Chapter 12

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.