Stretcher bearers at work in Ploegsteert Wood, World War I. Royal New Zealand Returned and Services' Association: New Zealand official negatives, World War 1914-1918. Ref: 1/2-012915-G. Alexander Turnbull Library, Wellington, New Zealand. /records/22419935
There has arisen out of the tragedy of the great war amazing progress in medical research, so great and wonderful that it cannot be fully comprehended and appreciated in the present troublous times. It is one of the wonders of the war. A glance at what has been done is all that can now be attempted and reveals achievements that must redound to the credit of the medical profession. The well-known fact that antiseptics applied to wounds are more or less damaging to the tissues and incapable of penetrating to deeper recesses, and the frequency of suppuration and gangrene in gunshot wounds in this war, led Sir Almroth Wright, and many other investigators subsequently, to search for improved methods for the purification and healing of wounds. Hypertonic salt solution promoting an outflow of lymph, Dakin’s solution and Alexis Carrell’s modification of Dakin’s solution have caused a transformation in results. Dr. Depage published valuable information in the form of “bacterial charts” of wounds, and statistics showing only two temporary failures in 137 cases in which wounds were closed by suture after preliminary cleansing with Dakin’s solution. Valuable researches into the relative value of various antiseptics, in the search for the ideal one, were carried out under the Medical Research Committee of the National Insurance Act at the Institute of Pathology at Middlesex Hospital. It was found for instance, that while iodine in 1 in 10,000 dilution killed cocci in water, a strength of 1 part in 700 was necessary to kill the cocci in serum, but iodine in a strength of 1 part in 3,500 prevents the action of the leucocytes. Dakin’s solution in a dilution of 1 in 1,000 killed cocci in serum, but 1 part in 4,000 of Dakin’s solution prevented leucocyte activity. After this began the testing of aniline dyes for their antiseptic properties, and flavine was found to be the best. It has great antiseptic power, practically no deleterious effect upon the leucocytes, and is free from irritating effects upon the tissues. Flavine has now been sufficiently tried to show that it very closely approaches towards the ideal of what an antiseptic ought to be.
It is reasonable to conclude that cerebro-spinal meningitis can now be well controlled. It was assuming such large proportions in the earlier stages of the war that every effort was required to find proper measures for preventing its spread. Sir Alfred Keogh, the head of the medical service of the army, adopted the method of what is known as a “mass attack” upon the problem. He is a man alive to new ideas and new methods, and the line of least resistance is abhorrent to him. It is fortunate for the nation that he neither brooks delay nor half measures. The investigators began with isolation, segregation of contacts, and bacteriological examination. A central laboratory and 37 district laboratories were established, and the best bacteriologists in England were set to work upon the problems. Four types of meningococcus were differentiated, and a polyvalent serum prepared and distributed which reduced the mortality of the disease from 40–60 per cent to 9–13 per cent. Truly, “peace hath her victories no less renowned than war.” The final triumph of the “massed attack” was when it was discovered that the problem of the carrier of cerebro-spinal meningitis could be overcome by treatment in an inhalation chamber in an atmosphere laden with steam and chloramine.
To any doctor who had experience of the scourge of dysentery and enteric in the South African War, the progress made in the prevention of these diseases in this war is as amazing as it is joyful. The problem of the carrier in these diseases was at first as baffling as in the case of spotted fever. In the campaign against dysentery the “massed attack” was made not only by medical men, but by botanists, zoologists and other scientists, and none but trained and competent observers were employed. A report stated that “it is almost better that no examination at all should be made than that it should be made by an incompetent or inexperienced person. Examinations made by persons, however skilled they may be in other matters, who have not served their apprenticeship to the actual work itself, possess no scientific value whatever.” It was discovered that in 90 per cent of uncured cases of amoebic dysentery by the sixteenth day after treatment by a course of emetine the amoebae re-appeared, although examination was negative during the course of treatment. Dr. Dale then introduced bismuth emetine which was found to be effective in the treatment of acute and carrier dysentery in the great majority of cases.
It is well-known that enteric fever hitherto has caused more deaths in war than shot and shell. It accounted for 20,000 casualties in the Beor War, but nothing like that figure has been reached in this war, where millions of troops are engaged. Inoculation and adequate attention to sanitation have been the cause of this almost miraculous change.
Other triumphs have been the practical eradication of typhus fever in Servia, the discovery of the cause of epidemic jaundice, the investigation of Bilharziosis, of trench nephritis, the bacteriology of the anaerobes, and the causation and prevention of trench foot. Chemical investigation of materials in munition factories prejudicial to health, of poisonous gases and of new drugs have added greatly to the store of knowledge, and in the realm of hygiene attention has been given to the dietaries of workers, the effect of fatigue in industries generally, the suitability of various kinds of industrial work for women, and the prevention and cure of many neurological affections.
In addition to all this there is the colossal work of preparing statistics of the sick and wounded of the army. The cards that are used in this work already weight over fifteen tons.
The effect of these achievements is well summarised in the Times History of the War:—“But it must be pointed out that this scientific work, begun by the army for the army, had a vast effect upon the attitude of the civil population to research. It inaugurated a new conception of medicine; it introduced new methods of attacking and resisting disease; the sure knowledge that by mass attack upon these lines any disease could be mastered and stamped out gained currency. All manner of workers began to demand that army methods should be applied to the problems of home life—the syphilis problem and the problem of consumption. In the Medical Research Committee the British people had an assurance that the good work would be carried on in peace as in war until one by one the fortresses of disease should be assaulted and forced to surrender.”