The 1917 Halifax Explosion: the first coordinated local civilian medical response to disaster in Canada.

SUMMARY: The 1917 Halifax Explosion was an unfortunate but predictable tragedy, given the sea traffic and munitions cargo, resulting in sudden large-scale damage and catastrophic injuries, with 1950 dead and 8000 injured. Although generous support was received from the United States, the bulk of the medical work was undertaken using local resources through an immediate, massive, centrally coordinated medical response. The incredible care provided 100 years ago by these Canadian physicians, nurses and students is often forgotten, but deserves attention. The local medical response to the 1917 disaster is an early example of coordinated mass casualty relief, the first in Canada, and remains relevant to modern disaster preparedness planning. This commentary has an appendix, available at canjsurg.ca/016317-a1.

Consequences of the radiation accident at the Mayak production association in 1957 (the 'Kyshtym Accident').

This paper presents an overview of the nuclear accident that occurred at the Mayak Production Association (PA) in the Russian Federation on 29 September 1957, often referred to as 'Kyshtym Accident', when 20 MCi (740 PBq) of radionuclides were released by a chemical explosion in a radioactive waste storage tank. 2 MCi (74 PBq) spread beyond the Mayak PA site to form the East Urals Radioactive Trace (EURT). The paper describes the accident and gives brief characteristics of the efficacy of the implemented protective measures that made it possible to considerably reduce doses to the exposed population. The paper also provides retrospective dosimetry estimates for the members of the EURT Cohort (EURTC) which comprises approximately 21 400 people. During the first two years after the accident a decrease in the group average leukocyte (mainly due to neutrophils and lymphocytes) and thrombocyte count was observed in the population. At later dates an increased excess relative risk of solid cancer incidence and mortality was found in the EURTC.

The crowd-out effect of a mass casualty incident: Experience from a dust explosion with multiple burn injuries.

A mass casualty incident (MCI) can have an enormous impact on an already crowded emergency department (ED), affecting the quality of health care provided to non-MCI ED patients. On June 26, 2015, a burn MCI (BMCI) occurred due to a cornstarch explosion at a party at a water park. The competing needs of the BMCI patients might have crowded out the needs of the non-BMCI patients. Although crowd-out effects have been previously documented in a variety of health care situations, they have not been extensively evaluated during MCIs. We aimed to determine whether the outcomes of the non-MCI patients were compromised during this incident.We conducted a retrospective observational study comparing several health care parameters and outcomes between non-BMCI patients and historical controls during the designated period using institutional electronic records and the National Health Insurance Research Database.On the night of the incident, 53 patients were sent to our ED; most of them arrived within 3 hours after the BMCI. There was a significant increase in the wait time for ICU beds among non-BMCI patients compared to the wait times during the corresponding week of the previous year (8.09 ±â€Š4.21 hours vs 3.77 ±â€Š2.15 hours, P = .008). At the hospital level, there was a significantly increased length of hospital stay (LOS) in the ICU after the MCI compared with the LOS in the ICU in the same week of the preceding year (median days: 15 vs 8, P ≤ .001). At the regional level, there were no significant differences between the 2 periods in the LOS in acute care, LOS in the ICU or mortality rates at the involved medical centers.Crowd-out effects from the MCI occurred in the ED and at the institutional level. Although there was an increased wait time for admission to the ICU and a longer LOS in the ICU, the LOS in acute care beds, treatment of time-sensitive diseases, and mortality rates were not compromised by the current MCI protocol at either the institutional or regional levels.

The Halifax Explosion of 1917: the oculist experience.

BACKGROUND: Despite its prominence in Canadian history, there are few publications about the Halifax Explosion of 1917 that deal with the care of victims with eye injuries. METHODS: Archived documents relating to the nature and treatment of eye injuries sustained during the Halifax Explosion were reviewed at the Public Archives of Nova Scotia and the Maritime Museum of the Atlantic. A review of current literature was performed. RESULTS: Detailed accounts regarding the personal and surgical experience of 2 ophthalmologists, G.H. Cox and F.T. Tooke, were found. Several unpublished government and personal documents on eye injuries sustained during the Halifax Explosion are filed at the Public Archives of Nova Scotia. Twelve ophthalmologists treated 592 people with eye injuries and performed 249 enucleations. Sixteen people had double enucleations. Most of the eye injuries were caused by shards of shattered glass. Sympathetic ophthalmia was the feared complication for penetrating eye injuries and a common indication for enucleation in 1917. A Blind Relief Fund was established to help treat, rehabilitate, and compensate the visually impaired. INTERPRETATION: Many of the eye injuries sustained during the Halifax Explosion were due to flying shards of glass. Details of their treatment provide insight into a unique and devastating event in Canadian medical history and demonstrate how eye injuries were managed in 1917.

Making fire work: pyrotechnics and natural philosophy.

Everyone is familiar with fireworks, common to festivals and celebrations across the world. At first glance, the history of science might appear to have little to do with the history of these explosive devices. However, fireworks were an important element of court culture in Europe, which relied on spectacle and festival to manifest the power of princes. From the fifteenth century, courts regularly set off fireworks around elaborate theatrical scenery and ephemeral temples, fascinating audiences with a variety of exotic motions and effects exploding in the night sky. Fireworks also intrigued natural philosophers, and over several centuries there were diverse interactions among the sciences and pyrotechny.

Responding to a medical crisis: Lessons from the Halifax disaster 100 years ago.

One hundred years ago, a massive explosion occurred in the harbor of Halifax, Nova Scotia, destroying the city and killing more than 2,000 and injuring more than 9,000. It was the worst manmade explosion the world had ever seen, not exceeded until the atomic bomb blast over Hiroshima in 1945. An urgent appeal for assistance came from the survivors, and many volunteers responded. This report describes the prompt and remarkable medical relief effort of the citizens of Massachusetts to help their Canadian neighbors.

The Halifax Explosion a century later: Lessons for our time.

A brief historical account of the Halifax Explosion, one of North America's greatest mass urban trauma casualty events of the 20th century. This disaster, in Halifax, Nova Scotia, was the result of the cataclysmic explosion of a fully loaded World War I munitions ship on the densely waterfront of that city, resulting in nearly 2000 fatalities and 9000 injured. It remains a case study in response to disasters which overwhelm local medical capabilities.

The Halifax disaster (1917): eye injuries and their care.

Explosions, man-made and accidental, continue to require improved emergency medical responses. In the 1917 Halifax Explosion, an inordinate number of penetrating eye injuries occurred. A review of their treatment provides insight into a traumatic event with unique ophthalmological importance. Archived personal and government documents relating to the Halifax Explosion were reviewed at the Public Archives of Nova Scotia, Canada, along with a review of current literature. Twelve ophthalmologists treated 592 people with eye injuries and performed 249 enucleations. Sixteen people had both eyes enucleated. Most of the eye injuries were caused by shards of shattered glass. A Blind Relief Fund was established to help treat and rehabilitate the visually impaired. The injured were given pensions through the Canadian National Institute for the Blind, Toronto, Ontario, Canada, which continue to this day. Sympathetic ophthalmia was the feared complication for penetrating eye injuries and a common indication for enucleation in 1917. Even so, the severity and the overwhelming number of eye injuries sustained during the Halifax Explosion made it impossible for lengthy eye-saving procedures to be performed. Enucleation was often the only option.

Rumblings in the air: understanding earthquakes in the 1690s.

After a wave of earthquakes in 1692 and 1693, the astronomer John Flamsteed composed an innovative explanation of their causes. He argued that they did not originate underground but were caused by explosions of nitrous and sulphurous particles in the air. Although the idea now sounds strange, Flamsteed's account was expressed in terms that were familiar to his contemporaries in the Royal Society, drawing particularly on Boyle's chemistry and air-pressure experiments. Flamsteed was more unusual in his conviction that the earth was virtually solid; this made him an opponent of structural theories offered by Thomas Burnet, Robert Hooke and Edmond Halley. Flamsteed's ideas were dismissed by Hooke as 'nonsensicall', but by the time they were published, long after his death, they appeared closer to mainstream thinking.

William Ladd before the Halifax explosion.

Legend holds that treating the hundreds of children injured in the Halifax explosion of December 6, 1917, compelled Dr. William E. Ladd (1880-1967) to dedicate his career to the surgical care of infants and children. However, he had made the commitment to be a pediatric surgeon several years before when he joined the voluntary staff of the Children's Hospital of Boston in 1910. In the years before Halifax, he was among the vanguard of American surgeons who brought the mortality of intussusception to 45% from 90%, and of pyloric stenosis to 15% from 60%. Among his early innovations was the contrast enema for intussusception for diagnosis and therapy. Shortly after the explosion, Dr. Ladd led a medical relief effort of 100 doctors, nurses, and orderlies from Boston. With supplies enough for a 500-bed hospital, they battled through a blizzard, downed telegraph lines, and blocked railways to reach the strickened city on December 9. The enormity of the Halifax tragedy and the dedication of Dr. Ladd and his team led to the creation myth of the birth of pediatric surgery. The record was set straight by Dr. Ladd himself in a handwritten letter to a pediatric surgeon who had asked about when he dedicated himself to the field. "The Children's was [my] very first and most permanent love," Ladd wrote. "As soon as it became feasible after the first World War, I devoted myself exclusively to pediatric surgery and have never regretted it."

Is Blast Injury a Modern Phenomenon?: Early Historical Descriptions of Mining and Volcanic Traumatic Brain Injury With Relevance to Modern Terrorist Attacks and Military Warfare.

BACKGROUND: Given the recent interest in blast injury spurred by returning soldiers from overseas conflicts, we sought to research the early historical descriptions of blast injuries and their treatments. Consideration was given to specific descriptions of survivors of closed head injury and their treatment. METHODS: A review of the medical and nonmedical literature was undertaken, with particular emphasis on pre-1800 descriptions of volcanic eruptions and mining accidents. Compilations of accounts of the Etna eruptions dating from 126 BC were translated into English, and early mining texts from the 1600s and 1700s were reviewed. RESULTS: Accumulations of flammable gases were recorded in many medieval sources and this knowledge of toxic gas which could lead to blast injury was known in the mining community by 1316. No direct attribution of injuries to blast forces was present in the historical record examined before the 1300s, although mining accounts in the 1600s detail deaths due to blast. No specific descriptions of survivors of a closed head injury were found in the mining and volcanic eruption literature. CONCLUSIONS: Descriptions and warnings of blast forces were commonly written about in the medieval and Renaissance mining communities. Personal narratives as early as 1316 recognize the traumatic effects of blast injury. No mining or volcanic blast descriptions before 1800 detailed severe closed head injury survivors, suggesting greater mortality than morbidity from blast injury in the premodern era. This review also uncovered that there was no historical treatment or remedy recommended to survivors of blast injury. Blast explosions resulting in injury or death were frequently described, although in simplistic terminology.

[Accidents in chemistry laboratories in the XIXth century]. / Des accidents dans les laboratories de chimie au XIXe siècle.

The author reviews the main accidents produced for most in French chemistry laboratories in the XIXth century: explosions, burns, serious poisonings.

Alfred Nobel's unusual creativity: an analysis.

Howard Gardner identified five different kinds of creative activity among eminent creators, namely, solving a well-defined problem, putting forth a general conceptual scheme, creating a product that embodies ideas, stylized innovation of an art form, and a 'high-stakes' performance in the socio-political arena. In this paper, I report that Alfred Nobel's creativity can be assigned to two mutually exclusive domains. In the scientific domain, he solved a well-defined problem of his time in the study of explosives, by patenting dynamite, creating blasting gelatin as an ideal explosive and developing a nearly smokeless blasting powder. In the socio-political domain, Nobel designed a 'unique instrument' (in the form of annual prizes, which later came to be known as Nobel prizes) to recognize merit among those who contributed to social welfare at the global scale. The influence of Nobel's mentors, Nikolai Zinin, Yuli Trapp, Theophile-Jules Pelouze, Ascanio Sobrero, John Ericcson and Immanuel Nobel in igniting Nobel's scientific creativity also deserves recognition. Personal traits that helped Nobel to sharpen his creativity include his business acumen and talent for information access using his multi-lingual skills.

Bashkiria train-gas pipeline disaster: a history of the joint USSR/USA collaboration.

In June 1989, a methane/propane pipeline explosion destroyed two passenger trains in the Bashkirian Republic of the Soviet Union. Over 400 passengers died immediately and 806 were injured. Most of those injured suffered thermal injuries. One hundred and fifty patients were treated at Hospital 21 in Ufa, Bashkiria, by a combined Soviet-US team. Twenty-six patients underwent excision and grafting of their burn wounds. Microbiological studies indicated significant resistance to locally available antibiotics. Antibiotics provided by the US team proved useful in treating the resistant organisms. This disaster and the international response to it exemplify the need for a coordinated response to major burn disasters and the positive results of international cooperation.

The first mail bomb?

A news item in the newspaper, the Evening Star, for the Country, October 18, 1833, probably is the first report of a mail bomb in the United States. It is also likely to be the first defusing of a mail bomb. The device appeared to be extraordinarily sophisticated and would have likely worked had it not been for suspicions of the recipient of the bomb.