CHAPTER V THE SCIENTIFIC BACKGROUND OF ARMY MEDICINE IN THE WAR THEscientific history of Army medicine in the War of 1914-18 IS concerned with two spheres of experience, and two phases of time. The first sphere of experience is internal, The the Army Medical Service being a self-con- milieux of 1914-18 tained system with a scientific outlook and organisation-a nzilieu intkrzeur-of its own. But it has intimate relation to a much wider sphere-the milieu exotique-of its scientific environment ; the great world of knowledge and research lying outside its structure, uninterested in its activities, and to a great extent alien to its ideals and objectives. And the history of each of these spheres of experi- ence is concerned with two periods-(a) the situation prior to and at the outbreak of the war, and (b) developments, especially internal, occurring in the course of that war and, in certain directions, after it. “That blessed word” Science, and its even more sacrosanct derivative “scientific”, have reached-as the present generation has come to discern-a phase of deification at Science and medicine which it is desirable to examine closely the form that they clothe. Is (men are asking) the unprepossessing body of Science (as applied, let us say, to war) the true form and substance of Science? Or is this garment but a verbal figment, a fetish, distorting not revealing the true form, of scientific “wisdom”? That as applied in war, “science”- speaking generally-is almost wholly destructive is not open to dispute. In the Great War medicine, almost alone among war’s exploitations of peace, was able to “save its soul alive” and, after some initial frustration, began to pick up the threads of peace-time scientific progress. Though so short a time has elapsed since the outbreak of 220 18m-1gooJ THE SCIENTIFIC BACKGROUND 22 1 the First World War, it is already necessary to remind our- selves that the scientific, as well as the social The and the political outlook, have considerably erotique changed since then. The war of I914 came with the crest of a wave of technical “scientific” activity unsur- passed, probably unequalled, in the history of man’s cultural evolution. In the particular region that formed the milieu exslique of the Royal Army Medical Corps and its Australian confrere, Pasteur (1822-95), Koch (1843-1910) and Lister (1827-1912) were only one generation into the past. In the cavalcade of comparatively recent events Jesse W. Lazear, with Reed (1851-192) and Carroll, had sought and gained by the experimental bite from infected Stegomyia protection from Yellow Fever for humanity and death for himse1f;l Laveran and Ross had solved the puzzle of malaria; Almroth Wright, (1861- ) had conducted his early studies in Australia and his later researches in China and England; these and many others had created lines of research which in the World War were to abolish typhus fever from the Western Front, control malaria and dispel the menace of typhoid. The enunciation of the abstract theory of the “closed benzene ring” by August KekulC in 1865 was at once the inspiration for and the means of Ehrlich’s crea- tion of “606” and the Bordet-Gengou-Wassermann reaction. In yet another domain, that of “orthopaedic” surgery, despised and rejected of the orthodox surgeon, Hugh Owen Thomas (1834- 91) of Liverpool, in 1875 in the wire frame of his “knee splint”,2 determined principles of surgery as fundamental as the law of gravity, and was to confer on the wounded soldier in battle benefits unsurpassed in the long history of medical aid in war. Herbert Page (1845-1926),of London, when in 1881 against bitter opposition, by the force of exact “scientific” observation and fearless deduction he dragged the subject of train-collision “shock” from the meaningless jargon of “railway spine” to the light of a scientific concept as a “traumatic neurosis” laid the foundations on which in 1920 were based the conclusions of the Royal Commission on “Shell Shock”. 1Cf p. 250-the unveiling of Trench Fever on the Western Front 2 It is necessary to modify the statement made by Fielding Garrison-lntroductron to the Htstory of Medrrme, 4th Edn. 9. 792-which creates the impression that the Hodgen wire splint was used in every stage in the evacuation of men with fractured femurs It was not. 222 PROBLEMS AND SERVICES [400B.C.-A D. 1914 None of these men-except, perhaps, Ross-could have con- ceived how vast a practical application was to be given to their observations as that which came in the war of 1914-18. It will be noted that the science responsible for these advances had proceeded, as Western medical research had done since its beginning, along two distinct lines Observation which to this present century have usually V. Analysis run separate though parallel--commonly dis- tinguished as the obsewatzonal or clinical method and the analytical or laboratory. The first, originally associated with Hippocrates of Cos, was a system of exact ob- servation and record of the phenomena of health and disease and of the influence of external conditions and agents on individual and communal health-clinical medicine and epidemiology. The second was Aristotle’s analytical method of investigation of individual structure and function, as applied to medical problems by “the first experimental physiologist” Galen. The tradition of British Medicine has tended to be clinical, though the maintenance of balance and a sense of proportion have always, perhaps, been its leading characteristics. Nevertheless the acceptance-as vital in medical history as the Renaissance itself-in the “germ” theory of Pasteur and Koch of a specific “cause” for plagues and diseases ; together with the innovation of the “cellular” theory of structure of Schwann (1810-82) and Virchow (1821-1p2), had brought a sweeping reversion to the analytical idea of science. Then in 1910 Ehrlich (1854- 1915) created “606”; and the rising sun of bio-chemistry had appeared. The great majority of “new diseases” discovered in the quarter century before the war were of bacterial or other parasitic origin, so that a bacteriological and ‘i Scientific pathological laboratory came to be looked on research ” as almost ipso facto a research centre, and the bacteriologist and parasitologist a “research” worker. The expression “medical science” became in effect identified with some form of analytical investigation, and “scientific” discovery in medicine meant “laboratory” findings and “laboratory” research. It is true that since that time the aura of adventure has in a great measure been transferred to the bio-chemist and endocrinologist so that pathology, bacteriology and even 19141 THE SCIENTIFIC BACKGROUND 223 parasitology are becoming primarily diagnostic in function. But at the beginning of the war of 1914-18 the bacteriological laboratory carried such a halo of experiment that the liaison between the clinician, the pathologist and the bacteriologist was gravely defective. There were it is true giants who envisaged medical science as one and indivisible; the writings of Osler (1849-1919) and Allbutt (1836-1925) are great for this The more reason. But in the main, contemporary litera- ~~~e~~~~t~~-ture not less than scientific jargon saw in the clinician laboratory the authentic and only temple of “scientific” medicine. Not the least interesting feature of the history of war medicine is seen in the deliberate break-away from this fetish. It is of peculiar interest to Australia that among the early departures from it was the co-operation of clinicians and laboratory workers at No. 3 A.G.H. on Lemnos in 1915. Australia, which is not even yet “on the map” of the world in scientific medicine, was in 1914 almost completely terra incognita save to a few specialists or post-graduate schools such as those of Vienna, medicine in 1914 the kyo Clinic, London, and Liverpool. Yet by I914 Australian medicine had become fixed as at least a cultural variation from the British School, with its own subvariants in the several medical schools, Melbourne, Sydney and Adelaide, each tending to breed true to type.3 The generation of Australian medical men which in the 1880’s and 1890’s had graduated at Edinburgh, London, and in a less extent Cambridge, Oxford, Dublin and Glasgow, still formed the backbone of the consulting practice in the a Cardinal stages in its evolution are marked by the creation of Public Hospitala and Medical Registers; the formation of Clinical Medical “Associations”. the establishing of Professional Journals, the founding of Medical Schools, the successive extensions, in time and substance, of their curricula the creation of new Professorial Chairs; the development of specialties within 0; adjuvant to the organised medical profession as nurses, opticians, pharmacists; the development of post-graduate study, the formation of museums, and of professional libraries. Less tangible but not less important are the development of facilities first for the application. to general practice of advances made in laboratory analysis-bacteri- ology, biechemistry, radiology&s distinct from clinical observation and clinical diagnostic technique Lastly, but most relevant here, the creation of a spirit of and facilities for medical research. The outstanding exception to this steady progress in provision for medical culture was the gross neglect, save by a few enthusiasts. of medical historical libraries. 224 PROBLEMS AXD SERVICES [I914 capital cities. In the Australian medical schools the professorial chairs of anatomy, physiology, pathology, were still being filled from overseas, though clinical chairs-medicine and surgery-were now generally regarded as a responsibility for men born and trained in Australia. They had from the first been filled by men of the kind that create traditions and impress their personality.