Emergency typhoid immunisation after the fall of Singapore 1942.

Singapore surrendered to the Japanese invasion in February 1942 after its water supply collapsed. At the suggestion of the colonial medical authorities, an emergency typhoid immunisation campaign was then begun using locally manufactured vaccine from extemporary materials; within 3 months, >600 000 had been immunised. Comparison with prewar statistics suggests that a postsurrender typhoid fever epidemic was prevented despite an increase in other enteric infections. Public health crises with disrupted supply chains may make locally manufactured vaccines of increasing importance in the future.

Jean-Alexandre Barré: Babinski's brilliant student.

Guillain-Barré Syndrome, (GBS), is a popular eponym that comes from a paper written in 1916 by Doctors. Guillain, Barré, and Strohl. Its spectrum has been enlarged considerably since the first description of it. Jean Alexandre Barré was a French neurologist, whose name is still widely associated with that of Georges Guillain, (1876-1961). He is also known for the leg manoeuvre. As Joseph Babinski's brilliant student, (1857-1932), we wanted to briefly retrace his biography in order to highlight some of the salient points within it and subjects that are topical for young neurologists today.

When war came home: air-raid shock in World War I.

During World War I, civilians became a target of the war machine. Air raids transformed the lives of those not involved in active combat and blurred the lines between the home front and the war front. This paper argues that the experience of air raids in World War I was comparable to the combat stress at the Western Front. The author bases her argument on contemporary publications in medical journals, measures taken by British authorities to prevent air-raid shock, and contemporary case records. The narratives of air-raid shock - similarly to those of shell-shocked soldiers - reflect the feelings of terror and loss of control, and demonstrate the profound effect these experiences could have on individuals' mental health.

-80 °C deep frozen erythrocytes during military operations. The Dutch frozen concept.

The Dutch military uses frozen blood products for the treatment of bleeding trauma patients during military deployments. With -80 °C frozen blood products it is possible to follow operational demand while reducing the number of resupply transports and loss of products due to expiration. In this paper lessons learned are described on efficient blood management with -80 °C deep-frozen erythrocytes (DEC).

An Easy-To-Use External Fixator for All Hostile Environments, from Space to War Medicine: Is It Meant for Everyone's Hands?

Long bone fractures in hostile environments pose unique challenges due to limited resources, restricted access to healthcare facilities, and absence of surgical expertise. While external fixation has shown promise, the availability of trained surgeons is limited, and the procedure may frighten unexperienced personnel. Therefore, an easy-to-use external fixator (EZExFix) that can be performed by nonsurgeon individuals could provide timely and life-saving treatment in hostile environments; however, its efficacy and accuracy remain to be demonstrated. This study tested the learning curve and surgical performance of nonsurgeon analog astronauts (n = 6) in managing tibial shaft fractures by the EZExFix during a simulated Mars inhabited mission, at the Mars Desert Research Station (Hanksville, UT, USA). The reduction was achievable in the different 3D axis, although rotational reductions were more challenging. Astronauts reached similar bone-to-bone contact compared to the surgical control, indicating potential for successful fracture healing. The learning curve was not significant within the limited timeframe of the study (N = 4 surgeries lasting <1 h), but the performance was similar to surgical control. The results of this study could have important implications for fracture treatment in challenging or hostile conditions on Earth, such as war or natural disaster zones, developing countries, or settings with limited resources.

Neurosurgical work during the Napoleonic wars: Baron Larrey's experience.

OBJECTIVES: Considered as the most famous French military surgeon, Dominique-Jean Larrey (1766-1842), who joined all the campaigns of Napoleon, wrote his memoirs and several medical articles. This paper discusses how in the Napoleonic times, Larrey dealt with neurosurgical diseases or injuries. PATIENTS AND METHODS: We reviewed four main publications of Larrey published between 1812 and 1838 and analyzed the type of neurosurgical cases presented and their treatment. RESULTS: These works include his practice of what we call now "neurosurgery" since most injuries described concern the skull or spine. He seemed to treat patients with humanity, integrity and perseverance. Larrey dealt with many aspects of neurosurgery, such as cranial or spinal trauma surgery, and also infectious diseases. He saw many head injuries inflicted not only by muskets or artillery, but also with spears and sabers. Unlike some others, Larrey advocated the use of trepanation in many situations as practiced, for instance, in the treatment of depressed fractures or in presence of subdural collections. On the other hand, this surgeon who saw thousands of amputees during his career did not mention the phantom limb phenomenon in his memoirs. Similarly, the issue of cerebral localizations is only mentioned in his last work, published in 1838. CONCLUSIONS: In his work, Larrey (and all his contemporaries) dealt essentially with "cranial" surgery, as in skull fractures where the brain could potentially have been injured by bone fragments. The time for brain surgery had not come yet.

Syrian field hospitals: A creative solution in urban military conflict combat in Syria.

Since the war started in Syria nearly two years ago several independent organizations reported the use of medicine as a weapon by the Syrian authorities, killing of doctors and arresting patients who were admitted to the hospitals for treatment. In year 2012 the World Health Organization (WHO) found nearly 50% of hospitals are not functioning due to lack of staff, equipment and medicine. This report highlights how the doctors in Syria are creative and courageous to risk their own lives to save thousands of innocent lives.

Palestinian children in the hemato-oncology ward of an israeli hospital.

PURPOSE: An encounter between Palestinian parents of children with cancer and Israeli medical staff is a very special situation where "potential enemies" interact in a caring, trusting and intimate relationship for long periods of time. Our aim was to study the psychological and cultural encounter in order to understand the dynamics involved. METHOD: The study is a qualitative one. Data was collected by way of structured in-depth interviews. Participants were physicians and nurses employed in the department, and Palestinian parents accompanying their children who were hospitalized during the research period. RESULTS: SIX MAIN THEMES EMERGED FROM THE ANALYSIS OF THE INTERVIEWS: (1) The decision to come to Israel for treatment. (2) The "meeting points" of the two peoples: the Israeli check points and the Palestinian Authority permits. (3) Encounter with the Israeli hospital. (4) Relationship between medical staff and parents. (5) Language and cultural barriers. (6) Emotions, thoughts and behaviors during high security tension. CONCLUSION: The interviews depict a poignant picture of the unique encounter between Israeli Doctors and nurses and Palestinian parents. The psychological mechanism used by parents and doctors is "splitting"-having a dichotomized, simple emotional-perceptual picture of a situation with no conflicts. Nurses use another psychological mechanism in addition which enables them to contain the paradox and the conflict.