Dr William Wilson Ingram (1888-1982): doctor-soldier, physician and Antarctic expeditioner.

Dr William Wilson Ingram (1888-1982), a Scottish-born physician, contributed significantly to the health and heritage of Australia, his adopted land. Born on Speyside and educated in Aberdeen, he was a doctor-soldier in two World Wars and decorated with the Military Cross. Ingram was a Foundation Fellow (1938) of the Royal Australasian College of Physicians and established one of the first specialist diabetic clinics in Australia, in Sydney in 1928. As an arachnologist, he published clinical descriptions of both surviving and fatal cases of envenomation by the Sydney funnel web spider, Atrax robustus. He founded the Kolling Institute of Medical Research at the Royal North Shore Hospital in Sydney where for two generations he was a leader in both undergraduate and postgraduate medical education. The international significance of his life's work relates to his service as the medical officer and biologist on the two British, Australian and New Zealand Antarctic Research Expeditions (BANZARE) of 1929-1931, for which service he was awarded the Polar Medal and subsequent Clasp. Those expeditions secured, for the British Crown, what was to become the Australian Antarctic Territory, ceded to Australia by a British Order in Council of 24 August 1936. Sir Douglas Mawson, polar expeditioner and the leader of BANZARE, described Ingram as 'an ideal medical officer', one who in addition to his clinical skills and judgement, manifested courage and 'physical endurance and a full measure of camaraderie'. Ingram has no published obituary or biography. This précis records some details of his extraordinary life.

Idiopathic necrotizing dermatitis: current management.

OBJECTIVES: To identify and demonstrate necrotizing dermatitis in infancy; an uncommon, puzzling syndrome, in which anecdotal reporting and personal experience indicates that one third of cases may require skin grafting. Much informed discussion about the pathogenesis of this distressing syndrome centres on the role of spider envenomation; and in particular on the speculative role of the Australian White-tailed spider, Lampona cylindrata. METHODS: We present here six cases of necrotizing dermatitis treated surgically at the Royal Children's Hospital and Mater Children's Hospital in Brisbane over the period from 1991 to 1999. Clinical history, surgical details and pathological investigations were reviewed in each case. Microbiological investigation of necrotic ulcers included standard aerobic and anaerobic culture. RESULT: Nocardia and Staphylococcus were cultured in two cases, but no positive bites were witnessed and no spiders were identified by either the children or their parents. All cases were treated with silver sulphadiazine creme. Two of the infants required general anaesthesia, excision debridement and split skin grafting. The White-tailed spider, Lampona cylindrata, does not occur in Queensland, but Lampona murina does; neither species has necrotizing components in its venom. Circumstantial evidence is consistent with this syndrome being due to invertebrate envenomation, possibly following arachnid bites. CONCLUSION: In our experience there is insufficient evidence to impute a specific genus as the cause, at this stage of scientific knowledge. If the offending creature is a spider, we calculate that the syndrome of necrotizing dermatitis occurs in less than 1 in 5000 spider bites.

Ciguatera poisoning: an example of a public health challenge.

Ciguatera is a common form of fish poisoning, endemic in all nations of the Pacific region. Several thousand cases have been notified to Queensland authorities over a 10-year period. However, many cases remain undiagnosed and most go unreported. The public health implications include raising awareness of the condition, ensuring that ciguatera is considered in differential diagnosis and promoting better documentation and reporting.

The Australian Medical Support Force in Rwanda.

In the aftermath of the Rwandan civil war, Australia's defence forces deployed a medical force to support the United Nations Assistance Mission. In this article, Wayne Ramsey, Commander of the Australian contingent, Lindsay R Bridgford, Officer Commanding Bravo Section, Robert J Lusby, Lt.-Colonel (Surgeon), Australian Medical Support Force Hospital, and John H Pearn, Colonel, and Director of Intensive Care in the Australian Medical Support Force Hospital, describe the Australian effort in the rebuilding of a shattered people and, in particular, of Kigali Central Hospital, the country's major medical facility.

Snakebite in herpetologists.

OBJECTIVES: To define the risk of snake envenomation in herpetologists, assess factors which lead to their being bitten, assess their occupational morbidity and propose preventive stratagems. SUBJECTS AND DESIGN: Interview of 14 of the most experienced professional herpetologists in Queensland; and questionnaire to 14 members of the Cape York Peninsula Herpetological Society, Cairns, Queensland. RESULTS: The 28 herpetologists had sustained 119 bites by potentially dangerous species, and hundreds of clinically insignificant bites. Seventeen had been admitted to hospital. Only five had never been bitten by a medically dangerous snake and 14 had been bitten on two or more occasions. Correct first-aid techniques were applied in less than half the bites. Two had permanent morbidity--renal damage, and permanent tissue damage to the hands. Anaphylactic reactions from the repeated use of antivenom did not occur. The experienced herpetologists sustained a life-threatening bite every 10 years (median). Four herpetologists had been bitten by the western taipan (Oxyuranus microlepidotus), the world's most venomous snake. CONCLUSIONS: Herpetologists working with highly venomous snakes are at high risk. Prevention involves recognising the risk; possessing a first-aid certificate; applying standard first-aid if a bite is sustained; carrying a mobile telephone; and not working alone.

Erythroblastosis fetalis--the discovery and partial elimination of rhesus incompatibility--the origins of exchange transfusion in Australia.

The first 2 exchange transfusions in Australia for Rhesus-induced erythroblastosis (hemolytic disease of the newborn) were conducted in the 9 mth period from December 1945 to August 1946. These pioneering endeavours in medical research were undertaken by 3 transfusionists who were, or had been, directors of the Red Cross Blood Transfusion Service in Australia. Called "substitution transfusion" or "exsanguination transfusion" they were conducted prior to the international publication of the first case series of exchange transfusions for "Rhesus Disease". The first successful exchange transfusion in Australia, and one of the first in the world, was performed by Dr George Kelsall at the King Edward Memorial Hospital for Women, in Perth. Dr Kelsall had monitored pregnancies with serum raised himself from blood from a Rhesus monkey in the Perth Zoo. The second exchange transfusion, and the first with volume-monitoring, was successfully undertaken in Brisbane by Dr Eric Shaw, pathologist and Director of the Queensland Red Cross Blood Transfusion Service, and Dr Noel Gutteridge, a former Director and senior pathologist of Brisbane. Dr Kelsall's pioneering transfusion in Perth was a direct non-anticoagulated transfusion which was undertaken within minutes of birth and was completed within 5 min. The first volume-controlled exchange transfusion, in which the input-discard volumes were matched, used a plastic tube obtained from the Telephone Branch of the Postmaster General's Department, and employed citrated blood. These heroic exchanges (heroic for the infants and families concerned as well as for the operators) form a significant milestone in the history of blood transfusion, serology and preventive medicine in Australia.

Courage and curiosity: surgeon-explorers in Australia and New Zealand. Part II. The science of the outback. The Herbert Moran Lecture concluded.

After the broad brush of the topographical features of Australia and New Zealand had been mapped, the process of fine-tuning the geographic details of these countries continued. In parallel with this, a great wave of detailed scientific exploration proceeded and it was to these expeditions that medical men brought special skills. Surgeons played a special role because of the need of their practical skills in the field. Dozens of expeditions were commissioned throughout the nineteenth century. The aim of some was to search for minerals and document the fertility and water supply for pastoral and agricultural lands. Others had as their major raison d'etre the documentation of the many groups of animals and plants which populated these domains new to Western science. Surgeons and physicians were valued not only for their professional skills in the field, but for the pursuit of botany, zoology and geology, and in many cases for ethnological studies as well.