Lost Lessons of the 1918 Influenza: The 1920s Working Hypothesis, the Public Health Paradigm, and the Prevention of Deadly Pandemics.

In standard historical accounts, the hyperlethal 1918 flu pandemic was inevitable once a novel influenza virus appeared. However, in the years following the pandemic, it was obvious to distinguished flu experts from around the world that social and environmental conditions interacted with infectious agents and could enhance the virulence of flu germs. On the basis of the timing and geographic pattern of the pandemic, they hypothesized that an "essential cause" of the pandemic's extraordinary lethality was the extreme, prolonged, and industrial-scale overcrowding of US soldiers in World War I, particularly on troopships. This literature synthesis considers research from history, public health, military medicine, veterinary science, molecular genetics, virology, immunology, and epidemiology. Arguments against the hypothesis do not provide disconfirming evidence. Overall, the findings are consistent with an immunologically similar virus varying in virulence in response to war-related conditions. The enhancement-of-virulence hypothesis deserves to be included in the history of the pandemic and the war. These lost lessons of 1918 point to possibilities for blocking the transformation of innocuous infections into deadly disasters and are relevant beyond influenza for diseases like COVID-19. (Am J Public Health. 2022;112(10):1454-1464. https://doi.org/10.2105/AJPH.2022.306976).

Homage to Dr med. Bozidar Kostic.

Dr Bozidar Kostic (1892-1960) - physician of noble heart - was born in Nis (Kingdom of Serbia) in a distinguished family of academically educated parents. As there were no medical faculties in Kingdom of Serbia, after high school, which he had finished with great success, in 1911 he enrolled at the Graz University of Medicine, a prestigious medical university. Soon he transferred to the Faculty of Medicine at Charles University in Prague, where he continued his studying for another ten semesters. In Prague, The Golden City, after the First World War, he finished his studies with an average grade of 10. After the Second World War, he worked as a doctor with a private medical practice in Belgrade, but soon he moved to Vranje, where he established the Town Polyclinic and contributed to the final flourishing of the most important forms of health care activities in liberated Vranje, donating his rich knowledge and skills, which led the health service to move to forms of independent work and development of new activities. For his contribution to the community, by decree of His Majesty King of Yugoslavia Alexander I Karadordevic, he received the Order of Saint Sava. Dr Bozidar Kostic and his wife Pravda devoted their lives to the health and educational upbringing of the people in the south parts of Serbia (then Social Federative Republic of Yugoslavia). Until his last days he lived and worked as a true folk doctor.

'Images from our orthopaedic hospital': photography in the rehabilitation of disabled war veterans in Croatia during the First World War.

PURPOSE: To demonstrate that Spisic's photographs were used as a tool in representing the strategies and public health position of orthopaedics as an emerging medical specialty in Croatia in the period from 1915 to 1917. METHODS: Formal and contextual analysis of photographs included in the book How we help our invalids: Images from our orthopaedic hospital and courses for disabled people, which was published in 1917 by the founder of orthopaedics in Croatia Bozidar Spisic (1879-1957), as well as historical documents and articles. RESULTS: Spisic's 102 photographs cover all phases of the rehabilitation of disabled war veterans and depict them holistically and during typical everyday activities. CONCLUSION: Spisic's visualization of disabled veterans attempted to demonstrate the transformation and reactivation of disabled bodies, using them as a persuasive tool in the rehabilitation not only of individuals, but of the society as a whole.

Exploring The Netley British Red Cross Magazine: An example of the development of nursing and patient care during the First World War.

Netley Hospital played a crucial role in caring for the wounded during the nineteenth century and twentieth century, becoming one of the busiest military hospitals of the time. Simultaneously, Florence Nightingale delved into the concept of health and developed the theoretical basis of nursing. This research aims to describe the experiences related to nursing and patient care described in The Netley British Red Cross Magazine during the First World War. The analysis displays different nurses' roles and the influence of environmental factors in the delivery of the soldiers' care. There are indications that Nightingale's ideas would have infiltrated the nursing practices and other aspects of the soldiers' recovery at Netley. The history of the Netley Red Cross Hospital shows the theoretical and practical advancement of nursing care towards a holistic approach.

Writers as Shell Shock Witnesses during World War I.

The issue of First World War shell shock has been documented mainly from a medical perspective. Many medical texts dealing with war psychoneuroses and their aggressive treatments, such as electrotherapy, were published during the war. Accounts from shell-shocked soldiers are rare. Nevertheless, shell shock was described from a non-medical point of view by a few writers who had undergone or witnessed this pathology. Their texts deal mainly with the psychiatric forms, the most striking ones, but also with the more common concepts of commotion, emotion and pathological fear. The French philosopher Émile Chartier (1868-1951), alias Alain, described the commotional syndrome from which he suffered. The German writer Ernst Jünger (1895-1998), a brave officer and an example for his men, reported his emotional shock. Some psychiatric forms of shell shock are present in the work of the pacifist writer Jean Giono (1895-1970), the naturalist Maurice Genevoix (1890-1980), who suffered himself from a section of the left median and ulnar nerves, or the British poet Siegfried Sassoon (1886-1967). War hysteria and pathological fear have been described, on several occasions, by Blaise Cendrars (1887-1961) or the German writer Erich Maria Remarque (1898-1970). Electrotherapy has been scarcely reported except by Louis-Ferdinand Céline (1894-1961).

Edgar Adrian (1889-1977) and Shell Shock Electrotherapy: A Forgotten History?

The English electrophysiologist Edgar Adrian (1889-1977) was the recipient of the Nobel Prize for physiology in 1932 for his research on the functions of neurons. During World War I, at Queen Square in London, he devised an intensive electrotherapeutic treatment for shell-shocked soldiers. The procedure, developed with Lewis Yealland (1884-1954), was similar to "torpillage," the faradic psychotherapy used in France. Adrian and Yealland considered that the pain accompanying the use of faradic current was necessary for both therapeutic and disciplinary reasons, especially because of the suspicion of malingering. According to Adrian, this controversial electric treatment was only able to remove motor or sensitive symptoms. After the war, he finally admitted that war hysteria was a complex and difficult phenomenon.

The Rise of Massage and Medical Gymnastics in London and Paris before the First World War.

Massage and medical gymnastics experienced a rapid institutionalization across Europe and North America between 1850 and 1914. This article explores how this process took place in London and Paris. Physiotherapy developed many of the hallmarks of an independent discipline during this period, including an identified corpus of manipulations and exercises, some autonomous training courses and degrees for future practitioners, and even the creation of departments within several hospitals. The article analyzes all of the processes surrounding this rise, paying special attention to the influence of the ambassadors of Swedish gymnastics (which led to the re-invention of massage across Europe), to the installation of physiotherapy in hospitals in London and in Paris, and to the practical and institutional innovations driven by nurses in England and by doctors in France.

Trauma and the state with Sigmund Freud as witness.

Just before and after the end of World War I, Sigmund Freud took on an activist role and in his writings and speeches, redirected the concept of war trauma from individual failure to a larger issue of community responsibility. Testifying in Vienna as an expert witness for the state, Freud said that the military psychiatrists-not the soldiers-had "acted like machine guns behind the front" and were the "immediate cause of all war neurosis." Freud was called on by the legal community when Julius Wagner-Jauregg, a future Nobel Prize winner (and also future Nazi Party adherent), head of the municipal Clinic for Psychiatry and Nervous Diseases, was accused of the lethal use of electrotherapy on shell-shocked soldiers. As sociological as psychoanalytic in his responses, Freud's withering critique came just 2years after he avowed that "it is possible to foresee that the conscience of society will awake." That speech on the human right to mental health care affirmed Freud's alliance to the social democratic position and inspired the second generation of psychoanalysts to develop community-based clinics throughout Europe where treatment was free of cost, for war neurosis and beyond.

Tackling Shell Shock in Great War Oxford: Thomas Saxty Good, William McDougall, and James Arthur Hadfield.

Shell shock was an important object of diagnostic and therapeutic concern in Oxford during the Great War. The efforts of three Oxford physicians--Thomas Saxty Good, William McDougall, and James Arthur Hadfield--are of particular significance to our story. All worked on the problem at various sites throughout the city. They often collaborated. All were committed to employing innovative techniques such as psychotherapy and hypnosis. Each rose, to differing extents, to prominence in the field of psychological medicine during the succeeding decades. Yet all have been neglected in the current historiography. I argue that a close examination of their practices reveals a curious combination of therapeutic pragmatism and psychoanalytically informed techniques that later helped inform clinical psychology's challenge to psychiatry's dominance over the concept and care of mental disorder.

[Treatment of syphilis with malaria or heat]. / Behandeling van syfilis met malaria of warmte.

Until the end of the Second World War, syphilis was a common sexually transmitted infection. This stigmatising infectious disease caused mental decline, paralysis and eventually death. The history of syphilis was given public attention because of 'malaria therapy', which had been applied from the First World War onwards in patients with paralytic dementia. In 1917, the Austrian physician Julius Wagner-Jauregg (1857-1940) induced fever in these patients by infecting them with malaria parasites; in 1927, he received the Nobel Prize for his discovery of the healing properties of malarial fever. One source, not cited anywhere, is an interview that the American bacteriologist and science writer/medical journalist Paul de Kruif conducted with Wagner-Jauregg in 1930. The reporting of this meeting, and De Kruif's later involvement in the mechanical heat treatment of patients with syphilis, form the inspiration for this article. When penicillin became available, both treatments became obsolete.

["On a strictly scientific basis." German constitutional medicine establishing itself, 1911­1921]. / "Auf strengster wissenschaftlicher Grundlage." Die Etablierungsphase der modernen Konstitutionslehre 1911 bis 1921.

In the years between 1911 and 1921, modern constitutional medicine established itself as an interdisciplinary research program in German-speaking countries. Untouched by later holistic interpretations and still far from the ,,crisis of medicine" of the late 1920s early constitutional medicine was very attractive due to its scientific self-characterisation. Thus, it became influential across the medical disciplines. This paper examines history and subject matter of German modern constitutional medicine in its first decade, starting in 1911, the year constitutional medicine was first publicly discussed by the Wiesbaden congress for internal medicine, including its development during World War I and closing with the first textbooks for medical students in 1921.

The Colour Treatment: A Convergence of Art and Medicine at the Red Cross Russell Lea Nerve Home.

When the Red Cross opened its new convalescent home at Russell Lea in Sydney in 1919, it contained a coloured room designed for treating 'nerve cases'. This room was painted by Roy de Maistre, a young artist, and was modelled on the Kemp Prossor colour scheme trialled at the McCaul Convalescent Hospital in London for the treatment of shell shock. Dubbed the 'colour cure' by the popular press, this unconventional treatment was ignored by the Australian medical profession. The story of de Maistre's colour experiment is not widely known outside the specialist field of Australian art history. Focusing on the colour room as a point of convergence between art and medicine in the context of the First World War, this article investigates Red Cross activities and the care of soldiers suffering from nervous conditions.

CHRONICLE OF THE "ANGLO-YUGOSLAV CHILDREN'S HOSPITAL" IN SREMSKA KAMENICA.

As a peacetime work of Katherine S. Macphail (Glasgow, 1887- St.Andrews, 1974) MB ChB (Bachelor of Medicine and Surgery), the Anglo-Serbian Children's Hospital in Belgrade was established after World War I, and the English-Yugoslav Children's Hospital for Treatment of Osteoarticular Tuberculosis was founded in Sremska Kamenica in 1934. Situated on the Fruska Gora slope, the hospital-sanatorium was a well-equipped medical institution with an operating theatre and x-ray machine providing very advanced therapy, comparable to those in Switzerland and England: aero and heliotherapy, good quality nourishment, etc. In addition, school lessons were organized as well as several types of handwork as the work-therapy. It was a privately owned hospital but almost all the children were treated free of cost. The age for admission was up to 14. During the period from 1934 to 1937, around 458 children underwent hospital treatment, most of them with successful results. During the war years the Sanatorium was closed but after the war it was reactivated. In 1948 by the act of final nationalization of all medical institutions in the communist Yugoslavia, the hospital was transformed into a ward of orthopedic surgery under the supervision of the referent departments in Belgrade and Novi Sad. Today, hospital is out of work and deprived of its humanitarian mission. The building is neglected and in ruins although it has been proclaimed the national treasure by the Regional Institute for Protection of Monuments of Culture.

[Humanities as a means of survival: the testimony of a Siberian prisoner of war in the First World War]. / Humanistika kao sredstvo prezivljavanja: svjedocanstvo sibirskog zarobljenika tijekom Prvog svjetskog rata.

This article looks into the autobiography of the Croatian chemist and pharmacognosist Antun Vrgoc (1881-1949) entitled My Memories of the World War 1914-1920 and published in Zagreb in 1937. The author was captured in October 1914 and deported to Siberia, where he remained prisoner of war until 1920. Since there are few memoirs describing the life of Siberian prisoners during the First World War, this work is a precious testimony about the attitude towards the prisoners of war, human relations, and the survival of an AustroHungarian army officer. The book shows a striking lack of civilian or military hostility towards the prisoners and the respect of the Geneva Convention. Antun Vrgoc adopted the culture, customs and language of his formal enemies, took part in their civilian life, and taught at their university. His cathartic experience of survival includes a clear message about the absurdity of war.

Paula Lind Ayers: "song-physician" for troops with shell shock during World War I.

BACKGROUND: Little is known about the therapeutic uses of music during the First World War. This historical study provides a biography of Paula Lind Ayers (1891-1974), a vocalist, actress, and YMCA Entertainer who became known as "the girl who could sing away shell shock." OBJECTIVE: The purpose of this study is to describe Paula Lind Ayers' respite services during World War I and provide a contextual biography of her life. METHODS: The author conducted an exhaustive search regarding Paula Lind Ayers' life and her activities during World War I. Numerous databases were used to locate print sources. Libraries, archives, and organizations were consulted to obtain unpublished primary sources. The author evaluated materials via a recursive process that included corroborating evidence, assessing source reliability, and contextualizing information. Data were synthesized and analyzed for emergent themes. RESULTS: Findings suggest that Paula Lind Ayers developed a systematic approach using familiar, live singing that was effective in alleviating symptoms of shell shock. Her method was replicated by others overseas during World War I. After the war, she returned to a successful performance career until the Great Depression. No information was found about Ayers' life from the year 1929 until her death in 1974. CONCLUSIONS: Understanding Paula Lind Ayers' contribution to music therapy provides a deeper awareness of past therapeutic uses of music with soldiers who experienced shell shock. Such understanding helps shape the way we view the present conception of music therapy with veterans and how we might answer questions that will affect the future of the field.

World War I psychoneuroses: hysteria goes to war.

During the First World War, military physicians from the belligerent countries were faced with soldiers suffering from psychotrauma with often unheard of clinical signs, such as camptocormia. These varied clinical presentations took the form of abnormal movements, deaf-mutism, mental confusion, and delusional disorders. In Anglo-Saxon countries, the term 'shell shock' was used to define these disorders. The debate on whether the war was responsible for these disorders divided mobilized neuropsychiatrists. In psychological theories, war is seen as the principal causal factor. In hystero-pithiatism, developed by Joseph Babinski (1857-1932), trauma was not directly caused by the war. It was rather due to the unwillingness of the soldier to take part in the war. Permanent suspicion of malingering resulted in the establishment of a wide range of medical experiments. Many doctors used aggressive treatment methods to force the soldiers exhibiting war neuroses to return to the front as quickly as possible. Medicomilitary collusion ensued. Electrotherapy became the basis of repressive psychotherapy, such as 'torpillage', which was developed by Clovis Vincent (1879-1947), or psychofaradism, which was established by Gustave Roussy (1874-1948). Some soldiers refused such treatments, considering them a form of torture, and were brought before courts-martial. Famous cases, such as that of Baptiste Deschamps (1881-1953), raised the question of the rights of the wounded. Soldiers suffering from psychotrauma, ignored and regarded as malingerers or deserters, were sentenced to death by the courts-martial. Trials of soldiers or doctors were also held in Germany and Austria. After the war, psychoneurotics long haunted asylums and rehabilitation centers. Abuses related to the treatment of the Great War psychoneuroses nevertheless significantly changed medical concepts, leading to the modern definition of 'posttraumatic stress disorder'.

[The flu epidemic after World War I and homeopathy--an international comparison]. / Die Grippe-Pandemie nach dem Ersten Weltkrieg und die Homöopathie im internationalen Vergleich.

The "Spanish Flu" began in 1918 and was the most devastating pandemic in human history that had ever been, claiming more lives than World War I. The flu virus had not yet been discovered, and the usual therapy measures were merely symptomatic. In many parts of the world the pandemic was treated by homeopaths. At the time, homeopathic medical practices, out-patient clinics and hospitals existed in various countries. To this day homeopaths refer to the successful homeopathic treatment of the "Spanish Flu". The following paper looks at what this treatment consisted in and whether it was based on a particular concept. It also examines contemporary evaluations and figures, as well as the question as to whether homeopathy experienced a rise in demand as a consequence of its success during the pandemic.

The Lourdes medical cures revisited.

This article examines the cures recorded in Lourdes, France, between 1858, the year of the Visions, and 1976, the date of the last certified cure of the twentieth century. Initially, the records of cures were crude or nonexistent, and allegations of cures were accepted without question. A Medical Bureau was established in 1883 to examine and certify the cures, and the medical methodology improved steadily in the subsequent years. We discuss the clinical criteria of the cures and the reliability of medical records. Some 1,200 cures were said to have been observed between 1858 and 1889, and about one hundred more each year during the "Golden Age" of Lourdes, 1890-1914. We studied 411 patients cured in 1909-14 and thoroughly reviewed the twenty-five cures acknowledged between 1947 and 1976. No cure has been certified from 1976 through 2006. The Lourdes phenomenon, extraordinary in many respects, still awaits scientific explanation. Lourdes concerns science as well as religion.