[ Music ] ^M00:00:12 >> Good evening everyone and it's great to see such a large crowd here on a very wet evening. Welcome to the second in the series of the University of Melbourne's Anzac Centenary Lectures. My name is Kate Darian-Smith, and I'm a professor of Australian Studies in History and chair of the history programme here at the university in the school of historical and philosophical studies. I would like to acknowledge the traditional owners of the land on which this event is taking place, the land of the Wurundjeri people and pay respect to their elders and families past and present. I also extend a special welcome to any veterans and current service men and women who are here with us this evening. Tonight is the second of the University's Anzac Centenary Lectures. This series brings together some of Melbourne's most important scholars and thinkers to consider how the changes after and during the First World War still resonate today. These discussions were conceived by Dr. James Waghorne from the University, sorry from the History of University unit and James is here tonight. And they've been held in a way echoing a series of public lectures that were organised by the University of Melbourne during 1915. Lectures that aimed to assist Melbournians makes sense of the Great War. Two weeks ago at the Shrine of Remembrance, the first of this current lecture series discussed the recent archaeological survey of the Gallipoli Battlefields. The survey revealed among many other things, the different diet of the respective combatants. The Turks had access to fresh food, while the Anzacs endured bully beef and obtained rationed and faced acute water shortages. The huge 3 volume official history of the Australian Medical Services in the First World War, described the Gallipoli campaign as "A disease debacle." With many of those sick with diarrhoea and dysentery greatly outnumbering the dead. In 1915 as part of the University of Melbourne's public lectures, William Osborne, the professor of physiology spoke on the challenges of battlefield nutrition. Osborne considered the heat and energy and the fibre and protein of various food stocks. Under his scheme a fighting ration of bread and jam was considered quite healthy. Osborne's lecture predated modern theories about the vitamin content of food and reminds us I think of just how much medical knowledge has been learnt since. And much of that during the First World War. In this industrialised warfare of that conflict the provision of healthcare was instrumental for military success. There were two medical issues, those of injury and those related to illness and disease. New fighting strategies of artillery shelling, tunnelling and mining, machine guns, and the advent of chemical attacks created new conditions that had to be dealt with medically, such as disfiguring wounds, trench foot, trench mouth, and so on. And did so on a scale that was unprecedented and I think before the First World War like so many things that happened in the First World War completely unimaginable. There was also the spread of disease, including the worldwide pandemic of influenza in 1918 to '19 which had more fatalities than the Black Death. The war was indeed one where the sick fought the infirmed. In response, scientific innovations that had lasting effects on the practice of medicine were developed and health was of primary concern of the combatants. Australian doctors, dentists, surgeons, and other health professionals answered the call and enlisted on mass. The University of Melbourne shortened its medical degrees to provide the training necessary for frontline service. A number of women medical doctors who were excluded from the military services made their own way to Europe to serve in field hospitals. The contribution of thousands of Australian nurses serving in the world, both in Australian and in British hospitals was highly significant. Many of those in the medical field who served during the First World War did not return and their loss was acutely felt. During the First World War and in trying circumstances, new medical treatments emerged. And I'll just mention a few. The Welsh surgeon, Hugh Owen Thomas pioneered the use of traction splints to set bones broken by shrapnel which is credited in reducing the death rate from as high as 80% to less than 10%. Blood transfusions, a technique developed in the years leading up to the war, were used on a large scale for the first time. The administration of saline fluid into patients with wound shock, a condition in which men with relatively minor injuries presented with ash and grey complexion and failed to thrive was also pioneered These are celebrated cases, but the true story of the medical war was much broader. And tonight we're going to examine a number of these medical advances, and recall how this reflected on medicine then and what an enduring resonances these elements had for the continuing practice of medicine, dentistry and so on today. And I also commend to you the informative exhibition entitled, "Compassion and Courage, Doctors and Dentists at War" that is now showing that the University's Medical Museum. I just should advise our audience that we're recording this event. And the recording will be made available on the University's website after tonight. And it's now my very great pleasure to introduce our esteemed panel who will all present their own brief reflections on the medical war before we open up the session to a wider conversation. Professor Doulas Hilton is the director of the Walter and Eliza Hall Institute and research professor of medical biology and head of the department of medical biology as well at the University of Melbourne. His research interest is molecular regulation of blood cell formation and function. Professor Sharon Lewin is the director of the Doherty Institute for Infection and Immunity and an Australian National Health and Medical Research Council practitioner fellow. She's a past president of the Australasian Society for HIV medicine, and currently serves on the government's ministerial advisory Committee on Blood Borne Viruses and Sexually Transmitted Infections, and on the International AIDS Society International Working Group. In 2014, Professor Lewin was honoured as the Melbournian of the Year. Dr. Warren Crossley, is Deputy Head of Oral Surgery at the Royal Dental Hospital. Warren trained as an oral and maxillofacial surgeon in South Africa where he gained experience in trauma management, including gunshot injuries. He moved to Melbourne in 2008 and currently lectures at the University of Melbourne and conducts private practice in Hawthorne. The Doherty Institute is named after Laureate Professor Peter Doherty who shared the Nobel Prize in physiology of medicine in 1996 for the discovery of how the immune system recognises the virus infected cells. He was Australian of the Year in 1997 and has since been communizing between St. Jude's Children's Research Hospital in Memphis in the United States and the Department of Microbiology and Immunology at the University of Melbourne. His research is mainly in the area of defence against viruses and Peter regularly devotes time to delivering public lectures and media commentary. So welcome to the panel, we're going to hear from them in succession and I'd like to invite Professor Hilton to take the podium first. ^M00:09:56 [ Applause ] ^M00:10:01 >> Thank you so much. I'm not going to talk about the medical problems that were associated with the Great War, I'm going to talk about a topic that as an institute, the Walter and Eliza Hall Institute, we've been reflecting on for the few days, and that's the topic around the loss of potential. This is a topic that has been beautifully covered by the author, Russ McMullin in his poignant and beautiful book, "Farewell, Dear People." And anybody who has not yet read Russ's book and has any interest in the Great War, or war history, I would commend the book to you in the highest way. Russ' book contains 10 extended biographies of young men who exemplified the generation Australian lost in the Great War, including the Walter and Eliza Hall Institute's inaugural director designate, Gordon Clunes Mackay Mathison. And I'm going to tell you a little bit about Mathison. He was a pretty special guy. Mathison was born in 1883 in Country Victoria and he grew up in Melbourne. And was educated at Elsternwick primary school and Caulfield Grammar. After that as a member of Queens College at this University he started medicine and after graduating he undertook medical research in London. And that's a sort of trajectory many researchers take today. Do their basic training and their PhD for example at this university and then travel overseas to get additional experience. Mathison was brilliant. He spent a few years in London working in a couple of different laboratories. And published a string of papers that led him to be acclaimed as one of the top researchers of his generation. On the declaration of war, toward the end of 1914, Mathison enlisted and was part of the Second Field Ambulance, Australian Army Medical Corps. Mathison then returned to Melbourne, bound for Egypt aboard the HMAT Wiltshire where he was attached to the Fifth Battalion of the Australian Imperial Force and was deployed to Gallipoli just before the Gallipoli landing. A few days after he arrived in Gallipoli, on the 10th of May while sitting in camp quite a long way from the front, he was wounded in the head from a stray bullet, he was evacuated to Alexandria, and without ever regaining consciousness died 100 years ago the day before yesterday, on the 18th of May, 1915. The institute had been established in partnership by the University of Melbourne, the Walter and Eliza Hall Trust, and the Royal Melbourne Hospital on the 23rd of April, less than a month before Mathison was killed. And the letter offering him the inaugural directorship of the Walter and Eliza Hall Institute was sent on the 23rd of April, but he died never knowing of the offer that we was to receive. Last Monday, a couple of days ago, we unveiled a statue by Michael Meszaros commemorating Mathison's death and mourning the loss of potential. It's actually on the forecourt of the Walter and Eliza Institute and anybody who doesn't know the institute, we're almost directly opposite this building on the other side of Royal Parade, tucked between the Royal Melbourne Hospital and University High School. And anybody who's interested in sculpture or Mathison, is most welcome to have a look at the sculpture on the forecourt. Mathison's story is pretty well known. I think what's less known is that our first and second directors, those who actually took up the post, Sydney Wentworth Patterson, and Charles Halliley Kellaway, were also medical doctors in the Great War. Patterson was born in Melbourne, the year before Matheson. And Kellaway was born in Melbourne six years later. Like Mathison, Kellaway was educated at Caulfield Grammar. Patterson was educated at Scotch College. Like Mathison, both Patterson and Kellaway attended medical school at the University of Melbourne. Kellaway as a fellow of Trinity and Patterson a fellow of Ormond, rather than at Queens like Mathison. Patterson and Kellaway both enlisted and both served during the Great War. Like Mathison, Kellaway was sent to Egypt where he served before being sent on to Flanders in 1917. Patterson served in France as a pathologist for a couple of years, from 1917 to the end of the war. Unlike Mathison, Patterson and Kellaway survived. Like Mathison, Patterson had worked in London. Patterson worked with the great physiologist E.H. Starling in 1913 and '14 just before the war and actually fell in love and married Starling's favourite daughter. Patterson was appointed as the first director of WEHI in 1919. In the last year of the war, Kellaway also worked in London on anoxia and he also worked with E.H. Starling. And although I'm not certain of it, I suspect they knew each other while working together in Starling's lab. Kellaway stayed with Starling in London until 1923, when he moved back to Melbourne to take over the directorship of WEHI, the Walter and Eliza Hall Institute from Patterson who moved back to England to pursue more clinically grounded research. And also for family reasons. And we celebrate our annual general meeting tomorrow and our centenary year as an institute and one of the remarkable things about an annual general meeting is that we're going to have their Patterson's daughter who lives in Tasmania. Patterson died in 1960 and was director of WEHI over 90 years ago. It's remarkable that his daughter's able to attend. Those three men, their backgrounds, as I've outlined were very much intertwined. Similar experiences in war, their destinies, and the realisation of their potential and their contribution to humanity were ultimately determined by the trajectory of a stray bullet. What I'd like to reflect on, and what I'd like you to reflect on is how many other scientists, or doctors or academics, or people in other walks of life, how many of them, how many of their destinies are determined by such random events. And I'd like to reflect just on one more scientist. One of my favourite autobiographies, and maybe it's my favourite because it's about one of my favourite scientists, is that of the jewel Prize Winner in Physiology or Medicine, Fred Sanger. And this autobiography was published in "The Annual Reviews of Biochemistry" in 1988. Sanger was born towards the end of the Great War, in 1918. And in this review, in this autobiography rather reflectively said, "I was not academically brilliant, I never won scholarships and would probably not had been able to attend Cambridge if my parents had not been fairly rich. However, when it came to research where experiments were of paramount importance, and fairly narrow specialisation was helpful, I managed to hold my own even with the most academically outstanding. Sanger's family wealth allowed him to fund himself through his PhD and into his postdoctoral years. And really got him a start in research. I wonder how many unknown Sangers were born into the slums of Manchester or London at the same time Sanger was born into relative wealth and Gloucestershire. How many unknown Sangers couldn't pay their way to university or bankroll the early years of their research life? How many unknown Sangers have given up because they have no good role models at high school or unsuccessful in getting their APA's their post graduate awards that we have now that support for PhD students. Or gave up because they didn't get their first National Health and Medical Research Council Grant. Or because they lack the support at home or from their employers after having children. We know that fate can be capricious at war, but it can be equally capricious in times of peace. So what I'd like to ask a lot of you who may have links to the university, have senior roles in industry and the community is let's be aware of the unnecessary obstacles and barriers we place in front of people as they try and fulfil their potential. Thank you. ^M00:18:58 [ Applause ] ^M00:19:06 [ Footsteps ] ^M00:19:15 >> Well welcome, and great to see a full audience on a miserable Melbourne night. I'll start by saying that I'm no historian. I'm an infectious diseases physician and basic scientist and essentially spent my career and most my daylight hours focussing on HIV and AIDS. So when I reflected on what unique perspective I could possibly bring to the conversation this evening, I thought of two aspects of the medical war that I think were hugely important and perhaps less frequently highlighted in our Anzac reflections and in our discussion of the great medical challenges of that time. And they are women and sex. ^M00:20:02 So I've been fascinated by the role female doctors played in World War I. And I'll start by saying that my inspiration has come from reading most of the work and writings of Heather Sheard a post doctorate fellow here at the University of Melbourne who has extensively researched the role of women in the medical war. I think Heather is here tonight I'm not sure if I can see her in audience and I'd like to acknowledge her work upfront. So a few interesting facts that many of you in the room might not know. By 1914, there were only 130 women registered as medical practitioners in Australia. But none were allowed to enlist in the armed services in Australia, New Zealand, and England. However, by 1918, more than 20 Australian women had actually worked as surgeons, medical officers, anaesthetists, and pathologists across Europe and were directly involved in the war effort. So how did they get there? Well firstly just as a result of sheer need the medical services of the allied armies were simply overwhelmed by the challenge of wounded soldiers but in addition by the consequences of great movements of people, both the military and fleeing civilian populations. And this led to significant outbreaks of infectious diseases, such as typhoid and typhus for which we had no treatment back then, but now entirely treatable diseases. The second was the formation of voluntary medical units in the hospitals in England and Europe that were actually outside the edges of the Royal Army Medical Corps. And woman were allowed to work in these hospital networks, and did some amazing things there. I was fascinated by another story, a story of the Sydney pathologist, Elsie Dalyell. A brilliant student, Elsie was the first Australian woman to be awarded a prestigious fellowship to study at the Lister Institute in London in 1914. After arriving, within months she was sent to Serbia in February of 1915 to manage a typhus epidemic. After Serbia she moved to a field hospital in France, and at 34 she was one of the oldest doctors in the team who treated many of the badly wounded soldiers from the battlefields. Quite incredible to phantom that people were doing that at that age. She then went on to complete some groundbreaking work around gas gangrene. A major infection that can complicate dirty wounds. Now, entirely treatable with penicillin and surgery, but then a devastating universally fatal complication of injury. And in 1919 she was appointed an officer of the order of a British Empire and was decorated by the government of Serbia. She then worked briefly in Vienna as a researcher and in the early 1920s returned to Sydney and couldn't find a job. In fact this was a very common experience for many of the great heroic medical women, they became overqualified. In contrast to their male colleagues, Elsie and many of her female colleagues once back in Australia were unable to set up private practice, couldn't get an appointment as a consultant at a public hospital, a critical role for any medical practitioner. And even worse, would have been that she had very few colleagues to share her experiences with. In contrast, the returned service men there were no similar networks for women, and I read of many who suffered greatly from isolation, depression, and the outrageously limited opportunities when they had proved to be so competent. Over tonight I think we will hear some of the great heroes of the medical war and clearly the very special medical women should not be forgotten. Now to the other forgotten story, sex. And sex in foreign places usually comes with a problem of sexually transmitted infections, something we rarely talk about but was hugely important at that time. In the US Army during World War I, sexually transmitted infections were the second most common reasons for disability and absence in duty. Being responsible for nearly 7 million lost person days and the discharge of more than 10,000 men. Only the Spanish influenza epidemic of 1918 to '19 accounted for more loss of duty during that war. And amongst the Australian forces, it was estimated that at least 60,000 Australian soldiers were treated by Army doctors for venereal infections between 1914 and 1919. Something we don't talk about much. But what was really alarming to me when I read about this more was not just the scope of the problem, but how sexually transmitted infections were managed. And not just how they were medically managed, how they were managed in other social aspects which is so important. It was an offence to conceal a sexually transmitted infection, its victims were guilty of misconduct. It actually still remains so. But what was vastly different at the time of World War I was the total disregard for confidentiality and the incredible stigma associated with the sexually transmitted infection including being shunned by society, and designated as a sinner by the church. Amazingly following the diagnosis of a sexually transmitted infection, a soldier's pay was stopped for the duration of their treatment. And surely if that happened how could that have been kept confidential. Families at home would be very quickly aware of the diagnosis. Nowadays, there's such incredible attention toward confidentiality in the setting, it was amazing to read this. Added to that, there was only a brutal regimen of toxic cocktails administered by injection with no evidence of any benefit, and we now know there was no benefit. And of course the discovery of penicillin means that now syphilis and gonorrhoea which were the commonest sexually transmitted infections at the time can actually be cured, but that didn't arrive until the 1940s. Prevention from sexually transmitted infections was also probably never discussed, and close to impossible, really aside from abstinence which we know never really works on any large scale. At the time, prophylactic ointments of mercury and silver and vulcanised rubber condoms were all that was around, and obviously not too popular. So William Osler a huge figure in modern medicine once said that "In war the microbe kills more than the bullet." And this couldn't have been truer than in World War I. Traditionally we think of surgical infections being the big killer and of course they were incredibly important, but there were so many others. Influenza, which I'm sure you'll hear much more about from Peter, typhoid, typhus, the two organisms Elsie worked so hard on. Tuberculosis, and of course sexually transmitted infections. So in our conversations tonight let's not forget two critically important, often forgotten stories of the medical war and celebrate the great advances we now enjoy for both medical women and the dramatic changes in the way we manage and prevent sexually transmitted infections. Thank you. ^M00:27:50 [ Applause ] ^M00:27:57 [ Footsteps ] ^M00:28:03 >> Good evening. Coming from South Africa, traumatic background and we still treat patients from northern areas Rwanda, Burundi, and war is still carrying on. We're very lucky, I've got family living in Melbourne and it is great to live in Melbourne. Injuries in World War II learnt a lot from what happened in World War I. The injuries in World War I were very different to anything previously experienced. In the trenches people were in a little narrow ditch. You just heard it was wet, it was muddy. The conditions were not great the food was not good. These are young people. We need to remember there were young guys who some of them didn't even have a family of their own yet. And normally they would be healthy but because of the circumstances they were in they weren't. Trenches were dug in farmland and we've got manure we've got decaying, decomposing material there. There were rats there were all sorts of things, much more likely to get gas gangrene. There's no antibiotics. The other thing about trench warfare is the vulnerability of the face, the head and neck. Guys were in trenches prevents any damage to your body, but you just pop your head above there and these guys were in muddy trenches day and night for a short while. They were there for years. If you watch any of the YouTube videos it's pretty difficult to understand that it wasn't advancing you need a tank or something else to advance the front. So they were just in there and trying to survive. The other thing that's different is the weapons. The weapons were invention of the machinegun and large calibre weapons, shrapnel. Shrapnel was completely new. ^M00:30:01 And the type of injury you get from that is instead of just breaking bone, you'd have shattered bone and you'd also have loss, complete loss of soft tissue. When someone is involved in a motor vehicle accident, things are disarrayed and you start putting back a puzzle. You take the pieces, you put them back. And we've got plating, we've got all kinds of things these days. These guys had they would survive and they would go back. So I'm thinking for every person who died in World War I, at least two went back injured. And they were surviving this, but they weren't going back to normal life. They were going home, but they were not going back to normal life. Cleaning of wounds has changed so they are obviously much better. Debriding wounds, necrotic tissue removed, copious saline lavage, development of sodium hypochlorite, so-called Milton's today. And Edinburgh University Solution eusol was used up until the '90s can find it in South Africa still. And of course antibiotics. So surgeons at the time were very reliant on a really good blood supply and fortunately for us, our faces do have an excellent, excellent blood supply. Prior to World War I there were only porters so for people to get transferred to a hospital, there really wasn't, there was no recognition for kind of a first responder. And so this was something that really was developed well at the time. And they would put on tourniquets, they would stop bleeding, and they would provide morphine, give some tea, and something probably not today, they would give them a cigarette. Not really a great medical environment there. New Zealand borne Harold Gillies was only 32 at the time of the war. He was an ENT, and he recognised that there was a vast need for reconstructive surgery and particularly to the face as much as restoring function but also aesthetics. The whole psychological impact of a facial injury up until this stage wasn't really recognised, and I think even still it wasn't recognised. He set up along with the British Armed Medical Corps, he set up a plastic surgery unit, and they developed a specially designed hospital, Queens Hospital at Sidcup in London where 5000 med were treated between 1917 and 1925. The advantage of this kind of thing is that a large number of casualties were treated and records were taken as case studies and we learnt easily from that. And I look at my training relative to what we're providing in Australia. And when there's a sporadic case here or there it's quite difficult to remember exactly what you did last time. But when you're doing a number of these again, and again, and again it's a lot easier to learn from those cases. Gillies was very keen to document the surgery and the outcomes they clearly didn't have video cameras or anything like that, but they had colour pastel sketches, and artists photos as well, just black and white photos of before and after. And they raised flaps from distant sites. What he was really well renowned for was the tube pedicle. Where tissue is missing. In order to put tissue at that site you need a blood supply to be developed. And when you just take tissue from someone else and place it there, particularly without antibiotics, that is going to die. So what they did was they would raise a pedicle from another site, a distant site and flap it around, attach it to the site where it needed to be placed, and then roll it into a tube and suture down the tube. So you would have basically it could look like the handle of a beer mug going from the chest to your face and then that would need to stay like that until the blood supply developed, and you got a blood supply at the site of where it had been inserted. And then you could release it on the host site. And this is one of the major things that they did. They also developed new instruments and every surgeon knows about the Gillies and Mcindoe and so not just the techniques but the materials and the equipment that we use. And just of interest after the Battle of Somme in July 1916 more than 2000 guys were injured and needed surgery in one day. That was certainly amazing. Gillies learnt from these procedures and the also learnt that things needed to be staged, which is something clearly we do as well today. There was an airman who had his face really badly burnt and we're aware of systemic inflammatory response, things like that. They didn't have names for them then, but they clearly understood that it would be just too much to do too much in one go. And so when we do patients with syndromes you would need to perhaps move some things and stage the procedure so cleft palates, Crouzon syndrome, things like that today we still stage the procedures. The other thing to remember is that these guys were after going back home, they couldn't go back home immediately so they would be in hospital for up to three years having these procedures done and once they went back home, they went, they still weren't the same person they were before they left. Nurses were taught not to act astonished or act surprised when they saw these wounded soldiers. And mirrors were taken out of hospitals and you wonder whether it's a good idea to do that or not because clearly the guy in the bed next to you, you look at him and he looks terrible and he looks at you and you look terrible and it would probably just be a good thing to look in the mirror and come to terms with things rather than, I'm not a psychologist so this is just my own perception on it. But they would even have blue benches in the parks nearby, near the hospital and those benches were kind of designated for soldiers who'd been badly disfigured and locals would be aware that yes it could be frightening to see someone sitting on one of those benches. The psychological impact just wasn't taken care of. Our faces are our window to the world so I look at my little boys in the morning and I give him a smile and they smile back to me and no word is, we haven't even said anything and it's just an expression and being able to express things. Not to mention obviously we breathe, we taste, we smell, we communicate, speech. Where would we be without speaking, as well as obviously eating? For soldiers too badly injured where they couldn't get them back to satisfactory aesthetic outcome, they would go to what they call the Tin Noses Shop, which was a department. The real name was Masks for Facial Disfigurement Department and they would have masks made. It took about a month to make a mask and ladies, in fact the explorer Scott, everybody knows about Scott, but nobody knows about his wife who was an excellent sculpture. And she was involved in making masks for these chaps. The masks that we see are just a photograph and if you look at a photograph, it's a static thing. There's no animation there. We look at Walt Disney these days and you look at that compared to just aesthetic picture. The masks were clearly not as good as what we thought they were. The photos that we have are only black so we don't know really what they look like. The masks didn't have function, they didn't have anything like that. These guys would go back and they might not be married yet. They would think will they get a job, will they be able to sustain a family will they be able to. And so there were stories about guys going back and or just writing a letter back home to their loved one and saying, I found a new girlfriend. And you wondered whether they had found a new girlfriend or whether they were just too scared to go back home. Guys who did go home would end up leaving, some of them even taking their own lives, some of them just going, and living in isolation. They also didn't get a pension, so if you lost a limb you'd get a pension. And if you had facial disfigurement you wouldn't get that. You wouldn't get that. So even after the successful surgery they might be too shy to go and live an ordinary life. Treating these guys today is still difficult and we've got clearly antibiotics, we've got a lot more stuff, we still don't have excellent outcomes Dr. D was just saying at lunch time today he spoke with people regarding facial transplants, and it is a reality, but the guy who had the first one done in 2012, apparently didn't look in the mirror either, his personal choice. So World War I recognised early an aggressive management, the blood transfusion, triage, rapid transport back, the Thomas Splint, obviously saving lives. And what war does is it accelerates the training. So we've heard that doctors get trained a lot quicker, it accelerates that. And there are terms that we use these days, we talk about peer review and we talk about evidence based medicine, and I think in these instances, they didn't call it that, but that's exactly what they were doing. And we should be documenting and doing these things in our every day. ^M00:40:04 Everyday things that we do. There's a BBC article, well not an article a presentation, and they say what would you do. I'd like you guys to just reflect on this for yourself. If you had that terrible facial disfigurement would you opt for surgery, outcome not really sure, would you wear a mask, would you wear the scars with pride, or would you just avoid going back to the public? Thanks. ^M00:40:30 [ Applause ] ^M00:40:38 Well just from memory, there's a the American poet E. E. Cummings wrote a war poem called, "Etcetera" and as I remember it it goes something like this, "My sweet old etcetera Aunt Lucy during the recent war could and what's more did tell me what everyone was fight for. As for me, I just lay in the mud and thought of your hands, your eyes, your knees, and of your etcetera." [Laughter] I like that poem. Probably got it wrong, I've misspoke the Bible and Shakespeare too. So I wrote this down, I don't usually write talks down. "If I should die think only this of me, that there's some corner of a foreign field that is forever England, that shall be in that rich earth a richer dust concealed a dust whom England bore, shaped, made aware gave once her flowers to love, her ways to roam, a body of England's breathing English air, Washed by the rivers, blest by suns of home." He was Commission in the Royal Navy, volunteer reserve as a sub lieutenant. Twenty-eight-year-old Rupert Brookes sailed on the disastrous Dardanelles campaign and died on a French hospital ship in 1915 from a mosquito bit that turned septic. He lies in an olive grove on the Greek Island of Skyros which as I understand it is very close to Gallipoli. According to Yeats, Brooke was the handsomest young man in England. I love the way the English say things like that. I don't think Yeats statistical analysis would have been any better than a news poll but still, the handsomest young man in England, the cleverest young man of his year. I love those statements, they're so over the top. What a waste. Stupidity of war and especially this 1918, 14, 18 war, which I've always regarded as the stupidest of all wars and I've always sought to understand because to some extent I overlap with it, no I'm not that old, but there is some overlap. After World War I Brooke's fate to die of infection rather than wounds was the norm for soldiers. Apart from being the Gallipoli centenary, 2015 also marks 150 years since the end of the American Civil War, which in a sense was the first of modern wars. They didn't have machineguns, but they had repeating rifles and they had quite a bit of the ordinance that we saw later, and bombs and explosives and all the rest of it. In that conflict which came right at the time of Pasteur. It came right at the time of Pasteur was really establishing the German theory of infectious disease. And pioneers like Semmelweis and Lister were just beginning to establish the link principles of medical hygiene and antiseptic surgery. Then, more than 4 times as many soldiers died of disease as died of wounds. We see enormous advances in understanding sanitation and technology that occurred through the latter part of the 19th century. And there were great advances. Our soldiers who were vaccinated against typhoid on route to Egypt. They didn't like it very much but they got the vaccine. So that had changed dramatically by World War I. Overall throughout the hostilities the ratio of deaths from infectious versus combat in 1914 went from 4 instances to 1 in 1861, 65 to 1.1 to 1 in 1914, 18. By World War II that ratio had changed to 1 is to 7 or so at least for American troops. And that of course reflects that enormous advance in medicine and vaccines development and tetanus vaccine and all the rest of it that occurred through those years. Sharon mentioned some of the others were it's that early part of the 20th century that sees the beginnings of evidence based medicine. Particularly in institutions like Johns Hopkins University in the United States. Reflecting the intensity of the fighting and perhaps the very dry conditions, as Sharon mentioned many suffered from diarrhoea. Our boys at Gallipoli suffered something like 5400 killed in action compared with 665 in the official war record as designated as dying of infection. So that was dramatically different. Later in France the members of the first AIF were to suffer along with everyone else the constancy of lice infestations, and the horror of trench foot which could lead to amputation and was best treated by having a supply of dry socks. Which is pretty difficult in wet trenches, and smearing the feet with whale grease. That was kind of bad for the wales. And it was also the wale grease was also used, incidentally to protect the faces of the fighter pilots in World War I from the blowback from the machineguns. They'd come out of their planes and they'd be totally black. It didn't protect them from something else, a lot of World War I fighter pilots later developed cancer of the nose and pharynx, and the reason for that is that the fuel for those early engines the rotary engines, contained Castrol oil and that was blowing back into their face as well. Castrol oil is a great carcinogen. Then there was 5-day trench fever, which was caused by Rickettsia Quintana that wasn't worked out until after the war, while thousands of the wounded died of tetanus and gangrene, so the list goes on. And it wasn't just the soldiers who were afflicted. Sharon told us something of the women doctors who went. There were large numbers of nurses and VADs and other women who cared for the sick and wounded and they suffered too. They suffered from severe infections, especially to their hands from the suppurating wounds that they tended. The women too caught the diseases of the trenches, typhus, dysentery, measles, mumps, and influenza. And influenza of course provides the key events for Tom Keneally's fine World War I novel, "The Daughters of Mars" which deals with two sisters and their fate. And it was the 1918 influenza pandemic, which killed more than 40 million people worldwide that helped bring this disastrous conflict to an end by weakening the armies of both sides. Neither admitted to the problem, of course, which is why it was called the Spanish flu. The Spanish weren't in the war, they put their hand up and said we've got the flu and so it's called the Spanish flu. Any good lawyer will tell you never admit to anything and that's one reason. The debate concerning the origins of that influenza virus. Some believe that a milder form, a less virulent form was circulating possibly first in British troops, as early as 1916. You might wonder why we don't know. Well we didn't isolate the influenza virus during the First World War. The first influenza virus wasn't actually isolated until 1931 from pigs in the United States, and then a little bit later from humans in London, there at the Medical Research in Mill Hill. Other's think that it didn't start in 1916, but it actually began in Kansas in February of 1918 and was brought across to Europe by the US troop ships. They were having deaths early on in Kansas, and the US training camps actually served as an incubator and then the rumbly short boat ride across to Europe also ramped it up. So the Americans really suffered very, very badly from the influenza. And one of the reasons for thinking that there may have been an earlier virus circulating is that the Americans were much worse affected than for instance our soldiers who'd been there for quite a long time. So there may have been pre-immunity that protected many from the most severe of the infections. Overall the figures show that looking at US soldiers, including those who never got anywhere near the front, almost twice as many people died of infections as of wounds in World War I and I think that's probably influenza. What about our soldiers? Between July 1980 and February 1990, Humphry McQueen the historian rates that 10% of the Australian soldiers in Britain were infected, and 209 died, perhaps protected by the long voyage out, the disease didn't actually get to Australia until 1919, mid 1919. That was in New Zealand much earlier, and they had a bad time of it and they had a lot of deaths. ^M00:50:03 And there are other sequelae of course. For the return of Australian soldiers more than 3000 suffered from tuberculosis and so many with lung irrevocably damaged by gas attacks died early from various respiratory infections. I knew some of these people. I was born in 1914. And I was taught by some of these damaged men. And I also was taught by single women who lost so much in this great and entirely avoidable catastrophe. When I think about 1914, 18 I still have enormous questions in my mind and I can't re-gather anything other than a sense of profound personal grief. ^M00:50:47 [ Applause ] ^M00:50:56 >> Thank you very much all of our speakers for really leaving us with so much to think about. I'm not even quite sure where to start with a question, but I do want to really just return to the start of our discussion about loss of potential as opposed to opportunities. Because I think you one of the things that the First World War did do for Australian society was it opened up opportunities, particularly for returned servicemen who'd had little education, they could through repatriation schemes, gain further training and in fact it did serve to, I suppose unsettle some of the set class barriers in Australia. But you know there's two things, loss, great loss of potential, but then I'm thinking, Sharon, when you talk about women, women doctors in many ways had some opportunities overseas. They were disadvantaged when they returned because of the preferential employment of returned servicemen, but also other jobs opened in, for instance public health, and I'm thinking of someone like Vera Scantlebury Brown who had to move into that area. And I think that you know loss and opportunity really run through all of these in a way because there are new opportunities of course to trial and perfect surgical procedures. That would never occur in peacetime. So I just wondered if you had any further thoughts. This is really a question to everyone on the panel, about how war disrupted that, and particularly, the First World War, which I certainly agree with Peter when you look back now, you know what were they fighting for becomes really a very pertinent question just this extraordinary war of attrition. Anyone want to respond? >> Yes. >> Yes. >> Yeah, any other thoughts? >> Well, yes I think I guess if we go back to this issue around opportunity and experience and especially very, very young people or in the cases that I was speaking about with women, they were given an incredible responsibility at such a very young age. I guess you could see it you know as an opportunity, but in extraordinary difficult circumstances. And when I was reading about the opportunities when they came back suddenly everything narrowed completely and women, you mentioned about going to public health. That was really one of the only options. And it was almost, it was just that sobering choice and yet they had obviously proved themselves so competent in being able to face upward to those challenges, I was quite stunned by that. It was wonderful that women were already being trained at that time, but still the opportunities were really so much more limited. >> I think one of the things that I found slightly depressing was the story you told of the women coming back finding the barriers to promotion through their medical profession, at least from a medical research perspective, that's still around 100 years later it is almost in every institution we now have more than 50% of our undergraduates and graduate students in biology and medicine are women, and yet when we get to the professorial level, despite the fact that we've had that quality of entry into the professional pool now for 40 years, it's still at somewhere between 10 and 15% so you know not a lot has changed. >> I'm intrigued by your statement about the STD yeah because you know reading up on this and I'm glad I didn't go into STDs because you did. But as I recall. >> Figuratively speaking [laughter]. >> Yes, that too, but as I recall the British at least had organised brothel and for separate of course of the enlisted men and the officers, as one must. But did they have such a severe section against those who contracted? >> Did the British? I don't know I just read this around the Australian. >> So we condemned people for having sex, they shot people. We didn't shoot people, but they, we didn't shoot our own people. >> Yeah. Yeah and the fact that opportunities you know access in brothel were widespread around in Egypt, particularly that was a really significant part of it, France and the UK. But the response in how it was managed was really terrible. >> The other thing I wanted to ask Peter as an older gentleman, was what the vulcanised condoms look like [laughter]? You're also from Queensland so as a young man in the 1940s or maybe 1950s. >> I can remember that vulcanization was sort of a patch that you used to put on tyres. And you'd screw it up with a thing and then there was a kind of surrounding thing that you would light and it would heat. So I don't quite envision a vulcanised condom. But I suspect there must have been used by Scottish regimen [laughter]. >> I don't think people used them post war basically. There were around. >> They were used in the, historically people used things like sheep intestine which seems less atrocious than the vulcanised. ^M00:56:50 [ Laughter ] ^M00:56:56 >> Yeah, look I suppose just following up there on that point, you know in some ways, 1915 seems a very long time ago. And I think it's very hard to imagine the scale, the actual scale of the fighting and the war from our perspective now. But there are of course many things in our society that remain in some ways the same. Mentioning about barriers to women in medicine. Obviously though, I just want to think about medical training and how I mean that has changed dramatically. All of you who've had to deal with students both undergraduate and postgraduate in medicine, I mean you know sometimes think, how would your students cope in this situation. And I think about very young people, just wondering about any thoughts there because certainly we hope, I know but we hope that medical training has changed, but would our graduates be prepared for scale? >> Well I was for a time, well I was actually at an associate institute, but I was a professor at the University of Pennsylvania. And I think we got about 5 people shot a day in Philadelphia. And so they got plenty of trauma experience actually if they cared to do so. And also I wanted to ask Warren now, with I mean horrific damage that we see in some of Britain, I think Barker wrote about it in a novel that's been written, the horrific damage that happened to people, but now with modern medicine, and helicopter evacuations, I understand that some of the injuries that people survive are infinitely worse than they ever survived before and how do they cope with that? Do you see anything? >> Clearly in Melbourne, fortunately we're not really seeing a lot of that, but back in South Africa, yes. A lot of, even in private practice, hijacking, basically just because guy steps up to the car window, shoots through the window and neck injuries that no one would have survived, people are surviving. And so because you get such quick response and you just get great intubation techniques you know things have really come a long way but it does mean that much more significant injuries are survived, and then you've got to try and deal with the aftermath. >> Yeah and certainly there are case in many American veterans often we see. >> I was going to get back your question, Kate, I must admit there's a whole lot of, at the moment most medical courses, or undergraduate courses range between five and six years, post graduate course is about four years. And the traditional model was to do three years at university and three years in the hospital. But actually most of your, there's a lot of fundamental, scientific principles that underpin medicine. But really a lot of it is apprenticeship and learning on the job. ^M01:00:03 And it still remains the case now and I think particularly with surgery. So I think in the settings that these men were exposed to or women was just the volume of work and the incredible experience. I gather there was minimal supervision, that's the difference. But and that means that you don't get trained in the same way that you would with under supervision. But a lot of your expertise in medicine is around you know, calamitous, rigour, you know how much time you've actually spent doing, not just studying. So I would have thought people would have become very competent very quickly. But then there's all the other stuff that we really, it is so important around the support and psychological support required and strength in dealing in those situations, which I gather they would have had none of that. So. >> I think just looking at the numbers they would be learning by discovery and that was pertinent for the time because if people don't know stuff, simple stuff you can learn by discovery. We are not anymore, we shouldn't be allowing postgraduates to learn by discovery, they should be you know learn from somebody who knows. We know that. Having said that, just what I was saying about sporadic things. If something just happens every now and then, it's quite difficult to build on your experience, whereas if you've done a lot of something, it's second nature to you. >> Yeah. >> Well look just to finish up this evening, I'm going to take a couple of questions from the floor because I think there's so much to ask. And I, we have one, did you have your hand up? >> Yes. >> Yes? We've got, just wait for the microphone if we can, okay we'll start here and then we'll come over. >> That was a very interesting presentation. What interested me is what legacy did the medical practice during World War I leave on medical practice in the civilian sphere and also on medical research, because usually large conflicts like this do have an enormous impact, particularly on medical research. Any comments on that? >> Well, I'm happy to talk just briefly on the medical research. You know certainly both Kellaway and Patterson's experience in London before the war and then during the war where they both conducted research during war I think led to you know one of the enduring themes at the Walter and Eliza Hall Institute and probably influenced their recruitment, and that was including infectious disease. So for much of the first 30 or 40 years of the institute's existence, other than working on snake bites, infectious disease was the big thing. And that you know I think in many ways you can then see that transforming into the golden years of immunology as Burnet shifted the focus of the institute from trying to understand infectious diseases one at a time, to trying to understand how the body would respond generically to infectious disease. And you know so form an instructional view point and a science and Melbourne viewpoint, you know I think you can trace a lot of the themes of medical research locally down to the experiences of those two men in the First World War. >> You know I think with infectious disease, really, research really got underway in the 19th century. And the latter half of the 19th century is absolutely an extraordinary period. And you have these institutes that are focussed on infectious disease, but almost nothing else in medicine that's really high quality research institute. And then it's really people like Osborne and so forth that you start to see true academic medicine emerging in the early part of the 20th century. So and then you know by 1967 I think Douglas says that Mac Burnet was saying the era of infectious disease was over. Well that was before Sharon started working on HIV, we didn't know about HIV so you know it's always with us but. >> Mac Burnet was wrong about quite a few things in his later years. >> He was right about quite a few things. >> He was right about quite a few things. >> Pretty extraordinary guy actually, but. >> Okay another question here. >> I'm old enough to know you know people from the First World War and the impact it had on them and I was I'm just a bit worried that we're losing touch with that experience and we might be losing the lesson learnt. In the Second World War, people were afraid to be in the Second World War because they remembered what happened in the First World War. People learnt those lessons. Are we losing those lessons we learnt in medicine and in other areas, we're not being afraid of what's happening in Syria and so on because we started losing. >> No, no I grew up with both those generations really. I mean my father's generation was the Second World War generation and then the generation before that was still around. I they would come to our school and talk on Anzac Day. We would talk with them. I don't remember any of them, firstly ever really wanting to talk about war. And I certainly don't remember anyone every glorifying war in any sense whatsoever. So I'm quite disturbed by some of this military step further we seem to be developing. >> Anyone else have a comment or are there any questions? No. I mean just to add to that I'm actually a historian of the Second World War and the home front in particular one of the areas I've written extensively on. And I think that the shadow of the First World War is so strong with the second. But you know we have to remember it's a generation later. It's 20 years later. It's literally fathers and sons and families as well so you know your question is really about how we remember as times go past. And certainly now there are small numbers of veterans remaining from the Second World War. You know time is moving so quickly that I think it is important that we do remember and we remember the scale and the horror of all wars really. Any other questions from, yes we've got one up here to finish off. >> Well that brings, what you just said, the home front. You know if all the medical schools in Australia were shooting these kids out so they could go over to Europe, what was the medicine like in Australia? Was everybody dropping dead because there were no doctors around, or [laughter]? >> Does anyone want to comment? >> I don't know. >> Well but I can comment just briefly. Of course you know the First World War, and Second World War and current wars, you know youth is a great, it's the young people who are wanted to go over there because you know they've got the stamina. You know they must have had to have had extraordinary stamina I think to work in the medical areas in the First World War. So there is, there are elderly doctors and nurses. You know not everyone goes. So there still is healthcare in Australia, although actually it must have been, I don't know entirely, but it must have been somewhat diminished. Because a lot of women went, a lot of the nurses went as well. I mean that's a very good question. Of course war does come home in a medical sense with the flu pandemic, you know at the end of the war, that spreads into the civilian population and that's where the states all try and put up quarantine and between each other and all sorts of things to try to stop the spread. Well, look I think we probably have to come to a close for this panel. I'd like to thank everyone tonight for their comments and for the discussion and also to thank those who brought this series together including Lucy Chancellor Will and the Engagement Team. And those in the audience who are interested in medical questions that arise out of the First World War, might also like to note that there's a later panel discussion on the 17 of June at the Mobile Museum that's looking at advances in the understanding of psychology created by the war. And of course that's the other part of if you like, medical research is how work on psychology really moves after the First World War. And you can certainly book that online. So wish you all well this evening for the rest of this evening and hope to see you at future university events. Thank you very much to the audience and thanks to our panellists. ^M01:09:59 [ Applause ] ^M01:10:03 [ Music ]