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) 

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!

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...

Researching "The Invisible War" - Pozieres

We are thinking to time the story around the battle of Pozieres because:

•  It’s important to Australia in terms of our cultural memory of the war
• We’ll be facing the 100 year anniversary in the months after we launch the book 
• Australian service-folks were fresh off the boat from Gallipoli where the dysentery was most rife, so we can use plot points around immunity and re-infection.
• Pozieres has a sense of futility, because it was lost again so quickly 
• It arguably affected the outcome of the referendum for conscription 

I’m reading Graham Keech’s book “Pozieres” – which details the movements of each battalion, day by day, hour by hour. I'm not very good at imagining a map in my head and it's pretty boring reading a list of who went where when, but feels like I should know the basics. Fascinating, how completely absent are the stories of anyone not a fighter or a commander. In this version there are no medical staff, cooks, sanitation teams, messengers, previous residents of the area. 

I’m noticing how, in language, a place becomes an event, becomes a time. Pozieres is a village, Pozieres is a battle, Pozieres is when the battle happened. 

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": Conscription and Objection

I’m reading What’s Wrong with Anzac? Part of what they are saying seems to be that Australians promote an idea that our nation was shaped by that conflict, by those months in Gallipoli, but that actually this country was also shaped by the peace movement. That this is an important part of our history to keep telling. I remember reading about the Australian conscription referendums when I was in high school. I remember my little modern history class and the sense of pride we all had that our country had voted no. That every soldier in Australia who went, had the choice. That the soldiers at the front voted no. I remember reading the classic “Blood Vote” poem and analysing it to learn about propaganda and emotive language.

One of the nurse’s journals I’m reading – Olive Haynes, makes a note when the results of the referendum comes in. She is furious and heartbroken. Our brave boys fighting in such awful conditions while the shirkers sit at home. They should be forced to come. She’s tending these broken men every day and sending letters home to the mothers of those who died. She thinks they deserve all the support their countrymen can give. “Our boys say they only voted no because they didn’t want to ask for help.”

My great grandfather, Herbert Dobbing

My great-grandfather was a conscientious objector in the UK. He was imprisoned as a traitor with all kinds of other criminals for the duration of the war. The story I heard as a child was that the conscientious objector “traitors” were actually on their way to the front on a train, to be sent over the top first without weapons. Someone on that train wrote a note and threw it out the window and it made it to the newspapers. There was an uproar. So the objectors were brought back and imprisoned instead. Whether this story is true I don’t know, but it’s a powerful one for a seven year old to form an identity around. That my great grandfather was not prepared to kill for his beliefs, but he would have died for them.

I’ve been reading Regeneration by Pat Barker. Siegfried Sassoon in his internal moral battle. An officer whose men loved him, who fought bravely and was tactically hugely successful. Who didn’t believe that war was wrong, but who came to believe that this war was wrong. My favourite story about Sassoon is that he singlehandedly took a German trench, scattering 60 German soldiers, and then instead of letting command know that he’d done it, he sat down and read poetry for two hours. The British gained no tactical advantage from his skills and bravery that day.

I don’t imagine there will be room in this book we're writing for a debate about conscientious objection, the peace movement and the political reasons for war, or Australia’s involvement. But perhaps it would work for the story to have conversations about the conscription debate – which was so divisive in this country and people had such strong opinions about. I also have a vision of one soldier patient with his bandaged foot in the air being in the corner of every page. Saying nothing, but one day reading Sassoon’s “Declaration of a Soldier” and the next Bertrand Russell etc etc. So the ideas are pointed to, but don’t make part of the main text.

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.