, Dr. Murchison, in his great work
on the continued fevers, after a lengthy argument, stated that
typhoid fever ''may be generated independently of a previous case
by fermentation of faecal, and perhaps other forms of organic
matter. It may be communicated by the sick to persons in
health, but even then the poison is not, like that of small-pox,
given oflf from the body in a virulent form, but is developed
by the decomposition of the excreta after their discharge.'' In
many standard text-books the doctrine of contagion was treated
as a doubtful matter, or even gently laughed at.

Under such circumstances Mr. Thomson commenced his
inquiry; he espoused with the greatest ardour the doctrines of
Budd ; he referred to the experience of our hospitals as con-
vincing proof that we had to deal with typhoid, and typhoid
only ; and by analyses of statistics and by histories of pai*ticular
outbreaks, he endeavoured to show that contagion was the one
law which governed the prevalence of the fever. This view,
though advocated with very great ability, did not commend
itself to the Central Board, and Mr. Thomson was foi-ced to
publish his report on his own behalf. He rei>eatedly returned
to the same subject, the tlurd and last edition appearing in 1878.
Mr. Thomson now contended that the varying prevalence of
typhoid in the colony had been governed by the degree in which
disinfectant treatment had been pursued. His eai*nest and
untiring advocacy of the contagion theory has without doubt been
of decided service to the public, and has greatly hastened the
spread of nvore correct opinions among the profession ; and if lazy
Boards of Health and ignorant municipal bodies took advantage
of these views to save themselves the trouble of attention to
ordinary sanitary measures, that evil cannot fairly be laid, as it
has been, at Mr. Thomson's door. His own words are as follows ;
'* A purely contagious theory of typhoid fever causation neither
implies nor involves carelessness about dirt and disease. Dirt
creates disease in many ways, although it is neutral about one
particular mode ; and dirt engendered diseases are often deeper,
more deadly and enduring, with worse remote consequences, than

Digitized by VjOOQIC



320 Auttralian Medical J<yurnal. July 15, IMS

even the fatal outrspoken fever." It may be regretted that
Mr. Thomson did not bend his acute mind to a fuller study of the
conditions which favour or check the activity of the typhoid
virus— a field in which so much remains to be dou?. But perhaps,
had he done so, he would have clouded his main issue that the
disease is due to germs and can be prevented by appropriate dis-
infectant measures, a doctrine which all recent experience has only
served to confirm.

Space will not allow us to follow Mr. Thomson in his other
works ; he always took a lively interest in the prevention of the
various cattle plagues, and thus again placed the colony in his debt
In 1871 he was elected a Fellow of his College ; and for many
years he was a member of the Medical Board of Victoria. He
devoted much attention to the Bacon-Shakespeare controversy,
warmly espousing the title of Lord Bacon to the authorship of our
great national dramas ; but despite all the learning and ingenuity
which he brought to the defence of his pet theory, the public
would none of it. For many years Mr. Thomson was deeply
engaged in an extremely large practice ; his views on the
contagious nature of phthisis and the influence of antiseptics
attracted to him great numbers of consumptives, and cases of
chest dise-ase generally ; and it was matter for wonder how he
found time for his varied literary undertakings.

It will thus be seen that we regard Mr. Thomson's works as
having been of most signal benefit to the community ; and we
deeply regret that a vein of acrimony an<J ego-ism which frequently
intruded itself into his writings alienated during his lifetime many
who might have been his co-workers. But none the less earnest
is the general tribute to his memory, as a man of great talents,
wide culture, immense industry, who laboured untiringly for the
public welfare: His death took place at his residence '* Gamock,"
South Yarra, on May 22nd, in the 64th year of his age.



LIST OF WORKS PUBLISHED BY MR. THOMSON,

** The Transversus Pedis in the foot of the Gorilla," 1864.

" On Phthisis and the Supposed Influence of Climate," 1870.

** A Sequel to the Essay on Phthisis," 1871.

** On Typhoid Fever in Melbourne," 1874.

" The Histochemistry and Pathogeny of Tubercle," 187(5.

** A Third Analysis of the Statistics of Phthisis in Victoria —
completing the series — to which are prefixed Remarks on
one of the Modern Modes of Medical Treatment," 1876.



Digitized by VjOOQIC



July 15, 1883 Atutralian Medical JomfwU. 321

"Etiology of Typhoid Fever," 1878.

" On Phthisia aad the Supposed Influence of Climate-— being

an analysis of statistics of Consumption in this part of

Australm — with remarks on the increase of that disease in

Melbourne," 1879.
"Remarks on a Review of the Report on the Cause and

Extent of Typhoid Fever in Melbourne," 1879.
" The Lancet and tiie Aram on Typhoid Fever in Melbourne,"

1882.
" The Cerm Theory of Phthisis verified and illustrated by the

increase of Phthisis in Victoria," 1882.
"The €^rm Origin of Tubercle, illustrated from the History of

Phthisis in Victoria," 1882.
" The C^rm Theory of Disease applied to eradicate Phthisis

from Victoria," 1882.
" On Renascence Drama, or History made Visible," 1880.
" The Political Allegories in the Renascence Drama of Francis

Bacon," 1882.
" William Shakespeare in Romance and Reality," 1881.
" Bacon and Shakespeare, on Vivisection," 1881.
** Bacon not Shakespeare, by W. T., in rejoinder with

Shakespeare not Bacon, by J. S.," 1881.
" Ship Yachts and Full-Power Steamers," being a letter to the

President of the Melbourne Chamber of Commerce,

15th December, 1872.



SystemaUc Cennu of Atutralian Plants : Part I. Vasculares.

By Baron F. Von Mueller, M.D., F.R.S., &c. The

Government Printer, Melbourne, 1882.
This work supplies another proo^ if proof were needed, of the
extensive erudition and unwearied industry of Baron von Mueller,
who has made the study of the Australian flora his life's work.
Of its value to students of that flora, and even to botanists
generally, there can be no doubt ; and there can also be no doubt
that it was needed. The great " Flora Australiensis," begun by
Mr. Bentham, but carried on very largely by the assistance of
Baron von Mueller, contains descriptions in proper order of most
of the known plants of this continent ; but, since its publication
was commenced in 1863, many new species have been discovered
and described which could not find a place in that work.
Supplements will be needed, but they would involve much labour
in preparation, and some delay would of course bring with it the

X



Digitized by VjOOQIC



322 Afutralian Medical Journal. July 16, 1888

advantage of allowing of completeness, no small matter in a book
which is not likely soon to run to a second edition. The object of
the present work is to supply full and exact references to all
publications, in which are to be found descriptions of plants
whether given in the " Flora " or not. Most of them are to be
found in the " Fragmenta Phytographi«," the volumes of which
themselves needed some such systematic index. But this work is
much more than a mere index to the "Flora" and the "Fragmenta,"
since it supplies references also to the first puUished descriptions,
with dates and names. It is therefore in a manner a history of
Australian descriptive botany. And even with this its interest
and value are not ended ; since, by the addition of notes showing
when and by whom the various genera, natural orders and other
divisions were set up, it also becomes to a certain extent a history
of botanical classification in its present form. If Baron von
Mueller had been able to carry out his wish of adding to the
Australian habitats references to localities in other parts of the
world where certain species also occur, the interest of the work
would have been considerably increased, as it would thereby have
become also an essay on the geographical distribution of plants
found in Australia. Such additions perhaps would have been
beyond the scope of the Census, and would have necessitated an
increased size of page, with, of course, considerable increase also of
labour and expense. For the work as it stands gratitude is due
to the learned author, and if space did not fail many points of
interest might have been mentioned, suggested by a review of its
pages. It is to be earnestly hoped that such encouragement and
assistance may be given to Baron von Mueller, that he will be
able to issue the second part, containing similar lists of the
Australian *' Evasculares '' at as early a date as possible.

===—===== J.J.

THE LANCET.
PlumbUm.
Dr. Porter of Sheffield, in referring to the relative frequency of
the special symptoms of lead-poisoning, stated that among thirty
cases colic had occurred in twenty-seven, some loss of power or
paralysis in eighteen, and eclampsia in two. The characteristic
blue line was present in twenty. He believed that lead palsy

Digitized by VjOOQIC



July 15, 1888 Australian Medical Journal. 82S

only occurred after long exposure to the poison. As to
pathology, he stated that it was doubtful whether the palsy was
<lue to an anterior polio-myelitis, or whether it was to be regarded
as a general peripheral neuritis. He dwelt strongly on the
importance of preventive measures being adopted among those
who were unavoidably exposed to the action of lead.

Chlorosis and Pyrexia.

Although much irregular fever has been detected in cases
of so-called progressive or pernicious ansBmia, the temperature
of the ordinary cases of chlorosis met with in young women is
usually believed to be normal This belief has been contested
by M. Moli^re in a recent number of the Lyon JiSdicale. His
observations were made on eight young women who presented
no other signs of disease beyomd the an»mia for which they were
under treatment. The temperature was taken every morning
and evening over a period varying from two to fifty days, and
was found to oscillate between 101-8^ F. and 102-8«* F. The
Amount of urea eliminated per diem was estimated and found
io be normal.

Perforating Ulcers of Both Feet.

A case of the above, reported by Mr. Frederic Heath, contains
A report of the microscopical appearances of the nervous lesions.
The posterior tibial nerves were examined. There was a great
increase of the connective tissue, especially the peri and epi-
neurium. The lymph spaces surrounding each nerve bundle in
the trunk were much expanded.

The chief points in which the case differs fi-om those previously
reported are — (1.) There was no ansesthesia of the affected limbs,
but on the contrary, in the case of the left leg at least, hyper,
sensitiveness. (2.) There was no profuse or foetid sweating in
the left leg or foot, although this was occasionally found in the
right. (3.) There was no diminution of tendon reflexes.

The Micrococcus of Gotiorrhoea.
Dr. Sternberg of Philadelphia, U.S.A., has continued hi9
observations on this subject. He finds that the micrococcus i6
continually pi-eseut in gouorrhoeal pus; it has in all cases the
same morphological appeaiunces, and no other organisms than
it develope in culture fiuids inoculated with this pus. His
experiments agree with many other facts adduced against the

X 2



Digitized by VjOOQIC



S24 AtutraUan Medical Journal. July 15, 1881^

specific nature of gonorrhoBa, and they show the need of caution
against accepting the disooyery of the presence of a microooccua
in a morbid discharge as proof of the rdle played by the organiBm
in the causation of the disease.

On a Method of Controlling Hamorrhage in Amputation at, or
JSxcieion of, the Hip-joint, — ^Mr. Jordan Uoyd, in a paper read
before the Midland Medical Society, describes his method for the
above* , It consists in first emptying the affected limb of
bloods by elevation. A strip of black indiarubber bandage,
about' two yards long, is to be doubled, and passed between the
thighS) its centre lying between the tuber ischii of the side to be
operated on and the anus. A oommon calico thigh roller must
next be laid lengthways over the external iliac artery. The ends
of the rubber are now to be firmly and steadily drawn in a direction
upwards and outwards, one in front, and one behind, to a point
above the centre of the iliac eldest of the same side. They must
be pulled tight enough to check pulsation in the femoral artery.
The front part of the band passing across the compi-ess occludes
the external iliac, and runs parallel to and above Pouparf s
ligament. The back half of the band runs across the great sacro-
sdatic notch, and by compressing the vessels passing through it,
prevents bleeding from the branches of the internal iliac artery.
The ends of the bandage thus tightened must be held by the hand
of an assistant, placed just above the centre of the iliac crests the
back of the hand being against the surface of the patient's body.
It is a good plan to pass the elastic over a slip of wood held in
the palm of the hand, so as to diminish the pain attending the
prolonged pressure of the rubber 1)andage. The solid rubber
tourniquet may be used instead of this bandage. He prefers,
however, the bandage. The soft parts are less damaged by reason
of its greietter breadth, and it is less likely to roll off the compress
placed over the external iliac. The ligature being altogether
above the limb, is out of the way of the surgeon in any operation
at or about the hip-joint. The great trochanter is fully exposed,
the hip being free upwards as far as the iliac crest, and inwards
to the perineum. The plan is equally applicable in amputation
by transfixion, or in excision of the joint.

On Three tSttccesrfiU Casee of Nephrectomy. — Mr. Knowsley
Thornton, in commenting on these cases, states that ihey seem to
demonstrate the advantage of the lateral over the median incision j

Digitized by VjOOQIC



July 15, ld88 Aiutralian Medical Jaumai. 325

the perfect suitability of the abdominal operation to all cases in
which nephrectomj, and not mere nephrotomy, is the end aimed
at ; the capability of the peritoneum to dispose of large quantities
of effused fluid under aseptic conditions, without the aid of the
drainage tube, and without serious constitutional disturbance
arising from the absorption of the effused fluids, even after the
removal of such an important eliminator as the kidney. The
great difierenoes in the ages of the patients, seven, twenty-six, and
fifty-eight, and the varying diseases for which the operations were
performed, make the records of especial value. '^ The operation
of Langenbach, with the extra-peritoneal treatment of the bladder
end of the ureter, seems so surgically perfect^ that I cannot
conceive any case presenting itself in which I should care in the
future to face the difliculties and uncertainties of the loin incision.''

Iodoform. — Mr. A. F. MHjrill believes that iodoform may be
applied with advantage in four different classes of cases : — (1.) In
old septic wounds, the result of inflammation or of traumatism.
(2.) In recent wounds, in the infliction of which it is impossible
for the surgeon to adopt full antiseptic precautions. (3.) In
wounds near any of the natural orifioes of the body. (4.) As an
external application combined with other antiseptic dressings.

Catarrhal Deajheu in Children. — Mr. Field read some notes on
this subject to the Harveian Society of London. Catarrh of the
middle ear is the commonest and most important cause on account
of its sequels ; its early arrest is of the highest moment. It may be
£elf-curative, but the popular plan of leaving it to itself is unsafe.
For its cure one has to abolish the fons et origo malij catarrh of
the naso-pharynx. The first effects of the latter disease are
43welling and blockage of the Eustachian tubes, and consequent
deafness from rarefaction of the air in the tympanum. Thickening
of the membrana tympani, clogging of the tympanic cavity, and
interference with the movements of the ossicles are among
its ultimate serious effects, and autophony and noises caused
by the mucus in the tympanum may occur as symptoms. Chief
among the means of treatment is Politzer's air-bag. The use
of this bag, as also of Valsalva's method of ventilating the
tympanum, may be rendered more than futile by a too frequent
employment. Astringents, tonics, and mild aperients must not be
ignored, as also the influence of hygienic and local conditions, and
subjects of the disease should be cautioned to provide against the
.admission of cold water into the ear in bathing.

Digitized by VjOOQIC



326 Australian Medical Journal. Jult 15, 188a

Cigarette Smoking, — In cigarette smoking the tobacco leaf is
reduced to very fine shreds, and it is consumed with great celerity.
The smoke passes directly into the mouth, and whatever nicotine
there may be to affect the ot^ganism of the smoker is taken up with
especial avidity. The influence of cigarette smoking on the pulse
IB often strongly marked. The sphygmograph gives tracings which
are characteristic of the depression produced by tobacco on the
vaso-motor centre and nerves, and these tracings are more
characteristic in the case of the habitual smoker of cigai*ettes than
in that of the smoker of cigars or a pipe. The writer concludes,
" We neither share the fashionable belief that alcoholic drinks are
injurious when taken in strict moderation, nor do we for a
moment think that a moderate use of tobacco is to be deprecated,
except in special cases ; on the contrary, we are convinced that for
the relief of many mind and nerve troubles, and for the reduction
of needless and mischievous excitement in the brain and other
nerv^e centres, tobacco smoking is often useful ; but at the same
time we are persuaded that a protest against the habitual smoking
of cigarettes is needed."

Severe Hasmorrhage after Tooth Extraction treated by Trans,
fusion. — The Bevue OdoiUologique contains a case of almost fatal
haemorrhage after tooth-extraction. The patient, a young soldier of
twenty-two, with a marked history of hereditary and collateral
hsemorrhagic diathesis, was admitted to the H5tel Dieu, and had
some molar roots removed, without telling the house-surgeon any
facts as to his history, and the operation was followed by profuse-
haemorrhage of a dark color without clots. Next morning
plugging with lint and perchloride of iron was tried without per-
manent effect. On the third day actual cautery was tried at the
bottom of the socket, followed by sponge pressure, the jaws being
£xed by a bandage, and ergotine subcutaneously injected. On the
fourth and fifth there was no haemorrhage ; injections continued-
Next day (sixth) the bandages were removed, owing to sloughing and
suppuration of the gums, and from the raw surfaces profuse
bleeding recurred, and no local measures were effective to arrest
it. On the eleventh day the patient was moribund, and it was-
decided to try transfusion of blood. After plugging the socket
again, 100 grammes of blood were transfused into the cephalic



Online LibraryJohn M. (John Milton) NilesThe Australian medical journal, Volume 5 → online text (page 33 of 58)