Lives of the fellows

John Henderson Bolton

b.9 March 1907 d.14 November 1988
MB BS Melb(1932) MD(1936) MRCP(1939) FRCP(1957) FRACP(1964)

Born in Bendigo, the son of a bank manager, John Bolton was educated at Wesley College and the University of Melbourne, graduating in medicine in 1932. He became a resident medical officer at the Royal Melbourne Hospital, and was appointed its medical superintendent in 1936. Concerned by the morbidity amongst the hospital’s nurses, he recorded and weighed the food entering and leaving their dining room; he subsequently reported a significant decline in morbidity, not so much by improving the diet as enhancing its palatability. His concern with nutrition, so important in his war years, lasted throughout his life. In 1938 he undertook postgraduate training in London, interrupted by the outbreak of war. Rather than return to Australia to enlist, he joined the RAMC as a lieutenant and went to France in January 1940 with the 17th General Hospital. A fortunate billeting during the cold war greatly advanced his appreciation of French red wines, but in May 1940 he was one of six of the hospital’s medical officers to stay behind to care for the wounded after the evacuation of France. He was repatriated to the United Kingdom in 1943 with nephritis, which he characteristically studied in himself to the extent that the camp facilities allowed. With improvement in his health, John Bolton voluntarily returned to active service in Belgium and Germany, a brave move as further capture of a repatriated prisoner carried dire penalties. He was mentioned in despatches in 1946, when he was discharged with the rank of lieutenant colonel. In February 1944 he contributed a paper on his experience of diet and nutrition as a prisoner of war to the Inter-Allied Conferences on War Medicine, and later reported on an epidemic of diphtheria.

Returning to Melbourne with the WRNS officer, Elizabeth Rodwell, née Nankivell, whom he had married in 1944, he established a consultant medical practice which extended over 40 years, indeed virtually to his death. He was appointed to the medical staff of his old hospital, serving as an outpatient and later inpatient physician until his retirement in 1966, with periods as dean of the clinical school and as chairman of the honorary medical staff. He was also a physician to the Repatriation General Hospital, and for some years a research scholar in the university department of obstetrics and gynaecology. For many years he was a member of the Walter and Eliza Hall Institute of Medical Research and a board member, representing the medical staff of the Royal Melbourne Hospital, from 1958-66. He was able to ensure that the clinical research units of the Institute and the Hospital as a whole maintained a successful relationship.

As a postgraduate teacher John Bolton was outstanding. At a time when the teaching of clinical medicine tended to be dogmatic and didactic, he was ever questioning. The appearance or disappearance of a physical sign was, for example, a challenge to explain the mechanism or to explore the pathophysiological basis for the change; expertise in clinical medicine was to be gained not merely by observing but by thinking at the bedside. Treatment was a mini-experiment to be followed by quantitative data or objective evaluation wherever possible, tested often by statistical appraisal. His use of statistics in ‘simple’ situations as well as in research projects was well in advance of the times; his statistical method was not always appreciated by senior physicians, as when he recorded the number of times individual members of the honorary medical staff spoke at their business meetings.

Perhaps Bolton’s most important contribution to nutritional evaluation was the progressive grading of tongue changes in nutritional deficiency, but equally important was his regular indication of minor signs to students, signs such as diminution of vibration sense, follicular keratosis and angular cheilosis in patients with other major problems; statistical data from a continuing survey of all his patients provided the basis for the interpretation and nutritional significance of these signs. Later work related nutritional factors to the outcome of pregnancy as well as to coronary disease and the health status of the elderly. He introduced a quantitative response to the assessment of capillary fragility, thus allowing its application in a variety of clinical situations not immediately obvious. Another major interest was haematology, notably reflected in research on red cell fragility, but also apparent in his papers on nutritional subjects. The stimulus he provided to juniors with different interests is reflected in collaborative work published locally on asthma and diaphragmatic behaviour. Towards the end of his life he was preparing or assisting in papers on fat distribution and on cancer chemotherapy - the latter another collaborative interest with a younger colleague. Few physicians in full time private practice can have achieved his research output, but for the most part it was based on his own patients and directed towards their collective welfare. Not surprisingly, he devoted no attention to medical politics or economics.

John was the kindest of men and the most humanistic of physicians; academe, which he might well have adorned, he eschewed as too restrictive of his interest in people. Reticent rather than shy in his personal relationships - he declined entry in Who's Who in Australia, and never added to the basic entry in medical directories - he was yet a stimulating and provocative conversationalist and a great club man; with Elizabeth, he was a superb host, and withal he was a golfer and classical violinist of great ability; he established an orchestra in Germany, and played jazz for pocket money as a student. He also exploited an esoteric theory of chance in numbers with such sureness as to be requested not to play roulette at a London club, and to extract a regular return in later life from the local government lottery.

Truly a most remarkable, original and lovable man, revered by his patients and students, John Bolton left an indelible mark on the history of medicine in Melbourne, He was survived by his wife Elizabeth; their only child died in childhood.

B Gandevia
MG Whiteside

[RACP History of Medicine Library:papers & bibliography]

(Volume VIII, page 34)

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