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. 

 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’).

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) 

Researching "The Invisible War" - a bit of process

We spend hours reading the books we have, trawling the internet for more articles, writing to librarians and archivists, reading out moments of gold, explaining the new information we've found. We're working everywhere, out in the garden, over lunch dinner, over coffee, in the car on the way to the next battlefield.

We gather round the table to map out timelines and sometimes find it difficult to hear each other, the scientist to the artist to the writer. We are absorbed, frustrated, irritated, astonished, overwhelmed. We curl up after dinner to watch ANZAC Girls and All Quiet On the Western Front and comment on locations, gas masks, medical equipment, make verbal notes of what we need to look up tomorrow. 

I take the war poets to bed and read Owen, Sassoon, Rosenberg, Gurney blinking to sleep over the pages. 

Briony emailing museum archives in the 'jardin'

Gregory demonstrating the movement of phages through mucus, with the assistance of three chopsticks and a prawn cracker, over dinner at Fuji Yama

Researching "The Invisible War" - Battlefield tourists

French army surgical kit - Musee Hisorial de la Grand Guerre

Two days of Somme battlefields, memorials, museums. Displays made up of kooky soldier manikins who look like the Thunderbirds; sweeping monuments to war standing over a spread of sunny fields; an aeroplane propeller, crafted from rich, brown hardwood; Otto Dix; Wilfred Owen, cigarette packets and propaganda.

I’m the designated driver, gripping the steering wheel too hard as I go anti-clockwise round the roundabouts, windscreen wipers lurching into action every time I try to indicate.

We have been seeking out references to medicine, sanitation, nurses or Australians. References to dysentery seem like too much to ask.  

Musee Historial de la Grand Guerre

We visited Musee Somme 1916 built into a crypt turned air-raid-shelter under a church. It’s a long dank tunnel, limping through reconstructions of bunkers and dugouts and information displays. Villers Bretonneux where a kangaroo silhouette on the sign welcomes you into town and the school museum is full of photographs from the Australian War Memorial. Musee Historial de la Grande Guerre has a rich collection of artwork which touches me more deeply than the artefacts. Uniforms are laid out like corpses in indents in the floor.

There are moments I am stopped short. A photo of two small girls dressed as nurses, a display of artworks made from shell casings. Something about humans in awful circumstances, using their time and their hands to craft beautiful objects. 

Art-works made in the trenches from shell-casings at Musee Somme 1916

None of it is quite what we’re looking for - so much of it male and soldier/battle focused - but giving us a broader sense of the human-scale story. We really looking for images of the kind of toilets they used, and what water purifiers looked like. I’m also looking everywhere for references to the mobile laboratory, because I read about it in the Official History of the Australian Army Medical Corps. I’m starting to feel like we need to do some much deeper research and that maybe the internet would be more useful.

Every time Briony asks a museum attendant for references to dysentery in her fumbling French (wayyyy better than mine), we get blank looks and, “Non” “Non”.

But there's something which feels important anyway, about immersing ourselves in this landscape, where the human-scale section of the story is set. 

a field near Pozieres, looking over at the Thiepval memorial

Researching "The Invisible War": The Official History of the Australian Army Medical Services Vol II

It’s a great, fat blue tome, which is exactly as you’d imagine from the title. I am drawn into the disease prevention chapter: diagrams of different shit-pits used in different locations. Statistics on the various illnesses suffered at any one time (trench fever, typhoid, mumps, VD.) The view of sanitation as a core army discipline. Procedures from diagnosis to reporting to quarantine. Information that I find hard to retain – but which it will be necessary to get right.

It doesn’t seem like the kind of chaos war stories often depict. It seems efficient. I’m astonished that in “that mad world of blood, death and fire” they managed to keep such detailed records. There is a great sense of achievement in the text. It tells a success story – a pride that the rolling war bureaucracies across several nations’ armies kept illness to a minimum. I’m struck by the paradoxical efficiency of keeping men healthy so they can continue to kill. I wonder if the nurses were? I find this paragraph:

It will be carried out as follows: Diagnosed cases of the above diseases will be notified by telegram to this office immediately a diagnosis has been arrive at. The notification will be sent by the officer commanding Casualty Clearing Station…Suspected cases of Dysentery will also be notified…the ADMS of the Division who will at once take steps in direct communication with the Officer in charge of the Mobile Laboratory concerned for the investigation of the carrier condition of the contacts in order that those found free from infection may be returned to duty without unnecessary delays and that the carrier contacts may be suitably dealt with.

Order dated 14th June 1916, quoted in The Official History.

I read it over and over again. The Mobile Laboratory! What did it look like?

I search the index for dysentery. There is one page here, two pages there. I start to find references to the bacteriology. They know how many cases were caused by the Shigella bacteria and how many by the Flexner. Which means, I assume, that someone was looking at soldiers shit under a microscope? Or would the bacteria be present in a mouth swab? I’ll have to check with Gregory. The bacteriology sections reference the notes of an Australian, Leiut. JC Martin and I wonder where he was working and what his days looked like?

And then, surprisingly, it references the notes of a woman: Miss F. E. Williams. She seems to have worked alongside Martin. Many of the references are to notes shared between them. A woman. I’m suddenly excited. Can I make her my central character? Who was she? Where was she from? (Fingers crossed she was from Victoria, because our main character needs to be.) What was her relationship to Martin? Did they ever meet D’herelle? I’m going to spend some time trying to track her down.

Researching "The Invisible War": State Library and the nurses

Sitting in the La Trobe Reading Room with its great arched ceiling and old timber chairs. My book requests arrive from the stacks and are announced by text message, lighting up my silent phone. Nurses’ writing. Olive Haynes, Elsie Tranter, R. A. Kirkcaldie, a collection of letters, a contemporaneous diary, an after-the-fact memoir respectively. I read them quickly in the echoing afternoon, skimming for the trenches, for the women’s workload, for their political opinions.

Olive Haynes, from the website of The State Library of South Australia, item B68419

Of course the letters are censored. The memoir is rosy and nostalgic. The journal is full of descriptions of new landscapes, of days off, and the songs the soldiers sang. What did their working days look like? What exactly did they do? What did the wards smell like? Which muscles ached at the end of the day? I want to see the grit of their daily lives. I want to see their horror and despair (did they feel those things? I can’t find it. They are so unerringly brave and hopeful in their own texts). I love Olive best, possibly because of Anzac Girls, finding the letter which must have inspired the Turkish delight scene, or the one from the night of the storm on Lemnos, And of course when she contracts dysentery. She’s so stoic though, and gives very little information, just rails against being kept in bed. I’m going to have to find a first hand account from a person who suffered dysentery elsewhere. I’m only part way into Elsie’s diaries – she’s still so full of hope, of love for the soldiers, of wonder at the places she’s visiting. I wonder how things will change for her and if it will reflect in her diaries? 

Researching "The Invisible War": Coburg RSL

Coburg RSL. Where the Boer War, the World Wars and Vietnam are jumbled together in two glass cabinets of memorabilia. The bar’s furniture is in upheaval, the walls smell of fresh paint and while we sit, turning over artifacts, two men mount a new flatscreen to the wall and then cheer as channel nine lights up the room.

We open medical kits rolled in neat little boxes, that could have been made by Brunswick hipsters selling moustache wax. But they weren’t. They were made last century, to be taken to war.

Gregory strikes gold. “The War Pictorial” a monthly magazine, contemporary to the war, full of photographs. We pour over them, showing each other the images, horses chest deep in mud, hospital tents tidy and shiny, hospital tents bombed and lying in piles of wreckage, women in munitions factories, women with shovels over their shoulders, women welding, women spinning wool to make bandages. I’m compelled by the pictures of these women.