Contribution of the Serbian military medical service to global medicine in 1914/15

Abstract

Serbia was unprepared for a new war, which came on suddenly, but which Serbia was forced to launch in 1914. The Government had been plagued by corruption scandals. When it comes to spotted typhus, what the Serbian Military Medical Service had at its disposal in 1914 was the practice of "separating the healthy from the sick". In addition, "total war" postponed the rational spending of money for the army's medical needs. All this caused, as is well known, poor accommodation of the wounded and the sick, lack of medication, hygienic products etc. The lack of accommodation was handled by transporting wounded soldiers to the country's interior. Lice were considered pests, so in the midst of the war tribulations they were "bearable problems" as there were far worse hardships to endure. Numerous factors led to the spread of the outbreak, among which the leading factor was that, unbeknownst to medical science, lice were of epidemiological importance for the spread of spotted typhus and relapsing fever. The failures of palliative measures increased the number of the sick and forced the government to seek medical assistance from the Allies. Once the teachings of C. Nicolle were accepted, that focused the efforts of the medical teams on delousing, not only in the affected patients prior to their hospitalization as the medical practice of the time demanded as a routine matter of hygienic pest control. The uncertainty of the arrival of foreign medical missions and the inability to put the newly recognized epidemiological significance of lice infestation to proper use by delousing in factory-made autoclaves launched a wave of engineering ingenuity in Serbia. A coordination body of the Parliament and Government was formed on 13 February 1915 named the National Disease Containment Board, to manage the outbreaks. In those days, once foreign missions had been invited, in only two weeks the Serbian Military Medical Service made a scientific contribution worthy of global medical attention. The emergency caused by the growing epidemic led the doctors to improvise. Already in early March, the "central disinfection station" was commissioned, repurposed from an old brick factory and furbished with an oven with dry hot air, to which a bathroom had been added. It had a daily capacity of 1200 users, whose clothes were deloused in the chamber while they were bathing, so that they could put them back on again. Without the use of the bathroom, it could process 4-5000 items of clothing and bedding. It was the most valuable method world-wide to contain and prevent the spotted typhus in the upcoming 28 years, until the emergence of DDT.