Prehospital care in the United Kingdom rarely lasts more than a few hours other than in exceptional circumstances (for example, mountain and cave rescue, oil rigs). In other parts of the world hospitals may be much more distant and in expeditions to remote areas, prehospital care may extend to days or even weeks. When this occurs, the boundaries between primary care and prehospital care blur.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
In 1908/9 Sir Ernest Shackleton led an expedition to the South Pole. He failed to reach his goal but got to within 97 miles of the Pole. In his book The heart of the Antarctic1 he describes the drugs and medical equipment which he took with him on his march South. These are shown in boxes 1 and 2. The total weight of medical equipment and stores was seven pounds.1 As most of these drugs will be unfamiliar to modern doctors and some of those which are familiar may have been used in a different way, I have described their uses. They can be compared with the medical supplies that are taken into the field by teams from the British Antarctic Survey (BAS). These are contained in a wooden box (the field medical box) and weigh about 40 pounds (see box 3).
Box 1 Drugs taken by Shackleton
One tube laxative pills
One tube boric acid
One tube perchloride of mercury
One tube iron and arsenic composition
One tube quinine bisulphate
One tube eye soloids
One tube Hemasins (adrenalin)
Two tubes cocaine hydrochloride
Two tubes zinc sulphate
One tube aloin compound
One tube Crete aromat cum opio
One tube chlorodyne
One tube sulphonal
One tube soda mint
One tube bismuth pepsin charcoal
One tube potassium chlorate
One tube ammonium bromide
One tube ginger essence
One tube sodium salicylate
One tube morphine sulphate
600 tabloids Easton's syrup (1 dr)
Box 2 Dressing materials and medical equipment taken by Shackleton
Two clinical thermometers
Four first field dressings
Two triangular bandages
Two ounces compressed absorbent wool
Two ounces compressed cyanide gauze
Two pieces wood splinting
One reel adhesive plaster
Packet court plaster
One tube gold beaters' skin
One pocket surgical dressing case
Two pairs spare goggles and spare glasses
One pair molar dental forceps
Two bottles Newskin
Six ounces emergency Oxo
Box 3 Contents of BAS field medical box 2001
– Gastrocote (alginic acid, aluminium hydroxide, magnesium trisilicate, and sodium bicarbonate)
– Microgynon 30
– Adrenaline 1 in 1000
– Water for injection
– Acyclovir eye ointment
– Framycetin eye ointment
– Cyclopentolate eye drops
– Pilocarpine eye drops
– Fluorescein eye drops
– Amethocaine eye drops
– Acyclovir lip cream
– Aqueous skin cream
– 1% hydrocortisone cream
– Factor 30 sun protection cream
– Factor 15 sun protection li salve
– Silver sulphadiazine cream (Flamazine)
– Zinc undecanoate dusting powder (Mycota)
– Savlodil sachets
– Zinc ointment
– Lignocaine gel 2%
– Moist tissue wipes
– Anusol HC suppositories
– Sodium chloride and dextrose oral powder (Diorylate)
– Adcortyl in orabase
– Oil of cloves
– Cavit (for temporary dental fillings)
– Bandages conforming and crepe
– Adhesive tape—elastoplast and micropore
– Wound dressings—various
– Safety pins
– Eye patch and dressing
– Gauze swaps
– Plaster of Paris and orthopaedic padding
– Syringe 5 ml
– IV cannulas—various
– Velcro tourniquet
– Dental rolls
– Laerdal pocket mask
– Oropharyngeal airway 3 sizes
– asopharyngeal airway
– Hand operated sucker
– Ryles tube
– Clinical thermometer and low reading thermometer
– Polythene bags for burns of hand and feet
– Disposable latex gloves
– Adjustable Stifneck extraction collar
– Foley catheter
– Bladder syringe
– Eye bath
– Suture set
– Scalpel handle and blades
– Dental mirror and dental excavator
– First aid manual
Each drug was looked up in a pharmacopoeia of the time and details of the drugs are given. The main source was the British Pharmacopoeia of 1907 2 but where that did not mention the drug, the British Pharmacopoeia of 1911 3 and Martindale of 1910 4 were consulted. Then, as now, drugs might have several uses and might be used in different ways (for example, orally and topically). I describe the most likely indications for which each drug was taken. Indications for drugs that would not have been relevant for Shackleton's expedition have been omitted.
This was used as a mild antiseptic. It was also used as a food preservative but it is unlikely to have been used in this way as, although they ate their horses, the cold would have preserved the horsemeat.
Perchloride of mercury (mercuric chloride)
This was used an antiseptic and disinfectant. As an ointment it was used to treat parasitic skin infections.
Iron and arsenic composition
Iron was used not just for anaemia but “has a tonic action in all chronic cachectic conditions, such as malaria, syphilis, lardaceous disease, and tubercle; that is, it tends to improve the functions of the body.” It was also used “as a tonic to promote appetite, and to improve the general condition...”. 3 Arsenic was “employed in certain diseases of nutrition and as a general tonic, but how it exerts a beneficial action is unknown.” The combination of iron and arsenic was used primarily to treat pernicious anaemia but I presume that it was taken to the Antarctic for use as a general tonic.
Soloid was a trade name for a range of preparations manufactured by Burroughs Wellcome. The Soloid range included drugs, nasal preparations, culture media, and microscopic stains. 5 “Eye soloids” presumably refers to eye drops and/or ointment. The actual drugs used are not mentioned.
This is more soluble than quinine sulphate. It was used not only for malaria but also for intermittent fevers, continued fevers, and as a tonic.
Adrenalin (Hemesin was a trade name)
This was used for sudden cardiac failure. It was also used then (as now) for creating a bloodless field for minor surgery and for potentiating the effects of local anaesthesia.
This was used as a local anaesthetic. In pill form it was also used to relieve gastric pain and to allay sea sickness.
Zinc sulphate was used for nervous disorders such as chorea and epilepsy. It was also used as an astringent in diarrhoea. Topically it was used as an astringent to lessen secretions from mucous surfaces in leucorrhoea and subacute gonorrhoea.
This is a plant extract from aloes and was used as a purgative. “It is one of the most valuable drugs in the treatment of chronic constipation.” 2
Crete aromat cum opio
This mixture of chalk and opium was used for diarrhoea.
This mixture consisted: chloroform 6, morphine 0.5, tincture of Indian hemp 3, tincture of capsicum 1.5, liquid extract of liquorice12, mucillage of acacia12 (used to maintain the other substances in suspension), treacle 25, glycerine 22, oil of peppermint 0.1, alcohol to make 100. It was used for diarrhoea, colic, and flatulence. It was also used for coughs and as a sedative and antispasmodic
Sulphonal was used as a hypnotic.
Soda mint (compound sodium bicarbonate tablets)
This was used as an antacid and as a carminative (that is, a drug to reduce gas in the gastrointestinal tract) in gastric flatulence.
Bismuth pepsin charcoal
Bismuth pepsin charcoal itself is not mentioned in the 1907 British Pharmacopoeia but bismuth and pepsin mixture was used as a sedative to the gastric mucous membrane and was also used as a digestive. The pharmacopoeia describes other substances added to the mixture including iron, podophyllin, and strychnine. A mixture of bismuth and pepsin with charcoal would seem (to a doctor in 2001) to be less harmful than the other mixtures!
This toxic substance was mostly used topically. The theory behind its use was that it gave up oxygen to the tissues and so it was used as a gargle for inflamed and spongy gums, aphthous ulcers and tonsillitis. It could also be used on skin ulcers.
Used as a general sedative with a more rapid action than potassium bromide.
Ginger essence (strong tincture of ginger)
Used as a carminative and aromatic stimulant in atonic dyspepsia and flatulence. It was also added to purgatives to prevent griping.
This is described in the pharmacopoeia mostly as an antipyretic. Its other main use was for acute rheumatism but it was also used for chronic rheumatism, sciatica, and neuralgias of rheumatic origin.
Morphine sulphate was used as an analgesic and was also said to arrest useless coughs (though it was contraindicated in productive coughs) and was useful for diarrhoea and colic. It could also be used for sedation, particularly in patients with internal haemorrhage and in patients with “febrile illness, especially where sleep is delayed, morphine is invaluable.”2
Tabloids of Easton's syrup (syrup of phosphate of iron with quinine and strychnine)
Easton's syrup was used as a tonic during convalescence from acute disease, in general debility with anaemia, and in neurasthenic conditions. Tabloid was a Burroughs Wellcome trade name. The company made its reputation by producing drugs in tablet form and the name “tabloid” came to be used as a synonym for tablet. Shackleton obviously uses the word with this meaning but in fact it was used by Burroughs Wellcome to indicate a range of products including dressing materials, injections, and medicine cases.5 Shackleton took a Tabloid medical case to Antarctica.6
Cyanide gauze (gauze impregnated with mercury and zinc cyanide)
Mercury and zinc cyanide was used as a germicide and antiseptic.
Issinglass was a transparent jelly prepared from the dried swimming bladder of a fish from the Black and Caspian Seas. It consisted mostly of gelatin. This, when spread onto silk was called court plaster. It was used as a dressing material
Gold beaters skin
This preparation was the peritoneum of the ox or of the sand shark, which was kept in alcohol and used to cover granulating wounds.
This was a collodion (pyroxylin in ether and alcohol). This is still used. It was applied to surgical wounds, cuts, abrasions, and chilblains. When the solvents evaporate the pyroxylin forms a protective “skin” over the wound.
Burroughs Wellcome presented at least one of their medical kits to Shackleton.6 I am uncertain whether this was taken on the South Pole expedition or whether this was left at the base camp and a smaller kit taken.
Clearly there are many differences between Shackleton's expedition and the field parties of the BAS. The former was a private expedition of four, relatively young, male explorers who had to be self sufficient for 91 days without communication with their support party. The group contained a doctor. The BAS is a government run research organisation and the scientists and support staff (male and female) have an employee's right to the best Health and Safety services compatible with the environment. The staff are mostly young but can be of any age though all have to pass a strict medical examination before being allowed to go to Antarctica. Medical care in the field is provided by first aiders with extended training. They have radio communication to Antarctic bases and from there back to the BAS headquarters or to medical advice from consultants at the BAS Medical Unit (BASMU) based in the Accident and Emergency Department in Plymouth. Modern Antarctic travel can take advantage of skidoos and aircraft (during the Antarctic summer). The field medical boxes are designed to support all groups in the field from a group of two working unsupported for several months to a larger group of five or six people for a shorter time. The box also serves as first aid supplies for an aircraft if it was forced into an unexpected landing. There may be occasions when the field party contains a doctor. There are more medical supplies held at the BAS bases and, at the larger bases with a full time doctor, these include equipment to provide anaesthesia and to do surgical procedures.
Despite the differences between 1908 and 2001, there are also similarities. The environment and weather are just as hostile as they were in 1908 and it is still possible for field parties to be trapped in bad weather and for aircraft to be unable to fly for several weeks. The medical equipment has to be more than a first aid kit and to provide the medical care for illness that could occur over a several week period. It also needs to provide the “over the counter” remedies that patients would normally not seek from a doctor. Weight and volume are limited on sledges whether pulled by horses and explorers as on Shackleton's expedition or by skidoo, and compromises have to be made between the comprehensiveness of medical equipment and its weight and volume (this must be considered by anybody who feels that the list of equipment and drugs supplied by BASMU is inadequate).
It is not possible to determine from Shackleton's book why the drugs and equipment that were taken, were chosen. They seem to be a strange choice to the modern practitioner and the differences between 1908 and 2001 clearly reflect major changes in medical practice and these changes do not need to be explained. They are presented as being of interest and the only lesson is to wonder how the 2001 medical box will appear to doctors in 2094.
I would like to thank Mr I C Grant medical director and Mr P Marquis, manager of the British Antarctic Survey Medical Unit for their assistance.