Newspaper Page Text
MEDICAL TR TT TMPHS OF THE WAR ZONE
New Serums, Antitoxins and Surgery
Methods Will Remain as Perma?
nent Gain in Years of Peace
An Interview With
Dr.Simon Flexner, Lieut. Col. U. S. Medical Corps
Director of Laboratories of the Rockefeller Institute for
Copyright, 1918, by The Tribune AssocUttion (The Kew York Tribune)
THE Great War, now approach?
ing the close of its fourth
year, has seen a smaller per?
centage of death and disability due
,0 disease than any previous war of
?j/hich there is adequate record, as?
sorts Dr. Simon Flexner, director of
_ laboratori e s
r ~??at^r l ?f the Rock"
i ^mS^- ^**ir*\ . medical
MjEW^-^^?mm*** science sug
l"?igk "I tions would
^?3?&?S=5~ r o r. The
Dr. Simon Flexner trenches of
the Western front would be an un?
imaginable mass of diseased and
suppurating flesh. In spite of the
difficulties arising on a scale never
before dreamed of, medical science
and preventive sanitation have
been able to control most of the
familiar types of war disease
and have reduced them to a
point far lower than that of previous
wars. Xew diseases have made their
presence felt and rare infections
have become common. But medical
science has met most of these prob?
lems with adequate remedies, limited
in their action only by the physical
proportions and difficulties of apply?
ing them. A substantial list of new
discoveries, methods, serums and
antitoxins is the fruit of the scientific
study of the war's medical problems,
and some of these discoveries will
retain a value to mankind in suc?
ceeding years of peace.
? In New Problems
Dr. Flexner, who is now Lieuten
ant-Colonel S. Flexner, M. C. N. A.
is perhaps the world's foremost bac?
teriological expert. His work ir
connection with New York's in
famile paralysis epidemic, whicl
he helped to curb, is still re
merr.bered, and his antotoxin fo
cerebro, spinal meningitis is possibl*
the most definitely successful discov
cry of its kind in the past ten years
The Rockefeller Institute, under Dr
Flexner's direction, has likewis?
made material headway in the seien
tifie tight against cancer. Since th?
war broke out in Europe Dr. Flexne
has been tireless in his work to mee
the new problems. Dr. Flexner ha
been decorated with the Cross of thi
Legion of Honor.
Dr. Flexner is a member of th?
National Academy of Sciences, th?
.Association of American I^hysicians
the American Philosophical Societ;
and the Amerian Association of Pa
thologists and Bacteriologists anc
other scientific societies at home am
The present war, Dr. Flexner as
serted, stands in sharp contrast t<
all previous conflicts on a large scab
by tiie relatively small proportion o:
deatli and disability caused by dis
ease and infection.
"War and pestilence," he said
"have in the *:ast been almost con
vertible or synonymous terms. If w?
wish to consider the relation of dis
ease to wounds in the present wa:
we should choose for comparison s
war or wars waged on a large scab
before the ushering in of the presen
era of preventive medicine, which i
based largely on bacteriological in
Vtstigation made in the last thirt;
years. Perhaps our Civil War wouh
furnish a fair basis of comparison
since medical diseases as compare
with wounds received in action fa
Outweighed the latter as causes o
disability and death. If to the modi
fid diseases are added the infection
of wounds occurring in hospital, th
overweight is prodigious.
"The medical catastrophes of th
t'ivil War are practically outside th
memory of the present generation o
purgeons and laymen. Happily, ther
18 still among us a great surgeon wh
as a young man saw much active sei
v'ce in the field and hospital. Di
*? W. Keen, of Philadelphia, in hi
w^cngs has give? vivid pictures o
?? destruction worked by the germ
of typhoid and other fevers and thos
?wound infection, including th
Sw'ft and deadly hospit?al gangrene
?Ut the medical catastrophes of th
?^panish-American War are withi
tl!e memory of many of us. Th
???voc which typhoid fever mad
*mong our unseasoned troops in tha
short contest is matter of commo:
Knowledge, to he contrasted with th
Present virtual abolition of tha
Ha-j-ue as a military disease. Wher
formerly the camp and typhoid feve
were inseparable companions, to-day
While that disea.?*? still prevails li
civilian communities, it is all but un?
known in our military establish?
"The Russo-Japanese War, it had
been supposed, was the high-water
mark of sanitary wars. There seems
good reason to believe, as a matter
of fact, that the Japanese at least
| gave their troops the benefit of mod?
ern methods in sanitation. But the
data available on which to base an
estimate of the actual success with
which the Japanese suppressed the
medical diseases within their fighting
forces are not great.
"The present war, of course, can?
not be compared with any previous
war, because of the disproportion be?
tween the numbers engaged and the
manner in which the fighting is be?
ing conducted. Where formerly we
reckoned in thousands we now reckon
in millions of men engaged in actual
warfare, and where formerly we
spoke of hundreds we now speak o?
thousands aggregated behind th?
lines engaged in the manufacture oi
munitions and the other parapher?
nalia of warfare.
"Hence the medical problem of th?
present war embraces as never be
foro enormous numbers of persons
both men and women, and not alom
in the immediate theatre of fighting
but also in remote places where the;
are assembled in factories, etc. Fo:
the first time, therefore, entire popu
lations of the belligerent countrie
are engaged in the operations o
war. Just as it may be stated witl
truth that the scale on which th
great war is being waged would b
impossible without a high degree o
industrial development, so may i
also be said that it would be equall;
impossible without a high measur
of sanitary control.
"This sanitary control has bee
gained laboriously within a generE
tion, through the discovery of th
nature of the bacterial causes an
the manner of their propagation c
| the infectious diseases?both of mec
I ical and surgical nature."
Scientists divide the diseases <
modern warfare into three group
Dr. Flexner declares. Of these, tl
group emanating from intestinal d
rangements is now the least feare
having been effectually met by va
cination and sanitary control.
"The medical diseases attenda
upon military organizations," ]
said, "may be divided into tho
causing intestinal infections?th?
i are represented by typhoid fcv<
?dysentery and cholera; those ori?;
nating in respiratory infections ai
represented by the various forms
pneumonia and epidemic meningiti
those associated with eruptions
the skin and including smallpc
measles and scarlet fever; and th
certain more irregular maladies,
which mumps may be taken as an <
ample, since it may become ve
"Formerly the diseases of inte?=
nal origin were most, while now ti?
are least, feared. The reason for t
change of view is to be found in 1
great measure of control exerch
over them. Typhoid and the relai
paratyphoid fever have been ab
ished by vaccination; cholera 1
been and. can always be brought .
AN OUTPOST OF THE MEDICAL BATTLEFRONT
Copyright, 1918, by Underwood & Underwood
The defensive work of the doctors against disease, even more than the wonderful hospitals behind the lines, has been vital to the main?
tenance of the tremendous armies of this war. This is one of their out posts?a distilling plant furnishing safe drinking water to British sol
?lipra ir? Flnnrlfirs. whpre almost all undistilled water carries a multitude of ?-I?kpakps
der control by means, first, of ready
methods of disinfecting the drinking
water, and second, by vaccination.
Dysentery has also been held down
by water sterilization and by latrine
sanitation. Moreover, recent investi?
gations have brought bacillary dys?
entery, which is the variety of that
disease prevailing in temperate cli?
mates, within possible control by
means of vaccination, should an epi?
Those who had supposed that
pneumonia was merely an after ef?
fect of "taking cold" will be sur?
prised to learn that war-time science
has met the disease effectively with
inoculation or vaccination.
"The commoner lorms of pneu?
monia," says Dr. Flexner, "have in
a large measure come under control.
The bacteriology of that affection has
now been wholly worked out; the dis?
ease is now recognized as contagious,
which fact essentially affects the
handling of the sick and the pro?
tection of the well from avoidable
exposure ; and for one of the severer
types of this pneumonia we now pos?
sess a curative serum. Moreover,
here again vaccination is holding out
hope of substantial accomplishments;
and if present indications are uphelc
it will be not outside the limits of the
practical to immunize by a harmless
kind of inoculation or vaccination
even millions of men who would thus
be protected from acquiring pneumo?
nia of the severer forms."
?Spinal meningitis, at one time on?
of the most baffling and cruel of dis
eases, has now largely come undei
the control of preventive medicine
Dr. Flexner points out. The meth
od, largely developed during the war
he describes as follows:
"The germ cause of epidemic men
the body through the mucous mem
brane of the nose and throat, the so
called upper respiratory membrane
From that location the germ enter;
the blood, with which it is carried to
the membranes about the brain and
spinal cord, which are the sites of
location or election for its growth
inside the body. But not every per?
son who carries the meningococcus in
his nose and throat is in danger of
acquiring meningitis. Indeed, con?
siderably more persons carry that
germ than develop the disease. These
contaminated persons are called
healthy carriers of the meningococ?
cus, and they are a source of poten?
tial danger, since they convey the
germ by coughing, sneezing, etc., to
other healthy persons who are less
resistant to infection and hence may
develop the disease. At the present
time bacteriology is competent to
discover the dangerous healthy car?
riers o? the meningococcus, and when
they are present within the military
organizations they are thus detected
and segregated until they become
clear. This process requires from
ten days' to several weeks, but it can
be hastened by appropriate treat?
"In this manner meningitis may
be brought under control. Here
again, should conditions warrant it
protection can, it appears, be con?
ferred by vaccination. Moreover, w?
now possess an efficient and specific
method of treating epidemic menin?
gitis by means of a curative serum
Hence we feel forearmed to a higi
degree with reference to this disease
which in earlier wars in the char
acter of spotted fever was regard?e
as one of the most fearful of pesti
One of the peculiar medical prob
lems of war time was particularly
related to American conditions. This
a severe form of pneumonia, ha!
been the result of so trivial a diseasi
ay the measle.s.
"Unusual conditions surrounding
America's entrance into the war,'
Dr. Flexner explains, "necessitatinj
the rapid assembling of recruits ii
large numbers from all parts of tin
country, led to certain unforeseei
problems of disease. It happenei
that in rural districts many adult
had never been exposed to measles.
Under conditions of camp life large
numbers of cases of that disease, of
childhood, properly speaking, arose;
and, following the measles, a form
of pneumonia, known to succeed it at
times in children, became unusually
frequent and severe. This pneu?
monia is caused by other bacteria
?a streptococcus, indeed?than
those causing the usual pneumonia
of civilian and military life. This
particular medical military problem
is now being studied from every
point of view known to sanitary
science, and it is a fair assumption
that the near future will see it
sclved in greater or less measure."
As is generally known, the war
has produced new diseases of its
own. The most familiar of these,
"shell shock," is not strictly a medi?
cal problem. But Dr. Flexner has
investigated another, the so-called
"trench fever," which has been the
subject of much scientific study, and
which is now on the point of being
mastered as a result of the work of
an American army officer, Major
Richard P. Strong.
"In the East as in the West," says
Dr. Flexner, "a very baffling and
highly prevalent disease has arisen,
to which for the sake of convenience
the name of trench fever has been
applied. The disease possesses, how?
ever, a series of synonymes accordin.?
to the locality of its ?occurrence. It
is known to prevail in Flanders and
France and frcm the Vosges to the
sea, on the Italian and Austrian
fronts, at Sal?nica, and to a small
extent in Mesopotamia, but not ap?
parently in Egyrpt, Syria or East
Africa. This particular fever rarely
kills, but it is the moist prolific source
ni disability with which the armies
have had to contend. Moreover, the
disability it causes, while usually
measured by a few weeks, may ex?
tend into many months, and not in?
frequently its victims are perma
nently disabled and unable to returr
to the ranks. As a side effect it pro
duces cases of irritable heart, in turr
a disabling affection.
"Under the circumstances it is
obvious that the solution of the rid?
dle as to its nature and mode of
propagation became of immediate
military importance. The best scien?
tific medical talent of the European
belligerents devoted themselves to
the task; but the solution was denied
it?to be yielded just the other day
to a medical commission headed by
Major Richard P. Strong, of the
United States army! The half dozen
medical officers?with the exception
of one Englishman, all Americans?
who solved the riddle deserve, with
the sixty-eight volunteers from our
ranks, the credit of this great and
highly important discovery. Trench
fever is now to be regarded as an
infectious and communicable disease
of verminous origin, since it is
propagated by the body louse. Thus
to all the other reasons for carrying
out a vigorous anti-louse campaign
among the troops is added the su?
premely important one of reducing
or abolishing trench fever. The army
which accomplishes that task first
will have won a large potential mili?
tary victory over its adversary.
"The discovery of the verminous
transmission of trench fever recalls
the ravages of typhus in Serbia and
Rumania after the Austro-Germar
invasion. The underfed, tinhotisec
and neglected crowds that swarmec
out of the occupied regions fell ready
victims to typhus, which prevails epi
demically in the Balkans. Serbiar
and Austrian prisoners alike wen
stricken and died by thousands. Th?
plague was arrested by improving
hygienic conditions and by reducing
"Typhus fever disappears before *
hygienic manner of living. Henci
the advanced Western nations hav?
become free of it. Its last strong
holds, as considering its nature i:
now obvious, were the prison and th?
poorhouse. But the disease still ex
Old Camp and Trench Plagues Routed
and New Diseases and Infections
ists in the Eas: and still lurks in the
backward parts of the West, in the
oalkans, as mentioned, in parts oi
Russia, in Mexico, etc. Germany and
Austria are being again invaded by
typhus, which was brought in by
Russian prisoners of war, and from
there it has spread to the civilian
populations. A number of eminent
physicians in Germany and Austria
have fallen victims to the fever. The
eradication of the disease will be?
come an important after the war
problem with the Central Empires.
Thus far typhus has not become a
menace to the armies or the peoples
on the Western fronts."
One of the curious medical para?
doxes of the war, Dr. Flexner points
out, is the fact that surgeons were
at first hampered in their treatment
of wounds because they knew too
much. The onerating room methods
of recent years, before the war, had
virtually dispensed with the lore of
antiseptic surgery, because aseptic
surgery, or the prevention of infec?
tion before it appeared, had wholly
supplanted it. Thus the surgeons,
face to face in France with condi?
tions which made infection inevita?
ble, were for a time at a loss.
"Modern surgery," Dr. Flexner
explains, "has been developed since
our Civil War. The constantly in?
creasing knowledge and skill ac?
quired by surgeons had enabled them
within the past quarter of a century
practically to abolish wound infec?
tion. Hence first so-called antiseptic,
then aseptic surgery arose. The first
dealt with wounds already infected
and strove to render them clean or
sterile, the latter resulted from a re?
fined operative technique which ex?
cluded infection. Latterly infected
wounds became rare in the best hos?
pitals, and the mass of our surgeons
of the present had had little experi?
ence in the treatment of surgical in?
"Trench warfare was tu change
the whole outlook of war surgery.
Had it been possible to succor the
wounded immediately after injury,
the terrible ravages of infection
which have cost so many precious
lives and have been the cause of so
many thousands of permanent crip?
ples would have been controlled.
Moreover, had not so much of the
actual fighting been carried out in, if
not actually under, the ground in a
country for centuries in a high state
of cultivation, the almost perfect
conditions favoring wound infection
would not have existed. The element
of delay, amounting to hours and
days at times before the wounded
could be rescued and brought to hos?
pitals, added to trench warfare,
yielded unimagincd numbers and
kinds of infected wounds."
Still another of the war's para?
doxes is the fact that a certain class
of diseases flourished in France pre?
cisely because the country was so
"Soil highly fertilized with animal
excrement," Dr. Flexner explains,
"contains the spores or seeds of the
tetanus or lockjaw bacilli, of the ba?
cillus of gaseous gangrene and of
other bacilli, whic-b, entering lacer?
ated wounds, cause death and disor?
ganization of the tissues; and be?
sides these particular bacilli there
are omnipresent the gcrrns of sup?
puration. Thus it happened at the
beginning of the war that tetanus or
lockjaw was distressingly prevalent.
The mortality, too, of the cases was
THE MODERN HUN IN THE WORLD OF ART
(Continued . from Page Six)
gracious of all the European art pe?
riodicals, was compelled by force of
practical conditions to suspend pub?
lication for a time, but it has been
revived, and now appears in thick
quarterly number:*, alert and lumi?
nous as ever. Some time after the
war broke out I wrote to M. Doucet
about the half dozen societies to
which he has been in some sort a
Medici, the society for the reproduc?
tion of old drawings, the society for
the promotion of the engraver's
cult, and so ou. Would the rest of
the St. Aubin catalogues be brought
out? Would the Pisanello facsim?
iles be completed? Of course they
would. But the staffs had all gone
to the war. When they returned,
triumphant, the various publications
would be resumed. No discourage?
Paris is never discouraged. In this
new Salon there is a picture by Guil?
laume, "The Hour of the Taubes." A
group of idlers, a child with his hoop
in the foreground, is looking on as at
a show. It is the spirit of Paris in?
carnate. The art sales continue
even while shells ?re dropping in
the city, and as the dispersal of the
Degas collection clearly showed
only a few weeks ago, prices are, if
anything, higher than before the
war. Let us not forget, either, that
at the Panama-Pacific Exposition in
San Francisco, in the summer of
1915, France made a fine contribu?
tion to the art collection, necessarily
smaller than it would have been in
times of peace, but still on a gen?
erous scale and characteristically
creditable. There has been a great
quantity of brilliant work done by
French artists at the front, paint?
ings and drawings by Flameng, Sa
batier, Hoffbauer, Jonas and many
others, invaluable as records and
sometimes of much artistic charm,
for which the world will long be
grateful. But chiefly the thing which
we shall longest remember is that
which I can only describe as the
ground swell, the national spirit un?
derlying these individual perform?
ances, the French passion for beau?
ty, defying the Hun forever.
What is to be the upshot of it all?
How will the genius of art emerge
from the war, not only in France,
but everywhere in the world where
art is honored? All the countries
are involved, and though France and
Belgium, for obvious reasons, have
chiefly concerned us in this inquiry,
there are matters of interest to be
noted elsewhere. Italy has suffered
much, especially in Venice. Eng
THE HOUR OF THE TAUBES?By Albert Guillaume
A picture in the Salon, now open in Paris, denoting the scornful mood
in which the citizens regard the destructive efforts of their enemies
land, whose monuments have on the
whole escaped injury, has also her
share in the artistic annals of the
period. She has sent some admira?
ble artists to the .front, Muirhead
Bone at their head, and she, too.
like France, has gone consistently
ahead with her artistic affairs. The
Royal Academy has "carried on."
The Walpole Society has kept up its
delightful "Annual." Even as I
write there comes to my' desk a
luxurious folio by Dr. William?
son, published by the John Lane
Company. It is "The Life and
Works of Ozias Humphry," the
sumptuous kind of volume which
one would have supposed the war
had postponed indefinitely. And an
English publishing house, that of
the Macmillans, is collaborating
with Hachette, in France, over the
making of a new series of European
guide books, to take the place, once
and for all, of the hitherto ubiqui?
tous Baedeker. What a cheering
bit of news that is! Baedeker has
been serviceable, to be sure, but the
very name is hateful now, when one
reflects that tl;e Germans who made
those books, and prepared the maps
for them, may easily have taker,
part in the work of espionage which
the Hun has never developed more
skilfully than while enjoying the
hospitality of foreign lands.
The new Anglo-French guides
may be set down as one tangible
blessing which is to be vouchsafec
students of art after the war. Bui
it is the intangible fruitage of tht
future that interests most inquirers
upon art, they ask, and wonder il
it will not include the liberation oi
new ideas, new principles, neu
What is to be the effect of the war '
schools. The question is, frankly,
unanswerable. There is no evidence
on the horizon. No one knows what
the artists are going to do when
they get back from the fight. But
any one may guess, and I have, for
my own part, no expectations what?
ever of revolutionary movements,
least of all contemr1ating the likeli?
hood of that kind of "independent'1
activity which is illustrated by the
cubist and his fellow faddists. I
think the artist will be very weary,
in a mood for rest and the old sanc?
tities of home. He will turn to the
time-tried masters as he will turn
to the people he loves, his family
and his friends. The classics will
steady his harassed mind and spirit
as the quietude of familiar, cherished
scenes will soothe his jangled nerves.
That, after all, seems to me a rea?
sonable hypothesis. For if there is
one thing that the bestiality of the
Hun does it is to throw us back
upon the ancient inviolable law, tc
make us cling with renewed faith tc
all that is honest and of good re
port. Xo matter how much the wai
may stir the imaginations of artist!
?and there, I believe, we maj
look for remarkable developments?
it ought to strengthen rather thar
weaken their hold upon the funda
mental standards which are the lif?
blood of art.
very high. Now, on the other hand,
the production of tetanus antitoxin,
already known before the war to be
a preventive when injected after in?
jury, is so large that every wounded
man can and does receive an injec?
tion as soon as he is brought to a
dressing station, since which tiro?
that particular horror has been
"The case of gaseous gangrena
was quite different. The disease it?
self was known, as it arises occasion?
ally as the result of accident in civil
life. Its bacterial cause was dis?
covered by Professor Welch, of
Johns Hopkins University, in 1891,
and has since received the name of
Bacillus welchii. But gaseous gan?
grene on a large scale is an incident
of this war. Like the tetanus bacil
ius, the gas bacillus inhabits the in?
testine of animals and is discharged
jvith the excrement. It exists, there?
fore, in cultivated soil, and from th?
soil it gains access to the fur of ani?
mals and thus wool often carries it.
In the subsequent handling of wool
and its conversion into clothing, the
gas bacillus may not be destroyed.
When, therefore, particles of cloth,
as frequently happens, are carried
into wounds by bullets or shell frag?
ments, or when dirt is likewise car?
ried into them, gaseous gangrene
"The treatment of gaseous gangrene
and suppurations has up to now been
by surgical measures. Young sur?
geons have had to learn the prin?
ciples of antiseptic surgery which
those of aseptic surgery had dis?
placed, and older surgeons had to
revive their almost forgotten knowl?
edge of the treatment of infected
Wtunds. The new conditions led al?
most immediately in all the bellig?
erent countries to the investigation
of old and new antiseptic chemical
agents. A supreme effort was being
made to find means of meeting this
prodigious menace of wound infec?
tion. Among all this laudable effort,
the method which stands forth as
having met the surgical emergency
best is the one which goes by the
name of Carrel-Dakin. The peculi
? arity of the method is that it applies
in a particularly searching manner
an old antiseptic?sodium hypochlo
rite, deprived of its caustic propertie?.
The method, however, includes tha
bacterial control of the wound which
gives the indication when it may be
closed without riek. In this way
many, perhaps innumerable, limbs
have been saved and crippling ha;
been averted, and large numbers o?
lives saved as well."
Among the scientists who hav?
achieved eminence in the alleviatioi
of war's horrors, Dr. Flexner men
tions Dr. C. G. Bull, of the Rocke
feller Institute, the discoverer of at
antitoxin for the gas bacillus. Th;
antitoxin, Dr. Flexner asserts, ha
ushered in a i c-w era in the treat
ment of gaseous gangrene.
"It is applicable," he explains, "ii
the manner of tetanus antitoxin as ?
prevention of.Bacillus welchii or ga
gangrene infection, and it is mor
eff'cacious in the treatment of de
veloped gaseous gangrene than is th
tetanus antitoxin in developed t(
tanus. Moreover, recent experiment
have proven that the tetanus ant
toxin and gas gangrene antitoxin ca
be made jointly, so that a singl
serum injection carrying both can be
administered successfully at one
operation. The discovery greatly sim?
plifies the problem of affording pro?
tection to the wounded from tetanus
and from gaseous pangrene; and in?
cidentally greatly cheapens the pro?
duction of the protective serum."
If the war was made inevitable by
modern industrial organization, as
L.. Flexner believes, it was equally
made possible by modern miedical
j-cicnce. At least, without mod?;m
medicine it could not have been
fought on so extensive and pro?
tracted a scale. On the other hand,
Dr. Flexner permits us to hope that
some permanent blessings in the field
of medicine may accrue to the world
from the present catastrophe.
"The war on the eoloissal scale tc*
which it is bein# fought," he says,
"is an outgrowth of industrialized
nations; that it can be so waged
without still greater horrors than
those now occurring is attributable
to the progress of medical science
within less than half a century and
sirce the experimental method has
been introduced into and widely ap?
plied in medical research. Undoubt
edly war conditions hare stimulate?
(crtain kinds of medical disc-oven
and ha^ve therefore yielded certair
results which will remain as per
manent additions and benefits aft?
the f-truggle is over. We are per
mitted to find what comfort we cai
in the crumbs of beneficial scientifi
echiev?rrent. while so much that i
precious is being lost forever."