War Hospital Research Articles

Knowledge, attitudes, and readiness about critical antimicrobial resistant organisms among healthcare workers at colonial war memorial hospital in Fiji: a pre and post intervention study

BackgroundGram-negative bacteria resistant to carbapenems are also known as critical antimicrobial resistant organisms. Their emergence at Colonial War Memorial Hospital (CWMH), the largest hospital in Fiji, is a major clinical concern. This study was conducted to determine the knowledge, attitudes, and readiness of healthcare workers (HCW) at CWMH regarding management of patients with infections caused by critical antimicrobial resistant organisms.MethodsA questionnaire was designed using a Likert scale to assess knowledge, attitudes, and readiness. Two cross-sectional studies were conducted, before and after the implementation of targeted educational activities which were informed by the pre-intervention study findings.ResultsA total of 393 and 420 HCW participated in the pre- and post-intervention studies, respectively. The majority of respondents were female (77.3%) and 18–34 years of age (67%). HCW professional roles included nurses (56.3%), doctors (31.6%), and laboratory personnel (12.2%). In the post-intervention study, significantly more HCW reported having received infection prevention and control (IPC) and antimicrobial resistance education and training (26.8% in pre to 45.5% in post intervention, p < 0.001). The majority of nurses and doctors (> 85% to ≥ 95%) were aware of how AMR organisms spread in healthcare settings and knew the IPC measures to prevent transmission of AMR infections including hand hygiene, standard and transmission-based precautions. Attitudes towards AMR were positive, with 84.2% pre intervention and 84.8% of HCW post intervention expressing their willingness to change their work environment to assist with AMR prevention. Perceived readiness to address the problem showed mixed results. Improvements in laboratory AMR surveillance data availability were noted (29.4–52.4%, p < 0001). Modest improvement in the hospital’s capacity for outbreak response (44–51.9%, p = 0.01), and treatment of AMR infections (38.9–44.4%, p = 0.01) was reported.ConclusionsOur data revealed high levels of staff awareness and knowledge about AMR and IPC. However, readiness for outbreak response and treatment of critical AMR infections requires more attention. Improving AMR prevention and containment in CWMH will likely require sustained and multisectoral interventions with strong administrative commitment.

“A Face of Anguish”: Pain and Portraiture in the Civil War Hospital

This essay traces the visual cultures that emerged around Civil War soldiers’ pain and argues that the method of portraiture has much to offer the field of health humanities. It begins by tracing efforts to capture Civil War soldiers’ pain in both popular and clinical media before turning to hospital accounts by Louisa May Alcott and Walt Whitman that adopt the trope of portraiture in order to make soldiers’ suffering legible to a wider audience. This essay argues that these ekphrastic accounts make visible not only soldiers’ suffering but also the act of observing and interpreting it, and the essay concludes by suggesting that by bringing into focus the process of perceiving another’s pain, the study of portraiture offers an important complement to both the field of narrative medicine and health humanities approaches to studying visual art.

Useful Objects: Museums, Science, &amp; Literature in Nineteenth-Century America

Useful Objects: Museums, Science, &amp; Literature in Nineteenth-Century America

Examine the effects of inventory management practices on operational performance in war memorial hospital and Wedam Medical Center, Ghana

Examine the effects of inventory management practices on operational performance in war memorial hospital and Wedam Medical Center, Ghana

Useful Objects: Museums, Science, &amp; Literature in Nineteenth-Century America

Useful Objects: Museums, Science, &amp; Literature in Nineteenth-Century America

Irish women’s wartime networks: care work and female agency on the first world war home front

ABSTRACT This article is a contribution to the growing body of literature that seeks to recover the experience of women on the Irish home front during the Great War. We focus specifically on women who were involved in unpaid wartime supply production and logistics in the vast imperial network of wartime relief crucial to the British war effort. This article draws upon recent scholarship on care work, arguing that the British Expeditionary Force as a micro economy relied on the unpaid labour of women, particularly women of the middle and upper classes, who were prevented by societal norms from participating in paid labour, to ensure the efficient flow of medical supplies. This unpaid work was largely carried out via the Irish War Hospital Supply Organisation (IWHSO), part of a UK-wide network established during the war to furnish troops with medical supplies which could not be met via regular military channels. We argue that this industrialised care work needs to be analysed within the larger context of a professionalisation of private networks and with a view to Ireland’s growing interconnectedness as a result of modernisation.

Surviving Fifty Years With Shrapnel Within the Brain

AimsTraumatic brain injury during the war by shrapnel or bullet is lethal and life-threatening. The mortality rate from traumatic brain injury is more than 90%. Mrs. N (70) of Bangladesh is an exceptional and one of the luckiest women of the world. She is a war victim and has been living with shrapnel within her brain for the last 50 years.MethodsAccording to the patient attendant, half a century ago, during the Liberation War of Bangladesh, one shell accidentally exploded in their backyard. Unfortunately, a few pieces of shrapnel penetrated her arm, leg and right side of the head. She lost her consciousness and immediately treated at war hospital as per level best. She forgets details of her treatment and has no treatment records. Last 50 years, she has been surviving with movement difficulties, weaknesses of the upper and lower limbs and occasional convulsions. Her sufferings have intensified day by day. Last few years she has been experiencing headaches, dizziness, vomiting and forgetfulness. Two months back, she drank some insecticide mistakenly. She also suffering insomnia and she often cried out from deep sleep. She complains about hearing unknown voices. The voices were talking about her. She also started to suspect her family members. She claims that her family members were conspiring to kill her. She has history of convulsions three times in the last 50 years, which were generalized and tonic clonic in nature. She didn't take any medication for convulsion. As her suspicion, irrelevant talk and oddity in behavior worsened, her family members took her to me for treatment. Considering her past traumatic brain injury, an X-ray skull was advised. Surprisingly, it showed a metallic foreign body (shrapnel) within her skull. Furthermore, a CT scan of the brain was done, and it showed there was an irregular bony gap at right parietal area, a shrapnel at right frontal area with extensive encephalomalacic Porencephaly communicating with lateral ventricle. Her thyroid and liver function are normal. She is non-diabetic, non-hypertensive. She was advised to take risperidone 2 mg daily at night. With this low dose antipsychotic medication her psychosis controlled.ResultsSurviving with shrapnel within the brain followed by traumatic brain injury is very much rare. Shrapnel gradually damages the brain parenchyma and creates a large porencephaly.ConclusionTraumatic brain injury by bullet or shrapnel is always fatal. It is very much rare in medical to survive fifty years with shrapnel within the brain after shrapnel injury.

‘Unearthly Music’, ‘Howling Idiots’, and ‘Orgies of Amusement’: The Soundscapes of Shell Shock at Edinburgh's Craiglockhart War Hospital, 1917–18

Military hospitals in Britain during the First World War cultivated a variety of activities that promoted healing for soldiers, of which music was central. This music was documented by soldiers in hospital-sponsored magazines such as The Hydra at Craiglockhart, an officers’ hospital in Edinburgh that specialized in treatment of shell shock. There, this article argues, music and sound were associated with a curative physicality and sensoriality, revealing the aural and tactile to be aligned within the ideology of the magazine and trauma therapies prescribed.Music's role in trauma narratives in The Hydra reflects the two approaches to shell shock treatment at the hospital. First, reviews identified weekly musical entertainments, which included singing, playing instruments and listening, as part Captain Arthur Brock's ‘cure by functioning’ regime. Second, narratives in literary contents that reference music in depicting memory and dreams reflect the Freudian psychotherapy used by Dr W. H. R. Rivers, a narrativizing process that I connect to the concept of ‘testimony’ in trauma studies. While the two approaches and their use of music are tied to social class, in both – as I show in drawing upon theories of Jean-Martin Charcot, Pierre Janet and Bessel van der Kolk – music is therapeutic because it is visceral – its curative properties lie in its ability to ultimately move the body and mind. Finally, drawing upon theories of cultural trauma by Jeffrey Alexander, this article posits that these narratives evince a self-fashioning of this shell-shocked community that has over time (amplified by the legacies of the hospital's most famous patients, Wilfred Owen and Siegfried Sassoon) become central to the dominant British cultural memory of the war. This article establishes music's role in narratives about trauma in First World War Britain, illuminating music's place in testimonies about not only hospital life and community formation, but also alienation, trauma and recovery; memory and mourning; and sacrifice and resilience.

SARS-CoV-2 (COVID-19) and the Teaching of Ignaz Semmelweis and Florence Nightingale: a Lesson of Public Health from History, after the "Introduction of Handwashing" (1847).

SummaryIgnác Fülöp Semmelweis (1818-1865) and Florence Nightingale (1820-1910) were two important personalities in the history of medicine and public health. They dealt with the problem of handwashing. Semmelweis is also known as the “father of hand hygiene”; just in 1847 he discovered the etiology and prophylaxis of puerperal sepsis and imposed a new rule mandating handwashing with chlorine for doctors. He also tried to persuade European scientific community of the advantages of handwashing. During the Crimean War, in Scutary (Turkey), Florence Nightingale strengthened handwashing and other hygiene practices in the war hospital where she worked and her handwashing practices reached a reductions in infections. Unfortunately the hygiene practices promoted by Semmelweis and Nightingale were not widely adopted. In general handwashing promotion stood still for over a century. During current pandemic SARS-CoV-2 (COVID-19) one of the most important way to prevent the spread of the virus is still to wash the hands frequently.

Hospital Sketches

In November 1862, Louisa May Alcott (1832–1888) signed up as a volunteer nurse for the Sanitary Commission charged with caring for the Civil War’s mounting casualties. From 13 December 1862 until 21 January 1863, Miss Alcott served at the Union Hotel Hospital in Georgetown in the District of Columbia, where she ultimately contracted typhoid and pneumonia and very nearly died. This book is her account of her journey south from Concord and her six weeks in the nation’s wartime capital. Styling herself by the fanciful name “Tribulation Periwinkle,” she brought humor as well as pathos to her subject, making this first-hand account of the absolute horrors of a 19th-century war hospital seem less shocking and more appreciative of the sacrifices being made by the wounded warriors and their families.

A historical analysis of surgery performed between 1941 and 1942 at the Bangour Maxillofacial and Plastic Surgery Unit, Scotland

In 1939, Bangour Emergency Medical Services Hospital was built as an annexe to Edinburgh War Hospital. The Maxillofacial and Plastic Surgery Unit opened in 1941, one of the several set-ups built with the support of Sir Harold Gillies, to ensure a service with specialist skills throughout Great Britain. The unit was led by Alexander Burns Wallace, who had to rapidly adapt the service to reflect the patterns of injury reflected by the more modern warfare practiced in the Second World War, while also incorporating techniques that were, at the time, revolutionary. Although much has been written about other units, Bangour's activity revealed through its case histories' highlights that plastic surgery was developing in parallel throughout Britain. The influence of Sir Harold Gillies was clear, and his input to support the fledgling service serves as an important aspect of the newly developing specialty of plastic surgery: collaboration and sharing of knowledge. This paper analyses the work of the Maxillofacial and Plastic Surgery Unit at Bangour General Hospital in Scotland between 1941 and 1942 and demonstrates its historical significance, as well as its relevance to current practice. Ninety-two case notes from the unit recently became accessible. These were analysed and four were selected for review in this study. These cases were selected as they were well-documented with photographs and good examples of the work performed at the unit in order to highlight the innovative, creative and complicated work carried out at the Unit.

Kirsten Twelbeck, "Beyond the Civil War Hospital: The Rhetoric of Healing and Democratization in Northern Reconstruction Writing, 1861-1882" (Bielefeld: transcript, 2018), 438 pp.

Kirsten Twelbeck, "Beyond the Civil War Hospital: The Rhetoric of Healing and Democratization in Northern Reconstruction Writing, 1861-1882" (Bielefeld: transcript, 2018), 438 pp.

Manly Sacraments and Masculine Devotions: Catholic Manhood in the Civil War

Manly Sacraments and Masculine Devotions:Catholic Manhood in the Civil War William S. Cossen55 Religion continues to be a subject of growing interest among historians of the Civil War era. Chandra Manning notes that it is in the midst of "a comeback, after decades of more or less benign neglect."56 The war has often been presented by scholars of U.S. Catholicism as a venue in which Catholics claimed for themselves and for their church a firmer inclusion in the American nation. Catholics' wartime loyalty, whether to the Confederate or Union causes, provided them with convincing proof of their patriotic virtue and functioned as a pointed rejoinder to claims of Catholic outsider status. Whether it was through the dedicated service of the Irish Brigade, Father William Corby's much-heralded, mass absolution of Catholic and non-Catholic soldiers at Gettysburg, or the distinguished record of wartime chaplains, Catholics could rightly point to the Civil War era as one that offered great potential for American Catholicism to claim its place as a leader in the wider national community. While the ethnic and nationalist dimensions of Civil War Catholicism have been the subjects of much research in Catholic studies, the topic of Catholic gender has not.57 To be sure, there has been ample scholarship on the work of women religious as nurses and on the dozens of priests who served as chaplains on battlefields and in camps, but what has been lacking in these studies is an exploration of how the war shaped Catholic soldiers as men.58 Additionally, because [End Page 29] research on the everyday, lived religion of Catholic soldiers has also been lacking in the ever-growing body of scholarship on the history of the war—for example, soldiers' reception of sacraments, their use of sacramentals, their prayer practices, and their conceptions of spiritual matters—we should spend some time considering how these wartime activities formed Catholic soldiers as Catholic men. Catholic newspapers, chaplains' diaries, soldiers' correspondence, and reminiscences of women religious who served as nurses in Civil War hospitals provide glimpses of a world in which Catholic women played formative roles in forming Catholic men's religious lives and in shaping a distinctly Catholic manhood. This is not altogether surprising given the conclusion of scholars that so many devotional practices in American Catholic history were frequently understood, whether explicitly or implicitly, as feminine, and that it is common to follow Ann Braude's lead in starting with the assumption that "women's history is American religious history."59 However, one of the dangers in not further interrogating these ideas is that it becomes easy to conclude that men, many of whom devoted themselves in the Civil War era to the cultivation of what historian Amy S. Greenberg terms "martial manhood," were only peripherally connected to these supposedly feminine practices.60 Assuming an innate femininity for the devotional practices of the past also risks reinforcing nineteenth-century anti-Catholic portrayals of an effeminate Catholicism opposed to a masculine Protestantism.61 As Colleen McDannell has explained, Catholic men were active and enthusiastic participants in nineteenth-century [End Page 30] devotional life, and "we do not know how 'feminized' Catholicism was in the late nineteenth century."62 Male Catholic soldiers indeed turned frequently to praying the rosary, wearing Miraculous Medals and donning scapulars, and they saw such items as not just spiritually nourishing but as physically protective as they enacted their martial manhood on the battlefield. Reverend J. Francis Burlando, the provincial director of the Daughters of Charity in the United States, remembered "poor invalid Catholics and Protestants all going to the chapel of the Sisters to assist at the Holy Sacrifice of the Mass, at the Way of the Cross, and other practices of piety! . . . And, what eagerness to obtain a Medal of our Immaculate Mother, a chaplet, an Agnus Dei." Burlando noted that "only when furnished with a medal" would "they return to their regiments."63 Another Catholic writer noted of soldiers receiving both communion and scapulars at a Mass in New Orleans during the first summer of the war, "Ah! would to God every Catholic young man who engages in the conflict may so fortify...

Florence Nightingale: The Making of a Hospital Reformer.

The first of two articles is to show how Florence Nightingale became a leading, effective hospital reformer. The aim of the first paper is to relate how Nightingale was influenced by the great defects in the war hospitals of the Crimean War (1854-1856) and how she learned the lessons from those defects to set a different course. The article shows how her famous Notes on Nursing is a positive treatment of the lessons learned, turning the sanitary defects, notably in ventilation, into chapters of the book. The importance of the pavilion model of hospital design is highlighted. There is coverage of the advances made by Semmelweis at the Vienna General Hospital. This is a purely historical study drawing on the extensive publications by Nightingale, augmented by her (massive) surviving correspondence and notes. The search for archival materials was done for the publication of the 16-volume Collected Works of Florence Nightingale, written by the author of this article. The collected works was peer reviewed, and the research process succeeded in locating material in more than 200 archives worldwide.

Six O’Clock in Princes Street

The First World War poet, 2nd Lieutenant Wilfred Owen, is remembered for his powerful testimony of war via his anti-war poetry. However, there has been limited focused investigation of Owen’s four months in Edinburgh between 26 June 1917 and 3/4 November 1917 and the impact of that period. Owen was in Edinburgh convalescing from ‘shell-shock’ at Craiglockhart War Hospital; his doctor called it ‘re-education’.1 Fresh research and analysis has been able to confirm the Scottish inspiration of a number of aspects of Owen’s poetry: from Owen’s first visit to Scotland, holidaying in 1912, and his four-month stay in Edinburgh in the latter half of 1917. During late 1917 Owen was able to craft some of the most poignant war poetry of the century, if not all time. That writing was made possible by the Edinburgh environment and important meetings in the social circles he benefited from in the city. It was facilitated by innovative ‘work’ cures, or ergotherapy, being implemented at Craiglockhart by Edinburgh-based physician Dr Arthur John Brock. Brock had been inspired in his medical thinking by Professor Sir Patrick Geddes. Geddes would evolve sociologist Le Play’s Lieu, Travail et Famille heuristic method and propose three themes as determinants of society: Place, Work and Folk. Geddes’ sociological survey model provides useful lenses for a more in-depth consideration of the socio-cultural impact of Edinburgh and its people on Owen and his writing.

Frado, Linda, Ellen, and Iola

Frado, Linda, Ellen, and Iola Cherene Sherrard-Johnson Like many other budding scholars and writers, I was a voracious reader prone to solitude and imagining "castles in the air" (117). It's no surprise that I would declare publicly that my favorite character from Louisa May Alcott's classic was Jo; however, in secret I also admired Amy's frank penchant for luxury and material comforts. I was never attracted to Meg's dutifulness or Beth's transcendent morality. Yet the scene I most remember is when the Moffats make over Meg into a "newly dressed doll" (76) in "borrowed plumes" (77) in chapter 9, "Meg Goes to Vanity Fair." As one of the few black girls in my private primary school, and later as the only black student in honors classes in my public high school, I knew what it was to constantly feel out of place, to be reminded subtly and overtly of your difference, and to want desperately to belong. That is why this scene at the "small party" (73), where, despite her desire to fit in, Meg has the "queer feeling" (77) of being made a spectacle, is memorable. It's where she and her sisters learn the importance of not judging yourself by the barometers of others but "to know and value the praise which is worth having" (83). Not until I was in graduate school at Cornell University in Lois Brown's class on nineteenth-century black women writers would the names of heroines from African American women's literature become as familiar to me as those from Little Women. The groundbreaking recovery work of Hazel Carby, Ann duCille, Frances Foster, Claudia Tate, and others would exponentially widen my literary landscape. While the March sisters are bemoaning how "dreadful to be poor" and a "Christmas without any presents" (11) in the midst of Civil War, Linda Brent's chapter "Christmas Festivities" describes enslaved women's attempts to "gladden the hearts of their little ones" despite the slave auction that presages "the Slaves' New Year's Day" (Jacobs 118, 15). Slowly, memorable exclamations like Amy's "Oh, Jo, how could you? Your one beauty" (132) in response to Jo's sacrifice of her abundant chestnut hair to bring her father home from the Civil War hospital would be supplanted by Iola Leroy's declaration that she was "tried but not tempted" by white men's propositions (Harper 115). Alcott's autobiographical novel set the standard for a decidedly American, New England girlhood, but nineteenth-century black women authors would deploy sentiment and sensation in their autobiographical fictions for a different objective. [End Page 99] In their hands, Alcott's tropes (with influence from Harriet Beecher Stowe and Lydia Maria Child) became powerful tools of resistance, shining the spotlight on "little women" who were not allowed a true or intact childhood; whose plot trajectories forked not between artistic spinsterhood and marriage, but who became adolescent mothers confronted with a choice for freedom with or without their children; whose domestic labors served others, toiling like the unaffectionately nicknamed Frado as "Nig" under the constant threat of a beating; and whose adventures abroad involved stowing away on a ship (Linda Brent) or gendered and racial passing on a train (Ellen Craft). I'm glad that on its 150th anniversary Little Women can be read intertextually alongside new classics that portray the diversity and texture of what it meant to grow up female in a nation besieged by racial injustice and sexual predation, but with the grounded hope that like Marmee's daughters they would have the opportunity "to be beautiful, accomplished, and good; to be admired, loved, and respected, to have a happy youth, to be well and wisely married, and to lead useful, pleasant lives, with as little care and sorrow to try them as God sees fit to send" (84). [End Page 100] Cherene Sherrard-Johnson University of Wisconsin–Madison Copyright © 2019 University of Nebraska Press

Deployment of specialized hospitals for the Red Army wounded in the Southern Urals during 1941–1945

This paper discusses specialized treatment of the wounded in the hospitals of the Southern Urals in the Great Patriotic War (19411945). It is proved that the specialized treatment of the wounded undergone significant changes during 19411945. The paper defines nature of injuries and damage, treatment time, forming, distribution of hospital beds and a contingent of the wounded and sick Red Army soldiers. The author states that throughout the war the surgical activity in the South Urals hospitals increased. The study deals with the problem of death in base hospitals. The number of Red Army soldiers deaths was undercounted. This study has shown that due to medical workers of the South Urals hospitals specialized treatment of the wounded made a qualitative leap in the development of the stage treatment. At the beginning of the war general surgery and general therapeutic hospitals were created. Then, in order to ensure the most qualified assistance to the wounded, specialized hospitals and offices were deployed. The authors estimated that the application of advanced methods of treatment in the evacuation hospitals of the South Urals helped to heal 72,3% wounded and 90, 6% patients and they returned to military service. These materials can serve as a basis for further research in the Southern Urals health history and, in general, the history of the South Ural Region, as well as the patriotic education of the youth.

Decoding Modern Hospitals: An Architectural History

The various currents in post‐Second World War hospital architecture have shared one central aim: to ‘normalise’ the healthcare environment. Rather than looking obviously like hospitals, these buildings have gone from resembling office blocks, to shopping malls, to techno‐utopias, to zoned campuses with a distinct local feel and a focus on sustainability.Professor Annmarie Adams, of Montreal's McGill University, refers to examples across North America and Europe to illustrate the different ways architects have found of putting the patient experience at the heart of their hospital design strategy.

APPLICATION OF GRAFTSKIN TO ACCELERATE HEALING OF ULCERS IN DIABETIC FOOT SYNDROME

Diabetic foot syndrome (DFS) is one of the severe and more frequent complications of diabetes. It is characterized by occurrence of chronic purulent necrotic processes (trophic ulcers) on the foot with damage of skin, soft tissues and osteoarticular system due to pathological changes in the peripheral nervous system (diabetic neuropathy) and vascular system (diabetic angiopathy). This study aimed to evaluate the possibility of accelerating of wound healing in DFS by using the dermal equivalent (graftskin) and determine the safety of the method, factors and indications for its application. The research included 60 patients with DFS who were cured at the period from 2013 to 2016 in departments of purulent surgery of Hospital of war veterans and Municipal hospital № 14 of Saint-Petersburg. The patients were divided into 2 groups by random sampling of two comparable groups in age and sex. The patients of main group were treated by standard method and using application of dermal equivalent (DE) on the area of trophic ulcers. The patients of control group had only standard treatment. The DE showed a high efficacy in the main group of patients. The application of DE in complex treatment of patients with DFS stimulated processes of healing and accelerated the rate of epithelization. The application of DE was the most effective in patients with neuropathic form of DFS.

Cardiac War Wounds

Summary The paper presents myocardial contusion and penetrating cardiac war wounds. The authors report their experience with thirteen cases of penetrating wounds, out of which only two were treated in the conditions acceptable for surgery. The other 11 wounds were treated in war hospitals which were mostly improvised, and in mobile surgical teams. The basic, exclusively physical examination methods are described here, with the emphasis that “it is better to open and see than wait and see”. Such procedure gave the results that could be compared with the best ones in the literature (only one death). Three, conditionally speaking, specific cases are presented: one tangential wound with relapsing hemorrhage and two spontaneously sanitized ventricle wounds followed by other kinds of complications.