1. Abstract ⦁ Childhood Citation: Stride P.Dr CharlesJames deVis, M.R.C.S.,L.S.A.En- gland, Surgeon to the Charters Towers Hospital, 1881- 1892. Ann Clin Med Case Rep.2022; 10(5): 1-20 Dr.Charles Jamesde Viswasbornin West Bromwich, UK, qual- ified as a doctor in England, and migrated to Australia where he spentmost of hisabbreviatedworking lifeinthenorth Queensland town of Charters Towers. Hisclinicalcasesandtimeasresidentsurgeoninthetowndistrict hospital are reviewed. He operated successfully on horrendous-ly mangled limbs from accidents, compound fractures requiring amputationsthattodaycouldonlybeperformedbyhighlytrained orthopedic specialists. Limbs that today may have been at least partially salvageable with reconstructive surgery, re-anastomosis ofnervesandvessels,internalfixationandsupportivemedicalcare includingintravenousfluidsandantibiotics.Hisamputationswere all reported to be recovering well post-surgery. His career, however, was blighted by chronic ill health and pre- mature death. He lost an eye and dislocated an arm in two acci- dents,frequentlywasonsickleavewithprobablymalariaanddied prematurely at the age of thirty-nine with ‘brain fever’ perhaps cerebral malaria. Inconclusionthespectrumofconditionsencounteredandthedis- ease management is compared and contrasted with contemporary 19thcenturyhospitalpredominantlyinminingtownswithinAus- tralia. The major sources of information come from Dr. de Vis’descen- dants and the Australian National Library Trove Website of dig- itized contemporary newspapers. These are not peer-reviewed medical journals but the best available source of information. -Charles de Vis was born on 25th September 1852 in West Brom- wich, Staffordshire, England, the eldest son of CharlesWalter De Vis and Julia Margaret Holmes. His father, Charles Walter de Vis (9 May 1829 - 30 April 1915) wasaneminentEnglishzoologist,ornithologist,herpetologist,and botanistwhooutlivedhissonbytwenty-twoyears.CharlesWalter migrated to Australia in 1870 and became a founder member of the Royal Society of Queensland of which he served as president in1888–1889,andfoundermemberandfirstvice-presidentofthe RoyalAustralasianOrnithologistsUnion.Heiscommemoratedin the scientific name of an Australian venomous snake, Denisonia devisi (Figure 1).
⦁ MedicalCareerinEngland Dr.CharlesDeVis,graduatedM.R.C.S.,England,L.S.A.Londin 1877, then worked as resident medical officer in the Birmingham General Hospital and house surgeon in the Hereford General In- firmarywherehefirstmethisfuturewife,AliceCattellwhowasa nurse there. He migrated to Australia in 1881 (Figure 2).
⦁ ChartersTowers ChartersTowers is a town in northern Queensland,Australia, one hundred and thirty-four kilometers inland to the south-west of TownsvilleontheFlindersHighway,andthirteenhundredkilome- tersnorth-westofBrisbane.Thecurrentpopulationisaroundeight thousand people. The town was founded in the 1870s when gold was discovered serendipitously at nearby Towers Hill on December 24th, 1871, by a 12-year-old Indigenous boy, Jupiter Mossman. He was with HughMossman,JamesFraserandGeorgeClarkewhowerepros- pecting for gold. A flash of lightning had frightened their horses which then bolted. While Jupiter was searching for the horses at thebottomofTowersHill,hefoundanuggetofgoldinacreekas well as the horses. ThetownnameisderivedfromthesurnameoftheIrishbornGold Commissioner, William Skelton Ewbank Melbourne Charters, a big man said to be about two hundred centimetres tall and weigh- ing nearly one hundred and thirty kilograms, andTowers because the local conical shaped hills resembled towers. -The next two decades were boom years for ChartersTowers.The populationgrewtothirtythousandpeoplemakingChartersTowers Queensland's largest city outside of Brisbane. The Great Northern railway linking Charters Towers and Towns- ville opened in December 1882. The Charters Towers gold field was Australia's richest major field with an average grade of thir- ty-four grams of gold per ton, almost double that of Victorian mines and almost 75% higher than the grades of the Kalgoorlie gold field in Western Australian. The ten major gold reefs eventually produced over two hundred tones or 6.6 million troy ounces of gold from 1871–1917 worth some six to seven billions dollars today. Charters Towers hosted its own stock exchange. The city was also affectionately knownas'TheWorld’asitwassaidthatanythingonemightdesirecould behadinthe'Towers',leavingnoreasontotravelelsewhere!The Venus battery stamping mill is still open for tourists today.There is said to be as much gold still below the city today as was mined in the past. Anderson Dawson, Australian Labor Party politician, 14th Pre- mierofQueenslandandpremierofthefirstparliamentarysocialist governmentanywhereintheworldworkedinChartersTowersun- fortunatelydevelopingthepulmonarydiseaseandalcoholismthat would ultimately lead to his death (Figure 3 and 4).
⦁ TheChartersTowersHospital. ThefirstChartersTowersHospital,builtofsaplingsandbark,was opened in Mossman Street in 1872. Two years later construction commenced on today’s excellent hospitalsiteinGillStreetoftemporarywoodenstructures,oneof which was called the Williams' Ward, being built by money left by a Mr.Williams, a miner, who had been treated in the hospital. In 1883 the main brick building was commenced and was com- pleted in August 1884 at a cost of seven thousand pounds. Latera separate wooden building was constructed as a fever ward at a cost of eight hundred pounds. By 1891 only the Williams' Ward remained of the original buildings (Figure 5).
Thedoctor'sresidence,showntotherightoftheillustration,cost £1000.At the rear of the main building are premises used as a li- braryandforotherpurposes,andalargekitchenandlaundry,and altogether the improvements may be said to have cost £16,000. The presence of a hospital library nearly one and a half centu-riesagoisanimpressiveadditiondedicatedtotheenhancementof medical knowledge. The ‘Northern Register’considered the hospital as the only Gov- ernment building here which was worthy of illustration, other Governmentbuildingsconsistingmostlyofwretchedwoodenedi- fices,whichitconsideredadisgracetotheplace.Inoldendaysone querulouslotofcommittee-mendidtakeexceptiontothefactthat the liquor bill for one month, with only four patients, was £9 10s, butthesetrivialthingswerenotallowedtoseriouslyendangerthe harmony of the occasion. Dr. Charles deVis is first recorded present in ChartersTowers in 1881andfirstrecordedatthehospitalin1884,followingDoctors Hineman, Kennedy, Little and Dr. Paoli. Prior to 1887 there used tobetwovisitingsurgeons,at£150ayeareach,butthiswasfound toactunsatisfactorily,andin1887Dr.DeViswasappointedthe -firstresidentsurgeontobesucceededbyDr.Forbesin1888. In this era before specialization in medicine, a rural practitioner often in solo practice would require more surgical skills than the average general practitioner of the twenty-first century. Aroutinedaymayincludeamputationsforcompoundfractures,a craniotomy for traumatic intracranial bleeding, an appendectomy and caesarean sections. Frightening stuff for a physician! In 1883 the average number of inpatients was twelve, but the number steadily increased to fifty-three in 1891. Then the main building had forty-eight beds, the fever ward had twelve and the Williams'wardwhichcanbeseenintheillustration,showingfrom the rear of the main building, was finished at a cost of £800 [1]
⦁ Dr.CharlesJamesdeVisinChartersTowers DeVisleftEnglandasasalonpassengeraboardRMSChyebassa. Shewasaonethousand,sevenhundredandeleven-tonironscrew steamerbuiltbyWilliamDenny&Bros,ofDumbarton,Scotland, launched on 28/07/1874, and finally broken up in Bombay inAu- gust 1900. TheshipdepartedfromPlymouthandheboardedinLondon,pos- sibly at Gravesend. The voyage through the Suez Canal would have taken about two months with Aden, Colombo and Batavia beingcommonportsofcallonthatvoyage.DeVisfirstappearsin QueenslandinCooktown,thenthemajorportinNorthQueensland on19thNovember1881accordingtotheAustraliaPassengerLists 1848-1912intheQueenslandStateArchives.DeVisdisembarked in Townsville, the second port of call, then travelled to Charters Towers arriving on the 1st of December [2] (Figure 6).
Injuriesandfatalitiesintheminesweretragicallycommonaround thetime of Dr. Charles James deVis’years of medical practice in ChartersTowers.Inevitablywherefortypercentofthemalework- force in town were employed in the mines, trauma and accidents would be a substantial proportion of medical practice. It was a common perception amongst the mine wardens that mining inju- ries were entirely due to the carelessness of the miners. Compen- sation and Workplace Health and Safety concepts were workers’ dreams for the future. In1878,threemenweredrownedattheIdentityMinewhenwa- terbrokethrough.In1881,regulationsgoverningfireprecautions, mining shafts and their fencing and explosive were introduced by the government including inspections by union and government representatives but only for mines with six or more miners. In 1882 a rock fall at Day Dawn mine crushed two workers to death at the site where previous non-fatal injuries had occurred, yet no protective timber support had been placed after the ini-tial incidents. That year there were thirty-two accidents in which twelvemenwerekilledandtwenty-sixsufferednon-fatal injuries. Between1891and1910therewerefifty-fivedeathsandtwohun- dredandnineteennon-fatalinjuriesintheshafts,passesandwinz- es of the mines. In the same period, there were forty-nine deaths and two hundred and thirty-six non-fatal injuries from rock falls. The average death rate in town was 2.54 per thousand miners [3] Charles de Vis’s first documented patient in Queensland was the three-year-old son of Henry Ure who fell down an old shaft some seventy feet deep landing on soft granite, rendered crumbly by time and water. He was fortunate to survive. De Vis found thathe had fractured the right thigh, and suffered contusions on the head, chest, and abdomen. Following treatment his condition was deemed critical but as a healthy three-year-old boy his prognosis was considered to be hopeful [4] Dr. deVis and Dr. Maxton treated Mr. Hugh Mossman, the same gentleman involved in the discovery of gold in Charters Towers, with severe injuries from an explosion. He was part of a picnic party on the Burdekin River about fifteen kilometers southeast of ChartersTowerswhenhelitthefuseofachargetothrowintothe river to kill and catch fish. He was either distracted or the charge appeared to ignite prematurely causing severe injuries. His left hand was shattered, some of the fingers of which were complete- ly blown off, and the bone of the wrist was laid entirely bare, a compoundfracture.Boththighswereseverelybutnotdangerously lacerated.Beingattheoppositesideoftheriver,Mossman,though suffering severely, swam back across, and was taken by carriage back to Charters Towers where Drs. de Vis and Maxton were obliged to amputate his left arm below the elbow. Following sur- gery, Mossman was reported to be progressing satisfactorily [5]. DeVismarriedAliceCattellinQueenslandon4thAugust1882 Dr. de Vis attended the October monthly meeting of the hospital board. He inquired on behalf of Inspector Meldrum whether an Indigenoustroopercouldbeadmittedtothehospital.Thetrooper’s diseasewasconsideredadvancedwithaprognosisoffourmonths atthemost.Itwasagreedbytheboardthatthehospitalwouldsee what could be done for the gentleman [6]. DeVissuedMr.Parkerforlibelsuccessfullyin1882,receivingten pounds damages. This case followed a letter by John Parker in the Northern Min-er stating that de Vis broke his engagement to attend Mrs. Parker during her confinement and that deVis was in the habit of break- ingengagements.DeViswrotethathewasacutelyillatthetime -and was yet to make a full recovery. Perhaps this was de Vis’s initial bout of malaria. He wrote that Parker was twice informed of this fact and advised to seek the attendance of Dr. Maxton. De Visclaimedtheimputationwasutterlyfalsewhichhewouldprove beyond question at the District Court in Charters Towers [7, 8]. CharlesdeVisattendedtheDecembermonthlymeetingofthe ChartersTowersHospitalcommittee[9]. Dr.deVisappearedasanexpertwitnessinacivilcase.Mr.Max- wellhadbeenbittenbyadogandsuccessfullysuedtheownerfor lossofearningsandtimeoffwork.DeVisconfirmedthatMaxwell had consulted him about a laceration on the plaintiff’s arm some inch long and half an inch-deep compatible with a dog bite [10]. Health problems continued for the most unfortunate Dr. de Vis,helostaneyeinsomeformofhorrendousaccidentwhiletreating a patient in Charters Towers Hospital. Dr. Paoli assumed care of alldeVis’spatientsandthehospitalforanuncertainbutprobably considerablelengthoftime.HeappearstohaveleftforSydneyfor a period [11]. A month later Dr. de Vis sailed from Sydney to Brisbane on the Governor Blackall under Captain Calder, and then from Brisbane toCooktownaboardtheQuirang,builtinGlasgowandnamedaf- ter the mountains of Skye, under Captain J.D. McLean [12,13]. The‘Miner’wasgladtowelcomebackDr.DeVis.Thepaperstat- ed that he had ‘been south for the benefit of his health. His health hasbeenquitere-establishedandhisnumerousfriendswillbeglad to hear that he resumes practice at once. He has suffered in the causeofscienceandourgeneralsympathyhasbeenexpressedfor his loss’ [14]. Drs. de Vis and Paoli were called to see an Indigenous lady, Jen- ny who had been accidentally shot, but she was already deceased before their arrival. Peter Goodwill Hammond who fired the gun claimed not to know the gun was loaded, but nevertheless was committed to stand trial on the circuit court on May 8th, having beenremandedonachargeofunlawfulwounding.Bailwasgrant- ed [15]. Dr. de Vis’ monthly salary of twelve pounds, ten shillings was confirmed as usual at the monthly hospital committee meeting. It was agreed that the monthly report should also include the num- ber of outpatient consultations and that a tent should be procured to accommodate admitted patients who were ‘blacks, Kanakas or Chinamen’! [16]. Drs. de Vis and Paoli appeared as expert witnesses in the trial of John George Middleton and William Simpson charged with the murderofRobertBrownNesbitt.Paoliperformedthemainautop- sydetectingaperforatedscalpovertherighttempleregion.There were no powder marks around the wound indicating this was notasuicideasthetriggerwaspulledadistancefromthehead.Abul- let was removed from the wound which penetrated into the right ventricleofthebrainasthecauseofinstantaneousdeath.DeVis assistedintheexaminationofthehatNesbitthadbeenwearing and the microscopy of blood and hair around the bullet hole. The three men were all acquaintances who drank together. Simp- son admitted possession of the revolver that fired the bullet but claimedthegundischargedaccidentally.Bothmenwerecommit- ted for trial at the Circuit Court, to be held on 8th May [16]. Mr.PatrickRyan,atwenty-three-year-oldforemanplate-layersuf- fered a broken left leg when his ballast train had a brake failure which concluded in Ryan being thrown off the train and dragged along some distance by the guard irons. This compound fracture requiredthemoredisablingabovekneeamputationperformedby Drs.deVisandPaolifollowingwhichRyanwassaidtobemaking a good recovery. Compensationforamanwithawifeandoneyoungchildwasnot discussed, though the paper considered there was an onus on the government to ensure all equipment was functioning safely [17]. Dr.deVisattendedtheJunemonthlymeetingoftheChartersTow- ersHospitalCommittee [18]. Dr. deVis amputated the leg of Herbert May above the ankle fol- lowinganaccidentattheDayDawnMill.Whileengagedinshift- ingsomeheavymachineryMay’sfootwasbadlycrushedbutfol- lowingsurgerythepatientwasprogressingasfavorablyascanbe expectedaccordingtothenewspaper.DeViswasconsultingfrom roomsinGillStreetoppositetheCatholicChurchbetween9-10am and 6-8pm [19, 20]. Dr.CharlesJamesandAlicedeVis’sfirstchild,CharlesHoward deVis1883-1970wasbornon10thSeptember 1883. Dr. de Vis attended George Gregory aged six with an eye injury. Hisfather,Mr.G.F.Gregorywasboringaholewithanaugurinto a strainer post on the Day Dawn tram way, near its junction with the railway line. Little Gregory was on the other side of the post looking to see the augur come through, but unfortunately the lad hadhiseyesoclosetotheholethatwhenthemanjammedtheau- gurthroughtocleanouttheholeitenteredtheboy'srighteyeand literally bored it out. Dr.DeViswascalledinanddidwhathecouldfortheyoungboy, butdeVissaidthesightiscompletelygoneandtheeyedestroyed. DeVisrodeachestnutgeldingwithanE4Qbrandonitsshoulder forwhichheoffereda£2rewardinJanuarywhenitwaslost [21]. DeVisadvertisedforallaccountsowingtobepaidbeforeJanuary 20th, 1884, or legal action would be initiated [22] Drs. de Vis and Paoli attended the hospital between June 30th, 1883,andJune30th,1884.Theycaredforonehundredandeighty- two inpatients which are detailed below, and two hundred outpa- tients.Thedoctorswereapparentlypermittedbytheadministration toadmitmedicalemergenciesbutotherwisethegeneralcommittee of subscribers gave themselves the right to select who should be admittedelectivelyandwhoshouldnot!Onewondersw
ChartersTowersDistrictHospitalasgazette23rdSeptember1880, and reports and list of contributors as listed for the year ending June 30th, 1884 [23,24]. Between 1884-1885, Dr. de Vis appears in the press mainly for his arrivals and departures and his at least temporary sojourns in Sydney, possibly related to his health issues. Dr. and Mrs. de Vis and her servant arrived in Townsville on the ninehundredandeighty-tonsteamerBurwah,builtintheRoyal ScottishBoroughofKinghornandcaptainedbyG.H.Smith,trav- elling from Brisbane and Rockhampton [25]. In1885Dr.deVisofferedhishouseinTwickenhamTerrace,Stan- more Rd. Sydney, to let. The property had six rooms, a kitchen, laundry,bathandstable,andwassituatedneartheseaandalsobus and tram routes.Applicants were to apply to DeVis on the prem- ises. Stanmore Rd today is southwest of the city center just north of Mauriceville [26]. A month later Dr. de Vis, now in 51 Newtown Rd, applied for a good general servant noting there were two in the family, though he currently had a wife and one child [27]. InJune1885,Dr.andaverypregnantMrs.deVisandherservant embarkedonthethousand-tonsteamerKatoomba,commandedby CaptainB.ArmstrongforBrisbaneandNorthernports.AliceMar- garetdeVis,1885-1969wasreportedlybornon16thJune1885in Sydney,thougheitherthelocationordatedoesnotaccordwiththe sailing details [28,29]. Dr. de Vis departed from Sydney again in 1885 first aboard the Redondo for Brisbane, Maryborough and Rockhampton, a one thousand,onehundredandnineteen-tonsteamerthatsubsequently hit a reef in 1894 and sank, and then aboard the five hundred and forty-ton steamer Morton under Captain G.Andrews heading for Cooktown.ThepresenceofMrs.deVisandtheirtwochildrenwas noted aboard the Morton [30,31]. De Vis advertised that, having returned to Charters Towers, he would recommence consultations at his residence in Hodgkinson Street during the hours of 9 -10am, 2 – 3pm and 6 – 8pm [32]. De Vis appears to have been absent again in early 1886 for he announceshispracticeresumptioninApril1886,againconsulting athisresidenceinHodgkinsonStreetduringthehoursof9-10am, 2 – 3pm and 6 – 8pm [33]. Misfortune continued to dog Dr. de Vis when he was only just recovering from a tedious illness. He suffered a dislocated right clavicleandshoulderinaridingaccident.Afootballbeingkicked around by some boys landed on his horse which took fright and bolted, it broke the martingale, threw back its head and knocked deVisoff.(Themartingaleisadeviceforsteadyingahorse'shead orcheckingitsupwardmovementthattypicallyconsistsofastrap fastenedtothegirth,passingbetweentheforelegs,andbifurcating to end in two rings through which the reins pass.) The Brisbane Couriercommented,‘indeed,poorfollow,hisconnectionwiththe Towers seems to have been one long misfortune Accidents and sicknesses have alternated rapidly with him;’ [34,35]. Dr. deVis was appointed as surgeon to the ChartersTowers Hos- pitalfortheremainderof1886ataspecialmeetingofthehospital committee following the resignation of Dr. Horan.The following dayon26thOctober1886,hisseconddaughter,HesterFrancisde Vis (1886-1975) was born in Charters Towers [36]. Dr.deVisappearedasanexpertwitnessinthePoliceCourtin-the case of Mung Lee vAlfred Brown, on a charge of wounding with intent. Mung Lee Mew, a gardener living four miles outside MillChester,asuburbofCharterstowers,wascarryingvegetables for sale to Charters Towers. Mung claimed Alfred Brown asked himforbananasandthenhitMungontheheadwithhiswhipand stirrup iron when he said he had no bananas. Brown and his sup- porting witnesses claimed Mung started the physical altercation. Dr.DeVisstatedthathesawMungLeewhenhecametohishouse and de Vis found a contused scalp wound one and a half inches longon.thecrownoftheheadontherightside.Thefreeskinwas cut and the lesion extended down to the bone. He said Mung had lostaconsiderablequantityofbloodashisclothesweresaturated withblood.DeVisconsideredawoundsuchasthiswouldrequire afairamountofforceandwascompatiblewithcausationbyastir- rup iron. He did not consider the wound to be particularly severe or potentially fatal. AlfredBrownwasremandeduntilthefollowingmorningthough bailwasallowedintwosuretiesof£40each[37] EdwardGriffithwasadmittedtotheChartersTowersHospitalun- der deVis. On examination Griffith had marks and bruises on his body which he stated were inflicted on him by a man with whom hehadquarreled.Initiallyheappearedtobeprogressingfavorably, but then deteriorated such that the wardsman then went for the Police Magistrate to take Griffith’s statements, but on his arrival atthehospitalthepatientwasunconsciousandexpiredshortlyaf- terwards. AmagisterialinquirybeforeMr.W.Palmerfollowed.Griffithhad a long history of heavy alcoholism attested by several witnesses, with deteriorating health, back pains, periods of stupor, frequent falls and a combative nature when drunk and delirious. Prior to his admission he had argued with Charles Edward Roberts and probably initiated a fight with Roberts which resulted in Roberts hitting him perhaps only once and Griffith falling over. Shortly afterwards as he appeared quite unwell he was taken to hospital under de Vis. The hearing was suspended as de Vis was absent. The following month the inquiry was reconvened and de Vis ap- pearedasanexpertwitness.HeadmittedGriffithtothehospitalon 11thFebruary1887andhediedthreedayslater.DeVisexamined Griffithbetweenfiveandsixpmshortlyafterhisadmissionthere, finding him feeble, wanting of vitality and complaining of pain andtendernessontheleftsideofthechestandback.Hewasfever- ish,andonexaminationdeVisfoundhisribswerebrokenonthat side with contusion on that side and on the back. He complained ofacoughandshortnessofbreath.ThefollowingmorningdeVis found he had several ribs broken from the sixth to the eighth and the pieces of the broken ribs were so loose that the side of the chest gave way on pressure. Griffith had pleuritic pain from the broken ribs and passed a restless night, wandering in his sleep. TwodaysafteradmissionGriffithdeteriorated,thoughwasnotde- liriouswhenawake,andansweredquestionsquiterationally.On the third day he was much worse, and towards the middle of the daydeVisdidnotexpecthimtoliveashischestwasfulloffluid andtherewasnoairenteringthelungsonthisside.Hediedabout half past one o’clock. De Vis performed a post- mortem examination three hours after death. He found bruises of the skin on the left side over the lower halfofthechestandfoundthelastsixribsbrokenwiththeexcep- tion of the twelfth rib. The sixth, seventh, ninth and tenth were brokenintwoplaces;theeighthribwasbrokenacrossthemiddle. Inmostofthemtheboneswereverylooseandrough.Theleftside of the chest was full of fluid consisting chiefly if not entirely of blood.Thewholeoftheinjurieswereontheleftside,theleftlung itselfwascollapsedanddevoidofairandwasslightlylaceratedon the outer surface corresponding with the fracture ribs. The heart was firmly contracted, the kidneys were slightly con- gested and the other organs were natural. The quantity of blood effused intothe chestwas overa hundredand fortyounceswhich corresponds to four liters. De Vis considered the cause of death was syncope and asphyxia, and that the injuries could only have been inflicted by direct violence such as multiple blows of some kind.Theinjuriescouldhavebeenreceivedbythedeceasedbeing kicked while lying on the floor or by a man’s fist used with great force.Itwouldhavetakenseveralblowstohaveinflictedtheinju- ries,atanyratefourorfiveblows.Amanmightbreaktworibsor at the outside three with a powerful blow. Griffith’s six fractured ribs would have required at least three heavy blows and were not compatible with a single fall. Afterfurtherwitnessestheinquiryclosedandthebenchmainlyon the evidence of Dr. de Vis demonstrating multiple traumas, com- mitted Charles Edward Roberts to take his trial at the ensuing sit- tingsoftheSupremeCourtscommencingshortlybutallowedbail [38,39, 40, 41]. Dr.deVisgaveevidenceasanexpertwitnessinthetrialofChris- topherPickeringforthemurderofMartinEmerson,thoughagain Dr.Mohswastheprimarycarerandwitnessinthiscase.Mohsand aseniorconstablewereaskedtoattendPickeringafterhehadbeen assaulted at Ravenswood Junction and Mohs arranged his imme- diate admission to ChartersTowers Hospital. On arrival Emerson was unconscious with a head injury but still breathing. Mohs and deVisoperatedremovingthreefragmentsofskullbone,however Pickering deteriorated and died two hours later. Dr. Mohs performed the post-mortem. The left side of Emerson's skull was completely smashed, there being a large hole in it three incheslongbytwoincheswide,withtheboneallsplinteredbythe force of the blow from a heavy crowbar used on the railway and weighingaboutthirtypounds.Theskullwascrackedrightoverto theleftear,andwhenDr.Mohstookofftheskullitfellinhalves. The extravasation of blood was considerable, and the medical of- ficersweresurprisedthatEmersonlivedforawhilewhenstillun- conscious. -Mohsappearedfirstasanexpertwitnessinthetrial.Hestated he found three scalp wounds in an unconscious male with con- siderable blood loss. Mohs also noted a blood stained crowbar at the scene of the crime. He detailed his post-mortem finding and expressed an opinion the one powerful blow could have caused the injuries. Dr.DeVisagreedwithmostofMohsevidenceandopinionthough considered the fatal skull damage was more likely to have caused bythreeseparateblowsbytheendofthecrowbar,andunlikeMohs thought the injuries would have caused blood to spurt a distance probably causing blood stains on Pickering’s trousers. These minor matters had insignificant effect on the verdict, the jury considered Pickering to be guilty, the judge pronounced a deathsentenceandPickeringwashunginBrisbaneJailattheend of May 1887 [43, 44, 45, 46, 47, 48] Dr. de Vis apparently expressed an opinion that Sun Jim Sing, a Chinese storekeeper, who was charged at the Police Court with carnally knowing and abusing a girl named JaneYoung, aged six yearslastJunewasmedicallyinsane,thoughhewasnotthedoctor involved.ThegirlidentifiedSingasthepersonwhocommittedthe offence. Jane stated that in passing to school she went into a shop of the accused and asked for a banana. He then took her to a back room and committed the offence Dr. Mohs was the doctor responsible for examining Jane after the eventandgivingconfirmatoryevidenceoftheallegedrapeincourt against Sing. The Northern Miner was skeptical about the concept of insanity writing that when Drs. Mohs and de Vis pronounced Sing insane they murmured " mad doctors." The paper continued ‘according tosomedoctorsnooneissane.WereadthesamethinginHorace long ago when everyone was insane barring the Stoic. That hea- then Chinese was too deep for the doctors.’[49, 50, 51]. Dr. de Vis performed a post-mortem in the presence of Dr. Mohs onthebodyofJamesScottinChartersTowersHospitalfollowing hisdeathlastnight.Hefoundnineribsontherightsidebrokenin aline,namely,thesecond,third,fifth,sixth,seventh,eighth,ninth, tenth,andeleventh,someof themintwo places.Therewasalso a contusion of the right kidney. Scott was the contractor for the plastering of the new building in MossmanStreet.TheMinerthoughtScotthadbeendrinkingheav- ily and in consequence fell from the top scaffold of the building,a distance of thirty feet to the ground, and in his descent struck againstabeamonhisrightside,sustainingnumerousinjuries.He diedinhospitalbeingconscioustothelast,presumablywithaflail chest and pneumothorax, problems perhaps curable today with a chest drain, intubation and ventilation in an intensive care unit. Scottwastwenty-fouryearsofageandleftawifeandthreechil- dren [52]. Drs.RedmondanddeVishadanunprofessionalcontretempsin the Northern Miner newspaper in which the relevant letters are best quoted verbatim for clarity, attitude, hubris and self-impor- tance.RedmondclearlythoughhisMDwasvastlysuperiortothe qualifications of de Vis.
⦁ TotheEditor Sir,-IshouldliketoaskMr.DeVis,surgeonapothecary,forsome explanation of his conduct to-day if he is at all versed in medical etiquette. I was called to see a boy named Hooper, who had fallen from his horseinHodgkinsonstreet.Havingexaminedthelad,placedhim in a quiet position, and driven off a number of disturbing sym- pathizers. I was engaged writing a prescription when the above- named model of politeness appeared on the veranda with a fresh mob, and without taking any notice of my presence or asking my permission, at once proceeded to put my unconscious patient through a fresh tour of surgical gymnastics, which had not ended when I returned from visiting a patient in Rutherford Street. The diagnosis did not seem so dificult to determine as how to get the patientoutofmycare;andthiswasgotoverbyurgingtheneces- sity of removal to the hospital, on the staff of which this surgeon apothecary has been placed by his all providing friends. As a Doctor of Medicine of a university I resent the impertinent intrusionofanapothecary,andasaMasterofSurgeryIresentthe unprofessionalinterferenceofapersonholdingmerelyadiploma in surgery. Yourstruly, LEONARDREDMOND,M.D March 29th, 1887. [53]. Sir, -Noticing in your issue of this morning a letter from Dr. Red- mond commenting in a. very unfair manner on the conduct of Dr. deVisatthesceneoftheaccidentinHodgkinsonstreetyesterday I,asaneye-witnessofthewholeaccident,wouldliketocorrectthe impressionhisremarksmightconveybystatingthetruefactsofthe case.Whentheboywaspickeduphewascarriedintothenearest house,andDr.Brownewasimmediatelysentforbuthenotbeing athomeatthetime,Dr.Redmondwascalledandinthemeantime, asthesuffererappearedtobeinaseriouscondition,andnomed- ical man having turned up, I suggested that Dr. De Vis should be called, as he resided within one hundred yards of the scene of the accident, which was done. During the interval Dr. Redmond arrived, and after casually ex- aminingthesuffererenteredthehouseandremainedthereinsome time.WhenDr.DeVismadehisappearance,andnotbeingaware thatanyothermedicalmanhadbeencalled,proceededtoexamine the boy's injuries. Dr. Redmond having handed his prescription to the boy's broth- er, walked out of the house to the buggy; so he had no opportu- nityofwitnessingwhathesoelegantlydescribesasthesurgical -gymnastics practiced by Dr. De Vis. In conclusion, I should have imagined, that Dr. Redmond being a professional man, and like- wise supposed to be a gentleman, would have waited until he had madehimselfmoreconversantwiththetruenatureoftheincident, beforeherushedintoprinttotrytoslateabrotherprofessionalin suchascurrilousmanner.AsitismerelyinthespiritoffairplayI claimtheinsertionoftheabove.Iamsureyouwillallotmespace. MAURICE BARNEAT March 30, 1887 [54].
⦁ TotheEditor.Editorial WEhavenodesiretointerferewiththemedicalduelbetweenDr. RedmondandDr.DeVis,butwe.arebound,intheinterestoffair play,tostatethatMrs.Sorohenwasthefirst,withhertwodaugh- ters, to bring the boy Hooper into her house and to clean the dirt from his mouth and face. She tells us that Dr. Redmond was writ- ingaprescriptionwhenDr.DeViscame.ShetoldDr.DeVisthat Dr. Redmond was in the house, and that he thought the boy's col- lar-bone was broken. Dr. De Vis did not see Dr. Redmond at this time,butMrs.SorohenhadinformedDr.DeVisthatDr.Redmond was there. Dr. De Vis, after examining the boy, came out on the veranda and then saw Dr. Redmond. Probably Dr. de Vis did not catch what Mrs. Sorohen said anddid not know that Dr Redmond was there. He knew it afterwards, andshould,wethink,havegivenDr.Redmondsome explanation. AnyhowwethoughtDr.Redmond'sletterratherharsh,andinvain advised him to modify it [55]. Dr.RedmondwasborninIreland,graduatedMBBSfromQueen’s College, Belfast, and later after working in Africa, returned to Queen's College where he gained an M.D., Doctor of Medicine. Redmond’s obituary in 1935 states he was highly intelligent,well-travelled and educated, contributed considerably to the field of medicine and had many friends. It also states that he was im- menselyproudofhisdoctorate,thattheNorthofIrelandtempera- mentwasstronglypronouncedinhimandthathewasaneducated Irish gentleman. AyearpreviouslyrelationsbetweenDrs.deVis,BrownandRed- mond had seemed superficially more harmonious. Redmond con- sulted the other two about a boy in obstructive respiratory fail-ure with diphtheria. Browne agreed the child would probably die within minutes. Redmond performed an immediate tracheostomy andinsertedtwoconcentrictubesintothelarynx.Immediatelythe child could breath and fell asleep. Redmond removed the tubes after five days and the boy was astonished to hear his own voice and to be able to breath normally. The Northern Miner stated, ‘A very clever operation was per- formed here. This is the first successful operation performed for diphtheriahere,andDr.Redmonddeservesgreatcreditforit.We can add our own testimony to the skill shown by Dr. Redmond in difficult surgical cases, and his brother practitioners on the field willingly acknowledge the ability of Dr. Redmond.’ Redmondappearstohavesoughthiscolleague’sopinionmorefor adulation than confirmation of his diagnosis and proposed man- agement. He did not seek assistance with the operation and was probably gratified by the paper’s report! [56]. Redmond’s comments about Charles de Vis being an apothecary are somewhat unfair. The Worshipful Company of Apothecaries was founded in 1617 with a Royal Charter from King James I, was given the power to license and regulate medical practitioners throughout England and Wales by the Apothecaries Act of 1815 andretainedthisroleasamemberoftheUnitedExaminingBoard until 1999. Some notable people who qualified in medicine as a Licentiateof the Society (LSA) were the poet John Keats (1816), Elizabeth GarrettAnderson(1865,thefirstopenlyfemalerecipientofaUK medical qualification) and Nobel Prize Winner Sir Ronald Ross KCB FRS (1881). Dr. de Vis appeared as an expert witness at the enquiry held on 12thApril 1887 into the death of William Turrey in the Charters TowersHospitalon8thApril.Turreyhadseveraladmissionswith deteriorating mental function. His behavior as attested by several witnesses was irrational, variable between somnolence and hyper mania,oftenseverelyrestlessandsometimesaggressive.Theonly othernotedpathologywaslivercongestion.Hisalcoholconsump- tion was not mentioned. De Vis performed the autopsy on the body of Turrey in the pres- enceofDr.Paoli.DeVisopenedtheskullandfoundthemeninges, the cerebral membranes to be markedly thickened and also found otherevidenceofchronicdiseaseofthebrain,thoughdetailswere notspecified.DeVisfoundtheotherorganstobehealthywiththe exception of a small congestion of the liver. He considered the brain condition to be the primary cause of death which was then documented on the death certificate. Theinquirywasadjournedtoallowtheevidenceofother witness- eswho were not present [57]. Thisisanunusualcase,mostofthoseattendedbydeViswerepa- tientswithtrauma,Turreyisamedicaldiagnosticproblem.Today werecognizemanycausesofmeningealthickeningsuchasinfec- tivecausesforexamplesyphilis,mycobacterialorfungalpatholo- gy,ormalignancysuchasduralmetastases,plaquemeningiomaor lymphoma,orinflammatoryandautoimmunecausessuchasgran- ulomatosis with polyangiitis, neurosarcoidosis, rheumatoid, AN- CA-associatedvasculitisorIgG4-relateddisease.Tertiarysyphilis was well recognized by this time but not mentioned! In July 1887, de Vis put his current abode in Hodgkinson Street upforrent.Hisproposedsubsequentresidenceorabsencewhile -travellingarenotclarified[58]. Dr.deVisappliedtobereinstatedasChartersTowersHospitalsur- geon,butthecommitteeelectedDrs.MohsandPaolibyballotfor thenextsixmonthsinfavorofdeVisandDr.GrahamBrown[59]. Dr. de Vis was one of several residents willing to pay the neces- saryratestothecouncilforwateringGillStreetfromtheNorthern Mines office to Church Street [60] (Figure 7).
Dr. de Vis attended George May and his two children, and Mrs. Purcell following an accident on their buggy. The horse bolted throwingMayout,thencareeredonfinallysmashingthebuggyto piecesonatelegraphpoll.Mrs.Purcellandthechildrenfortunate- ly escaped with a few scratches. The miner states that May had a corkleg,‘butthatthisproveduseful,asthebootgottorn,andifhe hadafleshlegitmighthavebeensmashed’implyingperhapsthat he had an artificial lower limb. Themoreusualdefinitionofacorklegisquadricepscontusionas theresultofasevereimpacttothethighwhichconsequentlycom- presses against the solid surface of the femur. This often causes deeprupturetothemuscletissueandhemorrhageoccurs,followed by inflammation [61] Dr.deVisadmittedanunidentifiedunconsciousgentlemantothe Charters Towers Hospital in a critical condition who had been found lying in a state of unconsciousness in the bush near Ra- venswood Junction and was conveyed to hospital by the police. Hours after admission he remained critical [62]. Drs. de Vis and Paoli attended three men in the Charters Towers Hospital following an accidental explosion at the No. 2 Queen Company's nine, at Queenstown three kilometers from Charters Towers.Sixmenwereengagedsinkinginanewshaft,andsome of them were told to bore a fresh hole, instead of charging an old one,asitwassuspectedtherewasanunexplodedchargeinthelat- ter,howevertheystartedtore-boretheoldhole,causingaterrible explosion when the old change detonated. Three men, William Williams, Thomas Kago and Johnson were injured the two former seriously and the later slightly and were immediately transferred to the hospital (Figure 8).
De Vis reported that Williams was the most severely injured sus- tainingadeepcutontheforearmwhichdividedthearteriesandhis righthandwasverymuchlacerated.Hewasalsoburnt,scratched and bruised all over the body especiallyon the chest and side and therewereseveralcutsonbothsidesofhischest.Itseemsunlike- ly that this means the artery was completely severed as a skilled re-anastomosis or an amputation wound be required Lagohadascalpwoundandpossibleinternalcontusion.Bothmen wereinastateofcollapsefromtheshock,butinneithercasewere thereanybonesbroken.Johnson,hadaminorcutontherightarm requiring dressing following which he was discharged home. De Visconsideredthatneitherofthemenwasinanyimmediatedan- ger and that if they survived the first forty-eight hours then full recovery was expected. AweeklaterDr.deVisinformedtheMinerthatWilliamWilliams and John Lago were progressing favorably toward full recovery [63, 64]. Dr.deVisassistedDr.Browneinperformingapost-mortemexam- ination on the body of a young woman, named Flora Cartwright, agedabouttwentyandanativeofEnglandhadbeenfounddeadin a well. The cause of death was considered to be drowning. There were no marks of violence except some abrasions on the knees whichmighthavebeencausedonfallingdownthewell,orin struggling to get out. The report states quaintly that she was en- ceinte following intimacy with a Paddy Donovan. It had been reported to the police that Cartwright had been found deadinawellonapropertyoccupiedbyaMr.andMrs.Williams atNaglesCreek,aboutfivekilometersfromChartersTowers.Dr. Browne, the acting Government Medical Officer, and the police went to the place finding the well to be about twenty feet deep, with eight feet of water and with the body at the bottom. There werenomarksofanystruggleroundthemouthofthewell,butthe ground was so hard that even if there had been one it would have made no impression. Utilizing ropes and grappling irons it was broughttothesurfaceandtakentotheHospitalmorguewherethe Police Magistrate and Sub Inspector Meldrum viewed the body. The police immediately commenced enquiries. They discovered Cartwright had been in service at the North Australian Hotel, where she met Patrick Donovan. Once she discovered her preg- nancyshewenttoliveatWilliams'spropertywhileDonovanpro- videdthemoneyforherboard,andoccasionallyvisitingherthere. On the evening of Cartwright’s death, Mr. and Mrs.Williams left theirhouseaboutseveno'clockintheevening,andwentintotown, leavingherathomealone.Aboutnineo'clockthecouplemetDon- ovan in Mosman Street, and after some conversation in which he statedhehadseenthedeceased,theyhaddrinkstogether.Donovan told Mrs. Williams he had "chucked her up" and would not pay anothershillingtowardshersupport.Heappearedtobeinahurry and left. Mr.andMrs.Williamswenthomesoonafterwards,andfoundthe doorofthehouseopen,andthelampburningonthetable,butthe girlwasabsent.Atfirsttheythoughtshehadgonetovisitaneigh- bor but found that was not the case. They searched round about theplaceanditwasnoticedthatthecoverofthewellwasopen.A youngman,whowaspresent,wentdownthewell,andwiththeaid ofalongstick,probedittothebottom,andfoundwhatafterwards proved to be the body of the unfortunate young woman. Actingon the above facts, and on other information, the police arrested PatrickDonovan,atHayes'NorthAustralianHotelonsuspicionof having murdered Flora Cartwright. Donovanwas subsequently committed at apolice court for trial at thenextsittingsoftheCircuit Courtandbailwasrefused [65,66]. Leon Darg was admitted to the Charters Towers Hospital under Dr. deVis following a fall from a train. His feet were found to be severely smashed with several broken small bones. He was de- scribed as a colored man who does not speak good English and therefore unable to give a very lucid account of the manner in which the accident occurred. After unspecified medical attention he was said to be progressing favorably [67]. Dr.deVispresentedtheannualhospitalreportfortheyearending June 30,1888 while he was resident surgeon. There had been a significantincreaseinthenumberofcasesfromsixhundredand twenty-nine in the previous twelve months up to seven hundred and sixty-seven over the last year, this increase being largely due toafiftypercentincreaseinthenumberofoutpatients.Therewere thirty-nine inpatients remaining on June 30, 1887, followed by fourhundredandnineteenadmissionsasinpatientsandthreehun- dred and nine seen as Outpatients. Six hundred and ninety-seven weredischargedcuredorrelievedandthereweretwenty-threere- maining inpatients on June 30th, 1888. During the year there had been forty-two deaths, or 5.5% of the admissions. Of these deaths seven were due to consumption or phthisis,sevenfromtyphoidfever,fivefromalcoholismfourtothe directresultofanaccident,threefrompneumonia,threefrommor- buscordis,twoeachfromcancer,pleurisy,skullfracture,syphilis andexposure.Thenoneeachfrompericarditis,apoplexy,paraple- gia, morbus brightii (Bright’s renal disease), syncope, rupture of liver,andfractureofribsandlacerationoflung.Sixofthesecases died within twenty-four hours of admission. Today one would hope the some of these would survive. Skull fracture with a craniotomy and drainage of an intracerebral hem- orrhage,liverrupturewithlaparotomyandarrestingthebleeding, fractured ribs with an intercostal catheter and lung expansion, in- fections with antibiotics and exposure with intravenous fluids De Vis was delighted with the erection of the Fever Ward which he intended to open imminently and suggested a similar separate buildingforthecasesofalcoholismanddementiaastheywerenot suitable for admission into the general wards [68]. Dr.deVispresentedthemonthlypatientdatatothehospitalcom- mittee.Thereweretwenty-nineremaininginpatientsfromthepre- vious month followed by thirty-three admissions, thirty-four dis- chargesandfivedeathsleavingtwenty-threeremaininginpatients. Another thirty-four cases were seen as outpatients. The deaths were Eliza Hamill with chronic Bright’s disease (kidney failure), Andrew Watt with phthisis, Thomas Henry Jones with fractured ribs, lacerated lungs and pneumonia, James Bums with alcohol- ism, Jessie Rickards with syphilitic disease of liver. DeVis also reported that a patient named John ColeThwaite was discharged for continual disregard of hospital rules in spite of re- peated admonition. Thwaite was suffering from bronchitis and asthma, and that he had made a practice of breaking the Hospital rules. On several occasions he had been found in the water-closet smoking with the seat down. The nurse had reported this offence when she first discovered it, and de Vis then reprimanded the pa- tient,but,owingtohispersistinginviolatingthisrule,hefoundit necessary to discharge him for the discipline of the Hospital. Hospitals in the 19th century appear significantly more authori- tarian than today and why smoking with the seat down is a more serious offence, the miner does not make clear! Amongsttheaccountsisthemonthlystipendof£41134forde Vis[69]. Dr. de Vis was an expert witness into an enquiry was held yes- terday about the accidental and subsequently fatal injuries in the minesaffectingThomasJones.Thedoctorstatedthathewasresi- dentsurgeonoftheChartersTowersHospital.Joneswasseenim- mediately on his arrival about 1 o'clock. De Vis found a severe bruiseacrossthebottomoftheback,anotherontheleftsideonthe upperpartofthechestbelowtheshoulderbladeandathirdacross theshoulders.Hefoundthefifth,sixthandseventhribsontheleft sidebrokenandfromthesymptomspresentheascertainedthatthe lung was lacerated by the broken ribs. The distal spinal cord was damaged and there was a great deal of shock. Over the next day, Jones developed paralysis of the bladder and bowelsresultingfromthespinalcordinjury.Onthethirddayacute inflammation of the left lung set in, and he died eight days after theaccidentfrompneumoniaandspinalcorddamage.Everything wasdonethatcouldbedone,hehaddrugsforhispain,andhisribs were attended to, deVis considered it to be a hopeless case when inflammation of the lung developed. 1888 was prior to radiology to detect a pneumothorax or haemothorax, before ventilators and routine chest drainage, before antibiotics and before much under- standingofthemanagementofaparaplegia.Deathisunsurprising James Williams, a miner and work colleague of Thomas Henry Jonesstatedthattheywereascendinginabucketafterworkingsix hundredfeetundergroundlayingchargeswhenJoneswasknocked out of a bucket sustaining injuries that did not appear too severe initially.Hehadbeensittingontheedgeofthebucketratherthan securely inside when dislodged by a solar or platform narrowing the shaft though it was still a traversable width. Workers in the mines were supposed to be afforded some protec- tion at work by the Mines RegulationAct as outlined by another expert witness. The Mining Warden said it was a most unfortu- nate affair, and that he regretted that all mines were not brought under the operation of the Mines RegulationAct of 1881, so that the authorities would have more command over them.At present nomineunlesssixmenwereemployedbelowcameundertheop- erations of that Act. In the present case only four men were em- ployed below, and consequently the mine was not under thatAct. Theaccidentwasnotreportedforsevendayswhenthedeathofthe deceased was imminent.The fifth clause of the Mines Regulation Act of 1881 was noticeably clear on the matter, which he read as follows: "The mining manager shall, within 24 hours after the occurrence of any accident attended with serious injury to any person, give noticethereoftotheInspector;andanyminingmanagerwhowill- fullyomitstogivesuchnoticeshallbedeemedguiltyofanoffence against this Act." The Warden considered it was most important that accidents should be reported at once, and it would be as well for managers ofminestoknowthatitwastheirdutytoreportaccidents,andnot trustittothesecretaryofacompany,asthemanagerwastheonly person recognized. The enquiry concluded by stating that the depositions were then orderedtobeforwardedtohead-quartersintheusualmanner,and theinquirywasclosed.Theconceptofemployerliabilityorcom- pensation to a wife or dependent children if any were not men- tioned at any stage [69]. OnlysixdayslaterDr.deViswasbackbeforeanotherinquiry,this timeintothedeathsoftwominersinanotherfatalminingaccident at the Bonnie Dundee G.M. Co.’s mine in which Thomas Davies and Thomas Trevethen, lost their lives. The two men were drill- ing holes and laying explosive charges when some dynamite was somehow accidentally detonated. Witnesses considered the Da- vies was killed instantaneously, butTrevethen was conscious and bleeding heavily at the residual stump of his left hand. Trevethen was unable to explain how the accident occurred. Both men had workedasminersinMonmouthshire,Walesforsevenyearsbefore migration. Trevethen left a widow and five children, and Davies left a widow and three children. DeVis performed a post-mortem on the body ofThomas Davies, oneofthevictims.Hefoundthatseveraloftheleftupperribswere fractured, there was a large laceration on that side between the shoulderandchest,therewasextensivescarringoverthechestand abdomen, ill-defined contusion of the abdomen and a wound on the right forearm several inches long, deVis believed shock from anexplosionofdynamitewasthecauseofhisdeath.Itisnotclear if the abdominal cavity was opened. The second victim Thomas Trevethen, was alive on admission to the Charters Towers Hospital. He was in a condition of a severe shock, suffering from considerable shock from severe hemor- rhage;thelefthandandwristwereblownoffwiththeexceptionof one finger, there was a lacerated wound on the right hand, one on the left thigh, immediately above the inside of the knee joint, one ontheinsideoftheleftgroin,thefaceandchestandlegsandarms were covered with small wounds. From subsequent examination when the man was dead deVis found that both eyes were perma- nentlydestroyed.Theimmediatecauseofhisdeathwasshock,and hemorrhage.DeVisdidnotthinkthehemorrhagecouldhavebeen stopped had the proper appliances been immediately at hand, the shock was too intense. Againthisisanerabeforeeffectiveresuscitationwithintravenous fluids or blood transfusion, antibiotics for the inevitable wound infections,surgerytopreventhemorrhagingfromwoundsoreven measurementofbloodpressuretoassesstheseverityoffluidloss- es. JosephShakespeare.InspectorofMines,wasunabletoexplainthe sequenceofeventsleadingtotheexplosionbutconsideredallnor- malprecautionsappearedtohavebeentaken.Asusualthiswasde- clared an accidental death with no liability or compensation [70]. Dr.deVisandMrs.deVisattendedaFancyDressMasquerade Ball in Charters Towers dressed respectively as ‘The Graphic,’a British weekly illustrated newspaper, and as a Red Cross nurse [71]. Dr. de Vis as the Charters Towers Hospital Medical Officer's re- ported the monthly hospital patient statistics. There were twenty patientsremainingattheendofJulyfollowedbytwenty-threead- missions, seventeen discharges and six deaths leaving twenty re- maininginpatientsThere had also been twenty-seven people seen as outpatients. The patients who died were William James, Wil- liamYoung,Thomas Shaw, RobertWalker,Thomas Munjutt and GeraldLally.Nodiagnosesweregiven.DeViswaspaidforty-one pounds for his month’s work De Vis also stated there had been a number of complaints about his refusal to admit certain patients and he sought the support and advice of the committee in prepar- ing rules for his and the community’s guidance in future. The visiting committee also noted there had been several com- plaints.AMr. Farrendon complained that deVis refused to admit his son to the hospital. Mr. Henderson said the public would like tohearsomethingofyoungFarrendon'scase.Dr.DeVisrespond- ed that he had received a letter from Dr. Clatworthy, of Towns- ville Hospital, saying that Farrendon's father had told that his son had been in the ChartersTowers Hospital, suffering from typhoid fever, that he was very weak, and it was thought the change to Townsville would do him good. Clatworthy had not seen the son. DeVisdisagreedstatingthatyoungFarrendonwasanepilepticbut was not suffering from typhoid fever and was quite robust when seen. Mr. Farrendon was offered a private ward for his son under theusualconditions,andtoprovidehisownnurses,butherefused. Mr. Henderson was glad the matter was made public, so that it mightbeseenthatjusticehadbeendonetoyoungFarrendon.Mr. Bucklandsaidtheboyhadfitsandlookedverydull,butthedoctor said he had no accommodation tor him in the hospital, and he did right to refuse him admission. The second complaint was a letter from a Mr. Sparre criticising Dr.deVis’smanagementofaMr.R.H.Smith.Correspondenceis quoted verbatim. Sparre wrote - To the President and Committee Charters Towers Hospital. Gentlemen, -On Wednesday, 29th. August, as I was going home from Mr. Deane's station, I found a man, well known on the Tow- ers, named R. H. Smith, leaning against a tree holding his horse. Knowingtheman,Icalledout"Bob,whatisthematterwithyou." On hisattempting towalktowardsme, he fellinafit.Iput himin my trap, took him home and washed him. He seemed to be a little better,andabletogetup,butashismindwaswanderingIlooked after him, thinking he would get better, but towards the eveningof the following day he took another fit. I carried him in and took him to bed but had to watch him all night. As he no better in the morning.Iwenttogetmyhorseandstartedwithhiminmytrap toChartersTowersandarrivedaboutsixo'clock.Iwentdirectto the police barracks, and the police advised me to take him to the hospital,asIdidnotfindoutwherehelived.Onmytakinghimto the hospital the wards man told him to see the doctor. The doctor asked me if I had a certificate from the Government doctor, and on my answering " No," he said he could not be admitted. I then told him that the two gentlemen, who had accompanied me from the Bluff, and myself were all subscribers, but our tickets were at home. He then said, " You had better take him home, as his wife wouldprobablywishhimathome,andhewouldbebetterattended there than at the hospital." 1 then left the hospital with the inten- tion of going to Collins Hotel, bat, seeing Mr. W. Parsons on the road, I asked him if he knew where he lived, and he said yes. He went with me to the house, and assisted me to carry him in, as he wasquitehelpless.Ithink,gentlemen,thatitisverywrongonthe partoftheoficersofthehospital,afterallthetroubleIhavebeen put to in the cause of humanity, to think that the door of a public institutionwereshutagainstsuchadeservingcase,andtoprevent such an occurrence taking place again I trust yon will cause a searching inquiry ta be made. In the event of this man being a perfectstrangerinthetown,whatpositionwouldIhavebeenin.-I have, etc. J. B. SPARRE. DeVis informed the hospital committee that he knew Smith well andthatastheproblemwasalcoholism,hefelttheoptimumman- agementwasnotadmissionbutdenialoffurtheralcohol.Hestated that Smith was conscious and mobile and that the police could havearrangedreviewbytheGovernmentMedicalOfficer.DeVis stated he would not refuse admission to those without a subscrib- er’s ticket or any sick patient and suggested the hospital should draw up a management policy for alcoholics. Smith was subse- quentlyadmitted.Hefeltpersonallythatconsciousmobiledrunks did not need admission but sought guidance from the committee. DeVisrepliedinwritingasfollows TotheVisitingCommitteeChartersTowersHospital. Gentlemen -The Patient R. H. Smith, who for some days past has givenusconsiderabletroubleandanxiety,decampedthismorning early.Thenightnurse,whoforsevera1nightshasbeenobligedto give less time to the general wards than is desirable from having to watch Smith so closely, had great trouble with him last nightin trying to keep him in bed, he, in answer to her remonstrations replyingbytheuseofbadlanguage,hadscarcelyturnedherback tolookaftersomethingelsewhenhequietlyslippedaway.Hehas since been returned to the hospital and re-admitted provisionally until I am instructed from you what course I am to pursue in the matter, as after what has passed I am not inclined to act upon my own responsibility. When found, Smith led the people to believe thathewasquitehelplessandunabletowalk,ashedidinthefirst instance. -I am gentlemen, yours faithfully, C. J. deVIS, R.M.O. The Hospital, Sept. 13th, 1888. MEMO-The Visiting Committee's action on receipt of this letter was as follows :-Instructed Dr. De Vis to give Smith in charge of the police on his attempting to leave the hospital again, but first toinformMrs.Smith,hiswife,ofhisintentiontodoso,givingher theoptionoftakinghimawaytoherhomeTheaboveinstructions werecarriedoutwiththeresultthatSmithwasgiveninchargeof thepoliceontheeveningofthefollowingday.andultimatelysent to the Reception House, Townsville. September 13th, 1888. The‘Miner’editorialexpresseddisapprovalofdeVisasfollows- ‘…Under the circumstances that Mr. Sparre had been to so much troubleinthecauseofhumanity,togetherwiththefactthathedid not know where Smith lived (in fact, he had no home of his own), we think Dr. de Vis might have admitted Smith at once, and not haveallowedMr.Sparrecartthemanaboutinthehopeoffinding someone to relieve him of his self-imposed charge. We cannot re- frainfromremarkingthatDr.DeVisdrawshislinesrathertoofine inmattersconnectedwiththeadmissionofpatients,anddisplaysa considerablewantoftact,andinsomecasesawantofcivilityand commoncourtesy;for,althoughwehavearulewhichpreventsour taking oficial notice of what people outside say, we cannot help hearingofthesnubbingwhichheadministerstosomepeople.His professionaldignityisaltogethertoosensitive,andinduceshimto sayoft-timesthingswhichhadbeenbetterleftunsaid.1haveisno doubt about it there has been more of his sort of thing during the last six months than for the previous five years. The doctor seems to forget that anything high-handed or autocratic in his behavior willnotbesubmittedtobythepersonswhosupporttheinstitution, andthesoonerhecanseehiswaytotonedownthebetteritwillbe for the institution and all connected with it.’ Sparre is obviously to be commended for his generous and un- selfish genuinely concerned care of an acquaintance. The Miner failstoseetheadverseeffectofaggressiveviolentpatientsonthe careofotherinmates,failstounderstandthefrustrationsofdoctors withtimeconsumingself-inducedyetnotseverediseases,failsto see that hospitals are not staffed or funded to act as the type of welfare home that ultimately and appropriately admitted Smith and fails to support nurses, saints on earth, who deserve grateful courtesy from inpatients for their dedicated work on low salaries, not foul language and distraction from other deserving inpatients. OnthemotionofMr.Heath,secondedbyMr.Henderson,thevis- iting committee was instructed to bring up a report on the mat- ter. Mr. Rixon mowed that a committee be appointed, including the medical staff, to draw up rules regulating the admission of patients, as requested by the doctor. Drs. Brown and Paoli were elected honorary medical officers. [72, 73]. GeorgeMoffattwasadmittedtotheChartersTowersHospitalun- der Dr. de Vis recovering from an attempted suicide. He had re- centlybeendrinkingheavilyandsufferingfromdeliriumtremens. He left a message for his wife saying he was sick and tired of life and saying goodbye, following which he took a dose of ‘Rough on Bats,’ a toxic deterrent no longer identifiable today. He was seen suffering in the Oriental Hotel. Drs. Kealy and Redmond weresummoned,theyadministeredtwobottlesofsaladoilwhich precipitated profuse vomiting, following which Moffatt started to improve. Later that day de Vis informed the ‘Miner’that Moffatt was no longer in danger [74]. Dr.CharlesJamesdeVisasresidentsurgeonattheChartersTow- ers Hospital appeared again in court as an expert witness in the Police Court where Daniel Silva, Dan, and George De Silva were charged with the murder of Peter. De Vis was asked to examinea bar of iron, the suspected murder weapon. He did not find any blood on the bar on microscopic examination, but considered it wasquitepossibletoinflictafatalheadinjurywithoutcausingex- ternalbleeding.DeVisthoughtthebarweighedbetweenfourand six pounds and that the accused, Dan De Silva would have been sufficiently powerful to inflict the fatal blow. Dr. Francis Paoli, as Government Medical Officer, at Charters Towers, stated that he accompanied the Police Magistrate and Sub-inspector Meldrum to a creek near the racecourse where he saw the body of a man in the bed of the creek. It was coveredwithsandbutthetoesoftheleftfootwereprotrudingthroughthe sand. He had the body exhumed and observed it was the body ofa colored man. Onexamination,Paolifoundastar-shapedwoundonthelefthand side of the skull frontal bone, about two inches over the left orbit or eye socket. The skull was cracked for about three inches in an upwarddirection,onecrackextendeddowntotheorbit;twoother cracks were also in the skull up to the right and left extending in bothdirectionsforaboutfourinches.Thebodywasinanadvanced state of decomposition, such that Paoli though the deceased had been dead about between two and three weeks. The left forearm bones were separated from the arm, and bare and without flesh. PresumablythoughnotstatedbyPaoli,thiswasduetothecorpse being attacked after death by an animal. Hebelievedthecauseofdeathwasthewoundontheskull,which had been inflicted with some blunt instrument. Paoli found traces of only one blow on the head. He considered the bar of iron pro- duced could have inflicted the injuries he described. He could not say positively what position deceased would be in whentheblowwasinflicted,ifoneofthewitnessesstatedthatde- ceasedwassittingdownonthegroundwhentheblowwasinflict- edthatstatementmightbecorrect.Owingtotheadvancedstageof decomposition in which the body was, he could not say if a blow hadbeenstruckonthebackoftheneckasablowcouldbestruck ontheneckthatwouldcauseamantofalldownwithoutcausing anysignificantinjurytotheneck. TwowitnessesdescribedthemannerinwhichPeterwasmurdered, and how the blows were struck. The three prisoners were committed to take their trial for willful murderatthenextsittingsoftheCircuitCourtatChartersTowers [75]. Dr.deVis,asResidentSurgeon,presentedthemonthlypatientsta- tisticstothecommitteemeeting.Thereweretwenty-twoinpatients remainingattheendofthepreviousmonth,followedbyforty-one admissions, thirty discharges and six deaths leaving twenty-sev- en remaining inpatients. Another thirty-two outpatients had been seen. DeathswereJohnWardwithpneumonia,ThomasBarneswithty- phoid fever, Nellie an Indigenous lady with syphilis of the brain, Andrew McLeary from typhoid fever, Joseph Greenwood also fromtyphoidandMichaelQuigleyfromtyphoidfeverandhyper- pyrexia. He also recommended that John Woods be sent to Dun- wich being an incurable disease DeVissuggestedthatseveralscreensbemadeforuseinthewards, and that in each of the larger wards there be placed a table and clothwithwashhandbasinandasuitableboxorbaskettocontain dressings and implements. He also suggested that diet sheets to show the names of patients and the diet and medicine they were using be procured, to be hung up at the bed heads, so that it may be seen at a glance how the patients were being treated. De Vis also begged to call attention to the very urgent need for old linen required by the hospital. There were a large number of typhoid cases now in the hospital, including three female patients therefore de Vis thought it desir- able that the fever ward be opened. Administration supported these requests and also suggested that noticesbeputupinthehospitalsettingforthhowtheopinionand advice of the honorary surgeons might he obtained. Dr.deViswaspaid£41134forhismonthlyservice[76,77]. His fourth child, Cecil Mawe de Vis 1889-1890 was born on 8th February 1889 in Charters Towers and died 27th May 1890 in Bedminster, Somerset, England aged fifteen months Dr. Charles deVisappearedasanexpertwitnessinthePoliceCourtbeforeW. M.Mowbray,J.P.whereEdwardRosewaschargedwithcarnally knowing and abusing a little girl named Maud Rodgers, age be- tween nine and ten. The issue became known when Maud’s petticoat was noted to be stained and she told her mother that a man named Edward Rose hadtakenherintohisroom,andthathelaidherdownonhisbed, andthatheunbuttonedhistrousers.Rosewasundertheinfluence of drink when arrested and was known to have been sentenced to twelve-months imprisonment previously for assaulting one Mrs. Smith at Mill Chester. Drs. Joseph Patrick Kealy and Francis Paoli, Government Med- ical Officer examined Maud both finding bruising, swelling and inflammation of the external genitalia with some tenderness andapurulentdischarge.Thehymenwasintactindicatingonlysuper- ficial penetration of the introitus. The accused was examined by Kealy and found to have similar stains on his shirt and a similar urethral discharge. DeViswasgivenpiecesofthispetticoattoexamineunderthemi- croscope. He considered the stains had the appearance of seminal fluidandagonococcaldischarge,butwasnotconfidentaboutthe stain,ashehadnotsufficienttimetoexamineitthoroughly.DeVis desired further time in order to make a more minute examination This imprecise and not-scientific evidence must be seen from the viewpoint of medical knowledge of the period. Gonorrhea had been recognized as a sexually transmitted disease for centuries, howeverresearchstudiesofbacterialculturesandgramstainonly commenced in European laboratories in the middle of the decade 1880-1890. Such techniques which would enable accurate identi- ficationofthecausativebacteriumNeisseriagonorrheawouldnot have been available to de Vis. Mobile sperms were first recognized under a microscope in 1677 byVanLeeuwenhoekwhocalledthem“animalcules”Heworried itwouldbeindecenttowriteaboutsemenorhowitwasobtained! Driedsemenwithimmobilespermsandnodiagnosticstainswould not be detected with certainty in 1889. The Court then adjourned [78]. Dr. de Vis presented the March monthly statistics for Charters Towers District Hospital. Committee Meeting. There were for-ty remaining inpatients at the end of February, followed by thir- ty-nineadmissions,thirty-fivedischargesandthirteendeathswith one sent to Dunwich. The deaths for the month were James O'Hare, chronic disease of liver and kidneys, George Dixon, alcoholism, Sara Howson, con- sumption, Edward Griffith, heart disease, syncope, Alice Barr, typhoid fever and collapse, William Findlay, burns of body and collapse, Mary McGrath, chronic consumption, Patrick Higgins, moribund from pneumonia, George Rolleston, typhoid fever, Ed- wardMarchant,typhoidfeverandpyrexia,RachelSloane,typhoid fever,collapse,ThomasGilbert,chronicbronchialasthmaandAn- drew Haig, congested liver and fatty degeneration of the heart. DeVisstatedthatquitehalfwereeitherbeyondallhelpwhenad- mittedorwereofanincurablenature.DeVisreceivedhisregular stipend of £ 41 13s 4d. He was concerned about cleanliness and vermin, recommending replacementofoldmattresseswiththenewwovenwiremattresses, provisionofcircularseatsroundsomeofthetreestokeepsmokers and their cigarette ends off the verandas and removal of patients ownclothingtoasecurelocationoutsidetheward.Thedoctorsaid thatoutpatientswererequiredtoreturnemptymedicinebottleto pharmacybut compliancewaspoor [79]. Dr.deVispresentedhisreportasthemedicalofficertothemonth- lycommitteemeetingthoughhemaynothavebeenpresent.There were thirty remaining inpatients at the end of March, followed by twenty-sixadmissions,twenty-sixdischargesandtwodeathsleav- ing twenty-eight remaining inpatients. Twenty-three outpatients had also been seen. The two patients who died during the month wereAlbert Peterson with typhoid fever and George Bailey with ulcers and exhaustion. De Vis also recommend that an incurable patient named Thomas IngrambesenttoDunwich.Dunwichwasthenaleprosariumsug- gestingIngramhadleprosy.DeVisthankedDrs.PaoliandBrown fortheirassistanceduringthemonth.Heremindedthecommittee that several recommendations which had received their sanction, hadnotyetbeenfulfilled,totheinconvenienceofthehospitaland deVishopedthattheensuingmonthwillseesomeofthemcarried out. He had procured a nurse and was currently trying to obtain anothertoreplacetheonewholeavesimminently.Thissoundslike an admission that he was not managing perhaps due to ill health. The May monthly meeting of the ChartersTowers Hospital com- mitteealsoconsideredthepositionsofmedicalofficerstothehos- pital.Oneconsideredoptionwastohaveonlytwovisitingmedical officers. SympathywasexpressedforDr.deVisbuttherewasafeelingthat his bodily infirmities affected him mentally and caused him to be gloomy in his demeanor towards the patients, and Mr.Armstrong thoughtthattoseeamangoingamongstthembrightlyandcheer- fullyhadalmostasgoodaneffectasthemedicine.Althoughthey might sympathize with Dr. de Vis for his afflictions Armstrong thoughtitwastheirdulynottoallowtheinterestsoftheinstitution to suffer. Many members of the committee were not satisfied with the way inwhichDr.DeVishadmanagedtheinstitutionforthislasttwelve months.Hehadhadhintstimeaftertime,buthadnottakenthem, andiftheyweretocarryonthesystematpresentinoperation,they musthaveamoreenergeticman.ToArmstrong’sknowledge,Dr. de Vis had been incapacitated from work for at least one month through illness during the past year, and part of the last month he had been unable to attend to his duties. So far as his professional ability was concerned there was nothing to be held against him, and he had every sympathy with him in his illness. The committee decided to place advertisements in the Brisbane, Sydney, and Melbourne, daily and weekly papers in a fortnight's time planning to appoint a newresident medicalby the end of the following month [80]. DeVisadvertisedthesalebyauctionofallhishouseholdfurniture andeffects,itwouldseeminpreparationfortheirproposedtripto England to improve his health [81]. Dr.deVisasResidentSurgeonpresentedthemonthlydatatothe monthlymeetingofthecommitteeoftheChartersTowersDistrict Hospital.Thereweretwenty-eightremaininginpatientsattheend ofApril, followed by twenty admissions, twenty-two discharges, fivedeathsandtwosenttoDunwich.Anadditionalthirty-nineout- patients were seen. De Vis apologized for his absence from the previous meeting whichheattributedtoanattackofmalarialfever.DrPaolicovered duringhisabsenceandherejectedtheallegationofaboardmem- ber that patients were not seen till 5.00pm. he recommended that eitheranextensionshouldbemadetoWilliamsWardorthatanew building be constructed for cases of venereal disease [82]. Numerous reports had appeared relating to the poor health of Dr. deViswithnodiagnosisofferedapartfromhistwoaccidents.His casualcommentaboutbeingabsentbrieflywithanattackofmalar- ia could well explain deVis’intermittent episodes of poor health, thedayswhenhestruggledwithhiscaseload.Therestofhisstory falls into place. Malariaisapotentiallyrelapsinganddebilitatingdiseasetypically causing fever, lethargy, vomiting, headaches, jaundice and ulti- mately death.Typically found in tropical areas, mosquitos spread this parasitic disease. De Vis frequently was in the northern port ofCooktownandatleastonceinBurketown,locationsofmosqui- to-bornediseases.Theonlyknowneffectivetreatmentatthattime was quinine. While the disease has been well known since the days of Hip- pocrates, the Plasmodium microorganisms were not identified in blood till 1880 when Charles Louis Alphonse Laveran, a French army doctor working in the military hospital of Constantine in Algeria, observed parasites inside the red blood cells of infected people for the first time. There is an inevitable lag time from first discovery to common diagnostic usage and de Vis’s diagnosis was probably on clinical features. One species, Plasmodium falciparum can cause cerebral malaria,aconditioncharacterizedbyfever,comaanddeathwhich in1892wouldbeoneofthediseasescoveredbythecontemporary umbrella term brain fever from which de Vis died. Charles Ellery, an employee of John Mills, was admitted to the ChartersTowersDistrictHospitalunderDrdeVisfollowinganac- cidentwithacorncrushingmachine.Thesleeveofhisshirtcaught inthecogwheelsandhisarmwasthendrawninandcrushedterri- blyattheelbow.Atourniquetwasappliedandarrestedtheprofuse bleeding.DrBrown,firstdoctoronthescene,orderedhisremoval tothehospitalwheredeVisamputatedhisarmthreeorfourinches below the shoulder aided by Drs. Browne and Elliott. Following surgery Ellery was reported to be progressing favorably [83]. Dr. De Vis wrote and requested a testimonial as to the manner in which he had discharged the duties of honorary and resident sur- geon at the Charters Towers District Hospital. Themedicalofficer'sreportstatedthattherenineteenremaining inpatients on 31st May, followed by thirty-four admissions, ten discharges and one death leaving thirty-two remaining inpatients. In addition, thirty-one outpatients were seen. Theelectionofanewmedicalofficer,inplaceofdeViswasthen proceeded with.The following were the candidates for the office, Henry L. Forbes, Frederick John Elliott, William Coningham Asche, Charles Peyton Moreton,T. E.Abbott, John McGuinness, William. H. Tomlinson, Charles Souter, Samuel Wilson, D. W. BalfourWilkie, T.R.Horton, WalterH. Tofft,WilliamHeinman, C.S. Gunther Nagel, John Ward, W. Magill and L. Maxton. An impressivelistforasolo-practitionerresidentsurgeoninaremote rural hospital. After balloting Henry L. Forbes was appointed, and the secretary was instructed to communicate the fact to him. Drs.BrownandPaoliwereappointedhonorarysurgeons[84]. Dr.andMrs.deVisandtheirfourchildrencommencedtheirvoy- age to England, perhaps to improve his health, aboard the one- thousand-tonsteamerKatoombaunderGeorgeKing,fromBurke- town,viaBrisbaneforSydneyinsteerage.Thisbeingthecheapest accommodationonboard,theirfinancialsituationappearssubop- timal [85]. Mr.RichardsmadeoutapowerfulformalaccusationagainstDr.de Vis and the wardsman of the ChartersTowers Hospital at a meet- ingoftheMiners'andAccidentAssociationattheSchoolofArts. The paper apologized for not having sufficient space to publish details which cannot be located elsewhere [86]. Dr. de Vis returned and resumed his medical practice. A month later at the meeting of the Bowen Hospital Committee he was ap- pointed hospital surgeon [87, 88]. AndrewGordonwasadmittedtotheBowenhospitalunderDr.de Vis with a broken femur suffered while driving home when his springcartcapsizedoverastump,throwinghimout.Hewassub- sequently said to be doing famously [89]. Dr. Charles de Vis joined a tour of ‘Celebrated Medical ExpertsinallDiseases’visitingTownHallChambers,QueenStreet,Bris- bane, Queensland, 23 Oriental Chambers, Collins Street, Mel- bourne,Victoria,153RundleStreet,Adelaide,SouthAustralia,65 BeaufortStreet,Perth,WesternAustralia,8PoetOfficeChambers, Wellington, New Zealand and Masonic Buildings, corner of Per- kin and King Street, Newcastle. The tour on behalf of the Medical Association of Australasia of ‘TheGrandestAmalgamationofProfessionalTalentintheHistory of Science’! for the purpose of treating Chronic Diseases and De- formities,providedfreeconsultationsbetween10to12a.m.,2to6 p.m.,and7to8p.m.dailyandchargedonlyformedication.They guaranteedtocureeverydiseaseandpromisedaforfeitof£200if unsuccessful! ThisstellarcollectionofdoctorsaswellasCharlesdeVis,Lic. Apoth.Soc.etM.R.C.SwasDrGunn,ChiefSpecialist,Lic.R.Col. Phys.,Edin,Dr.Rie,MD.,Michigan,U.S.A.,Dr.Eames,MB.,Ch. B.Univ.Dub,Dr.Soule,MD.,Vermont,U.S.A.andDr.Goodall, MD., Univ., Victoria, Toronto. Specialist Fellows of Royal Col- leges and higher doctorates are notoriously absent [90]. Dr.deVistenderedhisresignationtothemeetingoftheKennedy Hospital Committee last night, but agreed to remain in charge for threemonthstoallowtimefortheappointmentofasuccessor.No reasonisgivenbutdeVishadlessthanafortnighttoliveandpoor health may have been the cause [91]. TheNorthernMiningRegisterreportedwithregretdeathofDr. C.J.deVisonFebruary5th,1892,intheChartersTowersHospital andpublishedashortobituary.HehadarrivedatChartersTowers about nine-years ago, and practiced his profession successfully, being then one of the visiting surgeons to the Hospital, also hav- ingconnectionwithseverallodgesaswellasanextensiveprivate practice. He met with an accident by which he lost one of his eyes, and shortly after travelled south for treatment. He returned, however, in 1886, and in 1887 he was appointed the first resident surgeon oftheChartersTowersHospital.Afterabout18months,however his health failed him and be went to England whence he returned twelvemonthsago.Hewasthenappointedresidentsurgeonofthe BowenHospital,andheremainedthereuntilafewdaysago,when he was brought to Charters Towers from Bowen by the steamer. Cintra,fortreatment.Hewasinaseriousstateofillness,suffering from brain fever. De Vis received every possible attention at the hands of Dr. Forbes, the highly popular hospital surgeon, but the casewasdeemedhopeless.Thenonspecifictermbrainfeverisno longer used but could mean encephalitis or meningitis [92, 93]. ⦁ Clinical Diagnoses The majority of the cases documented in the papers, particularly the Northern Miner, seen by de Vis somewhat surprisingly were limitedtovariousformsoftraumawithbrokenbonesandamputa- tions, deaths, post-mortems and court cases. Many patients come under more than one heading in the lists below (table 2). Table2:ClassificationofpatientsseenbyDrdeVisanddocumentedin Trauma 24 Accidents 16 Criminal court or enquiry 13 Fractures 10 Crimes 8 Died before admission 6 Post-mortem 6 Died during admission 5 Amputations 4 Explosions 4 Gun shots 2 (both fatal) Non-trauma 4 newspapers1881-1892 Unlike other contemporary hospitals internal medical diseases, particularlyoutbreaksofinfectiousdiseasewererareormostlynot documentedbythelocalnewspaperswhilethehospitalwasunder the care of de Vis. There are informative parallels and contrasts withcontemporaryAustralianhospitalinQueenslandorinterstate, inminingorruralcommunities.ThisincludestheQueenslandmin- ing ghost towns of Maytown and Mungana, the rural Queensland townofSpringsure,andthetwointerstateminingcommunitiesof ZeehanandKalgoorlie.Thesehospitalsatthistimeoftenhadout- breaksoftyphoid,diphtheria,pertussis,measles,influenza,tuber- culosis, dengue or simply ‘pyrexia of unknown origin’ (P.U.O.). Theoccurrenceoftyphoid,T.B.,pneumonia,leprosyandsyphilis was further researched. ⦁ Typhoid TheTyphoid bacillus was first detected and identified in 1880 by Karl Eberth and confirmed as the cause of the disease by Georg Gaffky in 1884, however the lag time from discovery to common usage in the medical workplace implies that typhoid would have been diagnosed in Charters Towers in the 1880s on clinical fea- tures rather than microbiology. The history of a pre-febrile phase with headache, malaise, bron- chitisandanorexia,followedbyafebrileillnesswithdiarrheawas stronglysuggestiveoftyphoid.Thepresenceofsplenomegalyand rose-coloredspots,blanchingerythematousmaculopapularlesions usually 2–4 mm in diameter usually on the abdomen and chest foundin5–30%ofcaseswerekeyfeaturesonclinicalexamination [94]. In the era before intravenous fluids and antibiotics there was no specific therapy for typhoid. The predominant physician of the timeandoftenconsideredthefatherofmodernmedicine,SirWil- liam Osler believed medications were of no avail and that careful nursing under an intelligent nurse was critical in the management of seriously ill patients in the Charters Towers gold rush era. He advised a low residue diet predominantly of milk with plenty of water, but alcohol only for weakness, high fever or a weak pulse. Patients with a high fever over 102.50F should be immersed in a cold bath every three hours, and severe diarrhea was treated with starch and opium enemata. Acetate of lead and opium were rec- ommended for hemorrhage. Osler recognized that neurological features,peritoneumandheartfailure,forwhichherecommended alcoholandstrychninebeinguncertainofthebenefitsofdigitalis, indicated a poor prognosis [95]. PatrickMansoninhistext‘TropicalDiseases’notesthefrequency ofthediseaseinEuropeanssoonafterarrivalinunsanitaryplaces inAsia,particularlyfromdrinkingcontaminatedwater.Hewrites: - ‘Similar testimony has come fromAustralia, where typhoid has occurred in the back country in lonely spots, hundreds of miles from fixed human habitation’ [96]. The association of typhoid with poor sanitation and disposal of sewagewasthereforewellknownbythegoldrushperiodinChar- tersTowers.Thediseasewasnotasfrequentasitwasatthesame timeasinthesimilargoldminingtownofKalgoorliewheresome two thirds of inpatients suffered from typhoid and about one in five died. Even the nursing staff and visiting clergy there caught typhoid from inpatients [97]. TyphoidisrecordedinChartersTowersintheannualdeathstatis- tics provided by the Resident Surgeon of that year. Menghetti in her PhD thesis cites other sources documenting typhoid to be the commonestcauseofdiseaseinChartersTowersthoughitisrarely mentionedinthedailypressunliketrauma.Dr.DeVisrecordedan annual total of nine deaths from typhoid in his monthly statistics during his time as resident surgeon. Typhoid was even more common in Charters Towers in times of drought when the water supply was limited. In 1883 wells were dug near cesspits causing an outbreak. Between June 30th, 1883, and June 30th, 1884, there were forty-eight cases of typhoid ad- mittedtohospitalwithelevendeaths.Drs.PaoliandBrowneinthe 1884 annual meeting of the Charters Towers Hospital committee notedthissubstantialincreaseinthenumberofpatientsadmitted, mainly due to the number of men received from constructing the town railway where fresh water may have been scarce, and from the high prevalence of typhoid fever amongst them. In 1885 when only nine inches of rain fell in the year, the death rate from typhoid was 3% or thirty per thousand populations. In 1887, a town water board was founded and water pumped into town from the Burdekin River. In spite of this typhoid continued in the town with six hundred and fifty-seven cases between 1901 and 1911 peaking in 1903. There appears less effort by Charters Towers Public Health de- partments to trace and eliminate the sources of typhoid as was achieved with the Kalgoorlie water supply and in a Springsure dairy at the same time [98]. Munganaalsohadsometyphoidcases,thoughitwassaidthatcon- tamination of the water supply did not matter as the five hundred inhabitants preferred to drink in one of the ten hotels rather than from a water tap! [99]. In2021therearestilltentotwentymillioncasesworldwidefrom typhoid, mainly in poorAsia communities with over one hundred thousand deaths, a totally avoidable health disaster if business spent more money on vaccines, antibiotics and clean water rather than centi-billionaires space rockets and multimillion dollar sala- ries and bonuses for CEOs.
⦁ OtherInfectiousDiseases The additional causes of death from probable or possible infec- tious diseases listed in de Vis’monthly statistics during his time asresidentsurgeonwerethreefromtuberculosis,threefrompneu- monia,twofromsyphilis,twofromrenaldisease,andoneeach fromulcersandasthma.TwootherpatientsweresenttoDunwich presumably with leprosy. Deaths from non-infectious diseases in internal medicine included two from alcoholism, two from heart disease and one from burns [3]. Infectiousdiseasesweredifficulttodiagnoseinaperiodadecade ortwobeforeusefuldiagnosticmicrobiology.Diagnosistherefore depended upon clinical features and conditions currently in the community. Skin lesions facilitated diagnosis of smallpox, mea- sles,typhoid,andleprosy.Splenomegalycouldbeduetotyphoid, malaria, dengue or perhaps tuberculosis. Advanced tuberculosis would be apparent with chronic wasting with pulmonary symp- toms and signs. In the contemporary gold mining town of Maytown seven hun- dred and fifty kilometers to the north in the wet tropics with a wider spectrum of tropical diseases, febrile patient’s cases were diagnosedsimplyandnon-specificallyas‘fever’or‘gulffever’or ‘Palmer River fever’in the absence of better pathological testing. Dengue was a recognized disease in the 1880s with a concurrent outbreak occurring in Fiji. There were no published cases at the time in Charters Towers, though there was an outbreak there in 1993 [100]. InMungana,anothercontemporaryminingtown,thistimeforsil- ver,copperandlead,somefivehundredandfiftykilometersnorth of Charters Towers, there were deaths from measles.Areminder, likethe2019Samoanmeaslesoutbreakinwhicheighty-threeun- vaccinatedpeople,mainlychildrenundertheageoffivedied,that safe vaccines still play a life-saving role to prevent the plagues of yesteryear [99]. As previously noted between 1883-1884 there were also fifteen casesofmalaria,sixofphthisis,threeofsyphilis,threeofnon-spe- cific dysentery, three of hepatitis and one of anthrax in Charters Towers. It is not clear if de Vis was one of these, but the disease was present in the town and did not require a trip to the coast to be infected. Clearly other specific infections occurred though not enough to interest the press [3, 22]. Similarly, in 1888 there were seven deaths from typhoid, seven fromtuberculosisandthreefromsyphilisoutofatotaloffor- ty-two deaths. Five patients were sent to Dunwich presumably with leprosy [68].
⦁ Industrial Diseases Industrialdiseasesinevitablyfollowmining.Goldisembeddedin quartzhencesilicosisisentirelypredictableintheminersofChar- tersTowers.Thenknownasphthisisdoctorscouldnotdistinguish between pulmonary silicosis or pulmonary tuberculosis or both combinedwhichwasfrequent.Atleastninedeathsarerecordedin the Charters Towers Hospital from phthisis. Toxicityfromothermetalswasnotaproblemasforexampleinthe public health and disastrous environmental problems of Zeehan, Tasmania,becausetheywerenotintentionallyminedintheChar- tersTowersareaatthetime.ThenearbyThalangamineexcavating lead, copper and zinc did not open till 1989 and closed in 1998. Raised levels of mercury in the Burdekin River postdate the gold rush days [101]. ⦁ Family ⦁ Marriage De Vis married Alice Cattell in Queensland on 4th August 1882 and they had four children. ⦁ Children Charles Howard de Vis 1883-1970 was born on 10th September 1883, Alice Margaret de Vis 1885-1969 was born on 16th June 1885 in Sydney, Hester Francis de Vis 1886-1975 was born on 26th October 1886 in Charters Towers and Cecil Mawe de Vis 1889-1890wasbornon8thFebruary1889inChartersTowersand died 27th May 1890 in Bedminster, Somerset, England aged fif- teen months. ⦁ Death Charles de Vis died in Queensland on 5th February 1892 at the age of thirty-nine as recorded in the Register of Medical Practi- tioner. This document in which he first appears in August 1882 also confirms his qualifications in 1877 as MRCS, England and LSA, London [102]. HeisburiedintheChartersTowersPioneerCemetery. ThispicturebelowofCharlesdeVis’sgraveinwastakenin2021 by his great grandson, Colin Robert Melloy. Originally the stone crosshadbeenmountedabovetheheadstonebutinthepastithad broken off and now lies on top of the grave. MissHesterDeVis,seconddaughterofthelateDr.DeVis,entered Toowoomba hospital as a nursing probationer next month fifteen years after his premature death [103] (Figure 9) (Family Tree).
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StrideP. Dr Charles James de Vis,M.R.C.S.,L.S.A. England, Surgeonto the Charters Towers Hospital, 1881-1892. Annals of Clinical and Medical Case Reports 2022