ATN injection - what does ATN stand for?

[A Lancashire Fusilier by Proxy]

My grandfather was wounded on the Somme in early September 1916. He was lucky enough to survive, and wrote a diary detailing his experiences.

Describing his journey from the front line to hospital via a succession of aid posts and dressing stations he mentions that, at about the third stop along the way, he was given an “ATN injection”.

I am sure that this must have been, or included, an anti-tetanus injection, as I am aware that anti-tetanus was administered as soon as practicable to wounded soldiers in WW1, but I am puzzled by the initials. I have seen reference to “ATS”, standing for “anti-tetanus serum”, but I am wondering whether anti-tetanus may have been combined with something else to account for the “N”, or whether perhaps there may be an “N” word that I am not familiar with (“noculation”???), or whether ATN may not be so much an acronym as a convenient abbreviation?

My grandfather was an industrial chemist before the war, so is likely to have been relatively well-informed about the correct way of describing the injection. I have wondered whether possibly he may have had “ATS” in his mind, but absent-mindedly written “ATN”; however, mostly his writing is accurate, and I do not consider that to be a very likely explanation.

I have been transcribing and editing my grandfather’s diary with a view to publishing it for the benefit of Combat Stress/the Lancashire Fusiliers’ Museum, but at the moment the footnote relating to “ATN” reads, rather lamely:

This is probably anti-tetanus serum, which was routinely used in WW1, and administered as soon as possible, usually at a field treatment station, though it might be expected that the acronym would be ATS, rather than ATN.

Can anyone help with this?

Edited 21 October , 2020 by A Lancashire Fusilier by Proxy

[TEW]

First thoughts on seeing the title was towards it being a mistake for ATS.

 

Can't come up with an alternative correct for ATN. In context, yes ATS was administered as a routine during evacuation. Not entirely certain how organised this was as I've seen it administered on ambulance trains after being at a CCS and administered at CCS, presumably not at both.

 

How the error crept in is probably the complicated part to work out.

 

Your 'noculation' idea is pretty good I think. Consider that medical terms and knowledge were out of the realm of the average person and that a present day 6 year old would have a better understanding of digestion, respiratory & blood systems than the average person 100 years ago.

 

At the time I wonder if they bothered explaining to every man it was 'anti-tetanus serum'. Perhaps he asked and the term anti-tetanus was used, not necessarily with 'serum'.

 

Noculation seems a likely corruption of Innoculation.

 

I suspect (if I have it correct, we're talking about a Canadian Captain?) it may be recorded somewhere in the various medical level diaries that ATS was administered at some point of his likely evacuation route.

TEW

[Dai Bach y Sowldiwr]

Can you post the image?

[RegHannay]

If it is of use to you, My grandfather was with 36th FA  and M.O to a battalion at the front. in his diary he talks of administering. "anti serum" as routine,

The first time he mentions it is when at a small hospital set up by the FA in Armentieres where the 36th after picking up casualties from the front first took them.

 

"Some seven casualties including a man shot through the lower end of scapula and out just above base of heart then through top button of coat which was flattened out curiously. We give antiserum serum as routine."

Dave 

 

Edited 24 May , 2020 by RegHannay
correction to place where the administering of serum was carried out

[seaJane]

Anti TetaNus?

[michaeldr]

14 hours ago, A Lancashire Fusilier by Proxy said:

it might be expected that the acronym would be ATS, rather than ATN.

I've seen it put in a 1915 context as Antitetanic - with no s

so ATN could apply 

[A Lancashire Fusilier by Proxy]

Hi all, thank you all for your replies.

I attach an image from the text, from which it seems pretty clear that my grandad has written “A.T.N.”. Having said that, although I have been transcribing his writing for 2 ½ years now, so am pretty familiar with his handwriting, I can still be caught out – the other day I realised that what I had thought was a double questionmark for someone’s initials was in fact double “P”!

Before I began this thread, I searched ATN on the site, and found posts saying that this was commonly used as shorthand for the 18^th Division, on the footing that, if you say the letters quickly out loud, they sound like “eighteen”. Using ATN for 18 suggests that it was fashionable to use capital letters as a type of slang - a bit like some text jargon now – and this is what set me thinking that my ATN might not be an acronym, just a common shorthand for “anti-tetanus”, which I think is what SeaJane is getting at.

I’m beginning to think that this is the most likely explanation, unless there was an old word for “serum” beginning with an “n”, such as “noculate”.

It is obvious from my grandfather’s account that it was something that was routinely being given to everyone, not tailored to his particular condition, and I remain certain that the injection, whatever it was, was a prophylactic injection against tetanus, having read elsewhere that this was routinely given in WW1 after wounding, which is also confirmed by RegHannay’s post – thank you for that post, Dave.

As you will see from the accompanying photo, he received the injection at a dressing station on the Albert-Amiens Road. He had already been to two Aid Posts and a Dressing Station. Dave, it may be that your grandfather was administering the injection at a slightly later stage of evacuation, as my grandfather got it before he reached hospital.

He ended up in No 36 CCS, and, TEW, I see that in https://www.greatwarforum.org/topic/246473-36-casualty-clearing-station-casualties, you have transcribed a lot of detail from CCS36  records. It seems the available details are only staff names and those who died there – is this right? By the way, you may think that this grandfather was Canadian because I have mentioned in another post that my other grandad was with the Canadian Expeditionary Force, but the Lancashire Fusiliers grandad had no connection with Canada.

[TEW]

36 CCS records are as you say staff and by this time only officers that died there.

 

If you were willing to give a precise date for his injury and his LF battalion I could check through and possibly identify the field ambulances & dressing stations he mentions. Somewhere there must be an order that mentions giving ATS to troops passing through. That should marry up with his 'ATN' injection.

 

I guess the ATS given would have to be organised. Their field card might have been marked as such. Not sure what would happen if someone received multiple ATS jabs at various points.

TEW

Edited 15 July , 2020 by TEW
Spelling

[RegHannay]

5 hours ago, A Lancashire Fusilier by Proxy said:

Hi all, thank you all for your replies.

 

I attach an image from the text, from which it seems pretty clear that my grandad has written “A.T.N.”. Having said that, although I have been transcribing his writing for 2 ½ years now, so am pretty familiar with his handwriting, I can still be caught out – the other day I realised that what I had thought was a double questionmark for someone’s initials was in fact double “P”!

 

Before I began this thread, I searched ATN on the site, and found posts saying that this was commonly used as shorthand for the 18^th Division, on the footing that, if you say the letters quickly out loud, they sound like “eighteen”. Using ATN for 18 suggests that it was fashionable to use capital letters as a type of slang - a bit like some text jargon now – and this is what set me thinking that my ATN might not be an acronym, just a common shorthand for “anti-tetanus”, which I think is what SeaJane is getting at.

 

I’m beginning to think that this is the most likely explanation, unless there was an old word for “serum” beginning with an “n”, such as “noculate”.

 

It is obvious from my grandfather’s account that it was something that was routinely being given to everyone, not tailored to his particular condition, and I remain certain that the injection, whatever it was, was a prophylactic injection against tetanus, having read elsewhere that this was routinely given in WW1 after wounding, which is also confirmed by RegHannay’s post – thank you for that post, Dave.

 

As you will see from the accompanying photo, he received the injection at a dressing station on the Albert-Amiens Road. He had already been to two Aid Posts and a Dressing Station. Dave, it may be that your grandfather was administering the injection at a slightly later stage of evacuation, as my grandfather got it before he reached hospital.

 

He ended up in No 36 CCS, and, TEW, I see that in https://www.greatwarforum.org/topic/246473-36-casualty-clearing-station-casualties, you have transcribed a lot of detail from CCS36  records. It seems the available details are only staff names and those who died there – is this right? By the way, you may think that this grandfather was Canadian because I have mentioned in another post that my other grandad was with the Canadian Expeditionary Force, but the Lancashire Fusiliers grandad had no connection with Canada.

 

I think the word hospital in my grandfathers diary should be read as ADS. In this case a stop gap before moving on to Baillent hospital/CCS . The FA would pickup twice daily from RAPs  (Gunners farm, Headquarters farm, Houplines) take the wounded back to an old school house near Armentieres, carry out urgent work and some operations. The men were from there picked up daily by convoy (transport) and taken to Baillent. It was a big bone of contention with my grandfather that the seriously wounded were held up for up to 12/14 hours when these cases could have been taken directly to CCS. by their motor ambulances.

Dave

[TullochArd]

as suggested by seaJane ………. an “anti-tetanus” variation seems most likely …...

[KernelPanic]

7 hours ago, michaeldr said:

I've seen it put in a 1915 context as Antitetanic - with no s

so ATN could apply 

 

Here's a 1915 article from the Journal of the American Medical Assoc.

So, yes, possible referring to antitetanic.

 

Edit: But this article still refers to 'serum', so maybe not so helpful in this context.

 

Edited 24 May , 2020 by KernelPanic

[TullochArd]

He calls it A.T.N. but Serum it probably is. The routine administration of the anti-tetanus serum to wounded men in 1915/16, which undoubtedly prevented life threatening tetanus,  was one of the most successful preventive interventions in wartime medicine. 

[Dai Bach y Sowldiwr]

The Anti Tetanus Serum was extracted from horses, and was a post exposure treatment for dirty wounds, not a preventative prophylaxis.

Horses would be injected with active tetanus and they would then develop the disease themselves.I think the infection  usually proved fatal for the horses, but they did develop an immune response and make anti tetanus antibodies. So, their blood was taken off, the cells removed,  and the serum that was left was processed  into ATS.

All well and good and this saved many  lives from tetanus infection, but many people are  allergic to horse proteins , many developed anaphylaxis to ATS and many died from that.

 

True  tetanus prophylaxis came along in the 1920s with the introduction of tetanus toxoid  which is not a serum.

 

ATS is sometimes described as Tetanus  Antitoxin.

Could ATN be an abbreviation for AntiToxiN?

Edited 25 May , 2020 by Dai Bach y Sowldiwr

[A Lancashire Fusilier by Proxy]

Thank you everybody once again.

So, in short, it seems that ATS was a common abbreviation for the anti-tetanus injection, AT was also sometimes used; no-one who has responded to this thread has ever come across the abbreviation ATN, but it cannot absolutely be ruled out that it was either a colloquial or medical alternative.

In the light of this my footnote should be modified slightly to end "though the abbreviation would more normally be ATS or simply AT," instead of "though it might be expected that the acronym would be ATS, rather than ATN."

Dave, it seems that your grandfather was administering the injection at more or less the same stage after all.

TEW, my grandfather was in the 2/5th Lancashire Fusiliers when he was wounded, which was on 9th September 1916. I think that it is fairly well established that the anti-tetanus was given at the dressing station that he describes in the extract that I have photographed, so don't spend too long researching it, though, of course, it would be nice to have it absolutely confirmed that it was ATS.

He gives the names of all the aid posts and dressing stations at which he was treated except this one, which was between Becordel Dressing Station and No 36 CCS. He arrived there sometime after 8.00pm, and was at No 36 CCS in time to have been operated on and put to bed before breakfast time on 10th September.

Would the field cards to which you refer be with the officers' records at Kew if they survived?

[TEW]

If you want a quick overview of the evacuation process the 2/1 Wessex FA has a 2 page typed up scheme dated 7/9/16. WO95/2919/1, free from TNA at present, page 39 of download. It basically defines the routes from RAP to the 2 ADSs. From there it's off to the DCS Nr. Mametz them on to CMDS at Becordel which doubles up as a walking wounded station. From there I guess it's off to CCS if needed.

A station at Dernacourt also crops up (I think a Corps Rest Station) but is absent from the above typed up scheme.

The only mention of ATS Is that it IS NOT given at the DCS.

TEW

[Robert Dunlop]

Anti-tetanus serum was also referred to as anti-tetanic serum or just anti-toxin. I have not seen the abbreviation ATN in the literature but it could well be shorthand for the latter.

 

Robert

[RegHannay]

10 hours ago, A Lancashire Fusilier by Proxy said:

Thank you everybody once again.

So, in short, it seems that ATS was a common abbreviation for the anti-tetanus injection, AT was also sometimes used; no-one who has responded to this thread has ever come across the abbreviation ATN, but it cannot absolutely be ruled out that it was either a colloquial or medical alternative.

In the light of this my footnote should be modified slightly to end "though the abbreviation would more normally be ATS or simply AT," instead of "though it might be expected that the acronym would be ATS, rather than ATN."

Dave, it seems that your grandfather was administering the injection at more or less the same stage after all.

TEW, my grandfather was in the 2/5th Lancashire Fusiliers when he was wounded, which was on 9th September 1916. I think that it is fairly well established that the anti-tetanus was given at the dressing station that he describes in the extract that I have photographed, so don't spend too long researching it, though, of course, it would be nice to have it absolutely confirmed that it was ATS.

He gives the names of all the aid posts and dressing stations at which he was treated except this one, which was between Becordel Dressing Station and No 36 CCS. He arrived there sometime after 8.00pm, and was at No 36 CCS in time to have been operated on and put to bed before breakfast time on 10th September.

Would the field cards to which you refer be with the officers' records at Kew if they survived?

Looking at the "RAMC in the great war" website a RMO (regimental medical officer)  manning the RAP was supplied by the ADS and consisted of :-  Anti tetanus serum - assorted bandages- shell dressings assorted dressings, Etc. Primus stove, Beatrice stove? Acetylene lamp, Blankets  to name a few. And a hamper of comforts consisting of brandy, cocoa, bovril, oxo and biscuits etc (the human touch) Each man was labelled with a luggage tag noting injuries and medication given for required information further up the evacuation chain. So if for some reason the casualty had not received his anti tetanus at the RAP it would have been given at the first opportunity.

Can anyone tell me what a Beatrice stove was please.

Dave

[TEW]

The field cards I refered to are the same as the Luggage labels mentioned by Dave. Tags attached to the patient to denote injury, treatment etc. Only ever seen images of a few, doubt many survived long and not kept anywhere as far as I know.

 

I think the process of giving ATS must have evolved over the course of the war and varied depending on offensives, defence, or general holding of the line periods.

 

Normally when I've seen instructions that ATS was to be issued it was at EG. a dressing station or CCS. Although I've also seen it issued on board ambulance trains between CCS and base. Perhaps it was ok to double up a dose?

 

My original thoughts on the ATN variation was that it was likely to be an error by the recorder, in this case ALFBP's Grandfather (no disrespect intended). Was the diary kept up daily in the field (against regulations) or is it more of a memoirs write up?

 

So, I think whatever abbreviated initials can be made up  from 'Anti-Tetanus Serum' it would be unique to the writer and not something in temporary use at the time/place.

 

I get he's an officer with a background in industrial chemistry but the 55th Div. RAMC dealt with around 1100 wounded 9th/10th September. That's 1100 doses of ATS given, did they explain in detail to each man what it was?

TEW

[RegHannay]

1 hour ago, TEW said:

The field cards I refered to are the same as the Luggage labels mentioned by Dave. Tags attached to the patient to denote injury, treatment etc. Only ever seen images of a few, doubt many survived long and not kept anywhere as far as I know.

 

I think the process of giving ATS must have evolved over the course of the war and varied depending on offensives, defence, or general holding of the line periods.

 

Normally when I've seen instructions that ATS was to be issued it was at EG. a dressing station or CCS. Although I've also seen it issued on board ambulance trains between CCS and base. Perhaps it was ok to double up a dose?

 

My original thoughts on the ATN variation was that it was likely to be an error by the recorder, in this case ALFBP's Grandfather (no disrespect intended). Was the diary kept up daily in the field (against regulations) or is it more of a memoirs write up?

 

So, I think whatever abbreviated initials can be made up  from 'Anti-Tetanus Serum' it would be unique to the writer and not something in temporary use at the time/place.

 

I get he's an officer with a background in industrial chemistry but the 55th Div. RAMC dealt with around 1100 wounded 9th/10th September. That's 1100 doses of ATS given, did they explain in detail to each man what it was?

TEW

 

On 24/05/2020 at 14:23, A Lancashire Fusilier by Proxy said:

Hi all, thank you all for your replies.

 

I attach an image from the text, from which it seems pretty clear that my grandad has written “A.T.N.”. Having said that, although I have been transcribing his writing for 2 ½ years now, so am pretty familiar with his handwriting, I can still be caught out – the other day I realised that what I had thought was a double questionmark for someone’s initials was in fact double “P”!

 

Before I began this thread, I searched ATN on the site, and found posts saying that this was commonly used as shorthand for the 18^th Division, on the footing that, if you say the letters quickly out loud, they sound like “eighteen”. Using ATN for 18 suggests that it was fashionable to use capital letters as a type of slang - a bit like some text jargon now – and this is what set me thinking that my ATN might not be an acronym, just a common shorthand for “anti-tetanus”, which I think is what SeaJane is getting at.

 

I’m beginning to think that this is the most likely explanation, unless there was an old word for “serum” beginning with an “n”, such as “noculate”.

 

It is obvious from my grandfather’s account that it was something that was routinely being given to everyone, not tailored to his particular condition, and I remain certain that the injection, whatever it was, was a prophylactic injection against tetanus, having read elsewhere that this was routinely given in WW1 after wounding, which is also confirmed by RegHannay’s post – thank you for that post, Dave.

 

As you will see from the accompanying photo, he received the injection at a dressing station on the Albert-Amiens Road. He had already been to two Aid Posts and a Dressing Station. Dave, it may be that your grandfather was administering the injection at a slightly later stage of evacuation, as my grandfather got it before he reached hospital.

 

He ended up in No 36 CCS, and, TEW, I see that in https://www.greatwarforum.org/topic/246473-36-casualty-clearing-station-casualties, you have transcribed a lot of detail from CCS36  records. It seems the available details are only staff names and those who died there – is this right? By the way, you may think that this grandfather was Canadian because I have mentioned in another post that my other grandad was with the Canadian Expeditionary Force, but the Lancashire Fusiliers grandad had no connection with Canada.

 

 

On 24/05/2020 at 19:52, RegHannay said:

I think the word hospital in my grandfathers diary should be read as ADS. In this case a stop gap before moving on to Baillent hospital/CCS . The FA would pickup twice daily from RAPs  (Gunners farm, Headquarters farm, Houplines) take the wounded back to an old school house near Armentieres, carry out urgent work and some operations. The men were from there picked up daily by convoy (transport) and taken to Baillent. It was a big bone of contention with my grandfather that the seriously wounded were held up for up to 12/14 hours when these cases could have been taken directly to CCS. by their motor ambulances.

Dave

 

[Dai Bach y Sowldiwr]

I don't think ATS would be given more than once, possibly in view of the increased anaphylaxis risk.

The modern day equivalent certainly is a single dose.

This gives instant passive immunity for a couple of weeks, long enough hopefully to prevent the current dirty wound from introducing a fatal tetanus infection.

I suppose a second dose might have been administered when it was thought a dirty wound was still potentially dangerous after such a time period, but I can't see the point of giving a second dose within the first hours or days.

I'm not sure what the protocol would be for a soldier sustaining subsequent dirty wounds.

[TEW]

Thanks Dai,

I wasn't suggesting double dosing was carried out, more along the lines of making sure doses were not being administered by multiple units along the way. Seems it was available at RAP through to ambulance trains so presumably the field cards prevented accidental dosing.

You wouldn't happen to know what wound be meant (quantity wise I presume) by ATS 500?

TEW

[Dai Bach y Sowldiwr]

1 minute ago, TEW said:

You wouldn't happen to know what wound be meant (quantity wise I presume) by ATS 500?

I guess 'Units'  given? (Units as in International Units of drug, not military units...)

An ampoule would contain so many units,  bigger dosed for higher risk wounds maybe.

Where does it say it?

[TEW]

It's in the A/D book for 14 FA in May 1917.

An adapted column under Date of Transfer with Sick Convoy crossed out and replaced by 'ATS given'. Then in rows for the wounded '500', one entry says '500 units'. They are then moved off to CCS.

TEW

[A Lancashire Fusilier by Proxy]

Once again, thank you all - this is all so interesting, particularly the 2/1 Wessex Field Ambulance diary to which TEW has directed me, which details the very scheme which evacuated my grandfather on 09/09/16.The original scheme set out on 07/09/16 mentioned by TEW was in fact varied the following day. I think the main variation was to change the route for the right sector (my grandfather's sector) so that they were taken from the RAP at Delville Wood to Bernafay Wood instead of the Quarry (which is recorded as being difficult to access by Motor Ambulance). From Bernafay Wood they went to Becordel, the CDMS. My grandfather doesn't mention stopping at the DCS near Mametz - maybe they weren't unloaded there?, After Becordel (i.e.) by the time he got the "ATN" injection on the Albert to Amiens Road, it seems that they were out of the remit of the 2/1 Wessex Field Ambulance.

My grandfather mentions two of the doctors referred to in the diary of the 2/1 Wessex Field Ambulance. The death of Lieutenant McVicker, attached to the 2/5th Lancashire Fusiliers at the RAP, reported in typical matter-of-fact manner in the WFA diary, is one of the young lives lost that touches me most in my grandfather's account. 

On the subject of the field cards, this was staring me in the face all the time, as, on evacuation from the CCS, my grandfather says "Previously I had had several tickets pinned on my pyjamas", i.e. Dave's "luggage tags"!

I have spoken to a retired pharmacist who has an old pharmacy reference book from 1932 (he can't go back as far as 1916 unfortunately!) which refers to the normal dose of tetanus antitoxin as being 1000 to 2000 International Units for prophylactic use (i.e. after the wounding but before tetanus has developed), but that a very much higher dose is to be given if tetanus has already developed, and if the prophylactic dose is given late it should be somewhere between the two, which suggests that no harm would befall the patent if he accidentally received two doses. However, they would presumably have to be a bit more careful  about morphia!

The pharmacy reference book also states that preparations made in the United States were twice as strong, so presumably in an American context the normal dose would be halved - the ATS 500 isn't in an American context by any chance, is it? [Edit: have just seen post 24, so not obviously in an American context, but post 11 suggests it was maybe developed in America, so perhaps it was at American strength originally; or maybe a lower dose was thought to be effective originally, or possibly it had to be rationed?]

On the subject of my original query about ATN, maybe it was just a simple mistake on the part of my grandfather, either from mis-hearing or misremembering ATS, or having a moment of absent mindedness when he wrote the diary. I thought that, having shared a dug out with the doctor at the Aid Post for some of his time at the front, and assisted in at least one operation on a wounded man, perhaps he would have been familiar with the tools of the doctor's trade, but there is still the possibility of pure absent-mindedness.

He did, it seems, break regulations by keeping a brief record on a day to day basis for at least part of his time on the Western Front, which he used, along with letters home etc. to write a more detailed diary later, beginning it before the Peace Celebrations in 1919.

 

 

Edited 26 May , 2020 by A Lancashire Fusilier by Proxy

[Robert Dunlop]

He did break regulations - but thank goodness he did. Much less likely that the acronym was mis-heard or mis-remembered. I have records of men being treated for full blown tetanic spasms so will double-check on the doses of the serum. The risk of repeat dosing with the serum was the risk of developing a reaction to the other foreign proteins, etc in the serum.

 

Robert