Medicine Goes to Sea
Immersion foot need no longer be the dread of shipwrecked seamen ... thanks to the latest discoveries of the Navy's medical laboratories
E. BAKER REID
SEVEN-YEAR-OLD Jean Lariviere lay huddled against a granite boulder, whimpering from fear and the dull pain in his hands and feet. He tried
to escape, vainly, from the raw winds in the Ottawa district bush where he had been lost for five terrifying days.
It was the fifth night he had lain there—the fifth dawn he had seen since the afternoon he made the wrong turn from the highway which leads between Ottawa and Montreal. He thought that turn would take him to his farm home near Navan. Instead it led him to this sheltering boulder, six miles from his comfortable bed and six miles from his distraught father and mother.
His clothing was soaked-from the cold autumn rain which had fallen the day before. His face and lips were terribly chapped from the early November winds.
But what was, perhaps, most serious of all was the condition of his hands and feet. The hands had had no protection and each night the temperature dropped below freezing. The feet, soaking wet in the heavy, gum rubber farm boots, had never dried. They were severely frostbitten.
When he was found, on the fifth day, both his feet and his hands were swollen to almost three times their normal size.
It is a far cry from this French-Canadian farm child, sobbing behind his rock, to merchant seamen adrift in a life raft far out at sea; but because the Royal Canadian Navy’s men of science found a way to cope with the poisoned feet of those drifting seamen Jean Lariviere’s chance of escaping amputation was increased at least 100%. His was one of the first cases of a medical technique designed for war proving a boon to suffering civilian humanity.
His recovery was expedited, if not entirely made possible, because Navy doctors learned the way to heal immersion foot—the gangrene-threatening condition which exists almost always after seamen have lain for day after day on life rafts, in lifeboats and in rubber dinghies, their feet constantly immersed in the cold waters of the Atlantic.
I talked with Dr. Horace R. Viau, Ottawa child specialist, who attended the Lariviere child after he had been found and rushed to hospital in Ottawa.
“His feet and hands were swollen to almost three times their norma) size,’’ the doctor said, cupping his hands to show the shapeless, puffed mass the feet had
become. “He was suffering from first degree frostbite and in addition was terribly emaciated and dehydrated. If gangrene had developed—and there was a very real danger of that—I don’t know whether we could have saved him.”
Dr. Viau knew what to do because he is a careful reader of medical bulletins and the Canadian Navy had published its immersion-foot treatment in these journals as soon as it was satisfied of its efficacy. He had read of it there.
“After preliminary bandaging and wrapping of the feet, ice bags were packed on and around them and the whole enclosed in a Cellophane envelope,” he told me. “The ice bags were changed every four hours, and at times everything was removed and the feet exposed to room temperature. Today, as a result of the treatment developed by the Navy, the danger of amputation is past.”
It was from Surgeon Captain Archie McCallum, O.B.E., medical director general of the Royal Canadian Navy, that I learned first how much of their fitness fighting men owe to the medical scientists, and how much postwar living will benefit from their research.
“The immersion-foot treatment is only one of the things our research men have developed,” Surgeon Captain McCallum told me. “Many will have real peacetime possibilities.”
Early War Problem
IMMERSION FOOT was one of the early war problems. Its casualties began to appear almost immediately with the start of the Battle of the Atlantic. As they sat in lifeboats, survivors of sunken vessels were invariably crowded. They could not move to escape the water which sloshed around in the boat, usually foot and ankle-deep. At first, as the feet were affected, there was severe pain, but this gradually diminished. This meant circulation was slowing up. Then the flesh tissue was damaged and, as time went on, the foot became waxy white, swollen and insensitive either to pain or to temperature.
“Too often sympathetic crews picking up these survivors have given just the wrong treatment,” I was told by a spokesman at naval headquarters. “They have massaged the terribly swollen feet, have
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surrounded them with hot - water bottles and covered them with other warming comforts. In a short time intense stabbing pains began. Those well-meaning sympathizers could have done nothing worse.”
In one case almost all the survivors of an internationally known passenger ship had to have feet amputated as a result of these misguided ministrations. Many are on crutches or wearing artificial legs, who should have had no need for either.
There was established medical precedent for this warming treatment which had become standard for ships at sea. Immersion foot, medical research men explain, is very similar in appearance and symptoms to trench foot of the last war. Heat was the treatment for trench foot.
In an eastern Canadian port three naval doctors—Surgeon Commander D. R. Webster, Montreal; Surgeon Lieut. F. M. Woolhouse, Saskatoon, and Surgeon Lieut. J. L. Johnston, Stratford, Ont.—were tackling the problem. Frequent immersion-foot amputations had convinced them the heat treatment was not correct. They had an idea the chill treatment might work, both because of its value in cases of diabetic gangrene, which sometimes necessitated amputation, and because the old treatment for a frostbitten nose or ear was the application of snow. Surgeon Commander Webster went to Ottawa. He asked Surgeon Captain McCallum to arrange with the Department of Pensions and National Health, responsible for merchant Navy survivors, to turn these survivors over to him and his staff.
The department, too, was worried about the number of amputations. It was glad to co-operate and torpedoed seamen suffering from immersion foot were released to Surgeon Commander Webster and his staff as soon as they were brought ashore.
When these cases started coming in it was necessary to devise, quickly, some method of applying the cold. Among the first was that of ice bags— used by Dr. Viau on the Lari viere child. Later a cool blast from a fan was tried, and at another stage the patient’s feet were left exposed in a cold room while the rest of the body was warmly covered.
Finally, however, a refrigerator with two leg openings, similar to prisoner’s stocks of olden days, was devised. A fan was installed which blew a blast of air through an ice box, chilling the air which passed over the feet. It was the ideal solution.
Up until comparatively recently the Navy had compiled records of 150 cases of such treatment and in only seven was amputation necessary. Others, unquestionably, would have lost limbs had it not been for this treatment.
Socks For Rats
The Navy next turned to prevention. That was a job for the research unit in Toronto. They knew that grease, such as worn by marathon swimmers, was a protection against cold and decided to explore that avenue.
Obviously the first task was to cause immersion foot and just as obviously humans could not be used as guinea pigs. Into a cage, its bottom covered with water kept constantly at a temperature near freezing, went white rats. In eight hours they began to develop the immersion foot symptoms.
The type of grease to be used had to be decided. Early experiments proved animal greases were not the answer. They were absorbed too quickly into the body. Test after test was made and petroleum jelly proved best.
Then came the idea of socks impregnated with petroleum jelly and again humans could not be used for the research.
The girls in the laboratory got out their knitting needles. They made miniature socks to fit the white rats,
and when these were impregnated with the petrolatum jelly the rats wearing them gave no indication of immersion foot, although they were left in the cold water much longer than the eight hours which produced the immersion foot previously.
The human experiment is now being undertaken using the specially impregnated white woollen socks. Peculiar in appearance, with no foot shaping and the ribs going around the spirals, it is of a type skiers, perhaps, will recognize. Impregnation is effected by dipping the socks in soft petroleum jelly and putting them through a roller to remove the surplus. The process is repeated twice and, when ready, the socks are packed rolled up, so that all the torpedoed seaman has to do is to put his toe in and roll them up his foot and leg. It is estimated each sock contains about one pound of grease, and about 5,000 pairs are now being sent out to the Merchant Navy for packing in lifeboats and on life rafts. This has been done by The Navy League of Canada working in co-operation with the RCN Medical Research unit.
Turning from legs to ears, experiments have been conducted into the problem of noise aboard ships. This was investigated because noise in engine rooms has, on occasion, resulted in deafness.
If you are the average layman you probably believe all sound is heard by means of the ear passages, although they actually play a surprisingly small part in the fact that we can hear. If the ear were sealed tightly with wax, I was told, hearing capacity would be lowered only about 30 decibels— decibel is the unit for measuring noise —in a volume of 100 decibels. Seventy decibels would still be carried to the hearing diaphragm by means of the skull and face bones. Even a heavily padded helmet, of the football type, would stop little of the noise from penetrating in this way.
It is because we hear with every bone in our skull and facial structure, each funnelling sound to the hearing diaphragm, suspended in the skull bone structure, that the Navy had to design a new system for measuring hearing.
“Under the old system for testing hearing we used a whisper,” I was told. “We’d send a man into the corner of a room, tell him to put his finger in each ear, alternately, and then we’d whisper to him. If he heard, he was in.”
Now the naval scientists have developed a special hearing testing device, which is a great advance over the old procedure.
New Eye Tests
This war, with its specialized tasks, has produced the necessity for specialization in physical examinations—a necessity which did not exist in the last war. • In addition to discarding old hearing tests, new sight tests have also been developed.
“The old oculist’s card was not satisfactory for our purposes,” Surgeon Captain McCallum told me. “Because exactitude perhaps was not so necessary with civilian tests, the test cards were not illuminated equally. Sometimes, too, the linen on which the test letters were painted was allowed to get dirty. We’ve fixed that now. We light the letters by a photoelectric control, which assures equal light on every letter. We can provide any desired intensity of lighting, and by these more accurate tests we know exactly what a man will
see and the conditions under which he j will see it.”
In connection with the problem of sight, new discoveries concerning man’s two sets of eyes are being used to increase the efficiency of the Navy’s fighting ships. Before the war few, beyond restricted scientific circles, knew human beings are actually equipped with two sets of eye cells— rods and cones—the cones for day and the rods for night. Cones are most heavily concentrated about tflie centre of the retina, a part of the eye which is barren of rods.
These discoveries involved considerable research as the cones, used in daylight, may be perfect while the rods may be blind or, perhaps, of extraordinary power. Because the man blind at night is useless as a lookout in the dark watches, the naval research unit has developed a machine for testing night vision.
The first requisite was something which would test rod function alone. Built for them at Columbia University, the Navy’s machine operates in a dark room where the subject to be tested waits for three quarters of an hour to become thoroughly adapted to darkness. Looking through a tube he is asked to fix his eyes on a small, dim red light. Periodically the operator of the machine flashes a white light, just below the red one, and if the subject sees it he is told to signal the operator by means of an attached telegrapher’s key. The intensity of the white flash can be changed as desired and the night vision of the subject is indicated by his response through the key.
“We impress on our men on duty at night never to look directly at a spot where they expect to see an object,” a naval officer told me. “For instance, if they are looking for a ship they must look not at the horizon but about 10 deg. above it. The reason for this is that if they look directly at an object at night they are mainly using the cones in the centre of the retina, which are of use in daylight only. If they elevate their vision the rods have a chance to work.”
As a preliminary to the night vision machine considerable research was done on the lighting of ship chart rooms and other spots where men are stationed at night. It was found that if these places were lighted with a deep red illumination a man on watch could look up from a chart and out into darkness without his night vision being seriously impaired. It is because of this that instrument panels in nightflying aircraft are illuminated by red light. This was a carefully guarded secret but is now a well-known part of published ARP procedure.
These new facts on night vision, the scientists predict, will be of very real value in peacetime occupations.
A new color-testing lantern has also been developed. This has resulted in the salvaging of many recruits who would have been rejected had they ! been tested by the standard Ishihara, or ¡ color card, test alone. The Ishihara ¡ test, being very sensitive, it is believed, j excluded men who could distinguish j between red and green sufficiently well for all practical purposes.
In the field of contact lenses the Royal Canadian Navy was one of the first organizations in the world to j realize their possibilities for men on sea duty. The plastic types, which are not breakable, are used and their use has brought valuable men back to sea who, otherwise, would have been barred because the regular spectacle
I typo of glasses are not practical for sea I use.
The contact lense is simply an eye; shaped cup, ground to the necessary oculist’s prescription. The lens is filled with a special saline solution and fitted over the eyeball, being held in place by the upper and lower eyelids. Slipping them under the eyelids, which is done by hand, offers no difficulty, although grinding of the plastic lens to the oculist’s prescription is a slower process than with glass.
One field in which there has been considerable research is that of blood substitutes for use in shock from wounds and burns. The Royal Canadian Navy’s research has convinced its scientists of the merit of blood serum. These scientists, before joining the Navy, were responsible for the initiation of the Canadian blood serum project.
Value of the Canadian blood serum was well demonstrated in December, 1942, in the disastrous Knight’s of Columbus hostel fire in Newfoundland. Due to its generous use not a single patient brought to hospital died of burns.
In addition to blood serum and plasma, research is being carried out on isinglass, almost useless byproduct of fish, as another substitute for blood.
This is not a naval research unit project, but is being carried out by Dr. Norman R. Taylor, of the Department of Physiology at the University of Toronto. The isinglass, of course, is still in the experimental stage, but it does open an interesting field for research.
One of the more interesting achieve-
ments of the Navy’s research unit has been the development of the already publicized balanced ration kit. Weighing only 173^ pounds, four of them on a life raft are sufficient to keep 10 men in first-class condition for a period in excess of 10 days.
Based on the fact that water is more important than food, but that food is necessary for morale, at least, the kit contains more water than food, which is concentrated in tablets and consists largely of whole milk and chocolate. Interesting features are that the water container will not burst, even should the water freeze and expand with temperatures as low as 15 deg. below zero, while the chocolate bars which the kit contains will not melt at a heat of 212 deg. A method has been devised to prevent fats in the concentrated food tablets from melting and spoiling the food, even during sterilization, while the water has been treated with certain tasteless salts which prevent it being contaminated by rusting of the tin container.
For the benefit of the medical profession, the research unit has been busying itself. So far it has produced a portable laboratory kit permitting doctors to make simple urine, blood and bacteriological analyses, far from medical centre, while a new, medical officer’s battle belt permits him to carry, in a convenient, compact form, essential instruments and medicines right onto the field of battle.
“Our whole field of research is a wide and important one,” said Surgeon Captain McCallum. “It is designed, primarily, to make our fighting men much more efficient in battle but the things we are learning will make for a happier and healthier postwar population.”