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Army Medical School & Infectious Diseases Innovating for the future: The Army Medical School at Netley and developments in infectious diseases Introduction British Science Week 2021 has the theme of 'Innovating for the Future'. With this in mind, we have chosen to celebrate the medical developments that came out of the Army Medical School at Netley in the mid to late 19th century, particularly in the field of infectious diseases. Not only did these tackle some of the most serious problems facing British forces stationed overseas at the time, but they also paved the way for many future developments. The Netley staff and students you will encounter over the following pages really were 'innovating for the future' - our present. We would like to acknowledge the considerable contribution made by volunteer Tim Ford, whose extensive research forms the basis for this presentation. We would also like to thank the University of Southampton for their generous sponsorship of our British Science Week activities. Contents Historical & Military Context 5 Scientific & Medical Context 15 Cholera 24 Malaria 36 Leishmaniasis 42 Brucellosis 50 Dysentery 59 Typhoid (Enteric) Fever 64 Trench Fever 72 Historical and Military Context Return to Contents Any consideration of the advances in medical science pioneered at the Royal Victoria Hospital, or by those associated with its Army Medical School, must start with the military background. It must take account of the following: Great Britain’s global standing and international relationships in the mid- nineteenth century; the reasons for the foundation of the hospital; and the purpose of a military medical school. Painting: The Founding of Australia 1787 by A. Talmage 1937. Creative Commons The nineteenth century saw Britain's interest and activity expand throughout Asia as it attempted to increase its commercial activities with China. Singapore, Hong Kong and Malaya were all taken to facilitate trade and economic opportunities in the region, especially between India and China. The nineteenth century also saw Britain's interest in Africa bloom as it attempted to control the maritime routes via the Cape and later the Suez Canal. As rival European powers expanded their own imperial interest in the continent, there occurred something of a 'scramble'. This saw the majority of Africa come under direct European control in a remarkably short period of time. Britain's interest in the Gulf and Middle East also intensified as it sought to control access routes to and from the 'Jewel in the Crown'. British foreign policy both European and globally was generally to ensure that no other single power came to dominate either the continent or other parts of the world. Britain frequently joined alliances against the French in the eighteenth and early nineteenth centuries, the Russians in the mid- nineteenth century and the Germans in the early twentieth century. Those alliances brought Britain into conflict with opposing powers with the same intentions – the wars known respectively as the Napoleonic Wars, the Crimean War and World War One. Besides these, there were other local and equally draining campaigns in India and South Africa - indeed, wherever British interests came under threat. Inevitably these came at a cost in lives. The World in 1897. "The British Possessions are coloured Red“ Cambridge University Library However, the lives lost in military engagements were often more than equalled by deaths from the tropical diseases to which the troops and supporting personnel and Empire officials were subjected. This had been the case even since the Crusades. During the Crimean War (1854–1856) 34,000 British, French and Russian combatants were killed in action and 26,000 died from wounds. However, more than twice as many - 130,000 - died from diseases, particularly cholera, dysentery and typhus fever. Indeed, within a few weeks of the arrival of the British Army in the Crimea, more than 8,000 soldiers had contracted either malaria or cholera. Poor hygiene and insanitary conditions in the hospitals that were supposed to care for the casualties contributed to their swift spread. Events in the Crimea were quite explicitly reported in contemporary newspapers and letters sent home. A direct outcome of these was the establishment in 1857 of the Royal Commission on the Health of the Army. It was chaired by Sidney Herbert, the former secretary of state for war. Among the Commission's reforming recommendations was the establishment of an army medical school, with a particular focus on the teaching of hygiene and disease prevention. Running parallel to this was Queen Victoria's demand for a new military hospital, with more superior facilities than those she had seen in 1855 at Fort Pitt, Chatham. Queen Victoria's First Visit to her Wounded Soldiers by Jerry Barrett Oil on canvas, 1856 NPG 6203 © National Portrait Gallery, London These two facets coalesced at Netley. The Army Medical School was established at Chatham in 1860, then moved in 1863 to the newly- opened Royal Victoria Hospital. The logic of having both the new hospital and a teaching and learning centre of excellence on the one site was unarguable. The four schools of study at Netley were military surgery, military medicine, military hygiene and pathology. These reflected Florence Nightingale's insistence, and the Commission's recommendations, that army doctors gain an understanding of the principles and practices of preventative medicine. In the initial lecture that he gave new students in the 1880s, the Professor of Military Medicine, William Campbell Maclean provided an insight into the extent and global remit of the subject: "This great hospital… is intended for the reception of invalids from every part of the world where the British soldier serves, whether suffering from diseases or wounds. Opportunities are thus offered to you to study the effects of various climates and diseases..." Ward in the Royal Victoria Hospital, Netley Boer Wars 1899-1902 Maclean was equally explicit as to the need of such special instruction for military medical personnel: "above all because 60,000 British soldiers are always serving in India, requiring a large staff of carefully instructed medical officers for their care. Nor is this all. Side by side with those who devote their lives to the service of the British army sit a body of gentlemen, for whose benefit no less than theirs, this school was established. For them the study of tropical medicine is of vital importance. All their professional lives will be spent in India; on them the medical charge of a large native army will devolve, without the aid of which it would be impossible to hold India as a British possession... To them will in the future be committed the care of the valuable lives of those charged with the civil administration of India... From the ablest of them, the selection of teachers will be made to fill the chairs of the medical and allied sciences in the colleges established by an enlightened Government, and to be advisers on all questions affecting the health of the 200,000,000 people of the various races of the Queen’s empire of Hindustan." Surgeon-Major William Campbell Maclean (1811-1898) The importance of India and the medical care of both the British armed forces and the civilian population is clear. This is reinforced by the fact that for 15 years from 1865, students for the Indian Medical Service were required to undertake the same training as their British counterparts at Netley. However other parts of the Empire, and a world in which British geo-political interests were paramount, brought their own local medical challenges. The pages that follow highlight the most significant diseases encountered by the military. Although most prevalent in tropical areas, in a world where sanitation was often still rudimentary, they could develop and blight forces and the supporting civilians almost anywhere. The campaigns fought in South Africa in the late nineteenth century brought significant loss of life from typhoid. The strategic outpost of Malta in the Mediterranean was frequently and significantly impacted by brucellosis. British interests in India were severely affected by outbreaks of malaria, leishmaniasis and cholera. Finally, even fighting close to home on the Western Front in the early twentieth century saw the emergence of a new debilitating condition, trench fever, to be diagnosed, treated and overcome by those associated with the Army Medical School. A group of hospital patients at Netley during World War One. Whatever one's views on the British Empire from a twenty-first century perspective, the good intentions of many of its servants, leaders and specifically those connected with Netley at the time cannot be denied. However much they may have been intended initially for military ends, their achievements significantly benefitted humanity across the Empire and other parts of the world. Public recognition of several of those who worked or were trained at the Army Medical School came in the 1920s, when the London School of Hygiene & Tropical Medicine moved to its new premises in London. Among the twenty-three scientists named on the original frieze above the building were five from Netley: Edmund Alexander Parkes, the first Professor of Military Hygiene; Sir David Bruce, who trained in the 1880s and later served as Assistant Professor of Pathology; Sir Ronald Ross who also trained in the 1880s; Sir William Leishman who also served as Assistant Professor of Pathology; and Timothy Richards Lewis who, on graduating from the school in the 1860s, worked in India on several aspects of tropical medicine. The pages that follow outline the contributions made by these scientists and physicians in the field of tropical medicine. They also make mention of others acknowledged within the LSHTM frieze, such as Sir Patrick Manson and the German scientists Koch and Pettenkofer, who made their own pioneering progress in this area or worked with those with Netley connections.
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