Mobile laboratories, champagne and silver nitrate

I’ve been trying to get my head around what the actual day-to-day nursing of a dysentery patient would have looked like – and the relationship between the nurses at the Casualty Clearing Stations with the bacteriologists. What the nurses understood of the bacteriology, their relationship to the process of diagnosis etc etc. 

I’ve been reading an article by a guy called Robert Atenstaedt about the development of bacteriology (full citation below). He talks about the British going into the Crimean War with such a tiny, unprepared medical team (old soldiers who couldn't carry themselves let alone patients). It was the first war after Telegraph was invented, and the immediacy of the news about soldiers suffering (from dysentery amongst other things) generated outrage at home. That outrage drove the creation of the medical corps. It makes me think of learning about Vietnam, the televised war. It also puts Florence Nightingale in context.

He goes on to say that, despite new knowledge, bacteriologists in WW1 were considered low status - it was routine water testing. Anyone with medical training was wanted for what was felt to be more important work. So it makes sense that Sister Williams was able to carve a niche for herself as a bacteriologist. 

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 And now it comes to the link between the bacteriologists and the nurses.

Briony, seeking the Wellcome Library online catalogue has found the Mobile Laboratory. We were scanning through a whole screen of thumbnails and suddenly it was there. This image, I nearly squealed.

Atenstaedt describes the first one, quoting :

a motor vehicle was fitted out with all the pathology paraphernalia of the day including microscopes, centrifuges, autoclaves and incubators: 'The inside of this multum-in-parvo thing on wheels was equipped with everything that the heart of a bacteriologist would require’

 

(if you’re wondering what multum-in-parvo means, it’s ‘much in little” - ie. the old school way of saying ‘tardis’).

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He says there were 15 mobile laboratories built, and each had a two-seater cycle car for collecting specimens. I love the two-seater cycle car. It’s our physical link between the nurses and the laboratory. It's the pathway the samples take. 

A woman called Rachel at the British Royal College of Nursing helped me out, showing my how to search their archive. British Journal of Nursing has some fabulous articles about the treatment of dysentery. Some highlights: 

A SEVERE CASE OF DYSENTERY (Dec 1915)

The feeding of the patient from October 22nd to 26th consisted of small quantities of albumin water, egg-flip, jelly, brandy, and champagne, given every two hours

and

WHAT ARE THE CAUSES OF DYSENTERY, AND HOW IS IT TREATED? (a prize winning paper by Miss Bessie Grey Johnson 1917)

The patient should be kept warm in bed, and should use the bedpan for all evacuations... If there is not too much tenesmus, rectal injections of either of the following solutions, as prescribed, warmed to 100' F., should be allowed to run slowly into the bowel from a funnel through a long soft tube :- Boric acid, I drachm to I pint. Nitrate of silver, 5 or 10grains to I pint. Quinine, 10grains to I pint.

I read these aloud to Gregory and Briony who gasp and giggle and at one point Gregory muttered, “Pure witchcraft”.

Another prize winning article is all my heart desires: WHAT PRECAUTIONS WOULD YOU TAKE IN SAVING FOR MICROSCOPIC EXAMINATION, A SPECIMEN OF URINE, A SPECIMEN OF SPUTUM, A SPECIMEN OF FAECES? 

I still have a lot of questions. I want to know who drove the cycle car? Who ordered the specimens? Where did the nurses store them? How far did the mobile laboratories travel? And who emptied the bedpans...

Atenstaedt article details:

"The Development of Bacteriology, Sanitation Science and Allied Research in the British Army 1850-1918: Equipping the RAMC for War by RL Atenstaedt (JR Army Med Corps 156 (3): 154-158) 

And the Logie goes to...

On our journey up to QLD, Scale Free Network(ers) Briony Barr and Gregory Crocetti encountered a chap named Clinton, who lived in a beautiful rainforest home in a hidden little valley of Mullumbimby. Without having even mentioned that we were working on The Invisible War - Clinton told us he was the keeper of a Logie - awarded to his dearly departed friend Megan Williams

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Before we knew it, the Logie award was in front of us, showing that Megan Williams won 'Most Popular Actress in a single drama/mini-series' for her work in ANZACs.

Megan is also remembered for her role as Alice Watkin Sullivan in the famous Australian tv series 'The Sullivans'. And with a little digging, we discovered that Megan had played the role of Sister Kate Baker in the 1985 TV mini-series ANZACs, which was a hit for Channel 9. 

 

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ANZACs was the first dramatic role for Paul (hoges) Hogan of Australian Tax evasion and Crocodile Dundee fame, but Megan Williams was the real star of the series, winning the only individual Logie.

It's so great to see the role of an ANZAC nurse given Australia's premier TV award so many years ago!

 

As a rather amazing coincidence, the lovely lady at Auspcious Arts - who manages our project funding from the Department of Veterans Affairs - is also named Megan Williams.

 

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Meet the Scientists: Dr François-Xavier Weill

François-Xavier Weill is one of those rare truly interdisciplinary researchers: one part Microbiologist, one part Historian and one part Epidemiologist.

His work mainly focuses on the evolution, emergence and detection of new strains of enteric pathogens (which basically includes the nastier versions of Salmonella, Shigella, Vibrio and E. coli) around the different human populations on Earth…so that we can better understand how, when and why enteric diseases spread.

Of particular interest to our research, was François-Xavier’s focus for several years on the epidemiological mapping of large numbers of different Shigella species around the globe over the 100-odd years. This (currently) unpublished research specifically shows which Shigella species were prevalent during WWI and suggests how they might have moved around the globe during the war. We’ll link to the article highlighting this amazing body of work when it appears in late 2015!

Briony, Ailsa and I travelled out to Cambridge (UK) to meet with François-Xavier in his home...stopping to admire the punts along the river Cam.

In our highly caffeinated meeting, our discussions included:

  • the role of nutrition in affecting the acidity of the stomach – lowering the defenses of soldiers and nurses to dysentery;
  • the high similarity between E. coli and Shigella (something Kat Holt had also mentioned) – Shigella is essentially a weaponised E. coli, adapted to infect and rapidly multiply in humans;
  • the change from Shigella dysenteriae to Shigella flexneri with improved hygiene, corresponding with the modern understanding of how S. dysenteriae wreaked havoc in the god-awful conditions in Gallipoli to the lesser incidence of S. flexneri in the much improved (and less tropical) trenches on the Western Front;
  • how the identity of the dysentery-causing agents were strongly contested in the early 20th century – with many scientists insisting that amoebic dysentery (caused by the amoeba Entamoeba histolytica) was the only significant disease;
  • how the high morbidity of bacillary dysentery (that is, dysentery caused by the Shigella bacillus) created such a high burden to the resourcing of the war, considering the need for intensive nursing of each infected soldier over a period of several days to weeks;
  • the difficulty in studying dysentery, given that there are no animal models – that is, disease-causing Shigella only infect humans – and it’s never easy to experiment on humans…
  • and finally what sensitive creatures Shigella really are, especially outside of their niche in the large intestine!
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François-Xavier also made the interesting suggestion that we consider using Shigella dysenteriae type 1 as the anti-hero in our story, due to its ability to make the deadly Shiga toxin…although this presents other new difficulties to our current storyline!

 

Meet the Scientists: Dr. Laurent Debarbieux

The phage whisperer…

While in Paris, Ailsa, Briony and I travelled out to the Institut Pasteur to meet with Dr. Laurent Debarbieux – an expert on Bacteriophages – that is, viruses that infect bacteria. Laurent works at the forefront of research into using bacteriophages to attack and destroy particularly difficult bacterial infections, such as cystic fibrosis infections in the lungs. And while the results have been promising, there is still much work to be done to determine whether bacteriophages can be used reliably to treat clinical infections. At the same time, scientists like Laurent also need to convince our medical and public health authorities to consider the possibilities of using viruses as allies against particularly nasty bacteria! But with the current crisis in antibiotics, the stakes couldn’t be higher!

We had an amazing session discussing bacteriophages with Laurent, hearing his perspectives about how bacteriophages can adapt to infect new host bacteria. In particular, we picked his brains about the scientific creation of our story’s viral hero...