The agent of Cholera, Vibro cholerae had been discovered in 1883, (1) it was known that if Cholera took hold among Empire Soldiers in any future conflict in would decimate any army in the field. Victory in a future war depended more on an ability to defeat cholera than it did on numerical, firepower or tactical superiority by British Empire Forces in the Field. In 1915, Dr. Armand Ruffer, C.M.G., President of the Sanitary, Maritime and Quarantine Council of Egypt, Alexandria, sent the the following note to the various British Medical services.
Dr. Ruffer’s Views on Cholera
(Report begins) “The first point is that although, in many epidemics, cholera has been a water-borne disease, yet a severe epidemic may occur without any general infection of the water supply. This was clearly the case in the last epidemic in Alexandria. Attention to the water supply, therefore, may not altogether prevent an epidemic. The second point is that the vibrio of cholera may be present in a virulent condition in people showing no, or very slight symptoms of cholera, e.g. people with slight diarrhœa, etc.
The segregation of actual cases of cholera, therefore, is not likely to be followed by any degree of success, because this measure would not touch carriers or mild cases, unless orders were given to consider as contacts all foreign foes, and all soldiers who have been in contact with them. This is clearly impossible.
There cannot be any reasonable doubt, therefore, that if the Turkish army becomes infected with cholera, the British Army will undoubtedly become infected also.
Undoubtedly inoculation is the cheapest and quickest way of protection of the troops, provided this process confers immunity against cholera.
It is very difficult to estimate accurately the protection given by inoculation against cholera. My impression from reading the literature on the subject is that: (1) The inoculations must be done at least twice. (2) The inoculations, if properly made, are harmless as a rule. (3) The inoculations confer a certain protection against cholera. I may add that I arrived at this opinion before the war, when the French editors, Messrs. Masson & Co., asked me to write the article “Cholera” for the French standard textbook on pathology. My opinion was therefore quite unprejudiced by the present circumstances.
The cholera inoculations were harmless as a rule; that is, they were not always harmless. Savas has described certain cases of fulminating cholera amongst people inoculated during the progress of an epidemic. In my opinion, the people so affected were in the period of incubation when they were inoculated, and the operation gave an extra stimulus, so to speak, to the dormant vibrio. One knows that, experimentally, a small dose of toxin, given immediately after or before the inoculation of the microorganism producing the toxin, renders this microorganism more virulent.
The conclusion to be drawn is that inoculations should be carried out before cholera breaks out.
I am afraid I know of no certain facts to guide me in estimating the length of the period of immunity produced by inoculations. Judging by analogy, I should say that it is certainly not less than six months, that it, almost certainly, lasts for one year, and very probably lasts far longer.
I understand that 90,000 doses of cholera vaccine have been sent from London. I take it that the inoculation material has been standardised and its effects investigated, but, in any case, I consider that a few very carefully performed experiments should be undertaken at once in Egypt, in order to make sure of the exact method of administration to be adopted under present conditions.
Probably, a good deal may be done by the timely exhibition of drugs, such as phenacetin, etc., to mitigate the more or less unpleasant effects of preventive inoculation.
As I am on this subject, may I point out the necessity of establishing at the front a laboratory for the early diagnosis of cholera and of dysentery. Cholera has appeared in the last three wars in which Turkey has been engaged, and therefore the chances of the peninsula of Gallipoli becoming infected are great. The early diagnosis of cases of cholera, especially when slight, is extremely difficult and often can be settled by bacteriological examination only.
There never has been a war without dysentery, and almost surely our troops will be infected in time, if they are not already infected. But whereas in previous wars the treatment of dysentery was not specific, the physician is now in possession of rapid methods of treatment, provided he can tell what kind of dysentery (bacillary or amœbic or mixed) he is dealing with.
This differential diagnosis is a hopeless task unless controlled at every step by microscopical and bacteriological examination.The French are keenly aware of this fact, so much so that they have sent, for that very purpose, three skilled bacteriologists, two of whom are former assistants at the Pasteur Institute, to the Gallipoli Peninsula” (Report ends).(2) Most soldiers were then inoculated.
There was an international agreement on the control of infectious diseases which remained in force through out the Great War and an Isolation Hospital was established at Alexandra. Mecca was as now the major pilgrimage destination for Muslims and Cholera was thought to be rife both there and in Syria.(3)
Disater though threaten when there was an out brake in Sinai, Mentioned in Fifty Second (Lowland Division) 1914-1919,(4) An RAMC Captain, RS Taylor, was out looking for the wounded on the 7th August 1916 after the Battle of Romani (4-5 August 1916). He did not find any wounded but he came across a very sick Trooper from the Auckland Mounted Rifles.(5). Taylor had the Trooper isolated and informed 52nd Divisional Head Quarters. All the cases of diarrhea were also isolated just in case they had cholera. Cholera is a fear inducing disease and volunteers were called for. Four orderlies, most probably from 1/1st Lowland Field Ambulance, Captain Taylor’s unit, and a cook stepped up to the mark. Two officers were sent from the ANZAC Military Bacteriological Laboratory at Alexandria Colonel Martin, and Major Ferguson. They decided to establish local “diarrhoea camps” each with a temporary field laborator. All measures were taken to stop the spread of Cholera to the Suez Canal.(6) Thankfully they were successful. Over the next two weeks 28 cases were diagnosed, 16 were from the 10th ANZAC Mounted Division, 10 of whom from the 10th Light Horse. in all 7 soldiers died.occurred, with 7 deaths,The source of the infection was from a few wells in Katia a former Turkish encampment, and at Hod el Hassania. were the Turks had left some contaminated water barrels. The rapid response to the outbreak and the success of the measures undertaken were a remarkable achievement and saved Egypt from a repeat of the last cholera epidemic in the mid 1890s when thousands died.(5) The outbreak of cholorea was contained and over by the 23rd August 1916. There were two other outbreaks during the campaign, one at Aqaba in 1917, no imperial troops were in the area, and the other outside Tiberius almost entirely in the civilian population, one trooper caught the disease and died.
The victory of cholera has often been understated, but with out it there would have been no victory in Palestine, the death toll from the cholera could have been greater in the middle east than the number of deaths from Spanish Flu. as a gauge of the success of the anti cholera precautions taken by Allenbys Medical Services, during the time the Desert Mounted Corps were operating in the Esdraelon Valley there were of 11,000 cases of sickness admitted to ambulances. Only one of these cases was cholera.(7)
Notes 1) Page 82 Surgeon, Scientist, Soldier: The Life and Times of Henry Wade 2) Page 49 Official History of the Australian medical Services 3)Official History of the Australian medical Services 4)P295 5) http://www.gutenberg.org/files/41911/41911-h/41911-h.htm#Page_106 The Project Gutenberg EBook of The Australian Army Medical Corps in Egypt, by James W. Barrett and Percival E. Deane 6)Official History of the Australian Army Medical Services, 1914–1918,Volume III – Special Problems and Services (1st edition, 1943)Author: Butler, Arthur Graham http://static.awm.gov.au/images/collection/pdf/RCDIG1069708–1-.PDF, p261 7)History of the Great War Medical services, Vol 3, p482 Naval and Military Press reprint