John M. (John Milton) Niles.

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<iaused by a fall when she was nine years of age ; it gradually got
better, and she was free from pain till she hurt it some months
before her admission. After keeping her under notioe for two
months, I formed the opinion that the attacks of mania were
caused by the disease in the knee, and advised her to have the leg
taken off; and to this she gladly consented, and her husband also
agreed to the operation. The thigh was amputated on the 7th of
May, by a long anterior skin flap and short posterior flap, made
by transfixion through all the soft parts of the back of the thigh.
Mrs. R. made a very good recovery, and had no return of the mania.
She was discharged from the Asylum on the 24th of July, and I
recently heard that she has since kept welL

The second case was that of an epileptic girl, E. D., who was
allowed out on trial with her friends. When under their care she
fell into the fire in a fit, and was returned to the Asylum with
severe bums on the right side of the face and head, the eye on
that side being greatly disorganised. After her return the
epileptic fits were very severe and frequent, and her general
health very unsatisfactory. After a few weeks I advised the
friends to allow the diseased eye to be removed, both with the
view of saving the other eye and of improving her general state.
Her mother told me that a medical man had advised her not to
have any operation, as he believed the girl would die under chloro-
form ; she, however, left the matter in my hands, to do what I
thought best. On examination, I found the heart to be weak, but
otherwise free from disease. Equal pacts of chloroform and ether
were given, with very satisfactory results, and the eye removed
without trouble. In less than a week the parts were healed, and
the girl up and about. Since the operation she has had only a
few slight fits, and her general health has improved to a marked
4legree. The attendants say she is now no trouble in the ward.

LL 2

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532 Australian Medical Journal, Dec. 15, 188S

AN ANTISEPTIC TREATMENT OF TYPHOID FEVER.

By Geo. Talbot Woolley, M.R.C.S. Eng.

Finding that a considerable number of cases of typhoid fever
occur from time to time in this colony, I have taken the earliest
opportunity of bringing before the notice of the profession a line
of treatment, which is thoroughly consistent with the germ theory
at present accepted, and which most certainly was justified by its
results, and is in my opinion the only rational treatment for all
diseases that owe their origin to a foreign poison introduced into
the system, especially when that poison can be distinctly demon-
strated to have an actual existence in the body.

Very nearly nine-tenths of the cases are treated on the expectant
system, that is to say, a patient who is known to be stricken down
by a definite poison is simply put to bed and there allowed to
remain, with some cooling drink given, until the diseaae has nm
its unchecked course, symptoms only having been treated, and the
whole skill of the medical attendant being expended in guarding
against any probable bad results of the disease, rather than in
checking its career before any of those results have had tdme to
take place.

I have been enabled to apply the treatment to about 20 cases,
the diagnosis having been confirmed by additional testimony in
nearly every case, and as an illustration I am luckily enabled to
select three cases belonging to one family, all living in the same
house.

On being called in to see two children, aged respectively about
11 and 13, I was at once struck by their typhoid appearance, and
on examination found the typical stools, tongue, doughy abdomen^
and rose spots of typhoid fever, there being, as I afterwards found
a history of recent typhoid in the next house.

I ordered the usual sti*ict attention to rest in the recumbent
position, together with slop diet, and put each child on 3
minim doses of carbolic acid every 3 hours. On visiting them
the next day they both had a dry hot skin, and there was no
alteration in the feces ; but on the third day both looked brighter
and relieved; they had broken out into a gentle perspiration,
the tongue being moister and cleaner, and the faeces looked
decidedly more healthy. After this they made a daily improve-
ment, and at the end of a week the temperature was normal, the



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Dbc. 15, 1883 Australian Medical Journal. 533

motions well formed, all tenderness in the line of the colon gone,
and the rash disappeared, and in ten days they were both up and
well.

About the third day of my attendance a younger sister, aged
•eight years, was laid up with precisely the same symptoms as the
other two, but as a matter of experiment she was treated on the
expectant system, and given a little dilute nitro-hydrochloric
Acid. The disease, however, ran an almost typical course, it
being about a month or five weeks before the child was well
•enough to be moved ; thus showing the immense advantage of
the antiseptic treatment.

The above cases show no theoretical treatment worked out in my
mind, but were actually watched by another medical man, who is
almost a sceptic, but who was bound to admit that the cure was
perfectly genuine.

I have not written an elaborate treatise on typhoid fever, the
symptoms of which are unhappily only too well known, neither
have I given a separate account of all the cases I have treated
with the carbolic acid, but have simply selected a typical case,
and, having detailed the treatment, let the facts speak for them-
selves, for I consider them quite as eloquent as the subject is
important.

The disease being almost purely intestinal, I am inclined to look
upon the altered condition of the faeces as a sure indication that
the condition of the bowels was being improved, which improve-
ment took place under the direct influence of the antiseptic
administered.

In offering the above remarks, I do so with the greatest
deference to my older brethren, and with the hope that it may
induce some of them to try the above treatment, and, having done
fio, to place their experience on record, for there is no more
valuable source of information than the experience of general
practitioners, who are in a position to follow their cases up from
beginning to end.



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534 Atutralian Medical Journal. Die. 15, 188S



ORDINARY MONTHLY MEETING.

Wednesday, December 5th, 1883.

(Hall of the Society, 8 p.m.)

Present : Dr. McCreery, Dr. T. B.Ryan, Dr. Gray, Dr. Jackson^

Dr. E. M. James, Dr. F. J. Owen, Dr. J. P. Ryan, Dr. Haig^

Dr. Hewlett, Dr. C. S. Ryan, Dr. MacGiUivray, Dr. Brett, Dr.

J. S. Wilson, Dr. Le Fevre, Dr. Neild, Dr. Bage, Dr. Florance,.

Dr. J. Williams, Dr. Moloney, Dr. Alien, Dr. Bowen, Dr.

Jonasson, Dr. Girdlestone, Dr. W. Barker, Dr. Alsop, Dr.

WooUey, Dr. Snowball.

The President, Dr. James, occupied the chair.

The minutes of the two preceding meetings were read and
confirmed.

Correspondence.

A letter was read from Dr. Burke, the senior Vice-President
of the Society, requesting that he should not be nominated for
the Presidency, as his many evening engagements rendered it
impossible for him to attend the meetings of the Society with any
regularity.

Resignation.

The Hon. Secretary reported that Dr. Smythe, of Sandridger
had tendered his resignation of the membership of the Society,
which had been accepted by the Committee. In two separate
letters Dr. Smythe ui^ed that his reasons for resigning should be
read to the Society, but as they partook of the nature of a
complaint against a member of the Society, the function of
dealing with them rested in the first place with the Committee r
the Committee had so dealt with Dr. Smythe's statements, and
did not consider it necessary to bring them before the Society.

New Members.
The following gentlemen were then unanimously elected
members of the Society : Dr. W. Beattie^mith, F.R.C.S. Ed.,
L.R.C.P., of Yarra Bend Asylum, proposed by Dr. McCreery and
seconded by Dr. Allen ; Dr. A. Y. Henderson, M.B. et Ch.B. Melb.
of Ascot Yale, proposed by Dr. Allen and seconded by Dr.
Jamieson ; Dr. Barclay Thomson, L.R.C.P. et S. Ed., of South



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Dbo. 15, isas Australian Medical Joumai. 535

Yarra, proposed by Dr. "Webb and seconded by Dr. Allen ;
Dr. G. H. Zichy-Woinarski, M.B. et Ch.B. Melb., of Donald,
proposed by Dr. Stirling and seconded by Dr. Allen ; and Dr.
George Talbot WooUey, M.R.C.S. Eng., of Collins^treet east,
proposed by Dr. Neild and seconded by Dr. J. P. Ryan.

Three gentlemen were nominated for election at the next
monthly meeting.

Nomination of Officb-bearbbs of the Society for 1884.

A ballot was then opened for the nomination of office-bearers
of the Society for the year 1884. Dr. Williams and Dr. J.
P. Ryan acted as scrutineers. The number of nominations was
as follows : President 1, two Vice-Presidents 13, Hon Treasurer
4, Hon. Secretary 1, Hon. Librarian 1, six Members of Committee
30, two Auditors 4.

The following paper was then read :

ON PHIMOSIS AS A CAUSE OF REFLEX NERVOUS
AFFECTIONS.

By Wm. Snowball, M.B., L.R.C.S. Ed.
Hon. Surgeon to the Children's Hospital.

The fact that symptoms of most grave moment affecting im-
portant organs may in many cases be due to a slight exciting cause
in a remote part, is in no cases better exemplified than in those
where the apparently trivial condition of phimosis will, by
reflexion of irritation, produce the most alanning symptoms.

In the following cases which I have picked out of a considerable
number, as being most typical, I believe the performance of a
very simple operation saved in some cases lives, and in many
deformity.

For convenience I have divided the cases into two classes : —

1st — Where the trouble was reflected to the large nervous
centres, as the brain or spinal cord.

2nd — Where special groups of muscles were aflected. The two
following are well marked cases belonging to the first group : —

C. B., aged 4 years. First seen in Februaiy, 1882. The
mother states that for the last eighteen months the child has been
subject to peculiar convulsive seizures, especially if he were at all
unwell. The attack would seize him at any time, but particularly
during the night. There was no stupor following the seizure, the



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536 Atutralian Medical JcwmaL Dbo. 15, isas

child being apparently otherwise in good health. He had been
under various treatment^ the complaint being considered epileptic.
The family history is good. On stripping the diild he is strong
looking and well nourished. His prepuce is tightly adherent to
the glans. Though the preputial orifice is patent there is consi-
derable hypersensitiveness about the part, for when the prepuoe^ is
touched a peculiar thrill passes through the thigh muscles. The
prepuce was forcibly separated from the glans, the mother not
consenting to circumcision, a considerable amount of sebaoeoos
material removed, and the mother instructed to dress the surfiftoe
with oil to prevent re-adhesion. The child had one or two con-
vulsive seizures during the next week, but has had none since.

H. T., aged 20 months. First seen on November 30th, 1882.
The mother states that since the child was ten months old he has
had, at intervals of four or five weeks, what she calls epileptic fits,
the symptoms of which were violent convulsions affecting muscles
of the limbs and trunk. Tongue bitten since the teeth came ;
foams at the mouth, and lies after the attack in a state of stupor
for about an hour. The family history is good ; the father has a
slight strabismus, which followed scarlatina in infancy. The child
is well nourished and healthy looking ; has cut most of his teeth.
Head large, but well shaped. Has an extremely tight prepuce,
and frequently cries just before micturition. The father, on being
questioned, stated that he had noticed on several occasions the
fits had been preceded by a condition of the penis not unlike
chordee. On December 3rd, 1882, with the assistance of Dr.
Stirling, I removed the prepuce, and since then the child has bad
but two convulsive seizures, and these were both within six weeks
of the operation.

The following cases are examples where the muscular system
was most at fault : —

F. N., aged two years. First seen in March, 1880. The
mother informed me that for the last fourteen months the child
had suffered from prolapsus ani, which was gradually getting
worse. It had had various treatments — worms, stone in the
bladder, debility, being at different times assigned as the probable
cause. The child is otherwise healthy, is thriving well, and has
not any di£&culty in passing his water.

The family history is good. The child is well nourished, and
healthy looking. On attempting to examine him he commenced
to scream, and immediately a prolapse of the rectum took pAace

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DIM, 15, 1688 AiutraUoff^ Medieal JaumaL 537

to the extent of about two incheB. I found, on examination, that
his prepuce was tightly adherent to the glans penis, though the
opening was patent. This condition of things was rectified by
stripping the prince back^ and a quantity of indurated smegma
removed. Thenurse was told to dress theparts with oil, and to bathe
the gut, before replacing it, with cold water. Three months after
I had a letter saying the child was much better, and a short time
ago I saw the child, when he was perfectly welL I look upon this
case as one of paralysis of the sphincter ani, as the gut prolapsus ,
was quite a passive condition, and not a forced one, as is seen in,
those cases where it is squeezed down by constant straining. ,

R. 0., 4 years old. First seen April 4th, 1882. The case waa
brought to me as being one of hip-disease in the &rst stage. i

The mother states that for the lant three months the child has
dragged his left foot in walking, and complained of pain in the '
1^ leg. He frequently cries out in his sleep, as if in pain. There i
is no history of a previous accident.

On examination the child stands with the left leg slightly thrown
forward, and the foot everted. Walks with a decided limp ; and
though he complains of pain in the limb, it caainot be localised. ^
The adductor muscles of the left thigh are tightly contracted. He >
has a tight phimosis, and, on touching the prepuce with a probe,
spasms of the contracted adductors took place. He was circum-
cised, and the left thigh, especially on the outer side, rubbed with
a stimulating linament, and in two months he was quite well.

S. N., 4 weeks old. Was first seen October 7, 1882. Was
brought in with double talipes varus. At the same time I was told
he screamed and strained considerably just before passing water.
The deformity in both feet was easily overcome by a little force,
but on relieving them, they at once fell back into erring positions.
The foreskin was very tight, and almost impervious to a fine probe.
The child was circumcised, and his mother instructed to i*ub the
legs with salt water, and in a few months no defoinnity was
visible.

In both these last cases I have little doubt that if the irritations
caused by the contracted foreskin had not been removed, serious
trouble would have followed. In one case, the constant dragging
up of the head of the femur against the acetabulum would pro-
bably in time have set up inflammatory mischief, and a mimic case
of hip-disease would have become one in reality. In the other,
the long continuance of the talipes varus would have caused
change in the shape of the bones that it would take one a long
time to have rectified.

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538 Australian Medical Journal Dm. IS, 1989-

Dr. Moloney wm very pleased that Dr. Snowball had read
his paper, although he had framed for himself different ezplansk-
tions of the phenomena described. Still the views now advocated
were well worthy of consideration, and if oircamcision were^
practised in such cases, no mistake would be made. It wa»
certainly a wise precaution, unless in children with natnrallj
short prepuce; and considerable interest would attach to an
enquiry into the prevalence of hip-disease and similar oomplainta
among nations who habitually circumcise. Though some surgeona
had recently argued that phimosis and genital irritation were iho-
primary cause of hip-disease, it must be remembered that Uie
disease was more common in girls than in boys. Recently he had
seen a boy with a troublesome affection of the hip^ not morbus,
coxae, not genuine paralysis, but a nondescript condition which
required further investigation. In all boys up to four or five
years old whom he had to examine, the prepuce was more or lesa
adherent, so that this condition in itself could not be considered
morbid, or the real cause of other disease. In some children a
general reflex irritability expended itself chiefly on the genitals,,
and the same fact might hold even in later life ; thus he knew an.
instance in which the opening of a bubo was at once followed by
emissio seminis, and even irritation of the lower extremitiea
might produce the same result.

The following papers were then read by the President of the
Society:

CASE OF ACUTE ENDOSTITIS AT THE UPPER THIRD
OF THE TIBIA.

L. C, set 15. A delicate' looking lad. Admitted April 4th,
1883, with considerable enlargement of the upper end of the
right tibia, prominence of the patella, apparent displacement
backwards of the tibia and fibula, and unnatural lateral mobility
at the knee-joint. There was very little pain on movement, or
tenderness on pressure over the tibia, and no effusion into the
joint There were cicatrices of two incisions made, one on either
side of the tibia, three weeks before admission, while under treat-
ment at Wangaratta.

Patient was suffering no pain, and felt quite well at the time
of admission. He stated that his leg was perfectly sound a
month previously, and that the first thing he noticed was stiflheas



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Dec, 15, 1888 Australian Medical Joumal. 53^

about the knee-joint, soon followed hj great pain and swelling
below it, loss of appetite, rigors and febrile symptoms generally.
At the end of a week the incisions were made, and poultices
applied, escape of pus taking place some time after the incisiona
had been made, and continuing until about a week before
admission.

He had not met with an injury of any kind. Brothers and
sisters all healthy. Had always been well himself.

Patient continued in much the same state, with no constitu-
tional disturbance, and only slight increase of temperature below
the right knee joint, until May 10th.

He was then anaesthetized with chloroform, and an incision
about four inches long was made down to the bone just below the
head of the tibia. An irregular opening was found at the inner
side of the shaft of the bone, leading to the medullary cavity,
where the pus had evidently made its way through. The
periosteum was then lifted up from the bone, and a free opening
made into the cavity by means of a chisel. The medullary cavity
was greatly enlarged and filled with partially disorganised lymph.
It did not extend quite into the joint, though very near it. The
periosteum was greatly thickened.

A drainage tube was placed in the cavity, which was washed
out with carbolic lotion. Sponges were inserted to arrest
the hsemorrhage, and antiseptic dressings applied over these.
Limb fixed on back splint, with inner and outer Clines. After the
operation, patient was very weak, and in a state of collapse.

8.30 p.m. — ^Has rallied. Vomiting a good deal. Has not much
pain.

May 1 1th. — Much better. Pulse fairly strong. Tongue clean ;
no vomiting. Leg easy ; very little oozing.

May 12th.— Temp, (night) 103", (morning) 99". Slept well.
Takes his food well. Sponges removed from the wound, which
looks well. Washed out with carbolic lotion, and dressed anti-
septically. A little oozing after removing the sponges.

May 13th.— Temp, (night) 100% (morning) 98-6'. Feeling
very well. Wound dressed ; no further oozing.

May 1 6th. — Temp, normal, night and morning. Slight purulent
discharge from the wound. No constitutional disturbance. Eata
and sleeps well.

The wound continued to progress favourably — granulating from
below ; and on



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540 Atutndian Medical Journal. Dbc. 15, 1888

June 29, the splints were removed for the first time, and the
leg encased in plaster of Paris, with trapdoor over the wound.

July 2nd. — Opening nearly closed ; drainage tube removed.
Allowed to get about on crutches.

July 16th. — Only a superficial granulating surface remaining.
Sent out for change of air.

August 27th. — Plaster splint left off for some time. Re-
admitted with some oedema about the right leg. The same
abnormal lateral mobility of the knee-joint as before the operation,
and same tendency to displacement backwards of the tibia and
fibula. A sinus leads down to the medullary cavity from the old
wound, which has not quite healed. Oeneral health good.

September 25th. — Leg put up in plaster of Paris again, and
trap-door made over the sinus, from which there is still a free
discharge.

September 28th. — Sent out again for change ; to return in a
month or six weeks.



CASE OF DOUBLE DISLOCATION AT THE HIP-
JOINTS, WITH FRACTURED PELVIS, RIBS, AND
CLAVICLE— RECOVERY.

M.K., set. 44, labourer. Admitted on May 22nd. Thirty
hours before admission was working in a railway cutting, when
there waa a large fall of earth, about 15 feet high, from one of the
4Bidee. The earth struck him behind while in the act of running
away, knocking him down, and burying the lower part of his body.
The left knee was driven forcibly against the right side of his
chest, and it was some time before the man could be extricated.
He was brought to hospital from North Gippsland, partly by
waggonette, and partly by railway. On admission there was not
much shock — the. pulse being strong, and skin warm — but severe
pain at both hips. Both knees were drawn up, the right foot
being everted, and the limb abducted ; the left foot inverted, and
the limb adducted. Motion was impaired, but sensation perfect.
There was a very large bruise over the right pelvis, and crepitus
could be distinctly felt on the ilium. The fourth rib on the right
side of the chest was dislocated from the sternum, while the fifth
was broken near its centre. The right clavicle was extensively
comminuted near the middle third.



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Dec. 15, 1883 Australian Medical Journal. 541



The head of the left femur could be felt on the dorsum ilii, the
head of the right being apparently driven through the obturator
foramen. The urine was drawn off and found to contain blood.
Foments were applied to the hips, and morphia given hypoder-
mically.

The dislocations were left unreduced for five days, the limbs
being supported by pillows, and pain relieved by morphia. The
urine gradually became clear, but was under only partial control
of patient. Diarrhoea set in, but was relieved. Not much
nourishment could be retained.

May 27th. — Six days after the accident chloroform and tether
was administered, and both hips were successfully reduced, partly
by extension and partly by manipulation, the limbs being after-
wards fixed to a Bryant's splint. From this time patient had full
control over his urine. He began to take his food well, and was
soon asking to be let up out of bed.

June 19th. — ^The splint was removed, and a little extension
applied to both 1^ by weights and pulleys.

July 9th. — He was allowed to sit up in bed.

July 14th. — He was allowed to get up and use crutches, the
pelvis feeling firm, the ribs and the clavicle firmly united. A
comminuted portion of the clavicle lay across the bone causing
projection of the skin.

July 17th. — Patient walked a little without crutches, and was
discharged cured.

No passive motion was used at the hips throughout.

Dr. James then exhibited a boy on whom he had operated for
genu valgum, vrith photographs showing his condition before and
after operation. A conversational discussion ensued.



Exhibits bt Dr. Allen.
Tuberculosis of LangSy Intestines, and Peritoneum,
Throughout almost the whole of the ileum Peyer's patches are
occupied by tubercular ulcers, spreading transversely, with
irregular undermined or shelving edges, the mucous membrane
around being coarsely granular. The bases of the ulcers are pale,
grey, uneven, granular, or finely pitted. The sub-peritoneal
tissues opposite are thinly dotted with small pale granules,



Online LibraryJohn M. (John Milton) NilesThe Australian medical journal, Volume 5 → online text (page 54 of 58)