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Keywords:

  • advocacy;
  • anti-personnel landmine;
  • civil war;
  • disaster;
  • doctor-soldier;
  • paediatrician

Abstract

  1. Top of page
  2. Abstract
  3. Key Points
  4. Soldier-paediatricians
  5. Paediatricians, Military Service and the 21st Century
  6. References

Sick and injured children, like combatants wounded by shot and shell in war, are disproportionately represented in the tallies of both man-made and national disasters. Paediatricians have a particularly proud heritage of military service, a nexus dating in Australia from the early 19th century. This paper traces this link between service to children in peacetime and the care of servicemen, women and children in times of war and disaster. The extraordinary record of Australian ‘paediatric’ doctors who also served in the Gallipoli Campaign (1915) is documented as an illustration of this duality. Paediatricians who serve in the Defence Reserves and in civilian non-government organisations which respond to disasters and civil wars have special credentials in their advocacy for the protection of children enmeshed in conflict or disaster. Such applies particularly to the banning of the recruitment and use of child soldiers; support for children caught up in refugee and illegal immigrant confrontations; and continued advocacy for greater international compliance with the Ottawa Convention to ban the use of anti-personnel landmines. Volunteering for such service must occur in cold ‘down time’, ensuring that paediatricians are trained in disaster and conflict response, when such challenges inevitably confront the paediatricians of the future.

There exists a proud synergy between the specialty disciplines of paediatrics and those of military service.1 In Australia, more than a hundred paediatricians have served their nation in uniform – in peace, war and disaster deployments. More than half of these have been decorated for their exemplary military service.

As non-combatants, doctor-soldiers specialise in preventive medicine and public health, tropical medicine, disaster response, trauma management, emergency medicine and war surgery.2,3 Since the end of the Vietnam Campaign (1964–1972), their metier has included training in the prevention and treatment of post-traumatic stress disorders.4 All of these diseases and injuries afflict children caught up in combat and disaster zones.5 (Figs 1–4). Doctor-soldiers serving in disaster zones render care, assistance and treatment to such children both because of basic humanity; and also in the formal mission statement of military deployment, this latter determined by political and military dictate.6 Doctor-soldiers who encounter sick and injured children also care for and treat them as an international legal impost in terms of the Fourth Geneva Convention.7

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Figure 1. An 11-year-old girl, a landmine victim, in the convalescent phase of bilateral lower-leg amputations, 6 days after operation. The United Nations Hospital, Kigali, Rwanda, January 1995.

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image

Figure 2. The author with orphan toddlers and pre-school children, in the Mother Theresa Orphanage in Kigali, 7 months after the Rwandan genocide of 1994. Photograph, December 1994.

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Figure 3. The aftermath of conflict. Surviving orphan children, at roadside, near Kibilara, Rwanda. February 1995.

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Figure 4. A 7-year-old landmine victim, in triage, United Nations Hospital, UNAMIR II, February, 1995.

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Many milestones in the chronology of Australian paediatrics highlight the service of doctor-soldiers. The first medical publication in Australia, that exhorting the vaccination of children at Sydney Cove, published in the Sydney Gazette of 1804, was written by the second Surgeon-General in Australia, the Royal Navy surgeon Thomas Jamison (1745–1811).8

Key Points

  1. Top of page
  2. Abstract
  3. Key Points
  4. Soldier-paediatricians
  5. Paediatricians, Military Service and the 21st Century
  6. References
  • 1
    Examples of past service of paediatricians in conflict and disaster zones.
  • 2
    Emphasis of the nexus between those who practise in paediatric and child health disciplines and service in the Defence Reserves and non-government organisations.
  • 3
    Identification of areas of advocacy, specifically including support for the International Ottawa Convention and the ban on child soldiers.

Soldier-paediatricians

  1. Top of page
  2. Abstract
  3. Key Points
  4. Soldier-paediatricians
  5. Paediatricians, Military Service and the 21st Century
  6. References

The Melbourne paediatrician, Dr George Graham (1828–1893), a former soldier, wrote extensively about paediatric subjects from 1861. He published details of his surgical experiences with tracheostomy to save the lives of children with diphtheria.9 He wrote about children poisoned by snakebite.10 He promoted vaccination and described the measles epidemic which spread through Victoria in 1867. His colleague, Dr Ferdinand von Mueller, said of Graham that he was a ‘distinguished and benign promoter of science in our Colony’.11

Before his immigration to Hamilton in Victoria, Dr William Jenkins (1831–1875) had been a career doctor-soldier in the 14th and 18th Regiments with service in Crimea, India, China and Jamaica.12 His pioneering paper on antiseptic surgery,13 the first in Australia, described his experiences with the new Listerian principles in surgical operations that he performed on two boys with compound fractures. His first case was that of a boy aged 11 years with a compound fracture which healed without any complications. The second case was that of a 16-year-old adolescent boy whose forearm was amputated after a gunshot wound. Jenkins reported some of his clinical experiences in another paper in the Australian Medical Journal in 1872.14

Paediatricians at Gallipoli

In his encyclopaedic work, Gallipoli Doctors, the obstetrician and neonatal paediatrician Colonel Robert Likeman has compiled biographic profiles of the 270 Australian doctors who served on the Gallipoli Peninsula from 25 April to 26 December 1915.15 A review of these biographies has established that 34 of these 270 had a prior or subsequent career in one of the specialties of paediatric medicine or surgery (Table 1). This figure of 12%, or one in eight of all the doctors who served at Gallipoli, was a much higher ratio than that of the paediatrician : doctor ratio in the general medical workforce. (This normal ratio is approximately 1 in 30 or 3 percent. It varies according to regional affluence and distance from major metropolitan centres. It has also decreased progressively over the twentieth century. At the time of the First World War, the ratio of doctors with special training or qualifications in paediatrics was less than 1 percent. The ratio of paediatrically-oriented doctor-soldiers was thus one order of magnitude greater than that of the general medical population.)

Table 1.  A list of 34 Australian military doctors who served at Gallipoli in the ANZAC campaign from 25 April 1915 to 26 December 1915; and who served in paediatric specialties in their civilian lives
DoctorUnit at GallipoliPaediatric service
  1. Compiled from Gallipoli Doctors (Lt Col Robert Likeman CSM),16The Medical Directory for Australia (various issues) and other sources, with acknowledgements.

Major (later Sir) Denis John Wolko BROWNE KCVO FRCS FRACS13 Light Horse RegimentHospital for Sick Children, Great Ormond Street, London. Medical Superintendent at Great Ormond Street. Became President (1967) of the International College of Surgeons.
Major Elliott Arthur BRUMMITT MB ChB (1880–1934)RMO 1 Division Reserve ParkAdelaide Children's Hospital
Colonel Arthur Graham BUTLER DSO VD MB ChM (1872–1949)RMO of 9 Battalion. [Colonel Butler's award of the Distinguished Service Order [DSO] was one of only two awarded to military surgeons in the ANZAC campaign].Hospital for Sick Children, Brisbane. [Col Butler later wrote the three-volume Official Medical History of Australia in WWI].
Lt Colonel Horatio Victor Patrick CONRICK DSO VD MBBS (1882–1960)RMO HMS Nizam.Specialist Paediatrician in Sydney. Hon. Physician, Randwick Hospital for Infants.
3 Field Ambulance [Twice Mentioned in Despatches].
Colonel David Gifford CROLL CBE VD (1885–1948)2 Light Horse Field Ambulance (Second in Command; from May–Sept 1915 Commanding Officer)Hospital for Sick Children, Brisbane.
5 Light Horse Field Ambulance [Later, Military CBE and Mentioned in Despatches].
Colonel Ernest CULPIN ED MB ChM FRACS (1881–1963)7 Field AmbulanceHonorary Surgeon at the Lady Bowen Hospital, Brisbane (1913). Honorary Consultant Surgeon (ENT Department) Hospital for Sick Children, Brisbane, from 1920.
Captain John DEAKIN MB MCh (1885–1966)2 Australian Stationary Hospital (‘one of the few originals at ANZAC who remained with his unit for the entire campaign’ (Likeman p49)Perth Children's Hospital (Hon. Assist. Surgeon).
Colonel Graham Patrick DIXON CBE VD MB MCh FRACS (1873–1947)3 Field AmbulancePerth Children's Hospital
Wounded in Action
Mentioned in Despatches for Gallantry at Anzac Cove.
Major General Rupert DOWNES CMG KStJ VD MD ChM FRACS (1885–1945)3 Light Horse Field Ambulance – Commanding OfficerA career military doctor. Paediatrician, paediatric surgeon, Honorary Consulting Surgeon at the Melbourne Children's Hospital.
Lt Colonel David Moore EMBELTON OBE MBBS MD (1887–1962)MO at the Light Horse Camp at Mudros.Paediatrician at the Melbourne Children's Hospital 1912–1914. Honorary Physician at MCH 1924–1946.
3 Light Horse Field Ambulance.
3 Field Ambulance
Colonel Robert FOWLER OBE VD MD FRCS FACS FRACS (1888–1965)1 Light Horse Field AmbulanceObstetrical, gynaecological and paediatric surgeon. Wrote The Health of the Foetus or True National Insurance. Listerian Orator in Adelaide 1939.
Commanding Officer 4 LHFA
Major John Lockhart GIBSON MD MRCS FRACS (1860–1944)3 Australian General HospitalHospital for Sick Children, Brisbane.
Major John HARDIE MC FRACS (1889–1955)3 Australian General HospitalHospital for Sick Children, Brisbane.
Major Wilfred Kent HUGHES MRCS FRACS (1865–1941)3 Australian General HospitalMelbourne Children's Hospital.
Colonel Alan Frankland JOLLEY MBBS (1888–1969)RMO of 1 Division TrainMelbourne Children's Hospital.
1 Australian Casualty Clearing Station
2 Light Horse Field Ambulance
2 Australian Stationary Hospital [Later, Mentioned in Despatches; and awarded Belgian Croix de Guerre].
Major Gordon Bradley LOWE MB ChM FRCS Ed FRACS (1890–1956)3 Australian General Hospital [Later wounded in action at Bullecourt in April 1917; later DADMS 2 Div.].Randwick Hospital for Infants, Sydney. A pioneer paediatric surgeon.
Colonel George William MACARTNEY DSO ED MB ChM FRACS (1887–1958)RMO of 2 Light Horse Regiment.Mixed specialist adult and paediatric surgical practice, Brisbane.
Colonel Alexander Hammett MARKS CBE DSO VD MD FRACS (1880–1954)RMO of 3 Artillery Brigade.Hospital for Sick Children, Brisbane.
Colonel Roy Stanley McGREGOR DSO VD MB (1890–1963)RMO of 16 BattalionPerth Children's Hospital
Four times Mentioned in Despatches.Medical Superintendent 1919–1924.
Brigadier Douglas Murray McWHAE CBE CMG VD MD (1884–1969)3 Field AmbulancePerth Children's Hospital.
Wounded in Action
Mentioned in despatches for gallantry at Anzac Cove.
Colonel Frederick Le MESSURIER MBBS MD (1891–1966)1 Australian Stationary Hospital.Adelaide Children's Hospital.
Lt Colonel (later Sir) Henry Simpson NEWLAND Kt CBE DSO FRCS FRACP (1873–1969)1 Australian Casualty Clearing Station Commanding Officer 1915–1917)Adelaide Children's Hospital
President RACS
Major John Aloysius O'BRIEN FRACS (1887–1975)1 Australian Casualty Clearing Station.Melbourne Children's Hospital.
Captain Harold PLANT MB MCh (1888–1916)1 Australian General HospitalHospital for Sick Children, Brisbane.
1 Australian Stationary Hospital
Colonel John Arthur SHERWIN KStJ VD MD FRACS FRCOG (1881–1961)3 Australian General Hospital.Hospital for Sick Children, Great Ormond Street, London and Queen Charlotte's Hospital
Lt Colonel (later Sir) Richard STAWELL KBE MD (1864–1935)3 Australian General Hospital.Melbourne Children's Hospital.
Colonel Alfred SUTTON CB CMG VD MRCS (1863–1922)3 Field Ambulance (Commanding Officer)Hospital for Sick Children, Brisbane.
Acting DDMS Anzac Corps [Later, thrice Mentioned in Despatches. Awarded CBE and CB in 1918].
Lt Colonel William TRETHOWAN MB ChM FRACS (1860–1929)3 Australian General Hospital.Perth Children's Hospital.
Lt Colonel (later Sir) William George Dismore UPJOHN Kt OBE MD MS FRCS FRACS (1888–1979)3 Australian General Hospital. (Military OBE and twice Mentioned in Despatches)Melbourne Children's Hospital.
Lt Colonel Joseph Stanley VERCO MBBS (1889–1971)1 Australian Casualty Clearing StationAdelaide Children's Hospital.
HMHS Aquitania
Lt Colonel John Basil St. Vincent WELCH DSO MB ChM (1881–1919)1 Field AmbulanceMedical Superintendent of the Hospital for Sick Children, Camperdown, Sydney.
2 Field Ambulance (Commanding Officer)
Major Charles Herbert WESLEY MB ChM (1890–1968)3 Light Horse Field AmbulanceHonorary Consultant Surgeon at Hospital for Sick Children, Sydney.
10 Light Horse Field Ambulance
Colonel Edward Rowden WHITE VD MD FRACS FRCOG (1883–1958)3 Light Horse Field AmbulanceHon. Obstetrician, Foundling Hospital, Melbourne
4 Brigade Sanitary Officer
Mentioned in DespatchesMelbourne Children's Hospital Medical Superintendent
Major George Charles WILLCOCKS OBE MC FRCP FRACP (1888–1972)2 Field AmbulanceSydney Hospital.
Authority on Pink Disease in children.

Many of this group of Gallipoli ‘paediatric’ soldiers were decorated. Many went on to become leaders in paediatrics. Five became Superintendents of Children's Hospitals or those of tertiary hospitals caring for child inpatients (Browne, James, McGregor, Ross and White)17 (Table 1). Others, such as John Lockhart Gibson and George Charles Willcocks, became authorities on and contributed to scientific medicine in fields ranging from lead poisoning to pink disease. Four were knighted.

Paediatrics and military medicine

Besides the ‘Gallipoli’ medical officers, many other paediatricians played an active role as doctor-soldiers in the First World War. These included the two Welch brothers, originally from Sydney. Dr Leslie St Vincent Welch (1879–1947) served in Egypt on the Western Front with the 2nd Division Ammunition Column. He later became a champion of children's health and Medical Officer for the Department of Public Instruction in Queensland. Like his brother, Dr Kenyon St Vincent Welch, Leslie was one of the first clinical ‘flying doctors’ in Australia, an epitaph recorded on his headstone in the Brookfield Cemetery, Brisbane. Another brother, John Basil St Vincent Welch (1881–1919), who also served at Gallipoli, was Medical Superintendent of the Hospital for Sick Children at Camperdown, Sydney. In Brisbane, the most famous of all the Medical Superintendents of the Hospital for Sick Children, Dr Alfred Jefferis Turner (1861–1947), also served in France in the First World War, in the Royal Army Medical Corps.18 Turner was a skilled paediatric surgeon as well as one of Australia's pioneer paediatricians. He discovered the link between lead paint on domestic surfaces and the endemic plumbism which afflicted Australian children in the era from 1890 to 1920.19 He was also one of Australia's greatest lepidopterists.

Many soldier-paediatricians achieved in other areas as well. Lieutenant Colonel Joseph Verco (1889–1971), a Gallipoli veteran who had served also at the Adelaide Children's Hospital, is best known for his contributions to malacology. Dr William Blackall (1876–1941) is better known as a botanist than as a doctor-soldier, surgeon, paediatrician and obstetrician.20 An Oxford graduate, Blackall completed his postgraduate training in surgery before emigrating to Australia in 1904. In the First World War, he served as a doctor-soldier in France and a Medical Officer on the troop ship HMS Nestor (1819–1919). He became an esteemed authority on Western Australian wildflowers, and his major text, How to Know Western Australian Wildflowers, was described as ‘one of the most important botanical manuscripts ever published in Australia’.20 The two Australian genera of native plants, Blackallia and Nigromnia, perpetuate his life and works. Similarly, Dr Crichton Raoul Merrillees (1884–1959) is best known for the beautiful eponymic Camellia japonica‘Merrillees’.21 A medical graduate from Edinburgh University, Merrillees served with distinction in the First World War with the rank of Lieutenant Colonel. In 1935, he was appointed to the position of Director of Hygiene at Army Headquarters in Melbourne. His clinical interests centred on paediatrics and preventive medicine. He was one of the leaders in the Australian campaigns to promote immunisation against diphtheria – a major scourge of Australian children in the inter-War years. It was noted in his Obituary that Dr Merrillees was a leader in the immunisation campaigns ‘and by his example and his enthusiasm and his inspiration of his colleagues, both Departmental and Municipal, materially accelerated the dramatic reduction in the incidence of diphtheria which had occurred between 1932 and 1947’.22 His background as a doctor-soldier was influential in his work in the School Health System in Victoria. As a direct result of his advocacy, the rate of diphtheria dropped from 400 per 1000 thousand in 1932 to only 19 in 1947.21 Dr Merrillees also led the investigation and the ultimate eradication of the spread of Melbourne's last great typhoid epidemic at Moorabbin in 1943.

The first lifesaving ‘top-up’ transfusion for a baby dying from Rhesus disease was undertaken in Australia in Mareeba by Captain Fred Silverman of the US Army Medical Corps in August 1942.23 That pioneering intervention was successful. It was followed on 18 December 1945 by the first Australian exsanguination transfusion for Rhesus disease – also successfully completed and the second in the world. It was performed by Dr George Kelsall of Perth who, still in uniform, had served throughout the Second World War in the Australian Army Medical Corps.16

In the Second World War, a quite extraordinary number of paediatricians in Australia served in uniform in all three services. Dr David Jackson (1912–2006), as Surgeon Lieutenant Commander Jackson RAN, was decorated with the Distinguished Service Cross for gallantry in the Battle of the Dover Straits (February 1942). He chaired the original meeting, at Lennon's Hotel in Brisbane in 1949, which was to establish the Australian Paediatric Association, later incorporated as the Division of Paediatrics and Child Health within the Royal Australasian College of Surgeons. Brigadier Sir Kenneth Fraser (1897–1969) and Colonel Peter Grant (1921–2009) were other examples of dedicated paediatricians and paediatric surgeons who were national leaders not only in their specialty disciplines but also in military medicine and who both served in the Second World War. Others served in the Vietnam Campaign. Two of these, the author together with Colonel Harold Forbes (1917–2001), a pioneer advocate for child protection in Australia, went on to become the National Honorary Colonel for the Royal Australian Army Medical Corps. Other clinicians serving in paediatric specialties such as anaesthetics (Colonel John Overton) and dermatology (Colonel Terry Casey) went on to occupy national leadership roles in both military medicine and disciplines related to paediatrics.

In the late 20th century, many Western nations deployed specialised military medical teams to war and disaster zones in the aftermath of both natural and man-made disasters. The British 23 Parachute Field Ambulance and the Canadian and Australian (UNAMIR II) responses to the Rwandan genocide were examples of a (belated) armed United Nations' Peacemaking response to civil combat (Figs 1–4). The Australian and New Zealand response to the Sepik tsunami of 17 July 1998 in Papua New Guinea was an example of a response to a natural disaster which killed thousands of children and left several thousands of surviving children as orphans.

Paediatricians, Military Service and the 21st Century

  1. Top of page
  2. Abstract
  3. Key Points
  4. Soldier-paediatricians
  5. Paediatricians, Military Service and the 21st Century
  6. References

The chronology of paediatricians with military service has established an extraordinary tradition of response to the plight of children in many nations, a tradition now extending over two centuries. Against this perspective, there has never been a greater need for paediatricians to be trained in the skills of organised institutional response to both national and international catastrophe, whether this be war or natural disaster. Children are disproportionately represented in the tally of victims of both civil wars and natural disasters. In international conflicts, unfortunately, their needs initially take ‘second place’. During the Gallipoli Campaign of 1915, many children's hospitals went understaffed. In the Iran–Iraq War of 1982, paediatricians of both nations were drafted into the warring armies, and expatriate paediatricians (including the author) had to be brought in on short-term contracts to care for civilian children.

Paediatricians ‘in uniform’ serve in many organisations. Such include the Defence Reserves, Red Cross, Save the Children, Oxfam, Médicins sans Frontièrs, AusAID projects and any one of more than a hundred non-government organisations (NGOs) who respond to the plight of sick, injured, refugee or displaced children. My own research of medical graduates at the University of Queensland has indicated that one in eight such graduates volunteer for such service within 10 years of graduation. Such field service cannot be accepted without prior training. Training for volunteers to serve in the Defence Reserves or recognised charitable bodies has to be undertaken when times are ‘cold’. Volunteering for such training, to work as part of response teams, needs be taken in times of peace or ‘down time’ when disasters have not occurred.

In the past, paediatricians in uniform have achieved much by their advocacy for children's safety and welfare.24 In the 21st century, such advocacy has never been more needed. Besides the plight of refugee children and the children of illegal immigrants and asylum seekers, the scourge of child soldiers continues. Much has been achieved in the banning of anti-personnel landmines which continue to pose post-conflict death and disaster to children in more than 70 countries. Australia ratified the Ottawa Convention (the ‘Mine Ban Treaty’) on 14 January 1999, and New Zealand on 27 January 1999. However, the USA, China, India, Pakistan and Russia have not signed the treaty. Almost no country in the Middle East and only about half the countries of the Asia-Pacific region have signed the Ottawa Convention.25

The civilised world has evolved slowly with respect to the care of its children. Enormous social advances have been made but genocidal reversions of the 20th century (Holocaust, Pol Pot Regime and the Rwandan genocide) temporarily reversed this progression. Much remains to be done to enshrine the protection of children both in international law and in disaster and civil war deployments. The traditions of paediatricians serving in uniform or in NGOs, by their advocacy and credibility, can continue to achieve much in response to the threats of war and disaster, inevitably encountered by children of the future.

References

  1. Top of page
  2. Abstract
  3. Key Points
  4. Soldier-paediatricians
  5. Paediatricians, Military Service and the 21st Century
  6. References
  • 1
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    Pearn JH, Flecker P. ‘Northern exchanges’. In: Pearn J, ed. Outback Medicine. Brisbane: Amphion Press, 1994; 299306, 307–320.
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    Pearn JH. Landmines: time for an international ban. BMJ 1996; 312: 9901.
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    [Editor]. The Ottawa Convention: Signatories and States – Parties. Available from: http://www.armscontrol.org/factsheets/ottawasigs[accessed 22 May 2011].