LABORATORY WORK IN THE FIELD.
With the medical organization of the army in mind it may be seen that
a small mobile laboratory might be of great practical service to the
army in the field. Under the conditions which exist in the present
war, the army itself is not very mobile, nor is it necessary for the
laboratory to be, but it is of great importance to have a car which
will permit of the area being covered quickly should a specimen,
sample or investigation be required. The car is the really essential
mobile part of the unit.
Our laboratory had charge of both the bacteriological and hygiene work
of a given area; it was the only laboratory that did both types of
work. When our apparatus had been unpacked and set up in the old ball
room of the Hotel de Ville it made quite an imposing show, and after
we saw what equipment the other laboratories had we were decidedly
proud of ours.
Our first bit of work proved to be the examination of a number of
soldiers who had been in contact with a case of cerebro-spinal
meningitis, to detect "carriers" of the specific germ. Then material
of all sorts began to come in for examination from the casualty
clearing stations, field ambulances, sanitary and medical officers,
rest stations and other places. Most of the routine bacteriological
work proved to be of much the same nature as that done in a health
laboratory at home, and consisted of examinations to detect some of
the ordinary communicable diseases such as diphtheria, cerebro-spinal
meningitis, typhoid fever, malaria, dysentery, tuberculosis, and
venereal diseases.
Should a case of diphtheria, for example, be found in a soldier, all
his immediate friends and companions with whom he had been in contact,
would be swabbed to see whether they were infected. Those found to be
infected would be removed from the army at once.
In a case of suspected typhoid fever the examination of serum, blood
and excreta would be necessary to determine whether the case were
really typhoid or not. If found to be typhoid the laboratory would be
called upon to try to discover the source of the infection. The same
general methods hold good in other epidemic diseases where the
laboratory is capable of making the diagnosis, to see whether any
danger lurks in "contacts" or "carriers" and to find the source of the
infection where possible.
Very frequently material from wounds is sent in by the hospital
surgeons to see whether wounds are infected. The soil of Flanders has
been liberally manured for hundreds of years, and in every cubic yard
of this manured soil are millions of the germs which cause gas
gangrene and tetanus (lock-jaw) when introduced beneath the skin. If a
wound is infected with gas gangrene or other dangerous organisms, the
knowledge that they are present may materially modify the treatment
used by the surgeon, and the laboratory is of value to him sometimes
in determining that point.
The usual routine work of a hospital clinical laboratory was also
carried on by us for the casualty clearing stations in the area, and
all kinds of work from the making of a vaccine for the treatment of
bronchitis in a British General to the inoculation of a civilian child
with anti-meningitis serum came within our scope.
The hygiene work of the laboratory is also of a varied character: It
consists of the examination of water supplies, milk and foods; the
detection of poisons in water, and, occasionally, in human beings; the
evolving of methods to purify effluents discharged into streams; work
on poison gases and methods used to combat these, and many other
things.
In each division there are some sixty water carts, each of which holds
about 110 gallons. We attempted to get samples from all of these in
turn, to see whether the water had been disinfected. As all the
sources of water supply in Flanders, with few exceptions, contain
large numbers of bacteria, and as a properly chlorinated water
contains very few bacteria, it is easy to tell from a couple of simple
tests whether or not the water in the carts has been chlorinated.
As we sometimes had eight divisions in our area at one time, this
water control meant a good deal of work. The water carts were usually
to be found at the headquarters of the unit to which they belonged,
and we quickly discovered that the way to get the largest number of
water samples in the shortest time was to travel by the map up and
down the twisting narrow roads which intersected each other as though
following the trails of the original inhabitants.
It must be remembered that four or five miles behind the front line
every farm house and barn is in use most of the time for billeting
soldiers, and that these farm houses are infinitely more numerous than
they are in America. Little villages and towns are very frequent and
many of them bear the same name as other towns and villages a few
miles apart. Thus there are at least two Bailleuls, two Givenchys, two
Neuve Eglises and so on. In our quest of these water carts we had to
search the countryside diligently and we averaged a great many miles a
day; we soon got to know every road and almost every farm house in our
area.
When a cart was found it was necessary to get the man in charge of
it--the water detail--in order to obtain information as to the source
of supply, the amount of chlorine used, whether there had been
complaints of taste and so forth. While the information was being
obtained, officers of the unit would often come out to see what the
trouble was and would ask questions; possibly some non-coms and men
would also gather about, and the first thing we knew would be giving,
to a very interested audience, a little lecture on the dangers of
drinking untreated water; their interest would be greatly increased if
a bottle filled with the water, to which a couple of drops of solution
had been added, turned bright blue, thus showing the presence of the
free chlorine. By such means a good deal of practical educational work
was done, and the danger of men drinking raw water thereby reduced.
Reports of all samples were sent to the A.D.M.S. of the division
concerned, who forwarded them to the medical officers of the units,
with more or less caustic remarks should the samples be bad. The M.O.
in turn would get after the man in charge of the water cart, who
usually had some more or less plausible excuse.
The water details of the first Canadian Division were the best trained
lot of men we ever ran across. The very first day we took samples from
their water carts they were all sterile, and there were no complaints
about taste. It was an excellent example of what training could
accomplish, for they had all been carefully trained in their duties in
Canada and England.
As the water details of any division were constantly changing, the
efficiency of the treatment depended to a great extent on the constant
supervision of the problem by the A.D.M.S., medical and sanitary
officers.
We have found divisions coming into our area for the first time with
only 25 per cent. of their water carts chlorinated, whereas before
they left they would have 90 per cent. or more chlorinated, and the
division thoroughly educated as to the necessity for sterilizing their
drinking water properly.
Wells, springs, creeks, and ponds used as sources of supply were also
examined, and not infrequently samples from "springs," encountered
while digging new trenches, were sent in to be tested. The tremendous
number of bacteria found in some of these "spring" samples we on
several occasions reported as indicating the presence of buried animal
matter in the immediate vicinity of the springs, and resulted in
finding this to be correct. In one case in which a badly polluted
water was so reported upon, the burial place of some fifty Germans
was found only a few feet away.
One suspected epidemic of dysentery was a typically water borne
infection which did not prove to be the real thing. Half of one
company was in a front line trench and half in support. Part of the
one section took their drinking water from a shallow well near at hand
without treating it, and practically every one who drank it,
thirty-one in all, came down with typical symptoms of dysentery, while
all the others who did not drink it raw escaped. The well water was
found to be badly polluted. The sick were all quite well in four or
five days, and able to return to the front line, but it proved to be
an excellent lesson in hygiene to that Division.
A curious phenomenon in connection with the army water supply was
noted that first spring in Flanders. The flat surface of the country
in our area consisted of a very tenacious clay, and the farm wells
were usually sunk ten to twelve feet in that clay. In the months of
March and April, though the fields were water logged and the ditches
brimming over, the wells which were being used by the troops were
going dry. In other words the soil was almost impervious so that once
a well had been emptied it would not fill up again for days.
For this and several other reasons we reported the necessity for large
mobile water purification units, which could take the water from
larger bodies of water such as ponds, creeks, canals or rivers, purify
it, and deliver it filtered and sterilized into the water carts or
tanks. Such a system was subsequently adopted by the war office and is
now in general use in the British Armies.
One hot morning in mid June we received a telegram from the Surgeon
General to investigate a water supply complained of in the Festubert
region. A premonition seized me that I was going to be killed, for the
battery to be visited was in a very "unhealthy" spot. So I made a new
will, and wrote a letter of farewell, to be posted in case of
accident.
The battery was found nestling in the midst of an orchard, but the
M.O. who knew all about the water supply, was not to be found.
Reluctantly I accepted from the Colonel an invitation to dinner, for
the feeling was still strong in me that some danger was impending.
Half-way through dinner there came the well-known scream of an
approaching shell, which burst at the other end of the orchard. A
second shell burst a little closer; a third came closer still, and a
fourth rained shrapnel on the roof; all the others, with one
exception, fell short, and the shelling was over for the time. It was
just another one of those "intuitions."
While the shells were flying we all kept on eating as if this were a
usual everyday accompaniment to lunch, though I noticed that they
watched me with as much interest as I eyed them during the process,
each curious to know how the other took it.
The varied nature of laboratory work in the army and its practical
applications may be seen from the following examples:--
One day the O.C. of a hospital sent over a pint of tea suspected of
poisoning 28 out of 29 men who drank it. From the history of the
affair we did not believe that this could possibly be the cause, and
after making a few rapid tests to exclude metals, we proved that the
tea was not poisonous by the simple, practical test of drinking it,
Major Rankin being the official tester. This method of making a
practical physiological test rather astonished the British
authorities.
A German gas mask found on the battle field was submitted to us to
find what chemicals were present. That mistakes were sometimes made by
the Germans was evident when we found that the mask had not been
treated with chemicals at all; some of the Huns at least had been
unprepared for a gas attack.
The clarifying apparatus on the British water carts was mechanically
defective and usually broke at certain definite places.
Recommendations were made by us after we had experimented with rubber
instead of rigid connections, which resulted in all the water carts in
the British army being equipped with rubber connections, the results
being entirely satisfactory.
A great deal of experimental laboratory and field work was done with
chlorine gas and the efficiency of gas masks and helmets. Experimental
physiological and pathological work was done on animals with chlorine
and other gases, and on the drying out and deterioration of gas
helmets and the chemicals used in them. Subsequently a Gas Service was
inaugurated and all work of this sort carried out in special
laboratories at G.H.Q.
Quite a number of cases of nephritis occurred among soldiers, and
arsenic was suggested as a possible cause. The laboratory was asked to
examine a considerable number of samples of wine and beer to see
whether traces of arsenic were present or not. None was found. A large
quantity of wine found to be diluted with ditch water, and sold to our
soldiers, was destroyed, and the vendors fined.
One day a young medical officer, so excited that he could hardly
speak, rushed into the laboratory with a lot of dead fish. After some
questioning we found that there were tens of thousands of dead fish in
the Aire-La Bassee canal and, as this ran into the German lines, he
suspected that the canal water had been poisoned by the enemy. We told
him that we thought the fish had probably died from asphyxiation as a
result of organic matter from a starch works being emptied into the
stream. He went away unconvinced, to make a further enquiry and
returned later in the day to report that the fish in the canal died
every year in the spring when a certain distillery dumped its waste
into the canal. Thus did former experience with starch mills pouring
their effluents into Ontario streams and killing fish prove of
unexpected use.
The laboratory was used a great deal by the highly trained officers of
the Indian Medical service, who were always wanting some unusual
parasite or insect identified, and made a good deal of use of our
library.
A German high explosive percussion bomb was brought in one day for us
to identify the explosive present. We did not allow the messenger even
to lay it down but besought him to hold it tight and to keep moving
towards the explosives laboratory seven miles away while we escorted
him quickly and safely from the premises. The way some of those chaps
handled bombs and shells made you tired. It would have been a great
pity if that two hundred year old building had been blown up and the
British Army compelled to pay for it.
A poor soldier up and died one day without warning or preliminary
sickness. They thought it might be poison, and his wife would have
been deprived of her pension if the man had committed suicide. We were
asked to examine the stomach contents to decide whether poison was
present. No poison was found.
We were sent a little vial containing a small amount of material and
asked to determine the nature of the contents. The bottle had been
found beside a dead German. It proved to be opium, and the owner had
evidently been prepared for a painless passage across the Styx when
such necessity arose.
Occasionally we had to investigate possible cases of cholera among
troops coming from India. One day we received a telegram to proceed to
a certain place about ten miles away and report on the sanitary
surroundings and particularly on the water supply of a place where an
old Frenchman had died with "choleric dysentery." We found the place
after some search, and discovered that the old man had died a month
before, and that the suspected water supply, unboiled, had been used
ever since by a certain headquarter staff without ill effects.
Needless to say that was the best proof obtainable that the water
supply was safe.
The use of raw milk was forbidden in the army, and condensed milk was
issued instead. Sometimes "blown" cans of this were sent in for
examination and found to be infected with gas producing organisms.
Whenever such occurred, the report would be forwarded back through the
system to England and the manufacturer would be apprised of the fact
and checked up on his methods. Canned foods of various sorts were also
brought in for examination, but nothing of a harmful character ever
discovered. The food supply of the British Army, as a matter of fact,
was of the highest quality and had been subjected to rigid examination
by the Government inspectors during its preparation; practically none
of it was ever found to be bad.
Another unusual problem arose out of the fact that several soldiers
had contracted anthrax, both in England and in France, and the shaving
brushes issued were suspected of being the cause. We undertook to
search them for anthrax spores, but found it was too long and tedious
a job for a field laboratory, for the brushes were full of spores of
all kinds. Later on in England anthrax was actually found by other
bacteriologists in some of these brushes, according to reports
published.
These few examples taken at random will serve to demonstrate the
varied character of the work of a field laboratory, and to show that a
certain amount of experience is necessary in order to handle some of
the problems affectively. We were peculiarly fortunate in our combined
experience. Major Rankin, a first rate pathologist and bacteriologist
of the government of Alberta, had been in charge of the government
laboratory at Siam for five years previous to the war, and knew
tropical medicine like a book, while Captain Ellis had carried on
research work for three years in the Rockefeller hospital laboratories
in New York and was thoroughly conversant with all the most recent
work in vaccine and serum therapy. Consequently there was practically
nothing that we could not tackle between the three of us, either in
bacteriology, pathology, sanitation or treatment of epidemic disease.
Wherever an action was about to occur on the front the hospitals were
evacuated of all sick and wounded in order to obtain the maximum
number of empty beds. Consequently when fighting was going on the
hospitals were very busy but the laboratory routine greatly decreased
except in hygienic work. We therefore undertook scientific
investigations of various kinds to keep busy and be of the maximum
use.
At the suggestion of the D.M.S. of the army, Major Rankin made a
survey of the army area for anopheles mosquitoes. The Indian corps was
in our area at the time and he obtained the co-operation of the
officers of the Indian Medical Service, who being particularly keen on
biting insects collected many specimens for him. This variety of
mosquito transmits malaria, and, as we were getting a few cases of
malaria in troops who had been in tropical climates, it was important
to determine accurately the varieties of mosquitoes present,
particularly since the numerous ditches, canals and ponds of the
country were ideal places for their multiplication. In spite of the
anopheles mosquito being found everywhere, Major Rankin reported that
he did not believe that there would be many new cases of malaria,
develop in France and such proved to be the case.
Captain Ellis began an investigation into the grouping of the various
strains of "meningococci"--the organism causing cerebro-spinal
meningitis, with the ultimate object of obtaining a more efficient
anti-serum for the treatment of this disease.
Apparatus designed to purify wash water from baths before turning it
into the streams; designs for the building of small chlorinating
plants near the trenches, and the construction of field incinerators
for consuming garbage, were constantly being referred to us for
consideration and suggestions; we thus had a variety of sanitary work
of an interesting and useful kind, which helped to keep us busy.
The nature of our activities carried us through the area of shell
fire, among the batteries and sometimes quite close to the trenches.
We were free lances to all intents and purposes and frequently had to
hunt out new problems to work upon. In travelling about in the course
of our work we saw things more or less from the spectator's
standpoint, and there were few things going on that escaped us.
Many sad and depressing sights were witnessed, and one received many
vivid impressions of what war means to an invaded country,--impressions
which can only be attained by actual experience.
Accompanied by the sanitary officer of the 19th division one morning I
saw a very sad example of what ignorance of the essentials of hygiene
can bring about. Down in a swampy spot on a branch of the canal was a
little hamlet, and one of the tiny houses was occupied by a family of
refugees from La Bassee.
When we entered the house swarms of flies flew up from the table and
buzzed about while we did our best to prevent them from settling upon
us. The father of the family was in bed unconscious, with typhoid
fever. The mother, dead from the disease, had been buried the day
before.
During the funeral the eldest daughter, a pretty girl of sixteen, sat
up in a chair trying to look after the visitors. When we called she
also was in bed delirious with the disease in the same room as her
father.
The baby in the carriage had had typhoid. A little two year old boy
was just recovering, and was thought to have been the original case.
Two other boys of seven and nine years of age were getting some bread
and milk for their dinner, one of them being probably a mild case; and
a girl of eleven, evidently coming down with the disease, was going
about looking after the household.
With that swarm of disease-carrying flies in the house there was no
possibility of any of the children escaping the infection. It was with
the greatest difficulty that the sanitary officer of the division
succeeded in getting the French civilian authorities to move in the
matter and remove the cases to the French civilian hospital. The
father died a week later, and the sanitary officer himself was
subsequently killed during the battle of the Somme.
The French refugees do not complain; they are not that kind. They
told their stories simply and invariably finished with a shrug of the
shoulders and the phrase "c'est la guerre n'est ce pas?" (That is war,
is it not?) But if the French army ever gets on German soil I would
hate to be a German.
One night we found that our first Canadian brigade was going into the
trenches at Festubert without the chemical necessary to saturate their
gas masks, which had just been issued to the soldiers; we succeeded in
borrowing 500 pounds from a wide-awake army corps and took it down in
the car to an advanced dressing station which the brigade would have
to pass. The Germans were particularly jumpy that night as we felt our
way along that very rough road with no light to guide us except the
electric green light of the numerous German flares, the occasional
flashes of a powerful German search light sweeping the sky and ground,
and the angry red spurts from the guns which lit up the sky like
summer lightning.
Once we had occasion to make a trip from one shelled village to
another, the driver had been given the direction and no further
attention was paid to him until we came across a reserve trench manned
by Ghurkas. This drew our attention to the fact that the country was
quite unfamiliar. However, the next French sign post showed us that we
were on a road leading to the desired village and we kept on.
The day was very quiet and hazy and it was impossible to see very far.
We suddenly came upon the remains of a little village which had been
literally levelled to the ground; not two feet of brick wall could be
seen anywhere. At the cross roads in the centre of the village two
military policemen seemed to be surprised at our appearance with a
large motor car but said nothing, evidently thinking that we knew our
own business best, and we made the correct turn according to the sign
board and kept on. About two hundred yards farther on we ran into a
veritable maze of trenches, barbed wire entanglements and dug-outs,
without doubt part of the front line trench system. Needless to say we
made a rapid right-about face and speedily retraced our steps by the
road we had come.
We found later on that the road we had taken did go to the village
that we wanted to visit but that it went through the German trenches
en route. At the point where we had turned, which was only four
hundred yards from the German trenches, thirty men had been killed by
snipers during that month while getting water at one of the wells in
the neighborhood. The haze in the atmosphere saved us from observation
for we would have been a fine target for rifles, machine guns and even
whiz bangs.
We met officers in every branch of the service,--infantry, cavalry,
artillery, flying corps, ordnance, army service, medical, engineers,
construction, water transport, etc., and thereby obtained a splendid
idea of what was going on, and how the various branches of the service
worked together and viewed any given problem.
Some of these views were quite at variance with one another. For
instance the artillery man looked upon the infantryman as the man who
protected his guns and kept off the enemy while he killed them. The
infantryman naturally looked upon the artillery as the arm to support
him in time of trouble and prepare the ground while he did the dirty
work. The aviator called them all "ground soldiers" in a more or less
lofty manner.
The medical and other services looked upon the fighting man as the one
who gave them a great deal of work, and they all usually forgot that
they existed for the express purpose of keeping Tommy in the trenches
clothed, fed, healthy and protected from the assaults of the enemy;
for Tommy is the man, say what you will, without him everything else
goes smash; it is the human being who still counts in war; it is the
man power which will win.