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) 

Chasing Sister Williams

Since I found the reference to Sister F E Williams in the Official History of the Australian Medical Services, I’ve been looking for traces of her, wondering if she could be the hero of the story, if she can have ever met D’Herelle, how a woman came to be a bacteriologist at that time anyway.

The folks at the State Library of Victoria sent me this article by Dr Kirsty Harris, University of Melbourne.

It turns out Fannie Eleanor Williams was a noted bacteriologist who specialised in dysentery – starting as a technician working under a bacteriologist in Gallipoli, moving on to Cairo and then the Western Front. Here she is, in the laboratory on Lemos(Australian War Memorial Collection item ID H13944)

After the war Fannie Williams was one of the first three staff members of the Walter and Eliza Hall Institute, Australia’s oldest research institute - the first female scientist employed there. She worked there until she retired, and ran her own lab. They have their own little bio for her - where I found this picture. 

 http://www.wehi.edu.au/about-history/notable-scientists/miss-fannie-williams

Her early published articles were co-authored with Charles Martin, from Army hospitals during the war. I looked them up in the British Journal of Medicine and they look a bit like this:

She says great things like:

Attempts to isolate dysentery bacilli from 217 cases in which the stools contained muco-pus with or without blood were made. In many cases the amount of mucus in the stool was very small…The method employed was to wash the mucus, break it up in sterile broth and plate out some drops on the surface of a MaConkey plate.

Her dates don’t line up for Pozieres, and I think we want our main character to actually suffer dysentery, So it looks like she can’t be the hero of our story. But I’m enjoying seeking the aesthetic of the laboratory between the science-paper lines. I’m wondering what her relationship would have been like with the normal nursing staff, how she obtained her samples (!) (me - not getting over the whole thing about poo samples). There's something about having the specificity of what scientists knew about dysentery at the very moment our story is set. And there's something important for me about connecting this understanding to an Australian woman. Someone who lived in the same city as me. 

Researching "The Invisible War" - Meeting the computational biologist

Cycled down through a blustery Melbourne afternoon (no gloves, cold fingers) to meet Kathryn Holt at the Bio 21 Institute. She found us a spot on Flemington Road to have coffee and Gregory asked, “So, do you know why we asked to meet you?”

She shook her head, smiling quietly and I wondered if she thought we were a bit crazy. Gregory pulled out copies of Squid Vibrio and Zobi and launched into a description of Mission Symbiosis Storytelling.

Kathryn explained to me that she’s a computational biologist – which I had never heard of. There’s something kind of amazing and on the edge of humiliating about being the absolute novice thrown into these conversations. Kathryn talked me through it.

She’s working with samples of the Shigella bacteria, which causes dysentery (some of which are over a 100 years old, from WW1. Think of them sampling soldiers’ stools and keeping those samples intact for so long). Kathryn does genetic analysis and uses that information to trace where Shigella bacteria have travelled in the world. She told us about a guy from the Pasteur institute, who’s obsessively using genetic data to exactly track the movement of Shigella bacteria from trench to trench during the war. I love the stories I get to hear of humans dedicated to drilling down such specific details.

Kathryn talked about the Shigella bacteria’s “type three secretion system”. The they have 40 or 50 genes which can form the shape of a needle used to puncture a human gut wall. Then they manipulate our cells so they can live inside them. Her descriptions were so graphic. I was already seeing scenes of our story forming.

She talked about the microbiome, the thousands of species of bacteria in our gut, some of which would compete with Shigella, helping us to beat the dysentery.

I sat there, cold hands gripping my coffee, listening with a kind of gleeful astonishment.

The last thing I wrote in my notebook for that meeting was, “macrophages patrolling your gut”.

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.

Meet the Scientists: Dr. Jeremy Barr

The main stimulus for The Invisible War came from an article by Jeremy Barr “Bacteriophage adhering to mucus provide a non–host-derived immunity”, published in the prestigious US journal PNAS in June 2013.

Here, Jeremy, along with group leader Forest Rohwer, writer Merry Youle and other co-authors described a mutual symbiosis between mucus-producing (animal) “host” with their phage partners – where the virus partner limits mucosal bacteria, while the animal host presents new bacterial hosts in the mucus for the phage to reproduce.

The enemy of my enemy is a phage

Widely hailed as the discovery of a new immune system, we knew we had to speak to Jeremy Barr about the potential to describe this newly symbiotic relationship as a story in our series. We were overwhelmed by Jeremy’s enthusiasm about collaborating to communicate this discovery as widely as possible.

Jeremy also had an implicit understanding about the power of using narrative to engage people in a topic, something at the heart of our mission. One of our extra incentives for creating this particular story was the challenge of writing a story with a virus as a hero…something we hadn’t anticipated at the start of our process of creating Small Friends stories!