Medicine in First World War Europe: Soldiers, Medics, Pacifists 9781472510020, 9781472513243, 9781474204712, 9781472514165

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Medicine in First World War Europe

Medicine in First World War Europe Soldiers, Medics, Pacifists

FIONA REID

Bloomsbury Academic An imprint of Bloomsbury Publishing Plc

LON DON • OX F O R D • N E W YOR K • N E W DE L H I • SY DN EY

Bloomsbury Academic An imprint of Bloomsbury Publishing Plc 50 Bedford Square London WC1B 3DP UK

1385 Broadway New York NY 10018 USA

www.bloomsbury.com BLOOMSBURY and the Diana logo are trademarks of Bloomsbury Publishing Plc First published 2017 © Fiona Reid, 2017 Fiona Reid has asserted her right under the Copyright, Designs and Patents Act, 1988, to be identified as Author of this work. All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without prior permission in writing from the publishers. No responsibility for loss caused to any individual or organization acting on or refraining from action as a result of the material in this publication can be accepted by Bloomsbury or the author. British Library Cataloguing-in-Publication Data A catalogue record for this book is available from the British Library. ISBN: HB: 978-1-4725-1002-0 PB: 978-1-4725-1324-3 ePDF: 978-1-4725-1416-5 ePub: 978-1-4725-0592-7 Library of Congress Cataloging-in-Publication Data Names: Reid, Fiona, author. Title: Medicine in First World War Europe : soldiers, medics, pacifists /Fiona Reid. Description: New York : Bloomsbury Academic, an imprint of Bloomsbury Publishing Plc, [2017] | Includes bibliographical references and index. Identifiers: LCCN 2016035456 | ISBN 9781472510020 (hardback) | ISBN 9781472513243 (pbk.) | ISBN 9781472514165 (ePDF) | ISBN 9781472505927(ePub) Subjects: LCSH: World War, 1914-1918–Medical care–Europe. | Medicine, Military–Europe–History–20th century. Classification: LCC D629.E9 R45 2017 | DDC 940.4/75–dc23 LC record available at https://lccn.loc.gov/2016035456 Cover design: Anna Berzovan Cover image: 'The Doctor' © IWM (Art.IWM ART 725) Typeset by Integra Software Services Pvt. Ltd.

For Samson and For Lyra

CONTENTS

List of Figures  viii List of Tables  ix Acknowledgements  x List of Abbreviations  xi

1 War Is Good for Medicine  1 2 From the Trench to the Hospital  27 3 Iconic Wounds: Gas, Shell Shock, Facial Injury  71 4 Ordinary Soldiers and Ordinary Pain  113 5 ‘We Did Not Fight’: Medical Pacifism and War  149 6 Lessons and Legacies: ‘Blood Swept Lands and Seas of Red’  191 Notes 201 Bibliography  235 Index 256

LIST OF FIGURES

1.1 Staniforth: ‘A clean sweep’.  6 1.2 The massage – and a woman’s touch – could seem benign when applied to someone else.  15 1.3 Here the patient seems more tortured than comforted by his treatment.  16 1.4 Men romanticized and sexualized female medics but were also afraid of them.  17 1.5  Service de Santé en Campagne. Image provided by the British Library.  20 1.6 Daddy, what did YOU do in the Great War?  23 5.1 Men of the SSA 13.  184 5.2 The Friends Ambulance Unit Anniversary, 1917.  186

LIST OF TABLES

2.1 Statistics and battle losses  30 2.2 Journées d'Hospitalisation (hospital days) provided  39 2.3 Grand totals of sick and wounded arriving in the United Kingdom from August 1914 to August 1920  46 2.4 Twenty-one days of November 1915. Trench foot totals  55 2.5 Total number of sick and wounded disembarked at UK ports, 28 August 1914–31 July 1919  62 5.1 Queen Alexandra Hospital, Malo-les-Bains, Dunkirk: Total numbers treated, 1914–1918  170

ACKNOWLEDGEMENTS

No one writes a book on their own and a great number of people have helped me with this one over the years. My fellow-historians at the University of South Wales have all been generous and supportive throughout. In particular I would like to thank Dr Andy Croll, Dr Jane Finucane and Dr Brian Ireland for introducing me to the worlds of Welsh newspapers, early modern primers and 1970s comic books. They all play a part. I would also like to thank Dr Richard Allen for his helpful comments on some of the chapters. Amongst the wider School of Humanities and Social Sciences at the University of South Wales, I owe a very special thanks to Professor Philip Gross for his poetry and also for an insight into what it is to be a Friend. I am similarly very grateful to Dr Andy Thompson, Head of School, for enabling me to make the time for both research and writing. I would like to acknowledge all the staff in all of the archives that I visited while writing this book. I have received tremendous help from archivists and librarians in the Imperial War Museum, the National Army Museum, the Library of the Society of Friends and the Wellcome Library. Many years ago I visited the Gillies Archive, then held at the Frognal Centre for Medical Studies at Queen Mary’s hospital in Sidcup, and I would very much like to thank Dr Andrew Bamji for his time, his expertise and for his generosity. Some of the material that he kindly donated many years ago has found its way into this book at last. Material from the Gillies Archive is now held in the Brotherton Library at the University of Leeds, and I would like to extend thanks to the staff there who have helped with very particular queries on a number of occasions. This book makes much use of the images, diaries, letters and personal papers held at these various archives. I have not been able to trace all of the owners of all these documents and I apologize for any omissions. My aim throughout has been to treat the men and women who feature in this book with respect and to emphasize the ways in which they tried to keep one another alive during four long years of war. I owe the greatest debt, the deepest gratitude and all my love to my immediate family. My husband, Dr Norry LaPorte, has been consistently patient and has provided endless emotional and practical support while I have been writing this book. My daughter and son-in-law, Danu and Joseph Fenton, have provided a base in London for my many research trips and have made time in their busy lives to read and comment on drafts as I have been writing. They are all remarkable people and I thank all of them very much indeed.

LIST OF ABBREVIATIONS

ADF

Association des dames françaises

AMS

Army Medical Services

BRCS

British Red Cross Society

CCB

Central Control Board

CRF

Croix-Rouge Française

DRK

Deutsches Rotes Kreuz

FAU

Friends Ambulance Unit

FWVRC

Friends War Victims Relief Committee

GACA

Le Groupement d’Ambulances de Corps de l’Armée

ICRC

International Committee of the Red Cross

IPPNW

International Physicians for the Prevention of Nuclear War

KGH

King George Hospital, London

MAPW

Medical Association for the Prevention of War

MEDACT

Medical Action for Global Security

MO

Medical officer

MSF

Médecins Sans Frontières

NCO

Non-commissioned officer

PUO

Pyrexia of Unknown Origin

QAH

Queen Alexandra Hospital at Malo-les-Bains, Dunkirk

RAMC

Royal Army Medical Corps

SSA

Sections Sanitaires Anglaises

SSBM

La Société française de secours aux blessés militaires

CHAPTER ONE

War Is Good for Medicine War is the only proper school for a surgeon. (HIPPOCRATES)

War is an efficient schoolmaster 1

We all love a wartime doctor. He (much more rarely she) can be seen as a force for good in the complex and bitter world of combat, and cultural representations of the good doctor abound. Dr Zhivago was a compassionate and intelligent man, doing his best to live decently during the First World War in Russia and the brutal civil war which followed it.2 In MASH, the longrunning American TV series, Captains Hawkeye Pierce and John McIntyre were the funny, humane faces of the Korean War, a real antidote to the cruel and humiliating spectacle of US actions in Vietnam which continued to dominate American minds throughout the 1970s. More recently, television adaptations of the First World War have focused on medicine, doctors and nurses. The titular estate of ITV’s tremendously popular Downton Abbey became a war hospital, and 100 years after the outbreak of the war the BBC chose to launch its commemorations with The Crimson Field, a drama series set in a field hospital in war-torn France. This anniversary was also marked by a new film adaptation of Vera Brittain’s Testament of Youth, an interpretation focused partially on the author’s feminism but one which more thoroughly emphasized – and celebrated – Brittain’s medically inspired pacifism. Histories of doctors, nurses, orderlies, stretcher bearers and the like are far away from the buttons and trumpets associated with traditional military history. We are not required to engage with maps, manoeuvres or strategies, and we can even avoid the high politics and complicated diplomacy which usually attends the history of war. This human-interest focus is especially important in terms of the history of the First World War, long held to be the ‘bad war’ which no one won and everyone regrets.3 In addition, a history

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of medicine has often enabled the most bloody of wars to be presented as progressive, or it at least highlights the kernel of progress within the cruelty and chaos of military campaigns, refugee crises and war-induced epidemics. Hippocrates’ often-repeated dictum indicates a long-standing belief that doctors learn from warfare and that they become better doctors as a result. This ‘efficient schoolmaster’ may dispense harsh lessons but humanity benefits and even the most painful of wars can result in more knowledge and improved medical practices. Hippocrates’ words highlight the very obvious connections between war and medicine. In wars men have always fought and so they have always been wounded and therefore doctors, or at least men and women with some medical knowledge, have always been required to tend them. More specifically, surgery was a very dangerous practice until the anaesthetics and antiseptics of the nineteenth century and so it was largely avoided. The battlefield was one of the few places where a surgeon could gain real and sustained practice in his trade. Yet while there are essential links between war and medicine, it is only since the very late nineteenth century that the combatant has been attended by anything like an organized, funded team of healthcare professionals and only since the early twentieth century has medical care been central, rather than peripheral, to the armed forces of the European nation states. The medical history of organized European warfare is usually traced from the early modern armies, the direct ancestors of our current national armies with their uniforms and regiments and patterns of loyalty and obligation. State support for veterans was also initiated at this point. The Swiss confederation was the first to organize state-funded care for the wounded in the late fourteenth century, a principle which was gradually accepted throughout the continent, albeit in a slow and piecemeal fashion.4 In 1670 Louis XIV of France established the Hôtel National des Invalides for war veterans; then in 1681 Charles II of England authorized the building of the Royal Hospital in Chelsea to support old soldiers ‘broken by age or war’, and the hospital began issuing daily allowances to the infirm from 1685.5 On the whole, old soldiers in need turned to kinship networks, local patronage, religious foundations or simply begging but, as part of the process of early nation-building, monarchs wanted to be seen as providing for their own troops, although this provision was both partial and highly limited. While on campaign during this period elite commanders were usually accompanied by their personal surgeons, and sometimes by physicians. The less-prestigious barber-surgeons – the infamous ‘Sawbones’ – attended the ordinary soldiers. Clearly some commanders took the care of their men seriously, and Georg von Frundsberg (1473–1528), a German soldier who commanded forces of Landsknechte in the Hapsburg imperial armies, insisted that barber-surgeons should be ‘well-versed, skilful, experienced and trained’, and that captains should on no account employ ‘a poor beard-shaver or bathboy’ to tend the men.6 Some barber-surgeons were indeed highly skilled.

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Ambroise Paré (1510–1590) initially trained as a barber-surgeon and then went on to develop new and effective ways of dealing with gunshot wounds and of carrying out amputations as a result of his practical experience in warfare. He later went on to serve as the royal surgeon for the French kings.7 It was at this point – roughly from the end of the sixteenth century – that European armies began to develop recognizable military medical services, in part because the continent was dominated by widespread warfare, notably the Thirty Years’ War (1618–1648). The first ‘ambulant hospitals’ had appeared at the end of the sixteenth century and by the eighteenth century medical officers – physicians, surgeons and apothecaries – had been formally introduced to European armies and were trained to deal with a wide range of war wounds and disease, including venereal disease.8 The role of the modern military medical officer was developing during the early modern period but much of the everyday medical care was provided by the camp-followers, primarily the women in the baggage trains which accompanied all armies. Warfare is often seen as an ‘entirely masculine activity’ in that it has traditionally been men who have been soldiers, and this remains largely the case today.9 Yet although women rarely serve as combat troops, they have long played a crucial part in warfare. From the fourteenth to the nineteenth centuries women were important to all European armies because of the range of services they offered to the troops. They acted as sutlers, selling food, drink and luxury items to armies with very limited supply systems and a tendency to rely on requisitioning. They laundered and mended clothes and worked as nurses, providing basic medical care throughout the campaigns. Groups of men were sometimes organized to act as nurses but this was very much the exception and early modern armies relied heavily upon the women in the baggage trains both during campaigns and in peacetime.10 Women in religious orders provided a further level of care, especially during periods of active warfare. The numbers of women in any given campaign obviously varied but was usually substantial. As late as 1813, towards the end of the Peninsular War (1808–1814), Wellington amassed an army of 60,000 in Spain. This number included 700 Portuguese women, 400 Spanish women and 4,500 British wives ‘on the strength’, that is wives who were officially recognized by the army and so entitled to draw rations.11 By the mid-nineteenth century the baggage trains with their unruly, untidy camp-followers had become discredited and the women were dismissed as prostitutes and thieves of the lowest order. General Inspector Célestin Sieur (1860–1955) described the medics of the baggage train as ‘greedy charlatans’ who sold ‘elixirs, balsams and even secret charms for a high price’.12 Victor Hugo (1802–1885) had drawn an even more damning picture of the campfollowers when he created the low-life Thénardiers, who stole clothes and medals from the dead and dying after the Battle of Waterloo.13 By the time that Hugo and Sieur were writing it had become a point of honour for European army commanders to eliminate the baggage trains and to establish masculine, professionalized health and welfare services.

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Women were marginalized throughout the nineteenth century, although they never completely disappeared from military life. Lady Florentina Sale (1790–1853), the wife of Major General Sir Robert Henry Sale, was known as the ‘Grenadier in petticoats’ because of her role during the first Afghan War (1839–1842). She accompanied the British army on the 116-mile retreat from Kabul to Jalalabad; she nursed the wounded en route and was subsequently captured and imprisoned.14 Yet women like Lady Sale were exceptional and, unlike the women camp-followers, they were from the higher social classes. Lady Sale could be lionized as an exotic exception, whose exploits served only to highlight the essentially masculine world of the military. Despite its long history, female participation in military life had been so effectively dismissed by the end of nineteenth century that it seemed almost inconceivable by the beginning of the First World War. The elite hostility to women doctors at this point is now well-known. Dr Elsie Maud Inglis, the founder of the Scottish Women’s Hospitals (SWH), offered her services to the Royal Army Medical Corps (RAMC) in 1914 and was rejected with the scathing words, ‘My good lady, go home and sit still.’15 There was also a suspicion of women nurses, despite the idealization of Florence Nightingale, and the RAMC was initially reluctant even to employ women nurses in the casualty clearing stations.16 One suspects that this reluctance was as much to do with accepting women into the medical sphere as well as into the military sphere, for at a British Base Hospital in Etretat (Seine-Maritime) Captain James Dible – by training a civilian doctor – complained that ‘these hospitals are far too women-ridden’.17 By this point women’s auxiliary and medical roles were being presented as unprecedented and atypical, thus reinforcing the widely held belief that the military-medical world was exclusively and properly male.18 During the same period civilian medical doctors had become similarly professionalized. The old divisions between physicians, surgeons and apothecaries were broken down and medical practitioners developed more of a collective identity with greater professional autonomy and a far higher social status. Doctors required a university education and considerable social and economic capital, and as a result the profession was overwhelmingly male, with discrete and subservient roles only becoming available for women at the end of the nineteenth and the beginning of the twentieth centuries.

Modern medicine and modern warfare By the beginning of the First World War the European nation states were supported by two crucial bodies of well-organized professional men: their armed forces and their medical professions. Much has been written about the militarization of medicine and the medicalization of the military, and there were strong physical and conceptual links between the two, best symbolized by ‘the 50 royal military hospitals [which had] girdled the frontier of

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France, parallel with the ring of fortresses’ since the eighteenth century.19 In military terms the medical role was twofold. First, doctors were responsible for saving manpower and preventing wastage. As a result of developments in surgery and medicine it was possible for doctors to treat men and then return them to the fighting lines in unprecedented numbers during the First World War. In previous conflicts doctors had been able to save lives (i.e. by amputation) but were quite unable to make large numbers of men fit enough to fight again. Second, it was the doctor’s role to protect the state’s political legitimacy in an era when citizens were growing ever-more conscious of their rights. Linked to the role of political legitimacy was a sense of moral and national superiority which reified national difference to the extent that it became easy to dehumanize the enemy on simple racial grounds. A cartoon in Wales’ Western Mail from October 1914 shows ‘Mrs Britannia’ sweeping enemy aliens from the national home: like David Cameron’s ‘swarm’ of migrants in August  2015, these people were not fully human (Figure 1.1).20 The use of medical language – the aliens here are ‘microbes’ – emphasizes the link between the military and the medical professions because both were responsible for cleansing the nation to maintain its good health. While dehumanizing the enemy it became even more important to stress the humanity of one’s own people and to care for them accordingly within the safety of the imagined homeland. For all of these reasons, a medical assessment of the First World War was of vital importance, especially to the victors who continually emphasized the links between the medical and the military victories. Commenting on the Battle of the Somme, often presented as the British army’s greatest disaster, a doctor reflected that ‘when the full story of the work done by the British medical service in France can be told it will reflect undying honour on all the actors in it’.21 At this point the medical victory can be seen as compensating for any military inadequacies but after the war the victor nations produced highly detailed assessments of their medical triumphs for the general reader. The Times History and Encyclopaedia of the War was published in weekly parts from 1914 until 1920 and included large sections on the injuries and diseases associated with the war and, most importantly, with the successful treatments that were developed throughout. The Larousse Médical Illustré de Guerre served a similar function in France. Historians were slow to recognize these links and, as Roger Cooter has acknowledged, it was not until John Keegan’s The Face of Battle, first published in 1976, that the history of war and medicine began to be taken seriously.22 This history of war and medicine is now established and the history of First World War medicine is thriving, with a wealth of literature on very specific aspects of military medicine, for example surgery, shell shock or facial injury.23 More broadly, Mark Harrison’s The Medical War is a recent and detailed study of British military medicine as a whole and Ana Carden-Coyne’s Politics of Wounds explores medical power and patient culture in Britain during the First World War.24 Notably, Leo van Bergen’s magisterial Before My Helpless

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FIGURE 1.1  The nation at war had to be morally and physically healthy, hence the campaign to rid Britain of its polluting ‘microbes’: the German citizens, who had so recently become ‘enemy Aliens’.

Sight is the only overarching, international study of military medicine across the entire Western Front.25

Is war really good for medicine? At the heart of this relatively recent history is the relationship between war and medicine, and questions about the extent to which war really is good for medical progress.26 At one level this relationship is taken as axiomatic. Early histories of military medicine have charted scientific developments and outlined the organizational changes within armies, the medical profession

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and states.27 This approach has had a long and popular legacy as indicated by the NHS Military Medicine Timeline which begins with the proud claim, ‘For centuries, the extreme demands of war have driven medical advance and innovation, often leaving valuable peacetime legacies.’28 The splendid Musée de l’Armée, housed in the Hôtel des Invalides in Paris, holds Jeanne Til’s Aux Ambulances, a collection of six prints tracing the soldier’s journey from injury to convalescence. The explanatory notes emphasize the physical and moral care that the nurses provided for the wounded soldiers but also make it clear that the modern French nursing profession was properly structured as a result of the First World War.29 Again, it is the war which is presented as the catalyst for progress. This optimistic assessment is not, however, universal. Britain’s Science Museum is less celebratory and states boldly that ‘the carnage and waste of war outweigh any positive aspects of conflict, even for medicine’, while the NATO/OTAN Review, while recognizing medical achievements, also recognizes that this progress narrative is one to be questioned rather than simply fêted.30 These examples of a more nuanced popular history which queries the straightforward links between war and medical progress are the result of an historiography which has focused on questions of war, medicine and modernity since the 1990s. There is no doubt that there were clear examples of medical progress during the First World War: doctors were able to limit infectious diseases; typhoid and tetanus inoculations were effective; X-ray techniques improved, as did blood transfusions and amputations. Developments in wound management and orthopaedic surgery were particularly impressive and modern plastic surgery developed rapidly in a way that would have been inconceivable without the burns and the shrapnel wounds of trench warfare.31 All of these innovations were supported by more effective triage and evacuation processes which ensured that more men were in the right place actually to receive medical care. In addition to medical treatment, military authorities also paid greater attention to issues connected to health and welfare: sanitation, a proper diet, physical exercise, rest and recreation. Of course the war promoted conditions which then had to be tackled and which might not have existed otherwise, such as gas gangrene or trench foot, but it is undeniable that medical knowledge increased in the years 1914–1918. Yet the progress of medical practice in the First World War was also problematic in that it required the implementation of rational, efficient, standardized routines and behaviours. There was a strict division of labour, uniformity, centralized inspection regimes and an emphasis upon discipline and compliance.32 The male body became reduced to a standardized unit to be measured, assessed and used as an industrial component in an industrial war. This process affected medical staff too, especially the civilian doctors in the RAMC who initially chafed against what they perceived as a loss of individuality and professional autonomy. Nevertheless, medics had little power against the over-riding logic that a systematized military health service was required to deal with systematized military slaughter.

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We need also to question the extent to which the broader environment of war can really be helpful to medicine. The Western medical tradition has been based on local practice, empirical knowledge, religious belief and familial custom. At the same time practice has consistently been informed by what we would now think of as international or transnational communication and so there is no such thing as purely ‘French’ or ‘German’ medicine. There is not even European medicine.33 The internationalization of military medicine was facilitated by the customary use of the militarymedical observer. Surgeon General Sir Thomas Longmore (1816–1895), for example, went to France as an observer during the Franco-Prussian War (1870–1871) and was impressed by the Prussian use of the railways to transport casualties and by the Prussian vaccination policy which dealt effectively with smallpox.34 Similarly, French and German medical observers admired the special clearing hospitals organized for the Russian psychiatric casualties of the Russo-Japanese War (1904–1905). These procedures were widely discussed in medical journals after the war.35 This type of exchange was part of established medical practice by this stage but the heightened nationalism promoted by total war – and the long duration of the First World War – inevitably diminished international cooperation and so impeded rather than encouraged the exchange of medical information. Central to the argument that war is good for medicine is the belief that war allows doctors to innovate to an extent that would be impossible in peacetime. During the conflict doctors openly described the war as a great ‘experiment’ and this conceptualization has been explored in the historiography which has often emphasized the way in which doctors saw the war as ‘a great clinical trial and laboratory in which to refine concepts and practices from the civilian world’.36 Yet a war is not a laboratory. There are no control conditions; there is often little time for reflection; and during the First World War many doctors even complained that it was impossible to keep track of notes, let alone maintain effective dialogues with colleagues. Moreover, doctors were often diverted from strictly medical tasks and many felt they spent excessive amounts of time on army administration, especially with regard to transport and sanitation: ‘I joined the Army as a doctor and not as an odd-jobber’, grumbled Captain Henry Waynard Kaye, a civilian doctor who had joined the RAMC in January 1915.37 He was full of enthusiasm for the challenges of army life but quickly grew tired of military red tape and his war service was continually blighted by ‘petty little office jobs and signatures, stamping and censoring letters, war diary etc etc – an unadulterated nuisance’.38 Army bureaucracy was not simply irritating but could hinder medical progress and Kaye struggled to publish an article on meningococcus septicaemia on account of ‘the tangle of red tape, predatoriness [sic], and obstructiveness, which appears to be provided by the Army for such excesses of zeal’.39 Even when doctors could concentrate on medical work, military medicine was highly fragmented and a wounded soldier usually passed through numerous aid posts, medical stations and hospitals, with the result that no one doctor

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was able to maintain a complete view of his medical progress or of the development of complications. In addition, medical practice was not always as rational or as standardized as the military authorities would have wished and French doctors working at the Salpêtrière hospital in Paris admitted that some of their methods were ‘makeshift’.40 This was especially the case with unfamiliar conditions such as psychological trauma, and some Italian wartime doctors even abandoned the attempt to make any correlation at all between diagnosis and treatment.41 It is also the case that the experimentation required in the chaos of war may have had little use outside of the battlefield. First World War doctors were certainly innovative and courageous, they operated in makeshift and unhygienic theatres, they made-do with whatever drugs and instruments they had to hand and sometimes they even turned ballrooms into hospital wards. Yet these skills were often of little use anywhere else and medicine itself did not necessarily benefit from the fact that doctors had to work in dank and dangerous conditions for years. The surgeon who learnt to amputate limbs by candlelight in a hastily converted barn returned to brightly lit operating rooms as soon as he or she was able. Leaving practical issues aside, we also need to consider the repercussions of seeing war as a ‘laboratory’ or even ‘schoolmaster’. There are few straightforward ‘results’ or ‘lessons’ from battlefield surgery. Some practices could only be repeated in very specific circumstances; for example the conservative surgery which had been so successful in the hot, dry terrain of the Boer War was of no use at all on the damp, highly manured battlefields of the Western Front.42 It is hard even to imagine how some battlefield surgery could result in useful, transmittable knowledge. Kaye was both horrified and baffled by a bad wound he encountered in a dressing-station during a night of heavy fighting. He notes, ‘One man had a bad compound Tib and Fib with an irregular lacerated wound the size of my hand, which was crawling with maggots and a kind of centipede. Very unpleasant and surgically a new problem.’43 Kaye may well have solved this particular and novel problem but there is no reason to assume that he was able to put the acquired knowledge to good use afterwards. And even if there are useful lessons to learn, we do not always remember them as the treatment of combat trauma so aptly indicates. The ‘lessons’ from the treatment of First World War shell shock were swiftly and effectively forgotten, much to the detriment of men suffering from psychological injuries in later wars.44 We need also to consider the ethics of medical experimentation. While we all accept that medical experimentation is necessary and that it is in fact the bedrock of medical progress, we are all rather wary of it too and wish for medical research to be highly regulated. We want experiments to be conducted in laboratories at some distance from suffering humans and we are very wary of new, untested, untried medical procedures or products. This suspicion is in part due to the terrible abuses carried out by Nazi doctors in the name of medical experimentation and is in part due to fears about the

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impact of new drugs since the thalidomide disaster of the 1960s. Yet fear of medical experimentation is not just a post–Second World War phenomenon. First World War soldiers were wary of it too as Erich Remarque’s (1898– 1970) chilling description of a doctor’s ‘medical hobby-horse’ indicates: Let the old man get you under the knife and you’re cripples. He’s after guinea pigs for his experiments, and the war is a good time for him, just like it is for all the doctors. Have a look around the ward downstairs; there are at least a dozen men hobbling about after he’s operated on them. A good few of them have been here since 1914 or 15 – for years. Not a single one of them can walk better than he could before, and for nearly all of them it’s worse, most of them have to have their legs in plaster. Every six months he catches up with them and breaks the bones again, and every time that’s supposed to do the trick.45 Soldiers were entitled to refuse any unwelcome medical experimentation and of course most doctors simply did their best to treat the many sick and wounded men they encountered in wartime. Remarque’s fictional ‘old man’ does, however, indicate a real concern amongst soldiers, namely that war might have been better for medicine (and for unscrupulous doctors) than it was for men.

War, medicine and individual men A French soldier was brought in with a bad wound in his leg. Like many other cases at that time, it had been neglected and gangrene had set in. Our doctors did what any doctor would have done: they amputated the leg. The man’s life was saved but a thunder-clap of protest descended on our unit. Did we not realize that limbs could be amputated only by special official permission? Our doctors smiled as though they had no interest in any such authority, and they were shaken out of their ‘phlegm’ only when they learned the facts. The French had a definite and fixed rate of compensation and pension for the loss of a limb, and with true Gallic logic the government preferred to risk a man’s life rather than have the certainty of paying a pension to a disabled man.46 This story highlights the extent to which a man’s body was not his own during wartime but was very much part of the state-led, military-industrialbureaucratic complex. Yet it also raises another point. Whether or not war is good for medicine is somewhat of an abstraction; our concern here is more with the ways in which individual men experienced health, medicine and medical care during the war. There are those who argued that a soldier’s life was an essentially healthy one during the First World War. Reports indicated that young French troops

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were apparently benefitting from life in the open air, a comment indicating pre-war fears about the dangers of modern urban life which cooped up young men in unwholesome factories, shops and offices.47 Initially men were also given plentiful food in the French, German and British armies, a real boon for the young men from the poorest social classes, many of whom would have experienced real hunger and deprivation in their civilian lives. Even men from reasonably comfortable backgrounds could benefit from military life. Eric Peppiette, a 24-year-old Lance Corporal from Liverpool, had been an assistant librarian before signing up and so presumably had led a relatively sedentary existence. After five months of service he went home on leave, in high spirits and feeling very fit indeed. His family agreed that he ‘was much broader and never looked so well before’.48 Sieur believed that, for great warriors, ‘the soldier’s health is the highest good’ but the wartime doctor is concerned with the strength of the army as a whole, not the health and well-being of the individual soldier.49 The idealized doctor–patient relationship was one based upon intimacy, confidentiality and the primary importance of each patient but army doctors fell far short of this ideal and Peppiette was not alone in feeling disappointed, possibly even betrayed, by his first encounter with a medical officer on active service. He wrote the following in his diary: ‘The boys were medically inspected at 12 o’clock, or rather they were supposed to be medically inspected. The inspection consisted of a parade before a M.O. who asked laconically “Do you feel all right?” to each man. No attempt was made to sound the men or look for varicose veins.’50 Peppiette’s medical officer may have been just lax, or he may have been overworked and disillusioned. The more serious problem was that in the military world the doctor was very much part of the military hierarchy and medical complaints were a matter for public discourse and public display. Men could only see a medical officer at appointed hours and sick men had to appear at daily sick parades. As a result there was no intimate doctor– patient relationship and little doctor–patient privacy, and military doctors were much more concerned with discipline and punishment than their civilian counterparts. Kaye, who had only been in France for about four months by this stage, effectively outlined the duties of a medical officer during the war: It is however easy to see how extremely important it is for every care to be taken to see that men who go sick must be handled correctly from a military standpoint by the medical officers. The men must be made to understand that it is their duty to do their utmost to carry on with their work and not go sick, and if this attitude is steadily adopted by the medical officers, they all get to know it and it keeps them up to the collar – otherwise the wastage becomes enormous and also the difficulties of the men in the firing line are very much increased.51 Here the military hierarchy was made plain: men had a duty to avoid going sick and medical officers had to ensure that they were compliant. In a work

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published before the war, and republished after it, Charles Henderson Melville, professor of hygiene at the Royal Army Medical College, emphasized the importance of continual observation in this process: ‘The real invalidity of the unit resides in comparatively few men. These are the men on whom he has to keep his eye … the “weak points” of his unit.’52 As part of the fighting unit the potentially sick soldier was essentially dehumanized; he was less of a man in need and more of a ‘weak point’, a defective component in a much larger machine. This relationship was sometimes expressed through a gallows-humour, one in which the soldiers’ tendency to shirk and the doctor’s obligation to detect were made the butt of a joke. At one military camp the medical officer put the following notice outside the surgery tent: HINTS TO THOSE WHO FOR ONE REASON OR ANOTHER WISH TO GO SICK

1. Don’t spring smartly to attention and walk briskly up to the Medical

Officer when you have chosen an injured knee-cap. 2. Don’t forget that sprained wrists and ankles are always swollen. 3. Don’t, on emerging from the ‘Presence’, let your friends shout ‘Any luck?’ Those wishing for further advice should apply for my various illustrated pamphlets, price sixpence each. The most popular are: (1) How to raise and lower your temperature. (2) How to strengthen and weaken your pulse. (3) How to get a bad tongue. (4) How to get a very bad tongue (price one shilling). (5) How to make the joints swell. (6) Paleness. (7) Useful illnesses, their symptoms, duration and remedies.53 British military doctors were renowned for blithely dispensing pill ‘number 9’ (a laxative) to all soldiers, whatever their complaints, prompting a wellknown joke amongst medical orderlies: ‘In case of emergency, where there are no “Number 9’s”, give patient a “4” and a “5”. Failing “No. 5’s” give two “No. 4’s” and owe him one”.’54 Joking was one way of coping with the demands of military life but soldiers did not always see the funny side of medical-military discipline. This disciplinary role, one in which the health of individual men was a secondary consideration, provoked much hostility towards medical officers both during the war and afterwards. Ernst Thälmann (1886–1944), a corporal in the German army and later leader of the German Communist Party, kept reporting sick only to be told that he was perfectly fit. After going to the doctor with a burnt hand he was not excused from duties but sent to the front to join a combat unit.55 A sick or injured man should not have been sent to the front but given ‘light duties’, an elastic term which could be interpreted in a number of ways. Even at the beginning of the war, before

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there were fears about manpower shortages and excessive wastage, ‘light duties’ had become a well-known euphemism and men with acute rheumatic fever who were detailed to carry sacks of coal from lorries to furnaces may well have felt that their duties were far from ‘light’.56 At times the medical officer’s commitment to the army seemed excessive, even cruel. At a British medical board in 1915 a ‘broken-looking man with a shattered face and one eye’ presented himself to the officer in charge who refused to discharge him. There is ‘no reason at all for leaving the Army’, he insisted, ‘you can make yourself useful by cleaning out latrines and that sort of thing’.57 The casual cruelty of doctors is a limited but recognizable feature of the war literature. The novelist Léon Werth (1878–1955), who served as an ordinary soldier before being invalided out of the army, created a harsh, crude picture of military doctors. His Major Givet, a medical officer, was a vulgar, ruddy-face man who, when faced with a soldier having a fit, instructed the stretcher bearer to give the man a kick up the bottom.58 Displaying a similar hostility, Remarque’s old soldier, Kat, repeats a joke that had been told throughout the German ranks: Kat tells a story that has done the rounds all along the front, from Flanders to the Vosges, about the staff doctor who reads out the names of the men who come up for medical inspection, and, when the man appears, doesn’t even look up, but says, ‘Passed fit for service, we need soldiers at the front’. A man with a wooden leg comes up before him, the doctor passes him fit for service again – ‘And then’, Kat raises his voice, ‘the man says to him, “I’ve already got a wooden leg; but if I go up the line now and they shoot my head off, I’ll have a wooden head made, and then I’ll become a staff doctor”’.59 Soldiers displayed a specific anger towards doctors because of the contrast between the idealized doctor and the medical officer who was clearly part of a military compliance system. Doctors were educated and trained to be part of a compassionate profession and so should not have been part of a destructive military machine. Oskar Graf (1894–1967), the post-war novelist whose works were later prohibited by the Nazis, was drafted into the German army during the war and expressed the greatest bitterness towards doctors precisely because of the way in which they had betrayed their calling: You’re worse than any General or Kaiser, for you only use your knowledge to provide more people to be killed! – The Generals, the Kaiser, and all the military men do what they have been taught to do, but you – you, you have been taught something different, and you lend yourself to the greatest crime. You bring back to life men who have been hacked to death, so that they may be murdered and cut to pieces again! You’re a pander, a whore! 60

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Anti-doctor sentiment was visible in all combatant nations but especially in Germany, where, after the defeat, revolutionary ex-soldiers vilified military doctors, especially the psychiatrists who were sometimes even subjected to physical attack.61 Doctors did resent these criticisms and van Bergen has argued that in the post-war period doctors insisted ‘in the goodness of war for medicine’ precisely to justify their previous wartime activities.62 Doctors were not the only medics to provoke such anger. During the Boer War British soldiers routinely described the stretcher bearers as ‘bodysnatchers’. 63 In the soldiers’ minds the stretcher bearers were not much better than the thieving camp-followers of popular imagination, an association that still lingered in the armies of the First World War. During and after the war soldiers of all nationalities told stories about the dishonesty of medics, especially stretcher bearers and orderlies. The RAMC was widely known as ‘Rob All My Comrades’ and the first hospital scene in All Quiet on the Western Front emphasizes the soldiers’ certain knowledge that the hospital orderlies will steal their friend Kemmerich’s boots ‘the moment he is dead’.64 Ellen La Motte (1873–1961), an American nurse in France, described the fury of French soldiers when they arrived wounded from the front and encountered cold, indifferent orderlies who sat and drank wine, oblivious of the pain and the chaos around them. 65 Male orderlies were an obvious target for anger because they were men who, for one reason or another, were not fighting. The ideal, imagined carer was female as Lawrence Rowntree, a non-combatant in the Friends Ambulance Unit (FAU), made plain in April  1915 when castigating French brancardiers (stretcher bearers) for their cruelty: ‘I have heard of men nurses being as tender as women, but I’ve never come across a woman that would drop a wounded man off a stretcher from shoulder height, and laugh as she picked him up, but that is what four brancardiers once did. The man died’. 66 Female medical staff were assumed to be naturally ‘tender’ and were often idealized. It was easy to romanticize nursing and auxiliary staff especially the young, untrained female volunteers who were the perfect counterpoint to the essentially masculine, fighting soldier. Leaving the ideal to one side, individual women were subject to much derision too, and were castigated for being both cruel and sexually avaricious. An article in the Daily Mail made use of all of these tropes when describing the therapeutic massage carried out by female physiotherapists or ‘angel-faced sisters, gimlet-eyed “Sawbones”’: Lieutenants Jones, Smith and Brown, prostrate on downy quilts, are being spanked like naughty schoolboys by muscular young women … Let us look more carefully at these young Amazons with mystic symbols stamped on their arms. Who would believe that the dainty arms of that auburn-haired nymph could knead so mercilessly a bulging bicep streaked purple by a gunshot wound … another victim is perspiring with the friction imparted to his back by an unsympathetic thumper.67

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FIGURE 1.2 The massage – and a woman’s touch – could seem benign when applied to someone else. Source:  Reproduced with the permission of The Chartered Society of Physiotherapy. Wellcome Library, London.

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FIGURE 1.3  Here the patient seems more tortured than comforted by his treatment. The ‘Rules’ on the wall indicate who is really in charge. Source:  Reproduced with the permission of The Chartered Society of Physiotherapy. Wellcome Library, London.

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FIGURE 1.4  Men romanticized and sexualized female medics but were also afraid of them. The threat of a massage has reduced this soldier to the size and status of a captured German pleading for mercy. Source:  Reproduced with the permission of The Chartered Society of Physiotherapy. Wellcome Library, London.

This is a highly sexualized description in which the obviously alluring women were presented as a curious combination of dominatrix and angel. They looked like angels – French nurses were often described as les anges blancs (white angels) – but their actions were more like the early modern barbersurgeon armed with his sawbone. The men were wounded by the war and then beaten by ‘Amazons’ – warrior women – who continued to torture their flesh. A series of wartime cartoons emphasize the male fears of subordination here. The petite and sexually available physiotherapist, ‘the little bit of fluff’, becomes transformed into an overbearing and bullying matron. In response the wounded soldier cries out Kamarad, the word used by German soldiers giving themselves up for capture and pleading for mercy (Figures 1.2–1.4).68 In stark contrast to Til’s representation of women bringing succour, these images present female medics as malign bullies who have reduced British soldiers to the status of enemy prisoners. This anti-medical discourse was not universal but it did feature in commentary throughout the war and indicates that there was at least a section of the population who believed that the only really worthy role in wartime was that of the male combatant. It also served to underline the argument that medical staff – doctors, nurses, orderlies, stretcher bearers and so forth – were an intrinsic part of the whole war machine that served only to cause men pain.69

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Death, survival and a shared history Doctors were expected to save soldiers’ lives but they also had to deal with soldiers’ deaths. Alongside padres doctors were central figures at burial parties and Kaye described in detail the burial of an unknown soldier near Hooge (Belgium) in August  1915. First there were the preliminary rites: the collection of the pay book, letters and the man’s identity disc. This was standard military procedure but there were emotional requirements too. The subaltern in charge wondered aloud if the man’s family would like a button, prompting an immediate response from the other men: ‘Yes, sir, a large one’, chipped in a young soldier. ‘No, sir’, said the experienced older soldier, also of the party, ‘one large and two small, then they make a brooch of ‘em’.70 The officers agreed and Kaye commented that this was ‘a nice piece of thoughtfulness’ on the men’s behalf.71 In this war soldiers and their doctors were intimately linked by wounds, disease and death for almost four and a half years. The military hierarchy prevailed but there was still a strong relationship between ordinary soldiers and medics, as this episode by a stranger’s hastily dug grave indicates. It is the ordinary soldier, the man familiar with wounds and death, who is at the centre of this medical history of the First World War: the Tommy, the poilu and their German counterpart, the man they often called Fritz or Jerry or, more crudely, Boche. British soldiers had long been known as Tommies after ‘Tommy Atkins’, the fictional name used in the exemplar of a Soldier’s Pocket Book, and the French poilu (literally the ‘hairy one’) was so called because of his unshaven appearance.72 There is no similar nickname for the German infantryman. The men called one another Kamarad but the general public had no affectionate, familiar term for the ordinary soldier in Germany, possibly because the institution of the army was held in such esteem that a popular nickname would have seemed disrespectful rather than kindly or jocular.73 All of these men had a thorough knowledge of wartime medical practices (both formal and informal) and they had intense relationships with the doctors, nurses, stretcher bearers and orderlies who attended to them. By accounting for the men’s pain, their treatment and their care, we can get a glimpse of the social and emotional history of men at war. All combat troops and all medics encountered injury, illness, death and the fear of death, either personally or vicariously. In a sense this is very much a shared history: a German soldier with a shattered leg felt much the same as a French soldier with a shattered leg; a British doctor perplexed by the new gas wounds felt much the same as his German (one-time) colleague. Yet it is also comparative in that responses to pain and injury are to some degree social and cultural. In addition, while the conditions of warfare are often singular, military medicine is not a discrete category. On the contrary, there is a strong relationship between military and civilian medicine and the subject of medicine in war is inextricably bound up with contemporary notions of health, disease, power and privilege in societies at large.

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This book is organized thematically but focuses on the relationship between war, medicine and individual men throughout. It is a history of the primary combatant nations on the Western Front, that is to say, the ‘iron triangle’ of Germany, France and Britain.74 To some extent it compares these countries with each other in that there were different national traditions and different military organizations but it mainly stresses the shared experiences of wartime military medicine and it uses medical encounters to explore a history of the men who fought and of those who tried to care for them. Chapter 2, ‘From the Trench to the Hospital’, details the way in which the wealthy, well-developed societies of Western Europe organized their militarymedical services. For some commentators this was a real demonstration of scientific progress, efficiency and humanitarianism. For others it was an indication of complete medical and scientific failure in the face of industrial weaponry. Did these somewhat rarefied debates mean anything to ordinary soldiers? Men were aware of the highly organized and increasingly reliable medical systems around them but they were also familiar with the random, often surprising violence of life on the Western Front. Even without the violence of combat, a soldier’s life was characterized by disease and sickness, some of which were specifically associated with the trenches, namely trench fever and trench foot. The official, scientifically approved networks of care for these men involved neat diagrams and clearly demarcated transmission lines: the table illustrating the French Service de Santé en Campagne is like some kind of modernist dream with its neat rows of hospitals directly linked to well-defined armies by definite and well-staffed evacuation routes (Figure 1.5).75 This provides a stark contrast with wounded men’s stories of their own personal journeys, which, even when successful, were messy and complicated. It is part of the legacy of the First World War that some wounds have come to be emblematic of the long, drawn-out conflict on the Western Front. It is these ‘iconic wounds’ – gas, shell shock and facial injury – that are the subject of Chapter  3. These were not necessarily the most debilitating of wounds; nor were they the most devastating in terms of wastage. They have, however, come to symbolize the war on the Western Front, albeit with some national variation: facial wounds have become tremendously important in the French social and political history of the First World War, while shell shock occupies a similar position in British understandings of the war. In all of these cases, the wounded soldier exemplifies the ‘pity of war’ rather than the progress of medicine. Chapter 4 moves from the symbolic, highly represented, iconic wounds of war to a history of ordinary soldiers and their pain. 76 Ordinary soldiers often had to look after themselves and their friends without the aid of medical professionals. Sometimes wounded men simply had to wait for proper medical attention; more generally, sick, wounded and fearful men took responsibility for their own physical and mental health as best as they could. They used traditional soldiers’ remedies such as alcohol and tobacco but

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FIGURE 1.5 This diagram of the French army medical services outlines rational and clearly defined systems of transport and communication. Yet for many wounded men, evacuation and access to medical care did not seem so straightforward. Source:  Image provided by the British Library, London.

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they also used stronger drugs like opium and cocaine. Conceptualizations of injury were also a coping mechanism. Sometimes men could see themselves as heroes; sometimes they could celebrate a trivial wound (a Blighty) because it gave them some respite. Sometimes men were driven to self-destructive behaviour and they wounded themselves in an attempt, however, morally discredited, to save themselves. It is this self-management, some of which might now be categorized as self-medication, which has been historically marginalized, although it dominates both personal accounts and the wellestablished, literature of the war. 77 The aim of this book is to explore the medical world of the Western Front and to indicate how men managed the bodily and psychological demands of total war. There was one group of men for whom medicine occupied a very specific role, and for whom the relationship between war and medicine provoked serious philosophical and practical questions. Pacifists, those who held a principled objection to war, had few choices in the militarized nation states of Europe in 1914. To some extent they were emotionally and practically prepared for the conflict because pacifists had been discussing the threat of war many years before its outbreak. Norman Angell’s The Great Illusion was first published in 1910 and it argued forcefully that modern war was futile. It was extremely popular as was a widely publicized Russian study which outlined the probable consequences of a major European war: a horrendous bloodbath, trench warfare, military stalemate, no victory and widespread revolution.78 Foretelling a similar outcome, Wilhelm Lamszus’s The Human Slaughterhouse was published in 1912, and a second volume, The Madhouse, was scheduled for publication in 1914 but was delayed on account of the outbreak of the real, as opposed to the imagined, war.79 In retrospect these accounts seem remarkably prescient and appear to justify the pre-war pacifist movement as well as those men who refused combat roles during the war. However, refusal was difficult, if not impossible, for most men. In France, Germany and Britain men were all conscripted into the armed services and only in Britain was there a clause for ‘conscientious objection’, allowing some men the option not to fight under very specific and highly limited circumstances. Yet for many pacifists, simply saying ‘no’ was insufficient because it did not lessen the suffering by one jot and it could easily be taken for cowardice. For these men, some kind of medical service seemed like an obvious solution because it would enable them to do good in a world dominated by destruction. Nevertheless, a medical contribution was not always a straightforward solution and as war grew to encompass all aspects of national life many started to worry that medical service was simply another way of participating in military action. Chapter 5, on medical pacifism, looks at the role of pacifist medical volunteers in the British and French armies and highlights the somewhat neglected tales of those men who did not fight but who saw medicine as an alternative to military service, despite the compromises and contradictions involved. The experience of medical pacifists in the First World War raised important questions for later

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generations, namely: Is medicine an inherently pacifist profession? Is taking a medical role just another way of supporting militarism? 80

Daddy, what did you do in the war? One of the most enduring of the British wartime propaganda posters is Savile Lumley’s Daddy, what did YOU do in the Great War?, issued by the Parliamentary Recruiting Committee in 1915 (Figure 1.6).81 In this poster an imagined post-war father sits in a comfortable armchair with his daughter on his lap while his son plays with toy soldiers by his feet. However, ‘Daddy’s’ physical comfort is offset by his psychological unease because this man did nothing in the Great War and so had no war stories with which to regale his children. His shame is palpable. Not all men subscribed to the emotional state demanded by the Parliamentary Recruiting Committee and not all men needed a conventional war story. When asked, ‘What did you do in the war?’ James Joyce allegedly replied, ‘I wrote Ulysses, what did you do?’, but most men were not like Joyce.82 The men of the 1/3 West Riding Field Ambulance were acutely aware of the importance of telling their war stories, and during Christmas 1915 the editor of their journal proclaimed, ‘How proud you will feel when, in after years, you are asked “How did you spend the Christmas” of 1915?’ And you can look up unashamed when you give the answer’.83 Pride in military service and the garnering of a good war story were important but most children just wanted their fathers to stay unharmed and alive, a sentiment common in all wars as Philip Gross’s words – an imagined conversation with a father who had stayed alive during war– indicate. What did you do in the war, daddy? What did you do on Thursday? No simple answer to either except (if such point-blank words could come to save you: What I had to. Stayed alive.84 So for all of the attention which must be paid to wounds, sickness and death, this is a book about how men tried to stay alive and how they tried to keep others alive. Military doctors, for whatever reason, wanted to save as many men as possible, as did nurses, stretcher bearers and orderlies. Even the most jingoistic and militaristic army doctor was morally and legally obliged to help enemy troops as well as his own; even the most jaded stretcher bearer and the most callous of nurses and orderlies were part of a system designed to keep men alive. The fighting troops wanted to protect themselves and they wanted to help their friends and (sometimes) even their enemies. They

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FIGURE 1.6  ‘Daddy’ is uncomfortable because he took no part in the war. Soldiers and medics – even medical pacifists – all wanted war stories to tell in their post-war years. Source:  Reproduced with the permission of the Imperial War Museum, London.

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did so formally and informally, effectively and ineffectively. The history of this war is intensely focused upon those who were killed, and given the extraordinary casualty figures, this is no great surprise: the numbers of dead are still overwhelming and those who remained alive often found it hard to tell their stories. In response this is a book about the medical practices and the medicine that men used to ensure their own survival and that of their fellows. It is about those who, at the end of the war, could claim that they had simply ‘stayed alive’.

Further reading Brunton, Deborah, ed. Medicine Transformed: Health, Disease and Society in Europe, 1800–1930. Manchester: The Open University, 2004. This text provides good background information for understanding attitudes to medicine and medical concepts in the period. Cecil, Hugh and Peter Liddle, eds. Facing Armageddon. London: Leo Cooper, 1996. An international study of the experiences of civilian and service personnel which also shows how the First World War shaped the modern world. Carden-Coyne, Ana. The Politics of Wounds: Military Patients and Medical Power in the First World War. Oxford: Oxford University Press, 2014. A cultural history of military patients which provides a real insight into the minds of wounded personnel by its focus on their writing and their drawings. Cooter, Roger, Mark Harrison, and Steve Sturdy, eds. Medicine and Modern Warfare. Amsterdam: Rodopi, 1999. A series of essays examining the development of medical practices within the armed forces from the late nineteenth century until the Second World War. Cooter, Roger, Mark Harrison, and Steve Sturdy, eds. War, Medicine and Modernity. London: Sutton, 1999. This spans the period from the FrancoPrussian War to the Second World War and highlights the relationships between war, medicine and the modern world. Gabriel, Richard. Between Flesh and Steel: A History of Military Medicine from the Middle Ages to the War in Afghanistan. Washington, DC: Potomac Books: 2013. A chronological, cross-cultural and comprehensive history. Gabriel, Richard and Karen Metz. A History of Military Medicine from Renaissance through Modern Times, Vol. II. London; New York; Westport, CT: Greenwood Press, 1992. This volume charts the growing sophistication of military medicine in response to the Renaissance and the scientific revolution. Harrison, Mark. The Medical War: British Military Medicine in the First World War. Oxford: Oxford University Press, 2010. This is a detailed history of military medicine on the Western Front and in other theatres of war. It is essential reading for anyone engaged on the study of this subject. Jackson, Mark, ed. The Oxford Handbook of the History of Medicine. Oxford: Oxford University Press, 2011. This is a collection of thirty-four essays detailing the history of medicine from the Graeco-Roman world onwards.

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Keegan, John. The Face of Battle: A Study of Agincourt, Waterloo and the Somme. New York: Viking Penguin, 1985. This is primarily a military history which assesses the experiences of combat across time. Scotland, Thomas and Steven Heys, eds. War Surgery, 1914–1918. Solihull: Helion and Co., 2012. A detailed study of First World War surgery which argues that the work of surgeons in 1914–1918 laid the foundations for modern military surgical practices.

CHAPTER TWO

From the Trench to the Hospital In the summer of 1915, many different men in the Welsh regiments on the Western Front reported overhearing the following conversation: ‘Dai, which would you rather be killed in – a railway accident or an explosion?’ Dai munched for so long that the question was repeated, and he continued to weigh the choice before answering: ‘Well – I think I would rather be killed in a railway accident than in an explosion’. There was a pause before he was asked, ‘Why would you rather be killed in a railway accident than in an explosion?’ A tin was opened and jam spread on bread. ‘Well, Evan, I think I would rather be killed in a railway accident because there you are, but if you are killed in an explosion, where the hell are you?’1 This tale, probably apocryphal, reveals one of the soldiers’ greatest fears: that of being torn apart or of being literally blown to pieces. The literature of war often makes reference to a ‘baptism of fire’ as though the first bombardment was a test, after which everything was easy. Yet even battlehardened soldiers remained afraid and wanted to maintain their bodies intact, whether in life or death.2 The fear of disintegration even superseded that of death and explains why so many soldiers were repulsed at the thought of autopsies and other practices which threatened the integrity of the corpse, and may well explain the reluctance of wartime artists to portray soldiers without limbs. As a result, the everyday language of the soldier emphasized the importance of keeping a ‘whole skin’.3 As soldiers knew, many of them were quite unable to keep their skins whole and the high casualty statistics were unsurprising, given the context of total industrial warfare. Actual danger varied depending on the sector and the time of deployment but most men in active service were armed with – and confronted with – repeating rifles, high-velocity bullets, explosive shells, shrapnel, hand grenades, bombs, machine guns capable of firing 600 rounds a minute, artillery, flamethrowers and gas.4 The most up-to-date technology

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was employed to develop aeroplane bombardment; high explosives were dropped from zeppelins; and tanks, a new weapon, were deployed from 1916. Men like Dai and Evan were well aware of the consequences of this firepower and many war memoirs describe encounter after encounter with maimed, dead and damaged bodies. Surveying the scene near Pozières in July 1916, Paul Maze, a Frenchman serving with the British Expeditionary Force, noted that ‘whole parties had been blown to pieces … I had a glimpse of the previous night’s No Man’s Land pitted with fresh shell holes, most of them rimmed with motionless human forms’.5 Keegan has pointed out that less than 1 per cent of all First World War battle wounds were from edged weapons and that it was high explosives rather than bayonets that caused the real damage.6 Yet brutal hand-to-hand combat continued alongside the more modern means of destruction, and although not statistically significant, it had a great emotional and psychological impact. There were tales of men fighting each other with spades and Stephen Westman, a doctor in the German army, asked himself, ‘How could cultivated and civilized men hurl themselves against each other in the most savage manner, like mad dogs, and thrust bayonets or daggers into the chests or the bellies of their adversaries?’7 ‘Civilized men’ were also killed and wounded by the environment of trench warfare: men were caught on the barbed wire, they were buried alive and they drowned in the mud. About 30 per cent of all wounds were bullet wounds, a relatively low figure precisely because bullets were so lethal. Shell or bomb wounds were far more prolific as were those caused by splinters or shrapnel balls.8 All of these could inflict multiple wounds, sometimes leaving a man in pieces, sometimes causing him to disintegrate altogether, and in Dai’s words, they caused a man to wonder, ‘where the hell are you?’ When we look at old photographs of First World War battlefields, it is hard to see anything other than mud and chaos. Pictures of wounded soldiers similarly evoke disorder. The men wear dirty, torn clothes; sometimes they stumble alone; and often they are helped by their friends. Even those being rescued by official stretcher bearers or being treated by doctors at an aid post seem to be in disarray: the antithesis of the strong, intact and uniformed warrior. It was of course the duty of the various military-medical corps to bring some order into the chaos of the battlefield and many were proud at having done so. Clear systems of evacuation were organized so that soldiers could be moved swiftly from the battlefield to aid posts and from there to clearing stations and to base hospitals. A network of horse and motor ambulances, hospital trains and barges transported the severely wounded into the safe interiors of France and Germany. British troops required a further link – the hospital ship – to take them to the safety of home territory. This system relied as much on effective transport links and modern bureaucracies as it did on the advances of medical science. William Osler (1849–1919), professor of medicine at Oxford University, famously

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celebrated the way in which ‘there has been evolved a wonderful machinery, replete with science, for the transport and care of the sick and wounded’.9 On considering the destruction of modern warfare, Osler accepted that science could be seen as a highly destructive force. After all, it was the development of science that enabled the prosperous Western nations to build battleships and submarines, to create powerful artillery weapons and, most significantly, to use gas as a weapon. Yet on considering the benefits and drawbacks of science, Osler encouraged his listeners (and readers) to imagine a blissful, quasi-biblical scene: Come with me ‘somewhere in France’, to the top of a high down overlooking the sea. At our feet lies a city of tents, spread out for miles between the dunes and the downs, white and spotless against the evening sun. Lines are seen dividing sections of the encampment, and the scene reminds one of the description of the tents of Israel pitched in Moab and putting Balaam and Belak to sore perplexity. Figures in white and in khaki flit about, and now and again a motor lorry passes up the main line, but it is a peaceful scene on a summer’s eve – in Picardy.10 It was the power of science that enabled men to create such peaceful harmony in the midst of the horrors of the Western Front, a benevolent power recognized by the ordinary soldier. In asking the question, ‘Is science for or against humanity?’ Osler answered, ‘The wounded soldier would throw his sword into the scale for science – and he is right’.11 It is unsurprising that Osler, a man who had spent a lifetime considering the relationship between science and civilization, should pose such a stark question and answer in the affirmative but he cannot speak for the ordinary man in the trenches. Did the wounded soldier really ‘throw his sword into the scale for science’? Ellen La Motte did not think so. Watching the painful, prolonged death of a soldier suffering from gas gangrene, she concluded that ‘the science of healing stood baffled before the science of destroying’.12 Yet both Osler and La Motte were essentially spectators, albeit spectators with an intense emotional and professional involvement in the subject of war wounding. Their comments frame the debate but they do not answer a central question: How much faith did soldiers have in the medical services which surrounded them and in the whole medical-military machinery which had been designed to treat them?

Military losses: Wounds, sickness, disease For all its comic value, Dai and Evan’s conversation was one based on a sound understanding of the realities of war, as Table 2.1 indicates.

30

TABLE 2.1  

MEDICINE IN FIRST WORLD WAR EUROPE

Statistics and battle losses

Nation

Mobilized

Killed and died from wounds or disease

Wounded

Missing or prisoners

Total

British Empire

8,654,467

929,812

2,097,994

32,391

3,063,664*

France

8,407,000

1,109,000

3,025,613

252,900

4,387,513

Russia

12,000,000

1,700,000

4,950,000

2,500,000

9,150,000

USA

4,175,367

112,855

224,089

14,363

351,207*

Italy

5,500,000

460,000

947,000

1,393,000

2,800,000

Belgium

267,000

104,779

77,422

10,000

192,201

Roumania

750,000

200,000

120,000

80,000

400,000

Serbia

707,343

322,000

28,000

100,000

450,000

50,000

3,000

10,000

7,000

20,000

Greece

230,000

15,000

40,000

45,000

100,000

Portugal

100,000

4,000

15,000

200

19,200

Montenegro

Japan

850,000

300

907

3

1,210

Germany

11,000,000

1,686,061

4,211,469

991,341

6,888,871

AustroHungary

6,500,000

800,000

3,200,000

1,211,000

5,211,000

Bulgaria

400,000

101,224

152,399

10,825

264,448

1,600,000

300,000

570,000

130,000

1,000,000

Allied powers

41,640,177

4,960,746

11,535,718

4,434,857

20,934,995*

Central powers

19,500,000

2,887,285

8,133,868

2,343,166

13,364,319

Grand total

61,140,177

7,848,031

19,669,586

6,778,023

34,299,314

Turkey Total:

*Discrepancies in the original documentation. General Goodwin’s estimate of British losses, furnished to the surgeon general on 12 January 1921, was 474,254 killed in action, 139,664 died from wounds, 69,912 died from other causes, 1,668,573 wounded, 143 missing; total: 2,352,546. The French data were furnished to the surgeon general by Brig. Gen. L. Collardet, Military attaché of the French embassy on 22 April 1921. The Belgian data were furnished by Regimental Surgeon Voncken, editor of the Archives Medicales Belges, about the same time. Source:  Fielding H. Garrison, Notes on the History of Military Medicine (Washington: Association of Military Surgeons, 1922), 199.

Garrison’s calculations clearly contain some errors, even though they were produced in the relative calm of the post-war period, a reminder that we should be hesitant about the accuracy of all such statistics. It was simply not possible to determine the exact number of casualties across Europe. In the chaos of war the figures were often highly unreliable, even more so in those countries which suffered both war and revolution. Not all states had

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31

the extensive and sophisticated bureaucracies required to count accurately the numbers of wounded men and, in addition, hospitals tended to count wounds rather than wounded men, and many men were wounded on more than one occasion. Approximately half of all French troops were wounded twice and more than 300,000 were wounded three or four times.13 Ernst Jünger (1895–1998), a highly decorated German officer, counted up his wounds at the end of the war and reckoned that he had been hit at ‘at least fourteen times’, leaving aside ‘trifles such as ricochets and grazes’.14 Moreover ‘wounds’, ‘disease’ and ‘sickness’ are imprecise terms: a wound to the head or the trunk was more fatal than one to the arms or the legs; a wound to the abdomen was often more fatal than one to the head. An injury or a short illness could result in hospitalization, recovery and return to active service, or it could result in a lifetime of disability. The distinction between the sick and the wounded was officially an important one, nicely defined by Dr Henry Potter in 1917. Any man who is hurt by the act of the enemy is wounded whether it is a gunshot wound or gas pneumonia, while any man not hurt by an act of the enemy is sick. It makes no difference whether he is shot by his own rifle, burned by a premature powder blast, breaks his leg by falling in a charge, or is smashed up when troop trains crash together; he is a sick man on the records. A man may come in with a gunshot wound and die of pneumonia, but he dies of wounds. On the other hand, he may come in with feet frozen and die from amputation and secondary haemorrhage, but he dies a sick man.15 Caveats and fine distinctions aside, we do not need exact statistics to conclude that the number of casualties was unprecedented and horrific: approximately 8 million men were killed and almost 20 million were wounded. Of course, as the figures make clear, most men did not die and most men were not rendered permanently incapacitated by wounding. It can even be argued that from a military perspective casualties did not reach an unacceptable level.16 Nevertheless, millions of active servicemen – and those who loved them – had to live with the fear of death, disease and disability. As one British soldier told the war correspondent, Philip Gibbs, ‘I am a citizen of no mean Empire, but what the hell is the Empire going to do for me when the next shell blows off both my bleeding legs?’17 For men working in the developed nations of Western Europe, organized health care was no abstract concept because access to health care had been a significant, pre-war political issue. From at least the early modern period most European states had begun to develop institutional care for the very poor and the very sick, and, as we have already noted, especially for impoverished veterans. During the nineteenth century the process of industrialization had made questions of health and hygiene into important social and political issues, reflecting concerns about the health of the urban

32

MEDICINE IN FIRST WORLD WAR EUROPE

poor, the new industrial proletariat, in particular. Many of these problems were being tackled with some measure of success by the turn of the century.18 France, Germany and Great Britain were prosperous nations and life expectancy had increased in the late nineteenth century yet the health of both the urban and the rural poor lagged behind. Working people risked serious industrial injuries, they experienced arduous working conditions and working-class housing was often bleak and insanitary. The fear of famine had largely disappeared in Western Europe but working-class diets were generally inadequate and workers’ lives were blighted by periods of hunger. This chronic malnourishment was then reflected in a variety of health problems from rickets to defective teeth. In addition, the contrast between bourgeois and working-class health care remained stark. By the beginning of the twentieth century middle-class men and women leading comfortable lives were able to call on a scientifically-trained private doctor in times of need but working-class health care was generally precarious and largely based upon traditional charity and kinship networks, often supported by local philanthropists. The growth of scientific medicine, combined with greater worker organization, led to higher expectations amongst the working class. Trade unionists in particular were increasingly seeing access to public health care, or health care at work, as part of a wider package of (mainly male) workers’ rights. At the same time, elite fears about national degeneration and a diseased, dangerous working class ensured that there was a growing political consensus on health care. For a variety of reasons a number of different, often competing, sectional interests started to believe that widespread access to health care should be a matter of state policy. In pre-war Germany the Bismarckian welfare system had instigated a form of compulsory sickness insurance in 1883 to combat socialism amongst the working class. The system aimed to promote economic growth and to foster social stability by integrating the worker into society and the new German state. There was no unitary welfare state and much health care was still dependent upon local and voluntary activity, but the whole process had created ‘democratic expectations’, namely that health care should be based upon need, and not upon the ability to pay.19 The link between public health care and the state was reinforced by the fact that in Germany, unlike most of Europe, German doctors were civil servants and so were generally associated with public institutions or the state.20 In France the economically liberal state was intrinsically hostile to anti-individualist, collectivist approaches to welfare, and in consequence the secure working-class breadwinners tended to organize health care via mutual societies which employed their own physicians. Otherwise they turned to charity or to locally organized public assistance.21 Nevertheless the French state did provide free medical care to the very poor, and there was a level of state intervention in some areas such as vaccination campaigns.22 In industrial Britain, workers organized health care for themselves and their families through ‘friendly societies’ and the National Insurance Act of 1911 gave insured workers limited access to

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33

medical care from a ‘panel’ doctor.23 This system was extended during the war to cover all munitions workers.24 There is no essential link between democratic government and universal health care. Wilhelmine Germany was clearly authoritarian and neither the Third French Republic nor the pre-war British Empire could be described as democracies yet all of these states were representative to some degree and all accepted that the active male citizen had certain rights and deserved a level of state protection. More to the point, men, and increasingly women, were beginning to develop a sense of entitlement precisely because they saw themselves as citizens, whether they had the vote or not. These demands were particularly powerful in the context of mass conscription and total war when even British social elites began referring to the ‘citizen army’.25 The soldier of ‘no mean Empire’ was not convinced that his government would meet all its moral obligations when he was wounded but he was in no doubt that those obligations existed.

Army medical services Army medical services had increasingly professionalized throughout the nineteenth century. Moreover, scientific advances, especially developments in anaesthesia, antiseptic surgery and bacteriology, ensured that military doctors were able to provide more effective and consistent medical care to wounded soldiers than ever before.26 The potential of modern science and modern management methods was effectively demonstrated in the Russo-Japanese War (1904–1905) when the Japanese army pioneered an integrated casualty care and disease prevention system, ensuring that it lost fewer casualties to disease and infection than to wounds.27 The contrast with the Crimean War of only sixty years earlier could not have been starker. In the Crimea, British, French and Russian armies were ravaged by disease, primarily typhus fever, cholera, dysentery and scurvy, and the resulting scandals indicated the medical importance of sanitation and the political importance of paying serious attention to military health care. Military medicine was taken seriously during the First World War and medical staff were amassed on an unprecedented scale: the Allied powers mobilized 30,000 doctors on the Western Front alone and the Germans mobilized about 24,000.28 Nevertheless, at the beginning of the war none of the army medical services were properly prepared for the long-term industrial warfare of 1914–1918. In Britain the RAMC had been formed in 1898. At that point the British army had had little recent, direct experience of wars in Europe or of fighting against well-equipped and highly trained continental armies but the RAMC had reviewed its organization after the Second Anglo-Boer War. Medical officers were granted greater authority; education and training schemes were improved; and there was an increase in both military personnel and supplies. These changes were all due to the recognition that a large-scale

34

MEDICINE IN FIRST WORLD WAR EUROPE

European war was possible and that in the event of such a war casualty figures would be overwhelming. RAMC estimates indicated that a major continental conflict could produce casualties of up to 20,000 in any one day.29 Unfortunately their worst fears were completely vindicated. Reorganization was crucial to operational effectiveness but the sheer number of personnel mattered too. The RAMC required 12,000 medical officers at the start of the war and had to raise 11,000 of them from the civilian profession.30 In 1915 the War Office formally claimed all physically sound doctors under the age of forty-five years but initially the army relied upon volunteers, of which there was no shortage. Arthur Hurst (1879– 1944), who later became famous for his work with shell-shocked patients, was a civilian doctor attending a British Medical Association meeting near Aberdeen in August 1914 and he retained vivid memories of the outbreak of war. The meeting ended in dramatic fashion. There had been an exceptionally large attendance of German and Austrian doctors. On the last night the Lord Provost gave a ball, at which the foreign guests, who had been much in evidence at all the earlier social functions, were conspicuous by their absence. During the evening we noticed that one after another of the many officers present in uniform disappeared. The next day we said good-bye to our kind hosts and motored to Braemar, where we saw the mobilisation orders posted in the window of the village post-office. As we passed through Blair-Atholl we watched the gathering of the kilted private army of the Duke of Atholl and in the evening a telegram announcing the declaration of the war with Germany was read out in the lounge of our hotel at Pitlochry.31 Hurst’s descriptions hint at a vision of Britain, which has since become comforting and familiar through Ealing comedies and episodes of Dad’s Army. There is something vaguely amateurish about these preparations for war: suspicions were first aroused at a ball and then important government information was disseminated by local post office officials and helpful hoteliers. The private army – later associated with extreme right-wing activists – seems romantic rather than threatening here. Yet communications within Britain and the Empire were modern and efficient and made good use of the available technology. There was also a strong sense of commitment or compliance as of the 6,000 medical reservists who were called up, only seventeen failed to appear.32 On a less gentle note, Hurst’s reminiscences make clear some of the long-term consequences of an enduring and bitter European war. It was not just the occasional ‘foreign guest’ who left Britain in August  1914. The international medical networks of early twentiethcentury Europe broke up and the scientific profession as a whole faced real difficulties because the continental research community was shattered by the war. Some doctors regretted the way in which the ‘cosmopolitan

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35

character’ of scientific research had been destroyed but others gave in to an ugly xenophobia.33 Louis Pasteur had famously commented that ‘science has no country but the scientist has’ and this was certainly borne out by many medical men during the war.34 Captain Andrew MacPhail, professor of the history of medicine and a captain in the Canadian Army Medical Corps, later gave vent to anti-German sentiment in response to the Battle at Vimy Ridge in 1917: The German works in science as he works in war. He loves the underground. He throws out saps; he lives and moves and has his being in the darkness, when suddenly the free English spirit comes over the top in the full light of day. Science with us is only a part of life and a development from it. Our medicine is but a closer definition of what our fathers knew … let us grant to the uttermost that the pursuit of science is the pursuit of truth. The German cares nothing for the pursuit; he is all for the result, unaware that any given truth by itself is half a lie. There is the truth of the soldier, which is courage; the truth of the artist, which is beauty; the truth of the woman, which is virtue. The German believes that he has attained to all truth when he has discovered only a partial truth, forgetting that God alone is Truth, and that no man has looked upon God and lived 35 Here the language of science is merged with that of Christianity and with a romantic understanding of truth and beauty: according to all these markers of civilization the German had failed. Westman was aware of this type of judgement and later ruefully commented, ‘German centres of learning had been crowded with British scientists who had rubbed shoulders with us. Now they classed us as savage Mongolians, or Huns.’36 One way of demonstrating that the British were clearly not savages was by lauding the success of the medical services – the apogee of humanitarianism – and by emphasizing the extent to which ordinary citizens actively supported the army at war. The British army medical services did rely heavily on volunteers, not simply because this was an obvious response to the enormity and the expense of European warfare but because it had been deliberately built into the system. The Voluntary Aid Detachment (VAD) movement was established in 1909 with clear responsibility for a wide range of tasks. Its members were authorized to address weaknesses in the system of the collection and the evacuation of the wounded. VADs assumed responsibility for transporting the wounded from field ambulances to railheads and to hospitals, and for establishing rest and refreshment stations along the railway lines. VADs also established a network of auxiliary hospitals throughout the country. Given the highly gendered expectations of the early twentiethcentury workforce (whether paid or voluntary) men’s detachments were primarily responsible for duties of collection and transport while women’s detachments concentrated on rest stations and auxiliary hospitals.37 By the

36

MEDICINE IN FIRST WORLD WAR EUROPE

beginning of 1914, 519 men’s and 1,757 women’s detachments had been registered at the War Office.38 This proved to be a strong base from which to expand, and shortly after the outbreak of war there were 543 men’s detachments and 1,811 women’s detachments, with a total personnel of 23,047 men and 47,196 women.39 It is important to qualify this vision of a medically mobilized, highly efficient and war-ready Britain in August 1914. Not everything was efficient and not everybody was willing. Unlike Hurst, Warwick Deeping did not sign up straight away and remained working as a doctor in his own practice. It was only a result of social pressure from a number of sources – his wife, various aristocratic ladies, older country gentlemen and his senior partner – that he became ‘a patcher up of the bodies that the war would smash’ and he still remained reluctant to be involved with ‘organized murder and the organized collecting and reconditioning of those who have failed to become corpses’.40 For those who did sign up straight away there were some grumblings about the long gap between volunteering and actually going out to the front, and, when they were eventually in post some doctors then complained that they were not using their skills properly.41 Orderlies similarly complained that they were being treated more like navvies than like trained medics. There were also wider criticisms about the mismanagement of resources. On an important practical level there were particular problems with the assembly and the management of ambulance trains. Six ambulance trains were to be assembled in France at the outbreak of war so as to ensure the safe and swift movement of wounded troops. The six trains needed a total of 792 stretcher frames and 2,376 field stretchers as well as ordnance stores such as ward utensils. There were simply not enough stretchers and many trains were so poorly equipped that officers had to go to Paris to purchase essential supplies.42 The military reliance upon volunteers may well have allowed the British to feel that they were demonstrating ‘the free English spirit’ and that they were not under the yoke of Prussian militarism, yet a voluntary system has problems of its own.43 Modern British governments have traditionally held a strong ideological commitment to the small state but a condition of total war necessitates an overarching organization to mitigate against the variation and duplication which necessarily results from a high level of voluntary provision. One small example will suffice. In August  1914 the Army Medical Services (AMS) calculated that they needed sixty motor ambulance cars, and many companies and individuals stepped forward to provide them as gifts. The Wolseley Company donated a number of cars to the War Office, as did the Maharajah of Gwalior, Captain du Cros, MP, and the Automobile Association. Others were presented by the Scottish boroughs and by the British Red Cross. Being aware of this shortfall, Hurst gave his Wolseley car to the British Red Cross and offered to pay for its conversion to an ambulance but his offer was rejected and he was told that only horse ambulances were required in France.44 This may have been an isolated

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37

incident but the conflict between all the different voluntary agencies, namely the British Red Cross Society and the St John and St Andrew’s Ambulance Associations, led to confusion and disarray about the responsibility for service provision. Considering these problems shortly after the war, Surgeon William MacPherson, deputy director-general of the Army Medical Services, contemplated the reasons for this mismanagement: Great Britain had been for years notoriously backward in realizing the necessity of organizing voluntary aid for war and co-ordinating it, under War Office control, with the requirements of the medical services. The popular mind had for long been under the impression that voluntary aid, untrammelled by official control, would be the best, most prompt and readiest means of succouring the wounded on the battlefield.45 The ‘popular mind’ may well have been under this impression but managing all the wounded of the First World War required more than goodwill and enthusiasm. The voluntary services became increasingly under the control of the War Office as the conflict developed, partly to maintain military discipline and partly to ensure industrial-scale efficiencies. Yet the British government remained committed to voluntary medical provision, largely because it was cheap, and when wounded soldiers arrived back in the UK, they were transported almost entirely by volunteers and were very likely to be nursed in a voluntarily funded hospital.46

France France had a strong tradition of the regulation and state control of military medicine.47 After the French Revolution the armies of the new Republic recognized soldiers as citizens and acknowledged that they had the right to medical treatment on active service. Similarly, during the First Republic and the Empire doctors were also accorded citizens’ rights. In pre-revolutionary France they had mainly belonged to the Third Estate and so were devoid of privileges but under the post-revolutionary order they were valued citizens and they were promoted on merit. The early revolutionary years were marred by confusion as the old medical faculties and colleges were abolished but parts of the Napoleonic military-medical system, notably Dominique Jean Larrey’s (1766–1842) ‘flying ambulances’, light, two-wheeled vehicles which could quickly move the wounded to safety, were long held to be the basis for progressive, modern military medicine. The influence of Larrey, one of Napoleon’s physicians, was such that Captain James Dible later committed himself to translating Larrey’s memoirs in his spare time.48 Unfortunately the rights and the status conferred on French doctors remained largely theoretical and actual medical care fell far short of official commitments throughout the nineteenth century.49 Despite its progressive history, France

38

MEDICINE IN FIRST WORLD WAR EUROPE

was last major power to institute an autonomous military-medical service for its armies. When the French army entered the war in August 1914, it was supported by the Service de Santé des Armées (SSA). France began the war with 1,500 professional military doctors and mobilized all French physicians at the start of the war. In total, the French state mobilized 18,000 doctors and surgeons throughout the war but not all of them served at the front.50 The proximity of the theatre and the development of new technologies meant that physicians too old to be sent into the trenches could still play a key role in the army medical services. Raphael Blanchard (1857–1919), the parasitologist, pioneered evacuation of the wounded by aeroplane, while the renowned surgeon Théodore Tuffier (1857–1929) coordinated the administration of front-line surgery by telephone.51 This almost-total mobilization of physicians did have side effects, however and in some areas the civilian population found it almost impossible to access a doctor during the war years. In emergencies local people in the war zones, especially those without means, started to call upon the help of either military hospitals or army doctors billeted in their areas. This was the case in May 1918 when a young French mother brought her infant to the RAMC Base Hospital at Frévent (Pas de Calais). The military doctors agreed to operate on the ‘thin, semi-starved, miserable baby’ who was suffering from an internal abscess, and one of the soldiers’ wards then had ‘the novelty of a crying baby’, one of the many unintended medical consequences of warfare.52 Throughout the war doctors continually complained that they had limited power within the army structure and that there was poor liaison between the service at the front and at the rear. Pierre Hillemand, a medical student serving with the French army, described the conditions in a temporary hospital at Courville (Eure-et-Loir) about twenty kilometres west of Chartres, in February 1915. ‘Notre hôpital est une monstruosité’, he insisted.53 It had been snowing and the hospital was so short of supplies that the medical staff had to go from door to door asking for donations from the local population. They needed spoons, glasses, forks, coffee grinders, beds, pillows and mattresses, all of which the local people willingly donated but it was clearly no way to run a medical service. In addition, the hospital was not properly staffed or equipped to receive les grands blessés (seriously wounded men), a shortfall which could not be met by local goodwill.54 Allied commentators also noted that a very high proportion of French soldiers died from their wounds and they attributed this to the makeshift conditions in many French hospitals. The artist Christopher Nevinson (1889–1946), at this point a volunteer for the Friends Ambulance Unit, described the French military-medical services at their very worst, right at the beginning of war when the Service de Santé was almost totally overwhelmed: ‘Here they lay, men with every form of horrible wound,

FROM THE TRENCH TO THE HOSPITAL

39

swelling and festering, watching their comrades die. For three weeks they lay there until only a tortured half of them were alive.’ 55 Even as late as 1916, Henry Sheahan, of the American Field Service, provided a harrowing description of the French wounded, known as the déchets or ‘has-beens’. The château reeked with ether and iodoform. Pasty-faced, tired attendants unloaded mud, cloth, bandages and blood that turned out to be human beings; an over-wrought doctor-in-chief screamed contradictory orders at everybody, and flared into cries of hysterical rage. Ambulance after ambulance came from the lines full of clients; kindly hands pulled out the stretchers, and bore them to the wash-room. This was in the cellar of the dove-cote, in a kind of salt-shaker turret. The uniforms were slit from mangled limbs. The wounded lay naked in their stretchers while the attendant daubed them with a hot soapy sponge – the blood ran from their wounds through the stretchers to the floor, and seeped into the cracks of the stones.56 The French army medical services did improve rapidly throughout the war. The number of motor ambulances increased, hospital trains were improved and evacuation systems were streamlined. Aside from evacuation procedures, specialized medical and surgical centres were developed in the interior. The Service de Santé was directed by the state and the additional hospitals within France (lés hôpitaux complémentaires) were staffed by military personnel. Yet like all European powers the French government relied upon voluntary aid to maintain medical services throughout the war and the French Red Cross played a crucial role. By the end of the war, the three Red Cross organizations – L'Association des dames françaises, L'Union des femmes françaises and La Société de secours aux blessés militaires – had made an immense contribution to the auxiliary hospitals as the figures in Table 2.2 indicate. Nevertheless, although the Service de Santé gained much respect and autonomy by 1918, Sieur was still insisting that the army medical service held an ‘inferior, subalternized status’ long into the interwar years.57

TABLE 2.2  

Journées d’Hospitalisation (hospital days) provided

L’ Association des dames françaises

10,852,000

L’Union des femmes françaises

17,300,000

Société de secours aux blessés

45,170,000

Source:  François Bilange, ‘Justin Godart au Service de Santé Militaire durant la Première Guerre Mondiale’, Histoire des Sciences Médicales XXX, no. 1 (1996): 49.

40

MEDICINE IN FIRST WORLD WAR EUROPE

Germany The German army medical services were arguably the best-prepared for war in 1914. Since 1795 the Kaiser Friedrich Wilhelms Institut had incorporated military medicine into its training programmes, ensuring that Prussia had a well-integrated medical service far earlier than its European counterparts.58 At the outbreak of war the German state initiated an extraordinary mobilization of all sectors of industry and society and as a result all physicians were promptly mobilized for war service in August 1914.59 As in France, this does not mean that all of them were sent to the front but about 24,000 out of 33,000 male doctors saw service during the war.60 All German medical students had served as ordinary soldiers with the infantry for six months, and after qualifying as doctors, they had to serve as medical officers for a further six months.61 As a result, German doctors had far stronger links with the military than their British counterparts. Some British doctors had worked with the Officer Training Corps or in the Reserve Forces, but the majority of them had no experience of military life at all before joining the RAMC.62 The German army was fully prepared with both personnel and supplies, and plans were in place for the rehabilitation and re-education of wounded personnel.63 Like other European nations the German military also relied upon volunteers. The German Red Cross associations were organized on a Länder (state) basis, and on the outbreak of war, each state sent their contingents to aid the military corps. They also did much work on the home front where voluntary associations provided medical support and and ran soldiers' and sailors' welfare organizations.64 Yet the nature of the First World War was such that even a well-supplied and well-organized medical service still struggled and a reliance upon voluntary activity was no solution.65 On first seeing German advance field hospitals, Westman noted the long rows of stretchers awaiting a place at the operating table and wrote that ‘it was not exactly an encouraging sight’.66 Descriptions of his own treatment make the German army medical services appear basic, almost primitive, rather than modern and well-organized. After being wounded and rendered unconscious, Westman waited for hours, untended, in a slit trench. He was then transported by panje cart to a casualty clearing station where the operating theatre was ‘illuminated by candles and acetylene lamps’. His primary memory could be taken from any war in the early modern period: ‘I still remember the surgeon, in his apron spattered with blood, bending over me and cleaning my wounds.’67 The national armies of the Western Front each had their own medical traditions and organizations. Medical practice is always culturally based and there were clear differences between the medical organizations of the primary armies. There has been a tendency to compare the different medical services so as to rank them in order of efficiency but that is not the purpose of this chapter. The aim here is to stress the shared experience of wounded men,

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of whatever nationality. All army medical services operated a triage system and all organized care so that men could have immediate help from an aid post, a higher level of care from a clearing hospital and then prolonged care in rear or base hospitals if required. On a more abstract level, a soldier’s role changed somewhat once he was wounded and boundaries became blurred because it was common for men to use captured enemy prisoners to collect the wounded after a battle. The recently wounded captain Holtzapffel was able to see the absurdity in this, although he also acknowledged the humanity of his erstwhile enemies: I then had the priviledge [sic] of being carried back by four German prisoners, with a fifth holding a steel helmet over my face to keep the sun off! I give them their due. They were most careful and painstaking to make sure I was not jolted about going over the rough places, and we arrived at the aid post without any further excitement.68 In addition, all military doctors were obliged to treat the enemy wounded, and once wounded all soldiers were equally hors de combat and enemy combatants sometimes found themselves sitting or lying next to each other. Men who had been obliged to kill each other hours or even minutes earlier were forbidden to so as soon as they were wounded and in the care of the medical services. Jünger’s description of meeting a wounded British soldier at the Battle of Cambrai is uncanny in its ordinary, everyday acceptance of a shared responsibility. He [the British officer] felt obliged to explain to his opponent why his company had surrendered so quickly. We talked about various matters in French. He told me there were quite a few German wounded, whom his men had bandaged and fed, in a nearby shelter. When I asked him how strong the rearward defences of the line were, he would give me no information. After I had promised to have him and the other wounded men sent back, we parted with a shake of the hand.69 The German and the British officer spoke to each other in French, indicating a shared European culture. They were both aware of the same rules of war – the British officer would not give away any tactical information and Jünger clearly did not press him on the question – and they cared for each other’s wounded men. The story ends with both men shaking hands, as gentlemen and brother officers. Herbert Sulzbach, a young German officer, described his encounter with captured British prisoners of war in terms that were not just respectful but were cordial and warm-hearted. They were well-built chaps, with good uniforms and equipment … one of them was chap from Eastbourne. It was the only English town other than

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London that I knew, so I was able to tell him that I’d spent a holiday there in 1907 with my parents and my sister. He was really pleased. He liked to talk to a German about his hometown. There was no bad feeling. As soon as they became prisoners, we became friends.70 These almost chivalric tales of officers acting with honour seem out of place, given the industrial brutalities of trench warfare and one is tempted to wonder whether the memories were constructed so as to make the war more manageable in some way. Certainly relationships between wounded men became culturally important in the post-war years. In Renoir’s classic film La Grande Illusion (1937), the French Captain de Boeldieu and his German counterpart von Rauffenstein, are able to communicate partly because of their shared class background but also because Rauffenstein’s injuries have removed him from the combat zone. The prisoner of war and the wounded officer share a similar status. In Latzko’s Men in War, a bitter, searing and graphic account of the conflict and one which offers few glimpses of any redeeming features of the war, an older officer is reconciled with his rival, a young, brutal ambitious man, as they both lie fatally wounded.71 These fictional or fictionalized relationships tend to be about elite rather than working-class men and are more about cultural codes and expectations than straightforward descriptions of wounded officers and their behaviour. The  extent to which enemies, whether of class or of nationality, can be reconciled by wounding is highly debateable, although it is clearly an important filmic and literary trope. Nevertheless a wounded soldier, whether French, German or British, was technically safe once he was wounded and moved away from the firing lines. His own government had an obligation to care for him, free of charge, and although a wounded prisoner could be interrogated for information, international conventions ensured that enemy governments also had to care for him. Moreover, scientific advances meant that once a wounded man actually reached medical personnel, it was very likely that he could receive real and effective aid.

A quiet life in the trenches When considering First World War casualties in retrospect, there has been a tendency to look at the big set piece battles that produced so many shocking casualties in such a short time for apparently such little gain. Oh! What a Lovely War is punctuated by images of old railway information boards detailing the absurd, ever-increasing casualty figures from the famous battles of the Western Front: 60,000 men wounded on the first day of the Battle of the Somme and no ground gained.72 Any visitor to the First World War battlefields cannot help but think of these numbers when looking at

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the signposts which indicate how far the front lines moved, or rather didn’t move, during these battles. The enormous Thiepval Memorial, which lists the names of those 72,000 officers and men whose bodies were not found after the Battle of the Somme, reinforces the image in Oh! What a Lovely War: the war was a catastrophe because men were launched ‘over the top’ in one big push after another or were rapidly slaughtered in short but vicious ‘smart taps’. Yet, without denying the impact of big battle casualties, it is important to note that most casualties occurred outside of these big, landmark encounters.73 The fighting on the Western Front was not always structured around clear-cut battles and men continued to kill and to die whether it was ‘All Quiet on the Western Front’ or not. During the relatively calm period of December 1915–May 1916 the British army suffered 83,000 casualties as a result of ‘normal wastage’.74 Priestly, responsible for trenches at Souchez in 1917, saw his company go down from 270 to just 70 men while they were simply holding the line. There was no official battle activity.75 Jünger described a ‘quiet day’ in the trenches, a day in which there was no battle planned, no bombardment ordered, no raid to carry out. The ‘day’ began at dusk and the night-time was occupied by sentry duty. At daybreak men were mainly occupied with maintaining the trenches but also with the business of eating, smoking and gossiping. While all this was happening the men were clearly aware that the enemy was doing much the same on the other side of no man’s land. On hearing British troops working on their wire, a German soldier turned fire on them; in exchange the Germans took a lot of casualties once they began unspooling wire. This fighting was not the result of an order by a faceless bureaucrat; nor was it the whim of a remote and comfortable old general, far removed from the fighting front. On the contrary, Jünger described fighting which was both personal and erratic: ‘Hey Tommy, you still there?’ ‘Yup’ ‘Then get your head down, I’m about to start shooting at you!’ This was followed by a description of trench mortars and rifle grenades; there was then work on maintaining trenches until someone was killed by a British sniper. The death provoked momentary disquiet but then men continued ‘lobbing rifle-grenades and light-mortar bombs’, although some ‘more timorous souls’ objected.76 This almost light-hearted ‘lobbing’ did not just hurt the enemy, and Dr Henry Kaye, working in a British casualty clearing station in Bailleul (Nord), complained of British soldiers being admitted because of ‘the idiotic game of playing with a live shell: this seems impossible to stop’.77 There were also occasions when men seemed to place themselves in deliberate danger of enemy fire. At one point British soldiers

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put up a sign reading ‘Gott strafe the Kaiser’ in clear sight of the German trenches, and as a result of the ‘devilment’ or episode of ‘wild spirits’, eight men died in a mortar shoot.78 Some casualties seem more like gruesome mishaps or industrial accidents: men died of carbon monoxide poisoning during mining operations and men died when dynamite caught fire underground.79 Edwin Campion Vaughan (1897–1931) tells the tale of a fellow-officer who became seriously wounded simply because he was late and had run across the trenches to keep an appointment with a general: he was dashing across to No 35 post when he ran against the spike of a screw picket sticking out of the long grass, and tore a great hole under his knee … I found him waiting for the stretcher to take him down the line, with sweat pouring down his face and evidently in great pain … I felt sincerely sorry for him and his last appeal made me realize that I would not see him again for a long time – perhaps not again.80 Men slipped in the mud when carrying heavy packs and were unable to get up; if the ground was especially waterlogged they drowned. The detritus of war was also responsible for many deaths. Dr Harold Dearden, a British medical officer, recounted the death of a soldier who was simply chopping down a tree for firewood. ‘While doing so he missed the tree and his axe hit the ground, exploding a Mill’s bomb buried there, and throwing the front of his abdominal wall away.’81 Quantifying these ‘accidental deaths’ is evidently difficult. Whalen calculated that there were 13,470 accidental deaths in the German army but such calculations can only ever be estimates.82 Nevertheless we can assume that men were aware of the random nature of risk on the Western Front and that this had an impact on their mental health. While few men fought for long periods, quite clearly there were no real safe zones and the fear of death or impairment was commonplace. Even when men did not feel that they were in immediate danger, they knew that they could be at any moment, and their accounts of war were often dominated by the fear of death or of the injury that would send them home in pieces after the next encounter with the enemy. The twenty-year-old Vaughan found it impossible to contain his frightened imagination after hearing how his company had suffered some casualties near Cappy in February 1917: I lay awake for hours, thinking that I might have been in the line during that barrage and attack, or I might have been in Watkins’ place. Then how would I have acquitted myself? I saw horrible pictures of myself lying dead in a shattered trench, or helplessly bleeding to death in a shellhole, with no power to call for help … Devoutly I wished that the war would be over before our turn came to go into the line.83

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As a result, death and injury could often seem arbitrary and combatants habitually adopted a fatalistic response to risk, with British troops comforting themselves with the thought that if a bullet had your name on it there was just nothing you could do.

Disease and sickness in the trenches The extent to which active military service made men healthier or otherwise has been thoroughly debated. War provokes not just wounds but disease, as the scandals of the Crimean War made plain. Moreover, military life, aside from the obvious dangers of combat, could trigger a number of health complaints but the growing sense of citizenship amongst Western Europeans ensured that military authorities had to accept some level of responsibility for such failings. As early as 1876 there were official concerns about young men breaking down as a result of over-rigorous training in the army and by 1914 ‘Soldier’s Heart’, sometimes known as ‘Disorderly Action of the Heart’ or ‘Effort Syndrome’, had been a long-term problem for the British army and one which military doctors took seriously.84 Military physicians attached to the British and imperial armies were certainly proud of the way in which they faced the challenges of modern warfare and successfully maintained the health of their troops. MacPhail went as far as to claim that the military medical service ‘has yielded an army without sickness’.85 However, it is also the case that the links between combat and disease remained strong and that life in the trenches produced its own array of complaints and illnesses, ones not directly associated with actual fighting.86 The Western Front was the least dangerous sector in this respect, partly because the medical services became well-organized reasonably quickly (despite occasional breakdowns) and partly because modern weaponry was so effective that soldiers continually suffered a proportionally high level of wounds. The impressive wound-tosickness ratio actually says more about the deadliness of the weaponry than it does about the efficacy of containing disease. Even so, admissions for disease were still ‘much more numerous’ than those for wounds at some points, and doctors Mitchell and Smith insisted that for every British man incapacitated by wounding, two men were incapacitated by the ‘invisible enemy whose weapons are enervation and disease’.87 Rates of disease and wounding varied according to sector, and so many men were ‘unclassified’ that an accurate assessment is hard to come by, but Table 2.3 indicates the extent to which the British medical services had to deal with sickness just as much as injury during the war. The picture was similar in France and Germany. Throughout the war the French army recorded over 5 million cases of sickness and the German army recorded over 7 million cases of sickness and disease, largely stomach or intestinal disorders.88

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TABLE 2.3   Grand totals of sick and wounded arriving in the UK from August 1914 to August 1920 Year

Officers Sick

1914

3

Other ranks

Wounded Unclassified 24

2,713

Sick 184

Wounded Unclassified 820

69,811

1915

8,160

6,993

67

171,248

165,138

1,071

1916

15,285

14,095

207

265,613

284,652

3,368

1917

16,073

17,525

471

336,141

349,494

7,159

1918

16,427

22,458

560

287,261

387,726

6,796

1919

6,576

666

817

155,034

8,909

12,441

1920

412

14

129

10,755

100

1,629

Total

62,936

61,775

4,964

1,226,236

1,196,839

102,275

Source:  William G. MacPherson, ed., History of the Great War: Medical Services, General History, Vol. I (London: His Majesty’s Stationery Office, 1924), 390.

‘The beastly trench: What a horrible existence the infantry have’89 Men began to suffer the physical privations of active service long before they reached the firing lines. Vaughan was desperately keen for action when he set sail for France in January  1917. He was highly excited and spent much of the channel crossing on deck, arriving at the French coast ‘soaked to the skin with spray and feeling very fit’.90 Barely a week later the romance of war had paled as he struggled through France in bad weather, complaining that ‘every part of my body was numb and senseless … I was wet through, beastly hungry and over the boots in snow’.91 Soldiers suffered a whole raft of physical complaints by sheer dint of living and working in the trenches, especially in the exceptionally cold winter of 1916–1917. Men struggled with frozen ink, frozen wine, frozen bread and frozen boots.92 Even when it was not freezing cold, it was wet and ‘damp rusts men as it rusts rifles’, wrote Henri Barbusse (1873–1935).93 The soldiers of the First World War were ‘les ouvriers des la boue’; they were essentially sleeping rough and so coughs and colds were ubiquitous in the trenches.94 When the weather was not wet, there was less mud but men choked on the dust and continually suffered from catarrh and chest troubles. Jünger used to judge how close he was to the enemy lines by listening for the sound of enemy troops coughing.95 Other complaints were associated with poor hygiene rather than the weather, and as a result skin complaints, vomiting, enteritis and diarrhoea were prolific.96 Charles Carrington’s (1887–1990) regiment spent a bitter rest period near Contalmaison (Somme) in 1916. They did not attack; nor were they attacked but they managed to lose a third of the

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battalion, mainly through sickness.97 Men were inflicted by serious illnesses such as bronchitis, malaria, pneumonia and pleurisy as well as a whole range of debilitating minor complaints. Vaughan describes how he was suddenly struck down with an unspecified illness in the spring of 1917: After a small meal of bully we turned in. It must have been about midnight when I woke with violent pains in my tummy. I suffered agonies which grew worse and worse until I was hardly conscious. I groaned and rolled about until Thatcher [a fellow officer] thought – as I did – that I was going to die. Then at about 3am I was violently sick and the pain subdued. I think it must have been due to bad food or water.98 Vaughan felt better the next morning and so did not seek medical attention but some trench illnesses did not disappear so rapidly. The rats that have come to dominate all war memoirs were responsible for Weil’s disease and infective jaundice; in Mesopotamia they were even responsible for outbreaks of the plague. Swarms of flies were attracted by the leftover food, the untreated sewage and the dead bodies that were left in the trenches. These were not just a nuisance but were more mobile than domestic flies and so spread disease rapidly amongst the troops and amongst those living in the interior. In addition, all men serving in the front lines carried lice. Conditions in the trenches were such that new medical conditions arose, conditions specifically associated not with the combat of the war but simply with life in the trenches, the most prominent being trench fever and trench foot.

The traditional battle cry: ‘Kill that louse’ Lice were a standing joke. Young Bumford handed me one: ‘We was just having an argument as to whether it’s best to kill the old ones or the young ones, sir. Morgan here says that if you kill the old ones, the young ones die of grief; but Parry here, sir, he says that the young ones are easier to kill and you can catch the old ones when they go to the funeral’.99 Lice are small blood-sucking insects which can be easily spread from person to person by either direct physical contact or contact with infected clothes or belongings. The parasites wander all over the human body and so cause widespread itching; their tiny eggs (nits) are usually found, warm and wellcamouflaged, in the seams of clothes. Given that men in the trenches lived in close proximity to each other with few opportunities to bathe or to change clothes, it is unsurprising that lice, known as cooties or chatts in English, were so prolific. Lice were everywhere, and the colloquial use of the word ‘lousy’ to denote bad or miserable stems directly from this particular trench experience.100 The highly pleated waistbands of kilts were exceptionally suitable breeding sites but all soldiers’ clothes were infested with nits and

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they all had lice on their bodies. Wherever possible men would take off their clothes and run the flame of a candle up and down the seams to ‘crack’ the eggs so as to prevent any more of the lice hatching. This process of ‘crumbing’ or ‘chatting’ could take hours and was often a very sociable activity, one often visualized in cartoons or on popular postcards.101 Despite the associated humour and sociability, lice made the lives of men miserable. Hans Herbert Grimm, a young German, reported rubbing his chest raw with the front of his coat because he was so tormented by the itching of lice.102 He was not alone. All soldiers’ bodies became unbearably itchy, and as they scratched the bites they grew even more painful. More seriously, the lice were responsible for a fever which was endemic in the trenches. British troops referred simply to ‘trench fever’; for the Germans it was tied more specifically to place and they talked of Meuse fever on the Western Front and Russian or Polish fever on the Eastern Front.103 British medical officers first began to notice troops suffering from intermittent fever in the early summer of 1915 and it quickly spread to men serving in Salonica, Mesopotamia and Italy. This fever, officially described as pyrexia of unknown origin (PUO), affected officers and men living in the trenches and all hospital personnel, especially orderlies working in wards containing infected patients. At this stage there were no cases in the ammunition columns or amongst ordnance and headquarter troops, and it did not become obvious in French troops until May 1916. Later it became clear that there was a very high incidence amongst German prisoners of war, largely because they had such limited access to washing facilities.104

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105

At first medical officers did not know that lice were responsible for the fever. It may have been caused by mosquitoes or rats or mice, or any other of the numerous irritants of trench life. Like many others, Hurst began to suspect that trench fever was a discrete condition caused by lice, long before it became an established scientific fact. He first came across trench fever when working in a hospital in Salonica in 1916. Almost all patients admitted that they were lice infested up to the time of their entry into hospital, so that it is quite possible that the disease is conveyed by lice. A hospital orderly who had been free from lice since his arrival in Salonica, had to carry the kit of a number of new patients suffering from trench fever on May 2nd 1916. The clothes were swarming with lice, and the same evening he found some in his own clothes. He got rid of them in the course of a few days, and on May 20th an attack of trench fever began. He was not employed in the wards, he never came into contact with any patients suffering from the disease, and he was the

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first case of trench fever in the personnel of the hospital to which he was attached.106 The fever usually began suddenly, although it was preceded by a feeling of malaise for a few days. Initial symptoms included serious headache, shivering, flushing, sweating and sometimes constipation with abdominal pain. It could easily be confused with the influenza or the early stages of typhoid at this stage but then men developed lower back pain and pains in the shins, leading to troops complaining of ‘trench shin’, an unhelpful term, given that men also suffered from ‘trench shin’ without a fever. PUO was rarely fatal, but in its short form it could last for ten days and in the more usual long, or relapsing, form it kept men incapacitated for a good four to six weeks and so it had a real impact on available manpower. At its most extreme PUO accounted for 40 per cent of evacuations and 60 per cent of all sickness in one British unit alone.107 Hurst’s suspicions were correct in that the louse was directly responsible for trench fever but even when the associations were clear doctors still did not know whether PUO was a modified form of typhoid or a discrete entity. By 1918 research, largely carried out by the US Medical Services, had established that what was known as trench fever was caused by a specific virus carried by the ordinary body louse (Pediculus humanus corporis). First, the infected lice bit men, transferring the virus directly into the bloodstream; second, as men scratched they rubbed infected louse excreta directly into the skin. It is unsurprising that so many men became infected. On another level, research into the transmission of trench fever gives us some insight into not just the enforced intimacy but also the sociability of trench life. One sergeant who had served in France and Salonica was continually reinfected after he returned to his unit, and in turn he infected about forty other men, including a sergeant who had wrestled with him, another one who had danced with him, a corporal who had slept next to him and a private who sat closely beside him.108 Given the ubiquity of lice in the trenches, it was nigh on impossible to prevent contagion and there was little that could be done about the fever itself. Doctors treated men with quinine, arsenic, salvarsan, perchloride of mercury, antimony and colloidal silver, but all to no avail.109 It was possible to relieve the symptoms of trench fever somewhat and so doctors gave aperients to those men who were suffering from constipation and acetyl-salicylic acid (aspirin) was used as an analgesic. Cold compresses of saturated magnesium sulphate gave temporary relief to tender shins and some doctors prescribed galvanic baths to ease the pain and stimulate the circulation. Making men more comfortable was important but the only real way to manage trench fever was to eradicate the lice. Troops were regularly taken to bathhouses and wash houses, and their clothes were steamed or steeped in a chemical solution of cresol-soap emulsion and Lysol to destroy the nits.

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Soldiers’ bathhouses varied from the relatively simple to those verging on industrial capacity. In 1915, one bathhouse close to the Belgian border consisted simply of two bathrooms and one rectangular cement tank of about 16 feet × 15 feet containing about 18 inches of water. Outside in the yard there were cauldrons of boiling water and each man was instructed to take half a bucketful and then to top up with cold from a nearby stream. There was a far bigger operation just inside the Belgian border where part of a convent had been turned into a large bathhouse equipped with thirty-two tubs, eight washing machines, four boilers, untold numbers of clothes pegs and large quantities of washing soda. Thirty Belgian women washed and ironed the men’s clothes in one shed and a third shed was turned into a drying room. The field ambulance in charge could bathe ninety men an hour (three relays for thirty tubs for twenty minutes) and averaged 500 a day, although on one occasion they did manage to bathe 800 men in one day and supply them with clean clothes.110 Washing so many men and providing them with clean clothes was a massive logistical problem and also one of supply. This level of bathing required constant running water which was not always available, and at one bathhouse in an old brewery they abandoned providing freshwater for each tub and simply brushed off the scum after each batch.111 Coal was needed to heat the water and it was not always possible to replace the shirts and socks that were either filthy or simply beyond repair. More to the point, bathing was only ever a temporary solution to lice. It was immediately effective but as soon as troops returned to the trenches they quickly became reinfested; according to Erich Remarque ‘the lice are back within a couple of hours anyway’.112 The soldier with lice has now become one of the stock characters of the First World War. No longer a subject for humour, the poor, beleaguered soldier who ‘rarely changes his lice-infested clothes’ reminds us of the dirt, the brutality and the futility of a long, industrial war fought by men living in holes in the ground.113 Men with broken limbs even had lice living under their plaster casts. Yet before dismissing our own horror of vermin as sentimental and ahistorical, it is worth remembering that early twentieth-century men, and not just the socially elite officers, were similarly revolted and Gibbs’s words are powerful reminder of the shame provoked by a verminous body: ‘To English boys from clean homes, to young officers who had been brought up in the religion of the morning tub, this was one of the worst horrors of war. They were disgusted with themselves. Their own bodies were revolting to them.’114 The majority of men were aware of the importance of hygiene and attempted to remain clean in the most trying of circumstances. Kaye argued that most Englishmen were ‘astonishingly cleanly’ and Vaughan makes repeated references to men (including himself) attempting to bathe in a mug of water and he was clearly disturbed on discovering his own personal infestation.

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I lay for a while on my upper birth, smoking and reading a book on trench warfare. Then I began to feel itchy, and the itchiness grew, and spread so much that I was unable to concentrate on my book. So I lay on my back looking at the timber roof a foot above me, and I wondered whether the saw marks across the beams were the work of the Boche to ensure the roof falling in when a time-mine exploded. I was distracted from this thought, with its potential horrors, by the sight of moving insects. Raising the candle I found the place was crawling with lice. During the night I felt them dropping onto my face, and in the morning I was infested with them.115 The lice distracted Vaughan not only from his book but also from his (fairly habitual) fear of German time-mines. For Barbusse, the lice (les poux) exemplified the very wretchedness of the trenches and the despair of body and soul that was literally, and metaphorically, eating the ordinary soldier: ‘Alone in a corner, Cocon cowers. He is tormented by lice; but weakened by the cold and wet he has not the pluck to change his linen; and he sits there sullen, unmoving – and devoured.’116 Nurses felt similarly revolted and ashamed. Kit Dodsworth, a VAD at No 12 General Hospital in Rouen, noticed that she was covered in ‘grey backs’ during a period of intense fighting in 1915 and was deeply distressed: ‘I found them when I was brushing my hair, and I was so exhausted that I just collapsed in tears. It seemed the last straw. I sat up nearly all night crying and washing my long hair again and again in disinfectant. I felt as if I’d never be clean again.’117 The working populations of Europe, especially those living in urban slums, had been long accustomed to vermin, yet to be seriously lousy was to suffer from a vagabond’s disease and it was usually only found in the casual wards of workhouses, dosshouses or particular hospitals. Many men from the ranks shared Dodsworth’s response and were so embarrassed about having lice that they were reluctant to seek medical attention. In our own culture much has been written about the extent to which girls and women suffer severe psychological harm on account of their hatred of their own bodies. This is in many ways a separate debate but is related in one respect, namely that many men went to war expecting to become battle-stained heroes and then later found that ‘their own bodies were revolting to them’.

Trench foot Trench foot is one of the most widely remembered of the Great War complaints. It is embedded within British popular culture to the extent that people often make reference to cases of trench foot in the most unlikely of scenarios, music festivals in particular. One festivalgoer described his experiences at Glastonbury in 2007:

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Every year I can I go to the Glastonbury Festival and pick up a T-shirt or two as a memento. But last year’s souvenir was unexpected and certainly unwelcome. I came home with trench foot. Muddy festivals are no surprise but 2007 Glastonbury was something else. The rain barely ceased for a moment and site conditions resembled the Battle of the Somme – with music.118 It is easy to scoff. Glastonbury Festival is nothing like the Battle of the Somme and revellers were not enduring conditions that were in any way comparable to those of men in the trenches. Yet the immediate popular association between mud, trench foot and the First World War indicates the importance of the war in British popular consciousness and it is notable that the term ‘trench foot’ is still meaningful, or at least makes some sense, to a mainstream audience in the twenty-first century. The topic of trench foot has become somewhat trivialized throughout the twentieth century, but, unlike lice, it was rarely a subject for humour in the trenches. Foot-care was a serious issue and all armies were affected, with the British complaining of trench foot, the French of pieds gêlés, froidure or frigorism and the Germans of Nasserfrierung der Füsse or Fussbrand (the latter term was also used for gangrene of the feet). Men continually complained of bruised feet, swollen feet, sodden boots and feet so cold they were burning. Arnold Zweig’s description of a soldier literally weighed down by his attempts to keep his feet warm was recognizable to almost all soldiers: Somewhere down in the vague depths of his inner consciousness he felt he would have liked to rub his feet together, for they were rather cold, but they were enveloped in thick boots, and wrapped round with rags and the lower part of his trousers, so he let them be. His legs were embedded in the deep snow, side by side like the hind feet of an elephant.119 Non-combatants suffered too, as Laurie Rowntree’s description of working in an ambulance convoy in the winter of 1914–1915 indicates: My costume used to consist of several layers of underclothes, a tunic, khaki breeches, leather breeches, a leather waistcoat, an oilskin jacket, British warm, and rubber boots with two pairs of socks, but I was none too warm, and after about a week I began to suffer from what is called French foot, and is extremely painful, so much so that at last I could hardly walk.120 Rowntree’s ‘French foot’ was very probably frostbite and trench foot was initially described as ‘akin to frost bite’, an easily recognizable medical condition.121 The British army attempted to disseminate medical information on the subject right at the beginning of the war but unfortunately the

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information was not effectively disseminated. In the winter of 1914–1915, 250,000 copies of Prevention of Frostbite or Chilled Feet were sourced and delivered to the Western Front but only 103 copies were actually distributed.122 This apparent negligence was a problem and men did suffer from painful feet as a result of the extreme cold, but trench foot was not simply frostbite and it struck men in both warm and cold weather. According to Kaye, the distinction between frostbite and trench foot was plain: The feet are swollen, very painful and warm, brightish pink in colour, i.e. it appears essentially to be due to arterial dilation and there is no sign of the blue venous appearance which one associates with exposure to prolonged cold. It is a serious problem as once a man gets it I understand he is useless for this work again throughout the winter.123 Kathleen Yarwood, a VAD at Dearnley Military Hospital in Rochdale, worked with a large number of trench foot and frostbite cases in the bitter winter of 1916–1917 and she described the long and painful process of nursing these men back to health. We had to rub their feet every morning and every evening with warm olive oil for about a quarter of an hour or so, massage it well in and wrap their feet in cotton wool and oiled silk – all sorts of things just to keep them warm – and then we put big fisherman’s socks on them. Their feet were absolutely white, swollen up and dead. Some of their toes dropped off with it, and their feet looked dreadful. We would say, ‘I’ll stick a pin in you. Can you feel it?’ Whenever they did feel the pin-prick we knew that life was coming back, and then we’d see a little bit of pink come up and everybody in the ward would cheer. It was very painful for them when the feeling started to come back, and some of them had to have crutches. They couldn’t walk at all because they simply couldn’t feel their feet.124 Some men felt embarrassed at being invalided with something as un-warriorlike as trench feet but the links between feet, fighting and endurance cannot be exaggerated. In English, ‘cold feet’ is a colloquialism for cowardice and in times of adversity we are urged to put our ‘best foot forward’. In practical terms trench foot was rarely fatal but it was extremely painful and very bad cases could result in amputation. In consequence all armies were aware of the importance of maintaining sound feet. The Soldier’s Small Book, carried by all British soldiers, made it clear that all men were responsible for looking after their own feet. They were instructed to ensure that they had clean feet and socks, and the right size boots; they were told to soak their feet in salt or alum and to take care of their toenails and protect any blisters.125 Officers were given more detailed instructions stressing the importance of circulation and of maintaining dry feet:

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1. Cold is likely to give rise to frost bite when the circulation of the

blood is impaired. The feet are likely to be frost bitten under the following circumstances: (a) When the boots and putties are too tight. (b) When the general circulation throughout the body is less active than normally. (c) When the socks, boots and putties are wet. The following precautions should be observed: 2. Boots should not fit tightly, but should be at least a size too large and

loosely laced up. When large boots are worn it is well to wear two pairs of socks; but this is dangerous if the boots are small, as it leads to further pressure on the foot. Putties should never be put on tightly. 3. The best preventive for frost bite is to take off the boots and dry and rub the feet well; circulation is also improved by moving the toes inside the boot. Greasing the feet or rubbing them with Vaseline, after drying, is also a preventive. Feet can be kept warmer by wrapping canvas, sacking or other material loosely round the outside of the boot and filling the interval with straw. 4. The general circulation can be kept up by keeping the body warm and dry. A waterproof sheet worn over the greatcoat is of assistance where no mackintosh is available. 5. A dry pair of socks should be carried in the pocket when available. 6. Officers should see that dry standing is provided in trenches whenever possible, by means of drainage, raising the foot level by fascines of brushwood or straw with boards on top, or by the use of pumps where these are available.126 Officers did have a responsibility to provide a ‘dry standing’ and trenches should have been constructed so that they were properly drained, but this was not always the case, especially in the clay soil of Flanders and northern France, and by Christmas 1914 there were tales of men living in trenches that were knee-deep or even waist-deep in mud and water.127 These conditions were exceptional but in the winter of 1914–1915 there were about 6,500 British soldiers hospitalized with trench foot and Major General Sir Anthony Bowlby (1855–1929), consulting surgeon to the forces continually – and with growing frustration – stressed the ‘need of good and dry trenches which I have advocated daily for the last six weeks at least.’128 Some doctors despaired of ever being able to ensure that trenches were dry and tried to find ways of protecting soldiers’ feet. Kaye suggested that it would be better simply to warm the trench water electronically, believing that men would suffer less from standing in warm water than in cold water.129 The RAMC

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received a proposal along these lines for a highly complicated contraption, ‘the trench foot-warmer’, which was a kind of personal, portable centralheating system for men in the trenches.130 This type of Heath Robinson device was clearly impractical. On a simpler level, Professor Sheradin Delépine (1855–1921) designed waterproof ‘oil-silk bags’ to replace puttees so as to prevent the restricted circulation which led to trench foot. In a similar vein, a letter writer to the Daily Mail recommended replacing the constrictive puttees with ‘“cork socks”, covered on the surface next the foot with stout felt and dusted with ordinary red pepper (Cayenne not Nepal)’ to maintain good circulation.131 Oil-silk bags and cork socks sound fanciful but the question of circulation was nevertheless an important one. Osler noted that Canadian timbermen continually had cold, wet feet but they did not suffer from trench foot, concluding that some factor other than the cold and the wet had to be responsible. Moreover, there were fewer cases amongst French troops because their soldiers did not wear the highly restrictive puttees.132 There were also differences in rates of trench foot within the British army and this is what convinced Bowlby that the condition was preventable. His own research, conducted in the winter of 1915, indicated a real discrepancy between trench foot in British officers and in men from the other ranks. Table 2.4 indicates not just the extent of trench feet in this particular sector, but Bowlby’s anger at the army’s inability to deal with this problem. Bowlby argued that the reasons for this discrepancy were clear and that ‘practically no officers get bad feet because they take precautions. The men ought all to be protected also by similar precautions’.133 The conditions of active warfare meant that it was often impossible for men to soak their feet in salt water and change into clean socks daily, but Bowlby insisted that there were ways of protecting men’s feet. Officers could ensure that men did not have to fight in waterlogged trenches and he personally congratulated General Sir Douglas Haig for not allowing his men ‘to go into the deep water in the wet trenches’.134 If men did have to fight in wet conditions they should be provided with waders and should be removed after 24–36 hours to allow their feet to recover. While it was clearly impossible to maintain clean, dry feet at all times, men could protect their feet by massaging them with Vaseline or whale oil whenever possible and by using talcum powder before putting on clean, dry socks. French soldiers were also urged to grease their feet or to soften them with oil.135

TABLE 2.4  

Twenty-one days of November 1915. Trench foot totals

2nd army

Total 1,999

To Base 1,265

1st army

Total 1,812

To Base 1,312

3,811

2,577

Source:  Anthony Bowlby (25 November 1915), Unpublished War Diary. WL RAMC/ GC/181.

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So trench foot was clearly preventable, and for this reason it was criminalized within the British army in 1916 and ordinary soldiers or junior officers could be dismissed or court-martialled for it.136 However, the responsibility for good feet was not down to the individual soldier or commanding officer alone. Could trench foot really be seen in the same category as shamefully casting away arms or even falling asleep at a sentry post? Were men really neglecting their feet so that they could be sent home with trench foot? There was certainly some concern that men were ‘too careless and obstinate’ to use the rubber boots provided, although Captain Dunn, a medical officer with the Royal Welch fusiliers, argued that gumboots were not actually very helpful in the trenches anyway.137 Edmund Blunden (1896–1974), at that point a young officer, was clearly incensed that trench foot was being treated as a military crime, but as far as Robert Graves (1895–1985) was concerned, there was a clear link between the incidence of trench feet and morale.138 ‘Trench feet’ seemed to be almost entirely a matter of morale, in spite of the lecture formula that NCOs and officers used to repeat time after time to the men: ‘“Trench feet” is caused by tight boots, tight puttees, or any other clothing calculated to interfere with the circulation of blood in the legs.’ Trench feet was caused, rather, by going to sleep with wet boots, cold feet, and depression. Wet boots, by themselves, did not matter. If a man warmed his feet at a brazier, or stamped until they were warm, and then went off to sleep with a sandbag tied around them, he took no harm. He might even fall asleep with cold, wet feet, and find that they had swelled slightly owing to the pressure of his boots or puttees; but trench feet came only if he did not mind getting trench feet, or anything else – because his battalion had lost the power of sticking things out. At Bouchavesnes, on the Somme, in the winter of 1916–17, a battalion of dismounted cavalry lost half its strength in two days from trench feet; our Second Battalion had just completed ten days in the same trenches with no cases at all.139 Obviously tight boots and tight puttees did matter but Graves’ psychosomatic explanation makes some sense too. Even in purely practical terms, men suffering from poor morale were disinclined to look after their feet properly and disenchanted front-line officers were unlikely to instil the discipline needed to maintain an effective foot-care regime.

Treatment of trench foot The treatment of trench foot varied according to its severity. In light cases men lay with their feet elevated, their feet were cleaned and the man was given anti-tetanus serum because sufferers of trench foot also often had

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tetanus. Once clean and dry the feet were generally painted with some kind of antiseptic, often picric acid in spirit, and large blisters were punctured and dressed. Cold feet were rubbed frequently; if men were suffering from hot feet – akin to very severe chilblains – their feet were left exposed. More serious or enduring cases were also treated with massage or electricity. Sometimes men developed gangrene as a result of trench foot but amputation was only ever a last resort, and doctors tried to avoid it where ever possible. Like many other wartime complaints trench foot was often presented to the lay public in a sensationalistic manner and used to demonstrate the extent to which doctors were producing miracle cures in response to the trials of trench warfare. A Times correspondent described one case in which the foot was ‘so distorted so as to be useless’. He then went on to describe how doctors fashioned a new one: A considerable quantity of diseased bone and tissue was removed by the surgeon from the centre of the foot, and the remaining bones brought closer together. The man now has a considerably smaller foot than before, but it is fairly well-formed and promises to be quite serviceable. What has practically been accomplished is to make a new foot out of the sound parts of the old one.140 The reality for most sufferers was more mundane and even slight cases of trench foot, that is those without extensive blisters or gangrene, took weeks or sometimes months to recover and the men then became more susceptible to further attacks.

The wounded journey How can we understand what happened to sick and wounded men, let alone begin to assess their reactions? There were at least 20 million diseased and wounded men throughout the whole war and so any kind of generalization appears meaningless. Moreover, the array of evidence is not just complex but conflicting, and First World War medical services have been hailed as emblematic of the triumph of civilized medicine and yet are also portrayed as symbolic of the cruel wastage inherent in the very essence of this conflict. We can make some safe generalizations about the First World War battlefield on the Western Front. The war was initially one of movement and the German army was within twenty-five miles of Paris by the end of August  1914. After the Battle of the Marne (6–10  September  1914) the French capital had been saved but armies then began ‘the race to the sea’ in an attempt to gain the channel ports. As winter approached the armies dug themselves into their positions and the initial war of movement began to turn into one of trench warfare, known in German as Sitzkrieg (static warfare). It is this static, trench warfare that has dominated so much of the

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history of the First World War and become symbolic of the slow, apparently futile, war of attrition that continued until the war again became one of movement in the spring of 1918. Yet while ‘trench warfare’ and ‘slaughter’ are now almost synonymous, it is important to note the lethality of the war of movement and to stress that trenches were initially dug so as to save lives.141 Soldiers’ uniforms also changed in an attempt to save lives. At the beginning of the war the French went into battle sporting jaunty red trousers: ‘It seems cruel to have sent them to the front in such a conspicuous get-up’, commented Evelyn Blücher, the English wife of a German officer.142 It was certainly impractical and so the French troops changed into the rather more sober ‘horizon blue’ during 1915. During that year the French were the first to supply their troops with the protective steel helmet – the now famous ‘Casque Adrian’ – and the British followed suit with the bowl-shaped ‘Brodie’ helmet, which was first patented in 1915 and widely distributed in 1916. German troops were also issued with the new Stahlhelm (steel helmets) in 1916. These were necessary moves because cloth caps offered no protection and in the early stages of the war French soldiers protected their heads with their knapsacks.143 The traditional German Pickelhaube was particularly unsuitable for modern warfare because fragments of the leather or brass often infected head wounds.144 Of course these changes simply indicated that war had grown more brutal, and even the already hardened Jünger thought that the first German soldier he saw in a steel helmet was ‘the denizen of a new and far harsher world’.145 The establishment of trench warfare promoted a whole number of defensive measures more generally such as barbed wire, gas masks and the tendency to attack at night. All of these defensive measures resulted in what Fussell has famously called the ‘troglodyte war’, a war in which men lived in deep dark holes and fought one another in the dark before returning to the same, or similar, holes.146 The notion of the ‘troglodyte war’ was best illustrated at the time by Bruce Bairnsfather’s cartoon Tommies, ‘Bill’ and ‘Bert’, who spent the war grumbling and grousing in a variety of ‘oles’, none of which afforded them much protection or comfort.147

Triage and the hospital network The fictional Bill and Bert, rather like the apocryphal Dai and Evan, give us some understanding of the way in which men articulated their fears. A brief glimpse into some medical statistics gives us some awareness of the enormity of the medical operation on the Western Front, and of the context in which men had to assess their chances of survival. The British army alone used 109 million bandages in the years 1914–1918; stretched end to end, these bandages could have been wrapped around the globe fourteen and a half times. The Army Medical Services used 82,721 miles of gauze and from August 1914 to August 1919 medics used 7,251 tons of cotton wool and

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lint.148 To maintain this effort, medical systems were refined and developed throughout the war. Transport systems were extended and became more comfortable; staff were better trained; resources were better deployed. In addition, and largely thanks to the stationary nature of trench warfare, the casualty clearing stations and front-line medical units which were initially quite basic, tented constructions became much more like modern hospitals by the end of the war. Immediate care in the trenches or close to the fighting front obviously remained basic throughout. Stretcher bearers, usually in teams of sixteen, sometimes of thirty-two, were positioned in the trenches before a big attack, and the call ‘Bearers Up!’ was a clear signal that men were about to be sent over the top. Sometimes medical officers even sent stretcher bearers over the top with the advancing troops.149 At the beginning of the war, stretcher bearers often had a limited knowledge of first aid. They had more advanced training as the war developed but amongst the noise and chaos of a battle there was sometimes little they could do anyway.150 Karl Gorzel, a twenty-year-old law student from Breslau, described the pitiful scenes at the Battle of the Somme where the wounded lay groaning, the supply of water ran out and the stretcher bearers could do no more than simply try to carry the wounded men as far back as possible.151 Despite these limitations, men of all nationalities grew to recognize the bravery of their stretcher bearers who had a ‘devilish rotten job’.152 Often doctors waited in the front-line trenches during a big raid too; they could not do a great deal there, but many thought that they were good for morale, although others questioned the wisdom of needlessly putting doctors’ lives in danger. Front-line medical officers were equipped with a knife, iodine, bandages, morphine and an indelible pencil. Sometimes they carried a small supply of rum with them. Thus equipped they did their best to dress wounds and to give men a comforting drink or a shot of morphine if required. If a man did have a dose of morphine, the medic would mark a cross on his forehead with the pencil so that medical staff further up the line would be able to avoid the possibility of overdose. As with all systems this was only partially effective, and Kaye, working at a casualty clearing station, complained that men often arrived having had too much morphine and that this made diagnosis difficult because it obscured the clinical picture.153 Even when good, well-equipped, effectively coordinated and properly staffed medical facilities were available close to the front, the conditions of trench warfare meant that it was often difficult to move the men. Maze described a system in almost total collapse on the second day of the Battle of the Somme: I watched the wounded who were crawling down to the aid-posts. The stretcher bearers, climbing over the earth in places where the trench had been blown in, were obliged at times to expose their burdens to the merciless sniping from La Boiselle … I followed a stretcher and heard groans as the bearers stumbled and shook their limp load, of which I only saw a wobbling boot and an inert pale hand stained with dried blood.154

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Medics of all nationalities wore a Red Cross brassard. They were easily recognizable as non-combatants but nothing could protect them from stray bullets, shrapnel, splinters and gas. Even in the absence of enemy fire, bearers had to carry seriously wounded men in almost impossible situations: the trenches were narrow, they were often mired in mud, visibility could be poor, surfaces were uneven at the best of times and collapsing trenches meant that the front was frequently treacherous on account of huge, sometimes flooded, craters. At times it was even difficult to carry men to the nearest aid post, and Frank Dunham, a young stretcher bearer from Norfolk, recounted one incident during December  1916 when it took four stretcher bearers three hours to travel 400 yards because the mud was so deep. Clearly this was an exceptional case but it was not an isolated one.155 Once out of the trenches wounded men should have been able to find medical help relatively quickly. Official British guidelines stated that dressing stations should be constructed immediately behind the fire trenches. The following instructions in The Manual of Field Engineering make this plain: Some covered dressing stations should always be prepared in rear of the fire trenches. Each should be large enough to contain a plank table 6ft. 6in. × 2ft. 6in. with 2ft. clear space all around. These stations should be placed near any cover trenches or splinter-proofs that may have been made in order that these may serve as waiting rooms for the wounded, otherwise the communication trenches are liable to become blocked.156 No doubt many stations were handily and neatly situated. Others were improvised under any type of shelter and could be found under banks, out in the open air, in hollows or in ruined buildings. While it was important to provide immediate primary care for the wounded in the trenches, or as close to the front line as possible, the medical services of all armies were organized so as to move seriously wounded men away from the battlefield and into a safe, clinical environment as swiftly as possible. The relatively settled nature of trench warfare had a paradoxically positive effect on military-medical arrangements in that the front was so static that it became possible to develop a sophisticated network of hospitals close to the fighting front. Men who passed through the aid posts travelled on to advanced dressing stations and then to the field ambulance for limited care and medical treatment: a shot of anti-tetanus serum, warmth, food and drink. The British field ambulances had initially been designed for surgical work but they became centres for triage and evacuation as the casualty clearing stations developed into hospitals, many within 10,000 yards of the front lines. These casualty clearing stations were initially mobile, tented constructions, sometimes stationed in forest clearings, sometimes in old lunatic asylums or monasteries but they developed rapidly, with medics like Bowlby calling for more clearing stations from 1915. By the end of

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the war seventy-eight casualty clearing stations had been established along the Western Front to serve the UK expeditionary forces but proximity to the front did not always mean that access was easy. Kaye, working in a casualty clearing station about ten miles from the front, noted that it normally took men three to four hours to travel from the aid posts close to the trenches, although sometimes it could take as long as eight hours. These stations played a crucial role in surgery because when men were treated quickly it was possible to prevent the onset of gangrene and sepsis. Clearing stations also began to deal effectively with abdominal wounds – previously considered fatal – from as early as 1915.157 After the clearing stations, men were moved to base hospitals, much further from the fighting. Many men made the arduous journey from the trenches of the Western Front to hospitals in the UK, an extensive logistical operation. Men were usually moved by ambulance train with specially equipped carriages, capable of carrying approximately 400 men at any one time. Sometimes they were moved by hospital barge. These hospital barges were first organized on the Seine in 1914 to bring patients from Paris to Rouen. Later, four additional flotillas were formed, of six barges each, for use on the Calais and Dunkirk system of canals with direct links to the Flanders front and the Somme.158 Once at the channel ports wounded men were placed on hospital ships, many of which were cross-channel passenger steamers which had been hastily converted at the beginning of the war. There were only three hospital ships in August  1914, but a fleet of 100 ships, plus attendant ambulance transports, was mobilized throughout the war.159 Some hospitals ships were very large and could carry up to 4,000 sick and wounded men but a typical hospital ship had about 800 beds. The Asturias, for example, could carry 800 patients in cots and berths and could accommodate the more lightly wounded on deck and in times of emergency she could carry as many as 2,400 men across the channel in one journey.160 Table  2.5 details the numbers of sick and wounded who disembarked at ports throughout the UK and thus provides some insight into the extent of these operations. Men talked about being sent ‘home’ for treatment but ‘home’ did not always mean ‘home’. Sometimes soldiers were hospitalized a long way from their friends and families and had to keep in touch by postcard, telegram or telephone. Telegrams were for emergency use only, very few people had home telephones and not everyone was literate enough, or well enough, to write long letters home. As a result hospital could be an isolating experience, with soldiers and their families relying on the ever-popular picture postcard for news. The French, fighting on their own territory, had to respond most rapidly to the changing nature of warfare on the Western Front. The Service de Santé was a medical service constructed around the assumptions that the French army would fight short wars and that it would be possible easily to evacuate wounded personnel to areas of safety, far from the fighting lines. For this reason the service was primarily committed to evacuation before treatment

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TABLE 2.5   Total number of sick and wounded disembarked at UK ports, 28 August 1914–31 July 1919 Officers

Other ranks

Southampton

59,710

1,257,928

Dover

67,008

1,226,337

Avonmouth

1,628

21,258

Devonport

636

7,572

Liverpool

34

1,594

0

1,840

Folkestone Newcastle

15

93

Boston

349

3,726

Leith

252

4,196

London Docks

19

121

Hull

24

685

129,675

2,252,350

Totals

Source:  William G. MacPherson, ed., History of the Great War: Medical Services, General History, Vol. I (London: His Majesty’s Stationery Office, 1924).

and wounded soldiers were initially sent to hospitals in large towns and cities, especially Paris. This doctrine was ill-suited to the war that was about to develop on the Western Front. The French army faced near-disaster in August–September 1914, when the German army came within twenty-five miles of Paris. After the ‘race to the sea’ when trench warfare became fully established, largely on French territory, the service had to change tactics to develop ways of treating large numbers of men close to the fighting lines. Général Paul Chavasse was appointed director general of the Service de Santé at the end of September  1914, and from 1915 the military-medical system stabilized and the French armies were served with a clear treatment system which stretched from the front lines to the base. The Poste de Secours Principal du Regiment (the regimental aid post) was close to the firing lines; further to the rear were the Le Groupement d’Ambulances de Corps de l’Armée (GACA), which were situated ten to fifteen kilometres from the front lines and were equipped to deal with medical and surgical cases; later Ambulances Z were established to deal with gas cases. The primary evacuation hospitals (Hôpitals d’Évacuation Primaire, or HOE 1) were thirty to fifty kilometres from the fighting front and even further behind were the secondary evacuation hospitals (Hôpitals d’Évacuation Secondaire, or HOE 2), which were situated 150–200 kilometres from the frontlines. Throughout the long stalemate the French military services established a number of hospitals very close to the front line, as in Zuydcoote (Nord), Berck (Pas-de-Calais) and Bar-le-Duc (Meuse). There were others in fortified

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positions such as Mont-Notre Dame (Aisne), Blérancourt (Aisne) and Hargicourt (Somme). The network of trenches and military formations had a mirror image in a network of aid posts, ambulance routes and hospitals. However, not all military-medical care took place in the fighting zones. To supplement the pre-existing hospital network in the French interior, public buildings were requisitioned for the war effort and turned into hospitals. Le Grand Palais in Paris, initially constructed for the International Exposition of 1900 and dedicated to the glory of French art, became a major hospital with over a thousand beds.161 Spacious private homes were similarly transformed, and so although much was made of the distinction between home and front, the presence of military hospitals in the most incongruous of places indicates the extent to which the most painful aspects of the war intruded into civil and domestic life. The wounded French soldier’s journey through this system began when he was picked up by battalion stretcher bearers under the direction of a médecin auxilliaire (usually a medical student). He was given first aid and then carried through the trenches to the regimental aid post. Conditions at these posts varied considerably, depending on the location and the nature of the fighting. Sometimes they were set up in dugouts, sometimes under the protection of a cliff or the clearing of a forest and sometimes in the cellars of destroyed houses. A médecin du régiment was in charge and he cleaned wounds, treated them with antiseptics, stopped haemorrhages and immobilized fractures. Men received immediate and vital medical help in these places, but Barbusse’s description of a French aid post is far from comforting: A doctor is trying with shouts and gesticulations to keep a little space clear from the rising tide that beats upon the threshold of the shelter, where he applies summary bandages in the open air; they say he has not ceased to do it, nor his helpers either, all the night and all the day, that he is accomplishing a superhuman task. When they leave his hands, some of the wounded are swallowed up by the black hole of the Refuge; others are sent back to the bigger clearingstation contrived in the trench on the Bethune road. In this confined cavity formed by the crossing of the ditches, in the bottom of a sort of robbers’ den we waited two hours, buffeted, squeezed, choked and blinded, climbing over each other like cattle in an odour of blood and butchery.162 Sometimes the regimental aid posts were supported by a poste de chirurgie d’urgence, an emergency surgical unit pushed as far forward as possible and equipped with two surgeons, a sterilizing room and an aseptic operating room, as well as sufficient electrical power for lighting and for radiography. It was theoretically possible for a wounded man to reach one of these stations within two hours of being wounded and the surgeons were equipped to

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operate on the most severe cases, including abdominal wounds. Bowlby was very impressed by a field ambulance which had been set up in a chateau to serve the French sixth army in the summer of 1916. It had its own laboratory, a throat and ear department and a VD department. Crucially, it also had sufficient power to light and run the theatre and the X-ray plant.163 At the regimental aid post and the emergency surgical unit, the primary aim was to make men fit for evacuation so that they could be moved by horse or motor ambulance to the GACA further up the line. These were more permanent structures and were generally established in several houses in a village or had been set up in a chateau or a large farm where the established buildings were expanded by marquees or huts. These divisional ambulances were each furnished with an aseptic and a septic operation room, a room for dressings and, often, a plaster room and the full complement of medical and administrative staff. The wounded man was first brought into a sorting room where an orderly officer made sure that he was warm, gave him an anti-tetanus injection and dealt with any immediate medical need. The surgeon then decided whether the man should be treated there and then or whether he should be evacuated further. As a general rule, wounds of the head and chest and severe wounds of the limbs were kept in the divisional ambulance and all other cases were sent on to the evacuation hospitals. If it was not possible to operate in the divisional ambulance, it was often supported by a mobile surgical ambulance. These were staffed by four surgeons and organized so that they could be divided into the three sections: one for aseptic operations (requiring three tables), a second section acted as a sterilizing room, a third was for dressings and for septic operations. The mobile surgical ambulance had its own boiler for sterilizing water, instruments, appliances and dressings, and for heating huts or tents.164 Once fit for travel, the man was sent to an evacuation hospital, but this process was far from swift and the average time delay between being wounded and arriving at hospital was forty-two days.165 Like his French or British counterpart, the wounded German soldier had first to make his way to an aid post. Stretcher bearers carried away the heavily wounded, and at the beginning of the war, medics used dogs to find wounded soldiers who were hidden in ditches or craters.166 If the man was only lightly wounded, he would be treated and sent back to his unit; more serious cases would be transferred to the field hospitals (Feldlazarette) and then, if necessary, to one of the very large military hospitals in the rear (Kriegslazarette). Given that the Germans were fighting on enemy territory, they had to establish hospitals in requisitioned French property. A surgical hospital was set up in the Palais de Justice at St. Quentin (Aisne), and at Le Câteau (Nord) a large textile factory was turned into a hospital which could house over 10,000 casualties.167 Finally, a man requiring extensive treatment could be sent back home to the reserve hospital (Reservelazarett). These large hospitals in the rear were controlled by area commanders, and military hospitals in the home territory were controlled by deputy commanding

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generals.168 Further care was provided by a range of ‘additional hospitals’ (Vereinslazarette), privately established institutions set up to meet the excessive and unprecedented demands of wartime.169 In Germany there was also a range of highly renowned specialist hospitals such as Dr Silex’s School for the Blind in Berlin, Dr Kraepelin’s psychiatric hospital in Munich and the Düsseldorf Clinic for Facial Wounds.170 In the French, British and German armies the military-medical system stretched from the trench to hospitals in the home territory, and at all points in between, men were assessed, labelled, tagged and dispatched. This was health care but it was also commodification and men were processed at ‘sick sorting posts’ in the same way as ammunition, food and clothing.

Personal journeys There was clearly a huge military-medical machine on the Western Front. There were modern systems and processes, professional staff, trained volunteers and up-to-date equipment. Yet for any wounded man the overarching system was less important than his own particular journey through it, and the road running from the boucherie or abattoir of the battlefield through to the safety of a clean white hospital could seem like an attractive one.171 Donald Hankey, a young British officer, watched the walking wounded leave the battlefield after having being relieved from heavy fighting: The doctor was in a field. Rows of wounded lay there waiting for stretcher bearers to come and take them to the ambulances. As many as could went on, those wounded in the leg with their arms on the shoulders of those whose legs were whole. They limped painfully along the interminable road till they came to the ambulance. Then their troubles were over. A  rapid drive brought them to the dressing station. There they were given cocoa, inoculated for tetanus, their wounds washed and bound up. Another drive took them to the camp by the railway. Next morning they were put in the train, and at length reached the hospital. There at last they got the longed-for bath and the clean clothes and – joy of joys – were put to sleep, unlimited sleep, in a real bed with clean, white sheets. They were at peace.172 Hankey watched the men limping painfully along the road to the ambulance and so could describe that part of the journey, after which point the narrative becomes an imaginary one. Hankey’s essays appeared in the Spectator and so he was obviously writing for an audience who wanted to think of their wounded friends and relatives sleeping peacefully in beds with clean white sheets. Yet one should not be too cynical about this writing. Hankey was also writing the journey that he wanted his comrades to take, and the journey that he hoped he too would take in the event of injury.

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In this he was to be disappointed: Hankey was killed on the Somme in October 1916 and his body was never recovered. Carlos Paton Blacker (1895–1975), a 22-year-old officer in the Coldstream Guards, was luckier. He was wounded very early on the morning of 27 September 1918, at the Battle of Canal du Nord. As he was climbing out of a canal to reconnoitre a trench he was hit by a German field gun; he then hobbled into the nearest trench which was already full of wounded men. It was while making his way through this trench that Blacker lost consciousness, something he obviously found difficult to describe: ‘crash! – concussion and darkness. The light went out. Full stop. Blankness’.173 His left temporal artery had been cut and was losing a lot of blood, so much that a field dressing could not staunch it. In the trench a medical officer tied a ligature to the artery; this stopped the blood loss and Blacker continued to fight for the rest of the day until he was eventually helped to a dressing station where his wound was cleaned with iodine and then dressed. ‘Feeling like a cripple’ he hobbled towards an advanced field dressing station and found a horse ambulance. Unfortunately the driver had to wait until the ambulance was full before leaving, and so Blacker pressed on alone, on foot. At the main dressing station he was given hot tea and biscuits and from there it was a reasonably short ambulance drive to the field hospital at Beaumetz-les-Cambrai (Pas-de-Calais). There he noted that the noise from the battlefield was at last, only ‘intermittent’. On the following day he was put in an ambulance where he suffered a nightmare of a journey to a casualty clearing station south of Bapaume (Pas-de-Calais), and from there he was put on to a Red Cross train. Once on the train he was given an injection and ‘everything became basically all right … I was basking in a drug-induced euphoria’ and he was clearly in good spirits, three days later, when he arrived at Lady Murray’s hospital in Le Tréport (Seine-Maritime).174 He had travelled roughly a hundred miles before being put into ‘a real bed with clean white sheets’. On the other side of the Western Front, Jünger’s journey was similar. He too relied upon his comrades to provide first aid; he then had a horrific ambulance journey, punctuated by the ‘cries and screams’ of the other passengers. From there he was taken first to a clearing station and then to a hospital established in what had once been an affluent home.175 Blacker and Jünger both describe difficult but ultimately successful journeys. They both reached hospitals in good time, they were treated properly and they survived the war. In today’s military-medical profession there is much talk about ‘the golden hour’, the period immediately after injury when clinical care is vital, and First World War soldiers and medics were also aware of the need for rapid treatment.176 However, it was not always possible because these journeys, although theoretically straightforward, were often problematic in practice. Hospital staff, even those stationed relatively close to the front lines, complained that when men arrived for treatment their wounds were often two or three days old and that they had

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often been waiting in the open air in the meantime. One French soldier was furious with the stretcher bearers who left him waiting in pain for hours: ‘Sales embusqués!’ (Dirty cowards) he cried angrily. ‘How long is it since I have been wounded? Ten hours! For ten hours have I laid there, waiting for you! And then you come to fetch me, only when it is safe! Safe for you! Safe to risk your precious, filthy skins! Safe to come where I have stood for months! Safe to come where for ten hours I have laid, my belly opened by a German shell! Safe! Safe! How brave you are when night has fallen, when it is dark, when it is safe to come for me, ten hours late!’177 Some men died because they were unable to access any medical care at all. Some wounds were so severe that men may well have died regardless of medical intervention but Keegan estimates that up to a third of the 21,000 killed and missing on the Somme ‘died as a result of wounds from which they would have had a chance of recovering if they could have been brought even to the Regimental Aid Post within the first hours of injury’.178 Others simply suffered additional discomfort and possibly complications as a result of delayed treatment. When Henry Oxley, an NCO, was hit by machine gun fire he managed to get himself to a battalion dressing station but it was overcrowded and so he had to leave. He then managed to find an advanced dressing station but it too was overcrowded, and so he eventually received just rudimentary treatment from some ‘RAMC chaps’ who were stationed in a captured German pillbox. From there he had a bumpy ride in a horsedrawn ambulance which took him to an army lorry which eventually took him to a railway station so that he could be taken to a hospital near Boulogne.179 Oxley was not alone in having to arrange matters for himself and Paul Baumer, the protagonist in All Quiet on the Western Front, readily recognized that he would have to bribe a sergeant to get good treatment while waiting for a hospital train. We are lying on our stretchers at the station. We are waiting for the train. It’s raining and the station hasn’t any roof. Our blankets are thin. We’ve already been waiting for two hours. The sergeant looks after us like a mother. Although I’m feeling very ill I don’t stop concentrating on our plan. I let him see the packet of cigars as if by accident, and give him one as an advance payment; for that the sergeant gets a tarpaulin and puts it over us.180 Remarque’s Baumer is a fictional character and this act of bribery is one which is imagined rather than remembered. Yet All Quiet on the Western Front was designed to remind men of their war experiences and it did so effectively. This was a description which made emotional sense to many men remembering their own wars and their own wounded journeys.

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Transport by ambulance was generally uncomfortable. Ambulances were often cold, and whether horse-drawn or motorized they jolted over uneven ground and the men were packed in with their wounded fellows, all of whom could be crying or bleeding or dying. Moreover, the smell of gas gangrene was sometimes overpowering. Gas gangrene was the direct result of fighting in the highly fertile, well-manured farmland of France and Flanders. Wounds became contaminated easily and the resulting ‘gasfilled bubbles under the skin’ meant amputation and, very often, death.181 Ambulance crews hated the smell of gas gangrene, knowing full well that it was very probably lethal. In addition, motor convoys had to drive without lights to avoid attracting enemy attention, a necessary precaution but one which obviously increased the risk of accident. Although technically safe and on their way to greater safety, most wounded men reported suffering great distress and discomfort while being transported by ambulance, and amongst all the difficulties of evacuation and treatment, ‘the abiding recollection of the worst part of the whole business in the wounded man’s mind is his time in the ambulance’.182 Leslie Buswell, a volunteer in the American Ambulance Field Service, described one such horrific journey near Pont-à-Mousson (Meurthe-et-Moselle) in the summer of 1915: One of the couchés was raving and he yelled and shrieked the whole 17 kilometres. It was horrible. When I arrived at Belleville, where they are put on a train and sent to a base hospital, I found that in his agony he had torn off his clothes and broken the hangars of the stretcher, so it was a wonder he did not completely fall on the two men below.183 All army medical services invested in new motorized ambulances to transport the war wounded but many transport arrangements were improvised and very far from the optimistic modernist vision of shiny, well-equipped ambulances. Sometimes men were transported by mules or by panje cart and sometimes even by wheelbarrow. In other areas the wounded were carried in private cars or in London buses.184 Even when medical transportation was at its best, it could never be prioritized. In the trenches, the movement of ammunition was given precedence, then the movement of troop reinforcements and only then were the wounded able to take their turn.185 Throughout the entire network the military priorities always remained the same, and fully loaded hospital trains were often shunted to one side to give priority to troop or ammunition trains.186 There may have been military logic to this process but it meant medical staff and casualties were always unable to work out how long any given journey would take.187 A wounded soldier waiting in the sidings of an unknown railway line, unsure of his final destination, was probably unlikely to ‘throw his sword into the scale for science’ with any great enthusiasm.

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Further reading Secondary sources Anderson, Julie and Heather R. Perry. ‘Rehabilitation and Restoration: Orthopaedics and Disabled Soldiers in Germany and Britain in the First World War’. Medicine, Conflict and Survival 30, no. 4 (2014): 227–51. A comparative analysis of the evolution of orthopaedics and rehabilitation in Germany and Great Britain. Chickering, Roger and Stig Förster, eds. Great War, Total War: Combat and Mobilization on the Western Front, 1914–1918. Cambridge: German Historical Institute and Cambridge University Press, 2000. A collection of twenty-five essays examining the First World War in the light of the concept of total war. Horne, John, ed. A Companion to World War One. Chichester: Wiley-Blackwell, 2012. A collection of thirty-eight essays on a range of themes including war crimes, science and technology, and the arts. Mayhew, Emily. Wounded: From Battlefield to Blighty, 1914–1918. London: Vintage, 2014. A popular account of British stretcher bearers based upon scholarly primary research. Michl, Susanne. ‘Mapping the War: Gender, Health, and the Medical Profession in France and Germany, 1914–1918’. Medicine, Conflict and Survival 30, no. 4 (2014): 276–94. A comparative analysis using case studies of venereal disease and psychiatric disorder. Whitehead, Ian. Doctors in the Great War. London: Leo Cooper, 1999. This is a comprehensive study of British doctors in the First World War. It covers all issues concerned with recruitment, training, the role of women doctors and links between the military and civilian medical professions.

Published primary sources Barbusse, Henri. Under Fire: The Story of a Squad. USA: Feather Trail Press, 2009 (first published in 1917). This is one of the very first examples of combatant literature. Barbusse was wounded several times and eventually invalided out of the army. As a result of the war he became a communist and pacifist and was part of the ‘World Anti-War Congress’ in 1932. Blacker, John, ed. Have You Forgotten Yet?: The First World War Memoirs of CP Blacker, MC, GM. London: Leo Cooper, 2000. This contains a good description of Blacker’s journey through the medical system in France. Dunn, J.C. The War the Infantry Knew, 1914–1919. London: Abacus, 1987 (first published in 1938). A classic account of life in the trenches with associated medical encounters. Graves, Robert. Goodbye to All That. London: Penguin Classics, 2000 (first published in 1929). This is a fictionalized autobiography featuring Graves’ war experiences.

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Muir, Ward. Observations of an Orderly: Some Glimpses of Life and Work in an English War Hospital. London: Simpkin, Marshall, Hamilton, Kent & Co Ltd, 1917. A highly accessible source describing daily life in a war hospital. Available on Project Gutenberg. Remarque, Erich Maria. All Quiet on the Western Front. Translated by Brian Murdoch. London: Vintage, 1996 (first published in 1929). One of the most famous of the established canon of disillusionment literature and featuring some classic descriptions of hospital life and of military doctors.

CHAPTER THREE

Iconic Wounds: Gas, Shell Shock, Facial Injury The early twentieth-century soldier was expected to be ‘sound in wind and limb’ but soldiers on active service also understood that they ran the risk of disease, injury, disablement and death.1 This provoked fear – as Dai and Evan have indicated – but throughout Europe young men had also long taken pride in their ability to inflict and withstand wounds, and French and German youths in particular were wont to display duelling scars as badges of masculine honour.2 Duelling declined in respectability throughout the first half of the twentieth century but a war wound remained especially honourable and the sign Reservé Pour les Mutilés de la Guerre (Reserved for the War Wounded) became standard in French public transport after the war. Even the horrors of the First World War did not completely destroy the romantic associations attached to the wounded soldier, and as late as 1937 a respectable scientific study was able to discuss the erotic attraction of the wounded soldier: The soldier’s value as a lover did not diminish if he happened to return wounded or mutilated. On the contrary, the evidences of what he had suffered on the field of honour proved his courage, his heroism, and even made him more desirable in the eyes of the women. The women walked proudly in the street beside a hero who had his arm in a sling, or his head wrapped in bandages.3 Yet representations of the wounded soldier were often more complicated than these descriptions indicate and the wounded soldier later came to dominate visual images of the conflict in a way that was not seen in previous wars. In the post-war art of George Grosz (1893–1959) and Otto Dix (1891–1969) we see the limbless and the maimed, men not just damaged by the war but rendered grotesque. In Dix’s The Skat Players (1920) the war invalids can only function because they are plugged into

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mechanical prosthetics: this image reflects the later absurdities of surrealism as well as the everyday realities for men without hands, feet, whole limbs or even ears. In Britain, images by John Singer Sargent (1865–1925) and Christopher Nevinson portray prosaic but piteous images of the wounded. In particular, Nevinson’s The Doctor (1916) has come to symbolize an enduring conception of the war. The scene is shambolic, the patients are semi-naked in an old goods’ yard and they are clearly the victims of both the war and the military-medical men who were so crudely attending to them. Images of the wounded and images of aid posts, ambulances, clearing stations and hospitals came to dominate war art for a variety of reasons. On one level, violence was central to the soldiers’ experience of war, as was disease. In Rankean terms, these images simply tell it as it was. Yet placing the sick or wounded soldier at the centre of the narrative is no neutral decision, because mobilizing the power of the wounded, the dying and the dead poses poignant questions about the war and its outcome. In Abel Gance’s film J’accuse (1919), the actors included actually wounded soldiers playing the ghosts of dead soldiers, implying that only the dead or dying soldier had the moral authority to decide whether or not his sacrifice had been in vain.4 Furthermore, images of suffering removed from the battlefield are devoid of the glory and the excitement of combat: in First World War art the soldier became a victim of war rather than its hero.5 Soldiers were much more than just victims of war and not all soldiers were defined by their injuries. Yet some wounds have become powerfully emblematic of this war, in particular, gas injuries, shell shock and severe facial injury. These were not necessarily the most common or even the most problematic of injuries but, rightly or wrongly, they quickly grew to symbolize the particular brutality of this war and so have retained an iconic status.

Gas; Kampfgas; gaz de combat I shall never forget the horrible agony of surprise in the eyes of the men who got that first dose. It was the look of a dog being suddenly beaten for something it hadn’t done. They looked at each other with questioning eyes – I only recall hearing one man start cursing – then they began gulping and coughing, and then fell down with their faces in their hands … My first sensation was of a smarting away up inside of my nose; this quickly extended to my throat, and then as my lungs suddenly seemed filled with red-hot needles, I was seized with a spasm of coughing. Coughing up redhot needles is not exactly a pleasant operation, and the pain was intense. Mercifully, it was only a few minutes before a sort of stupor seemed to come on, but even as I passed into half-consciousness I was aware of my outraged lungs revolting, in heaves that shook my frame against the poison that had swamped the trench.6

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Lewis Freeman, a Canadian soldier, described being caught in one of the first gas attacks on the Western Front. What is striking about his description is not just the intense pain but also the sense of injustice amongst men who were clearly prepared for pain, injury and death. For many people, gas warfare simply broke the rules. It was the German army which first launched a large-scale attack with chlorine gas near Ypres on 22 April 1915. It was not the first time in history that chemical warfare had been used – poisoned arrows can be categorized as chemical warfare, as can the ‘stink-pots’ traditionally attributed to Chinese and Malay pirates.7 More pertinently, chemicals such as tear gas, bromide and turpinite had already been used on both the Eastern and the Western Fronts.8 Nevertheless, this was the first large-scale use of industrial, chemical warfare and it provoked widespread fear and condemnation. Major General Henry Sinclair Horne (1861–1929) was stationed close to Ypres at the time and in a letter to his wife he made his feelings plain: ‘The use of poisonous gases is a most barbarous thing. It means that the wounded, both ours and also theirs would have no chance! They are extraordinary inhuman brutes, and grow more & more so.’9 There was really little point in the Western powers trying to claim any moral high ground on this issue because the British and French had been developing chemical weapons and they went on to use gas too. Yet still the use of gas did provoke particular moral anxieties. The European powers had agreed to avoid the use of ‘asphyxiating or deleterious gases’ in conflict at the Hague Peace Conferences in 1899 and 1907, and no one wanted to take moral responsibility for being the first to breach this agreement.10 MacPherson castigated the Germans for adopting ‘a method of warfare which had always been repugnant to men who believed in observing a code of honour in wartime’, and Hurst argued that Britain only used it because ‘the employment of gas by the Germans compelled us’.11 In a similar vein an officer of the German Chemical Warfare Corps gave doctors a brief history of gas warfare and emphasized that the French army had ‘introduced rifle grenades containing poisonous gases’ in 1914 and that ‘the French had been the first to bombard German positions at Verdun with lethal gases’.12 For the British medical profession the use of gas as a weapon was especially problematic because it called into question the links between scientific development and peaceable enlightenment values. Debates in the Lancet throughout 1915 indicate a sense of crisis amongst the medical elite because of the way in which doctors saw themselves as men of science and civilization (at this point elite doctors were, by and large, generally men). In the pages of the Lancet doctors argued that science was the search for harmony and that the study of science had an intrinsically aesthetic value.13 Yet how could they maintain the privileged position of science as central to the heart of the civilized world when science was responsible for producing such deadly weapons? In Germany there was much talk about Clara Haber, the wife of the chemist Fritz Haber. Clara Haber had been deeply opposed

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to her husband’s work on the development of chlorine as a weapon of war and she committed suicide after the German use of it at Ypres.14 Motivations for suicide are usually complex and rarely attributable to one factor alone, but the interest in this story, which posited woman as the standard-bearer for universal civilized values, indicates the extent to which many felt that the use of gas was morally repugnant. Chlorine was the first gas used during the war and it was sometimes known as pineapple gas on account of its distinctive pineapple and pepper smell. It was reasonably easy to detect but a two-minute exposure in a concentration of one part gas to 10,000 parts air could cause pulmonary lesions.15 Later developments included phosgene, from December 1915, which was twenty times stronger and harder to detect, being initially odourless and invisible, and so was greatly feared because men did not quickly realize that they were breathing it. In a concentration of one part gas to 50,000 parts air, it could cause great damage to the lungs after only one minute.16 Phosgene gas also had a deleterious effect on the heart and some soldiers died of heart failure some days after exposure. Mustard gas, a sticky, brownish liquid rather than a gas, was the most deadly and feared of all the chemical weapons. The Germans first used it before the Third Battle of Ypres (July 1917) and the Allies deployed it from June 1918. It bore no relation to mustard but smelt slightly of mustard or garlic, hence the nickname, although it was sometimes known as ‘yellow cross’ because of the distinctive markers on the German canisters; the French called it yperite because they first encountered it at Ypres.17 The gases of war ranged in intensity; some were lethal and others were merely irritants. In some cases gases, or mixtures of gases, were used to kill the enemy and at other times gases were used merely to produce ‘a temporary disablement’.18 As time went on men became more adept at dealing with gas and the resulting ‘casualty producing power’ became more important than its killing power.19 There were no precedents for dealing with gas casualties and so doctors had to learn by trial and error, by constant improvisation and by clinical studies conducted under the stress of warfare. Almost a year after the first big attacks, Henry Kaye and his colleague Elliott Glenny still felt that there was much to learn. Glenny had been one of the first doctors to study the treatment of gas casualties in 1915, but a year later both men still seemed shocked, and almost baffled, by the sheer power of this new weapon, noting in a report that ‘4 ½ miles away a cow was asphyxiated; 6 miles away a field of clover was bleached’.20 Doctors categorized gas casualties by the symptoms they provoked. Chlorine and phosgene gases are lachrymators and sensory irritants. They made men’s eyes water and produced an intense burning sensation in the throat and chest. Major General Anthony Bowlby described some of the early, almost futile attempts to manage the casualties of chlorine gas: At 7.30pm yesterday on Hill 60 the gas came into their trenches in a thick cloud, and either killed (?20) or incapacitated about 200. About 50 came into Nos 2 and 8 Clearing Hospitals, and of them 10 died within

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12 hours. Those we saw were fighting for breath. We found that the best thing was to make them vomit, for in the straining and retching they cleared their bronchi of a lot of aerated fluid. Post mortems showed oedema of lungs and much acute emphysema.21 While doctors were struggling to respond, soldiers looked on, aware that their doctors could do little, and that despite well-organized medical services, they could simply be left to die. Even Jünger voiced an element of despair, writing that ‘we saw a lot of men affected by gas, pressing their hands against their sides and groaning and retching while their eyes watered. It was a bad business, because a few of them went on to die over the next several days, in terrible agony’.22 These men died of asphyxiation. Just as the eyes watered because of a protective reflex – the body was trying to dilute the poison – the bronchial muscles began to spasm so as to block the passage of gas into the alveoli. This obstructed the entry of air into the lungs, causing men to die a painful and terrifying death.23

Mustard gas Mustard gas was quite different, being a vesicant, namely an agent that causes blistering. It was also far more damaging and mustard gas casualties accounted for 70–80 per cent of all admissions for gas in the British army.24 The gas seeped into the thick army uniforms, irritating and burning the skin, especially on, or in, the moister areas of the body. First, men’s eyes began to water and they began sneezing. Watery eyes soon became swollen; the men then developed conjunctivitis and irritations of the respiratory tract. Sometimes the throat was so affected that a man’s voice would become harsh or he would lose altogether the power of speech. This was accompanied by nausea and extreme stomach pains; meanwhile the burns produced large, painful, suppurating blisters. Even those who had not directly experienced an attack could be affected because the mustard gas lay in pools on the dry soil, affecting food and drinking water. An autopsy reveals some of the very worst instances of gas poisoning: Case 3. – Exposed to mustard gas during early morning of 29th July, 1917. Admitted to casualty clearing station on 31st. Died six days after exposure to gas. Autopsy very soon after death. Extensive burning and blistering of the skin of face, neck, abdomen and scrotum. One large blister occupied practically the whole surface of the anterior abdominal wall. Blistering also found on both feet in a situation which must have been covered by the boots if they were on at time of exposure.25 It is this mustard gas which has imprinted itself firmly on the British collective memory of the war, and contemporaries were most struck by the lines of gassed and blinded men struggling towards aid posts. Helen

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Dora Boylston, an American nurse, described a scene which has now become familiar to all of us: ‘There were strings of from eight to twenty blind boys filing up the road, their hands on each other’s shoulders and their leader some bedraggled, bandaged, limping youngster.’26 This image is best portrayed in John Singer Sargent’s Gassed (1919), now hanging in the Imperial War Museum in London. During the 1970s this image was reproduced in Charley’s War, a popular children’s comic, ensuring that a later generation visualized gas casualties in a similar way, namely as blinded, helpless men stumbling across a blasted landscape. The impact of this painting has remained strong. It is almost ubiquitous in school text books and there are oblique cultural references to it in the strangest of places, such as the initial restaurant scene in Richard Curtis’ romantic comedy, About Time (2013). The enduring popularity of this image is in part due to the way in which the blind men physically and emotionally lean on each other: their mutual helplessness and support is in stark contrast to the heavily armed military powers who have turned their back on cooperation to wage ferocious conflict amongst peoples. Mustard gas was especially damaging but arsenical gases also produced a wide range of disturbing symptoms: an intense irritation of the nasopharynx, some paralysis of the nervous system and irritation of the alimentary canal when men had drunk contaminated water from shell-holes.27 Essentially all of these gases led a man to feel completely out of control of his own body; he felt that he was not simply wounded but painfully disintegrating from within and without.

Gas attacks: Prevention If someone yelled ‘Gas’ everyone in France would put on a mask.28 Most doctors agreed that the best way to reduce gas casualties lay in individual and collective prevention, more specifically the development of efficient gas masks and the inculcation of strict anti-gas discipline. During the first gas attacks soldiers were completely unprepared; they had no masks and they had to use socks soaked in their own urine for protection. The first proper masks were simple cotton pads soaked in hyposulphate of soda, sodium bicarbonate and glycerine, but by the summer of 1916 British troops were being supplied with a range of respirators, goggles, fabric helmets and some large box respirators. By early 1917 all troops were issued with small box respirators and from April of that year these all contained a filter which removed the solid substances in the gas clouds.29 Collective methods included information boards indicating the location of potential gas zones and simple warning devices such as klaxons, sirens and gongs made from old shell cases. The British also carried portable alarms or rattles. These rather primitive devices were essential so that warnings could be made clear in the event of telephone wire being cut. In addition, dugouts

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were routinely protected with anti-gas curtains and men were issued with ‘Vermorel sprayers’ (initially intended for spraying crops) to neutralize the gas: hyposulphate of soda was used for chlorine attacks and chloride of lime was used to neutralize the mustard gas. All of these measures required troops to remain vigilant at all times and the importance of gas discipline was continually emphasized. Reporting on gas casualties in 1916 Kaye stressed, ‘No man who put on his helmet suffered’, implying that at least some men had not put on their helmets.30 The official criticism of men who would not wear their masks grew more pointed throughout the war, and the following report, dated September 1918, made continual reference to the apparent carelessness of the men. Although it must be admitted that losses are unavoidable owing to the heavy concentration of gas produced in the case of direct hits, yet the majority of the casualties are shown, by the report of units, to be due to surprise and carelessness … Considerable losses were caused by the gas attacks which have taken place latterly. The casualties were mainly due to the men being surprised in dug-outs, to the neglect of gas discipline, masks not being at hand, to faulty masks and to the use of old pattern drums which could not afford protection against the type of gas employed by the enemy.31 Men on the ground could do little about faulty masks or out-of-date drums but they did seem reluctant to wear their masks, even when they were not faulty. In 1917 some wounded British soldiers even threw their gas masks away, leaving themselves vulnerable to a mustard gas attack near Hill 60 in Flanders.32 Edmund Blunden was clearly irritated by men mining in an area vulnerable to gas attacks because ‘in spite of words’ they would not wear their masks and ‘two or three of these obstinate men were gassed’.33 However, the men were not simply careless or obstinate; nor were they guilty of mindless bravado. Some of them just had little faith in gas masks, especially at the beginning of the war. Robert Graves, for one, was scathing about the first respirator which was ‘a gauze-pad filled with chemicallytreated cotton waste, for tying across the mouth and nose … it could not keep out the German gas’.34 Others were unsure about the real impact of gas, an understandable position, given that there were often no immediate symptoms with phosgene gases, and, in any case, gases ranged in impact, with some being lethal, whereas others were merely irritants. For this reason, men did not always seem to recognize the gravity of gas training. Private Newton, a stretcher bearer in a Field Ambulance Brigade, even complained, ‘We have had several route marches wearing gas masks to get used to them; it is nearly as bad as being gassed.’35 Corporal Vince Schürhoff was equally reluctant to comply with gas discipline and was irritated with a local decree insisting that respirators be worn by all personnel for an hour each day. He confided grumpily to his diary that he had ‘escaped the one hour’s gas

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helmet wearing stunt’ by ‘taking a novel and hiding in a wood down by the river’.36 Men learned how to deal with gas throughout the war and often had to see the effects of gas for themselves before deciding to take gas precautions seriously. Although he knew about gas warfare, it was not until witnessing men suffering from a chlorine attack in 1916 that Ernst Jünger decided to stop carrying sandwiches in his gas mask case and begin using it for its proper purpose instead.37 On the whole, though, men were sorely afraid of gas and responded quickly when alerted, as Lord Moran noted when describing ‘a minor stampede’ caused by an officer calling ‘gas’.38 They refrained from wearing masks for fairly rational reasons, primarily because they were uncomfortable to the extent of being impractical. Jünger’s description of a chlorine attack near Adinfer woods shortly before the Battle of the Somme indicates the difficulties of adhering to ‘gas discipline’, despite the obvious presence of gas. A penetrating smell of chlorine confirmed for me that this was indeed fighting gas, and not, as I had briefly thought, artificial fog. I therefore donned my mask, only to tear it off again right away because I’d been running so fast that the mask didn’t give me enough air to breathe; also the goggles misted over in no time, and completely whited out. All this of course was hardly the stuff of ‘What To Do in a Gas Attack’, which I’d taught so often myself.39

Gas attacks: Treatments It was impossible to prevent gas casualties altogether and so it was necessary to develop treatment regimes too. There was, however, little that could be done because there was no obvious and immediate chemical response to the wounds caused by gas warfare. Lachrymatory gas shells were intensely irritating but not lethal, and troops generally just required rest.40 Men affected by pulmonary irritants similarly required warmth and complete muscular rest. If a patient was agitated, he might be given a small amount of morphia to calm him down but only if absolutely necessary because the drug can depress the respiratory system and so it could do more harm than good. Men with severe pulmonary oedema were given oxygen, and French, German and British medical officers also treated them with venesection (bleeding) to manage cyanosis and to relieve headaches and chest pains.41 In the main men were primarily kept quiet and given lemonade, weak tea or water to alleviate the painful thirst which accompanied gas poisoning. With mustard gas casualties medics aimed first to alleviate the immediate symptoms and then to prevent any septic after-effects because it was the secondary infections which were fatal. Men were first stripped and washed to remove all traces of the gas, a procedure that was hard to manage at

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a poorly provisioned German aid post close to the lines, as the following description indicates: At our dressing-station we tore off the uniforms of the soldiers soaked with liquid gas, and as far as our very limited supplies permitted washed their bodies, bandaged them properly, and bedded them on straw … I decided to send those who could walk to the rear, accompanied by two of my stretcher bearers. But here another difficulty arose. We had removed their gas-soiled uniforms and underwear from most of the soldiers; we tried to keep at least our cellar free from the lethal gases. Thus they were completely naked; so to each of them we gave a blanket.42 Men’s eyes were bathed with boracic acid, normal saline or a 2 per cent solution of sodium bicarbonate. Liquid paraffin was used to stop the eyelids from being glued together. Shades made from brown paper were used for photophobic patients and a mild antiseptic was used on the eyes in the later stages. The raw, burning throats of mustard gas patients were sprayed with paroleine or soothed with inhalations of menthol in the British army, whereas the French used huile gomenolée (Gomenol oil).43 There was very little that could be done for men’s lungs: antiseptics could help to ease coughing but there was nothing to counter infection of the bronchi. Most of the medical effort was concentrated simply on treating men’s burning, blistered bodies with baths and dressings, then by encouraging recovery through re-hydration and diet. Men who were reluctant to eat were coaxed with milk and beef-tea or with Guinness and milk pudding – traditional British comfort foods – before embarking on ‘a generous diet’.44

Gas attacks: The mental and emotional consequences By the end of the war, clear procedures for dealing with gas casualties existed in the British, French and the German armies. Yet as well as dealing with the physical consequences of gas warfare, the authorities also had to deal with the emotional or mental effects. MacPherson was especially concerned about men who were victims of arsenical warfare and his commentary indicates that their primary response was one of acute mental anguish. Others in whom consciousness was never lost passed into a lethargic condition for a period of twelve to twenty-four hours. A remarkable period in these severe cases was the intense mental distress which accompanied the symptoms already described. Even the slighter cases felt and looked miserable and wretched until the irritation passed off, and the picture of utter dejection and hopeless misery furnished by the severe cases had no counterpart in any other type of gas poisoning. Occasionally the psychical depression resulted in the temporary loss of mental control,

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and men were in a few instances reported as having acted as if they were driven mad by their pain and misery. In at least one instance a man in this condition had to be forcibly restrained from shooting himself, and in another case a man tried to get under the floor of a hut under the delusion that he was being pursued.45 The German authorities were similarly worried about the way in which gas could provoke disturbances of the mental system, and overall there were clearly strong links between responses to gas attacks and responses to shell shock because ‘gas shock was as frequent as shell shock’.46 Moran, then a medical officer with the RAMC, made these links plain: Late in 1917 I was sent to Boulogne to find some means of checking the backward stream. In a quarter of these men we found a nervous disorder – frequently hysteria – implanted on the physical harm caused by the gas, which in itself was often trivial. When after a few days the bodily hurt had gone, there was left an emotional disturbance like a mild attack of shell shock. The physical effects were often absent or of no moment; it was the mind that had suffered most.47 These links between gas shock and shell shock had a clear impact on diagnostic and treatment regimes. Gas casualties suffering from functional aphonia or paralysis were treated with re-education, suggestion or faradization in exactly the same way as shell-shocked patients.48 Gas casualties could not be easily dismissed in the same way as shell-shock casualties but there was certainly a strong belief that men’s responses to gas attacks were personal and subjective, with pathologist Frederick Mott (1853–1926) arguing that the ‘excitable and over-anxious’ were more susceptible to the effects of gas than their level-headed peers.49 This led to concerns about the way in which gas victims were being treated, and just as some complained about the misplaced sympathy lavished on shell-shock sufferers, so others complained about the undue or excessive sympathy given to gas attack victims. Similarly there were suspicions about men who were feigning gas sickness or had deliberately exposed themselves to gas and the German authorities made it plain that such men would be tried by court martial.50 There is a stark contrast between the horror associated with gas and these concerns about undeserved sympathy and malingering. In part this is because despite the ugly and painful injuries wrought by gas attacks, recovery rates were in fact very high.51 Rapid improvements to the quality of protective clothing meant that 70 per cent of gas casualties recovered fairly quickly; across all armies 93 per cent were able to return to the front. Gas casualties spent about half the time in hospital than men hit by bullets or shell fire.52 There were of course different types of gas casualties. The man who happened to catch a whiff of chlorine was in quite a different position

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to someone who had suffered a full frontal attack of mustard gas and in severe cases about 12 per cent of affected men died.53 Yet at the time there were even those who argued that gas was a humane weapon because of the way that it caused high-level disruption with only low-level casualties. Overall, only about 3 per cent of gas casualties died and under 2 per cent were invalided.54 This led some to argue that men had misunderstood the impact of gas casualties and were convinced that it was far more dangerous than objective studies indicated.55 What concerned men was not the reasonably objective reality of a gas attack but the fear that should they fall victim to gas their wounds would be painful, there would be little that could be done about them and if they died of gas poisoning it would be a truly dreadful death. As Osler realized, what was so bad about gas was not simply that men died; it was the way in which they died.56 On a practical level the use of gas was also problematic because it was unreliable and susceptible to changing wind patterns. This was especially the case in gas cylinder attacks and also, to some degree, when troops were using gas-filled projectiles. In the build-up to the Somme offensive in 1916, Bowlby complained about the numbers of British men wounded ‘by our own gas’, yet once gas warfare had begun neither side was willing to abandon it and there was an escalation in its use during the final year of the war.57 For all of these reasons, many felt that the use of gas was unjustified; in Henri Barbusse’s words gas warfare meant using ‘unfair tricks’.58 There was universal condemnation of gas warfare after the Armistice and it was outlawed anew by the Geneva Protocol of 1925.59 Nevertheless, chemical weapons have been used in wars throughout the twentieth and twenty-first centuries and attempts to regulate them continue.

Shell-shocked men; les obusites; Kriegszitterer I cannot forget it, no matter how I skylark.60 (British shell-shocked soldier, 1916) Men like Dai and Evan were certainly worried about keeping a whole skin but they were also concerned about keeping a sound mind. The stresses and strains of intense industrial warfare provoked all kinds of ‘war neuroses’, commonly known as shell shock in Britain. Soldiers began to break down after the Battle of Mons in August 1914 and continued to develop mental health problems throughout the war and long after the Armistice. Quite how many men were affected is difficult to gauge, but there were over 80,000 recorded cases amongst the British armies on the Western Front, approximately 200,000–300,000 German troops were affected and the number of French combatants suffering from mental wounds was similar or possibly higher.61 Overall, shell-shocked men accounted for only a relatively

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small percentage of battle casualties but the statistics indicate that a horrific number of men were severely traumatized by the war and, for the first time, psychologically wounded men presented armies with real problems of morale and manpower.62

Initial responses to shell shock The extent of military-mental breakdown was new during the First World War but the concept was far from novel. Old soldiers had long claimed that men could lose their nerves as a result of the ‘wind of a shell’ or the vent du boulet. British soldiers talked about men becoming ‘windy’ or having the ‘wind up’ when they were no longer able to cope, and this was not simply soldiers’ lore but was reflected in official medical practice too. Moran wrote about how to recognize signs of ‘the wind’ and articles in the medical press detailed the damage that the wind of a shell could do to a man’s nervous system.63 More specifically, during the Russo-Japanese War the Russians had developed innovative treatment systems for psychiatric casualties, namely forward treatment centres supported by a central psychiatric hospital behind the lines.64 In response the French army agreed to organize a military psychiatric section in April 1914; however, this did not materialize and the French army dealt with psychiatric casualties in a fairly ad hoc way during the first few months of the war.65 No armies were adequately prepared for the mental casualties of the First World War, and Moran acknowledged that ‘we did not bother about men’s minds’ in the early days of the conflict.66 This neglect – although crucial – was not simply the result of carelessness. Medical authorities did not bother about men’s minds because they could not foresee the consequences of four years of industrial warfare. Several months after the start of the conflict the French government commissioned a study into the ‘strain of warfare’ and concluded that the war did not provoke any considerable amount of insanity, that battle fatigue was rare and that no further action was needed.67 Meanwhile, the British were convinced that a small, professional or volunteer force which encouraged ‘the right sort of chap’ would have an inbuilt resistance to mental disorders.68 Conversely, a conscript army – not instituted in Britain until 1916 – would be riddled with inherent weaknesses. This belief in the essential inferiority of a mass army endured, even after the victory, and into the post-war period Mott continued to argue that ‘a conscript army drawn from all grades of society [will] of necessity contain a large percentage of men with an inborn or acquired nervous pre-disposition’.69 There were a whole number of deep-seated ideological or cultural reasons which mitigated against an intense preparation for mentally wounded casualties, what the French called les blessés sans blessures (the wounded without wounds). At the beginning of the twentieth century many of the social and political elites, including the medical elites, believed that modern

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civilization was causing an epidemic of weak nerves and that war would heal them. Modern urban life with its unnatural rhythms and temptations was seen as enervating; modern men were likely to be debauched and many German doctors believed that ‘cathartic front experiences’ would strengthen feeble, degenerate, modern men.70 Similarly, many French doctors believed that the war would regenerate French science and medicine, France as a nation and individual Frenchmen.71 This crude social Darwinism persisted and even after the war the psychiatrist Emanuel Miller (1892–1970) insisted on the positive mental effects of ‘hard fighting’, arguing that ‘several instances have come under observations of decorations for bravery that have been won under the occurrence of “shell-shock”’.72 Unfortunately the war did not produce the much hoped-for regeneration and soldiers began to collapse with a whole range of bewildering mental symptoms right from the beginning of the conflict. Often the men were stammering or displaying nervous tics; they were occasionally mute or deaf, or suffering from hysterical blindness. Sometimes they displayed fullblown hysterical paralysis. Others displayed extreme anxiety symptoms and suffered from stupor, inexplicable headaches, amnesia, sleep disorders or somnambulism. It is very likely that men described all of these conditions as ‘shell shock’ from the outset but the term first appeared in print in an article in the Lancet by Dr Charles Myers (1873–1946) in February 1915, and at roughly the same time the French military-medical profession began to publish works on the neuroses of war.73 There was a general consensus that these complaints, although odd and unprecedented to some degree, should not be considered as novel and German medical experts also tended to dismiss the idea that ‘war psychosis’ was a new disease.74 Despite this consensus, popular commentators largely assumed that shell shock was yet another new wartime medical condition and – somewhat paradoxically – it was also a form of madness. The idea that soldiers were going mad in this new and terrible war was disturbing in itself and caused great anxiety on account of the soldier’s role as the exemplar of patriotic masculinity. The links between national identity and strong nerves were such that there was initially an element of denial about the extent, or even the possibility, of military mental breakdown. Nervous collapse was something that happened to other, inferior and uncivilized, troops. The French interpreted mental breakdown amongst German troops as testimony to their essential barbarism; German neurologist Max Nonne (1861–1959) insisted that psychological complaints were only found amongst the French and that there was no ‘masculine hysteria’ in Germany.75 These comforting national stereotypes were ultimately unconvincing and the incidence of shell shock served to highlight pre-existing fractures within supposedly homogenous nation states and allegedly unified empires. The British army insisted that it was troops from southern Ireland – that is those whose patriotism was already in doubt – who were particularly prone to mental breakdown. The German army held similar prejudices about

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Jewish soldiers and the French believed that black troops, especially those from Senegal, were the most prone to psychiatric weakness.76 All of these fears demonstrated a long-standing cultural dread of madness, lunacy or loss of reason. In France the mental health of the soldier reflected the vigour of the French race and it was widely accepted that ‘if they were madmen they would not be soldiers’: there was little noblesse guerrièrre attached to a mentally wounded French soldier.77 Even in Britain, where the army was not as culturally significant as it was in Germany or in France and there was not an historic link between the soldier and the citizen, there was a clear determination to ensure that mentally afflicted soldiers would not be treated like ordinary lunatics.78 In short, soldiers could not be, or even become, madmen.

Shell shock: Diagnoses and debates The term ‘shell shock’ stuck. Arguably it is one of the most popular and recognizable medical conditions of the First World War, and in Britain it has entered everyday language where it is now commonly used to express extreme and unpleasant surprise. Yet, popular though it was, ‘shell shock’ was an ineffective medical term, as Myers quickly recognized, because it implied a simple, direct and causal relationship between the blast of a shell and a man’s mental disorder. The neuroses of war were much more varied and far more complicated than ‘shell shock’ suggests. No sooner had shell shock been identified as a medical condition than doctors began to debate the extent to which a soldier’s mental collapse was organic (i.e. the direct result of physical damage to the nervous system) and to what extent it was purely emotional or psychological. This debate was carried out in the pages of the Lancet, with Myers arguing that a psychological approach was required, but Mott stressed the importance of ‘a physical or chemical change’ in the mentally disordered soldier.79 The French authorities similarly divided men into ‘emotional’ or ‘commotional’ casualties, although French soldiers were very commonly described simply as suffering from ‘mental confusion’ or le cafard (depression).80 Yet the medical position was not as polarized as this language suggests and most doctors recognized an interrelationship between the physical and the emotional strains of war. Albert Devaux and Ernest Benjamin Logre, two French neurologists, emphasized the emotional shock that mentally wounded soldiers had suffered and insisted that the invalide du courage should be treated with the same respect as the physically wounded soldier.81 To a very large degree, these debates about war neuroses simply continued pre-war discussions and disagreements about weak nerves or nervous collapse. Doctors across Europe had long recognized that the victims of industrial accidents often developed psychological problems. Like s­hell‑shocked soldiers, people involved in railway or factory accidents often suffered from

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headaches, amnesia, dizziness or partial paralysis, some of which could be explained by damage to the central nervous system but some of which was clearly attributable to ‘fright alone’.82 Popularly known as ‘railway spine’, this concept of traumatic neurosis was embedded within the state pension legislation in Germany and in Britain, and attitudes to mentally wounded soldiers were very similar to those displayed towards neurotic or traumatized workmen beforehand. The pre-war concept of traumatic neurosis was useful in that it created an acceptable legal and medical category for those suffering from the psychological consequences of physical accidents. Yet, for others, it was problematic in that it provoked questions about simulation and motivation, whether conscious or unconscious. This conflict explains the changing understanding of ‘neurasthenia’ before the war. George Beard (1839–1883), an American physician, coined the term to describe patients suffering from nervous damage on account of the strains of modern urban life. Initially, it was highly powered and successful businessmen who were described as neurasthenic and so the term lacked the stigma usually associated with mental health complaints, but by the early twentieth century it was often applied to malingering workmen, or at least to those with something to gain from the pension system. During the war the inherently ‘neurasthenic man’ was associated with the martial misfit, namely the man who was not ‘much of a warrior’ and ‘who did not wish to recover, dreading a return to the front’.83 The fear that feckless, neurasthenic workmen were being encouraged to abuse the pension system was transformed into a fear that mentally disordered soldiers were being rewarded by a pension system which recognized mental disorders as war wounds: the ‘work shy’ had become the ‘shell shy’.84 Only in Britain did the label neurasthenia regain some of its earlier, more respectable status and it was the label most commonly given to nerve-wracked officers at the beginning of the war, whereas working-class men were usually diagnosed with some form of conversion hysteria or functional neurosis. Disagreements between those who recognized the medical importance of ‘fright alone’ and those who were primarily concerned about ‘pension neurosis’ dominated all wartime debates and reached a particular crisis point in Germany during the war, with serious political implications. In 1889 the German Imperial Insurance Office had accepted Hermann Oppenheim’s (1858–1919) thesis that traumatic events could provoke posttraumatic neuroses. As a result, German workers who displayed neurotic symptoms after an accident were entitled to compensation, provoking some doctors to complain that pensions only encouraged the weak and the ill-disciplined to develop even more symptoms. Arguably neuroses became fixed and recovery remained elusive. In the heightened atmosphere of wartime, those opposed to the concept of traumatic neuroses were able to isolate and defeat Oppenheim at the 1916 War Neurology Congress in Munich. From that point elite German military psychiatrists rejected the previously accepted models of diagnosis and treated war neurotics as

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malingerers, degenerates or frauds. Even those who avoided such pejorative language believed that the mental casualties of war were tainted with a ‘psychopathic pre-disposition’.85 The German model was unique in the way that it initially completely conflated peacetime industrial trauma with war neurosis but this German approach did reflect wider discussions within the European medical profession. Again and again doctors returned to the key question, namely to what extent was shell shock caused by battle (in much the same way as a wound caused by bullets or by gas) and to what extent was it caused by inherent individual weakness. Moran argued that ‘bad stock paved the way for shell shock’ but wanted to distinguish between ‘the good fellow who has done well but is worn out’ and ‘the rest’ who were simply ‘bad stock’.86 This distinction between ‘good’ and ‘bad’ shell shock reflected the traditional British distinction between the deserving and the undeserving poor and therefore it was more of a moral than a scientific judgement. Such moral judgements affected the way in which medical officers throughout Europe assessed symptoms and devised treatment regimes.

Shell shock: Symptoms and treatment Descriptions of shell-shocked men were diverse and were sometimes eccentric. There was the shell-shocked French baker who thought that he was a general and so wrote a letter to the Kaiser; another French soldier apparently ran naked into enemy shell-fire, calling for his mother.87 There was a German soldier who was admitted to hospital with a frog on a lead, insisting that it was a bear; another German soldier allegedly drank ink, claiming that it was good wine.88 One British shell-shocked soldier lost his Lancashire accent and started to speak with a West Country one, and when taken to the zoo he tried to stroke a lion.89 However, these colourful and somewhat bizarre descriptions are atypical, especially in Britain, where the shell-shocked soldier was generally presented simply as young, nerveshattered and unable to fight. Most shell-shocked men displayed symptoms which were quite mundane and doctors generally divided them into two broad categories: nervous collapse or anxiety states and functional neuroses, often described as hysteria. John MacCurdy, an American doctor who worked in Britain from 1917, described one typical anxiety case. A 27-year-old man had enlisted in October 1914 and had adapted well to the demands of trench warfare. By October 1916 he had endured much heavy bombardment, had been buried alive several times and had served mainly in the Ypres section where it had been impossible to bury all of the dead. He began to suffer from hallucinations and to drink heavily but carried on until the following March when he started to have extreme and debilitating headaches. Once in hospital, he found it impossible to sleep:

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As soon as he got into the hospital he began having nightmares which was typical of the anxiety state. In them he was back on the Somme front and being shelled mercilessly. Shells would come closer and closer to him, finally one would land right on top of him and he would wake with a shriek of terror. After a long time he would go to sleep again, to be almost immediately reawakened with another of these dreams, the content being always the same and continued to fighting, in which he was inevitably getting the worse of it.90 In contrast to these generalized anxiety states, men with functional neuroses or conversion hysteria tended to display more specific physical symptoms. In these cases, there was ‘an alteration of dissociation of consciousness regarding some physical function’ – in short, ‘an idea is carried over into a physical symptom’.91 These hysterical men were most likely to suffer from speech disorders, with stammering at the mild end of the spectrum and complete mutism at the most severe end. Men also suffered from hysterical deafness and with motor disturbances such as tics, tremors and, in some cases, paraplegia. Very often men suffered from localized anaesthesia; more rarely men suffered from hysterical blindness, ambylopia (‘lazy eye’) or with disorders of smell and taste. MacCurdy argued that hysterical conditions usually began with concussion, as in the following example: Case XV, the sergeant, who was exhausted and had been worried about his inability to shout without spitting up blood, and therefore had his attention directed to his voice  …  After his concussion and return to consciousness he was mute, following that, aphonic, and then stammered.92 Much has been written about hysteria as a female complaint and there is some merit in attributing the stigma of shell shock to a perceived lack of masculinity in its sufferers. Certainly doctors sometimes noted that shellshocked men seemed to lack ‘sexual desire’ or were somewhat effeminate.93 Nevertheless, class was much more of a factor than gender, especially in the British army. Doctors treating men afflicted with conversion neuroses were more likely to associate them with ineffectual working-class males than with hysterical women. They largely assumed that officers suffered from anxiety states because they were weighed down with a heightened sense of responsibility and idealism, and were overly anxious about fulfilling their duties and maintaining a sense of honour. In the harsh environment of the trenches these men were emotionally crippled because their human desire for self-preservation conflicted with their overbearing sense of duty. Doctors did not perceive such a conflict in men from the other ranks because ‘their ideals are not so high’ and because they did not have to make decisions for themselves.94 A private, a corporal or even a sergeant with a disabling

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wound allegedly felt no inner conflict when removed from the fighting. On the contrary, once recovery set in, he quite naturally was reluctant to leave the safety of a hospital. MacCurdy described the typical response of a man beginning to realize that he was on the verge of recovery: Once recovery sets in, however, the prospect of returning to the trenches is plainly before the eyes of the soldier. Under these circumstances, while he is both consciously and unconsciously loth to leave the comfortable position in which he finds himself, he naturally pays considerable attention to the pain or disability that is a direct outcome of his wound. This attention, backed by his wish for the symptoms to be permanent, convinces him that there is no improvement in any respect that to him is subjectively obvious. Consequently his consciousness gradually adapts itself to the disability until it is incapable of conceiving the idea of true recovery.95 In practice the distinction between the anxiety-ridden officer and the hysterical man was not so clear-cut because British officers were routinely diagnosed with the more respectable neurasthenia even when they displayed hysterical symptoms.96 Nor did the label of hysteria mean that men were automatically treated as malingerers who were concocting their own symptoms. What these cases do indicate is the extent to which the term ‘shell shock’ was a real misnomer because both categories – although crude in themselves – indicate the complexities of Great War shell shock. Whether men were suffering from nightmares, inexplicable headaches, unexplained blindness or a myriad of other disorders, the real problem was that they simply could not forget the traumas of war. Initially the British sent traumatized troops home to be treated or cared for in hospitals far from the fighting, and the German army did the same. For the French army, which was facing attack on its own soil and a rapidly moving front line, it was not so easy to designate a safe zone away from the fighting and so medics began treating men close to the front. Myers was impressed with the French system, arguing that men recovered more rapidly when kept close to the front than when they were sent home. He wanted the British army to adopt a similar system but the Director General of the Army Medical Services was adamant that mentally ill men would not be treated close to conflict zones. Nevertheless, Myers persisted and by the end of 1916 there were four special centres for shell-shocked troops in the rear of the army areas.97 In the first instance shell-shock treatment was simply rest and persuasion and Myers painted a very positive picture of this rapid and straightforward intervention: When men have left the trenches and arrive tremulous or even mentally confused at the Aid Post, the Regimental Medical Officer who has won

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the confidence and respect of his unit may still combat their condition by the aid of moral suasion, and he may thereby successfully induce them to return to duty; whereas if once sent down to a Field Ambulance and thence farther down the line, it may take many weeks or months before they are again fit for duty.98 This type of persuasion which could appear like guidance or even a friendly chat was clearly based upon a strict hierarchy. The doctor–patient power relationship is always asymmetrical and this power was especially potent in the army where the doctor’s class and professional status was boosted by military rank. If a man could not be convinced by ‘moral suasion’, British medics tried to persuade him under light hypnotism, a medically accepted technique in both Britain and Germany at the time. Rendering a man suggestible with hypnotism alone was not always easy and so doctors relied also on anaesthetics to render men more susceptible. At a casualty clearing station on the Western Front, Dr Milligan, a captain in the RAMC, treated all manner of shell-shocked patients by slowly administering chloroform and then making apposite suggestions when the patient was in a most ‘impressionable state’. Like many shell-shock treatments this was based upon previous practice in the civilian world where ‘chloroform hypnosis’ had been used to assist women in labour.99 German medics did not use hypnosis at the beginning of the war but Nonne’s early experiments with hypnosis appeared remarkably successful and so it was widely adopted throughout 1915. Again, the therapeutic relationship and a clear power dynamic was central to the process, and Nonne insisted that the doctor should be completely self-confident, the patient should be totally obedient and the environment be one of healing so as to heighten patient expectation. To reinforce patient vulnerability and the doctor’s power he also insisted that patients should be naked.100 French doctors did not use hypnotism because they associated it with occult and unscientific practices but they were certainly committed to treatment by suggestion, based on the pre-war work of Joseph Babinski (1857–1932).101 In 1915 a French unit suffered a direct hit from a German shell. Two men were killed outright, over a dozen were buried alive and three were rendered ‘deaf and dumb’ by the event. Gustave Roussy (1874–1948), a leading French neurologist, placed the three hysterically wounded men in separate rooms, told them all that they would get better and apparently the results were astonishing: ‘Two recovered hearing partially and speech completely the next day, the third the day after.’102 German medics also quickly learned the importance of keeping patients in a military environment and argued that discharge from the army delayed recovery.103 This was largely to do with keeping men away from the feminizing environment of the home front and promoting what today we would call resilience. Dr von Hansemann summarized this approach effectively in 1916: ‘He gave his patients plenty of freedom to walk about, so that they might learn to rely on themselves again. The influence of parents,

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wife, and children, was, he said, most detrimental.’104 Limiting the influence of women was important to the treatment of shell shock throughout Europe. Women served as nurses, physiotherapists and auxiliary staff in all medical services and hospitals, and women were generally welcomed in territorial hospitals, whether as family members or as philanthropic lady visitors. Yet women were much more excluded from the formal treatment of shell shock. The French medical services would not allow women in neurological centres, and although women did nurse British shell-shocked men, many medical professionals were generally hostile to the presence of women in shell-shock hospitals, whether as wives, nurses or well-intentioned lady visitors. What of those soldiers who were unable to return to duty quickly? All armies wanted men to recover rapidly and to return to duty but they still had to deal with those who did not respond to persuasion close to the front. Military-medical authorities developed a whole range of treatments for more chronic cases of mental confusion; these range from what were described as ‘soft’ to ‘active’ or ‘harsh’ (possibly punitive) responses. Nevertheless they were all similar in that they all relied upon persuasion or suggestion.

Soft treatments and active therapies As a rule hysterical patients were treated more harshly than those deemed to be neurasthenic but generally medics treated all mentally wounded men in the same way when they first encountered them. At one British stationary hospital in France all men were encouraged just to stay in bed for three or four days. The French similarly encouraged rest, good food, balneotherapy (therapeutic bathing) and massage; shell-shocked men were also offered heliotherapy, a light therapy traditionally used for patients with tuberculosis.105 Even those officially categorized as hysterical in the German army could initially be given ‘soft therapy’, such as spruce needle baths, wholesome food and drops of valerian.106 Yet other approaches encouraged men to understand their own condition and participate in their own recovery. Mott, in charge of the specialist Maudsley hospital in London, insisted upon an ‘atmosphere of cure’, in other words an environment in which recovery was compulsory.107 Roussy, at Salin-les-Bains, used more prescriptive language and made it clear that those who would not participate properly would be quickly identified and then isolated.108 Men who were sufficiently disturbed to be sent home for treatment faced a level of stigmatization. British shell-shocked soldiers were transported in special segregated carriages which were unloaded in quiet railway sidings; similarly French patients were moved in closed carriages so that they could be hidden from public view. Westman explicitly linked shell shock with fearful and easily transmittable conditions by describing trains full of men with infectious or mental diseases as ‘our sordid load’.109 Men were embarrassed at being sent to lunatic asylums and they resented being treated by alienists

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as though they were insane. That some men were sent to asylums – known as pauper lunatic asylums in Britain – was deeply distressing for them and for their families but it was not the way in which the majority of shellshocked men were treated.110 British soldiers with psychological or neurological complaints were traditionally treated at D-Block in the Royal Victoria Hospital at Netley but it was clearly insufficient for the number of shell-shock cases being sent home from the Western Front. A network of different psychiatric centres developed throughout the war, one of the most prominent being the Moss Side Military hospital at Maghull, near Liverpool. The hospital was initially owned by the local Board of Control, but it was commandeered by the War Office at the end of 1914 and it housed severe cases of shell shock (mainly non-commissioned officers and men from the other ranks) until the middle of 1919. In total 3,638 patients were treated at Maghull throughout the war years.111 Doctors at Maghull, many of whom were interested in psychodynamic ideas, recognized that more than the shock of the shell was involved in shell shock. Men broke down because they had been living under great strain and so were unable to deal with ‘some special shock’ such as the death of a friend, a close explosion or, in one case, a man’s realization that he had accidently killed a comrade.112 Central to medical practice at Maghull was a belief in the importance of seeking the underlying causes of mental disturbance. Dr Richard Rows, the medical superintendent at Maghull, argued that once a man realized why he was acting in a disturbed manner he would be able to cease doing so. This was the basis of the talking cure, which, unlike much other treatment, did not try to make men forget about their awful experiences. On the contrary, it urged men to manage their memories: The patient will understand that it will not be possible for him to banish the memory completely. But he can be induced to face the trouble, to reason about it, and to recognise it simply as a memory of the past instead of allowing the emotional tone connected with it to dominate him until the condition of anxiety had been produced.113 This process was not quick, being based on a number of doctor–patient interviews, each lasting for at least an hour. ‘Short cuts may be attempted’, warned Rows, ‘they rarely lead to success’.114 The doctors at Maghull were humane and progressive but their methods were not completely successful. The men resisted all attempts at dream therapy because they thought that the doctors would identify something in them that would indicate they were fit to return to the front.115 Some doctors found this lack of engagement dispiriting and William H. Rivers (1864–1922), now lionized in Pat Barker’s Regeneration trilogy, grew tired of working with uneducated men who could not relate to his methods and he transferred to Craiglockhart War Hospital for Officers in 1917.

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The processes at Maghull contrast vividly with Hurst’s treatments at the Royal Victoria Hospital, Netley, and at Seale Hayne in Devon. In 1917 Hurst made an educational documentary demonstrating how ‘vigorous persuasion and manipulation’ cured men with functional neuroses in a very short time.116 Hurst’s film gives us a rare glimpse into the shell-shock hospital of the First World War and it provides harrowing images of men with severe hysterical disorders. In the footage which now appears as voyeuristic we see under-nourished-looking men, all from the other ranks, writhing and struggling in a bleak hospital environment. Sometimes they were dressed in the characteristic hospital blues and sometimes they were almost naked. These men were characterized by their physical disorders, ‘Wire spring gait’ – ‘Slippery ice gait’ – ‘Battling with the wind’, and appeared in rather crude ‘before’ and ‘after’ images. Thirty-two-year-old Private Read was buried by a shell in August  1917 and as a result suffered from ‘hysterical gait, swaying movements and nose-wiping tics’ for a full five months before being admitted to Netley. After only two hours of ‘treatment and re-education’ he could walk normally and appeared cured. Private Richards’ recovery was even more dramatic, and after a mere thirty minutes he threw down his stick and walked.117 Contemporaries treated Hurst’s claims with some suspicion, and Dr Thomas Lumsden insisted that while it was relatively easy to remove symptoms in a short time, the relapse rate was very high.118 Hurst was unclear about the methods he used but they obviously involved some hypnotism and some physical manipulation. These were perfectly acceptable medical approaches at the time, but he also strayed into areas that were somewhat more controversial when he carried out what can only be described as fake operations on men suffering from hysterical deafness. Hurst clearly saw no ethical problems with this procedure which he saw as being both logical and efficacious and he was also keen to stress one soldier’s ‘intense delight’ at the results.119 Mott too used what we now consider to be ethically dubious processes: I have cured functionally paralysed hands that have been treated by electricity, by telling patients that their hands are cold and benumbed, and that the blood supply to the part is insufficient to excite the nerves, so they have lost consciousness of the hand; but after it has been warmed by radiant heat, they will be conscious of it and able to move the fingers.120 Was this the point at which suggestion bordered on trickery? Did the accusation of trickery matter if the man was cured? These questions become even more pertinent in the case of the fake operations which were carried out, with some success, in both France and Germany. In 1915 Alexandre Souques placed a shell-shocked soldier in a plaster corset to deal with his hysterical ‘camptocormie’ (bent back); German medics used a whole range of physical procedures including fake operations, phoney drugs, false injections, X-rays in darkened rooms, cold compresses and the application

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of small balls into the larynx to mimic suffocation.121 It is also the case that methods which sounded like ‘soft’ therapy could easily become more punitive. Balneotherapy or spa therapy had long been popular, especially in France and Germany, and it was the Romans who first developed spas to help wounded soldiers recuperate. The ‘sleep baths’ for shell-shocked soldiers were clearly part of this tradition and they sound gentle and inviting. Yet enforced and prolonged bathing was deeply unpleasant and could be seen as a punishment rather than a cure. Oskar Graf, who was hospitalized in 1916, was perceived as a very provocative patient, and he insisted that he was being bathed simply because the hospital attendants wanted vengeance and because they wanted to make him compliant. We were defenceless, lying stark naked in a bath of hot water at 104 degrees Fahrenheit. The room was full of steam and wet and slippery. Three attendants walked to and fro at the window. If one of us tried to get out of the bath, they simply pushed him in again, so we just had to lie still, to lie and wait. We were given our dinner in the bath but we were not hungry. We grew weary and then weak. We heard horrible cries of distress from cell doors on one side: shouts, screams, curses, and prayers. It was not till the third day that I was taken out of the bath, utterly exhausted and put to bed.122 While one could argue that all of these procedures were justified if men were cured, it is also clear that they could be brutal and that they bordered on cruelty.

Electrotherapy in Britain It is the use of electrical treatment that has now become the most controversial of all shell-shock treatments, although this was not always the case at the time. Doctors had been interested in the effects of electricity on nerves since the beginning of the nineteenth century. ‘Galvanic therapy’ and ‘faradism’ were offered alongside massage as a beauty treatment in clinics and in fashionable Turkish baths, and medical electricity was an accepted treatment in France, Germany and Britain at the beginning of the twentieth century, although its popularity was on the wane, especially in Britain.123 The war reinvigorated an interest in electrotherapy, in part because of the importance attributed to physical shock. A fleet surgeon in the Royal Navy remembered visiting a clinic to witness the treatment of functional dumbness before the war. The physician touched the patient’s vocal chords with an electrode and the patient recovered his speech instantly. The cure was not attributed to persuasion but to the actual effects of the shock, and he went on to explain thus: ‘The electric shock cured the effects of the previous shock, no matter from what cause, and is on all fours with the case

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of the soldier who cured himself by inadvertently placing the lighted end of a cigarette in his mouth.’124 In retrospect this appears to be overly simplistic but other doctors developed very complicated and highly technical approaches towards the administration of electrical treatment. Edwin Ash, neurologist to the City of London Red Cross hospital, provided this glowing – and somewhat convoluted – account of electrotherapy in 1917: For a number of men suffering from the nervous irritability, hypersensitiveness and indefinite muscular pains which are not infrequently met with in the convalescent stages of war neurasthenia, the descending galvanic current applied with the anode over the cervical spinal region and each foot placed in a small bath, and the baths both connected to the negative pole, gives excellent results … For the treatment of shell shock after the initial stages I cannot speak too highly of the static apparatus. Where there are irritability, restlessness, disturbed sleep and headache, I have found simple charging with the patient on an insulated platform connected to the negative pole whilst an electrode is adjusted to give a gentle head breeze an invaluable method.125 Captain Wilfrid Garton, another supporter of electric treatment, put it more succinctly, arguing that electricity was ‘the most powerful agent we have for stimulating the nerves’.126 Others were sceptical about this rather elaborate therapy. David Eder, who was interested in a psychoanalytic approach and therefore dismissed the mechanistic focus on nerves, thought that electric treatment savoured ‘of charlatanism’ and that it should not be used on hysterically-mute soldiers, provoking some rather snide comments in the Lancet: ‘Those who have used it with success’, wrote his critic, ‘will probably smile at Mr Eder’s veto’.127 In Britain, Lewis Ralph Yealland (1884–1954) of the National Hospital for the Paralysed and Epileptic, Queen’s Square, was the foremost advocate of electric treatment.128 He used it on both officers and men, and produced a therapy based on the three-fold power of electricity, suggestion and the personality of the doctor. My plan in treating these cases, has been to make a display of examining the throat, ‘the seat of the trouble’, and while doing so, I have asked the patient to say ‘ah’, to cough, to gargle water aloud, to clear the throat, etc. If the response has not been successful a spatula applied clumsily to the back of the throat has sometimes produced the necessary sound. A sound evoked so easily requires little re-education … Electricity is the great sheet-anchor of treatment in these cases, and until its use has been employed the patient must not be led to believe he is being treated, even though a return of voice may be expected during an examination of the larynx.129

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There were a number of levels of deception in Yealland’s approach. First he pretended that the complaint was a purely physical one which required a straightforward physical treatment. Yet, as his words make plain, the ‘great sheet anchor’ of electricity was little more than theatre. Even more striking was Yealland’s insistence on carrying out the electrical treatment even if a soldier’s voice returned during the preliminary examination. This was clearly an exercise in power – the voice must not return until Yealland deemed it appropriate – which is why his methods were later deemed punitive and compared to the most ruthless and manipulative of animal training techniques.130 Yet at the time many in the medical profession appreciated Yealland’s work with the ‘difficult cases’ who might otherwise have remained uncured. Mott, for one, applauded Yealland’s efforts, although he acknowledged that ‘strong suggestion’ rather than the power of electricity was the key to Yealland’s success.131 In Britain the success of electrical treatment was attributed to a variety of causes: to the straightforward shock which cancelled a previous shock, to the mysterious forces created by electrical energy, and to its pivotal role in the persuasive therapeutic theatre of a charismatic physician. Whatever the motivation or explanation, it was clear that electric treatment was potentially exploitative, as political scandals in France and in Germany made plain.

Electrotherapy in France: ‘Cette guerre aux blessés’132 Whatever the merits of electrical treatment, soldiers were afraid of it and its fiercest critics saw it not as treatment but as a ‘war on the wounded’. In France electrical treatment was known as torpillage, translated as ‘torpedoing’ in the British press, and it was explicitly described as a treatment which was brusquée, a word indicating an abrupt or sudden attack.133 This was a clearly painful process, far removed from the ‘galvanism’ found in spas and Turkish baths. Neurologist Dr Clovis Vincent (1879–1947), a captain in the French army, became well-known for practising this ‘faradic treatment’ or torpillage at the neurological centre at Tours, arguing that as a result of his work 15,000–20,000 men had been returned to military service.134 Well-respected medical bodies such as the Société médicale des hôpitaux and the Société de neurologie supported the use of electrical treatment; nevertheless, Vincent and his torpillage became notorious during the war, prompting questions about the role of the military doctor and the rights of the citizen-soldier.135 Baptiste Deschamps (1881–1953), an ordinary soldier in the French army, was wounded in November 1914 and after surgery he suffered from severe camptocormie. He was sent to several neuropsychiatric centres before arriving at Tours in May  1916. Once there, Deschamps became terrified by soldiers’ stories about Vincent’s torpillage. Medical and military authorities thought that it was effective and medically respectable, but soldiers reported being hit by an electrical force that could have knocked

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out a tram, they talked of soldiers being found dead in the treatment rooms and many claimed that they would rather face a court martial than another session with Vincent.136 Soldiers thought that it was more like torture than therapy. By the time Deschamps was called for treatment he was not only afraid but furious. He refused the torpillage, and when Vincent persisted he thumped him, an action punishable by death, given that Vincent was an officer and therefore his military superior. The case provoked much press attention, with one journalist even going so far as to have the torpillage himself to see if it was as painful as the soldiers claimed. By the time the case came to court it was clear that there was overwhelming public support for Deschamps, and despite the power of the medical-military elite, he was given only a six-month suspended sentence, unprecedented leniency for the crime of assaulting a superior officer.137 Not all soldiers were opposed to torpillage and some reported that the treatment had made them better. Some French doctors continued to practice it after Vincent’s trial, notably Roussy, who remained committed to psychofaradique treatment at his clinic in Salins-les-Bains (Jura).138 Its supporters argued that soldiers who wanted to get better accepted the treatment; it was only those who wanted to remain in the safety of a hospital who resisted it. The debate in France was not so much about the efficacy of electrical treatment as about the soldier’s right to refuse medical treatment. Was the soldier’s body his own or did he have to submit it to military discipline even when wounded? Did the patriotic imperative to fight for France mean that the soldier lost his individual liberty, even over something as intimate as medical intervention? For most French citizens the answer was clear, and from the spring of 1918 electrical treatment for nervous disorders was obviously in decline.139

Electrotherapy in Germany Electrotherapy was used much more extensively in Germany than in France or Britain and its key proponent was Fritz Kaufmann (1875– 1941), an Austrian-Jewish neurologist based at the nerve hospital in Ludwigshaven. Kaufmann had grown frustrated by the ineffectiveness of what he saw as the softer therapies because the warm baths and gentle sedatives were just not returning nerve-shattered soldiers to the front in sufficient numbers. Since 1915 there had been occupational therapy programmes in which the shell-shocked men worked on farms and in forests. They were unsuccessful too and many of the patients were simply pensioned off. Like many others, Kaufmann had come to the conclusion that war neurosis had become too attractive and it offered soldiers an easy way out of the trenches, depriving the German empire of a fighting force and stoking up an unmanageable pension bill for years to come. Kaufmann was determined that even if he could not return men to the

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front, he could at least make men well enough for civilian work so that they would not need state pensions for the rest of their lives.140 Kaufmann detailed the principle features of his approach in a paper which received international attention in late 1916: 1. Preliminary suggestion, consisting not only of the stock methods

of suggestion but also the ‘atmosphere’ of a hospital in which successful cures are numerous. It was impressed on the patient that, though the treatment would be painful, the cure would be complete and permanent. 2. Powerful electrical shocks supplemented by vigorous ‘wordsuggestion’. As a rule, the sinusoidal current of a pantostat was preferred to the faradic current. It was combined with the galvanic current when there were symptoms of hysterical anaesthesia. 3. Maintenance of an atmosphere of strict military discipline. From the moment the patient was admitted to hospital he was impressed with the spirit of unquestioning, unreasoning obedience. 4. Masterfulness and pertinacity were essential; it might take hours before the desired effect was obtained, but with perseverance and the exertion of the physician’s whole personality success was ultimately achieved.141 What came to be known as Kaufmannisch (the Kaufmann cure) was painful, and Kaufmann referred to his own treatment as Überrumpelungsmethode (the unexpected attack method), a term very similar to the French torpillage and the label brusqueé. English physicians, obviously thinking along the same lines, sometimes referred to ‘rough treatment’. This language emphasized the combative rather than the therapeutic nature of the process, and was also known as ‘active treatment’ because it depended upon a highly energetic medical intervention, unlike the earlier, more gentle approaches.142 The distinction between active and punitive was a subjective one, and British medical opinion was quick to label Kaufmann’s approach as ‘disciplinary’ and to stress its brutality, arguing that the treatment was one which ‘even some of his fellow countrymen have considered inhuman’.143 The Kaufmann cure was certainly brutal but contemporaries were less concerned about its brutality than its efficacy. Like Yealland, Kaufmann combined strong suggestion with electric shocks and the power of the physician’s personality. He was also insistent on completing the session according to the physician’s, rather than the patient’s, judgement: the nerveshattered soldier did not have the right to pronounce that he was cured or that he needed no more treatment. According to Kaufmann this system led to very high rates of success, and he claimed that at one point he had cured forty men, each in one single session.144 The key point about the Kaufmann cure is that it was seen as being successful not in spite of its brutality but

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because of it. Kaufmann perceived the treatment as a battle of wills between himself and the soldier who was ethically inferior and so simply did not want to be cured. To win the battle of wills it was important thoroughly to emphasize the unbeatable power of the army doctor. For this reason Kaufmann, like Nonne, ensured that his patients were often stripped naked: it increased their sense of vulnerability and so made the doctor (who was also a military officer) appear invincible.145 Electrotherapy was used in a similar way in Britain, France and Germany but provoked slightly different responses in each country. In Britain it remained a marginal treatment and so was associated with no great scandal, although there was much medical debate about its success or otherwise. In  France the Deschamps–Vincent affair raised questions about the individual liberty of the citizen-soldier, a topic which seems quite absent in German debates about the Kaufmann cure.146 Leaving these national differences aside, there were widespread similarities in the medical-military assumptions about the sort of men who required electrical treatment. Yealland, Vincent, Roussy and Kaufmann were all occupied to some degree with the concern that many men did not want to get better. It was therefore the physician’s role to provoke in these men a sense of honourable and patriotic masculinity. The retrospective criticism of electrotherapy has mainly been focused on the pain and the humiliation of mentally damaged men – an issue which also motivated some contemporaries, especially in France – but soldiers were expected to endure pain, and pain is highly subjective. Professor Otto Schultze, writing in defence of Kaufmann, argued that the pain of electrotherapy was not so very different from the pain suffered by a woman in labour.147 The subtext here was that if a man could not withstand the pains borne routinely by women, he was clearly not much of a man. Vincent made a similar point in a different way: What was the pain of torpillage when compared to the pain of the men fighting at Verdun?148 This is again a gendered comment because those who were still holding the line at Verdun were clearly demonstrating the highest qualities of patriotic masculinity. One hundred years after the event electrotherapy seems cruel and almost primitive in its barbarism. In the 2014 stage play of Pat Barker’s Regeneration there is a ‘terrifying scene’ in which a mute soldier is given ‘electro-convulsive shock treatment’ and the imagined Rivers – emblematic of an enlightened, modern and humanized medical approach – ‘watches in disgust’. The play is constructed so that we are all Rivers, looking back not just in disgust but in anger.149 There are two points for the twentyfirst-century observer to bear in mind here. First, the electrotherapy of the First World War was not the same as the controversial electroconvulsive treatment which targets the brain. Second, we also need to remember that electrotherapy with its dazzling equipment seemed highly modernistic at the time. Despite the obvious reliance upon suggestion and traditional hierarchy it was a supposedly modern and technological way of turning martial misfits back into soldiers.

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Facially wounded men; les gueules cassées; Gesichts-Entstellten (Gesichtsentstellten), Menschen ohne Gesicht Throughout the war severely wounded men returned to France, to Britain and to Germany. These men may not have kept ‘a whole skin’ but they were at least alive and their return was usually greeted by cheering, patriotic crowds as well as – no doubt – anxious friends and relatives. A short wartime film shows wounded men coming home to Britain by ship. The first image is of cheery, uniformed chaps on the top deck of the ship. They were the men labelled ‘BS’, the lightly wounded, who were ‘boat-sitting’, as opposed to more seriously wounded men, who were ‘BL’ or ‘boat-lying’. Once the men begin to disembark we start to see men on crutches, men propping up their friends and even some men on stretchers.150 Clearly these men were badly hurt and in need of medical treatment but they were at least the respectable face of the wartime wounded: we can look them in the face because they still had faces. Those with severe facial wounds, the ‘bad cases’, the ‘men without faces’, were in a different category and invoked horror or revulsion rather than sympathy.151 In French, the term les gueules cassées (literally ‘broken mouths’) refers to the gaping mouth of an animal not a human being, rendering the term essentially dehumanizing. In Germany men with severe facial wounds were most commonly described as Gesichts-Entstellten, using the pejorative ‘twisted’ to describe the face.152 Alternatively they were Menschen ohne Gesicht, men without faces, or men without the most significant marker of humanity. Approximately 280,000 men from France, Germany and Great Britain suffered from maxillofacial injury during the war, that is, injury to the jawbone and to the soft tissues of the face.153 Trenches were primarily designed to protect men from the intense highly industrialized warfare of the Western Front yet men could not avoid being hit and hurt. Their bones were shattered and splintered by high velocity bullets; a man’s face could be almost destroyed by large entry and exit wounds and by splinter or shrapnel balls. They could be burned by flamethrowers or maimed by vicious handto-hand fighting. Head wounds were not the most common of wounds. Estimates indicate that of all the French soldiers reaching hospital alive, 21 per cent had been hit in the torso, 51 per cent had been hit in the arms or the legs and 17 per cent had been hit in the head. Only 11–14 per cent of French wounds were directly to the face.154 Yet head or face wounds were seen as being especially horrific. Recounting his war experiences many years later, Westman was still dismayed and dumbfounded at his memories of men without eyes and men without jaws.155 Similarly, Claire Tisdall, a VAD nurse, had seen scores of severely injured men but it was one facially injured man who stuck in her mind with particular horror.

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The worst case I saw – and it still haunts me – was of a man being carried past us. It was at night, and in the dim light I thought that his face was covered with a black cloth. But as he came nearer, I was horrified to realize that the whole lower half of his face had been completely blown off and what had appeared to be a black cloth was a huge gaping hole. That was the only time that I nearly fainted on the platform.156 There has long been a suspicion of those who are physically misshapen. A seventeenth-century children’s primer explained that ‘Monstrous and deformed people are those which differ in the body from the ordinary shape’, and those with facial wounds differed in the most alarming manner.157 Observers felt a real conflict between this age-old, deeply ingrained horror of the ‘monstrous’ and a simultaneous but conflicting desire to feel sympathy for the wounded. Henriette Rémi, a Swiss volunteer nurse, wrote frankly about how she had to struggle with fear and loathing before she could find the compassion needed to communicate with the facially disfigured men whom she initially saw – in early modern terms – as ‘monsters’.158 It was not easy to care for these men, and medical staff were so affected by these wounds because the social, cultural and emotional value of the face can hardly be overstated: ‘losing face’ is shameful, we ‘face up’ to the world when we are courageous, we ‘show a face’ when we are needed and women even ‘put on a face’ when leaving the house. Preserving and displaying the right face has often been seen as a particularly female preoccupation – it is Eleanor Rigby who keeps her face in a jar by the door – yet the face is important as a marker of identity and humanity for men too. Men with damaged faces were isolated, even from themselves, as they endured long periods in hospital where mirrors were forbidden and men could only guess at their own appearances by looking at the faces of one another. Of course, men have always suffered from facial injury in wartime, and such injuries have always provoked a very particular dread. Gehrhardt even notes that during the Napoleonic Wars facially wounded men were generally killed by their comrades ‘to spare them further misery’.159 What was different in this war was that the wounds were more extensive and horrific than ever before and that men were more likely to survive these terrible injuries than ever before. Private McGowan of the Black Watch was one of those men who managed to survive severe facial injury in almost unimaginable circumstances. He was fighting at Cambrai in March 1918 when the conditions were far from those of anonymized, industrial warfare, and he later recalled, ‘The fighting at this point was of a very ferocious nature it was practically hand to hand.’160 He was shot in the left wrist and the left shoulder, and an explosive bullet had struck him sideways in the face. He lay in his trench for nearly six hours before being carried to a German dressing station. As a POW he was not prioritized and simply lay on a ‘heap of stones’ while noting bitterly that the German wounded had straw to lie on. He was sent to Germany in a

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goods truck, a journey that took three days; he then spent three months in a German POW hospital before being sent back to Britain for proper medical treatment.161 For men like McGowan, new developments in plastic surgery were crucial.

Harold Gillies and plastic surgery of the face The principles laid down by the fathers of surgery are found still to be of general application. But our work is original in that all of it has had to be built up again de novo.162 Like many other wartime specialities, plastic surgery was not new and there had been significant pre-war developments in aesthetic surgery, the most prominent being the work of the Prussian surgeon Jacques Joseph (1865–1934), who pioneered modern rhinoplasty. Initially the French and the Germans were the leaders in maxillofacial surgery due to their experiences in the Balkan wars; nevertheless, as Gillies’ words indicate, plastic surgery was reinvigorated and redeveloped during the war because of the sheer number of patients.163 All army medical services had to treat facially wounded men throughout the war, and wartime developments in facial surgery are widely held to be the bedrock of later, more sophisticated, work in plastic surgery. The Dutchman Johannes Esser (1877–1946) worked with facially injured servicemen in Vienna, Budapest and Berlin during the war, and consequently he became known to the Dutch as the ‘father of plastic surgery’.164 Esser had been marginalized before the war because of his experimental work on cosmetic surgery, a field many of his contemporaries dismissed as both unproven and unnecessary, but in 1916 he assumed control of the Facial Plastic Surgery division at the Charité Hospital in Berlin and in 1919 he was appointed professor, despite his refusal to renounce his Jewish religion.165 The surgeon Hipployte Morestin (1869– 1919) was held in equally high regard by both colleagues and patients at the Val de Grâce, the primary treatment centre for facial injuries in Paris.166 The most renowned pioneer of wartime plastic surgery was Harold Gillies (1882– 1960), a New Zealand-born ear, nose and throat surgeon who developed a specialist centre for the treatment of facial injuries at Queen Mary’s Hospital in Sidcup, Kent. Captain (later Major) Gillies joined a Belgian ambulance unit at the beginning of the war and was very impressed by the work on jaw injuries which he had witnessed at the 83rd General Hospital at Pasde-Calais. He was persuaded of the need for a specific treatment centre on mainland Britain and in January 1916 he established a specialist facial surgery unit at the Cambridge Military Hospital in Aldershot. From this point all facial casualties were sent directly to Aldershot but the unit soon became overstretched and simply could not cope with the number of casualties arriving from the Battle of the Somme (July–November 1916).167 As a result Frognal House at Sidcup was converted into Queen Mary’s Hospital and it

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opened on 18 August 1917 with 320 beds.168 By 1918 there were a thousand beds available and Queen Mary’s was home to facially wounded troops from Britain, Canada, Australia and New Zealand. Between 1917 and 1925, 5,000 servicemen were treated at Sidcup and associated hospitals, and doctors performed a total of 11,000 operations.169 Wartime facial reconstruction was initially directed by Colonel Sir William Arbuthnot Lane (1856–1943) at Aldershot. Lane was a renowned physician and surgeon and the team at Queen Mary’s was further energized by surgeons from Canada, New Zealand and the United States. Gillies’ greatest achievement was possibly bringing together a whole range of specialists: Major Seecombe worked in injuries to the nose, Captain King pioneered repairs to the jaw and Captain Kelsey Fry was the chief dental surgeon. The wounded could ‘call upon surgical skill from the whole AngloSaxon race’ and key doctors at Queen Mary’s also worked closely with French experts. Although it was not possible to work with colleagues from enemy nations, Gillies carefully studied the techniques used by German plastic surgeons.170 Yet facial surgery required more than medical expertise; this was an area where ‘Surgery calls Art to its Aid’ and the medical work was supported and enhanced by the artistic work and design of Henry Tonks (1862–1937), Francis Derwent Wood (1871–1926) and the Australian Daryl Lindsay (1889–1976).171 This approach was not unique to Sidcup, and the German facial surgeon Erich Lexer was similarly interested in art and sculpture.172 Men like Private McGowan frequently arrived at Queen Mary’s long after they had been wounded and their patient record cards were often lost, damaged or incomplete. Sometimes their wounds had partially healed; sometimes doctors in France had attempted repairs and this rather makeshift surgery had to be taken apart and work begun afresh despite the growth of extensive scar tissue. The men were exhausted, undernourished and prone to infections. Gillies outlined the principles which underpinned the medical approach to these men at Queen Mary’s. Although the press celebrated ‘wizardy’ and the ‘making of new faces’, Gillies was not attempting to make new faces but was trying to rebuild and repair the underlying structures of the pre-existing face. In the first instance he aimed to allow normal tissue to be replaced wherever possible. It was tempting to try to close ‘unsightly gaps’ but in the long term it was counterproductive because too much surgery, too quickly, tended to produce swelling, suppuration and excessive scar tissue.173 Once surgery began Gillies aimed to work with the existing facial scaffold as far as possible and to replace ‘bone for bone, cartilage for cartilage, fat for fat’.174 He warned against the use of foreign implants, which ran the risk of being rejected, and encouraged the use of grafts taken from the patient himself. Most crucially, Gillies was committed to the primary importance of restoring function to the face and to repairing underlying membranes before attempting any work on surface tissue. The key was repair rather than replacement because ‘there is no royal road

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to the fashioning of the facial scaffold by artificial means’.175 There has been a tendency to distinguish between plastic surgery (for functional repair) and cosmetic surgery (for aesthetic purposes), with the latter being dismissed as frivolous. Yet there is an intrinsic link between function and form, and ultimately the most successful of cases were those in which the underlying structures of the faces were carefully repaired before any type of superficial work was begun. In Gillies’ words, ‘the best cosmetic results are, as a rule only to be obtained where function has been restored’.176 The particular importance of the aesthetic dimension of facial surgery and of the relationship between art and surgery is best emphasized by the work of Tonks. Initially a doctor by profession, Tonks demonstrated the link between art and surgery in his own career. Tonks studied medicine at the London Hospital in Whitechapel; he was elected fellow of the Royal College of Surgeons in 1888 and became a demonstrator in anatomy at the London Hospital Medical School in 1892. At the same time he maintained a vital interest in art. In the late 1880s he began to study at the Westminster School of Art and in 1892 he left his medical career to  become a professor of drawing at the Slade School in London. When the  war broke out, Tonks returned to medicine, first as an orderly, before being commissioned  into the RAMC. It seems obvious that a trained medic should act as a doctor during wartime but Tonks’ wartime experiences provoked deep misgivings about his medical role: ‘I have decided that I am not any use as a doctor’, he wrote to a friend in 1915.177 It was Gillies who gave Tonks the opportunity to use both his medical and his  artistic expertise to best effect. Gillies had long recognized the importance of art to surgery and had previously taken drawing lessons better to record his surgical procedures. In this spirit he employed Tonks to draw sketches which would assist surgeons working on facial injury cases, and to draw these patients before and after surgery.178 Tonks’ pastels of facially wounded men are now seen as iconic images of the war, demonstrating its inhuman violence and the damage it wreaked on the bodies of young men. Later these, and similar, images played a role in displaying the horror of war and the potential of modern surgery to mitigate this horror. However, Tonks was ambivalent about the public display of these images which he had produced for more discrete (and discreet) medical purposes. Tonks’ medical training ensured that he had a thorough understanding of the underlying structures of the face – the tissues, the bones, the muscles – and his drawings served a clear surgical purpose, as Gillies acknowledged when, for example, thanking Tonks for his insights into the possibilities of surgical repair to the upper lip.179 When looking at Tonks’ drawings, it is important to see not simply icons or emblems of the brutal machine-war but real men who were enduring the painful processes of reconstruction and rehabilitation. In the case of facial injury ‘cosmetic results’ really mattered. A prosthetic limb need not look like a limb in order to function properly but a human face has to look like a human face. In blunt, practical terms Lane wrote that a man’s ‘market value’

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was less without a face; in short he would struggle in both the marriage market and the labour market.180 On a more emotional level, Corporal Ward Muir, an RAMC orderly at a London hospital, wrote of children ‘running screaming’ from facially disfigured men, and Rémi described the suicide of a soldier who was fit and well enough to go home but who was finally crushed by his small son’s rejection of him.181 The Dowager Duchess of Limerick, looking back on her time as a VAD, effectively expressed some of the difficulties faced by these men: [the facially wounded soldiers] were terribly self-conscious and thought that everybody was going to shun them and it was, well I mean it is the same now when you see somebody very disfigured isn’t it? It is even worse not to look at them than to look at them because they feel then that you can’t look at them and at the present moment you know in East Grinstead we have a big plastic surgery unit there and I remember the surgeon there saying that East Grinstead was an ideal place to have a hospital of that sort because there were just enough people to know what the condition of these patients were when they first came out into the street. Enough to know not to stare at them and not to look away and I think that really is the whole secret in dealing with those cases.182 There were ways of managing facially wounded men in the public sphere. Around Sidcup some benches were painted blue to indicate that they were reserved exclusively for the facially wounded men of Queen Mary’s hospital.183 Was this a way of protecting men from potential hostility or was it simply protecting the public from the awful ugliness of war? In any event, these benches were a symbol of exclusion and emphasized the difficulties of carrying a damaged face into the world at large. Another way of re-entering the public sphere was to wear a mask, and an article in the Times celebrated the new mask-making technology as early as 1916. Disfigured Faces Restored Some of the most cruel wounds are those in the jaw. The disfigurement is often horrible … magical results are being achieved in a south-western district hospital by the provision of masks perfectly counterfeiting the lost section of the physiognomy. Lieutenant Derwent Wood, A.R.A., is the inventor of the plan. With the help of photographs of what a patient was like before being wounded, he will make a false nose of silvered copper, artistically painted to match the surrounding complexion, which will so far defy detection as to enable the owner to go out into the world again without shrinking, and play his old part in the affairs of men. To do that is to create value for the nation in the truest sense.184 Wood – dubbed ‘the face-maker’ by the Daily Mail – made facial masks which were extraordinary in their detail. Wood, a renowned sculptor, joined

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the RAMC as a private in 1915 and was employed as an orderly before he was transferred to making splints. He initially experimented by making a facial mask for a trooper in the Life Guards, he was rapidly promoted and received a commission in 1916. Captain Wood then became the director of the Masks for Facial Disfigurement Department, known by the Tommies as ‘the Tin Noses’ Shop’. Wood’s work began once the man’s face was fully healed and he required no further operations. He would take a plaster cast of the man’s face to produce a perfect, but negative, replica of it. Further moulds were then made from clay or plasticine to turn the negative cast into a positive one, which then served as the basis for the mask. Ward Muir described how the art of the sculptor lay in bringing the plaster face back to life: The shut eye must be opened, so that the other eye, the eye-to-be, can be matched to it. With dexterous strokes the sculptor opens the eye. The  squeeze, hitherto representing a face asleep, seems to awaken. The eye looks forth at the world with intelligence.185 The next stage was to turn the positive cast into a lifelike mask. The masks were made of very thin copper, 1/32 of an inch thick and weighing between four and nine ounces. Artificial eyes were held in place by thin bands soldered on to the mask, or sometimes they were glued in place. Wood covered the mask with an electric deposit of silver and, using a pre-war photograph as a guide, he used oil paints to re-create the man’s complexion and he affixed eyebrows and lashes. At first he used false hair but it did not weather well and so he cut thin sheets of tin into tiny, delicate strips to create the impression of living brows and lashes.186 The finished mask was held on to the head with spectacles. We can estimate the number of masks that were regularly worn by the number of spectacles issued: in 1924 the British government issued 148 pairs of spectacles of a ‘special type’ for men suffering from serious facial injury.187 Inspired by Wood, Anna Coleman Ladd, an American sculptor, opened the Studio for Portrait Masks in Paris.188 Surviving film shows us some of the ‘face-making’ processes and we can see soldiers being fitted with new chin masks and face masks. These images show us men once again ready to face the world.189 Sometimes facial masks were clearly successful. One soldier’s wife wrote to Wood to thank him because, wearing his mask, her husband had been able to return to work for a family business in which appearance was essential.190 More poignantly, a soldier wrote to Ladd, ‘Thanks to you, I will have a home … The woman I love no longer finds me repulsive, as she had a right to do.’191 However, simply wearing a mask was no straightforward solution to the problem of facial deformity. Most men did not expect to look like their prewar selves; they merely hoped to ‘pass’ as normal men in the public sphere but wearing a mask did not really enable them to do so.192 On a practical level, oil paint chipped, colours faded and the masks were uncomfortable. They were far lighter and easier to wear than the pre-war alternatives

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which were heavier and often made of rubber but they were still hot and cumbersome. Men did not like wearing them. Furthermore, masks were expressionless, they did not age and, no matter how lifelike – or perhaps because of their life-like qualities – facial masks were eerie and uncanny. In  a study of the uncanny, Freud has emphasized the extent to which we are disturbed by objects which are both familiar and unfamiliar. Waxworks, puppets and dolls are fascinating but frightening because they appear to be real and they can fool us, although we know full well that they are unreal or artificial. We are unsettled because the boundary between the animate being and the lifeless object is a crucial one, and we become anxious when it is breached.193 A facial mask provoked similar anxieties because the viewer could not help but wonder what it concealed. Paradoxically, by covering a facial disfigurement a mask was also revealing it. It is hard to gain a sense of patients’ subjective experiences of facial injury because men rarely wrote down, or even discussed, their experiences of operation, convalescence and post-war life. In addition, much of this history has been focused on the surgeons and on their medical practices and the associated medical progress. Other accounts emphasize the extreme horror of facial injury and openly question the value of life with a mutilated face. Both La Motte and Rémi employed the image of the ‘hairdresser’s son’ to demonstrate the impossibility of a facially wounded man re-emerging into mainstream life and work. In a hairdresser’s shop the values of physical beauty and the importance of intimate customer relations loom large. In short, the salon epitomizes the superficiality and commerce-driven nature of bourgeois society: How could an ugly man have a place in such a world? La Motte describes a young man pleading with his father to kill him; Rémi describes a distraught father insisting that it would be better if his son were dead because he could have no future with such a broken face. After all, who would want such a creature to touch them?194 La Motte and Rémi’s stories tell us much about the fear of facial disfigurement and, for all their personal involvement with wounded men, they come close to using the men simply as anti-war symbols. They are men who display the awful carnage of the war on their bodies. A case study of an individual man is obviously less dramatic and more prosaic. There was no typical facial injury – cases were complex and variable – but the personal history of Reginald Evans (1888–1943) indicates the long and painful process of even the most successful of facial injury cases. Evans joined the Territorial Army in 1913 and went to France in 1914 on the outbreak of war. He was shot in the face in February 1916, sent to the hospital in Wimereux in March and eventually transferred to the specialist unit in Aldershot on 13 April, a good two months after his initial injury. During this period his family were not fully aware of the extent of his injuries and relied on secondhand information which was purposefully vague. Sister Stratton, a nurse in a field hospital close to the front, was the first to contact Evans’ mother and her words were clearly chosen to comfort the family:

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Your son, Sgt Evans was admitted to this hospital last night, suffering from a gunshot wound of face and scarlet fever … He feels very seedy at present; but he is not dangerously ill he sends his love and says you are not to worry, he will write when he is able too [sic] and I shall write again very soon and let you know how he is progressing.195 Mrs Evans must have been worried by her son’s inability to write to her and she grew even more anxious as she lost contact with him altogether until he was finally settled at Wimereux. The family was very lucky to receive a personal communication so quickly after Evans’ injury because many others simply received an official and therefore anonymous telegram. Nevertheless, Mrs Evans had every reason to be anxious. Evans needed an artificial jaw and new teeth, and he was in great pain for a long time and was unable to eat or talk properly. When he arrived at Aldershot, he needed X-rays and massage to break down the scar tissue which had developed around his mouth, and in December 1916 he was still undergoing operations and still complaining that his mouth did not look right or feel right. Yet Evans was clearly one of Gillies’ great successes. He was introduced to the king and queen on one of the royal visits to the ‘plastics’ ward, prompting the king to announce ‘how splendid it was to think that men who might have been hideously disfigured for life could now look forward with hope to the future’.196 Soon afterwards Evans was on show again, this time to a visiting French surgeon, and he proudly described the encounter in a letter home to his mother. ‘They bought a famous French Surgeon round the other day’, Evans wrote home, ‘he was very interested in me and thinks my career (from a doctor’s point of view, I mean) wonderful and my recoveries from the various ills I have had to combat, splendid and my looks a great improvement on the photographs he was shown’.197 Evans’ account of his own injury and recuperation provides some insight into the way in which men came to terms with facial injury. He was obviously proud of his recovery and enjoyed the status of a privileged patient who was occasionally on public display. He was able to react to his injury with some good humour, a characteristic feature of the military hospital, best exemplified in hospital newspapers. We need to treat the popular image of the wounded but persistently cheery Tommy with some caution but the cliché of the ‘cheery chap’ did enable men like Evans to communicate with family and friends. In one of his early letters to his mother Evans described his new situation with apparent hilarity: You will be glad to know that I have been up a little while these last few days and I bet you would have laughed if you could have seen me when I was dressed. The suit they dressed me in was made for a man of Charlie Samson’s generous proportions so you can guess what I looked like. Every time I looked at myself I had to lay back and laugh till my head and sides really ached.198

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Evans was so debilitated at this stage that his letter had to be written by a nurse so it is unlikely that he was enjoying uproarious laughter in the ward. Nevertheless the telling of a funny story was one way of comforting his mother and humour was also the way in which Evans and his brother Will (also in the army and stationed in Egypt) managed to communicate with each other. ‘Keep your pecker up’, advised Will, ‘and keep smiling, if your jaw will let you’.199 Humour was one way of maintaining communication but Evans was not always able to appear light-hearted. He thoroughly disliked the homecoming party that his old employer and friends arranged for him and was irritated at being unable to eat. Nine months after his initial injury he was back at the Cambridge hospital in Aldershot and was clearly dispirited: I’ve been feeling pretty rotten but am a little bit better now and have got up for a bit this afternoon. How I’ve been thinking of the times we had together and the heaps of grub always nice and well-cooked I had when I was at home. Couldn’t I do with some of it now eh? Some of that pork and apple sauce with the potatoes, turnips etc. My face is so stitched up again that I can scarcely talk let alone feed again.200 Evans was probably not alone in regretting the misery of the ‘mince diet’ so often described in Gillies’ case notes. Recuperating men had to come to terms not just with a different diet but with a different role in the world and this too was dispiriting. ‘What a useless individual I am and how hard it comes to me to know that at my age I am simply an old crock’, Evans complained, and many facially wounded soldiers suffered from a similar sense of depression.201 In despair one soldier concluded that he was ‘an object of terror to my own child, a daily burden to my wife, a shame for humanity’.202 Much of the depression was a reflection of men’s fears for the future. Rémi, accompanied Lazé, one of her patients, on a train journey home and described the humiliating and painful scenes in a railway carriage where the other passengers were intent on avoiding Lazé at all costs. He simply could not occupy the public space.203 In many ways military life protected men from the public gaze. Evans left hospital in March 1917 and was transferred to ‘a very cushy job at Brigade Headquarters’.204 Yet Evans was aware that this sort of protection could not last indefinitely and thought that he would be unable to be part of a settled community once the war was over. In a downcast mood he reflected on his plans in a sombre letter home: ‘I think that when the war is over (if it ever does end) that I shall be a tramp and go all over the country just doing an odd job or two as the fit takes me.’205 Like many men, he could not really imagine either the end of the war or his place in a post-war world. In the event Evans did not lead a nomadic post-war existence. Despite his injuries, Evans was able to lead a normal and emotionally fulfilling life after the war when he married, had three children, ran a newspaper

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business and worked as a reporter for the Stafford Press. Others found it much more difficult to re-create their lives after facial surgery, or even to endure the surgery itself. One patient suffered extreme damage to his cheek, his upper lip, his jaw bone and his nose at the beginning of July 1916. After numerous painful operations and an associated infection the man had clearly had enough despite Gillies’ attempts to persuade him of the benefits of rhinoplasty. The notes end with the rather terse comment that ‘the patient refused further treatment’.206 Gunner Butt had similar wounds and the initial brevity of his medical notes serves only to highlight the extent of the damage: ‘G.S.W [Gunshot wound]. Face. Nose, Mouth and Cheeks. Loss of nose and upper lip. Fractured mandible and maxilla’.207 By this time Butt was twentyeight years old. Immediately after being wounded he had been taken as a prisoner of war and German surgeons had carried out the initial operations to his face; then once back in the UK he began another round of operations. In June 1919 his operation was deemed to be ‘not completely satisfactory’, the operation in August was ‘mainly satisfactory’, in September his condition was described as ‘satisfactory’ but medical procedures continued until 1925, when he made it clear that he did not want any further treatment. Butt’s refusal was accepted because he had undergone over six years of surgery but refusing treatment was not always easy. Private Cullimore, who had been wounded in 1915, objected to further medical treatment in 1921 and his concerns were roundly dismissed: 8.10.21 Patient is anxious about his health and is hypochondriasis, I have pointed out that his health is largely dependent on the repair of his mouth and jaw but he insists that his nerves are too bad to undergo a series of operations. He submitted willingly to his shoulder operations, and while he is feeling depressed and ill, I do not consider that his objection amounts to a refusal of treatment.208 Serving soldiers were still under military discipline when wounded and so had to obey the orders of superior officers. But even men who had been discharged from the army found it hard to refuse treatment because concepts of normative masculinity implied that they should be able to endure the discomfort of surgery. Yet after the surgery, life with a facial injury, even a well-repaired facial injury, could be extremely arduous. Depending on the specific nature of the wound, men had to spend the rest of their lives with some severe restrictions. Many men were unable to chew food properly, while others had difficulty breathing, talking, hearing or seeing properly. Facial wounds also affected men in the most intimate of ways, a problem sensitively imagined by Louisa Young when describing the post-war sexual difficulties faced by the once handsome Riley Purefoy, a fictional character based on one of Gillies’ own patients.209 The issue of troubled sexual relations is implicit in the testimony of wounded soldiers and medical staff. La Motte’s description of a man without

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a nose underscores his sexual inadequacy. He was ‘a little screaming man, five feet two, whose nose had been shot away, exchanged for the Médaille Militaire upon his breast’.210 The focus on his size, his hysterical screaming and on the living nose that had been exchanged for a worthless piece of metal all make it clear that this man was as likely to indulge in sexual relations as a man whose genitals had been blown away. Young men were understandably worried about being unmanned by facial injury and Evans was at great pains to tell his mother about his flirtations with the nurses because he wanted to reassure her that he was still sexually desirable.211 Nurses were often openly scornful of women who rejected their husbands because of their war-damaged faces and the staff on Rémi’s ward all had great admiration for a woman who was openly affectionate to her husband and who appeared to love him regardless of his ugliness. Only later did Rémi discover that the woman had a young lover – this was the only way that she could cope with the physical proximity of her mutilated husband.212 Clearly, facial injury did not just affect the wounded man but also had an impact on his family and friends, and their testimony allows us some glimpse into the interior lives of those facially wounded men who were discharged as effectively cured. Wright Whitehead was wounded on the Western Front in June 1917. His lower jaw was blown off but he had to walk to the nearest aid post. He was later transferred to Queen Mary’s hospital, where he underwent several operations and was eventually sent home in the spring of 1919. In March 2005 Whitehead’s grandson described the enduring physical and emotional effects of his grandfather’s injury: He continued to have trouble during the rest of his life, for 20 years he had a [sic] open cavity under his chin into his mouth this eventually skinned over. In 1940 during fire-watching on local property, Mr Matthews who was then the local dentist heard that granddad could not get a set of false teeth as the back of his jaw was now due to the operations in the centre of his mouth. Mr Matthews after several attempts succeeded 24 ½ years after the event, I know the trauma of the war his wounding and loosing [sic] his Comrades lasted a long time and it was not perhaps until the 50s/60s he was at peace with it.213 Private D. Howard was never able to be at peace with his post-war self. He was severely wounded in February 1918, suffering the loss of his lower lip, his chin and the anterior portion of his jaw. After numerous operations he was released from hospital in September 1920 and was found dead on the following Boxing Day ‘due to alcoholic poisoning’.214 All of these men – the gas casualties, the shell-shocked, and the facially disfigured – have come to be seen as particularly emblematic of the First World War and its brutality. These iconic wounds matter because they presented doctors with some of their greatest medical challenges and because they have come to frame the way in which both contemporaries

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and later generations have conceptualized the war. The gassed, the shellshocked and the facially wounded have all featured heavily in French, German and British representations of this war throughout the century, and these are the images that most readily come to mind when we now think of the ‘pity of war’.215

Further reading Secondary sources Barham, Peter. Forgotten Lunatics of the Great War. New Haven and London: Yale University Press, 2004. A compelling history of the British servicemen consigned to lunatic asylums after the war. Gehrhardt, Marjorie. The Men with Broken Faces: Gueules Cassées of the First World War. Bern: Peter Lang, 2015. This is one of the very few histories of facial injuries written in English. It examines the history of facially disfigured men from France, Great Britain and Germany. Hallett, Christine E. ‘“This Fiendish mode of Warfare”: Nursing the Victims of Gas Poisoning in the First World War’. In One Hundred Years of Wartime Nursing Practices, 1854–1953, edited by Jane Brooks and Christine E. Hallett, 81–100. Manchester: Manchester University Press, 2015. This essay focuses on the treatment of gas casualties and emphasizes the role of nursing care. Hofer, Hans-Georg, Cay-Rüdiger Prüll and Wolfgang U. Eckart. War, Trauma and Medicine in Germany and Central Europe (1914–1939). Freiburg: Centaurus Verlag, 2011. A series of essays looking at the relationship between war, trauma and medicine in Germany and Central Europe between 1914 and 1939. The focus is on the traumatic experiences of those who fought and also of those who suffered on the home front. Leese, Peter. Traumatic Neurosis and the British Soldiers of the First World War. New York; London: Palgrave, 2002. This is one of the first scholarly accounts of shell shock, its treatment and responses to shell shock in the British army during the First World War. Lerner, Paul. Hysterical Men: War, Psychiatry and the Politics of Trauma in Germany, 1890–1930. Ithaca and London: Cornell University Press, 2003. A scholarly account which highlights the relationship between trauma, male hysteria and masculinity in Germany. Reid, Fiona. Broken Men: Shell Shock, Treatment and Recovery in Britain, 1914–1930 London: Bloomsbury, 2012. A history of shell-shock treatment in Britain which emphasizes men’s attempts at recovery and respectability in the post-war world. Thomas, Gregory, M. Treating the Trauma of the Great War: Soldiers, Civilians and Psychiatry in France, 1914–1940. Baton Rouge: Louisiana State University Press, 2009. One of the few accounts of French shell shock which is available in English. van Bergen, Leo. Before My Helpless Sight: Suffering, Dying and Military Medicine on the Western Front, 1914–1918. Farnham, Surrey: Ashgate, 2009 (see

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pp. 172–202 for the section on gas). A magisterial history which provides a broad account of all wounds and illnesses from all sides of the conflict. This is essential reading for those interested in the direct experiences of the sick and wounded men of the First World War.

Published primary sources Gillies, Harold Delf, Plastic Surgery of the Face based on Selected Cases of War Injuries of the Face, including Burns, with Original Illustrations. London: Frowde, 1920. (Online version at https://archive.org/details/ plasticsurgeryof00gilluoft). Case studies containing details of Gillies’ patients. This is an excellent source of information on the medical and technical aspects of facial surgery. La Motte, Ellen Newbold. The Backwash of War. New York and London: The Knickerbocker Press, 1916. (See ‘A Surgical Triumph’ for a story of facial injury.) A collection of short stories written by an American nurse working in a French field hospital. Her accounts are sometimes bitter and disillusioned and are in strong contrast to, for example, those of Ward Muir. Available on Project Gutenberg. Latzko, Andreas. Men in War. Translated by Adele S. Seltzer. New York: Boni and Liveright, 1918. (See chapter VI, ‘Home Again’ for a story of facial injury.) A collection of six stories based on Latzko’s experiences of fighting on the Isonzo front. It is a bitter and searing account which was initially published in Switzerland in 1917 and was immediately banned by the German and Austrian authorities.

CHAPTER FOUR

Ordinary Soldiers and Ordinary Pain I’m alive, and I have reached this bed, and this bit of meat, and this pudding in a tin1

Ordinary serving soldiers had little time to think of how the pity and the pain of war were represented. Their focus was more on the basic practical and emotional work required to deal with the pity of war on a daily basis. They wanted to stay alive so as to reach hospital and gain some physical and emotional comfort, and it is this fragmented, unofficial history which is the subject of this chapter. Men fighting in the trenches required the rudimentary but important medical skills to manage their own or their comrades’ wounds and illnesses. These skills and tactics were vital, and men also used a variety of drugs, branded medicines and tonics throughout the war. Sometimes these were targeted on very specific complaints; sometimes they were used in a more general, almost ad hoc manner; sometimes men took ineffective products which could only have worked as placebos. Some men also relied on luck or superstition and maintained the old folk tradition of wearing amulets for protection.2 At other times men took powerful drugs with strong physical and psychological effects, and sometimes they combined the homely with the potent with Jünger, for one, vouching for the comfort to be gained from ‘lemonade and morphine’.3 At times very powerful drugs enabled men to escape the horrors of war; at other times they enabled them to cope with or even enjoy the demands of conflict. We can conceptualize these practices as a type of self-medication but there is always a fine line between self-medication and self-harm, and soldiers’ popular remedies sometimes carried their own dangers. This was especially the case when soldiers were illicitly taking morphine because a wounded

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soldier then ran the risk of being dosed twice (or more), thus masking his symptoms and making medical diagnosis difficult.

On being wounded Hynes has already emphasized the importance of the ‘soldier’s tale’ and has placed the soldier at the centre of his own war narrative.4 These soldiers’ tales, alongside doctors’ and nurses’ tales, should be fundamental to our understanding of medicine and war. Given the extraordinary violence of this war, soldiers’ encounters with wounds and disease and – most crucially – their methods of dealing with actual wounds and disease, or with the fear of them, were often the most meaningful and memorable aspects of war service.5 For many men the ‘anniversary’ of their wound became more important than any birthday and remained more important than any official or national commemoration. This was the point at which their lives changed forever, and in a military hospital ward, ‘one and all they know the exact hour and minute on which their bit of metal turned them for home’.6 We are all familiar with the cliché of the old soldier continually repeating tedious tales about his war wound. Soldiers have always described their wars in terms of the wounds they and their comrades received. Wounds punctuated war service by allowing a man temporary respite and they served as a lasting reminder of the war: a man’s war service was literally inscribed on to his body. Even during the war Henri Barbusse complained about ‘the horrible monotony of the story of wounds’, but, as van Bergen has noted, ‘few accounts have come down to us that describe what it was like to be wounded’.7 There are good reasons for the paucity of these accounts. Recently wounded men did not have the leisure, the energy or the wherewithal to write down their emotions and experiences. In Bourke’s words, ‘the body in pain seeks solitude and silence, instead of stories’, and for this reason pain is more usually described by an observer than by a sufferer.8 In any case, it is difficult, if not impossible, to describe pain. Jünger wrote about the First World War trenches as ‘the home of the great god Pain’, implying that pain was an external force but one which held men in thrall to it.9 The artist Fernand Léger (1881–1955) wrote about a wounded soldier who was in so much pain that he ate his own hands but we do not have – nor do we expect to have – the story from the man himself.10 The ‘body-in-pain’ is too distracted to communicate in a straightforward manner and once the pain is over it is strangely difficult to recall it.11 Enid Bagnold, a VAD nurse, recalled a soldier in great pain, struggling in a futile attempt to express his pain: ‘I’m in pain,’ Sister, he said. No one has ever said that to me before in that tone. He gave me a look that a dog gives, and his words had the character of an unformed cry … As he spoke his knees shot out from

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under him with his restless pain. His right arm was stretched from the bed in a narrow iron frame, reminding me of a hand laid along a harp to play the chords, the fingers with their swollen green flesh extended across the strings; but of this harp the fingers were the slave, not the master.12 Here the pain has been reified into a cruel master enslaving both the patient and the nurse. Bagnold could do nothing to help but could only watch the man who was, ‘helpless, overwhelmed by his horrible loneliness’.13 Mary Borden, an American nurse and novelist, similarly reified ‘Pain’ as ‘a lascivious monster’ who is ‘insatiable, greedy, vilely amorous, lustful, obscene’.14 Yet Borden’s ‘Pain’ was female and a rival. She gives a real twist to the conventional narrative of the battle-bruised soldier and the pretty nurse. Instead of the soldier–nurse romance Borden sees men who have been reduced to kittens and who can no longer love, or even recognize, real women like herself: ‘I am a ghost woman leaning over a thing that is mewing; and it turns away its face and flings itself back into the arms of Pain, its monster bedfellow. Each one lies in the arms of this creature. Pain is the mistress of each one of them.’15 For nurses like Bagnold and Borden, ‘Pain’ did not provide an opportunity for care and comfort; ‘Pain’ was intensely alienating and had the potential to disrupt rather than to foster relations between men and women. Those watching pain often feel helpless, and those suffering it feel infuriated. Pain is exasperating and at its most intense we believe that it is unique and incomprehensible. Another VAD nurse, angry and bewildered with earache, shouted to all who came near her, ‘You’ve no idea how it hurts!’16 Earache is hardly unusual but in the midst of her pain she could not believe that anyone else could recognize or understand it. Yet at the same time as being isolating, subjective and hard to communicate, pain is universal. ‘If you prick us, do we not bleed?’ asked Shylock, acknowledging that our shared physical frailty is one of the factors that makes us human. Physically we all respond in a similar way to a pinprick, a bullet or a shell, although our emotional responses are shaped by our personalities, our culture and our immediate environment. Privates Murray and Faragher were both ordinary soldiers who were seriously wounded on the Western Front and who later tried to describe the moment of wounding. For all that this moment was personally significant to them, their post-war descriptions prioritized the success of the enemy attack rather than their own physical or emotional reactions. Murray was wounded in action near Soupir (Aisne) in October 1914: We had not gone far when the German machine gunners got the range of us. And we all kissed mother earth in a very informed manner. Altogether there were seven of us and ‘Jerry’ had a present for each of us. He took a great liking to our corporal and gave him seven bullets all to himself. I was hit in the shoulder but only by a ricochet.17

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Faragher’s account is similar in style. He was wounded at the Somme in 1918 and had to have his leg amputated as a result: ‘No doubt Jerry thought here was a good opportunity of testing himself as a marksman . … He scored quite a number of bullseyes, myself among them.’18 These responses are both playful and almost workmanlike, with Murray and Faragher assessing their German rivals and judging their skills accordingly. By focusing on ‘Jerry’ and conjuring up benign images of ‘a present’ and ‘bullseyes’, the men managed to avoid describing the brutal reality of their wounds. Their bodies-in-pain became marginalized in this account because communicating or remembering the moment of wounding was simply too difficult. In addition, Murray and Faragher may well have been highly conscious of a possible audience and wanted to present their accounts as light-hearted to portray themselves as resilient and to maintain their own dignity. The soldiers’ personal resilience is encapsulated in the popular English expression ‘I stopped a bullet’, a phrase commonly used by soldiers and one which implies that the body somehow prevented the bullet from completing its task. It is not simply that communicating pain was difficult. Many soldiers, especially those wounded in action, did not notice their wounds straight away even if they were severe. After receiving his ‘present’ from Jerry, Murray apparently did nothing about it, and did not even seem to request aid. It was not until his second injury that he received any medical help at all. I rose up slowly on account of my weak state through having bled so much during the day. When I had just gained my feet a bullet struck me in the mouth and down I went for the ‘count’ – to use a boxing term. I remembered very little of what happened to me after that until I found myself in an ambulance train which took me to Versailles, where a huge hotel had been converted into a hospital.19 There may have been practical reasons behind Murray’s decision to carry on or he may have been quite unaware of the severity of his first injury. Many soldiers felt overwhelmed by fear and apprehension while waiting to go over the top but those feelings often dissipated when they mounted the parapet and charged. If morale was good, the charging soldier then became a member of ‘a pack’, united by a single clear purpose. He may even have felt elated.20 It was this emotional state rather than any mock heroism which made men like Murray ignore their wounds and carry on regardless. Men did not have to be part of an adrenaline-charged attack to be wounded. Private Ownsworth was walking across open ground close to Trones Wood (Bois de Trônes, Somme) when he noticed an abandoned tunic on the ground. He was cutting some brass buttons from it when he was hit by so many shell splinters that he had to be hospitalized for six months. Nevertheless the extent of his own injuries only dawned on him slowly:

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I was cutting those [the buttons] off when I heard a German shell coming. There was a trench nearby. I dived into that and eventually got blown out. Picked myself up … didn’t know I was hit at first. I walked on. The 2 officers had gone to ground about 50 yards in front of me. One of them called out was I alright and I said, yes, and so walked on. Then I felt that my hand was wet. So, I wiped it on my britches. Then I felt it wet again. So, I wiped it a second time and then I thought, damn it, there is no wet about. It was all blazing sun and dry and I found that there was blood running off my hand. Up to then I didn’t know that I had been hit. So, I called to them and they stopped and I came up. I said, I am hit after all. So, we sat in a shell-hole. I had 2 field dressings. One in each corner of my tunic and they started bounding me up round my neck. So, I said, it is not there. It is my arm. Well, they insisted that it was my neck as well. As a matter of fact I got one in the arm, one in the neck, one in the head, through my jaw which is still in there and one in the back and they didn’t know anything about that one in the back.21 In the heat of the moment soldiers often ignored their wounds or seemed oblivious to them. This was a kind of coping mechanism, because on recognizing the actual reality of a wound, a man could be overwhelmed by his fears, as this letter from a German student indicates: When I saw my comrades falling down I thought: Now you are getting your share as well. In the deepest anxiety of my soul I called upon God. ‘Oh my dear God, please help, help, save me, have mercy with the shot I am getting.’ I am prepared to sacrifice an arm or a leg … Considering an abdominal wound I was thinking if my bowels were filled, if I had been eating a lot recently. Considering a shot in the head I told myself that those were usually fatal. One can bleed to death when being hit in the carotid artery. Suddenly I thought about my eyes. If only I’m not blinded. I might be prepared to sacrifice one eye … if only I am not blinded. Now you are getting a hit. I am raising my hands towards my head and turn it left. The same instant I feel a terrible hit against my right ear. It is a feeling as if somebody had hit my right cheek with a rubber truncheon. There’s a heavy jerk and then a clear crack of bones … On my right side I see a comrade dropping to the ground with a wounded leg. On my left side I see a comrade holding his head with both hands. He has got his share too … There is blood dripping on my hands, too, and on my coat. When I see it I scream: I am bleeding to death I am bleeding to death.22 Here the young man considers his ‘share’. He assumes that he and his comrades have been allotted a level of pain and he does not expect to be spared, although he does plead with God in an attempt to mitigate his suffering: he could accept the loss of an eye, but not complete blindness. His terror is palpable and is made worse by the fact that his comrades were

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suffering similar injuries. Yet this soldier did not bleed to death because, like most men, he knew that it was essential to manage pain, and the fear of pain, effectively. They were all officially prepared to do so in that all soldiers were issued with field dressings and iodine but they also had a whole range of informal ways of looking after themselves and each other

Alcohol and other drugs There are many types of courage, there are many kinds of fear, There are many brands of whiskey, there are many brands of beer. There is also rum, which sometimes in our need can help us much But ‘tis whiskey-whiskey-whiskey hands the courage which is ‘Dutch’.23 Since the 1970s psychiatrists and psychologists have tried to understand and to humanize drug addiction. Self-medication theorists propose a psychodynamic model of understanding addiction and argue that addicts do not misuse drugs simply because they are hedonistic or weak-willed. On the contrary, the psychiatrist Edward Khantzian argued that addicts take drugs to overcome feelings of powerlessness and to turn helpless, passive suffering into controlled or active suffering.24 This is not to imply that all soldiers in the trenches were alcoholics or drug addicts but that the concept of selfmedication is a useful one for understanding the soldier’s approach to drink and drugs: soldiers were self-medicating because they were unable to care for themselves properly or because their drug (or behaviour) of choice provided the soldier with the best way of caring for himself in an environment of extreme conflict.25 For most soldiers alcohol was the drug of choice because it was readily available and culturally acceptable. Most significantly, the drinking of alcohol had a number of positive associations which became even more positive during wartime, and specific types of alcohol had traditionally been associated with healing and nurturing throughout Europe. Ferguson has argued that the war simply could not have been fought without alcohol, and in this he is reflecting much contemporary military-medical opinion.26 Commenting on the war shortly afterwards, Lieutenant Colonel Rogers, medical officer to the Black Watch, remarked that ‘had it not been for the rum ration I do not think we should have won the war. Before the men went over the top they had a good meal and a double ration of rum and coffee’.27 The chairman of the Brewing Industry Foundation even went so far as to claim credit for the effectiveness of the British armed forces, praising the

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major contribution of the drinks trade to victory in the war.28 Of course his claim has to be treated with caution because the Germans, the Russians and the Austrians all drank to excess too. Most soldiers have tended to drink on military campaigns and so the First World War was far from unusual in that respect. The English phrase ‘Dutch courage’ indicates one of the long-standing links between war and alcohol because the original ‘Dutch courage’ was the gin which British troops drank to give them courage while fighting in the Low Countries during the Thirty Years’ War.29 The popular term ‘groggy’, meaning dull, dazed and confused, stems directly from the effects of the grog (rum and water) traditionally given to British sailors in the Royal Navy.30 Alcohol was still really important to the fighting troops by the beginning of the twentieth century but governments, while recognizing the benefits of alcohol, were also concerned about the impact of excessive or inappropriate drinking and endeavoured to control alcohol consumption throughout the war. Drink was managed more than Ferguson’s and Roger’s words imply. This is because there had been pre-war concerns about the links between alcohol and degeneracy, and there were prominent temperance movements in many European countries prior to the war. These fears about the detrimental physical and mental effects of alcohol consumption then very much came to the fore during the heightened atmosphere of wartime. While alcohol was still seen as a medicine, excessive drinking was becoming increasingly perceived as a medical problem.

Wartime regulations and moral pressure In France, a country where the political elites were concerned about the twin evils of the demographic crisis and the moral degeneration of the population, the pernicious effects of alcohol consumption on the nation’s health had long been a matter of public discourse. The vivid images of violence and degradation in, for example, Zola’s L’Assommoir (1877) indicate potent fears of the damage wrought not just on individuals but on families and society as a result of excessive drinking. Such drinking was very obvious right at the beginning of the war when groups of newly mobilized men drank ostentatiously in public and it did not bode well for military discipline when troop trains left for the front jam-packed with drunken soldiers. Tales of French soldiers looting abandoned wine shops during the retreat from the Marne were even more alarming.31 Given the importance of physical, mental and moral health during wartime the government prohibited the sale of absinthe in February  1915, placed limits on the consumption of spirits, insisted that spirits for sale should not exceed 23 per cent proof and forbade the sale of alcohol to women throughout France and to everyone in the military zones. These measures sound draconian to Anglo-Saxon ears but the term ‘alcohol’ excluded wine, beer and cider

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so the French government was really just restricting the sale of spirits.32 The Russian government was also concerned about spirits, especially the traditional vodka, and in October 1914 the Tsar told the Russian Christian Temperance Society, ‘I have decided to prohibit for ever in Russia the Government sale of alcohol.’33 Government restrictions were clear but that did not mean they were effective. Russian soldiers continued to drink, and while Frenchmen grumbled about being unable to buy absinthe in cafes, they were able to find their own supplies without too much difficulty.34 In the event it was probably the Russian treasury that was most affected by this prohibition because government tax revenues were hard hit by the loss of official alcohol sales. In Britain there were similar concerns about the extent to which drink affected national efficiency and public order. The Defence of the Realm Act (8  August  1914) quickly restricted the sale of alcohol by controlling the supply of drink to the forces and the Central Control Board (CCB) was established in 1915 specifically to regulate the drink trade. The CCB restricted pub opening hours, prohibited ‘Off’ sales of spirits in the evenings and at weekends and diluted the strength of spirits. By restricting pub opening hours the wartime state not only intervened in a manner which would have been unthinkable prior to the conflict but had an immediate and long-lasting effect on British drinking habits because pub opening hours in England and Wales remained strictly regulated until the Licensing Bill of 2000.35 These initiatives were not simply aimed at the home front but were a recognition that in this new sort of war there was only a blurred distinction between the home front and the fighting front. Those on the home front had to remain sober to support the war effort and individuals crossed the line between the two fronts on a regular basis because citizen-soldiers were both citizens and soldiers. As a result, in Britain it became an offence to supply alcohol to patients in military hospitals.36 There was also a prohibition on ‘treating’ in pubs: it was one thing to welcome home soldiers who had been fighting hard, quite another to weaken the soldier’s fighting spirit with drink.37 Military and political elites warned about the dangers of drink right from the outset, with Lord Roberts urging men to become teetotal and Kitchener linking the harmful effects of alcohol with the dangerous influence of women. He warned ordinary soldiers to be ‘constantly on your guard against excesses. In this new experience [wartime] you may find temptation both in wine and women. You must resist both temptations, and, while treating all women with perfect courtesy, you should avoid any intimacy’.38 King George V tried to lead by example and committed both himself and the royal household to abstinence for the duration of the war. However, the king’s pledge indicates the extent to which alcohol was seen as both a social evil and a medicine. The king wished to set an example by avoiding all alcoholic liquor but on medical advice he continued to drink in private;

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similarly Cabinet ministers pledged to avoid ‘intoxicating liquor if it be thought necessary’, a useful caveat in the circumstances.39 Lloyd George was less circumspect, and in a speech in Bangor, amongst an audience sympathetic to temperance, he argued passionately about the dangers of drink: a small minority of workmen can throw a whole works out of gear. What is the reason? Sometimes it is one thing, sometimes it is another, but let us be perfectly candid. It is mostly the lure of the drink. They refuse to work full time and when they return their strength and efficiency are impaired by the way in which they have spent their leisure. Drink is doing us more damage than all the German submarines put together.40 It is difficult to estimate the effect of this elite persuasion. Dr Robert Simpson claimed that ‘tens of thousands’ of men became teetotal in response to Kitchener’s call but this is hard to verify and it is even harder to say for how long these men remained teetotal.41 Moral injunctions were relatively easy to ignore and many of the government’s practical measures were impossible to implement. Soldiers on leave continued to drink in pubs and there was no effective way of ensuring that strangers did not stand them a drink. French civilians donated alcoholic gifts to British hospitals in France and nurses often gave soldiers beer in British hospitals where a bottle of bass a day was seen as a well-deserved treat.42

The reintroduction of the rum ration The confusion and the controversy surrounding alcohol policy in Britain was probably best exemplified by responses to the reintroduction of the rum ration in the British army. Men on active service were officially subject to strict regulations regarding the consumption of alcohol, not just in terms of quantity but also in terms of category. Soldiers in the ranks were forbidden to buy spirits and the celebrated ‘whiskey-whiskey-whiskey’ was reserved exclusively for officers, and for relatively wealthy officers at that, for according to Charles Edmund Carrington, ‘whisky – at seven and sixpence a bottle’ – was a relative rarity for young subalterns.43 Yet the strict regulation of alcohol in general and spirits in particular was combined with a change in army regulations which enabled soldiers to receive a free rum ration for the first time since the practice had been discontinued in the 1890s.44 In September 1914 troops were all allocated 2 ½ ounces (half a gill) of rum to be issued ‘on very exceptional occasions … when certified by the Senior Medical officer to be absolutely necessary for safeguarding the health of the troops’.45 Yet the rum ration was far from ‘exceptional’ and it was issued daily to men in the fighting lines. This provoked much anxiety and debate amongst some military leaders and the elite medical profession. Major E.B.

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North issued the following statement, roundly condemning the routine rum ration in 1916: The issue of rum in the trenches is as a rule undesirable. It is difficult to supervise, and leads to drunkenness. If issued just before the men go on duty it makes them drowsy and unfit for the alert duties of a sentry. If it is considered necessary it is best issued in the morning, just after the men have been dismissed from standing to arms.46 From a more medical standpoint, Sir Victor Horsley, a surgeon and temporary captain in the RAMC, fiercely condemned ‘the old pernicious rum ration’, which he dismissed as merely ‘a deceptive substitute for real food’.47 At 40 per cent proof army issue rum was a strong spirit, and although men were obviously not incapacitated after just one drink, Horsley argued that research into the effects of a regular tot had demonstrated a number of highly negative side effects: 1. Decadence of moral. Causation of grousing, friction, and disorder. 2. Drunkenness. Punishments. Degradations in rank. 3. Decadence of observation and judgement. Causation of errors and

accidents. 4. Loss of endurance and diminution of physical vigour. Causation of fatigue, falling out, and slackness. 5. Loss of resistance to cold. Causation of chilliness, misery, and frostbite. 6. Loss of resistance to disease (particularly those occurring under conditions of wet and cold), namely pneumonia, dysentery, typhoid fever. 7. Loss of efficiency in shooting. (Half the rum ration causes a loss of 40 to 50 per cent in rifle shooting. The navy rum ration causes a loss of 30 per cent in gunnery shooting.) 48 No one could argue that 2 ½ ounces of rum a day would cause widespread drunkenness but critics of the ration recognized that, as with food, it was difficult to control distribution effectively. The rum ration was officially allotted to sections of twenty men but if all of the twenty men were not there – an obvious risk in warfare – then each man could drink more. Robert Simpson, another doctor who was critical of the rum ration, noted, ‘I have been told by a soldier that at one time he had his water bottle nearly full of rum.’49 There were also unofficial agreements about extra rations and men were often given a double tot of rum before an attack.50 Horsley was a committed teetotaller but even those who were not opposed to alcohol on principle were worried about excessive drinking amongst the troops. Astley Cooper, the medical superintendent at Ghyllwoods Sanatorium, near

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Cockermouth, blamed ‘private drinking’ rather than the rum ration and likened the soldier to a prize fighter in training. I would wish in the interests of the soldier and the nation to see the private consumption of liquor by the soldier (at least on active service and in training for active service) absolutely and entirely stopped, just as it is a matter of course forbidden to the boxer in training for a big fight.51 These debates were about the extent to which alcohol promoted the courage (Dutch or otherwise) to keep men fighting in extreme situations. Medical professionals also debated the extent to which alcohol should be seen as a medicine. Horsley roundly dismissed the ‘fatal notion’ that alcohol had beneficial or even medicinal properties.52 Charles Mercier disagreed and described a critical moment at the Battle of Ypres when every last available man, including the regimental cooks, had to be brought into the firing line. The men were exhausted but fought vigorously and disaster was averted because of ‘the supreme value of alcohol’ which has ‘the power of enabling the organism to utilize its last reserves of energy’.53 Dr Rawdon Wood argued that restricting alcohol was like restricting medicine, and in an attempt to ridicule his opponents, he complained that teetotallers might forbid giving morphine to wounded men because it would ‘prevent them writing shorthand at 200 words a minute’.54 A number of teetotallers also believed that alcohol had a medicinal value. Lady Griselda Cheape, citing her experiences as a nurse in a Temperance Hospital, insisted that alcohol should be used as a medicine and that the rum ration was ‘essential’; soldier abstainers at the front agreed and argued that they were not breaking their pledge if they took the rum ration for medicinal reasons.55 Horton, a teetotal stretcher bearer, resisted all alcohol throughout the war apart from one occasion when weakened by influenza and soaking wet he succumbed to a tot of rum to help him sleep.56 Whether or not some sorts of alcohol should be seen as medicinal led to genuine confusion about the use of alcohol as medicine in military hospitals. Dr William Chapple (1864–1936), a Liberal MP and practising Baptist, complained that some hospitals prescribed ‘champagne, wines, spirits, beer and stout’ to wounded men while others prescribed no alcohol at all. The official position was that ‘the prescription of alcohol must be left to the discretion of the medical officer attending the case’, a position which could hardly lead to uniformity but which re-enforced the widely held belief that alcohol was, at least in part, medicinal.57 Captain Holtzapffel certainly felt that he had benefitted from the prescription of alcohol. He was one of Gillies’ patients at Aldershot and he suffered terribly when some cartilage had to be taken from his ribs. He later described his successful treatment: The cut in my ribs necessitated some deep stitches and my cough did not improve, and as a result I soon suffered a good deal of pain every time I coughed. This was really quite exhausting, and one evening after a particularly

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tough bout of coughing the sister in charge got windy and fetched the M.O. to see me. The result of his visit made the cough almost worthwhile as he immediately said, ‘I think this calls for Champagne and Oysters,’ and sure enough I had half a bottle of champagne and a dozen oysters for my supper, and believe me that did me a world of good. I can recommend that medicine to anyone who is in a similar predicament, at any time!58 In this case the champagne can be seen as a treat, a way of cheering up Captain Holtzapffel, who was genuinely having a difficult time. Yet alcohol was not just a placebo and it had an accepted role in post-operative care. As CardenCoyne has noted, men often suffered from low blood pressure after operations and the standard procedure in the recovery period was to send the man back to bed, keep his head elevated and to provide ‘saline, no food just tepid barley water or raisin tea, and small sips of brandy, champagne or iodine in water to relieve vomiting’.59 In other places alcohol was not prescribed but was seen as a normal part of the diet. Sarah Macnaughtan, a nurse based in a British-run Antwerp hospital for French and Belgian men, liberally dispensed beer twicedaily to her patients as part of their regular midday and evening meals, and Gillies even paid for brandy out of his own pocket so that facially wounded men could enjoy nourishing (and indulgent) egg flip.60 The position of alcohol was even more privileged in French hospitals where medicinal wine was very strong (approximately 20 per cent proof) and the authorities had long discussed not whether but how much wine should be dispensed to patients on a daily basis.61 There was a widespread fear of alcohol abuse, but nonetheless the French medical authorities did treat alcohol as both a medicine and as a suitable comforter for invalids. Alongside tea, coffee and bouillon doctors prescribed a quart of warm, sweetened wine as preventative against the cold. They also advised small doses of rum at regular intervals for cold or shock.62 Moreover, French nurses in casualty clearing stations regularly used brandy as an anaesthetic; it was not ideal but in the absence of any proper anaesthetic agents it was better than nothing.63 Scientific debate about the medicinal value of alcohol was overlaid and possibly overshadowed by the highly positive cultural associations between war, alcohol and masculinity. Drink was of great social and cultural importance, and men drank to forge or to demonstrate clear bonds of fraternity, class, gender or nationality. In addition, soldiers quite simply saw alcohol as both a food and a medicine. As has been seen, the French government took active steps to curb the consumption of spirits, although like their British allies French soldiers were given rum or eau de vie before an attack. Wine, however, was a different matter and ‘pinard’ completely dominates men’s accounts of their war. The term ‘pinard’ was used in Champagne and Lorraine before the war, and amongst colonial troops, but during the war it became the most common word for describing the wine drunk by ordinary soldiers. This anonymous blend, a mixture of wines from across France, was an effective metaphor for all of the poilus

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who had left their regions to defend French civilization from the ‘enemies of wine’.64 The poilu and his pinard were justly celebrated in song – the soldier’s favourite La Madelon describes the pretty barmaid serving wine to the men on leave  – and similar images decorated popular postcards throughout the war. On an official level, the French government considered the ‘reasonable consumption’ of vin ordinaire as highly beneficial, and in 1917 it requisitioned 200 million gallons of wine from France and 40 million gallons from Algeria exclusively for use by fighting forces.65 In France each officer and each man initially received a quarter litre of wine a day and this was later increased to half a litre of wine daily to promote the ‘health and efficiency of the troops’.66 It was not just that the troops were drinking good French wine but that this wine was in stark contrast to the bitter (amère) German beer, a contrast which indicated the cultural and moral difference between simple French joie de vivre and the naturally sour Teutonic disposition.67 The official British response to drink was even more inconsistent than the French. Lloyd George railed against ‘the lure of the drink’ and praised the French and the Russian governments for their draconian policies. He insisted that absinthe was ‘like whisky’ and that it had been right to ban it in France. Yet he did not plan to ban whisky in Britain, insisting that there was no need for ‘anything as drastic as that’ because the British were ‘essentially moderate men’. ‘We have got great powers to deal with drink and we mean to use them’, he announced to loud cheers before going on to say, ‘We shall use them in a spirit of moderation, we shall use them discreetly, we shall use them wisely.’68 Possibly Lloyd George was motivated by the power of the drink lobby or by a fear of losing tax revenue. Vested interests certainly fought to protect the image of alcohol by insisting that the ‘anti-war party is the anti-booze party’ and so Lloyd George’s avowed hostility to the demon drink did not hinder his government from increasing the beer barrelage by 2 million barrels during the latter half of 1917.69 Nevertheless, the language of ‘moderation’ invoked a comforting, self-satisfied image of Britain at drink: the French and the Russians could not be trusted to limit their own drinking but the moderate British man was of a very different calibre and was encouraged to aim for ‘sobriety’ rather than ‘abstinence’.70 Unlike Lloyd George, British soldiers generally did not equate patriotism and moderate drinking. They openly celebrated drink while mocking official concerns with the overconsumption of alcohol, as spoof advertisements in the Wipers Times indicate: THE DRINK HABIT ACQUIRED IN THREE DAYS If you know anyone who doesn’t drink alcohol regularly, or occasionally, let me send my free book, ‘CONFESSIONS OF AN ALCOHOL SLAVE.’ It explains something important, i.e. How to quickly become an Expert ‘Bona-fide Toper’.

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For the first 15 years of my life I was a rabid teetotaller. Since the age of 16 I have never been to bed sober. If your trouble is with reference to a friend please state in your letter whether he is willing to be cured or not. Letters treated in a confidential manner. I can cure anyone. Address: J. SUPITUPS, Havanotha Mansions.71 French troops adopted a similarly irreverent manner towards alcohol warnings and their jokes retained an impact long after the war was over. In the opening scenes of La Grande Illusion (1937) there is a poster under the air squadron bar warning the men that ‘Alcohol Kills! Alcohol drives you Mad!’ and the bottom line proclaims: ‘The squadron leader drinks it!!’72 This film, designed to draw on memories of the Great War, began by reminding men that war was about drinking together as much as fighting together. Both British and French troops saw alcohol as essential and so were especially hostile to the civilians who made profits by supplying the troops with their much-needed alcohol. Henri Barbusse’s fellow-soldiers hated the locals who made a fortune by overcharging them for their wine and British soldiers were often driven to fury by the estaminet-keepers who watered the beer.73 In both cases the moral authority lay with the drinking troops. Drinking good British beer was a sign of patriotism, as it still is (Nigel Farage, the most prominent figure in the UK Independence Party, is constantly photographed holding a pint of beer to demonstrate his alleged patriotic integrity), and British soldiers were aggrieved that there was no official beer ration. This sense of aggravation was further deepened by the knowledge that their French allies were receiving a generous helping of pinard each day.74 Yet while British troops were proud of their own alcohol consumption they castigated the Germans for drinking excessively and – most crucially – for being barbaric as a result of drink.75 Turkish troops by contrast were perceived as alien because they did not drink at all and in Ernest Raymond’s Tell England the teetotal Turk was presented as a legitimate target for mockery. During the Gallipoli campaign, a group of young officers who had drunk to excess from the beginning of the war left a dugout in the expectation that it would soon be taken by Turkish troops. To greet them the padre ‘placed a mug of whisky on the table with a bottle of water so that Old Man Turk could pour it out to his liking’. A note by the whisky read, ‘Have this one with me John. You fought well.’76 While enemies’ drinking (or non-drinking) habits were a source for criticism and coarse humour, British officers also used their drinking habits to demonstrate that they remained civilized under fire. A young officer, talking about his life on the Somme for the populist Daily Mail, described how he and his fellow officers drank port while awaiting the order for attack. He acknowledged that the wine did not taste good ‘out of a chipped enamel mug … after it has been under shell fire’, an acknowledgement that betrayed

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his discomfort but emphasized that he had not lost any sense of discernment. He and his brother-officers could still claim an urbane understanding of fine wine, despite being in the trenches. Soldiers were also aware that the military authorities could use alcohol for nefarious purposes and they resisted this. Louis Barthas, a French soldier and committed socialist, described an incident in June 1915 when soldiers were getting ready to go over the top. While the men were awaiting final instructions the catering troops arrived with two cans of gniole (hooch) for immediate distribution. Some of the men filled their mugs but many did not, being suspicious of this apparent largesse just before an attack. ‘It smells like a pharmacy’, one of them complained; another, tipping his spirits on to the ground, insisted that he would not be made into an assassin for a drop of hooch.77 Men were prepared to selfmedicate but, despite a famed love of liquor, they were not always willing to let the army dupe them with industrial-strength alcohol. Amongst most fighting troops, drinking well was a symbol of pride and brotherhood and not drinking (or not drinking well) was evidence of otherness. According to Ford Madox Ford, drinking properly was essential and ‘there were occasions during that period of warfare when the consumption of a certain amount of alcohol was a necessity if the human being were to keep on carrying on and through rough places. Then happy was the man who carried his liquor well’.78 The key to maintaining masculinity and brotherhood was precisely this ability to carry the liquor well. In all western European armies drinking was encouraged but it was an offence to be drunk on duty. Oskar Graf described how he and fellow soldiers were confined to barracks and then given twenty-seven days’ light field punishment after a bout of excessive drinking, and Captain Dunn went as far as to smash bottles of wine to limit the amount his men could drink.79 There was obviously much sense in this because drunken troops are undisciplined troops as French soldiers recognized at the beginning in the war when they attributed some of their early successes to the German overconsumption of champagne in Reims.80 Even after the war, alcohol was no excuse for bestial behaviour. While a late twentieth or twenty-first-century audience might sympathize with the heavy drinking scenes in Journey’s End, Field Marshall Sir George Milne believed that the play was a travesty and argued, ‘The British soldier was not a beast … No soldier would have sat down to a feast in a dug-out after a raid in which their comrades had been killed.’81 There were also genuine limits to the way in which men within national armies bonded over alcohol. The non-specific pinard should have bound all Frenchmen together but French regional identity remained strong and Barbusse tells of soldiers longing to drink wine from their own regions, especially those far from home, each of whom wanted a drink from ‘his own particular South’.82 Class barriers mattered too because the celebrated – but rough – pinard was only for the men, whereas the officers were issued with vin bouché (higher quality, bottled wine). These markers of privilege existed

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in the British army too, where champagne was officially reserved for officers. This regulation clearly could not always be enforced and Vince Schürhoff, a corporal in the Royal Engineers, drank quantities of champagne throughout his war service. Nevertheless the regulation that so privileged officers still rankled and was a ‘bloody cheek’ according to the writer Frederic Manning (1882–1935), who claimed that ‘half of them don’t know whether they are drinking champagne or cider’.83 British officers were not the only ones to confuse the two, and right at the very beginning of the war British surgeon Charles Roberts noted this somewhat gleefully in his diary: ‘Germans got 150 doz cider here thinking it champagne.’84 The cultural associations with drinking and sharing alcohol are clearly profound but alcohol was important to men in the trenches for pragmatic reasons too, namely for its food value. The German military authorities were irritated that men insisted on seeing alcohol as a food, and an official pamphlet issued to the German army in 1916 insisted that ‘There is no justification for calling beer “liquid bread”’, indicating that German soldiers were doing exactly that.85 There is good reason for arguing that alcoholic drink should not be seen as a food; spirits in particular have little nutritional value. Yet alcoholic drinks do contain calories and extra calories were much needed. Providing sufficient food to the trenches was difficult, which is no doubt why a particular group of medical researchers argued that the men could easily do without. Research into the ‘fast and work’ system produced the following conclusions: it is quite easy to work for 5 or 6 days at high pressure with no food, or only carbohydrate feed; that for the first 10 to 20 hours there is discomfort, but afterwards there is loss of appetite and ability to work for 16 hours a day for the next five days, with marked increase in nervous and muscular energy. There should then be given a glass of milk, after which the man will sleep soundly for several hours, and waking will have a good meal and again go to sleep, on re-waking he will have a ravenous appetite and will eat heartily and sleep soundly for the necessary 3 days’ rest period. [This] will make the food supply of armies much easier.86 Ordinary soldiers thought otherwise, and while Dunn’s complaint about ‘56 foodless hours’ was atypical, men constantly grumbled about ‘irregular food and tinned meats’, especially in the front-line trenches where men required over 4,000 calories a day.87 Even well behind the lines men may have had to survive on bread, biscuits and bully beef for long periods, a monotonous diet which did little for morale and tended to provoke constipation, hence the medical reliance upon pill ‘number 9’, the widely distributed and muchmocked laxative. Most men were dissatisfied with army food and the desire for more food, or food of a better quality and of a greater variety, dominates many wartime accounts. As far as Holtzapffel was concerned, the single most important factor about hospital life was not the safety and the comfort

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but the fact that there was ‘no bally rationing’.88 Like most men he simply wanted good food in plentiful quantities and was fed up with army rations, no matter how scientifically sound they might have been. In any case, many men were used to thinking of alcohol as an integral part of, rather than an addition to, their daily diet. The historian Robert Roberts recalled his father, a working-class Salford man, insisting that ‘Beer is my food!’ and given the limited diet available for workers at the time, there was much truth in this.89 Yet food is about more than mere nutrients. Food is about well-being and, quite simply, what makes us feel good, and soldiers saw alcohol as an integral part of the physical and emotional nourishment that they needed to cope with the rigours of army life. Eric Peppiette and his friends were at their happiest when they could treat themselves to fried cheese, and at every possible opportunity British soldiers would go to the local estaminet for eggs, coffee and beer. British troops preferred the familiar egg and chips – or pompadour fritz (pomme de terre frites) – to anything else on offer because they were rather suspicious of French food.90 However, they were much more accepting of the local alcohol and happily drank the wine too, and as a result the cheap vin blanc (‘plonk’) became part of British vocabulary and it has remained in use ever since. Alcohol was not an additional treat but an essential part of the everyday meal: ‘bread, bully, jam, a pipe and rum’ may have contained that ‘deceptive substitute for real food’ but as far as the men were concerned it was familiar and comforting and very much part of the ‘real’ meal.91 Doctors and politicians debated the merits or otherwise of treating alcohol as a medicine or a tonic but accounts from the trenches indicate men had few doubts about its value. At the most basic level, men turned to alcohol to celebrate, to commiserate and to cope with fear. To celebrate sailing out of Devonport towards what they thought was certain victory in the Dardanelles, Raymond’s subalterns drank copious quantities of champagne and liqueurs.92 At the other end of the war, Ernst Thälmann, sensing defeat, noted laconically in his diary ‘in despair got drunk’ in September 1918.93 Jünger argued fatalistically there was simply no reason not to get drunk, and after a bleak period in the trenches, Vaughan felt that there was nothing else to do but to drink: ‘So this was the end of “D” Company. Feeling sick and lonely I returned to my tent to write out my casualty report; but instead I sat on the floor and drank whisky after whisky as I gazed into a black and empty future.’94 Hans Grimm’s account of a German drinking game effectively illustrates how men could use alcohol to bind themselves together, especially when their fears were too great to articulate: Paul took six matches from his pocket, broke one of them and threw half of it away. Then he held up the matches so that only the red heads were visible. Every man had to draw a match. The one who got the half had to pay for a round. The next man took the five and a half matches

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and let the others draw. This way nobody had to talk; they could just drink beer and ruminate, aware that the offensive was about to start and that some of them would never come back. They kept playing this wonderful game all day long and into the night, and through the night till the morning, and then to the following lunchtime, and after lunch till late in the afternoon.95 These soldiers were clearly drinking themselves into oblivion, but alcohol can act as a stimulant and many accounts emphasize high levels of drinking throughout the war as men motivated themselves to fight with whatever alcohol was available. Vaughan and Jünger have written very different accounts of the war except for the fact that they both drank steadily throughout it. Vaughan’s tale is full of rum punch, bottles of whisky and mugs of port, and Jünger appears to be the living embodiment of the term ‘fighting drunk’. It was not only the combat troops who relied on the stimulation of alcohol to keep going; Henry Kaye’s colleague Maurice, a young medical officer, finished his shift at 9 o’clock one night, ‘famished and dog-tired’ having survived on ‘a mouthful of neat whisky for breakfast and nothing since’.96 As well as being a stimulant, alcohol is a sedative and some men saved their rum or their whisky to calm themselves down after an attack. As Clinton, a young officer, explained in Manning’s Her Privates We, ‘I don’t go over with a skinful as some of them do; but by God, when I come back I want it.’97 Those who had been injured had an even greater need of strong alcohol as Lance Corporal Baxter realized. He had no formal medical training but was ‘tender-hearted’ and cared for his men in a paternalistic (or possibly maternalistic) manner, and on attending to a wounded soldier in no man’s land he dressed his wounds, and gave him a drink of rum and some biscuits.98 Similarly, Graf described how his comrades brought him brandy and hot tea when he was frozen stiff, and shortly afterwards he ‘managed to move again’.99 The belief that alcohol was good for you, especially in cold weather, was deeply ingrained. Before he even reached the trenches Peppiette was using alcohol as medicinalstyle comforter as his preparations for guard duty on a chilly evening in Blackpool indicate: ‘Had two whiskies to keep out the cold, filled my water bottle with stout.’100 Yet he was not someone who considered himself to be an excessive drinker and he rather looked down on those men who drank too much. As we are all now aware, freezing men really did not need strong spirits. On the contrary, alcohol lowers the  core temperature of the body and reduces the body’s ability to maintain heat and so drinking alcohol in a cold environment is likely to promote  hypothermia. Nevertheless, men felt that alcohol was warming; it comforted them and made them feel that they were being cared for: ‘Curaçao’, wrote Schürhoff from a freezing dugout in January 1918, is ‘like a health tonic’, and Jünger simply asserted that ‘red wine is the best medicine’.101

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Alcohol is renowned for dulling the senses and for slowing down reaction time – for these reasons drink-driving is prohibited – but soldiers’ accounts often stress the extent to which alcohol enabled mental clarity and acuity. Robert Graves, for example, described an intense bombardment in a ‘corpse-strewn front line’. In the confusion of the fighting and almost paralyzed by the fear of gas, Graves felt physically and mentally unable to cope: ‘My mouth was dry, my eyes out of focus, and my legs [were] quaking under me.’ He was not able to cope again until he had doused himself with strong spirit, as he recounts: ‘I found a water-bottle full of rum and drank about half a pint; it quieted me and my head remained clear.’102 Manning similarly describes how Bourne, his central character, was ‘steadied’ by whisky at a crucial juncture and Vaughan gave ‘whacking doses of rum’ to a comrade who was ‘very windy’.103 This approach was medically acceptable and many British doctors believed that a stiff drink was a useful way of dealing with mental or nervous shock while their French counterparts insisted that wine was the best cure for le cafard. Moreover, it was probably better than the equally acceptable practice of just ‘knocking out’ your hysterical comrade in the hope that the shock would return him to his senses.104 Using alcohol to alleviate ‘windiness’ did not just lessen the possibility of full-blown shell shock but had an impact on men’s physical health too. Graves was especially attuned to the links between poor morale and ill health, and insisted, ‘Our men looked forward to their tot of rum at the dawn stand-to as the brightest moment of the twenty-four hours; when this was denied them, their resistance weakened.’ As a result, when a general with ‘teetotal convictions’ limited rum to emergency use only, the immediate result was ‘the heaviest sick-list that the battalion had ever known’.105 Soldiers also used alcohol to deal with very specific complaints. Gerlach, a German staff surgeon, took a shot of rum or arrack every morning to combat ‘Verdun fever’, the digestive problems caused by the ‘billions of flies’ in the fighting zones.106 Manning described a soldier who insisted that port wine and brandy were good for colic and Barbusse’s soldiers advocated giving men wine when they had lost blood.107 Wine had been the ‘wound drink of choice’ in the Middle Ages and there remained strong cultural and theological links between blood and wine.108 The French were also renowned for using brandy on dressings, as a sort of antiseptic, although British soldiers baulked at this and were convinced that the medical benefits of brandy lay in drinking it.109

Medicine from home Alcohol was not the only ad hoc remedy available to soldiers in the trenches. Most soldiers had come from families in which wives and mothers

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traditionally dispensed either home-made or over-the-counter medicines, and the patent remedies or tonics – the ‘Lung tonic, Mustard, Liver Pills and Beer’ – that had long been used for minor ailments at home were swiftly transported to the trenches.110 Even before they arrived at the fighting front British soldiers armed themselves with Mothersill’s Sea-Sick Remedy to ward off sea-sickness on the journey across the channel. Once in France and Belgium, British and French soldiers were always eager to find a source of Beecham’s Pills, a popular patented medicine which was reputed to cure almost anything. The companies that had marketed medicines to civilians before the war quickly adapted to the wartime economy and began marketing their wares to the sick or wounded Tommy, sometimes through the medical profession and sometimes directly to the lay public. Many of these articles had little active pharmaceutical power and the most innocuous of products were rebranded as medicines which could be put to almost limitless use in warfare. Horlicks, originally created as a milky drink for infants, promoted its tablets to medical professionals caring for wounded troops: A round airtight tin weight 7oz and containing 80 highly compressed tablets: – this is Horlick’s 24-hour Ration. From 10–20 tablets dissolved in the mouth as required supply the nourishment given by an ordinary meal, and they quickly restore energy and vitality. The contents of one tin are sufficient to maintain strength and vigour for 24 hours without any other food, and, in addition, the tablets relieve thirst. The comfort given by these food tablets to soldiers when wounded has been evidenced very largely during the war. They contain all the wellknown food qualities of Horlick’s Malted Milk. The neat tin in which they are packed may be carried without inconvenience by members of the RAMC and by Red Cross workers, and larger bottles should always be available in each ambulance and at all dressing stations.111 Horlicks certainly had some nutritional value, being largely composed of malted wheat and barley, whey and sugar but as anyone familiar with the product will know, Horlicks tablets certainly do not relieve thirst. Ovaltine, another milky drink, similarly marketed itself to the medical profession ‘at advantageous prices for hospitals and kindred institutions’. Although it did not claim to relieve thirst, Ovaltine did purport to be useful for the treatment of ‘nerve strain, insomnia, phthisis, convalescence, dysentery and all fevers’.112 Both Horlicks and Ovaltine had been sold as nutritious beverages before the war. Ovaltine was more specifically targeted at young children and convalescents, whereas Horlicks also boasted of its popularity with polar explorers. In both cases the comforts of a very domestic product were easily adapted to the needs of wounded men. Similarly the Wincarnis Remedy – a tonic wine containing beef stock – had long been marketed as a cure for ‘every sort of exhausting malady’ before the war and was especially targeted at housewives, anaemic girls and the elderly.113 However, during

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the war the marketing became targeted more at soldiers (or their relatives) and advertisers claimed that ‘thousands of our brave wounded, and the wounded soldiers of our gallant Allies, are quickly gaining renewed strength and new life from “Wincarnis”’.114 By this stage the gendered imagery in the advertisements had changed and young women were no longer the ones in need of the life-giving properties of Wincarnis; rather they were the ones dispensing it. Over an image of a young woman taking a wounded soldier for a punt, the links between womanly care and Wincarnis were made plain: ‘It is a common sight to see wounded soldiers being taken out on the water by their fair friends. The lady here is still further assuring the welfare of her wounded hero by supplying him with a glassful of life-giving Wincarnis.’115 The list of food supplements available at the time was extensive: French doctors recommended sweetened, condensed milk for diarrhoea, and in Britain Iron Jelloids were sold to combat anaemia. Vi-Casein, an alternative to the German Sanatogen, was marketed as ‘an aid to nutrition in health and disease’, and Oxo, Marmite and Bovril (including Bovril lozenges and Bovril chocolate) were all marketed to sick or convalescent soldiers.116 Oxo in particular was quick to sell itself as an emergency food source, more than equal to meeting wartime demands as this advert from October 1914 indicates. It featured the testimony of one of the survivors of HMS Hogue, a British cruiser torpedoed by the Germans at the start of the war: I felt the shock in the water, and saw the vessel afterwards go down. It was sometime after this that I was picked up, after I had been in the water for an hour and a quarter. It was a fishing smack or a trawler that picked me up, and I was finally taken on board the ‘Lowestoft’ with two or three hundred other survivors. We were all pretty nearly done for, I can tell you, but the crew were very good to us. They brought us round basins of hot oxo, with some brandy in it, and it bucked us up at once and made new men of us.117 Some products tailored their advertising towards very specific combat-related conditions. Harry Lauder’s Reudal Bath Saltrates were supposedly helpful for cases of trench foot and ‘Vitafer’ was recommended for those ‘on the sick list’ with neurasthenia or nervous disability.118 Right from the start of the war people were encouraged to send medication to their loved ones at the front, and ointments for sore feet, antiseptics and foot powder were all advertised as gifts or ‘comforts’ for the troops alongside chocolates, mufflers, thermos flasks and soap.119 Adverts for ‘Harrison’s Pomade’, originally designed to combat nits in children, were specifically targeted at soldiers’ friends and families during the war. Under the banner ‘Kill that insect Tommy!!!’ the text urged, ‘Send your pals “out yonder” some tins of Harrison’s Nursery Pomade: They’ll be very acceptable.’120 Families were also encouraged to send their men ‘The Trenchman’s Belt’, a commercial product designed to be worn under the uniform so as to deter lice and to protect against chills.121

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In part these advertising campaigns were simply the response of a cynical industry making the most of an extraordinary marketing opportunity but they also reflected the extent to which men relied upon themselves and their families for basic medical preparations. Soldiers did not always trust their own army medical services to provide them with the care they needed, especially for minor but debilitating ailments.

Hard and soft drugs: Opium, cocaine, tobacco Soldiers’ tendencies to treat themselves, whether for specific conditions or simply to ‘keep going’ under difficult circumstances, produced some moral panic on the home fronts, because while most of the products so far mentioned were essentially harmless, men did have recourse to stronger drugs. Opium had been used as an anaesthetic in wartime since the medieval period but Sassoon used it to induce constipation on the front lines and seemed quite oblivious to pre-war fears about ‘the drug habit’.122 Barbusse seemed similarly nonplussed about the use of opium and noted without comment that his comrade Volpatte was carrying a tube containing both aspirins and opium tablets.123 Of somewhat greater concern was the misuse of cocaine amongst the troops, although in some circumstances the use of cocaine was acceptable. The manufacturers of Hall’s Coca Wine trumpeted the ‘great sustaining power’ of coca leaves and the wine was widely marketed as ‘a restorative and nervine’.124 It could be easily obtained at chemists, at wine merchants and through mail order where a small bottle cost two shillings and a large was priced at three shillings and sixpence. Not only was it easy to obtain but it was cheaper than whisky, certainly at the prices that Carrington was paying. Soldiers were also used to buying snuff ‘strengthened’ with cocaine, a habit that many had begun before the war.125 Yet pure cocaine was a different matter, and in July 1916 Thomas James Lyons and William Mitchell were both sentenced to six months’ imprisonment and fined £100 each for selling cocaine to soldiers.126 As with alcohol, the problem was seen as drug management rather than drug taking, and it was not new. Soldiers had become so addicted to morphine and other opium preparations during the US Civil War that drug addiction became known as the ‘army disease’.127 Military authorities did not want to eliminate but to control the way in which men used drugs, as in the pre-war German army when doctors had experimented with giving cocaine to Bavarian soldiers on training missions.128 These concerns about drug management had long-term consequences, with the British government restricting the sale of opium and cocaine in 1916 and again in 1920, acts which form the foundations of today’s ‘war on drugs’. In a more precise attempt to control the soldiers’ attempts at self-medication, the Army Council ordered that none of the following articles should be sold or supplied to any member of the armed forces without a prescription from a registered

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doctor: ‘Barbitone, Benzamine Lactate, Benzamine Hydrochloride, Chloral Hydrate, Coca, Cocain [sic], Codeine, Diamorphine, Indian Hemp, Opium, Morphine and Sulphonia’.129 In this the British authorities were mimicking the much stronger German regulations which stipulated that drugs could be obtained by a system of strictly regulated doctors’ prescriptions.130 Despite these restrictions, pilots continued to use cocaine to keep themselves alert throughout the war.131 Cocaine and opiates are extremely powerful drugs but doctors were much more concerned about the excessive consumption of tobacco in the trenches. The strong links between tobacco and cancer were not identified until the 1950s but early twentieth-century doctors were aware of the damaging properties of nicotine, which is a mild stimulant and a sedative, and is highly addictive. More generally, there had been pre-war concerns about the effect of tobacco on health and about the dangers of addiction, particularly for boys, and during the war military doctors became concerned about links between tobacco consumption and defective action of the heart.132 The arguments were similar to those employed to discourage excessive alcohol consumption, namely that the soldier should be thought of as an athlete in training: What trainer would allow his students to smoke cigarettes, whether he was training them for boxing, football, racing, or other forms of contest necessitating a sound heart and good wind? Yet soldiers are not alone allowed but encouraged by well-meaning associations and people who are continually supplying them with these aids to inefficiency either free or at a small cost.133 Yet there were still some who argued that smoking was actually beneficial, and letters to the Times advocated the importance of tobacco’s soothing qualities in quasi-medical terms: If there is one thing more certain than another it is that enormous comfort both of mind and body comes with a pipe or cigarette when the smoker is in a tight corner. Tobacco at the front has a moral value which simply cannot be ignored, and it may be asked whether any ill-effects it possesses are equal to or even comparable with the ill-effects of shock and strain and stress which cannot be eliminated and which tobacco does so much to mitigate. War is not a health cure. The chief danger of war, speaking medically and putting actual wounds to one side, is its terrible effect on nerves. Practically the whole Army is of the opinion that in tobacco it possesses a means of counteracting this nervous strain.134 A soldier who had served in Gallipoli, Egypt and France put the case with more force, arguing, ‘If you know what smell is as I do, and shell-fire,

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you would smoke about 20lb a day. If any harm is done to the Tommy by smoking cigarettes it probably saved thousands from going stark staring mad.’135 Those who knew ‘smell’ and ‘shell-fire’ certainly did rely on tobacco, and according to official estimates, 96.5 per cent of British troops were regular smokers by Christmas 1914.136 On account of this popular support and a level of medical ambiguity, smoking was the one area of self-medication which neither the military nor the medical authorities attempted to police. On the contrary, families were urged to send tobacco and cigarettes to the troops to comfort them. In Britain this practice was initiated at the highest levels when in 1914 Princess Mary organized the distribution of tobacco and cigarettes to the troops in distinctive brass boxes, and in 1916 the War Office began supplying duty-free tobacco and cigarettes to all men in the armed forces.137 Cigarettes and tobacco were part of the free ration for British, French and German troops during the war. British soldiers were issued with 2 ounces of tobacco a day and the French had a smaller ration of 20 grams (approximately 0.8 ounces). Meanwhile the Germans were officially issued with two cigars and two cigarettes or with tobacco or snuff. Many men did prefer pipes at this time. Both Jünger and Sassoon describe smoking pipes in the trenches and French soldiers were renowned for their love of scaferlatti pour les troupes, a type of rough cut pipe tobacco. Yet cigarettes, whether manufactured or hand-rolled, were considerably more practical and easier to manage. In addition to the official rations all soldiers were able to buy cigarettes and tobacco cheaply because from an early stage it was seen as more of a necessity than a luxury. For this reason the International Red Cross ensured that POWs received weekly Red Cross parcels containing, amongst other goods, twenty-five ready-rolled cigarettes. In addition, as with alcohol, there were such strong links between tobacco and military masculinity that it was impossible to prohibit or even seriously to limit its consumption.138 Soldiers of all nations smoked to ward off fear, and as soon as they were injured they asked for a cigarette. Early in the war Flora Sandes, a British nurse, described the following encounter with a Serbian soldier: I asked a man one day who was suffering excruciating pain if he would like a cigarette. ‘No, thank you,’ said he shaking his head. ‘Do you feel too bad to smoke?’ I asked, rather alarmed, because for a Serbian to refuse a cigarette he must be in a very bad way indeed. ‘No,’ he said smiling up at me, ‘I’d like a smoke, but you have already given me so many of your cigarettes already!’139 Smoking was an easy and acceptable form of self-medication, because although more women began smoking during the war, the habit was one which denoted masculinity. Unlike drink, there was no obvious point at which a man was unable to ‘hold’ his tobacco and so men could share

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cigarettes with each other indefinitely. Also, cigarettes could be liberally and easily dispensed to wounded men in hospitals, on railway platforms, in parks and in public streets. Moreover, a woman could always comfort a man – even a stranger – by giving him a cigarette. It was better than giving him sweets (which could be infantilizing), and although cigarette-sharing could be flirtatious, it was not as sexually provocative as sharing alcohol. In practical and moral terms it was easier for a woman to give a man a cigarette than to give him a beer or a glass of wine.

Controlling wounds and idealizing wounds Soldiers attempted to self-medicate and doctors attempted to control drugs, a process which ensured that medical treatment and concepts of illness were all part of a wider disciplinary system. The relationship between soldiers and medical officers was often fraught because medical officers had the power to remove soldiers from danger or to send them back to the fighting front. Yet the soldier was not simply the passive recipient of physical injury or disease but he used his bodily ills to mark, to evade and to manage the trials of trench warfare. In terms of actual and immediate responses to wounding, most men were stoical and dealt with their own and their comrades’ physical needs pragmatically. Donald Hankey described wounded and unwounded men unable to move and simply waiting for relief after an attack: There were three men in a bay of the trench. One was hit in the leg, and sat on the floor cutting away his trousers so as to apply a field dressing. One knelt down behind the parapet with a look of dumb stupor on his face. The third, a boy of about seventeen from a London slum, peered over the parapet at intervals. Suddenly he disappeared over the top. He had discovered two wounded men in a shell hole just in front, and was hoisting them into the shelter of the trench. By a miracle not one of the three was hit. A message was passed up the trench: ‘Hold on at all costs till relieved.’ … Someone produced a tin of meat, some biscuits, and a full water bottle. The food was divided up, and a shell bursting just in rear covered everything with dirt and made it uneatable. The water was reserved for the wounded. The rest sucked their pebbles in stoical silence.140 The picture is bleak and unsensational, the men were simply doing their best to survive in the most difficult of circumstances and they all knew that the triage system was based upon maintaining manpower rather than relieving their own personal injuries. This was the everyday reality of dealing with wounds, pain, hunger and thirst. Yet men were also affected by the way in which their wounds were conceptualized, imagined and described. In an idealized sense there was a spectrum of wounds ranging from the romantic

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hero-warrior at one end to the discredited coward with the self-inflicted wound at the other. Between these two extremes were the men who were lucky enough to gain a much coveted ‘Blighty one’.

Heroic wounds W.D. Esplin, a British soldier sent home on account of a mental breakdown, felt far from heroic when he had to face the crowds awaiting the hospital ship at Southampton. They were disappointingly silent, and much to his shame he overheard one of the women telling her friends that they all might as well go home because the wounded soldiers were just ‘barmy’.141 His experience was in direct contrast to that of John Glubb, a young lieutenant who was given a very different reception when he returned home injured after the Third Battle of Ypres in 1917. On arriving at Victoria Station he was put in an ambulance for the Third London General Hospital in Wandsworth, and the nurse left open the back doors of the ambulance so that the wounded men could see the sunlight. On driving through the streets of London they were all given a rapturous welcome home: suddenly there was cheering all around them. Lifting his head he saw crowds of men and women lining the streets, waving when they saw him, calling out that he was brave and they were proud of him. Tweed caps were waved, flowers were thrown and there was singing. Wave after wave of applause followed each little ambulance leaving the station.142 As far as Esplin was concerned his wound lacked glamour and sexual allure simply because it was a mental wound, and he assumed that those suffering from physical wounds were essentially the ‘battle-stained heroes’ that women wanted. Clearly there was some truth in this as Glubb’s words attest. Cheering crowds were far more likely to greet physically than mentally wounded men, and some men did seem to like the status of wounded hero. Despite his injuries and his difficult journey, Carlos Blacker obviously enjoyed his arrival at Lady Murray’s hospital in Tréport and appreciated the company of Lady Murray, ‘an ample woman with a gentle voice and gracious manners’.143 What he especially seemed to enjoy was his own contrast to this genteel, feminine world where he ‘felt something of a brigand not having shaved for three days’.144 Hankey, too, relished ‘the glamour of vagabondage’ which was attached to active service.145 For these young officers the physical privations and dangers of active service offered a real escape from the stifling environment of education, the City or the suburbs, and for Blacker the country house milieu was comforting and familiar. Blacker’s wounds were neither critical nor ugly; he was mentally sound and in good spirits and as a result he was able to enter the role of

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the ‘battle-stained hero’ in a way that eluded the mentally wounded Esplin. For many men it was important to underplay their wounds and for young men it was especially important to present a resilient image to their parents. Prior to going into battle Herbert Wiesser, a German student, wrote to his mother and father saying, ‘I am not in the least afraid of bullets’, and this air of bravado continued even after the bullets had done their damage.146 Ward Muir noted how Australian and Canadian troops all underplayed their wounds when sending telegrams home. The short, understated comments – ‘Nothing serious’, ‘Trifling scratch’, ‘Rapid recovery expected’, ‘Slightly wounded ten pounds would be helpful keep smiling’ – were all ways of allaying family anxiety as well as ensuring that the men had every incentive to manage their own fears.147 One German soldier, a 38-year-old Bavarian farmer and father of six, recognized that he might be simply unable to write about his physical condition, and so he arranged a code with his family: ‘When I write “I am fine”, it is the truth’, he told them. ‘When I write “I am fine” and I have underlined “fine”, then you may assume that it means the opposite.’148 On a wider social level men were also aware of the difficulties of inhabiting an unwounded male body. In Britain a small number of women orchestrated a short-lived ‘white feather’ campaign in which they distributed the feathers (traditional symbols of cowardice) to non-uniformed and apparently unwounded men. While this campaign has certainly been exaggerated over the years it was based on the stark reality that most men did see active and obvious war service as essential to their status as men.149 A physical wound demonstrated successful masculinity, and not just in the countries where duelling still prevailed. This explains the almost scathing way in which young soldiers could sometimes describe those who failed to respond to danger in a suitably heroic manner. Hankey condemned a man who lost his nerve when under fire – ‘A man went into hysterics, a pitiable object’ – a judgement which can be seen as a way of ensuring that Hankey himself would not succumb to his fears in a similar way.150 However, there were limits to the usefulness of contemporary concepts of bravery and heroism. Esplin regretted not being a ‘battle-stained hero’ and clearly longed for the treatment meted out to men like Glubb and Blacker, but the role of gloriously wounded hero was a hard one to maintain. Wounded men who seemed from the outside to meet all the right requirements rarely felt like wounded heroes for long. A depressed US soldier asked, ‘How can I go back to Washington and be a hero when I’ve been shot through the belly?’151 An officer in the French Foreign Legion had fourteen decorations, including the Légion d’Honneur, but he refused to let anyone tell his wife that he had lost his right arm.152 For both of these men, their wounds were not heroic but shameful in some ill-defined way. Even Glubb, who had enjoyed waving to the crowds from the back of a London ambulance, had moments of anxiety, and in private, ‘the smell of his own infected tissue made him want to weep’.153

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In addition, the role of hero was a problematic one because wounded men were simultaneously lionized and infantilized, and the border between ‘battle-stained hero’ and child or pet was a strangely nebulous one. Injured soldiers from northern India were described as ‘contented children’ and then as ‘spoilt children’ in an article in the Times in 1915.154 Even the Australian troops, often presented as rough-and-ready warriors, already battle hardened by the rigours of colonial life, were sometimes infantilized. Gibbs noted the Australians soldiers’ love of sweets and lollipops, and described the men as ‘grown up children with a wonderful simplicity of youth’.155 Responses to Indian soldiers were obviously infused with racist concepts, and comments on the Australian sweet tooth should also be seen through the prism of the Empire. A colonial fondness for sweets was presented as childlike but there were no similar judgements about the French soldier’s liking for chocolate or the middle-class Englishman’s habit of requesting cake and boarding schoolstyle tuck-boxes from home. Yet often a man simply had to be wounded to be perceived as childlike. Hans Stegemann, a young German officer, described his own wounded men as ‘happy children’, and Dorothy Cator, an English nurse, described French soldiers as ‘simple and childlike’.156 These perceptions were then reinforced by the feminizing activities often given to wounded men. Adrie Schipper, a Dutch volunteer at the American Ambulance Hospital in Paris, noted that recuperating French soldiers were occupied with ‘needlework’ and that they made purses, baskets and dolls. Schipper was delighted at the ‘nimble’ French fingers but this was clearly not respectable, masculine work.157 Paradoxically, it was the attention of well-meaning women which could make being a hero so tiresome. Hankey thoroughly disliked the female journalists and society ladies who petted the ‘darling soldier-lad’, and Andreas Latzko fiercely hated the ‘aristocratic ladies’ who had cared for him after his injury and had persuaded him that his fiancée would still love him despite his injuries.158 Even the persistently gracious Muir could not refrain from criticizing the ‘plump women’ with their ‘bon-bons’ who mollycoddled but consistently failed to understand the wounded soldiers they visited in hospital.159

Self-inflicted wounds The battle-stained hero may have been misunderstood and mistreated but he was seen in a more honourable light than the man who had deliberately injured himself, the man who had created a self-inflicted wound to avoid service and, possibly, to receive the hero’s welcome which was not his due. Self-inflicted wounds were not unprecedented but they first became a phenomenon during the First World War.160 This is not simply because the fighting was more horrific than in previous wars but because the risks of a self-inflicted wound were previously too great when any wound (selfinflicted or otherwise) was likely to lead to death as a result of infection.

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In some ways self-inflicted wounds can be seen as evidence of the success of the wartime medical profession because it was only in this war that men began to calculate that their chances of survival were good enough to warrant the risk of causing injury to themselves. In turn it was difficult to ensure that any such wound would result in a permanent exclusion from the fighting because over 64 per cent of men wounded in the British army and 69 per cent of those wounded in the German army were effectively treated and returned to duty.161 The ideal self-inflicted wound was a plausible injury that removed a man from harm. French and British soldiers who were obviously wounded and out of action could be sent home to a genuinely safe environment. Incapacitated German troops were rarely sent home but were transferred to the war-industries behind the front lines where military discipline still prevailed; nevertheless it was still safer than actually fighting. Some men engineered very trivial avoidance strategies, for example those men in both the British and the German army who allegedly broke their own dentures so as to be moved away from the front lines.162 Broken dentures can hardly be categorized as a wound and only removed men from harm for a short while. To gain prolonged or permanent absence from the battlefields men harmed themselves in ways that ranged from the risky to the very serious. They swallowed pins or hair balls, or obscure items such as rubber ducks.163 Others chewed cordite (an explosive used for propelling bullets) to raise the heartbeat and to increase body temperature.164 Some soldiers developed a sophisticated understanding of the medical symptoms that could be produced by the items available to them. There was a widespread acceptance that it was difficult to simulate shell shock – the ‘lunatic’ held in Arras prison and described below was an exception – but physical complaints were far easier to provoke.165 French soldiers manufactured the symptoms of angina by drinking hot peppered white wine and they ingested picric acid (used in explosives and as an antiseptic) to simulate jaundice.166 Some practices were deeply repellent and indicate a very high level of desperation: men put faeces under their eyelids to induce infections or injected paraffin into the scrotum to mimic a hernia.167 Some soldiers in the Russian army went as far as to amputate their own sexual organs, an act of self-mutilation which was also a literal emasculation.168 Even minor self-mutilation carried a level of risk. Men who swallowed tobacco to raise their heart rates ran the risk of inducing a grave cardiac disorder; one British soldier who shot himself through the arm died of a haemorrhage in November  1914, only several months into the war. 169 It is not possible to say how many self-inflicted wounds went wrong and led to grave damage or to death but clearly the risk was always there. We must distinguish here between men with self-inflicted wounds and men who were malingering. Malingerers were men who had genuinely been wounded or had fallen sick and were consciously prolonging their sick leave. These were usually men who wanted to avoid becoming, in Sassoon’s words, ‘dangerously well’ and wanted to prolong their time away

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from the trenches.170 There were also men who simply insisted that they were just not fit enough to fight for a while. This low-level resistance appeared in all European armies throughout the war and was one which was broadly accepted to some degree. Vince Schürhoff was a diligent and committed soldier who was awarded the Military Medal in March  1918. Two years earlier, in May 1916, Schürhoff was covered with earth and deeply shaken when a ‘whizzbang’ burst close to him, and although physically unhurt, he was given light duties. He then revelled in his good fortune, as his diary entry indicates: Although I pose as a bit knocked about, in reality I’m feeling as fit as a fiddle. It has been the means of getting me off the detestable sapping and I spend the day receiving the congratulations of all and sundry on having escaped so well. Have to tell the story over heaps of times. Reminds me of when I was hurt at soccer.171 Schürhoff was a good soldier who just wanted to take advantage of a piece of luck. He felt that he deserved a break and his fellow-soldiers clearly agreed with him because they would not have been so supportive had he had a reputation for being untrustworthy or cowardly. Military doctors could turn a blind eye to cases of this sort but were obliged to counter more flagrant, systematic or habitual cases of malingering. Sometimes the responses of the medical-military authorities were downright brutal, as in the case of a man suspected of feigning shell shock who was held at Arras prison in May 1917. In the following description, Schürhoff’s words indicate clearly the point at which military medicine crossed a border and became part of a punitive disciplinary system: We saw the lunatic, or shamming lunatic, having his lunacy driven out of him. The general belief is that the man is acting and morning and afternoon he has to double, with knees up, all over the building, up and downstairs, everywhere … The lunatic, an athletic looking fellow with a beard, long hair and a large red sash like the Spaniards, still keeps his game up and is made to double up and down and round this building, followed by a police Corporal shouting ‘Knees up there’, ‘Go on you bastard’ etc. – not a pretty sight.172 Other approaches were more subtle and doctors usually aimed to employ medical rather than legalistic tactics, such as when a British doctor devised a new eye-testing system because he believed that the men had grown too familiar with the traditional cards and were pretending to poor vision to evade service.173 This was a dynamic process throughout the war as malingerers developed strategies to deal with detection, and in turn doctors devised further tests to deter malingerers.174 Malingering was a kind of coping mechanism and the malingerer was quite definitely deceiving the

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military authorities, yet a certain amount of malingering was acceptable and these men were in quite a different category from those who actively harmed themselves to evade service.175 Self-inflicted wounds were an offence punishable by the death penalty in all the European armies, and in the French army men were sometimes punished for self-mutilation by being tied up and thrown into no man’s land.176 Moreover, as far as military discipline was concerned, feigning a wound or an illness was just as much of a crime as actually fabricating one. In 1918 a British Division which had suffered a high number of gas casualties in the line was considered suspect and ‘there was a strong suspicion in this case that some men had either feigned gas sickness or wilfully exposed themselves to gas with a view to escaping duty’. The men were duly instructed that they would be tried by court martial.177 It is not possible to estimate the number of self-inflicted wounds effectively because by definition it was only the unsuccessful cases that became evident. However, 3,478 British soldiers were tried for self-inflicted wounds throughout the war, and it is clear that many military and medical staff were fiercely judgemental of men who maimed themselves.178 Doctors’ notes indicate the environment of suspicion that soldiers inhabited. As early as April 1915 Bowlby noted, ‘We had about 1100 wounded at Mont des Cats, and 35% were shot in the hand – rather suspicious.’179 Kaye was concerned about a bullet which had not been fired ‘in the usual way’ and Stephen Westman complained about ‘dodgers’ reporting sick in the German army.180 Temoin, a French surgeon, even argued that facially wounded men could ‘use their impressive jaw wounds to their advantage’ by allowing men to appear unfit for war service when they were not.181 Particular contempt was reserved for those who (allegedly) contracted venereal disease (VD) to escape military service. Andrew MacPhail poured scorn on the ‘base fellows’ in the British armies who contracted the disease deliberately and Westman similarly criticized the German soldiers who were rumoured to be deliberately infecting themselves with VD.182 It is almost impossible to judge whether a man has deliberately or accidently contracted VD. Men may well have done so. Alternatively it is perfectly possible that some men just became so dejected that they no longer cared whether they became infected or not and so acted less cautiously than they might have done otherwise. Whatever the explanation, the VD rate in the German army rose in the final year of the war, even though most soldiers were stationed away from civilian areas and so were further away from women than they had been throughout most of the war.183 Military and medical authorities were suspicious and the inevitable result of this environment of suspicion was that there was increased surveillance. French and Italian soldiers were suspected of taking picric acid so often that doctors began routinely to test their blood and urine to determine whether they really had jaundice or not.184 Men who genuinely had accidents, or oddlooking wounds, were under great pressure to prove that their cases were indeed genuine. Private Newton (RAMC) seemed to accept this pressure

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without any qualms, and after being injured while carrying men out of the trenches during a raid, noted simply, ‘I had to make out a special report about my accidental wound, as there have been many cases of self-inflicted wounds, especially among the Infantry. No doubt desperation drives them to it.’185 Officers were generally prepared to help their men in these cases. One of Blacker’s men was shot and lost a middle toe – ‘the sort of wound that a suspicious officer or NCO could think had been self-inflicted’ – in response Blacker wrote him a note certifying that the wound was a genuine one.186 Many doctors did find this policing role wearing. Charles Roberts, a surgeon with the RAMC, noted in his diary, ‘Wounded self-inflicted going to be duly shot. Alternately depressed & optimistic by news.’ He later went on to comment that self-inflicted wounds were ‘mostly accidental’.187 Even the most intransigent of medical officers must have sometimes doubted their own judgements in these cases. While men with self-inflicted wounds were seriously stigmatized, some medical opinion recognized that self-harm was in itself a pathology, and French physicians Laignel-Lavastine and Courbon recommended treating it a manner similar to hysterical shell shock.188 Stanford Read also perceived some self-inflicted wounds as evidence of psychiatric problems and treated the men accordingly.189 Medical staff on the front lines did condemn men with self-inflicted wounds but they were sometimes sympathetic to them too, simply because they were aware of what the men had suffered. Kaye, on finding a man with an ‘alleged’ wound in the hand, had him arrested and sent to a special hospital, but he did so with a heavy heart, indicating obvious sympathy for the ‘poor wretch’.190 Frank Dunham, a stretcher bearer on the Western Front, described a private soldier who had shot himself in the hand and he was genuinely non-judgemental about him, although he recognized that the man had committed a military crime: Philips shot himself through the hand and managed to get to England with a rush of casualties from the Bourlon attack. How Philips explained his wound away I never could make out, but I know that his nerves were in a bad state, and that he had served with the Battalion continuously in and out of the trenches since March 1915, so really he had done his bit.191 Dunham, like many others, clearly linked self-inflicted wounds with shell shock and recognized that both conditions could result from men becoming worn out with the strain of warfare. While it is too simplistic to categorize all self-inflicted injuries as the products of war neuroses, it is obvious that a high number of such wounds were a sign of low morale, as was the case with Bavarian peasants in the German army who had disproportionate levels of self-harm on account of lingering long-standing resentments and entrenched war-weariness.192 However, in some circumstances self-inflicted wounds were neither dishonourable nor a sign of weak nerves. Among prisoners of war the fabrication or simulation of disease could be ‘regarded as fair play

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and as rather creditable than discreditable’ if it enabled the soldier to be repatriated.193 Ford Madox Ford, writing after the war, even romanticized self-inflicted wounding by emphasizing how men could support one another in the task: ‘A man,’ the sergeant-major said, ‘would take the risk of being shot for wounding his pal … They get to love their pals passing the love of women’.194

The Blighty Fletcher got a nice blight wound through the thigh – shrapnel. Found him very fit. He had an omelette and then went off on the trolley line.195 If the self-inflicted wound was shameful, at the other end of the moral spectrum lay the ‘Blighty wound’, a well-worn term which, according to the glossary of an RAMC journal, was ‘a wound doing no serious or permanent injury to the patient, but sufficient to get him sent to an English hospital, with luck’.196 Ideally a Blighty was bad enough to have a man sent home but not so severe that the man was permanently incapacitated. All troops shared this concept but had different terms for it. The British term ‘Blighty’ originally came from India because ‘Blighty’ is the Hindustani word for home and it indicates the deep roots of the Empire in the British army. German soldiers talked about the Heimatschuss, the gunshot or the fire that would have you sent back to the Heimat or homeland; French soldiers talked about the bonne blessure, the good wound or the lucky wound and Americans had the $1,000 wound, in essence, the wound that was a prize. In Barbusse’s Le feu, Volpatte fantasized about the bonne blessure, which would not just release him from the trenches but provide access to pretty Red Cross nurses, white sheets, a stove, slippers, hot baths and, most importantly, plenty of good food.197 Private Wordsworth and his mates nicknamed a particular section of the Somme as ‘Blighty Wood’: it may have been a dangerous sector but at least it held out the promise, however fanciful, of a ticket home to safety and security. 198 According to Barbusse, a bonne blessure was the only thing a soldier could wish for if he were ‘not daft’.199 Even Newton, a stretcher bearer who could have had few illusions about the nature of injuries on the Western Front, repeatedly envied those who were wounded because they could be sent home and confessed, ‘I almost pray that I might be wounded so as to get out of this hell.’200 A ‘Blighty’ is not a scientific term and men realized that an unsympathetic doctor might need some persuading on the issue. Towards the end of the war Harold Reckitt described meeting a young soldier who had worked for his family firm before the war: ‘He showed me his wrist and asked me if I thought it was a Blighty wound. He had been out since 1915 in the 4th East Yorks and this was his fourth wound.’201 The wounded soldier clearly wanted help from someone of a higher social class

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and pre-war bonds of patronage could be useful in these cases. For all the talk of the war creating a greater sense of egalitarianism, class boundaries remained powerful and men obviously used all available opportunities to protect themselves or to pursue their own interests. Medical officers were under great pressure to send them back to the front and the men knew that this pressure was hard to resist.202 Occasionally a Blighty could be very lucky indeed. One young British soldier who had been slightly wounded and was destined for a swift return to duty was asked if he would donate blood for a fellow-soldier who needed a transfusion. A full understanding of blood types was in its infancy and so transfusions were risky. Moreover there were real problems with storing and transporting blood, especially at the beginning of the war, meaning that transfusions had to be carried out on a patient-to-patient basis. Given this cumbersome practice, doctors offered the donor a short trip home as a reward – a sort of ‘fake Blighty’ camouflaged by his minor wound. The soldier readily agreed and was able to enjoy an extra leave, in relatively good health, while enjoying the status of a wounded soldier.203 Yet this sort of officially sanctioned, temporary Blighty was highly unusual, and although soldiers often fervently wished for a wound that would have them sent home, the Blighty was of course a comforting euphemism for something which was undoubtedly painful and terrifying. As the men well knew, most wounded soldiers were treated quickly and then returned to the firing lines, and so any injury grave enough to result in a transfer home would have to be very serious indeed, certainly by civilian standards. Even the non-fatal Blighty wound was painful, ugly and often enduring. Dunn tells of a soldier’s delight when an officer accidently shot him in the foot, but what happened after the initial moment of release or relief?204 Men did not always relish the safety of the aid post or the clearing station. Young Richard Schmeider, considering the fate of the wounded, thought that ‘a dog lying in the poorest hovel at home, is enviable in comparison’ and even in a well-organized hospital on home territory a soldier's life could be miserable.205 Like Schmeider, Corrigan, an ordinary soldier, also used animal imagery when describing his treatment: ‘Treating me like a cow …’, he complained after a nurse surprised him with an anti-tetanus injection, a reasonable complaint given that the nurses had forgotten to tell Corrigan that they were going to inject him and ‘the needle was into his shoulder before he knew why his shirt was held up’.206 By definition a Blighty was not completely disabling but it could leave a man facing a very difficult life. Private Scutts had eleven wounds, including ‘two crippled arms’ and a missing eye, but he was glad that he was ‘safe enough from death’ and looked forward to the walking holiday he could have once he was fully discharged. The walking holiday was no doubt possible but a life with that level of disability was bound to be hard.207 More specifically, the musician who left the war with a serious and permanent injury to his wrist – ‘a rotten sort of Blighty’ – may well have felt that he had not earned an easy ticket home.208

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A genuine but non-lethal wound may have come as a relief to many men, but was there something shameful about actually wanting a Blighty? Certainly Sassoon was scornful about ‘lazy’ officers who hoped for a Blighty and a ‘cushy job’.209 It may have been part of male camaraderie to wish openly for a Blighty but the responses to the reality of being sent home were more complex as Vaughan’s conversation with a fellow-officer indicates: ‘Would you really like a Blighty?’ I asked. ‘I think it’s much more fun out here’. ‘No, I wouldn’t really’, he replied. ‘For two reasons: first because I wouldn’t survive another one, and second because this is the only country where a bloke can really be at ease.’210 A Blighty provided a man with an honourable exit from the war but a Blighty was also a serious (albeit nonfatal) wound, and after a long spell at war, men did not always find it easy to adjust to life amongst civilians. This adjustment was even more problematic for men who were permanently disabled. Ordinary men coped with their own wounds in ways which were largely practical but were sometimes messy and incomplete. In many ways men of all European armies shared the same approaches to wounds: they all had recourse to basic first aid, and almost all of them drank and smoked and used the sorts of drugs and patented products that had made sense to them in their pre-war domestic lives. Men may have drunk too much or smoked too much; they may have become dependent on opiates or cocaine. They may even have deliberately harmed or even killed themselves in the process of trying to cope with the violence of industrial war. All of these processes were rational coping mechanisms and the ordinary wounded soldier just wanted to reach the hospital bed and have his ‘pudding in a tin’. Yet these pragmatic approaches took place in the context of wider societies which simultaneously heroized, infantilized and sometimes even rejected or fiercely condemned wounded men. In this context it is unsurprising that men found it so hard to tell the stories of their wounds.

Further reading Secondary sources Acton, Carol and Jane Potter. Working in a World of Hurt: Trauma and Resilience in the Narratives of Medical Personnel in Warzones. Manchester: Manchester University Press, 2015. This is one of the few texts which examines the trauma suffered by medical staff during war. Berridge, Virginia. Demons: Our Changing Attitudes to Alcohol, Tobacco and Drugs. Oxford: Oxford University Press, 2013 (especially chapter 7, ‘Internationalism and War’, pp. 117–42). A broad-ranging study of attitudes and approaches to drugs and of the role of these key drugs during periods of war. Bourke, Joanna. Dismembering the Male: Men’s Bodies, Britain and the Great War. Chicago: University of Chicago Press, 1996 (especially chapter 2, ‘Malingering’,

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pp. 76–123). An essential study looking at the impact of war on the male body and on concepts of masculinity. Duffett, Rachel. The Stomach for Fighting: Food and the Soldiers of the Great War. Manchester: Manchester University Press, 2012. A history which details the practical and emotional significance of food to the fighting troops. Roper, Michael. The Secret Battle: Emotional Survival in the Great War. Manchester: Manchester University Press, 2009. This book explores the way in which men coped with the emotional demands of warfare and highlights the importance of familial relationships, particularly those between mothers and sons. Watson, Alexander. Enduring the Great War: Combat, Morale and Collapse in the German and British Armies 1914–1918. Cambridge: Cambridge University Press, 2008. This is a history of psychological endurance during the First World War. Like Roper’s work this is a useful counterpoint to the many narratives which emphasize the passivity of the soldiers in the trenches.

Published primary sources Bagnold, Enid. Diary without Dates. London: Virago, 1978 (first published in 1918). This is a memoir of a VAD who served for eighteen months in the Royal Herbert Hospital in Woolwich. It is primarily concerned with the relationships between nurses, VADs, Tommies and officers and was not well-received by the authorities when it was published. Available on Project Gutenberg. Borden, Mary. The Forbidden Zone. London: Modern Voices, 2008 (first published in 1929). The experiences of an American nurse who worked behind the front lines in an evacuation unit throughout the war. Jünger, Ernst. Storm of Steel. London: Penguin, 2004 (first published in 1920). A memoir of a German officer who served during the war and one of the first such accounts to be published in Germany. Jünger refers constantly to alcohol throughout and this work serves as a stark contrast to Remarque’s All Quiet on the Western Front. Macnaughtan, Sarah. My War Experiences in Two Continents. London: John Murray, 1919. The personal account of a writer who served with the Red Cross during the First World War until her death in 1916. Available on Project Gutenberg. Ulrich, Bernd and Benjamin Ziemann, eds. German Soldiers in the Great War: Letters and Eyewitness Accounts. Translated by Christine Brocks. Yorkshire: Pen and Sword, 2010. This is an intriguing selection of first-hand accounts from German soldiers.

CHAPTER FIVE

‘We Did Not Fight’: Medical Pacifism and War ‘Why don’t you refuse?’ my friend would say to the dairyman. ‘Why should you fight because another man tells you to?’ It isn’t so simple as that, is it, dairyman? 1

Just war and the just conduct of war In the previous chapters we looked at the ways in which men coped with the physical and psychological rigours of wartime. Most men knew the risks of the war but they wanted to learn how to cope with them: very few refused to fight or even seriously considered doing so. This is because, as Enid Bagnold indicated, the refusal to fight was far from simple. Ever since the French Revolution European citizenship had been associated with the responsibilities of soldiering, and even in countries without compulsory military service scheme, it was widely accepted that men should fight for their country if required to do so. Yet while war was accepted, it was also widely assumed that national wars should be just and fairly fought. The actual pursuit of the ‘just war’ has always been ‘as elusive as that of the Holy Grail’, but since the 1870s there had been concerted international efforts to humanize or to civilize war.2 Moreover, in the years immediately leading up to the First World War, pacifism, although far from widespread, had become more organized and influential. The medical profession had a particular role to play in these developments, in part because proper medical care became central to the humanizing of warfare and in part because many pacifists sought a medical role once war became established. In many ways the First World War was a

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doctors’ war in that the medical services were harnessed and organized in the service of the military to an unprecedented degree, but there were also those who saw medicine and war as quite incompatible, and they acted accordingly. St Augustine was the first to expound the principles of a ‘just war’ and while justifications for war have been constantly redefined, for most Europeans, Christian or otherwise, the basic tenets of jus ad bellum and jus in bello have remained unassailable. To meet the first condition a war requires a just cause, namely to counter rather than to provoke tyranny and injustice, and it has to be ordered by a legal and proper authority. Jus in bello refers to the conduct of war. A war can only be just if the military powers act in a proportionate manner and only attack legitimate targets, ensuring, for example, that non-combatants are protected and that armies do not engage in unwarranted aggression such as torture, rape or gratuitous violence. In consequence, disproportionate or indiscriminate violence can turn a just war into an unjust one, and for this reason armies have always maintained codes of conduct, especially with regard to the treatment of the wounded and non-combatants. Throughout the history of European warfare there have been mutually recognized symbols such as the white flag and the red cross to enable combatants to act in accordance with accepted customs. Of course these codes have not always been observed and military ethics have been regularly flouted by all armies in all conflicts. This has been especially the case in wars against supposedly inferior or primitive peoples, and European armies were particularly brutal and heedless of the rules of war in imperial conflicts. It was in an attempt to enforce a more consistent observance of these military ethics that the accepted tenets of a just war became increasingly codified throughout the nineteenth century, resulting in internationally agreed legislation designed to guarantee conduct in warfare.

The International Red Cross By the late twentieth century it became commonplace to look back on the First World War as a watershed moment in the history of war. This was the moment at which warfare became inhuman and its sufferings unsurpassable: the Great War was a war like no other and its atrocities changed attitudes to war for ever. Yet without denying the obvious horrors of the 1914–1918 war we need to avoid categorizing it as exceptional. The extreme violence of industrial warfare, or the potential for such violence, provoked genuine anxieties throughout the nineteenth century. These anxieties then prompted the creation of the international organizations and conventions that now govern (or should govern) state-sanctioned warfare. As we have noted earlier, in the decades following the Napoleonic wars military combat was more and more limited to the trained, organized, exclusively male fighting forces, ensuring that women, children and the infirm were increasingly removed from the fighting. This was widely welcomed as

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evidence of European progress and efficiency, and while more and more harmful weapons were being designed it was assumed that these weapons would only be fired upon legitimate targets. The laws of war had been evolving since the sixteenth century and developing proper procedures for the wounded was seen as part of a wider civilizing mission and an indication of both progressive thinking and an enduring commitment to the principles of a just war. In the words of the French general, Trochu (1815–1896), to his men while campaigning in Alexandria in 1859: ‘We will wage war in a manner humane and civilized.’3 Yet as far as Jean Henri Dunant (1828–1910) was concerned, modern war was far from humane and civilized. Dunant was a Swiss businessman who witnessed the Battle of Solferino (1859), one of the key battles in the wars of Italian unification. He was horrified by the butchery of the battlefield and also the inconsistent and inadequate care given to the painfully wounded, sick and often permanently disabled soldiers afterwards. Dunant accepted that there would be future wars and that they would be increasingly dominated by ‘new and terrible weapons of destruction’, so, he went on to argue, it was important to create organizations which would effectively deal with the wounded.4 He proposed that voluntary aid organizations – Sociétés de secours pour les blessés militaires – should be created to help the wounded. He wanted these bodies to be publicly funded by donation and so constituted that they could be organized quickly in the event of war and, with the support of military and political authorities, could provide medical care from the battlefield to the hospital and throughout convalescence. Dunant’s plans were the basis for the International Committee of the Red Cross (ICRC). Back in Geneva after the war, Dunant worked with the lawyer Gustave Moynier (1826–1910) to establish the Permanent International Committee for the Relief of the Wounded. In 1863 delegates from sixteen countries attended a convention in Geneva and approved Moynier’s draft agreement which committed private societies to support the work of the military-medical services in wartime. It included the provision that sick and wounded combatants as well as medical personnel should be recognized as neutral. This neutrality would be both proclaimed and protected by a universally recognized emblem, namely the red cross on a white background. There was some opposition to voluntary forces on the battleground, mainly from the British and French authorities, but in the following year, 1864, the delegates signed the first Geneva Convention for the ‘Amelioration of the Condition of the Wounded and Sick in the Armed Forces in the Field’. This formalized the previous agreement by international treaty.5 The International Committee of the Red Cross remained a small Swissbased organization throughout the nineteenth century, and its founders concentrated on designing and implementing humanitarian law and on fostering the growth of national Red Cross societies around the world. This was a highly successful endeavour in that there were over twenty national Red Cross societies in Europe by the mid-1870s, and during the Russo-Turkish

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war of 1876 the Ottoman authorities announced that they would use the emblem of the Red Crescent rather than the Red Cross, the emblem later adopted by all Islamic countries. Yet creating international agreements and structures with relation to war – the very issue that provoked the greatest of nationalist passions – proved to be a long and complex process.

National Red Cross societies The Croix-Rouge Française (CRF) was established in 1864 with the public support of Emperor Napoleon III (1808–1873). The French Red Cross continued to develop throughout the nineteenth century and was composed of three distinct organizations: La société française de secours aux blessés militaires (SSBM), founded in 1864; the Association des dames françaises (ADF), founded in 1879; and the Union des femmes de France (UFF), an exclusively female organization, founded in 1881. The CRF provided voluntary medical support for French troops in the Franco-Prussian war and was officially recognized as an auxiliary to the Service de santé de l’armée in 1878. Until 1907 the International Committee of the Red Cross only recognized the SSBM but after that date the central committee of the CRF was composed of four representatives from the SSBM and of two each from the ADF and the UFF.6 By the outbreak of the First World War the CRF was a formidable force and during the war the different organizations created over 1,500 military hospitals and eighty-nine temporary hospitals in railway stations (les infirmières de gare). Given that much of the war was fought on French soil and that large numbers of soldiers – wounded or otherwise – faced long, tiring journeys on their way to and from the fighting fronts, the CRF also organized rest homes and canteens for soldiers.7 Like the CRF, the Deutsches Rotes Kreuz (DRK) was also established in 1864 and Prussia had one of the first Red Cross societies. It was initially instituted in Germany by Dr Aaron Silverman of the Charité hospital in Berlin, but Germany was not a single nation until 1871 and so it was organized on a regional basis and this regional identity remained dominant even after unification. The DRK included a wide range of organizations, from voluntary male stretcher bearers to the German Women’s Association for the Colonies, and was not acknowledged by the Geneva Convention until 1929. Nevertheless its local organizations were active throughout Germany and abroad. They first provided medical care during the Austro-Prussian War of 1866 (sometimes known as the Seven Weeks’ War) and went on to organize medical services in European and colonial wars throughout the nineteenth and early twentieth centuries. Red Cross nurses studied subjects crucial for war work, such as the dressing of wounds and methods for dealing with internal injuries, and all Red Cross nurses were required to register for war work.8 This work, described by Evelyn Blücher as ‘self-imposed war duties’, was both extensive and wide-ranging, and included nursing in hospitals,

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working in soup kitchens and visiting women’s workshops and guilds.9 Much of the Red Cross work in Germany was devoted to dealing with the problems of the home front but still the links between the Red Cross and the military were strong, and were exemplified by the slogan Gott mit uns! (God is with us!), which was adopted by the DRK and which was also emblazoned on to the belt buckles of the fighting troops.10 The British National Society for Aid to the Sick and Wounded in War was formed in 1870 during the Franco-Prussian War. It was committed to the principles of the Geneva Convention and it used the emblem of the Red Cross in military campaigns across the world. It formally changed its name to the British Red Cross Society (BRCS) in 1905 and really expanded in the years leading up to the First World War. It was given a royal charter in 1908; Queen Alexandra became its president; and the VADs, which were established in 1909, were well-structured organizations designed to complement the military-medical services in time of war. All of these national Red Cross societies have different histories but they were all similar in that they all incorporated the Red Cross into existing national and military structures, and they usually had military or ex-military men in the most senior roles. Caring was women’s work but management and organization remained a male prerogative. The process was effective at both a practical and an ideological level. In Britain, Germany and France the authorities relied heavily on the Red Cross to complement militarymedical services. As a result some of the most important First World War hospitals in Britain were run by the Red Cross: the Red Cross hospital at Maghull near Liverpool was the single biggest facility for soldiers with war neurosis, and Queen Mary’s Red Cross hospital at Sidcup was the most important centre for the development of facial reconstruction. On a more conceptual level the Red Cross was important because it enabled a sort of ethical patriotic service. For French women, participation in the CRF was a respectable, gender-appropriate form of national service. The French Red Cross may have been characterized by a lack of unity but the three organizations provided men and women of all classes and of different religious persuasions to volunteer for work which was both humanitarian and patriotic. Certainly by the early twentieth century, entering a branch of the CRF and gaining a diploma had become almost a rite of passage for young, middle-class French women. Similarly in Britain, being part of the VAD was a way of demonstrating civic responsibility. Even in Germany, where the organization was not affiliated to the ICRC, the authorities were able to use the image of the DRK to promote the unity of Fatherland and Volk and to emphasize that the German Empire was essentially a benevolent state.11 In short, the national Red Cross societies became increasingly statecontrolled and militarized in the period leading up to the Great War, and the Geneva Convention of 1906 defined more closely the position and activities of voluntary societies in the field. The Red Cross emblem was restricted to the official medical services of armies and could only be used if recognized

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by the government concerned as forming an integral part of the medical services in war. From that point onward, Red Cross organizations acted more as auxiliary forces than as neutral, independent bodies: they were ‘wedded to their countries’ war machines’.12 By assuming control of the medical services, the military authorities ensured that the aims of the Red Cross were at all times subservient to military exigencies. Creating international agreements about conduct in war was clearly difficult and the ensuing ‘militarization of humanitarianism’ convinced many that it was simply not possible to wage a war which was humane and civilized.13 There had also always been those who believed that it was impossible to humanize war. In Tolstoy’s War and Peace, Prince Andrei denounced the whole concept of ethical warfare in what has now become the most famous denunciation of the liberal humanitarian position: Playing at war, that’s what vile; and playing at magnanimity and all the rest of it … They talk of the laws of warfare, of chivalry, of flags, of truce, of humanity to the wounded and so on. That’s all rubbish … If there was none of this playing at generosity in warfare, we should never go to war, except for something worth facing death for … War is not a polite recreation, but the vilest thing in life, and we ought to understand that and not play at war. We ought to accept it sternly and solemnly as a fearful necessity.14 This position is in direct opposition to Dunant’s approach, which was that ‘If war is unavoidable, then it should be waged with as little barbarity as possible.’15 Dunant believed that it was possible to be both realistic and humanitarian, but Tolstoy’s argument was that the attempted humanization of war simply made war seem more acceptable and encouraged people to wage war more readily because it blinded them to its true nature. Members of the Red Cross would certainly have resisted the argument that they actually encouraged war. Dunant’s aim of neutral humanitarianism was a lofty and idealistic one yet it was also practical and the Red Cross was obviously widely respected throughout the First World War. Dunn has described how the French Red Cross organizations cared for the German wounded; Blücher has provided a similar description of a German doctor tending an English soldier.16 Christopher Nevinson, as part of the British Red Cross in a Quaker-dominated unit, insisted that Red Cross doctors maintained a moral stance, despite pressure to the contrary. Our unit got into trouble with the French authorities because the doctors and dressers attended to some German prisoners whose bandages had become agonizingly tight over their swollen wounds. It seemed that we were permitted to be in France on the understanding that we looked after the Allies, and that the Boche might be attended to only when there was no other case needing attention. This attitude did not please our doctors,

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who did not hesitate to reply that the Red Cross was there to succour the wounded and that they would never demand to know the nationality of a patient.17 Despite the evident links between military authorities and the national Red Cross organizations, there remained a sense that there was a different ethos in the Red Cross. Nevinson later found it hard to move from the British Red Cross to the RAMC and agreed with an orderly who summed up the differences between the two by grumbling that ‘you ‘ad a soul in the Red Cross’.18 Yet this very attempt to keep ‘a soul’ in warfare allowed for an overlysentimental view of the Red Cross. Henriette Rémi, writing after the war, described the Red Cross as ‘committed to the suppression of all war in the world’, but – as we have seen – this was simply not the case.19 The Red Cross was committed to humanizing war and to limiting its damage – a distinction which was not always fully recognized. There were also those with the sort of romanticized view of humanitarian, medical aid which Tolstoy had condemned over forty years earlier. Imagining the thoughts of a wounded French soldier so as to raise money for the French Red Cross, Dion Clayton Calthrop (1878–1937) created an image that simultaneously infantilized the soldier and glorified the medics of the Red Cross: It is then that you realize, if you have the strength to realize anything, that you are in the hands of the Red Cross, and that from henceforth you will be lifted and carried like a child, and all that is going to happen to you lies at the door of those men who are risking their lives to save yours.20 Blücher’s similarly romantic notions allowed her to indulge in a momentary sense of moral superiority as she watched her husband depart for the front: I felt very proud as I saw him start off on his first journey, wearing his smart new uniform with the Red Cross band on his arm. It was a comfort too, to know what a good work he was undertaking, when he might have been setting off on such a different errand … thank God he is going out to cure and not to kill.21 This stark contrast between curing and killing – with the Red Cross on the side of the curing – made the medical role in war seem morally simple. There were of course breaches. Westman claimed that the French fired on German Red Crosses and Bowlby insisted that the Germans used the now-famous 1914 Christmas truce to fire on wounded British soldiers (a story which no longer features in this much-loved, much-repeated Great War tale).22 These examples, which may or may not be true, indicate an extreme flouting of wartime codes and therefore serve as morality tales to underline the very clear ethical code which prevailed: the symbol of the Red Cross dictated that conduct in war should be just.

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The principle of military neutrality for the Red Cross was accepted but there are no morally neutral acts. Medical neutrality sometimes conflicted with compassion and often conflicted with patriotism, as the case of Edith Cavell (1865–1915) makes clear. Cavell was a British nurse, working in German-occupied Belgium. In accordance with the principles of the Red Cross she treated men of all nationalities but in breach of Red Cross procedure she helped to smuggle Allied soldiers into neutral Holland. The smuggling was identified by the German military authorities and Cavell was arrested in August 1915, tried for treason and then sentenced to death on 12 October. Unsurprisingly Cavell was immediately presented as a heroine and a martyr by the Allied powers and the Germans were denounced as uncivilized brutes. ‘The heart of the civilized world will bleed’, began one very typical response in the Daily Mail.23 The German response was indeed excessive and was regarded as such around the world with neutral countries, especially the USA, requesting clemency for Cavell and her collaborators. However, the Red Cross, an essentially civilizing mission, simply cannot function unless it maintains a strict impartiality in its procedures and this sometimes means that individual members of the Red Cross need to suppress their own sense of what is just and compassionate. On a smaller scale, Blücher recounted the way in which a man-servant attached to the Saxon royal family escaped from his Russian captors disguised in a Red Cross uniform, a tale ‘so romantic that I sometimes feel as if I have been transferred into an exciting and thrilling novel à la Walter Scott’.24 Blücher was herself a member of the Red Cross, as was her husband, but she was so emotionally moved by the escape story that she did not think of the possible consequences for men like her husband if the Red Cross uniform became suspect. These two very different stories highlight the difficulty of maintaining a neutral medical service during war. Cavell’s role in helping her own troops – les enfants or ‘the boys’ – seemed so natural, so maternal and so intrinsically humanitarian that an adherence to strict neutrality appeared almost inhuman to many of her compatriots. Blücher could only feel sympathy and compassion for a man who had suffered much and yet had the wit and courage to escape. This is the essential and enduring dilemma of the Red Cross because the principle of neutrality so often conflicts with more visceral and more powerful emotions. This inability to maintain neutrality in a highly nationalized world, the perceived impossibility of humanizing warfare and the growing impact of machine warfare prompted the development of organized pacifism during the nineteenth century. The first peace societies were created in response to the Napoleonic Wars, a full century before the outbreak of the First World War. The first European peace organization, the Society for the Promotion of Permanent and Universal Peace, was established in London in 1815, and there were regular International Peace Congresses from the mid-nineteenth century onwards. Peace societies had a minimal influence on mainstream political policy but European peace movements enjoyed a ‘golden age’ between the Franco-Prussian War and the First World War, and there were

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twenty-one Universal Peace Congresses between 1889 and 1914.25 In the same period, national peace movements ‘commanded respectable followings’ in Britain, France, Scandinavia, the Netherlands, Belgium, Switzerland and Italy, and were also present in Germany and the Habsburg Empire.26 These groups had no unified doctrinal position, and adherents held a variety of beliefs, ranging from those who thought that no war was in any way justifiable to those who thought that wars of self-aggrandisement were reprehensible but that wars of self-defence, or even of national unification, were defensible. They all did, however, largely focus on the importance of turning to international arbitration to settle disputes. The late nineteenth century was a period in which it became much easier for progressive groups, and even individuals, to develop genuinely international networks, thanks to technological developments which led to improved postal services, telegraphic communication and transport. The ICRC could only exist because of effective communication systems, as could the worldwide socialist organization, the Second Working Men’s International Association. Similarly, it was in this atmosphere of international optimism that Esperanto was created in 1887: it was an international language to enable peoples from all over the world to communicate effectively and in a spirit of equality. So the peace organizations developed in a highly contradictory environment. The European nation states – supposedly peaceable entities – were all aggressively imperialistic. Militarization and military service were on the increase throughout Europe and the development of increasingly powerful weaponry made the thought of war seem more daunting than ever. Yet the long period of European peace, the ease of international communication and the increase in trade and prosperity made war (at least in Europe) seem anachronistic, or at least, avoidable. Many of those committed to peace were motivated primarily by their religious beliefs and the Society of Friends, more commonly known as Quakers, played a leading role in all peace groups, especially in Britain and the United States. As the chairman opened the Tenth Universal Peace Congress in Glasgow in 1901, he made this religious foundation plain when he declared that delegates met ‘not as politicians, not as citizens of Great Britain, the United States, France, or Germany, or any other country, but as men and women, recognizing, however imperfectly, the headship of Christ’.27 The term pacifisme was first used by the French lawyer Emile Arnaud (1864– 1921) in 1901, and this was the Congress at which the French word was first officially employed to describe the peace programme although neither ‘pacifism’ nor ‘pacifist’ featured heavily in popular discourse. In Britain, the term remained similarly marginal: ‘pacifism’ did not appear in The Times until 1905 and was not used in the more popular Daily Mail until 1911. Religious commitment was important but it was not the only possible basis for pacifism, and at the beginning of the twentieth century there was the development of a positivist-inspired medical pacifism. The scientific medical profession was international in character; moreover, doctors and

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nurses had long been committed to aims which were essentially universal and humanitarian. At best these aims were blind to nationalism; at the very least medical professionals had to follow ethical guidelines which demanded that their behaviour was different to that of the ordinary civilian who had a duty to bear arms. One of the first examples of medical pacifism was the Association Médicale contre la guerre, founded, in France, by Joseph Rivière (1859–1946) during the Russo-Japanese War. Members of the Association Médicale rejected a religious or emotional pacifism and emphasized instead the links between science and pacifism, and stressed the extent to which human solidarity relied on science and on reason. They had two essential arguments, the first being that medicine should prevent calamity, which was why doctors had an ethical duty to respect human life and to save lives on both an individual and a collective basis. During the nineteenth century (especially in France) many social problems had become medicalized, providing doctors with the responsibility to pronounce on the social conditions which provoked or aggravated health problems such as tuberculosis, alcoholism or syphilis. Yet how many more lives could they save if they prohibited the most dangerous of modern weapons or even stopped war altogether? For Association Médicale members, an opposition to war was simply an extension of the doctor’s established role as a pioneer of civilization and progress.28 Second, the Association Médicale argued that pacifism was not unpatriotic; on the contrary, pacifism was supremely patriotic. Members argued that militarism was sucking the life force from the nation, that there was nothing glorious in war and that the patrie could only flourish and find real glory in peace.29 Quite bluntly, what was patriotic about sending your own citizens to death? Doctors were not alone in raging against a system which encouraged them simultaneously to protect and to maim. Andreas Latzko made the same point, but with greater bitterness arguing, ‘Millions who have been carefully inoculated against smallpox, cholera and typhoid fever are chased into madness [to] hack, stab, shoot at each other, blow each other to bits, give their flesh and their bones for the bloody hash out of which the dish of peace is to be cooked.’30 Pacifism has so long been associated with internationalism that the notion of patriotic pacifism now seems almost oxymoronic. Yet the political and cultural climate of late nineteenth- and early twentieth-century Europe was broader in scope than is often assumed. For many the new, unified nation states, freed from either feudal domination or imperial control, were essentially pacific.31 The ideologically dominant doctrine of free trade was also held to be pacific because it was only possible to engage in free trade with global partners in a secure, law-abiding world. Conversely, global trading links would perish in periods of international warfare. The links between international peace and free trade appeared plain because, frankly, there is no point in shooting either your customers or your suppliers.32 The Association Médicale had a total of about 6,000 members across the globe

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on the eve of the First World War. However, like the Second International, the association did not survive the conflict. Before the war a medical colleague had told Rivière that he would be shot in the Place de la Concorde should there be war between France and Germany, but Rivière did not face this fate because he loyally served the French military by working as an army doctor from 1914 to 1918.33 Similarly Dr Madeleine Pelletier (1874–1939), previously considered as a dangerously radical feminist and one of the founders of the French section of the Second International, also served in the French Red Cross during the war years.34 The war histories of Rivière and Pelletier emphasize the key difference between medical pacifist organizations and other international organizations committed to peace. The socialists of the Second International had planned for an international workers’ strike to derail preparations for a European war but once war was imminent these international plans crumbled quickly. Working men across Europe were patriotic; more crucially they were afraid of military invasion and occupation and they were conscious that resistance to war could make themselves and their families vulnerable. As the American philosopher Sidney Hook (1902–1989) argued, ‘The pacifist argument that it pays everyone not to have wars runs up against the fact that it would pay some people, in a world where others are pacifist, to make war on the pacifists.’35 Moreover, working men who resisted war by going on strike risked imprisonment, as did most other men who refused to fight, and so the conflict between principle and practical choice was a stark one. Yet this conflict was markedly less stark for those in the medical profession. Whether a doctor was an international socialist and pacifist, a patriotic pacifist, a committed militarist or just an ordinary, law-abiding citizen was largely immaterial because in war the doctor’s role was not to fight but to heal the sick and wounded. As we have seen, some doctors baulked at military service – we have already mentioned Warwick Deeping’s initial reluctant response – but most doctors saw the role of military-medic as one which was in harmony with their wider professional ethics. For most men an opposition to war put them in conflict with their own political and social systems but for doctors – whether they supported war or not – their professional ethics both justified their work with the wounded and their exclusion from the fighting forces. Sometimes doctors did arm themselves and sometimes they did fight, but as a general rule, medics were not armed during the First World War and most medics were highly critical of those medical officers who did bear arms.36 In consequence, for non-medics who were opposed to war, embarking upon some kind of medical training seemed eminently sensible and morally justifiable. There were inevitably those who were innately suspicious of men who chose a medical rather than a combat role. Dorothy Cator’s description of male nurses in a French military hospital was scathing: ‘Our infirmiers consisted, for the most part, of the wrecks of the army, of those who were physically unfit for service, and of the men who rather than go to the front

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would do anything, even nurse the sick and wounded, if that would save them from it.’ She was also convinced that the men realized and were ashamed of their own weakness at heart, and went on to write as follows: ‘One of mine showed me proudly one day a photograph of himself in a smart cavalry uniform, and after looking at it fixedly, he said with a pained laugh, “And now I am an infirmier:” the contrast between the two pictures, what he had been and what he was now, was almost more than he could bear.’37 We only have one side of this dialogue and do not know if Cator’s understanding of the situation was the same as that of the infirmier. For all we know he may well have been justly proud of both of his roles. More to the point, while some may have believed that a medical position was just a way of avoiding war service, this cynicism is unwarranted. Most male medics, from the RAMC’s Ward Muir to the Friends’ ambulance men enjoyed a real sense of camaraderie with the fighting troops, wounded or otherwise. The  men saw medical work as respectable and honourable, and were seriously disgruntled when forced into lower status, manual work. One man who had been rejected by the City Battalion on account of his thirty-three-inch chest had joined the RAMC and was then severely disappointed by the extent of manual labour involved. By the end of 1915 he was exceedingly bitter about his journey from ‘medic to navvy’: when we came out to the front I was quite prepared to face the most bloody sights of mangled human forms without flinching … I have been in the war zone now eight months, not one splint or tourniquet have I improvized [sic], not one drop of blood or one single spasm of pain have I saved for one single, grateful patient. V.C’s and D.C.M.’s have never come within my vision, but instead (oh! pity me!) I have dug trenches, broken stones, pulled down houses like a ghoul, in the dead of night, the one-time homes of peace-loving men and little children; I have built huts, washed filthy clothes, concocted and cooked greasy stews for thankless, grousing gluttons, made roads and scavenged them.38 The complaint was not just that the work was menial but that it did not allow him to care for wounded men. Field ambulance men displayed genuine compassion for the soldiers who were suffering from wounds and from the rough medical treatment that was an inevitable part of warfare. One volunteer clearly struggled with his duties and found it hard to distinguish the violence of the war from the violence of war surgery: It has been my miserable lot to spend a large portion of my soldiering career in the abode of slaughter – called, for polite reasons, ‘The Dispensary’. Here I have seen innocent victims cruelly maltreated, and I have been called upon to assist in bloodthirsty deeds and acts of violence, until my heart has ached in sympathy for the poor misguided creatures that have been entrapped behind its portals.39

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The sense that medics were broadly sympathetic to the men, and deeply aware of the multiple layers of wartime violence, ensured that many pacifists believed a medical position would offer them a genuine way of alleviating the suffering of the Great War. As part of the history of this war the work of medical pacifists also indicates the impact of total war, especially given that they (unlike their military counterparts) were equally committed to providing care for the civilian as well as the military victims of war. The international peace movement collapsed in August  1914. For the French pacifists it was imperative that they support their invaded republic. Medical pacifism in Germany was extremely limited and its advocates faced much official and popular hostility. Georg Friedrich Nicolai (1874–1964) was one physician who did attempt to call for peace. Nicolai was the cardiologist to the German royal family, was a professor at the University of Berlin and held an important position at Berlin’s Charité hospital. He and Albert Einstein (1879–1955) were part of a small group of co-signatories to the ‘Manifesto to the Europeans’ published in October 1914 as a direct response to the German intellectuals who had backed the war with the ‘Manifesto of the 93’ a few weeks earlier. In retrospect the words of the ‘Manifesto to the Europeans’ now seem forcefully prescient: It would consequently be a duty of the educated and well-meaning Europeans to at least make the attempt to prevent Europe – on account of its deficient organization as a whole – from suffering the same tragic fate as ancient Greece once did. Should Europe too gradually exhaust itself and thus perish from fratricidal war? The struggle raging today will likely produce no victor; it will leave probably only the vanquished. Therefore, it seems not only good, but rather bitterly necessary that educated men of all nations marshal their influence such that – whatever the still uncertain end of the war may be – the terms of peace shall not become the wellspring of future wars.40 The ‘Manifesto to the Europeans’ had little support and little effect. Nicolai lost all his prestigious official positions and was sent to be garrison physician in Graundenz (now in Poland), a move which reinforces the argument that military-medical service should be seen as supportive of warfare.41 Those who opposed the war had very little room for manoeuvre. Gershom Scholem (1897–1982), later a scholar of Jewish mysticism, feigned madness to gain a medical exemption from German military service but his case was exceptional.42 On the whole the small number of German pacifists were focused not on resistance to the war but on moral protest and on making plans for a post-war international organization that would prevent future wars.43 Others, arguing from a left-wing perspective, insisted that a war against autocratic Russia was one that could be justified.44 Conscientious exemption from military service was simply impossible in either France or Germany; in any case French pacifists had long rejected

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conscientious objection to conscription, arguing that national service was a measure of equality and that it was international arbitration – not personal refusal – that would most effectively deliver peace. In any case, French pacifists and French socialists largely supported the war in 1914 because they saw it as war against German aggression and one in support of progressive, liberal values. Even the international socialist Jean Jaurès (1859–1914), assassinated on the eve of the conflict, had long considered a war of republican defence to be a just war.45 The situation was quite different in Britain, where initially there was no conscription and so those opposed to war could avoid military service without legal redress. Even after conscription, conscientious objection was at least a possibility for British citizens. Yet pacifism is about more than simply avoiding war and those serving in Quaker, or Quaker-led, organizations aimed to demonstrate a medical pacifism which would not just avoid war but alleviate its suffering without succumbing to the militarization which had beset the national Red Cross organizations.

The Religious Society of Friends (Quakers) [T]hose young men of whom he had been trying to speak did not feel they could fight. Neither did they feel their conscience drove or led them to prison. They felt there was something they could do betwixt and between. They gave their strength, and, if necessary, life itself in ministering to human need. (Ernest Taylor, Friend)46 It is through the Religious Society of Friends that we can most effectively witness medical pacifism in action during the First World War. These men and women who were ‘betwixt and between’ provided medical care for soldiers and civilians throughout the war by their work in two different organizations, the Friends War Victims Relief Committee (FWVRC) and the Friends Ambulance Unit (FAU). The FWRC was first founded in response to the Franco-Prussian war and it was reconstituted when the European war broke out in August 1914. Groups first provided support in hospitals, and from 1915 the FWVRC worked amongst the general population and in camps, hospitals and convalescent homes in Belgium and the Netherlands. As the war developed, the organization became more involved in famine relief, especially in Eastern and Central Europe, and in Russia. The FAU, a far newer body, was created in response to the First World War and was itself divided into two sections, the Home Service Section and the Foreign Service Section, a structure which mirrored the missionary work carried out by Quakers in the nineteenth century. The Home Service Section provided social and medical care across the UK, notably in the King George Hospital London, The Star and Garter Home in Richmond, Uffculme Hospital in Birmingham and Haxby Road Hospital in York. There was also a General

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Service Section, which supported work of national importance on the home front, for example providing agricultural labour where required. The Foreign Service Section assumed responsibility for work on, or close to, the fighting fronts. The FAU ran military hospitals at Malo-les-Bains, near Dunkirk (Nord-Pas-de-Calais) and Abbeville (Somme), and a shortlived casualty clearing station at Poperinghe in Belgium (now Poperinge). The unit organized motorized ambulance support in the area, FAU staff ran ambulance convoys for the French army and one ambulance unit went to Italy. The FAU also ran ambulance trains, hospital barges and two hospital ships, the Glenart Castle and the Western Australia. In addition, the FAU ran civilian hospitals, notably the Sacré Coeur Hospital in Ypres and the Château Elisabeth Hospital in Poperinghe. These hospitals were a testimony to the impact of the war on civilians in this area, but in this chapter we are primarily concerned with the military work of the FAU because these were the units in which pacifists came into the closest contact with the daily realities of industrialized, mass warfare. Casualty levels were not in any way comparable to those of the fighting forces but the FAU suffered the loss of twenty-three men and one woman while on active service in the years 1914–1918.47

The Peace Testimony and the Friends Ambulance Unit All bloody principles and practices, we … utterly deny, with all outward wars and strife and fightings with outward weapons … this is our testimony to the whole world … the spirit of Christ, which leads us into all Truth, will never move us to fight and war against any man with outward weapons, neither for the kingdom of Christ, not for the kingdoms of this world.48 (The Quaker Peace Testimony of 1661) The Quaker Peace Testimony has a long history and its meaning has been the subject of much debate. The original Testimony can be seen as a ‘quietest’ statement, issued not to oppose war but to assure King Charles II that the previously unreliable Quakers would henceforth be loyal and would not foment political revolt against him.49 The original Peace Testimony may have had its origins in interregnum politics but throughout the nineteenth century Quakers grew more politically active, and by the time of the First World War many felt that an opposition to war was central to the Quaker belief system and often cited the Peace Testimony to support or reaffirm the point. At the same time, Friends were also opposed to the imposition of dogma and so focused not on the text of the Peace Testimony or its original intent but on each individual’s interpretation of it. As a result, Friends held

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a variety of positions towards the war. Some were absolutists who refused all war work, some served in non-combatant corps and others (about onethird of the total) enlisted as combatants in the armed services.50 Many of those who enlisted would later be described as ‘pacificist’, a rather clumsy term, indicating an essential opposition to war alongside a belief that some wars were necessary or unavoidable.51 Others thought that a commitment to medical pacifism was the right response to war and the development of the FAU, initially known as the First Anglo-Belgian Ambulance Unit, demonstrates both the moral dilemmas associated with medical pacifism and indicates the medical-military contribution of those who were essentially opposed to the war from the outset. The FAU began in August 1914 when Philip Baker (1889–1982), a Cambridge undergraduate and athlete, issued a call for volunteers in the Quaker journal The Friend: Some members of the Society … want to render some service more commensurate with their powers and opportunities than is involved in the administration of war relief at home. They feel perhaps that in some cases this relief work is not of the sort for which they are fitted, and that in any case there are so many well-qualified people anxious to undertake it that what remains over for them will not feel sufficiently exacting to satisfy their sense of duty. It is on the other hand, very probable that at an early date the number of persons available for ambulance work at the front will be quite inadequate to deal with the needs of the situation. It has therefore been suggested that young men Friends should form an Ambulance Corps to go the scene of active operations, either in Belgium or elsewhere. A certain number of Friends have already expressed their willingness to join such an expedition and there is little doubt that a sufficient number will shortly do so to make up an ambulance unit of fortyeight … the expedition would go under the auspices of the Red Cross Society, whose work of course is entirely neutral. It is possible that it would in various ways involve some personal risk to members of the Corps. But it would probably result in the saving of a great many lives, and in the alleviation of a great deal of suffering among the primary victims of war.52 Baker went on to discuss raising money for those unable to volunteer without some financial support but a lack of funding was not the only obstacle to the new ambulance unit. Baker’s plan to ‘go to the scene of active operations’ conflicted with the Friends’ traditional approach towards medical pacifism in wartime. Henry Mennel, a member from Croydon, expressed the concerns which were shared by many Friends at the time: I should be the last to judge or criticise any Friend, young or old, who felt it to be clearly his personal duty to devote himself to the help of

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the wounded in battle, but the organization and equipment of a Quaker ambulance Corps to go to the seat of war and to form an essential and necessary part of the fighting force, as an ambulance most certainly is, seems to me to need most careful consideration, and to be scarcely consistent with what I have always understood to be the views and principles of Friends. I am the more anxious on this matter because I feel that, whilst there are now so many openings for personal service, in the near future, these will be infinitely more urgent and pressing. When we think of the sufferings of the peasantry of Belgium and of large areas of France, with their villages burnt and looted, and their crops destroyed, we shall see before us claims and openings for personal service and for material help with which Friends are specially qualified to deal, and which appear to them as being in no sense a part of the military organization and system, as the Ambulance unquestionably is. This was the view Friends took in 1870.53 For the majority of Friends relief work amongst civilians was the appropriate response for two reasons. First, civilians were the innocent victims of war. Women, children, the elderly and the infirm did not actively engage in war; they merely suffered from the effects of bombardment, and from disease, displacement and the general hardships of life in wartime. Second, by focusing on relief work amongst civilians, Friends could alleviate suffering without engaging with – and possibly supporting – the military machines that had provoked the war in the first place. So clearly the FAU was a compromise between traditional Quaker pacifism and the moral and emotional demands felt by many young, male Quakers in August  1914. For this reason the FWVRC remained the only official Quaker body responsible for war relief, and the FAU became an independent rather than an authorized Quaker body. It was not regulated by the Friends Yearly Meeting, the annual Gathering that was (and still is) the place at which Friends discuss and organize their collective work. So the FAU was not medical work in the Quaker tradition and in many ways it was an illogical development. This was certainly the view of William Olaf Stapledon, a twenty-eight-year-old lecturer from West Kirby, who acknowledged that ‘it was an attempt to have the cake and eat it, to go to war and be a pacifist’.54 Yet this type of active medical pacifism was both attractive and, ultimately, successful. Baker’s call attracted a small group of about forty men who started the FAU with a donation of one hundred pounds but by the end of the war over 1,000 people had served in the FAU (with an average age of only twenty-three years) and total donations reached £138,000.55 Initially the volunteers were mainly young Friends studying at Oxford or Cambridge but the corps rapidly became more diverse. There were well-established professionals as well as young men who had not yet had time to think about their careers. Thomas Thomson was a 35-

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year-old doctor and medical missionary who served with distinction and had a wealth of experience to bring to the FAU.56 In contrast, Ivan Bell was only eighteen and his ‘normal occupation’ was described as ‘ex-schoolboy’.57 A small number of volunteers already had medical training as doctors, dispensers and orderlies, and there were also final-year medical students who could serve as dressers, but in the main FAU volunteers came from a wide variety of professions and trades. There was a bricklayer, a baron and everything in between as the corps expanded to include young businessmen, artists, writers, teachers, mechanics, shop assistants, motor mechanics, architects, surveyors, builders, engineers, accountants, clerks and students. The call was initially for men but women joined too and approximately 150 women had served in the FAU by the end of the war. Many of these women were already trained nurses, especially those who served in the Foreign Section, but there were also teachers, governesses, students and women who had not previously engaged in paid work at all. Given the demands of foreign service most of the women were young and unmarried but there were also a few married women and some mature women such as Eleanor Chadwick, a 48-year-old nurse who joined the FAU in December 1917. This social diversity was matched by religious diversity because the FAU was not an exclusively Quaker body. There was a whole host of non-conformist members – Congregationalists, Baptists, Primitive Methodists, Wesleyans and Plymouth Brethren – as well as Anglicans and Roman Catholics. Consequently there was no religious uniformity but there was a commitment to an ethos, probably best exemplified by the comments on Robert Chester’s personnel card. Chester, a nineteen-year-old student from Stansted in Essex, was described as someone who was ‘not a member but holds Friends’ views, i.e. wars’.58 Some men joined the FAU for ostensibly practical reasons. For a number of doctors it was just a way of reaching the front quickly and avoiding the long delays which often plagued new recruits to the RAMC. Nevinson joined the FAU because he knew that it would be difficult to join the army on account of his limp.59 Yet, whatever their initial motivation, those who joined the FAU all held ‘Friends’ views’ to some degree. Some were committed Christian pacifists, and for many boys with a Quaker upbringing, the FAU was the obvious alternative to military service.60 This does not mean that the decision was always an easy one. Ernest Taylor, a 28-year-old metal smith from Sheffield, admitted that he, along with other Quakers, felt very confused at the outbreak of war. ‘Many Friends do not know “where they are”’, he confided to his diary. ‘Conscience and “righteous war”: it can’t be done!’61 Taylor clearly struggled to arrange his own thoughts on the right response to war and his wartime diary contains a large selection of Guardian cuttings on the subject of war and Christian ethics. He eventually joined the FAU in September 1916 and worked as an artificial limb-maker until he was demobilized in February 1919. In contrast, Stapledon, writing long after the war, gave a very coherent and considered account of his own reasons for joining the FAU:

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I heard of the Friends’ Ambulance Unit, an organization of young Quakers who wished to carry on the great tradition of their faith by serving the wounded under fire while refusing to bear arms or submit to military discipline. That sounded like the real thing. It also offered a quick route to the front … I had not the heart to stand by any longer, and yet I had not the conviction to be a soldier … Conclude, if you will, that the wielders of white feathers drove me to take up the best imitation of military service that conscience (or funk) would tolerate. To myself the situation presented itself otherwise. Somehow I must bear my share of the great common agony.62 Stapledon’s words may well have been a post facto rationalization but they also capture the primary convictions of the young FAU volunteers: medical service was one way of honourably upholding their commitments to their faith without appearing like cowards stricken with ‘funk’. His reference to the white feather campaign indicates a real sensitivity to accusations of cowardice and unmanly behaviour, and yet there is more. Stapledon, like many young men throughout Europe, was excited about ‘the real thing’ and ‘the quick route to the front’. He also talked about boys who were ‘eager for adventure’ and about young men who were ‘in a hurry to take part in the war without the tedium of military training’.63 Other Quaker ambulance teams made explicit links between their own service and romanticized notions about a warrior caste as they wrote about the ‘Great adventure’ and described themselves as looking for work ‘in almost knight-errant fashion’.64 Humanitarian work is often presented as worthy, highly moralistic and generally as rather dull. In part this is because humanitarians often have to justify their actions to unsympathetic audiences. This was especially the case with young men seeking an alternative to combat because the onus was on them to demonstrate that their actions were moral rather than cowardly or traitorous. Worthiness aside, humanitarian work does attract the bold and the audacious, and there was a genuine air of romance and adventure to the FAU because of its unstructured, almost irregular nature. FAU convoys were presented as ‘unenlisted, unpaid, unofficial, unapproved’ with ‘no plans, no programme, no orders, no authority’.65 This is only partially true but FAU work allowed men to be more autonomous than their military counterparts, particularly at the beginning of the war, and to face more actual danger than their fellows in the civilian relief teams. For these young men, pacifism found ‘a ready refuge in medicine’.66

Foreign service: The early days and the ‘Shambles’ The FAU did not just need volunteers; it needed trained volunteers and even those with a medical background needed to be properly prepared for

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war work. Initially the men attended a training camp at Jordans, a Friends’ property in Buckinghamshire. The training at Jordans included classes on first aid to the wounded, stretcher drill, sanitation and hygiene as well as field cookery, physical training and preparation for night operations. This was supplemented by courses at the Red Cross College of Ambulance in Vere Street, London, and the volunteers were all examined in stretcher drill and infantry drill at the BRCS headquarters, ensuring that FAU volunteers reached the same standard as those in the more established Red Cross organization. A second training camp was later opened at Oxhey Grange in Hertfordshire. The first volunteers to complete the course at Jordans formed the Anglo-Belgian Ambulance Unit and they crossed the channel to Dunkirk on Saturday 31 October 1914. The first party was comprised of three surgeons, thirty-eight men and seven motor ambulances, and they were all joined by a second group of five surgeons, five men and one motor lorry on 5 November 1914. It was shortly after this that the organization changed its name to the Friends Ambulance Unit, a title which obviously endured.67 The untested men of the Anglo-Belgian Ambulance Unit arrived in France just as the French military-medical services were on the verge of collapse due to the rapid German advance and the hard fighting required to repel it. The volunteers had initially aimed to establish a casualty clearing station on arrival but as soon as they approached Dunkirk the French army requested their help to deal with the unprecedented number of casualties from the Yser front. These men should have been evacuated to hospitals but the medical services had been unable to cope, and so about three thousand wounded men were lying, practically unattended, in the goods sheds at Dunkirk station, with only about half a dozen medics to look after them. Many of the men had endured up to three weeks in the extreme cold with only field dressings on their wounds; there were no proper beds and no proper sanitary arrangements so the men lay in dirty, urine-soaked straw with the dead and dying alongside the wounded. Thomas Corder Catchpool (1883–1952), a young engineer who was not qualified to serve as a dresser but ‘got round a Doctor somehow’, was one of the first to arrive at the Dunkirk sheds, and was aghast at what he found. I shall never in my life forget the sight and sounds that met us. Figure two huge goods sheds, semi-dark, every inch of floor space – quais, rails, everywhere covered with the flimsy French stretchers, so that in places you had to step on them to get about – and on each stretcher a wounded man – desperately wounded nearly every one. The air heavy with the stench of putrid flesh and thick with groans and cries.68 Nevinson’s initial response was similar and he later wrote, ‘The sounds of those broken men crying for their mothers is something I shall always have in my ears.’69 The sheds quickly became known as the ‘Shambles’,

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an old English word for a slaughter house and a more modern, colloquial term for disorder or chaos. Nevinson’s ‘The Doctor’ is set in the ‘Shambles’ and the painting (which is featured on the front cover of this book) vividly emphasizes the chaos, the brutal conditions and the raw pain which immediately confronted the young and inexperienced volunteers. The new, untested dressers were organized to work for eight-hour shifts in the sheds, their primary duty being to re-dress the men’s wounds. Clean wounds were left alone to avoid infection but most of the wounds were already septic and so the dressers removed dirty dressings, let out any matter and treated the wound with peroxide spray or iodine before applying a fresh dressing. It was a rudimentary and painful treatment but it was one way of limiting the spread of infection, although many of the men were destined either to die or to lose limbs anyway. Catchpool described some of the worst cases: Consider this man, both thighs broken, and he has travelled twenty kilometres, sitting on the seat of a crowded railway carriage. Or this one, with his arm hanging by a shred of biceps – or this, with bits of bone floating in a pool of pus that fills up a great hole in his flesh, laughing bitterly when I turn away to vomit, overcome by the stench of sepsis – he may well laugh bitterly – he has lain eight days on the filthy floor in an outhouse of some farm near the front.70 Like Catchpool, Nevinson had no medical background but within five minutes of arriving at the ‘Shambles’ he was acting as ‘a nurse, water-carrier, stretcher bearer, driver and interpreter’.71 It was in this period of acute crisis that the relatively untrained could establish themselves quickly in the medical services and only a few months later Nevinson was working with the skill of an experienced nurse in the hospital at Malo-les-Bains (Nord). The turning point for the FAU came in the spring of 1915. By this stage the French military services had become more organized and the war of movement had ceased and was replaced by trench warfare. While the trench warfare of the Western Front has been rightly castigated for committing men to years of mud and slaughter, the relative immobility of the armies also allowed for the growth of a stable network of hospitals, a development which enabled the first party of VAD nurses to join the FAU in October 1915. The FAU ran a number of hospitals throughout the war, one of the most significant being Queen Alexandra Hospital (QAH) for soldiers at Malo-lesBains, now part of Dunkirk. The QAH was initially set up to deal with the typhoid epidemic of 1914–1915 but it soon became – and remained – the primary hospital for all British troops in the area, as Table 5.1 indicates. By the end of the war the QAH had effectively treated a wide range of troops and civilians, mainly for wounds and disease but also for dental work, and there were over 16,000 dental cases between October 1915 and the end of the war.

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TABLE 5.1   Queen Alexandra Hospital, Malo-les-Bains, Dunkirk: Total numbers treated, 1914–1918 French army cases

2,324

British naval cases

2,187

British army cases*

6,292

US naval cases

103

Civilian cases**

203

FAU army cases

612

German army cases

1

TOTAL

11,722

*Including native Labour troops (Chinese, Egyptian, West Indian, Cape Boys etc.). **Including merchant seamen, French and Belgian civilians etc. Source: Meaburn Tatham and James Edward Miles, eds, The Friends’ Ambulance Unit, 1914–1919 (London: Swarthmore Press, 1920), 77.

The French convoys Possibly the most dangerous, and certainly the most sensational aspects of FAU work, can be found in the French convoys. It was in the convoys that the ambulance volunteers experienced most closely the everyday lives of soldiers in the field and this was also one of the most genuinely international of wartime medical experiences. While hospitals like the QAH treated a wide range of Allied patients (and a very limited number of Germans), the ambulance convoys were staffed by British men who, in effect, became a part of the French army for the duration of the war. They rarely encountered British troops but, according to Stapledon, ‘we were to come across Italians, Senegalese, Algerians, Annamites, American negroes, Russians’.72 This involved a level of international cooperation which was not witnessed by the more regular military formations and the volunteers operated not in the backwaters of the war but in key operations such as the Second Battle of Ypres in April 1915. The convoys began almost accidently in November 1914 when the FAU offered to establish a dressing station unit for the medical authorities of the 87th French Division at Woesten in Belgium. However, the French needed motor ambulance transport more than anything else because its motorized ambulance service was still in its infancy and it was not possible to evacuate wounded men with any speed. In response the FAU was able to offer them ambulance men and six ‘Mors’ ambulance cars which were on loan from the British Red Cross. The French medical services accepted this help with enthusiasm but ‘without any official sanction’ and the FAU

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promptly agreed to fetch wounded French troops from beyond the river Yser, the site of a key battle at the end of October 1914.73 They set up a base at Elverdinghe and collected men for evacuation to Poperinghe or to Furnes (an important railhead at the time) and established similar stations at Dunkirk, Ypres and Oostvleteren. By Christmas 1914 the small volunteer corps had twenty-four unit cars and had carried nearly 1,800 cases and run 10,000 kilometres.74 In many ways this was an ideal task for pacifist-inclined volunteers. They were not directly on the fighting front but they were doing valuable medical work within the sound of the guns. They were, in Stapledon’s words, having their cake and eating it, going to war and remaining pacifists. Yet like the work in the ‘Shambles’ the early endeavours of the convoys were of limited duration. The initial casualty crisis passed and the army authorities withdrew the FAU cars at the end of December simply because the FAU work had always been unauthorized and had no official place within the French army structure. Only the official station at Poperinghe remained but the French were keen to maintain FAU assistance and so in February 1915 the FAU ambulance cars were incorporated into the French convoys and designated as Sections Sanitaires Anglaises (SSA), organizations which were interchangeable with the French Sections Sanitaires. Each convoy was usually made up of eight ambulances and SSAs 13, 14 and 19 were staffed largely or exclusively by the FAU. Throughout the war the SSAs managed to maintain the flexibility that had made them so valuable in the early days. They worked with military casualties and with civilians, and they accepted work close to the lines as well as in the rear. However war work requires both flexibility and order, and the SSAs were subject to various reorganizations to ensure their suitability within the French army structures. By the spring of 1916 the SSAs were very well-equipped with ambulances, supplementary vans, tourers and loaders. The convoys were able to use the French army parcs (depots) for all supplies: petrol, oil, paraffin, tyres, sparking plugs, spare parts and so forth. They drew French soldiers’ rations and were also eligible for the solde, the sum paid to soldiers for billeting and vegetables, all of which was paid into a common convoy fund to boost the regular ration. There was a level of trust between the FAU and the French militarymedical authorities who in 1915 allowed the FAU convoys to go right up to the French aid posts to collect patients. The FAU were not allowed to go into the front-line trenches but the aid posts were often very close to the fighting lines and so the men in the convoys really did feel that they were sharing the dangers faced by the combat troops. Yet all this came at a price: a French lieutenant was appointed to each convoy and so the FAU officer in charge had to share his duties and responsibilities with a military officer.75

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Ambulance trains We go near the front to places like Remy and Lapugnoy, and bring down wounded and sick to Boulogne or Etaples and then we clean the white paint we’ve dirtied.76 (lines from No. 16 Ambulance Train Christmas play, 1915) FAU work on the ambulance trains was quite different from that in the convoys. There was little freedom of movement and so there was none of the derring-do and the spontaneity which characterized mobile ambulance service, hence the deadpan, rather cynical description above. Whereas medical work in the ‘Shambles’ and on the convoys grew out of genuine medical-military emergencies, the work on the trains developed far more in response to personnel requirements and to the changing political situation. When the ambulance trains first became operational they were staffed by the RAMC, but trains No. 16 and No. 17 had been donated specifically to the British Red Cross and so Sir Arthur Lawley, the BRCS commissioner, wanted them to be staffed by the Red Cross. Lawley had his way, and in August 1915 the RAMC was removed and was replaced with Red Cross and FAU staff. The situation changed again in November when many Red Cross men had to enlist as a result of the Derby scheme and the FAU willingly took on more responsibilities, in part because it was eager to keep all FAU members busy despite the growth of the official army medical services. The  situation was then compounded by the British Military Service Acts of 1916, which resulted in the FAU having even more men to employ.77 Many of the early ambulance trains were made from converted French rolling stock. There was no uniformity of design because the medical services had incorporated everything from goods’ wagons to first-class passenger coaches. In some of the old ambulance trains the wagons and the coaches were not always connected and ambulance staff could only move through the speeding train by climbing along the footboards. Later these were joined by the ‘khaki trains’ which were designed and built in England and were equipped with lying-wards, sitting-up wards, kitchen-coaches, a dispensary, an office, storerooms and living quarters. There were also segregated sections for shell-shocked patients and isolated coaches for men with infectious illnesses. Each ambulance was staffed by two or three medical officers, three nursing sisters and about forty-seven NCOs and men. It was repetitive industrial work. As soon as a casualty clearing station was ready to evacuate, the ambulance train would receive a ‘movement order’ and it would go to the railhead to collect the patients. At times the railhead was close to the casualty clearing station and the process was straightforward; at other times the clearing station might be as far as twenty miles from the railhead and patients had to be transported there by car or truck. Once at

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the railhead, stretcher bearers helped to load the wounded men on to the trains, and the medical officers and NCOs were responsible for distributing the patients to the right wards. The following extract describes the process of transporting men in a cold, dark Flanders night during the autumn of 1915: Near one end of the train, at the wooden foot-bridge which crosses the stream separating the camp from the railway track, there stands a powerful acetylene flare. As you watch the flare you see them emerge suddenly from the utter blackness beyond into the fierce glare of the light; they halt for a moment, while a cloaked officer standing on the bridge raises the waterproof sheet which protects the wounded man’s face from the beating rain; a name is given and noted; the covering is dropped over the head, and the bearers move on again, seeming to vanish as if by magic as they pass with their burden out of the light into the enveloping blackness. A pause, and another stretcher enters the circle of light; the same words pass, the same motions, and it too moves on, blotted out as suddenly as it appeared. Watching this, time after time, you feel as if a picture were being cast on a screen, and flashed off, over and over again: for there is something cruelly mechanical about it all … . Meanwhile, up at the far end of the train – a full three hundred yards trudge in ankle-deep mud – the lying-down wards are to-night gradually filling up: more slowly than usual for the bearers tonight have the gait of men worn out, almost disheartened, by prolonged and ceaseless toil. The long coaches, their interiors gleaming white in contrast with the outer darkness, were clean and fresh-smelling when the first patient was lifted in through the wide double doors. But now, after half an hour or so, the indefinable but unmistakable smell of wounded men straight from the trenches is making itself felt, and the spotless floor is stained with muddy prints, and running with water where the rain has dripped from the stretchers or scudded in through the open doors. The beds are filled,  but after such a day as this has been there are more men to be carried than the  beds can hold; every available square foot of space  is needed. Stretchers lie all down the central corridor, and leave you a passage of only ten or twelve inches; in the dispensary and in the treatment room they lie side by side on the floor; at the end of the train, one of the fourgons [wagons] dark and ill-sprung, holds a dozen or more. Of the sitting-up compartments every one is used for lying cases, stretchers on seats and floor. We walk up the train from one end to the other, and there will seem to be not a corner that has not its occupant: everywhere the  same inert shapes under the dark rough blankets; everywhere the same all-pervading stench, thick, sickening.78 There is nothing here about the excitement of war and nor is there a sense of emotional fulfillment or even human compassion. This is a bleak

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industrial war and the humanity of both the soldiers and the medics has been marginalized by process, procedure and sheer drudgery. At the end of their tedious railway journey men were then moved from the trains to waiting ambulances or ships. Once again the process seemed endless: a train could travel from the front to Rouen with wounded men and then from Rouen to Le Havre with convalescent men bound for the UK. Sometimes new patients were being loaded on to one end of the train, while wounded or convalescent men were still being taken off the other end. On  the whole it was a life of ceaseless routine for the ambulance staff. There was loading and unloading, and fetching stores, there was constant cleaning and there were everlasting water fatigues. The trains were often crowded and slow-moving, and sometimes there were long delays. Opportunities for recreation were limited and leave was infrequent, factors which no doubt contributed to the fact that there was a higher rate of illness among the personnel of ambulance trains than amongst any other FAU section.79

Hospital ships: Western Australia and Glenart Castle The hospital ship was the final link in the chain carrying men from the battlefield to home on mainland Britain. Thirty FAU men served on the Western Australia, a ship of 6,000 tons which sailed on routes between Southampton to Le Havre, Rouen and Boulogne. There were 305 beds on board and the FAU men normally served as hospital orderlies under the direction of one RAMC sergeant. This situation changed as submarine warfare intensified and the Western Australia stopped carrying nurses, leaving the FAU men to carry out all the surgical dressings. The Glenart Castle was a ship of 6,700 tons which worked on cross-channel voyages and in the Mediterranean Sea. It was well-equipped, being supplied with seven casualty wards and a special mental ward with padded cells attached. It could accommodate a total of 461 beds and was staffed by six doctors, two chaplains (in the Mediterranean only), one RAMC sergeant-major, thirteen nurses and forty FAU men who served as orderlies. The work in the  Mediterranean was especially demanding because the FAU could not rely on army stretcher bearers but had to take full responsibility for embarking and discharging patients. Once the sick and wounded were aboard, the staff worked in twelve-hour shifts, with limited breaks for meals during the day and only short breaks for light refreshments at night. The work on the hospital ships seems far removed from the battlefront but submarine warfare brought the ships to the very heart of the conflict zone and, as we shall see, provoked  a serious crisis about the role of medical pacifists in wartime.

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Witnessing medical pacifism: ‘A nightmare’ FAU work was clearly of medical importance to both the British and the French armies, and it obviously ensured that men with pacifist convictions were able truthfully to assert ‘we did not fight’. Yet the history of medical pacifism is a complex and troubling one, as Lawrence Rowntree’s story indicates. Laurie Rowntree was a first-year medical student at King’s College, Cambridge, when war broke out, and he joined the FAU almost straightaway. He was nineteen years old and from a long-established Quaker family so this decision may well have been a difficult one for him. Nevertheless he was fully committed and he worked hard in the convoys until August 1915. Despite his Quaker background, or perhaps because of it, Rowntree was plagued with doubts early on. Describing work in the hospital sheds attached to the QAH in April 1915, he was appalled to find men in the most awful conditions. Although the initial casualty crisis had subsided by this point, men were lying on straw which ‘was thick with dirt, blood and septic dressings from others who had been there before’, and Rowntree confessed that the stench and sight of the men’s grisly wounds made ‘me wish I hadn’t come’.80 Later these feelings of physical repulsion were compounded by his reactions to being under fire. After working in the sheds Rowntree worked in ambulance convoys responsible for collecting wounded men, and sometimes for collecting the bodies of dead men. He was then charged with carrying stores and letters to hospitals in Dunkirk, Ypres and Poperinghe, an area under constant bombardment. By May 1915 he and his companions were clearly feeling the strain and his reflections were similar to those of combatants suffering from shell shock: We slept in peace, except that when anyone closed a door or took his boots off, we arose and slew him. I was getting horribly nervy: the hard work I had been having, capped by constant shelling and not too much sleep, had knocked me up a bit. Certainly I was ashamed of myself, for I had never funked shell-fire like that before … The greatest curse out there is to have an imagination. You can’t analyse your fear; you don’t mind the thought of being wounded, you don’t mind the thought of death – much, but there is that great black fear sitting there, and making you feel the lowest of miserable worms.81 Rowntree then went on leave and when he returned the FAU had been reorganized and there was less scope for work within the line of fire. He was based in Caestre (Nord-Pas-de-Calais), close to the Belgian border, and worked for what came to be known as the Aide Civile Belge, where he distributed milk to refugees, to orphanages and to needy mothers and babies.

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This was war work very much in the Quaker tradition but Rowntree’s comments on it betray bitterness and real disillusionment. If anything, this work just made him feel worse. Caestre was a good place for a summer holiday, but anyone who said we lived under war conditions was a liar. The station was an old almshouse. We had a lovely garden with a pond and a raft, a Belgian woman as cook, and the minimum of work. That’s why I don’t propose to say much about this last three months … Once a week every baby was medically inspected by one of our doctors, and I must say that we reduced the death-rate by about 75%. So perhaps the work was worthwhile.82 Clearly the work was worthwhile yet Rowntree felt that he was wasting his time, and paradoxically he was missing the danger that had caused him so much anxiety the previous spring. He missed the fear which he described as ‘enticing’ and he especially missed ‘the jolly companionship of everyone which you get in face of common danger, and never so truly anywhere else’.83 Rowntree was then posted to a hospital in York where he really began to consider whether or not his pacifist convictions would allow him to remain in such a protected position and quickly concluded that they would not. He enlisted in the army, became a sergeant, was wounded on the Somme when driving one of the first tanks and was finally killed at the Battle of Passchendaele in November 1917. Rowntree’s painful history highlights the problems faced by all medical pacifists, to one degree or another. Rowntree joined the FAU and so did not act as a pacifist in the established Quaker tradition; he then joined the regular army, even further distancing himself from the ethical code in which he had been raised. On a personal level Rowntree was obviously racked by guilt and torn by his conflicting commitments to Quakerism and to patriotism. This conflict was clearly made worse by Rowntree’s sense of his own masculinity, and his inability to feel proud of his work amongst the Belgium civilians is both poignant and telling. This history also raises questions of structure and principle. First, how much autonomy could a medical pacifist within the FAU really expect in wartime? Could the organization remain independent and still work effectively with the armies in the field? Second, was it right for pacifists to carry out militarymedical work? To what extent did this embroil them in the military machine? Most crucially, was this work honourable if it gave pacifists undue protection? A lot of Rowntree’s anxieties stemmed from the fact that he could not control his work and so could not always work in accordance with his conscience. In an attempt to ensure that the FAU maintained the maximum amount of control over its work, the organization was committed to the principle of ‘voluntaryism’ and insisted upon a high level of FAU autonomy throughout the war. These principles were clearly

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outlined in form A7, which was issued to all FAU members when they joined the organization FRIENDS AMBULANCE UNIT The Unit is a purely voluntary, unpaid unit, working under the auspices of the British Red Cross Society. The FAU Committee, by which it is financed, administered and controlled, is composed of members of the Society of Friends. The Ambulance work consists in motor convoy work in France; hospital, medical and sanitary work in France, Belgium and England; the provision of orderlies for ambulance-trains and hospital ship work abroad; and of relief work of many kinds among the civil population of Belgium. There is no enlistment and no pay. Members are provided with food, lodging and travelling expenses while on service. Members are expected to pay for their own uniform and equipment about £10 (not including boots and underclothing), and to contribute about £5 towards cost of training. Special cases can be referred to the Committee when financial assistance is absolutely necessary, and cannot be obtained locally. Members are required to undergo a course of training at the Unit’s training camp. The Unit is not a part of the Army, and its members are civilians from the point of view of the Army Act, but all members are required to obey the Officers of the Unit and conform to its discipline and regulations. They are also required to conform to the military regulations in force in the area where they work, and to wear the authorised uniform of the Unit.84 Form A7 made it clear that the FAU committee was ultimately responsible for its own staff and its own training and that all FAU members remained civilians. However, there was also a recognition that members had to conform to military regulations, and in addition there was the vexed question of money. The FAU was not a wealthy institution, and although it had the funds to give some assistance to volunteers from poor families, it relied upon most members to fund their own training. Private donors were generous to the FAU throughout the war but it had to rely on other sources too. It was the French government who donated Villa St Pierre at Malo-lesBains in November 1914 so that the unit could turn it into a hospital. Then in January 1915 it was again the French authorities who invited the FAU to establish the typhoid hospital that later became the QAH. The establishment and maintenance of the QAH then required close cooperation with the British Red Cross and the approval of the War Office. These relationships clearly enabled the FAU to expand its work but it is of course difficult to maintain autonomy when you are financially and politically reliable on governments or on organizations closely associated with them.

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Testing autonomy: The Red Cross, the RAMC and the War Office The British Red Cross, like all national Red Cross organizations, had very much adopted a military character by the outbreak of the First World War. For this reason FAU members wanted their own independent organization but the FAU relationship with the Red Cross was of primary importance because FAU staff relied on the Red Cross for brassards, certificates, the supply of passports and also for the general security of being with a larger, well-respected organization. Many men and women came into the FAU having first completed Red Cross training courses, and the Red Cross was very insistent upon its own discipline. In consequence nurses had formally to agree to the following Red Cross regulations before they could be sent abroad with the FAU. 1. VAD members are not allowed to smoke except in their own

quarters when off duty, and subject to the rules of the Unit or Formation with which they are working. 2. No Members may have meals out alone with Officers. (In the case of a Father, Brother, or Husband, special permission may be obtained from the Head of the Unit.) 3. Whilst on Active Service, regulation uniform may only be worn by Members. No jewellery, fancy blouses, or fancy jerseys may be worn. 4. No member may move from the area in which she is working without permission from Headquarters. 5. The Joint Commission Brassard must be worn on the outdoor uniform, and the Identity Certificate must be carried. 6. No member is allowed to go out after dark (without special permission from the Head of the Unit) except when going directly to and from duty. 7. Members may be transferred by the Principal Commandant to whatever place they are required. 8. No member may bring the following dutiable articles from France without declaring them: 1. Tobacco, cigars, cigarettes, spirits, cordials, perfumery, saccharine, tea; 2. Motor cars and motor cycles, gramophones, musical instruments (except mouth organs), clocks, watches and articles connected therewith; 3. Cinematograph films.

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N.B. Dogs, though not liable to import duty, must also be declared and be produced. I UNDERTAKE to obey the above Regulations to the best of my ability, and realize that I am subject to dismissal if I fail to do so.85 A number of these regulations simply reflected the legal restraints of the time and others insisted upon a moral code which few contemporary Friends would have found controversial. They were also very similar to the requirements concerning good character and modest dress stipulated by the various associations of the Croix-Rouge Française. Nevertheless, the FAU committee still formally regulated its relationship with the British Red Cross by insisting also upon its own conditions: 1. The members of the unit are not thereby brought under direct

military discipline, or called upon to enlist, or in any way made a part of the army; 2. That the unit should not thereby be prevented from continuing its useful work of civilian relief at Ypres and elsewhere on the front; and 3. That the committee should continue in full control of the administration of the affairs of the Unit as heretofore.86 The FAU committee particularly insisted upon retaining control of recruitment so that the standard and character of the personnel would not be lowered, an important consideration given its commitment to a particular ethos. In response the British Red Cross agreed ‘full liberty of action’ to the FAU and the organizations worked together, largely in harmony, throughout the war. FAU members wanted some autonomy from the Red Cross but more importantly they wanted a definite demarcation line between their own organization and the RAMC, a body which was indisputably part of the military machine. On an individual level there were clearly strong friendships between the FAU and RAMC staff who worked together but there were also episodes of conflict. Whereas the French army had been willing to work with the relatively independent FAU, the British military-medical authorities were less inclined to do so. The FAU did set up a casualty clearing station in the area around Poperinghe in June 1915 but the RAMC was reluctant to work with it. The official rejection of FAU help did not explicitly cite political differences but did stress the difficulties of working with a unit ‘which had not a medical man at its head’.87 This was somewhat disingenuous because while it was the case that Baker, the FAU commanding officer, was not a medic (he was reading economics and international law at Cambridge), there was a team of fifteen respected doctors working in the FAU, all ably led by Dr Humphrey Nockolds (1883–1963), the principal medical officer.

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The FAU’s troubled relationship with the RAMC became most problematic at the King George Hospital (KGH) in London, which was staffed by 116 RAMC officers and 104 FAU men. Here the hierarchy of RAMC (military-medical men) and FAU (non-military-medical men) was made plain and FAU staff had a long list of complaints by October 1916: 1. The FAU commandant had no real control over FAU staff; has no

office and ‘is treated with disrespect and discourtesy by the nurses and the RAMC men’. 2. That the men are being employed at charing [sic] and cleaning work and not as nursing orderlies. 3. Exec Committee of KGH is the RAMC company; there are no FAU reps. 4. Hours are too long: 12–13 daily. 5. That the work now given to the Unit is ‘slavery’ work for the men in the RAMC. 6. RAMC men of higher rank – no FAU sergeants, only 1 corporal. 7. Nurses are called upon to report on the work of the FAU but not the RAMC; ‘many of the nurses are prejudiced against the FAU and make unequal and unfair reports; that many of the nurses are insolent’. 8. FAU paraded by an RAMC officer not their own officer 9. That the meals are unsuitably arranged, as there is no food obtainable between a light tea at 4 or 5 pm and coffee and biscuits at 6.30 pm.88 These grievances indicate not just that the FAU men felt that they were held in disdain by the RAMC officers; they were also disgruntled at their treatment by the nurses. The gender hierarchy of wartime was clear to all, and men, as fighters or potential fighters, were in all spheres superior to women whose roles – no matter how important – were always subservient to those of their male counterparts. Yet here, when faced with men who ‘would not fight’, nurses were able to assert a level of superiority and the fact that FAU men were reduced to the most menial of female roles – charring and cleaning – clearly rankled. The FAU committee members were anxious to deal with this problem diplomatically and did not want to cause the RAMC any embarrassment, but by the end of the year they realized that the situation was irreparable and the FAU men had to be withdrawn from the hospital altogether. Problems between the FAU and the RAMC were in some ways even more pertinent in the fighting zones. In the summer of 1916 the FAU requested stretcher-bearing duties with front-line troops, either with a field ambulance or with a casualty clearing station. The unit also requested permission to

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establish a casualty clearing station or a motor convoy near the front. All of these requests were rejected out of hand because the RAMC would not countenance having men near the front unless those men were formally under military discipline, in other words unless the unit agreed to be enlisted as part of the RAMC. For obvious reasons, the FAU chairman Sir George Newman (1870–1948) declined any such arrangement.89 Yet the RAMC/ FAU divide was not always so clear-cut. Nevinson served first in the FAU and then he joined the RAMC. Charles Frederick Dingle, a seventeen-yearold medical student at the outbreak of the war, was a committed pacifist by religious persuasion but he tried very hard to join the RAMC before eventually becoming part of the FAU in 1916. Dingle was not alone as a number of men with pacifist inclinations clearly did join the RAMC at the beginning of the war.90 This became evident in June  1917, when the War Office decided to merge the Territorial RAMC with the Regular RAMC and all the territorials were transferred to infantry battalions. This provoked some protest and RAMC men stationed at Blackpool formally complained to their own commandant and to the Army Council. Their primary grievances are summarized in the following paragraph: There are a number of men who for conscientious reasons do not feel that they could take part in actual fighting, but were quite prepared to do their duty helping the wounded, and have shared the dangers of warfare in the front line trenches; therefore we cannot be accused of selfish or cowardly motives, and we are of opinion that those of us who hold these objections should be given the opportunity of an individual appeal.91 This particular protest was signed by 1,104 men indicating that there was clearly a section of the RAMC that considered a level of pacifism as compatible with official military service. Those joining the RAMC with strong anti-war sentiments were definitely in the minority but their presence does challenge the prevailing stereotype of the hard-hearted medical man callously dispensing ‘medicine and duty’ and ‘pill number 9’ to wounded or ailing soldiers. FAU autonomy was most severely tested in its negotiations with the War Office. Here the FAU had to insist on recognition for its work at the same time as maintaining a principled stance in opposition to the war, a difficult position to maintain. While military service was still voluntary, the FAU position was relatively simple because those who rejected all connections with the armed forces were free to do so, although they did face much public scorn. The fact that the British army relied on voluntary recruitment at the beginning of the war was one factor which enabled the development of the FAU in Britain in a way that was simply not possible in France or Germany. Even in the United States, which did not have a long tradition of compulsory military service, the government disallowed an American FAU on its entry to the  war in April  1917. Yet the British commitment to voluntarism did

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not long  survive in a context of total war. In October  1915  Lord Derby introduced the Group Scheme (popularly known as the ‘Derby Scheme’) to increase recruitment. Voluntary enlistment was to be phased out by the end of December, and in the meantime men could either enlist voluntarily or ‘attest’ and be obliged to enlist as soon as they were required. By January 1916, all men were therefore required to attest or to claim an exemption. Although many did not recognize it at the time, this was more than a half-way house to conscription because from this point all men between the ages of eighteen and forty had to be either in military service  or officially and practically available for it. This raised real problems for conscientious objectors within the FAU because they were still officially civilians and were therefore liable for attestation. In a meeting between FAU  committee members and Lord Derby, committee members emphasized  that the FAU was doing useful and important work for the army but that if forced to attest the men would refuse on account of their conscientious objection to military service. Their good work would then be lost. Derby was clearly convinced of the value of the FAU and was prepared to certify it as ‘indispensable’ and to exempt the FAU from the recruiting scheme. He was also prepared to allow a further ambulance train and to permit the unit to make up any wastage it incurred. In many ways this was a real coup – there was obviously official respect for the FAU – but the committee decided that there should be no official statement about this agreement. After all, if the FAU was really ‘indispensable’ to the British army and some sections were, in effect, part  of the French army, surely it was part of the military machine. How could this possibly accord with any interpretation of the Quaker Peace Testimony? This question became even more pressing after the Military Service Act of January  1916, when all men between the ages of eighteen and forty were obliged either to enlist or to demonstrate grounds for conscientious objection. Later that month key members of the FAU committee – Sir George Newman, John William Wilson, then the Liberal Member of Parliament for North Worcestershire, and Arnold Rowntree – met Lord Derby and Sir Alfred Keogh and it was confirmed that the War Office would recognize the FAU as carrying out ‘approved’ work although it would remain as a voluntary unit under the Red Cross. It was also agreed that Friends should apply for exemptions from the tribunals and, in turn, the tribunals would refer the conscientious objectors to the FAU. Given the extra demands that this would entail, the War Office offered to facilitate the finding of suitable work and immediately offered the FAU the opportunity of service on the Western Australia. It is unsurprising that FAU autonomy was strictly limited by the War Office and the realization that FAU war work would always be restricted by the more powerful War Office prompted key resignations within the FAU, including that of Catchpool, who resigned the adjutancy in May  1916. This did provoke serious disillusionment and many Friends felt that the FAU would continually compromise with government bodies and that its

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Quaker principles had all but evaporated by this stage. Yet despite this obvious collusion the FAU did attempt to retain a principled position throughout. In the summer of 1916 the War Office attempted to construct a simple transmission system whereby Quakers who were unwilling to accept military service would be automatically transferred to the army reserve and ordered to report to the FAU.92 On the face of it this seemed like an ideal system: Friends who were pacifists would not face the threat of gaol, the FAU would have a ready supply of recruits and the War Office would have fewer troublesome conscientious objectors on its hands. Yet the FAU rejected this War Office proposal completely, arguing that it gave unwarranted preferential treatment to Friends (which it did because conscientious objectors who were not Friends were excluded from this system). Also, it would mean that some men would be effectively enlisted into the FAU. This was not acceptable because the FAU ethos could only be maintained if the units were staffed by those who had joined of their own free will and were considered suitable by the committee.93 The FAU took an even stronger stance in 1917 when there were concerns about War Office plans to carry unwounded German officers who were prisoners of war on the Western Australia. The FAU had no objections to working with wounded prisoners of war, many of whom travelled on the hospital trains, but were concerned that these unwounded prisoners were essentially to be used as human shields in an attempt to prevent the Germans from torpedoing the hospital ships. There were also plans to surround hospital ships with armed escorts, to remove the Red Cross insignia and even to arm hospital ships. Once the Red Cross insignia was removed, there was of course no reason not to use the hospital ships for transporting combat troops and munitions.94 As far as the FAU committee was concerned, work on the hospital ships had crossed an ethical border at this point; they were genuinely concerned about contravening Geneva conventions and so FAU staff were withdrawn. All of these conflicts arose due to questions about the extent to which pacifists could carry out military-medical work with integrity. The debates about arrangements with the War Office tested official and theoretical limits but the men who worked in the SSAs really tested the boundaries of pacifist military-medical work on a practical, day-to-day basis. Whereas Friends like Catchpool were convinced that official links with the military were necessarily corrosive, the men in the convoys believed they could work closely with the French army and still maintain a pacifist position. Stapledon worked with SSA 13 and insisted that it was possible to be part of the French army and yet to reject or resist commands in a way that it would not have been possible for a soldier (Figure 5.1). He later wrote, ‘Up to a point we did as the French army told us, but sometimes we found it necessary to be unaccommodating. For instance, when the motor convoy of which in due course I became a member was told to carry men or ammunition up to the front, it refused.’95

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FIGURE 5.1  These men became very much part of the French army medical services. They played an important medical role but enjoyed being perceived as cranks who wore shorts and did not drink all of their wine. Source: © Religious Society of Friends (Quakers) in Britain.

It was obviously not permissible for soldiers to be ‘unaccommodating’ or to refuse orders and the ability to do so was what maintained the FAU as an organization which was ‘quite unmilitary in spirit and internal discipline’.96 This unmilitary spirit did not stop the FAU men from having good relationships with the men in the French army; on the contrary, FAU volunteers had the most cordial of relationships with brancardiers, with poilus and with the officers. At this point Quakers did not proselytize but they did discuss their religious beliefs freely and, according to Stapledon, the French simply regarded them as ‘amiable and efficient cranks’ who for some reason wore shorts whenever possible and did not drink their full ration of wine.97 There is no indication that they were able to encourage any French soldier or medic of the merits of pacifism. It is possible that the FAU men were able to enjoy such good relations with the French precisely because of their outsider status. Military-medical officers had the reputation of being primarily disciplinarians whose first commitment was to the army rather than the beleaguered poilu, whereas the Friends sometimes had the luxury of putting the poilu first. Individual Friends found life in the convoys satisfying not simply because they were engaged in the practical business of saving lives in a war zone but also because they saw themselves as engaged in the wider project of forging meaningful bonds amongst those they had once considered as

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foreigners. The wider war, a consequence of extreme nationalism, was stoking xenophobia but in the French convoys at least, one group of men had ‘cast away a lot of foolish prejudices and narrow insularity’.98 Yet this fond, and rather romantic, interpretation of the work has to be set alongside a growing, albeit unconscious, militarization amongst the convoy volunteers. While they may no longer have perceived the French as ‘foreign’, they continually referred to the Germans as the ‘enemy’ and often used the pejorative Boche. Very early on in the war, the FAU had adopted military habits, and Rowntree’s description of arranging new shelter could easily have been written by a soldier: Our destination was a house in a long street, which didn’t seem to have been much harmed. It had been a nunnery and had two small shells through the roof. We found it had evidently been evacuated in a hurry, for goods and chattels were strewed all over the place, and in the kitchen pots were still on the stove, which had been out for days. We found some food, which we condemned mostly, a little water and plenty of wine and beer, which was augmented (this is a secret) by two bottles of champagne and some cigars ‘found’ by our most experienced looter in a neighbouring shop. He kept the champagne but shared the cigars.99 These cultural markers indicate a gradual internalization of military mores, a development captured in a cartoon drawn to commemorate the third anniversary of the FAU in October  1917. In the cartoon a puzzledlooking ambulance man looks up at different images of the FAU in the years 1914–1915 and then again in 1916–1917 (Figure 5.2). In the first image the FAU medic looks jaunty and is standing by an ambulance car, a symbol of the independent and rather adventurous early years; in the later image the medic has a more controlled and military bearing and is standing in front of an ambulance train, a vehicle offering little autonomy and no freedom of movement. The caption ‘1917 – ?’ indicates a real sense that the future development of the FAU was unknown and that the members did not always feel in complete control of their organization.100 The external markers of militarization became more and more striking throughout the war. Many FAU members in the convoys were awarded French military medals and were entitled to have the Croix de Guerre painted on their cars. This later worried Stapledon, who noted that ‘we were so deeply infected with the military spirit that many of us were more elated to think that the army respected us than disconcerted at the incongruity of pacifists with military decoration’.101 The incongruity of medical-military pacifism is clearly illustrated by the following description of FAU ambulances near Villers Marmery (Marne) during April 1917 when the French were fighting to recover territory near Reims.

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FIGURE 5.2  The men of the Friends Ambulance Unit had become more organized and more integrated into the military services by 1917. In response some members grew anxious about the risks of men aping military values. Source: © Religious Society of Friends (Quakers) in Britain.

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As the battle developed, all cars were called on to go up the long straight road out of Thuisy to the Bois de Cuisines and the Pyramid, open positions separated from the enemy’s hillside trenches by not more than a kilometre of flat bare country. On this road the cars found themselves mixed up with a convoy of French Tanks, and it was significant that some days later the German communiqués complained that the French were painting the Red Cross sign on top of their Tanks!102 The image of the ambulances and the tanks all jumbled together in the confusion of war is a fitting metaphor for the blurred boundary between the FAU anti-war ambulance convoys and the French military machine. But it is more than that. The German complaints were serious and this sort of misunderstanding could have had grave consequences. After all, why should the Germans respect the Red Cross symbol if they believed that the French were painting it on their tanks? Yet the authors’ tone is jocular: Did they really fail to understand the gravity of this episode or were they so much part of the military milieu that they interpreted this episode as combatants – here the Germans are clearly the enemy – rather than as pacifist or neutral medics? In this situation it was quite impossible to work in the ambulance unit and to maintain even the appearance of neutrality. During the same spring offensive Stapledon described how a German shell had exploded and blocked the road with splintered wood and with wounded horses and men. The FAU men had no choice but to clear the road to enable the ambulances to get through and at the same time ‘inadvertently’ assisted the French advance.103 At times of very great crisis, ambulance men could sometimes find themselves assisting the army in ways that were more than ‘inadvertent’. At about the same time Nevinson, who was at this point with the FAU, described how the Germans had broken through the French lines and so the French army insisted on calling out the Red Cross men to help repel the attack, attack ‘even to the cook with a long knife’.104 This was obviously an extreme situation and Nevinson’s account makes it clear that the Red Cross men did not actually fight on this occasion. Yet there could be more to his story than a simple description of French military collapse and the attendant panic. FAU volunteers were anti-militaristic: they did not want to become part of the military system but they also did not want to be seen as cowards, as Rowntree’s history attests. FAU men were constantly concerned about being labelled embusqué (a shirker, skiver or coward) and often questioned themselves about the extent to which their pacifism was just a cover for plain funk. This is why the FAU made repeated requests for work in danger zones (i.e. close to the firing lines), and the determination to demonstrate that pacifism was not cowardice clearly motivated men who were working under bombardment or the risk of bombardment. Yet this attitude, however understandable and morally sound, may well have led to an unhealthy (from a pacifist point of view) attraction to the thrills of war. Some reminiscences from convoy members read remarkably like those

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of combatants, and despite their moments of horror, they come close to sentimentalizing and glamorizing their war experiences, as in this account describing the French military advance of July–October 1918: Ha, the lust of the chase! Ah, the fierce joy of pursuing! Ho, the open warfare! … Perhaps we do feel a thrill when we see the sky lit up by distant fires and hear one poilu tell his fellow in deep sonorous argot that the Boche is doing all sorts of indescribable things, preparatory to the slinging of the Hunnish hook … But there are other things. We dislike stumbling over the unburied and unrecognisable dead, we shudder at a blackened head and shoulders staring at us from the ditch as we go by … We remember going ‘over the top’ and crawling down the other side, with strands of camouflage catching at us from above and yawing pitfalls for the never-so-wary waiting beneath to engulf us. And how we laughed (afterwards) at the Sapicourt-Courcelles joke, for it was a relief to be able to say of a cloud of smoke and rubbish and a great noise, that makes itself seen and heard sixty yards away, ‘That was in the next village.’105 This level of emotional engagement with the conflict was going far beyond Baker’s original aim of ‘going to the scene of active operations’. The FAU committee was aware of this danger and so did insist on trying to maintain the spiritual welfare of the men. They insisted that Friends on Foreign Service held Meetings for Worship wherever possible; they sent older Friends abroad specifically to maintain the spiritual and moral welfare of the men and responded quickly to all complaints about discipline, especially regarding bad language and drinking. In short, the FAU was insistent that its men should not act like soldiers, no matter how far they were integrated into army life.

Daddy, what did you do in the Great War? And in future years, when our children ask us ‘Daddy, what did you do in the Great War?’ shall we not have each of us his tale to tell, – ‘a tale which holdeth children from play and old men from the chimney-corner’.106 Returning to the post-war ‘Daddy’, it is clearly the case that pacifists, like other men, wanted to survive the war and tell their children a good story. No man wanted to be like Savile Lumley’s ‘Daddy’, comfortable and with a whole skin, but too ashamed to face his own children. This was a particularly potent issue for pacifists who were aware that their refusal to fight could be interpreted as cowardice. On the whole, FAU men were politically radical but they conceptualized their war years in much the same way as soldiers. They were proud of their work – as were most combatants – and it was personally meaningful because, as with many soldiers, their war

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work was the work which defined their youth and marked their transition into adulthood. Like soldiers, ex-FAU men wrote their memoirs, preserved their scrapbooks and held reunions so that they could tell and retell their tales. They also wanted mainstream recognition for their war work and to some degree they received it. FAU men won military honours from both British and French governments, the official medical-military authorities respected FAU work and the British government worked with the FAU to accommodate conscientious objectors. This official sanction is exemplified by the terms of the Representation of the People Act (1918), in which conscientious objectors as group were excluded from the franchise for a period of five years but conscientious objectors who were FAU members were eligible for suffrage because their work was classified as being of national importance. Medical pacifism had been far from being simple or easy during the years 1914–1918. The pre-war Association Médicale contre la guerre had posited a straightforward relationship between physicians and pacifism: it was part of the doctor’s duty to oppose war. The vast majority of doctors did not accept this. They were not pacifists and they supported their respective national war efforts either directly as part of the armed services or indirectly as part of a semi-militarized national Red Cross organization. There was no such thing as a neutral medical service in war – even pacifist and pacifistic FAU members imbibed the concept of the enemy – and the FAU in its attempts at anti-war war service left itself open to criticism from all sides. FAU men could be seen as cowards, as men who shirked military service and who sought refuge in the relatively safe rear zone. Alternatively they could be accused of complicity with the military machine and of craven subservience to the whims of the War Office. Yet despite these difficulties and the conflicts raised for Quakers in particular, European medical pacifism was strengthened as a result of the First World War and it was a real inspiration to the interwar peace movements.107 As we all know, those peace movements failed to promote lasting peace, and when a European war broke out yet again in 1939, the FAU was swiftly re-formed. Medical pacifism did not stop the First World War (or any subsequent war) but the Friends Ambulance Unit did enable some pacifists to do something more than simply to declare ‘we did not fight’.

Further reading Secondary sources Bibbings, Lois S. Telling Tales about Men: Conceptions of Conscientious Objectors to Military Service during the First World War. Manchester: Manchester University Press, 2011. For those interested in conscientious objection per se rather than medical pacifism.

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Cooper, Sandi. Patriotic Pacifism: Waging War on War in Europe, 1815–1914. New York; Oxford: Oxford University Press, 1991. A work which explains the now marginalized concept of patriotic pacifism. Dandelion, Pink. The Quakers: A Very Short Introduction. Oxford: Oxford University Press, 2008. This is a brief introduction of the Society of Friends and serves as a good starting point for those interested in its history and its beliefs. Kennedy, Thomas. British Quakerism, 1860–1920: The Transformation of a Religious Community. Oxford: Oxford University Press, 2001. This book charts the development of British Quakerism. It does not focus on pacifism but is useful for understanding the Quaker milieu. Lewer, Nick. Physicians and the Peace Movement: Prescriptions for Hope. London: F. Cass, 1992. A detailed account of medical pacifism in Britain from 1815– 1990. Richmond, Oliver. Peace: A Very Short Introduction. Oxford: Oxford University Press, 2014. An introductory work which attempts to define peace and to describe concepts of peace and peace-making strategies throughout history. van Bergen, Leo. ‘“Would It Not Be Better to Just Stop?” Dutch Medical Aid in World War I and the Medical Anti-War Movement in the Interwar Years’. First World War Studies 2, no. 2 (2011): 165–94. An article which discusses the controversial topic of a ‘medical strike’. Welch, David and Jo Fox, eds. Justifying War: Propaganda, Politics and the Modern Age. London Palgrave MacMillan, 2012 (especially chapter 4, David Welch, ‘War Aims and the “Big Ideas” of 1914’, pp. 71–94 and chapter 5, Catriona Pennell, ‘Why We Are at War: Justifying War in Britain, 1914’, pp. 95–108). This is a collection of scholarly essays examining how war has been justified from the end of the nineteenth century until the present day.

Published primary sources Brittain, Vera. A Testament of Youth: An Autobiographical Study of the Years 1900–1925. London: Phoenix, 2014 (first published in 1933). Brittain did not begin the war as a pacifist but became a pacifist as a result of it. Catchpool, Corder. On Two Fronts: Letters of a Conscientious Objector. London: George Allen and Unwin, 1919. Letters from Catchpool, an absolutist objector who served a two-year prison sentence for his beliefs. Hirst, Margaret. The Quakers in Peace and War, an Account of Their Principles and Practice. London: The Swarthmore Press, 1923. (Online version available at https://archive.org/details/quakersinpeacewa00hirsuoft).

CHAPTER SIX

Lessons and Legacies: ‘Blood Swept Lands and Seas of Red’ The Great War finally ended on 11 November 1918. The German authorities had agreed to an armistice, and although official peace treaties were not signed until June 1919, the conflict was effectively over. As the war ended it was time for personal reflection, for turning war experiences into war memories and for assessing the legacies of the war. A century later, these assessments continue. To commemorate the centenary of the outbreak of the First World War in Britain, Paul Cummins and Tom Piper filled the moat of the Tower of London with 888,246 ceramic poppies.1 Each red Flanders poppy represented a British or colonial fatality and the installation became so popular that 5 million people went to visit it between July and November 2014. Yet, like all commemorations of the war, this was a contested representation and the Religious Society of Friends produced a thoughtful response. Using the pacifist white poppies, Quakers of Britain created a map to illustrate the effect on London if poppies were used to represent all the war dead, and not just those from Britain and the Empire. Whereas the red poppies filled the enormous moat of the tower, the 19.5 million white poppies flowed along the banks of the Thames, around the Houses of Parliament, and filled the Mall up to Buckingham Palace.2 It is important to remember the scale of death because post-war Europe was dominated by grief and mourning for the dead.3 In anecdotes and family stories about the Armistice in Britain, there is the familiar tale of the street party disturbed by the dreaded telegraph boy: just as everyone was putting up the bunting to celebrate, the telegram arrived to say that a local boy had been killed. These stories are mythical in that they are not verifiable but they should not be discounted. They indicate the extent to which the end of the war did not mean that people could dismiss the fear of death. It was very possible that loved ones were not out of danger, in part because the fighting continued until 11 o’clock on the morning of 11 November, and in part because the end of the war was accompanied by the

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deadly influenza pandemic.4 Known as the Spanish ‘flu’ or La Grippe, the pandemic eventually killed between 50 and 100 million people and became inextricably bound up with people’s memories of the Armistice. ‘Flu is still claiming its scores of victims daily. There are more mourning coaches than taxis in the street’, wrote Ernest Taylor.5 The influenza pandemic is often presented as ironic or tragic. For many contemporaries it seemed like just another cruel blow of fate but it was in fact one of the highly predictable result of such extensive and intensive warfare, and this link between warfare and disease had been one of the primary bases for medical pacifism since the beginning of the twentieth century. The fear of death no doubt left a legacy within families. There has rightly been some criticism of the ‘lost generation’ thesis and the tendency, especially in Britain, to assume that First World War soldiers were more likely to be killed than to come home. The statistics simply do not bear this out.6 Yet, just like the story of the telegraph boy at the Armistice party, these myths tell us about the emotional impact of the war. Living with the fear of death took its toll on combatants and civilians alike. This understandable focus on the dead has ensured that until recently there was too little historical attention paid to the lives of disabled veterans. Nevertheless the symbolic value of the disabled veteran was powerful at the time. As the German delegation was led into the Hall of Mirrors to sign the Versailles Peace Treaty, a group of facially wounded French soldiers stood in silent witness to the formal capitulation of the recent enemy.7 Given the importance of the ‘war guilt’ clause, the presence of these men was clearly meant to signify to the Germans: ‘you are to blame’. Yet it was also a wider statement to the world, one which announced: ‘this is what war does to men’. A few years later this same message was loudly proclaimed in Ernst Friedrich’s Krieg dem Kriege! (War against War!), a book containing a series of shocking war photographs with captions in four languages to appeal to an international audience. The  images included all the myriad horrors of war: violated women, typhoid victims, gas casualties and the mutilated bodies of ordinary soldiers. Contrasting images were arranged to make clear political points about the horrors of war and its iniquities. In one such arrangement the well-groomed German crown prince, in tennis whites with a racquet in his hand, was set against ‘the war-wounded proletarian’, a one-armed man positioned at a lathe, laboriously making machine tools with a specially designed prosthesis. The sporting prince was ironically labelled as ‘the hardest worker’, while the disabled proletarian was described as being occupied with his own daily ‘sport’.8 Occupying a significant section of this anti-war tract are images of the most terrible facial injuries imaginable, although the author hints at those that are even worse, adding that ‘those gruesomely mutilated, did not allow themselves to be photographed, as they feared that their relatives who had not seen them again, would either collapse at the sight of their misery, or would turn away forever from them in horror and disgust’.9 This ‘Face of War’, the literally damaged face of the ex-soldier, similarly embodied an

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anti-war stance in French films during this period. Pour la Paix du Monde was released in 1927 and Abel Gance’s 1919 J’accuse was remade in 1938. These films included facially wounded veterans and were both supported by the Union des Blessés de la Face (UBF), the highly respected organization which represented the gueules cassées in France.10 Friedrich was an anarchist and internationalist who wanted to use these piteous images to promote revolutionary change; the UBF believed that facially-wounded men had a particular role to play in promoting peace and reconstruction. In both cases, the legacy was clear, namely that the broken bodies of the survivors had to be employed to prevent such carnage from ever happening again. Yet images can always be used in diverse ways. While progressive artists used the broken bodies of war veterans to critique militarism, eugenicists attacked ‘useless eaters’ for being repellent and genetically worthless. Even when this attack was not overt, the interwar cult of health and beauty can be seen as a condemnation of those whose bodies were far from beautiful as a result of their war wounds.11 Some have argued that there was a real discrepancy between the horror of these post-war images and the daily lives of those who had survived the war. Cohen in particular has made a point of emphasizing that German veterans did not need to beg and that the limbless, pitiful pedlars in George Grosz’s paintings simply did not reflect the reality of life for ex-soldiers in the Weimar Republic.12 Obviously men with shattered faces and ruined limbs were not sitting and begging on every street corner and we cannot assume that all beggars were abandoned war heroes. Nevertheless the immediate legacy of the war was a world in which large numbers of young men were either physically or psychologically damaged. Several months before the end of the war a soldier observed, ‘Our eyes look out on a Britain daily more and more peopled by sufferers in this war. In every street, on every road and village green we meet them.’13 Despite the development of statutory pensions and work assistance schemes many of these men were unable to cope and Evelyn Blücher certainly saw an increase in beggars just after the war, noting with an uncharacteristic lack of sympathy that ‘A new feature in Berlin is the number of beggars one now sees everywhere. All the blind, the halt, and the lame of Prussia seem to have collected here and are reaping a golden harvest.’14 Across Europe men were being reintegrated into families and communities bearing the sorts of disabilities that were rarely seen before the war. In the pre-war world the physically disabled were usually from the very poorest social classes and were stigmatized accordingly. By contrast, the war disabled were from all social classes. There were amputees, blind men, the facially wounded, men with war neuroses and those who were just generally damaged or debilitated by war.15 The governments of France, Germany and Great Britain all had arrangements for encouraging (or coercing) disabled war veterans back into the workplace but these men often had complex medical needs and there is evidence to indicate that many ex-servicemen

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became prematurely aged and were unfit for work at a relatively early stage. In 1936 a British study concluded: Many men are prematurely old because of the intangible effects of the war […] in the whole country there are about 18,000 ex-Servicemen between 40 and 60 who are chronically sick and compelled to apply for public assistance, and a further 25,000 under treatment at municipal hospitals. The Legion’s own records show that an additional 50,000 are managing with difficulty to dispense with public assistance.16 By this point the average age of the ex-serviceman was forty-eight years, well within what was considered the normal span of a man’s working life, and this led to genuine financial hardship because the British national insurance scheme assumed that a working man would not need his pension until he reached sixty-five years of age. The physical debility of many veterans was the primary issue for medics and pension officials at the time, but now historians are also paying attention to the long-term emotional legacy of the war veteran: What sort of father was he? How did these emotionally and physically damaged men carry out the caring work required of husbands and fathers, and what impact did this have on their children and their wider families?17 As Roper’s work is demonstrating, the legacy of the war did not just affect public discourse but was also a potent factor in the minute details of family life. The physical and emotional damage of this war was made publicly plain, and this reinforced the position of medical-military institutions throughout Europe. Specialized medical care and treatment became central to all military organizations in the First World War and have remained so. The centrality of medicine to modern military organizations has provoked uncomfortable questions. Aside from the partiality of the military medic – often suspected of putting military needs before medical care – it is pertinent to question the impact of the medical gaze on ordinary soldiers. We have already made reference to the relationship between care and discipline, and especially to those doctors who chose to reinforce their own power by insisting on patient nudity. We now inhabit an environment where patient empowerment is deemed to be paramount and so it is hard to read these accounts without discomfort. Referring back to the bureaucracy of First World War army medical services also raises awkward questions about the extent to which both soldiers and doctors had become embroiled in vast, impersonal systems. A level of bureaucracy was required because it is impossible to manage big organizations otherwise; yet over-bureaucratization is dehumanizing, and very crucially, often leads us to make poor decisions, or to abdicate decisionmaking altogether.18 We need to look beyond the military-medical systems and processes to understand the experiences of men who were wounded or sick, and those who were looking after them. The instructions for medical officers, the plans for sanitation trenches and aid posts and the diagrams of

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triage systems all have their uses but paying exclusive attention to them can risk creating a Potemkin village out of medical history. The official systems should have indicated how real men were treated, but they often did not, as soldiers’ ramshackle journeys towards clearing stations and hospitals indicated. While official medical structures have created one imagined version of the war, another has been created by post-war objectification, especially with regard to the creation of iconic illnesses or wounds, those which were tied linguistically or imaginatively to the First World War trenches. These conditions, such as shell shock, facial injury or trench foot, were real enough in themselves but have garnered a further emblematic power as the war has been remembered and re-remembered throughout the last century. The cultural history of these iconic conditions is significant in itself but it remains vital to question the way in which ordinary soldiers experienced pain, illness and medication. Roy Porter long ago emphasized the importance of a ‘bottom-up’ medical history and it is in the daily ‘making do’ of men and medics that we can best see how they responded to the demands of total war. Trained doctors like Henry Kaye and volunteer nurses like Ellen La Motte or Henriette Rémi experienced deep frustrations as well as satisfaction from their wartime medical service; combatants experienced pain, fear, anger and betrayal. Yet in terms of an overall assessment, their shared medical history indicates that the survivors of the Great War were humanized rather than brutalized by their experiences.19 Early twentieth-century notions of science, humanity and progress seem slightly naïve in our later age where there is much greater mistrust of science in general and the medical profession in particular. Nevertheless the experience of medical care during the First World War can be directly linked to the later development of welfare states throughout Europe. The  British government initiated a Ministry of Health after the First World War; the French established a Ministry of Hygiene; the new Weimar Republic instituted a range of welfare programmes which provided medical care for disabled veterans as well as pensions for wives and for children, even those who were born after the man’s military discharge.20 Men may have mistrusted medical officers and they certainly expressed anger at a whole range of medical staff during the war but they did not reject modern medicine. This sense of the importance of medical care endured which is why state-supported medicine became so central to the fully functioning welfare states which developed in Europe after the Second World War. Even in Britain, where the post-Second World War consensus has now collapsed and the welfare state has been largely dismantled, politicians must still pay lip service to the founding principles of the National Health Service. The perceived links between science, humanity and progress also lie at the roots of early twentieth-century medical pacifism. Men did not reject medicine during the war but some medics rejected war. Most doctors thought that they were morally bound to war service and accepted military discipline

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while still seeing themselves as part of a system designed to humanize war or lessen its evils. On one level, the wartime army medical services represented a continuation of the desire to humanize war which had been evident since the mid-nineteenth century, and Britain was unique in the way that it allowed medical pacifists to organize and to contribute to the war effort. This development can be seen as one which reinforces the importance of medicine to the modern army: it was so crucial that even the opponents of the war could be tolerated within that specific sphere. More cynically, nothing demonstrates the total nature of this total war as much as the fact that British government could even make effective use of its pacifists. As a history of the Friends Ambulance Unit indicates, the role of the medical-military pacifist was a complicated one and during the conflict many pacifists simply tried to do their best in an obviously imperfect world. As Norman Monk-Jones, an Oxford University undergraduate and FAU volunteer, said when forced to consider the reality of the army aid posts, ‘It’s a ghastly business if you think about it. But you don’t. After all … que voulez-vous? C’est la guerre.’21 Yet a small number of medical professionals did think about it and decided that there was only one way for medics to avoid encouraging or prolonging war. Jeanne van Lanschot-Hubrecht, a Dutch nurse, a feminist and a pacifist, was one of the first to publicly call for a ‘medical strike’. Responding to a call for civil conscription in 1918, Lanschot-Hubrecht asked her fellow nurses to consider the following: We know how medical science in the war-waging countries does everything it can to fix the men as soon as possible with the sole purpose of […] getting them back to the front; and this repeats itself until a wreckage or corpse is all that is left. Time and time again men are sent back to take upon themselves once more their work of murder, the only way I can describe it. And now I ask you: do you want to be a part of this by accepting civilian conscription? Compare the advantages and disadvantages thoroughly and carefully and then choose how you want to act: either accepting conscription and through your devoted, professional nursing cooperating in a speedy recovery of the sick and wounded, leading to a new trip to the front, so they can kill or be killed once more, or refusing conscription, leaving the sick and wounded to their fate, but with all the consequences this possibly could have. It is a question all nurses in our country should ask themselves.22 Medical Pacifism was an organized, albeit highly limited, force in Europe throughout the interwar years. The Physicians’ Conference against War met in Amsterdam between 27 and 29 August 1932 as part of the international ‘World Anti-War Congress’ led by the German Communist Willi Münzenberg (1889–1940). It attracted between 2,000 and 4,000 participants, one of the most prominent being the novelist Henri Barbusse, whose comments on the war have featured throughout this work.23 In Britain, medical pacifists were

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making the same arguments. John Ryle (1889–1950) was a pacifist who had served with the RAMC during the First World War. He became Regius Professor of Physic at Cambridge University in 1935 and was president of the Medical Peace Campaign. In the late 1930s, when the Spanish Civil War had made it clear that any future war would be dominated by aerial bombardment, Ryle insisted that the medical profession was the ‘only pacifist profession in the modern world’ and that it had the power to render war ‘almost unthinkable’ by a collective refusal to participate with military activities.24 If doctors and nurses refused to examine recruits, refused to inoculate service personnel, withheld sanitary advice and failed to staff ambulances, clearing stations and hospitals, it would surely be impossible for any government to wage war. While acknowledging the practical and emotional difficulties of holding a medical strike in wartime, Ryle went on to argue that a medical refusal to engage in war service was ultimately a humane action and that ‘there would be no inhumanity comparable with the inhumanity which medicine at present sanctions and prolongs’.25 There is some logic to the argument that medical and humanitarian actions can prolong wars yet there has never been widespread or longstanding support for a medical strike. This is in part because very few doctors were (or are) committed pacifists. In Britain, the 1930s were arguably the years in which pacifist activity was most pronounced – the Peace Pledge Union was formed in 1934 – and even then less than 2 per cent of doctors described themselves as pacifists.26 Even pacifist medics were reluctant to engage in a full-blown medical strike, in part because they felt that neglecting the war wounded was unethical and, in part, because it is possible to be opposed to war in the abstract while accepting that some wars must be fought in practice. Just as Rivière, the founder of French medical pacifism, served the French army in the First World War, Ryle believed that he had to do something to counter the threat of Fascism and he modified his pacifist stance so as to work with the Ministry of Health during the Second World War. Nevertheless, the sense that medical professionals should work actively either to prevent or to limit war remains. The Medical Association for the Prevention of War (MAPW) was founded in 1915, right at the start of the First World War. After the Second World War MAPW affiliated with International Physicians for the Prevention of Nuclear War (IPPNW), and later with Medical Action for Global Security (Medact).27 Medact explicitly links itself to the medical peace movement and it promotes peace and disarmament worldwide in a number of ways, including directly challenging the military-industrial complex.28 Moreover, while medical pacifism has always been a minority position, numbers of medical professionals have consistently remained committed to humanitarian organizations, and those opposed to war have consistently supported them. The national Red Cross societies and the ICRC grew in strength both during and after the First World War. The Friends Ambulance Unit regrouped for the Second World War, as did the Friends Relief Services. Other, more permanent bodies developed

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during the Cold War: Médecins Sans Frontières (MSF) was founded in 1971 and Doctors of the World in 1980.29 Both MSF and Doctors of the World are currently engaged with providing aid to the refugees of the conflicts in the Middle East, much in the same way as their predecessors did in the two world wars of the last century. The recent involvement of Western powers in the Middle East has caused physical and psychological harm to soldiers and civilians, and has provoked unprecedented refugee crises within the region and throughout mainland Europe. Military casualty levels are nowhere near those of the First and Second World Wars but the plight of permanently disabled veterans is once again a popular and political issue. On a domestic level, in Britain, we are once more presented with medical ‘wizardry’ as mutilated soldiers not only are made whole but are able to run marathons and trek to the North Pole. We celebrate wounded men who do not remain victims but who have become athletes due a combination of medical technology and personal grit.30 So once again we are faced with the questions that occupied many of the men and women in this book: ‘Is war good for medicine?’ Does the science of healing stand ‘baffled before the science of destroying’? Would the wounded soldier really ‘throw his sword into the scale for science’? Does medicine offer ‘a ready refuge’ for pacifists? Given the almost-universal desire to ‘keep a whole skin’ and the tendency of European powers to commit to warfare, these questions remain pressing but there are no simple lessons to be gained from the medical history of the First World War, and there is no one, straightforward legacy. Governments in Britain, France and Germany poured untold millions into their army medical services while civilian hospitals were starved of funds. Innovative, technically advanced medical procedures were developed while men in the trenches used brandy as an anaesthetic and sucked stones to ward off thirst while waiting for stretcher bearers to wade through the mud. It was the war which drew the  medical professions most thoroughly into the military sphere and it was the war which provoked the strongest and most effectively organized medical-pacifist organizations. War is not always good for medicine and sometimes  medical advances and interventions prolong wars. Returning to Private Murray’s war story, he  concluded by writing, ‘I like my country and if I can be allowed  to earn a respectable living in it shall never have anything to say against it.’31 Murray was keen to appear patriotic in his essay but his words contain a thinly-veiled threat. His patriotism was conditional and like all wounded soldiers he knew that he could only ‘earn a respectable living’ if he received proper medical treatment. What is most clear from the collective experience of war and medicine in the years 1914–1918 is that the men who had stayed alive during the war years had  developed a clear conception of the moral links between war and medicine. Men of all nationalities came out of the trenches with the firm belief that because they had gone to war they deserved good state-funded medical and social care, not just during the conflict but afterwards too. All those wounded in current wars deserve the same.

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Further reading Secondary sources Cohen, Deborah. The War Come Home: Disabled Veterans in Britain and Germany, 1914–1939. Berkeley: University of California Press, 2001. A comparative analysis of the different ways in which British and German veterans were treated by their respective states after the war. Gerber, David A., ed. Disabled Veterans in History. Ann Arbor: University of Michigan Press, 2012. This looks at the experiences of disabled veterans from North America and Europe from the ancient world to the present day. Pedersen, Susan. Family, Dependence and the Origin of the Welfare State: Britain and France, 1914–1945. Cambridge: Cambridge University Press, 1993. A comparative study examining the impact of the war and the different models of welfare state which later developed in France and Britain. Poore, Carol. Disability in Twentieth-Century German Culture. Ann Arbor: University of Michigan Press, 2007. A history of disability from Weimar Germany to the present day and one which argues for the centrality of disability to modern German culture. Todman, Dan. The Great War: Myth and Memory. London and New York: Hambeldon, 2005. A compelling analysis of the Great War myths which dominate British political and public life. This is essential reading for all concerned with the long-term cultural and political impact of the First World War. Winter, Jay. Sites of Memory, Sites of Mourning. Cambridge: Cambridge University Press, 1995. A powerful cultural study of the ‘collective remembrance’ of the First World War. Ziemann, Benjamin. Contested Commemorations: Republican War Veterans and Weimar Political Culture. Cambridge: Cambridge University Press, 2013. This text examines the way in which individual war memories fed into public narratives and public commemorations of the war in Germany.

Published primary sources Friedrich, Ernst. War against War! Nottingham: Bertrand Russell Peace Foundation, 2014 (first published in 1924). A powerful and provocative antiwar photo-book. Joules, Horace, ed. The Doctor’s View of War. London: George Allen and Unwin, 1938. A collaborative work, written by nine doctors, to make the case for peace and international cooperation.

NOTES

Chapter 1 1

Science Museum, London, ‘War and Medicine’, www.sciencemuseum.org. uk/broughttolife/themes/war (accessed 29 August 2016); the surgeon general of the US Army cited in Roger Cooter, ‘Medicine in War’, in Medicine Transformed: Health, Disease and Society in Europe, 1800–1930, ed. Deborah Brunton (Manchester: The Open University, 2004), 334. 2 Boris Pasternak’s Dr Zhivago was first published in 1957. It was made into an Academy Award–winning film in 1965 (director: David Lean) and into a television mini-series in 2002. 3 Dan Todman, The Great War: Myth and Memory (London and New York: Hambeldon, 2005), especially chapter 4, ‘Futility’, 121–52. 4 Fielding H. Garrison, Notes on the History of Military Medicine (Washington: Association of Military Surgeons, 1922), 100. 5 www.musee-armee.fr/lhotel-des-invalides/lhotel-national-des-invalides.html (accessed 29 March 2016); www.chelsea-pensioners.co.uk/historyheritage (accessed 29 August 2016). 6 Garrison, Notes on the History of Military Medicine, 103. 7 Science Museum, ‘Exploring the History of Medicine’, www.sciencemuseum. org.uk/broughttolife/people/ambroisepare (accessed 29 March 2016). 8 Garrison, Notes on the History of Military Medicine, 103–5; Célestin Sieur, ‘The Tribulations of the Medical Corps of the French Army from Its Origin to Our Own Time’, The Military Surgeon 64, no. 6 (June 1929): 844–49. 9 John Keegan, A History of Warfare (London: Hutchinson, 1993), 76. 10 Garrison, Notes on the History of Military Medicine, 108; Sieur, ‘The Tribulations of the Medical Corps of the French Army from Its Origin to Our Own Time’, 847. 11 Barton C. Hacker, ‘Women and Military Institutions in Early Modern Europe: A Reconnaissance’, Signs 4, no. 4 (1981): 655; John A. Lynn, Women, Armies and Warfare in Early Modern Europe (Cambridge: Cambridge University Press, 2008). 12 Sieur, ‘The Tribulations of the Medical Corps of the French Army from Its Origin to Our Own Time’, 844. 13 In Hugo’s Les Misèrables (first published in 1862) Monsieur and Madame Thénardier are grasping and materialistic villains who stole from men on the battlefield. The camp follower is here presented as the very lowest, most despicable type of character. 14 National Army Museum, London, ‘Lady Florentina Sale’, www.nam.ac.uk/ online-collection/detail.php?acc=1950-11-55-21 (accessed 29 March 2016);

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NOTES I would like to thank Danu Fenton, previously of the National Army Museum, for drawing my attention to the history of Lady Sale. For details of the Scottish Women’s Hospitals see www.nationalarchives.gov. uk/womeninuniform/swh_intro.htm (accessed 29 March 2016). Correspondence: Colonel Arthur Lee to Lord Kitchener (12 October 1914), Wellcome Library (hereafter WL), London, RAMC/466/3. J.H. Dible (8 July 1915), ‘First World War Account of Captain James Henry Dible, RAMC, 1914–1918’. Imperial War Museum (hereafter IWM) London, Con Shelf. For a detailed account of camp followers and their long exclusion from the history of war see Hacker, ‘Women and Military Institutions in Early Modern Europe’, 643–71. Mark Harrison, ‘Medicine and the Management of Modern Warfare: An Introduction’, in Medicine and Modern Warfare, ed. Roger Cooter, Mark Harrison and Steve Sturdy (Amsterdam: Rodopi, 1999), 1–27; Sieur, ‘The Tribulations of the Medical Corps of the French Army from Its Origin to Our Own Time’, 846. Joseph Morewood Staniforth, Western Mail, 24 October 1914. I would like to thank Dr Andy Croll for providing this image. For a full collection of Staniforth’s wartime cartoons see ‘Cartooning the First World War’, www. cartoonww1.org/index.htm (accessed 29 August 2016). In August 2015 David Cameron, then British prime minister, described refugees as ‘swarming’ to Britain, a comment which provoked much political outrage. ‘The Medical Service on the Somme’, British Medical Journal 2, no. 2907 (16 September 1916): 397. John Keegan, The Face of Battle: A Study of Agincourt, Waterloo and the Somme (New York: Viking Penguin, 1985); Cooter, ‘Medicine in War’, 331. Thomas Scotland and Steven Heys, War Surgery, 1914–1918 (Solihull: Helion and Co., 2012); Peter Leese, Traumatic Neurosis and the British Soldiers of the First World War (New York; London: Palgrave, 2002); Sophie Delaporte, Les Gueules Cassées: Les Blessés de la Face de la Grande Guerre (Paris: Noêsis, 1996). Mark Harrison, The Medical War: British Military Medicine in the First World War (Oxford: Oxford University Press, 2010); Ana Carden-Coyne, The Politics of Wounds: Military Patients and Medical Power in the First World War (Oxford: Oxford University Press, 2014). Leo van Bergen, Before My Helpless Sight: Suffering, Dying and Military Medicine on the Western Front, 1914–1918 (Farnham, Surrey: Ashgate, 2009). For a series of essays examining the relationship between war and medicine see Medicine and Modern Warfare, ed. Cooter, Harrison and Sturdy. See, for example, Richard A. Gabriel and Karen S. Metz, A History of Military Medicine from Renaissance through Modern Times, Vol. II (London; New York; Westport, CT: Greenwood Press, 1992). NHS, ‘Military Medicine Timeline’, www.nhs.uk/Tools/Documents/ Military%20history%20timeline%20read-only.htm (accessed 29 August 2016). Musée de l’Armée, Paris, Jeanne Til, ‘Aux Ambulances: Convalescence’, 1917–1918, www.musee-armee.fr/collections/base-de-donnees-des-collections/

NOTES

30 31

32

33 34 35 36

37 38 39 40 41

42 43 44 45

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objet/estampe-convalescence.html?tx_mdaobjects_object%5BidContentPor tfolio%5D=2498&cHash=8f4e7fd0e690553f123b4091e76a92ed (accessed 29 March 2016). Science Museum, London, ‘War and Medicine’; Revue de l’OTAN Magazine, www.nato.int/docu/review/2014/war-medicine/FR/index.htm (accessed 29 March 2016). Arul Ramasamy, W.G.P. Eardley, D.D. Edwards, J.C. Clasper and M.P.M. Stewart, ‘Surgical Advances during the First World War: The Birth of Modern Orthopaedics’, Journal of the Royal Army Medical Corps 162, no. 1 (February 2016): 12–17. Roger Cooter, ‘Medicine and Modernity’, in The Oxford Handbook of the History of Medicine, ed. Mark Jackson (Oxford: Oxford University Press, 2011), 100–14; for caregiving and discipline see Jeffrey Reznick, Healing the Nation: Soldiers and the Culture of Caregiving in Britain during the Great War (Manchester: Manchester University Press, 2004). Harold J. Cook, ‘Medicine in Western Europe’, in The Oxford Handbook of the History of Medicine, ed. Jackson, 190–207. Mark Harrison, ‘War and Medicine in the Modern Era’, in War and Medicine, ed. K. Arnold, K. Vogel and J. Peto (London: Black Dog Publishing, 2008), 17. Fiona Reid, Broken Men: Shell Shock, Treatment and Recovery in Britain, 1914–1930 (London: Bloomsbury, 2012), 12. Hans-Georg Hofer, ‘Beyond Freud and Wagner-Jauregg: War, Psychiatry and the Habsburg Army’, in War, Trauma and Medicine in Germany and Central Europe (1914–1939), ed. Hans-Georg Hofer, Cay-Rüdiger Prüll and Wolfgang U. Eckart (Freiburg: Centaurus Verlag & Media, 2011), 44; Gregory M. Thomas, Treating the Trauma of the Great War: Soldiers, Civilians and Psychiatry in France, 1914–1940 (Baton Rouge: Louisiana State University Press, 2009), 26–7; Nick Bosanquet, ‘Health Systems in Khaki: the British and American Medical Experience’, in Facing Armageddon: The First World War Experienced, ed. Hugh Cecil and Peter Liddle (London: Leo Cooper, 1996), 451. Henry W. Kaye (1 July 1915), Unpublished War Diary, WL RAMC/739/5. Kaye (25 March 1916), Unpublished War Diary, WL RAMC/739/7. Kaye (17 April 1916), Unpublished War Diary, WL RAMC/739/7. Johannes M.W. Binneveld, From Shell Shock to Combat Stress: A Comparative History of Military Psychiatry, trans. John O’Kane (Amsterdam: Amsterdam University Press, 1997), 116. Bruna Bianchi, ‘Psychiatrists, Soldiers, and Officers in Italy during the Great War’, in Traumatic Pasts: History, Psychiatry and Trauma in the Modern Age, 1870–1930, ed. Mark S. Micale and Paul Lerner (Cambridge: Cambridge University Press, 2001), 231. Cooter, ‘Medicine in War’, 344. Kaye (1 August 1915), Unpublished War Diary. WL RAMC/739/5. Fiona Reid, ‘Post Traumatic Stress Disorder’, in Twentieth Century War and Conflict: A Concise Encyclopaedia, ed. Gordon Martel (Chichester: Wiley Blackwell, 2015), 144–54. Erich Maria Remarque, All Quiet on the Western Front (London: Vintage, 1996) (first published in 1929), 2776, Kindle.

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46 Christopher R.W. Nevinson, Paint and Prejudice (Boston: Quinn and Boden, 1938), 98–99. 47 Emile Galtier-Boissière, Larousse Médicale Illustré de Guerre (Paris: Larousse, 1917), 99. 48 Peppiette (23 June 1916), Unpublished War Diary. Peppiette’s war diary is held by his family. My thanks go to Bridget Taylor for providing me with access. 49 Sieur, ‘The Tribulations of the Medical Corps of the French Army from Its Origin to Our Own Time’, 847. 50 Peppiette (22 July 1916), Unpublished War Diary. 51 Kaye (13 September 1915), Unpublished War Diary. WL RAMC/739/5. 52 Charles Henderson Melville, Military Hygiene and Sanitation (London: Arnold, 1912), 290. 53 Ward Muir, ed., Happy though Wounded: The Book of the 3rd London General Hospital (London: Country Life, 1917), 87. 54 The Lead-Swinger: The Bivouac Journal of the 1/3 West Riding Field Ambulance (27 November 1915) (Sheffield: J.W. Northend, 1916), 3. WL MS.8095. 55 Ernst Thälmann, Unpublished War Diary (25 May 1917), Stiftung Archiv der Partei und Massenorganisationen der DDR, Federal Archives, Berlin, Nachlaß NL 4003/2. 56 Nevinson, Paint and Prejudice, 110. 57 Ibid., 111. 58 Léon Werth, Clavel Soldat (Paris: Viviane Hamy, 2006) (first published in 1917), 82. 59 Remarque, All Quiet on the Western Front, 2974. 60 Oskar Maria Graf, Prisoners All (New York: A.A. Knopf, 1928), 156. 61 Paul Lerner, Hysterical Men: War, Psychiatry and the Politics of Trauma in Germany, 1890–1930 (Ithaca and London: Cornell University Press, 2003), 194. 62 Leo van Bergen, ‘The Alleged Goodness of War for Medicine’, unpublished paper distributed to the Medical History of the First World War Network (February 2016). 63 Richard A. Gabriel, Between Flesh and Steel: A History of Military Medicine from the Middle Ages to the War in Afghanistan (Virginia: Potomac Books, 2013), 194. 64 Remarque, All Quiet on the Western Front, 224 65 Ellen Newbold La Motte, ‘La Patrie Reconnaissante’ in The Backwash of War (New York and London: The Knickerbocker Press, 1916), 17–34. 66 Laurie Rowntree, ‘A Nightmare’ by Laurie Rowntree, 1916. Account of service with the FAU (Dunkirk & York)’. Library of the Society of Friends, London (hereafter LSF) Temp MSS 636, 3. 67 D. Smith, ‘“Massage”. Vigorous Young Women at Work’, Daily Mail, 30 July 1917, 4. 68 A.G. Bliss, Postcards (1916). Reproduced with the permission of The Chartered Society of Physiotherapy. Wellcome Library, London. 69 For more on massage and perceptions of brutality see Ana Carden-Coyne, ‘Painful Bodies and Brutal Women: Remedial Massage, Gender Relations and Cultural Agency in Military Hospitals, 1914–18’, Journal of War and Culture Studies 1, no.2 (2008): 139–58.

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70 Kaye (6 August 1915), Unpublished War Diary. WL RAMC/739/5. 71 Ibid. 72 Poliu denotes hairy, i.e. unshaven and unkempt (as soldiers often were in the trenches), but it also has a longer association which links hair with strength and virility, redolent of the way that, as in the Bible, Samson’s strength was linked to his hair. 73 The term Kamarad should be understood as ‘old soldier’ rather like the British ‘Old Comrades’ Association’; it does not have the highly politicized left-wing connotations of ‘comrade’. With thanks to Ralf Hoffrogge for his comments here. 74 Jay Winter, ‘Introduction to A Reckoning: Costs and Outcomes’, in The Cambridge History of the First World War, Vol. III: Civil Society, ed. Jay Winter (Cambridge: Cambridge University Press, 2013), 560. 75 Galtier-Boissière, Larousse Médicale Illustré de Guerre, 302. 76 For a detailed account of soldiers’ pain, wounded men and their cultural agency see Carden-Coyne, The Politics of Wounds. 77 For a broader history of coping strategies in the trenches see Alexander Watson, Enduring the Great War: Combat, Morale and Collapse in the German and British Armies, 1914–1918 (Cambridge: Cambridge University Press, 2008). 78 David Welch, ‘August 1914: Public Opinion and the Crisis’, in A Companion to Europe: 1900–1945, ed. Gordon Martel (London: Wiley-Blackwell, 2011), 200; from Jean de Bloch (Ivan Bliokh), La Guerre (6 vols., Paris, 1898) and cited in Sandi E. Cooper, ‘Pacifism in France, 1891–1914: International Peace as a Human Right’, French Historical Studies 17, no. 2 (Autumn 1991): 364. 79 Bernd Ulrich and Benjamin Ziemann, eds, German Soldiers in the Great War: Letters and Eyewitness Accounts, trans. Christine Brocks (Yorkshire: Pen and Sword, 2010), 20. 80 Daniel Messelken, ‘Physicians at War: Betraying a Pacifist Medical Ethos?’ Zurich Open Repository and Archive, University of Zurich (2013): 379–400. http://dx.doi.org/10.5167/uzh-78221 (accessed 29 March 2016). 81 IWM, online collection, www.iwm.org.uk/collections/item/object/17053 (accessed 29 March 2016). 82 Peter Barham, Forgotten Lunatics of the Great War (New Haven and London: Yale University Press, 2004), 389. 83 The Lead-Swinger (Christmas edition, 1915), WL MS.8095.1. 84 Philip Gross, ‘What did you do?’ in Deep Fields (Northumberland: Bloodaxe Books, 2011), 30. With many thanks to Professor Philip Gross.

Chapter 2 1

Capt. A. Attwater cited in James Churchill Dunn, ed., The War the Infantry Knew, 1914–1919 (London: Abacus, 1987) (first published in 1938), 134. 2 Werth, Clavel Soldat, 59. 3 Cay-Rüdiger Prüll, ‘Pathology at War, 1914–1918: Germany and Britain in Comparison’, in Medicine and Modern Warfare, ed. Cooter, Harrison and Sturdy, 145; Frederic Manning, Her Privates We. The Middle Parts of Fortune:

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Somme and Ancre, 1916 (CreateSpace Independent Publishing Platform, 2013) (first published in 1929), 153, Kindle; for the soldiers’ fears of living without a ‘whole skin’ see Wendy J. Gagen, ‘Remastering the Body, Renegotiating Gender: Physical Disability and Masculinity during the First World War’, European Review of History 14, no. 4 (2007): 525–42. 4 For a graphic account of combat in the First World War see Stéphane AudoinRouzeau, ‘Combat’, in A Companion to World War One, ed. John Horne (Chichester: Wiley-Blackwell, 2012), 173–87. 5 Paul Maze, A Frenchman in Khaki (Uckfield: The Naval and Military Press, 2004) (first published in 1934), 168. 6 Keegan, The Face of Battle, 264. 7 Denis Winter, Death’s Men: Soldiers of the Great War (London: Penguin, 1979), 209–10; Stephen Kurt Westman, Surgeon with the Kaiser’s Army (London: William Kimber, 1968), 57; Audoin-Rouzeau, ‘Combat’, 177. 8 Keegan, Face of Battle, 265. 9 William Osler, ‘“An Address on Science and War” delivered at the University of Leeds Medical School, 1 October 1915’, Lancet 2, no. 4806 (9 October 1915): 799. 10 Ibid., 799. 11 Ibid., 810. 12 La Motte, ‘Alone’, in The Backwash of War, 62. 13 Stéphane Audoin-Rouzeau and Annette Becker, Understanding the Great War, 14–18 (New York: Hill and Wang, 2000), 23; Sophie Delaporte, ‘Military Medicine’, in A Companion to World War One, ed. Horne, 296. 14 Ernst Jünger, Storm of Steel (London: Penguin, 2004) (first published in 1920), 288. 15 Henry Potter cited in Lyn MacDonald, The Roses of No Man’s Land (London: Penguin, 1993), 198. 16 Robert W. Whalen, Bitter Wounds: German Victims of the Great War, 1914– 1939 (Ithaca and London: Cornell University Press, 1984), 40. 17 Philip Gibbs, The Realities of War (London: William Heinemann, 1920), 52. 18 Christopher Hamlin, ‘Public Health’, in The Oxford Handbook of the History of Medicine, ed. Jackson, 417. 19 Paul Weindling, ‘The Modernization of Charity in Nineteenth Century France and Germany’, in Medicine and Charity before the Welfare State, ed. Jonathan Barry and Colin Jones (London: Routledge, 1991), 190–206. 20 Whalen, Bitter Wounds, 61. 21 Hilary Marland, ‘The Function and Malfunction of Mutual Aid Societies in Nineteenth Century France’, in Medicine and Charity before the Welfare State, ed. Barry and Jones, 172–89. 22 Philip Nord, ‘The Welfare State in France, 1870–1914’, French Historical Studies 18, no. 3 (1994): 834. 23 Martin Gorsky, ‘The Political Economy of Health Care in the Nineteenth and Twentieth Centuries’, in The Oxford Handbook of the History of Medicine, ed. Jackson, 434; Jane Lewis, ‘Medicine, Politics and the State’, Western Medicine: An Illustrated History, ed. Irvine Louden (Oxford; New York: Oxford University Press, 1997), 277–90. 24 Leo van Bergen, ‘Military Medicine’, in The Cambridge History of the First World War, ed. Winter, 299.

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25 Lord Moran, The Anatomy of Courage (London: Constable, 1945), xx–xi. Charles McMoran Wilson (1882–1977) served as a medical officer in the RAMC during the war. In 1943 he became Baron Moran of Manton and it is under this name that he wrote Anatomy of Courage, largely based on his experiences of the 1914–1918 war. 26 Gabriel and Metz, History of Military Medicine, 143–213. 27 Ibid., 238–89. 28 Susanne Michl, ‘Mapping the War: Gender, Health, and the Medical Profession in France and Germany, 1914–1918’, Medicine, Conflict and Survival 30, no. 4 (2014): 276–94. 29 William G. MacPherson, ed., History of the Great War: Medical Services, General History, Vol. I (London: His Majesty’s Stationery Office, 1924), 9. 30 Garrison, Notes on the History of Military Medicine, 195. 31 Arthur Hurst, A Twentieth Century Physician: Being the Reminiscences of Sir Arthur Hurst DM, FRCP (London: Edward Arnold and Co., 1949), 130. 32 MacPherson, ed., History of the Great War, 44–45. 33 ‘Science and the National Service’, Lancet 2, no. 4854 (9 September 1916): 481. 34 ‘La Science n’a pas de patrie mais le savant en a une’, for a discussion see JeanYves Le Naour, Les Soldats de la Honte (Paris: Perrin, 2011), 31–42. 35 Andrew MacPhail, ‘The Cavendish Lecture’, Lancet 1, no. 4896 (30 June 1917): 979–84. 36 Westman, Surgeon with the Kaiser’s Army, 43. 37 MacPherson, ed., History of the Great War, 31. 38 Ibid., 31. 39 Ibid., 56. 40 Warwick Deeping, No Hero This (London: Cassell, 1936), 11. 41 B. West (10 October 1914), Unpublished War Diary. IWM, PP/MCR/335; The Lead-Swinger (27 November 1915), 29. WL MS.8095.1. 42 MacPherson, ed., History of the Great War, 46. 43 The popular belief that Prussia (or Germany) was a militaristic state whereas Britain was an essentially liberal one has long been challenged. See Harrison, ‘Medicine and the Management of Modern Warfare’, 1–27. 44 Hurst, A Twentieth Century Physician, 32. 45 MacPherson, ed., History of the Great War, 33. 46 For the ideological and practical reasons behind voluntary care see Reznick, Healing the Nation, especially chapter 2. 47 Gabriel and Metz, History of Military Medicine, 126. 48 Personal communication with Dible’s family; for Larrey’s memoirs see Dominique Jean Larrey, Mémoires de Chirurgie Militaires et Campagnes (Paris: J. Smith, 1817), https://openlibrary.org/books/OL20580766M/ M%C3%A9moires_de_chirurgie_militaire_et_campagnes_de_D._J._Larrey_… (accessed 29 March 2016). 49 For a history detailing the many flaws of the French military-medical services see Sieur, ‘The Tribulations of the Medical Corps of the French Army from Its Origin to Our Own Time’, 843–56. 50 Garrison, Notes on the History of Military Medicine, 195; Galtier-Boissière, Larousse Médicale Illustré de Guerre, 301. 51 Garrison, Notes on the History of Military Medicine, 195.

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52 Jim Beach, ed., The Diary of Corporal Vince Schürhoff, 1914–1918 (Stroud: The History Press for the Army Records Society, 2015), 260. 53 Pierre Hillemand, Journal d’un Médecin sur les Deux Guerres Mondiales (Paris: Fiacre 2013), 59. 54 Ibid., 80. 55 Nevinson, Paint and Prejudice, 96. 56 Sheahan cited in MacDonald, Roses of No Man’s Land, 135–36. 57 Sieur, ‘The Tribulations of the Medical Corps of the French Army from Its Origin to Our Own Time’, 844. 58 Julie Anderson and Heather R. Perry, ‘Rehabilitation and Restoration: Orthopaedics and Disabled Soldiers in Germany and Britain in the First World War’, Medicine, Conflict and Survival 30, no. 4 (2014): 229. 59 Richard Bessel, ‘Mobilizing German Society for War’, in Great War, Total War: Combat and Mobilization on the Western Front, 1914–1918, ed. Roger Chickering and Stig Förster (Cambridge: Cambridge University Press, 2000), 437–51. 60 Garrison, Notes on the History of Military Medicine, 195; Paul Weindling, Health, Race and German Politics between National Unification and Nazism, 1870–1945 (Cambridge: Cambridge University Press, 1989), 283. 61 Westman, Surgeon with the Kaiser’s Army, 28. 62 Ian R. Whitehead, ‘The British Medical Officer on the Western Front: The Training of Doctors for War’, in Medicine and Modern Warfare, ed. Cooter, Harrison and Sturdy, 164. 63 Garrison, Notes on the History of Military Medicine, 195–96. 64 Jean H. Quataert, ‘Women’s Wartime under the Cross: Patriotic Communities in Germany, 1912–1918’, in Great War, Total War, ed. Chickering and Förster, 453. 65 Whalen, Bitter Wounds, 97. 66 Westman, Surgeon with the Kaiser’s Army, 47. 67 Ibid., 69. 68 Capt. Holtzapffel, ‘Amateur Soldier’ (unpublished and undated), Liddle Collection, Brotherton Library, University of Leeds (hereafter Liddle Collection) G.A. Wounds 58, 86. 69 Jünger, Storm of Steel, 210. 70 Lieut. H. Sulzbach cited in MacDonald, Roses of No Man’s Land, 275. 71 Andreas Latzko, Men in War, trans. Adele S. Seltzer (New York: Boni and Liveright, 1918), 128–29. 72 Oh! What a Lovely War was first produced as musical theatre by Joan Littlewood in 1963; the highly acclaimed film version was produced by Richard Attenborough in 1969. Both film and stage productions remain popular and influential today. 73 Jay Winter, ‘Demography’, in A Companion to World War One, ed. Horne, 254. 74 MacDonald, Roses of No Man’s Land, 148. 75 Winter, Death’s Men, 90. 76 Jünger, Storm of Steel, 42–43. 77 Kaye (23 October 1915), Unpublished War Diary. WL RAMC/739/5. 78 Winter, Death’s Men, 92.

NOTES 79

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W.G. MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II (London: His Majesty’s Stationery Office, 1923), 266–67. 80 Edwin Campion Vaughan, Some Desperate Glory: The Diary of a Young Officer, 1917 (Barnsley: Pen & Sword, 2010), 150–51. 81 Harold Dearden, Medicine and Duty: A War Diary (London: William Heinemann Ltd., 1928), 38. 82 Whalen, Bitter Wounds, 42. 83 Vaughan, Some Desperate Glory, 23. 84 Surgeon-Major F. Arthur Davy, The Breakdown of Young Soldiers under Training Explained (Woolwich: Cattermole, 1883). WL RAMC/31. 85 MacPhail, ‘The Cavendish Lecture’, 981. 86 For contemporary accounts of the long-standing links between war and sickness see Friedrich Prinzing, Epidemics Resulting from Wars, ed. Harald Westegaard (Oxford: Clarendon, 1916); Melville, Military Hygiene and Sanitation. 87 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 2; T.J. Mitchell and G.M. Smith, Medical History of the Great War, Medical Services. Casualties and Medical Statistics of the Great War (London: His Majesty’s Stationery Office, 1931), 56. 88 Audoin-Rouzeau and Becker, Understanding the Great War, 23; van Bergen, Before My Helpless Sight, 140; Whalen, Bitter Wounds, 52. 89 Kaye (20 June 1915), Unpublished War Diary. WL RAMC/739/5. 90 Vaughan, Some Desperate Glory, 2. 91 Ibid., 7. 92 Olaf Stapledon, ‘Experiences in the Friends’ Ambulance Unit’, in We Did Not Fight: 1914–1918 Experiences of War Resisters, ed. Julian Bell (London: Cobden-Sanderson, 1935), 367. 93 Henri Barbusse, Under Fire: The Story of a Squad, trans. Fitzwater Wray (USA: Feather Trail Press, 2009) (first published in 1917), 13. 94 Werth consistently refers to soldiers as ‘les ouvriers de la boue’ (mud workers) in Clavel Soldat. 95 Jünger, Storm of Steel, 44. 96 van Bergen, Before My Helpless Sight, 141. 97 Charles Edmonds Carrington, Soldiers from the War Returning (Barnsley: Pen & Sword, 2006) (first published in 1965), 130. 98 Vaughan, Some Desperate Glory, 35. 99 Robert Graves, Goodbye to All That (London: Penguin Classics, 2000) (first published in 1929), 1595, Kindle. 100 Paul Fussell, The Great War and Modern Memory (New York and London: Oxford University Press, 1975), 49. 101 See, for example, www.worldwar1postcards.com/chatting.php (accessed 29 March 2016). 102 Hans Herbert Grimm, Schlump: Tales and Adventures from the Life of the Anonymous Soldier Emil Schulz, known as ‘Schlump’. Narrated by himself, trans. Jamie Bulloch (London: Vintage, 2013) (first published in 1928), 92. 103 van Bergen, Before My Helpless Sight, 142.

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104 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 81. 105 ‘Trench Fever’, British Medical Journal 2, no. 3021 (23 November 1918): 577–78. 106 Arthur Hurst, Medical Diseases of the War (London: Arnold, 1918), 183. 107 ‘Trench Fever’, 577. 108 Hurst, Medical Diseases, 187. 109 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 371. 110 Kaye (22–25 June 1915), Unpublished War Diary. WL RAMC/739/545. 111 Kaye (22 June 1915), Unpublished War Diary. WL RAMC/739/5. 112 Remarque, All Quiet on the Western Front, 155. 113 For scathing criticism of the ahistorical horror of the trenches see Gordon Corrigan, Mud, Blood and Poppycock: Britain and the First World War (London: Cassell Military, 2004) especially chapter 3. 114 Kaye (23 July 1915), Unpublished War Diary. WL RAMC/739/5; Gibbs, Realities of War, 100. 115 Kaye (19 June 1915), Unpublished War Diary. WL RAMC/739/5; Vaughan, Some Desperate Glory, 6. 116 Barbusse, Under Fire, 77. 117 Kit Dodsworth cited in MacDonald, Roses of No Man’s Land, 109. 118 Andy Sully, ‘I Got Trench Foot at Glastonbury’, BBC News, 23 June 2008, http://news.bbc.co.uk/1/hi/magazine/7450410.stm (accessed 29 March 2016). 119 Arnold Zweig, The Case of Sergeant Grischa, trans. Eric Sutton (London: Viking Press, 1928), 10. 120 Rowntree, ‘A Nightmare’, LSF Temp MSS 636, 10. 121 ‘Need for High Boots’, Daily Mail, 9 December 1915. 122 Stephen Bull, ed., An Officer’s Manual of the Western Front, 1914–1918 (London: Conway, 2008), 6. 123 Kaye (2 October 1915), Unpublished War Diary. WL RAMC/739/5. 124 Kathleen Yarwood cited in MacDonald, Roses of No Man’s Land, 197–98. 125 T.M. Lewis, Soldier’s Small Book (Army Form B50) (undated), National Army Museum, London, NAM 1982-04-795, 17. 126 Bull, ed., An Officer’s Manual of the Western Front, 63–64. 127 Anthony Bowlby (31 December 1914), Unpublished War Diary. WL RAMC/ GC/181. 128 Bowlby (18 February 1915), Unpublished War Diary. WL RAMC/ GC/181. 129 Kaye (2 October 1915), Unpublished War Diary. WL RAMC/739/5. 130 William and Charles Ewart, ‘The Trench Foot-Warmer’, Lancet 1, no. 4819 (8 January 1916): 103–4. 131 E.M. Butcher, ‘Trench Foot’, Daily Mail, 28 December 1915. 132 ‘Puttees Condemned: Part Cause of Trench Foot’, Daily Mail, 10 December 1915. 133 Bowlby (22 November 1915), Unpublished War Diary. WL RAMC/ GC/181. 134 Bowlby (21 February 1915), Unpublished War Diary. WL RAMC/ GC/181. 135 Galtier-Boissière, Larousse Médicale Illustré de Guerre, 113. 136 van Bergen, Before My Helpless Sight, 146.

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137 ‘Prevention of Trench Foot’, The Times, 10 December 1915; Dunn, The War the Infantry Knew, 172. 138 Edmund Blunden, Undertones of War (London: Penguin, 2000) (first published in 1928), 3930, Kindle. 139 Graves, Goodbye to All That, 2659–70. 140 ‘New Muscles for Old: Achievements of the Military Hospitals’, The Times, 14 August 1916. 141 Hew Strachan, The First World War (London: Simon and Schuster, 2003), 160. 142 Evelyn Blücher, An English Wife in Berlin (New York: E.P. Dutton and Co., 1920), 73. 143 Werth, Clavel Soldat, 91. 144 Westman, Surgeon with the Kaiser’s Army, 158. 145 Jünger, Storm of Steel, 92. 146 Fussell, Great War and Modern Memory, 41. 147 For a full collection of Bairnsfather’s cartoons see www.brucebairnsfather. org.uk/index.htm (accessed 29 August 2016). 148 MacPherson, ed., History of the Great War, 165. 149 Frank Dunham, The Long Carry, ed. R.W. Haigh and P.W. Turner (Oxford: Pergamon Press, 1970), 45. 150 Westman, Surgeon with the Kaiser’s Army, 97. 151 Philip Witkop, ed., German Students’ War Letters, trans. A.F. Wedd (First Pine Street Books, University of Pennsylvania Press, 2002) (first published in 1929), 373. 152 Barbusse, Under Fire, 128. 153 Kaye (13 July 1915), Unpublished War Diary. WL RAMC/739/5. 154 Maze, Frenchman in Khaki, 141–68. 155 Dunham, The Long Carry, 19; for a lively history of stretcher bearers in the British army during the war see Emily Mayhew, Wounded: From Battlefield to Blighty, 1914–1918 (London: Vintage, 2014). 156 Bull, ed., An Officer’s Manual of the Western Front, 45. 157 Bowlby (18 September 1915), Unpublished War Diary. WL RAMC/ GC/181. 158 MacPherson, ed., History of the Great War, 54. 159 Ibid., 110. 160 Ibid., 110. 161 H. Deglane, C.-R. Coppin and J. Camus, Le Grand Palais pendant la guerre (1914–1915–1916) (Paris: Fournier, 1916). For images see Le Centre Canadien d’Architecture, www.cca.qc.ca/fr/collection/1412-le-grand-palaispendant-la-premiere-guerre-mondiale (accessed 29 March 2016). 162 Barbusse, Under Fire, 146–47. 163 Bowlby (15 June 1916), Unpublished War Diary. WL RAMC/ GC/181. 164 ‘The War. The French Army Medical Service: Recruitment, Organization and Work’, British Medical Journal 1, no. 2941 (12 May 1917): 627–28. 165 Delaporte, Les Gueules Cassées, 51. 166 Whalen, Bitter Wounds, 54. 167 Westman, Surgeon with the Kaiser’s Army, 69–71. 168 Whalen, Bitter Wounds, 54. 169 van Bergen, ‘Military Medicine’, 295–96. 170 Whalen, Bitter Wounds, 54.

212

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171 For comments on the champ d’honneur of the nineteenth-century French battlefield and the boucherie of the trenches see Audoin-Rouzeau, ‘Combat’, 185. 172 Donald Hankey, A Student in Arms (London: Andrew Melrose Ltd., 1916), 264–65. 173 John Blacker, ed., Have You Forgotten Yet? The First World War Memoirs of CP Blacker, MC, GM (London: Leo Cooper, 2000), 261. 174 Ibid., 265–70. 175 Jünger, Storm of Steel, 255. 176 For a critical assessment of the concept of the ‘golden hour’ see E. Brooke Lerner, ‘“The Golden Hour”: Scientific Fact or Medical “Urban Legend”?’ Academic Emergency Medicine 8, no. 7 (2009): 258–60. 177 La Motte, ‘La Patrie Reconnaisante’, in The Backwash of War, 181. French soldiers used the pejorative term embusqué to describe a man who was avoiding military service by finding a safe role for himself. It was usually directed at those in government offices but was sometimes directed at medical staff too. 178 Keegan, Face of Battle, 269. 179 H. Oxley (29 September 1918) (recorded 1975) IWM, Sound Archive, Acc. 716/8, reel 7. 180 Remarque, All Quiet on the Western Front, 2605. 181 van Bergen, Before My Helpless Sight, 335–36. 182 Kaye (1 November 1915), Unpublished War Diary. WL RAMC/739/7. 183 Leslie Buswell, Ambulance No. 10 (Boston and New York: Houghton Mifflin Company, 1916), 23. 184 Maze, Frenchman in Khaki, 65; MacDonald, Roses of No Man’s Land, 10. 185 van Bergen, Before My Helpless Sight, 289. 186 Westman, Surgeon with the Kaiser’s Army, 82. 187 Ibid., 82.

Chapter 3 1 Melville, Military Hygiene and Sanitation, 8. 2 Robert Nye, Masculinity and Male Codes of Honor in Modern France (New York; Oxford: Oxford University Press, 1993). 3 H.C. Fischer and E.X. Dubois, Sexual Life during the World War (London: Francis Aldor, 1937), 166. 4 For a full discussion of this film and questions of memory and remembrance see Jay Winter, Sites of Memory, Sites of Mourning (Cambridge: Cambridge University Press, 1995), 5–7. 5 Jean-Jacques Becker, ‘War Aims and Neutrality’, in A Companion to World War One, ed. Horne, 244. 6 Freeman cited in Hurst, Medical Diseases of the War, 310. 7 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 242. 8 van Bergen, Before My Helpless Sight, 188. 9 Simon Robbins, ed., The First World War Letters of General Lord Horne (Stroud: History Press for the Army Records Society, 2009), 105.

NOTES

213

10 Organisation for the Prohibition of Chemical Weapons, ‘Genesis and Historical Development’, www.opcw.org/chemical-weapons-convention/ genesis-and-historical-development (accessed 29 August 2016). 11 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 243; Hurst, Medical Diseases, 308. 12 Westman, Surgeon with the Kaiser’s Army, 119. 13 Arthur Schuster, ‘A Presidential Address on the Common Aims of Science and Humanity’, Lancet 2, no. 4802 (11 September 1915): 592. 14 Blücher, English Wife in Berlin, 88. 15 MacDonald, Roses of No Man’s Land, 80. 16 Ibid., 81. 17 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 292. 18 Ibid., 363. 19 Ibid., 251. 20 Christine E. Hallett, ‘“This Fiendish Mode of Warfare”: Nursing the Victims of Gas Poisoning in the First World War’, in One Hundred Years of Wartime Nursing Practices, 1854–1953, ed. Jane Brooks and Christine E. Hallett (Manchester: Manchester University Press, 2015), 85; Elliott T. Glenny and Henry W. Kaye (30 April 1916) ‘Notes and Observations on Cases of Asphyxia caused by an Enemy Gas Attack’, WL RAMC/739/11/4. 21 Bowlby (2 May 1915), Unpublished War Diary. WL RAMC/ GC/181. 22 Jünger, Storm of Steel, 81. 23 Hurst, Medical Diseases, 309. 24 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 425. 25 Ibid., 433. 26 MacDonald, Roses of No Man’s Land, 280. 27 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 469. 28 Winter, Death’s Men, 121. 29 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 271. 30 Glenny and Kaye (30 April 1916) ‘Notes and Observations on Cases of Asphyxia caused by an Enemy Gas Attack’, WL RAMC/739/11/4. 31 Bull, ed., An Officer’s Manual of the Western Front, 1914–1918, 140–41. 32 Westman, Surgeon with the Kaiser’s Army, 124. 33 Blunden, Undertones of War, 3871. 34 Graves, Goodbye to All That, 1456. 35 J.H. Newton (13 September 1917), A Stretcher Bearer’s Diary: Three Years in France with the 21st Division (London: Arthur H. Stockwell, 2009) (first published in 1931), 402, Kindle; Werth, Clavel Soldat, 82. 36 Beach, ed., Diary of Corporal Vince Schürhoff, 258. 37 Jünger, Storm of Steel, 81. 38 Lord Moran (undated) ‘Handwritten Notes for Book on Shell Shock, Including Other People’s Writing’, WL RAMC /PP/CMW/I3/1, 14. 39 Jünger, Storm of Steel, 79. 40 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 276.

214

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41 Ibid., 412–13. 42 Westman, Surgeon with the Kaiser’s Army, 123 43 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 452. 44 Winter, Death’s Men, 122. 45 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 475. 46 Ibid., 476; Winter, Death’s Men, 121. 47 Moran, Anatomy of Courage, 187. 48 Hurst, Medical Diseases, 313. 49 Frederick W. Mott, ‘Effects of High Explosives upon the Central Nervous System’, Lancet 1, no. 4824 (12 February 1916): 331. 50 Bull, ed., An Officer’s Manual of the Western Front, 1914–1918, 150. 51 MacPherson et al., eds, History of the Great War: Medical Services, Diseases of the War, Vol. II, 274; Garrison, Notes on the History of Military Medicine, 200. 52 van Bergen, Before My Helpless Sight, 176. 53 Ibid., 177. 54 Winter, Death’s Men, 121–25. 55 van Bergen, Before My Helpless Sight, 176. 56 Osler, ‘An Address on Science and War’, 798. 57 Bowlby (2 June 1916), Unpublished War Diary. WL RAMC/ GC/181. 58 Barbusse, Under Fire, 115. 59 Organisation for the Prohibition of Chemical Weapons, ‘Genesis and Historical Development’, www.opcw.org/chemical-weapons-convention/ genesis-and-historical-development (accessed 29 August 2016). 60 Richard G. Rows, ‘Mental Conditions Following Strain and Nerve Shock’, British Medical Journal 1, no. 2882 (25 March 1916): 442. 61 Martin Stone, ‘Shellshock and the Psychologists’, in The Anatomy of Madness: Essays in the History of Psychiatry, Vol. II. ed. William F. Bynum, Roy Porter and Michael Shepherd (London: Tavistock Publications 1985); Paul Lerner, ‘From Traumatic Neurosis to Male Hysteria: The Decline and Fall of Herbert Oppenheim, 1889–1919’, in Traumatic Pasts: History, Psychiatry and Trauma in the Modern Age, 1870–1930, ed. Mark S. Micale and Paul Lerner (Cambridge: Cambridge University Press, 2001), 141; Jason Crouthamel, ‘“The Nation’s Leading Whiner”: Visions of the National Community from the Perspective of Mentally Traumatized Veterans’, in War, Trauma and Medicine in Germany and Central Europe, ed. Hofer, Prüll and Eckart, 75; Marc Roudebush, ‘A Battle of Nerves: Hysteria and its Treatments in France during World War I’, in Traumatic Pasts, ed. Micale and Lerner, 254. 62 Harrison, The Medical War, 110. 63 Moran, Anatomy of Courage, 21. 64 Gabriel and Metz, History of Military Medicine, 236–38. 65 Naour, Les Soldats de la Honte, 23–25. 66 Moran, Anatomy of Courage, 3. 67 ‘The War’, British Medical Journal 2, no. 2814 (5 December 1914): 995

NOTES

215

68 J.H. Dible (12 January 1915), ‘First World War Account of Captain James Henry Dible, RAMC, 1914–1918’, IWM, London, Con Shelf. 69 Christopher Addison, Preface to F. Mott, War Neuroses and Shell Shock (London: H. Frowde; Hodder & Stoughton, 1919), viii. 70 Anton Kaes, Shell Shock Cinema: Weimar Culture and the Wounds of War (Princeton and Oxford: Princeton University Press, 2011), 39; Hans-Georg Hofer and Cay-Rüdiger Prüll, ‘Reassessing War, Trauma, and Medicine in Germany and Central Europe (1914–1939)’, in War, Trauma and Medicine in Germany and Central Europe, ed. Hofer, Prüll and Eckart, 18. 71 Thomas, Treating the Trauma of the Great War, 25; Naour, Les Soldats de la Honte, 64. 72 Emanuel Miller, The Neuroses in War (London: MacMillan, 1940), 127. 73 Charles Samuel Myers, ‘A Contribution to the Study of Shell Shock Being an Account of Three Cases of Loss of Memory, Vision, Smell and Taste, Admitted to Duchess of Westminster War Hospital, Le Touquet’, Lancet 1, no. 4772 (13 February 1915): 316–20; Naour, Les Soldats de la Honte, 26. 74 ‘“Nerve Shock” in War’, British Medical Journal 2, no. 2845 (10 July 1915): 64. 75 Annette Becker, ‘Guerre Totale et Troubles Mentaux’, Annales: Histoire, Sciences Sociales 55, no.1 (2000): 149; Max Nonne cited in Lerner, Hysterical Men, 20. 76 Joanna Bourke, ‘Effeminacy, Ethnicity and the End of Trauma: The Sufferings of “Shell Shocked” Men in Great Britain and Ireland, 1914–1939’, Journal of Contemporary History 35, no.1 (2000):60–62; Thomas, Treating the Trauma of the Great War, 64–65; Fiona Reid, ‘War Psychiatry’, in 1914–1918 Online: International Encyclopedia of the First World War (Berlin: Freie Universität Berlin, 2014), doi: http://dx.doi.org/10.15463/ie1418.10288 (accessed 29 March 2016). 77 Naour, Les Soldats de la Honte, 28; Thomas, Treating the Trauma of the Great War, 33; Laurent Tatu and Julien Bogousslavsky, La Folie au Front: La Grande Bataille des Névroses de Guerre (1914–1918) (Paris: Editions Imago, 2012), 172. 78 ‘Parliamentary Intelligence on the Treatment of Nerve-Shaken Soldiers’, Lancet 2, no. 4796 (31 July 1915): 261. 79 Frederick W. Mott, ‘The Lettsomian Lecture (I) on the Effects of High Explosives upon the Central Nervous System’, Lancet 1, no. 4824 (12 February 1916): 331–38; Mott, ‘Lettsomian Lecture (II)’, Lancet 1, no. 4826 (26 February 1916): 441–49; Mott, ‘Lettsomian Lecture (III)’, Lancet 1, no. 4829 (11 March 1916): 545–53; Charles S. Myers, ‘Contributions to the Study of Shell Shock: Being an Account of Certain Cases Treated by Hypnosis’, Lancet 1, no. 4819 (8 January 1916): 65–69; Myers, ‘Contributions to the Study of Shell Shock: Being an Account of Certain Cases of Cutaneous Sensibility’, Lancet 1, no. 4829 (18 March 1916): 608–13. 80 For the range of French diagnostic categories see Thomas, Treating the Trauma of the Great War, 51–61. 81 Devaux and Logre cited in Susanne Michl, ‘Mapping the War: Gender, Health, and the Medical Profession in France and Germany, 1914–1918’, Medicine, Conflict and Survival 30, no. 4 (2014): 284.

216

82

NOTES

Edgar Jones and Simon Wessely, Shell Shock to PTSD. Military Psychiatry from 1900 to the Gulf War Shell Shock (Hove: Psychology Press, 2005), 14. 83 Leonard V. Smith, The Embattled Self: French Soldiers’ Testimony of the Great War (Ithaca: Cornell University Press, 2007), 32; ‘The War: German Experiences: Neurasthenia among Soldiers’, British Medical Journal 1, no. 2882 (25 March 1916): 464–65. 84 Fiona Reid and Christine Van Everbroeck, ‘Shell Shock and the Kloppe: War Neuroses amongst British and Belgian Troops during and after the First World War’, Medicine Conflict and Survival 30, no. 4 (December 2014): 262. 85 Lerner, Hysterical Men, 228–29; Stefanie C. Linden and Edgar Jones, ‘German Battle Casualties: The Treatment of Functional Somatic Disorders during World War I’, Journal of the History of Medicine and Allied Sciences 68, no. 4 (2012): 628. 86 Lord Moran (undated) ‘Handwritten Notes for Book on Shell Shock’, WL PP/CMW/I3/1, 2. 87 Naour, Les Soldats de la Honte, 14–15. 88 Wolfgang U. Eckart, ‘Maltreated Bodies and Harrowed Souls of the Great War: The Perpetration of Psychiatry upon the War Wounded’, in War, Trauma and Medicine in Germany and Central Europe, ed. Hofer, Prüll and Eckart, 99 89 ‘Man Who Begins Life Again: Soldier’s New Self after Shell Shock’, Daily Mail, 10 July 1915. 90 John MacCurdy, War Neuroses (Cambridge: Cambridge University Press, 1918), 6. 91 Ibid., 87. 92 Ibid., 89. 93 Frederick W. Mott, ‘War Neuroses’, British Medical Journal 1, no. 3041 (12 April 1919): 439–42; MacCurdy, War Neuroses, 107. 94 MacCurdy, War Neuroses, 88. 95 Ibid., 90. 96 For a full discussion of the social construction of war neuroses see Allan Young, The Harmony of Illusions: Inventing Post-Traumatic Stress Disorder (Princeton, NJ and Chichester: Princeton University Press, 1995). 97 Charles S. Myers, Shell Shock in France, 1914–1918 Based on a War Diary Kept by Charles Myers CBE FRS Temporary Lieut. Col, RAMC Sometime Consulting Psychologist to the British Armies in France (Cambridge: Cambridge University Press, 1940), 90–92. 98 Ibid., 39. 99 E.T.C. Milligan, ‘A Method of Treatment of Shell Shock’, British Medical Journal 2, no. 2898 (15 July 1916): 73–74; P.R. Cooper, Correspondence, ‘Treatment of “Shell Shock”’, British Medical Journal 2, no. 2901 (5 August 1916): 201. 100 Lerner, Hysterical Men, 88–90. 101 Roudebush, ‘A Battle of Nerves’, 253–79. 102 Gustave Roussy, ‘Hysteria’, British Medical Journal 2, no. 2850 (14 August 1915): 270. 103 ‘The War: German Experiences, Neurasthenia among Soldiers’, British Medical Journal 1, no. 2882 (25 March 1916): 464–65.

NOTES

217

104 Ibid. 105 Miller, The Neuroses in War, 124; Naour, Les Soldats de la Honte, 16; Galtier-Boissière, Larousse Médicale Illustré de Guerre, 20. 106 Petra Peckl, ‘What the Patient Records Reveal: Reassessing the Treatment of “War Neurotics” in Germany (1914–1918)’, in War, Trauma and Medicine in Germany and Central Europe, ed. Hofer, Prüll and Eckart, 139. 107 Addison, Preface to Mott, War Neuroses and Shell Shock, xi. 108 Tatu and Bogousslavsky, La Folie au Front, 105. 109 Westman, Surgeon with the Kaiser’s Army, 85. 110 For shell-shocked men in British lunatic asylums see Barham, Forgotten Lunatics of the Great War. 111 Edgar Jones, ‘Shell Shock at Maghull and the Maudsley: Models of Psychological Medicine in the UK’, Journal of the History of Medicine and Allied Sciences 65, no. 3 (2010): 375; Ben Shephard, ‘The Early Treatment of Mental Disorders’, in 150 Years of British Psychiatry, ed. Hugh Freeman and German E. Berrios (London: Athlone, 1996), 435. 112 Rows, ‘Mental Conditions Following Strain and Nerve Shock’, 441; Jones, ‘Shell Shock at Maghull and the Maudsley’, 350. 113 Rows, ‘Mental Conditions Following Strain and Nerve Shock’, 443. 114 Ibid. 115 Shephard, ‘The Early Treatment of Mental Disorders’, 443–44. 116 Arthur Hurst, ‘Cinematograph Demonstration of War Neuroses’, Proceedings of the Royal Society of Medicine (Neurol. Section) 11 (1918): 40. 117 The film is available at the Wellcome Library, London. For a full discussion of the film and Hurst’s medical approach see Edgar Jones, ‘War Neuroses and Arthur Hurst: A Pioneering Medical Film about the Treatment of Psychiatric Battle Casualties’, Journal of the History of Medicine and Allied Sciences 67, no. 3 (2012): 345–373. 118 Thomas Lumsden, ‘The Treatment of War Neuroses’, Lancet 2, no. 4959 (14 September 1918): 370–71. 119 Arthur Hurst, ‘The Pathology, Diagnosis and Treatment of Absolute Hysterical Deafness in Soldiers’, Lancet 2, no. 4910 (6 October 1917): 517–19. 120 Mott, ‘War Neuroses’, 442. 121 Naour, Les Soldats de la Honte, 109; Eckart, ‘Maltreated Bodies and Harrowed Souls of the Great War’, 106; Lerner, Hysterical Men, 115. 122 Graf, Prisoners All, 160. 123 Stefanie C. Linden, Edgar Jones and Andrew J. Lees, ‘Shell Shock at Queen Square: Lewis Yealland 100 Years On’, Brain: A Journal of Neurology 136, no. 6 (2013): 1978; Lerner, Hysterical Men, 104. 124 Anonymous Fleet Surgeon, RN, ‘Soldiers Dumb from Shell Shock’, Daily Mail, 14 September 1916. 125 Edwin L. Ash, ‘Massage and Medical Electricity in the After-Treatment of Convalescent Soldiers’, Lancet 1, no. 4874 (27 January 1917): 165–66. 126 Wilfrid Garton, ‘Shell Shock and Its Treatment by Cerebro-Spinal Galvanism’, British Medical Journal 2, no. 2913 (28 October 1916): 585; Garton advocated the use of electricity for a wide range of complaints,

218

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including trench foot; see Wilfrid Garton, Electro-Therapeutics for Military Hospitals (London: H.K. Lewis and Co., 1917). 127 Book review of M.D. Eder, War Shock: Psychoneuroses in War: Psychology and Treatment (London: William Heinemann, 1917) Lancet 2, no. 4918 (1 December 1917): 828. 128 Lewis Ralph Yealland, Hysterical Disorders of Warfare (London: MacMillan, 1918). 129 Ibid., 3–4. 130 Eric Leed, No Man’s Land: Combat and Identity in World War I (Cambridge: Cambridge University Press, 1979), 173. 131 Frederick W. Mott, ‘Chadwick Lecture: Mental Hygiene in Shell Shock during and after the War’, Journal of Mental Science, 63 (October 1917): 478. 132 Paul Meunier (socialist deputy) cited in Tatu and Bogousslavsky, La Folie au Front, 102. 133 ‘Our Paris Letter’, Sunday Times, 13 August 1916; Naour, Les Soldats de la Honte, 17. 134 Tatu and Bogousslavsky, La Folie au Front, 94. 135 Ibid., 94. 136 Ibid., 101. 137 For discussion of the public reaction to the trial see Marc Roudebush, ‘A Patient Fights Back: Neurology in the Court of Public Opinion’, Journal of Contemporary History 35, no.1 (January 2000): 29–38. 138 Tatu and Bogousslavsky, La Folie au Front, 102–103. 139 Ibid., 118. 140 Lerner, Hysterical Men, 102. 141 Kaufmann’s approach as summarized in ‘The War: Notes from German and Austrian Medical Journals: Disciplinary Treatment of Shell Shock’, British Medical Journal 2, no. 2921 (23 December 1916). 142 Lerner, Hysterical Men, 114. 143 ‘The War: Notes from German and Austrian Medical Journals: Disciplinary Treatment of Shell Shock’, 882. 144 Lerner, Hysterical Men, 104. 145 Ibid., 111; Eckart, ‘Maltreated Bodies and Harrowed Souls of the Great War’, 108. 146 There was, however, a post-war political scandal about the use of electrotherapy in the Habsburg army. Hans-Georg Hofer, ‘Beyond Freud and Wagner-Jauregg: War, Psychiatry and the Habsburg Army’, in War, Trauma and Medicine in Germany and Central Europe, ed. Hofer, Prüll and Eckart, 49–71. 147 Schultze cited in ‘The War: Notes from German and Austrian Medical Journals: Disciplinary Treatment of Shell Shock’, 882. 148 Tatu and Bogousslavsky, La Folie au Front, 92. 149 Barker's Regeneration has also been made into a highly successful film (1997). 150 British Pathé, ‘Blighty Again – Wounded Coming Home’, 1914–1918; for a preview see www.britishpathe.com/video/blighty-again-wounded-cominghome (accessed 29 August 2016). 151 Gibbs, The Realities of War, 148.

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152 I would like to thank Leo van Bergen for his helpful advice regarding the most popular German term here. 153 Sandy Callister, ‘“Broken Gargoyles”: The Photographic Representation of Severely Wounded New Zealand Soldiers’, Social History of Medicine 20, no.1 (April 2007): 116–17; Suzannah Biernoff, ‘The Rhetoric of Disfigurement in First World War Britain’, Social History of Medicine 24, no. 3 (January 2011): 666. 154 Delaporte, Les Gueules Cassées, 30. 155 Westman, Surgeon with the Kaiser’s Army, 72. 156 MacDonald, Roses of No Man’s Land, 171–72. 157 John Amos Comenius, Orbis Pictus (London: Oxford University Press, 1968) (first published in 1670), 199. 158 Henriette Rémi, Hommes Sans Visage (Lausanne: Editions Spes S.A., 1942), 36. Note that Rémi’s book is written in French but she actually worked in a German hospital. 159 Marjorie Gehrhardt, The Men with Broken Faces: Gueules Cassées of the First World War (Bern: Peter Lang, 2015), 2. 160 Pte McGowan (January 1922) ‘My Personal Experience and Reminiscences of the Great War’, Reminiscences of six badly wounded soldiers collected by Lady Gough at Sidcup Hospital, Liddle Collection, General Aspects, Wounds, Item 34. 161 Pte McGowan (January 1922) ‘My Personal Experience and Reminiscences of the Great War’, Reminiscences of six badly wounded soldiers collected by Lady Gough at Sidcup Hospital, Liddle Collection, General Aspects, Wounds, Item 34. 162 Harold D. Gillies, Plastic Surgery of the Face: Based on Selective Cases of War Injuries of the Face Including Burns (London: H. Frowde, Hodder and Stoughton, 1920), 3–4. 163 Robert Love, Tom Brooking and Andrew Bamje, ‘Plastic Kiwis – New Zealanders and the Development of a Speciality’, Journal of Military and Veterans’ Health 17, no.1 (October 2008): 11–18. 164 van Bergen, Before My Helpless Sight, 345. 165 Hans Behrbohm, Walter Briedigkeit and Oliver Kaschke, ‘Jacques Joseph: Father of Modern Facial Plastic Surgery’, Archives of Facial Plastic Surgery 10, no. 5 (2008): 300–303. 166 Gehrhardt, The Men with Broken Faces, 69. 167 Andrew Bamji, Queen Mary’s Sidcup, 1974–1994: A Commemoration (privately published, 1994), 15. 168 Bamji, Queen Mary’s Sidcup, 15. 169 Francesca Kubicki, ‘Re-created Faces: Facial Disfigurement, Plastic Surgery, Photography and the Great War’, Photography and Culture 2, no. 2 (July 2009): 185. 170 Gillies, Plastic Surgery of the Face, Preface; Pound cited in Suzannah Biernoff, ‘Flesh Poems: Henry Tonks and the Art of Surgery’, Visual Culture in Britain 11, no.1 (March 2010): 4. 171 Gillies, Plastic Surgery of the Face, 10. 172 Hans May, ‘Erich Lexer: A Biographical Sketch’, Plastic & Reconstructive Surgery 29, no. 2 (February 1962): 141. 173 Gillies, Plastic Surgery of the Face, 6.

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174 Ibid., 12. 175 Ibid. 176 Ibid., 8; Louisa Young’s novel, My Dear, I Wanted to Tell You (London: Harpercollins, 2011) explores the relationship between plastic and cosmetic surgery, drawing sensitive parallels between the two. 177 Tonks cited in Biernoff, ‘Flesh Poems’, 25. 178 Biernoff, ‘Flesh Poems’, 27. 179 Gillies, Plastic Surgery of the Face, 83. 180 William Arbuthnot Lane, introduction to Gillies, Plastic Surgery of the Face, vii. 181 Ward Muir, The Happy Hospital (London: Simpkin, Marshall, Hamilton, Kent & Co Ltd, 1918), 346; Rémi, Hommes Sans Visage, 87–110. 182 Dowager Duchess of Limerick (October 1976, tape transcripts) Liddle Collection, General Aspects, Wounds, Item 216, tape 405. 183 Andrew Bamje, ‘Facial Surgery: The Patient’s Experience’, in Facing Armageddon, ed. Cecil and Liddle, 498. 184 ‘Mending the Broken Soldier: Our Debt to the Surgeon’, The Times, 12 August 1916. 185 Muir, The Happy Hospital, 150. 186 For details of Wood’s work see Sarah Crellin, ‘Hollow Men: Francis Derwent Wood’s Masks and Memorials, 1915–1925’, Sculpture Journal 6 (Fall 2001): 75. 187 ‘War Pensions: A Year’s Review’, The Times, 30 December 1924. 188 Caroline Alexander, ‘Faces of War’, Smithsonian Magazine 37, no.11 (February 2007): 72–80. 189 See www.smithsonianmag.com/videos/category/history/about-face (accessed 29 August 2016). 190 T.M.W., ‘Face-Maker at Work: Masks for the Wounded’, Daily Mail, 1 April 1916. 191 Alexander, ‘Faces of War’, 80. 192 On ‘passing’ see Sander Gilman, Creating Beauty to Cure the Soul: Race and Psychology in the Shaping of Aesthetic Surgery (Durham, NC; Duke University Press, 1998), xxxi. 193 Sigmund Freud, The Uncanny, trans. David McLintock (London: Penguin, 2003) (first published in 1919), 135; for further discussion about Freud’s concept of the uncanny in relation to facial masks see Katherine Feo, ‘Invisibility, Memory, Masks and Masculinities in the Great War’, Journal of Design History 20, no. 1 (January 2007): 17–27. 194 La Motte, ‘A Surgical Triumph’, in The Backwash of War, 158. Rémi, Hommes sans Visage, 85–86. 195 Correspondence: Sister Stratton to Mrs Evans (19 February 1916) Liddle Collection, General Aspects, Wounds, Item 232 Evans, RJJ GS 1816. 196 Correspondence: Evans to Mrs Evans (1 July 1916) Liddle Collection, General Aspects, Wounds, Item 232 Evans, RJJ GS 1816. 197 Correspondence: Evans to Mrs Evans (4 September 1916) Liddle Collection, General Aspects, Wounds, Item 232 Evans, RJJ GS 1816. 198 Correspondence: Evans to Mrs Evans (9 March 1916) Liddle Collection, General Aspects, Wounds, Item 232 Evans, RJJ GS 1816.

NOTES

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199 Correspondence: Will Evans to Evans (26 March 1916) Liddle Collection, General Aspects, Wounds, Item 232 Evans, RJJ GS 1816. 200 Correspondence: Evans to Mrs Evans (26 October 1916) Liddle Collection, General Aspects, Wounds, Item 232 Evans, RJJ GS 1816. 201 Correspondence: Evans to Mrs Evans (22 October 1917) Liddle Collection, General Aspects, Wounds, Item 232 Evans, RJJ GS 1816. 202 Rémi, Hommes Sans Visage, 106. 203 Ibid., 96. 204 Evans to Mrs Evans (1 October 1916) Liddle Collection, General Aspects, Wounds, Item 232 Evans, RJJ GS 1816. 205 Evans to Mrs Evans (7 December 1916) Liddle Collection, General Aspects, Wounds, Item 232 Evans, RJJ GS 1816. 206 Gillies, Plastic Surgery of the Face, 48. 207 Gillies Archive, Frognal Centre for Medical Studies (material provided by Dr Andrew Bamje). Case notes 19515, Gunner E.R. Butt (6 March 1919). 208 Gillies Archive, Frognal Centre for Medical Studies (material provided by Dr Andrew Bamje). Case notes 9385, Private Cullimore (8 October 1921). 209 Young, My Dear, I Wanted to Tell You, see the ‘Historical Note’. For the character who was the inspiration for the fictional Riley Purefoy see Gillies Archive, Frognal Centre for Medical Studies, Case notes 139: 168. 210 Rémi, Hommes Sans Visage, 5. For a direct psychic link between the nose and the genitalia see Gilman, Creating Beauty to Cure the Soul, 84–91. 211 Correspondence: Evans to Mrs Evans (undated, probably November– December 1916); Correspondence: Evans to Mrs Evans (undated, probably August 1916) Liddle Collection, General Aspects, Wounds, Item 232 Evans, RJJ GS 1816. 212 Rémi, Hommes Sans Visage, 83. 213 Gillies Archive, Frognal Centre for Medical Studies (material provided by Dr Andrew Bamje). Handwritten letter from David Whitehead, 21 March 2005. 214 Gillies Archive, Frognal Centre for Medical Studies (material provided by Dr Andrew Bamje). Case notes 206228, Private D. Howard, 26 December 1920. 215 The Wilfred Owen Association, www.wilfredowen.org.uk/biography/preface (accessed 29 March 2016).

Chapter 4 1

Enid Bagnold, Diary without Dates (London: Virago, 1978) (first published in 1918), 117. 2 For images of amulets worn by British soldiers see WL Images, L0057378, L0057381, L0057382, www.wellcomeimages.org (accessed 29 August 2016). 3 Jünger, Storm of Steel, 287. 4 Samuel Hynes, The Soldier’s Tale: Bearing Witness to Modern War (London: Pimlico, 1998). 5 For the enduring emotional importance of wars and their violence see Audoin-Rouzeau and Becker, 14–18: Understanding the Great War, 16–44. 6 Bagnold, Diary without Dates, 121. 7 van Bergen, Before My Helpless Sight, 170; Barbusse, Under Fire, 152.

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8

NOTES

Joanna Bourke, The Story of Pain: From Prayer to Painkillers (Oxford: Oxford University Press, 2014), 28; 22. 9 Jünger, Storm of Steel, 31. 10 Smith, The Embattled Self, 79. 11 For a considered discussion of pain and how we communicate pain see Bourke, The Story of Pain, especially chapter 2, ‘Estrangement’, 27–52. 12 Bagnold, Diary without Dates, 23. 13 Ibid., 23. 14 Mary Borden, The Forbidden Zone (London: Modern Voices, 2008) (first published in 1929), 40. 15 Ibid., 44. 16 Bagnold, Diary without Dates, 88; For the trauma of medical staff during war see Carol Acton and Jane Potter, Working in a World of Hurt: Trauma and Resilience in the Narratives of Medical Personnel in Warzones (Manchester: Manchester University Press, 2015). 17 Pte Murray (January 1922), ‘My Personal Experience and Reminiscences of the Great War’, Reminiscences of 6 badly wounded soldiers collected by Lady Gough at Sidcup Hospital, Liddle Collection, General Aspects, Wounds, Item 34. 18 Pte Faragher (January 1922), ‘My Personal Experience and Reminiscences of the Great War’, Liddle Collection, General Aspects, Wounds, Item 34. 19 Pte Murray (January 1922), ‘My Personal Experience and Reminiscences of the Great War’, Liddle Collection, General Aspects, Wounds, Item 34. 20 Charles Stanford Read, Military Psychiatry in Peace and War (London: H.K. Lewis and Co, 1920), 10–11. 21 L.J. Ownsworth (October 1976, tape transcripts) Liddle Collection, General Aspects, Wounds, Item 195, tape 370. 22 Letter from a medical student wounded in 1915, cited in Ulrich and Ziemann, eds, German Soldiers in the Great War, 71. 23 Christopher Westhorp, ed., The B.E.F. Times, 20 January 1917 in The Wipers Times: The Famous First World War Trench Newspaper (London: Conway, 2013), 164. 24 Edward Khantzian, Treating Addiction as a Human Process (Northvale, NJ: Jason Aronson, 1999). 25 Margaret A. Fetting, Perspectives on Addiction: An Integrative Treatment Model with Clinical Case Studies (Thousand Oaks: Sage 2101), especially chapter 7. 26 Niall Ferguson, The Pity of War: Explaining World War I (London: Allen Lane, 1998), 351. 27 War Office, Government Committee of Enquiry into Shell Shock (London: HMSO, 1922), 68. 28 Griesedieck (1942) cited in R.A. Dunbar-Miller, ‘Alcohol and the Fighting Man: An Historical Review’, Journal of the Royal Army Medical Corps 130, no. 1 (1984): 15. 29 Edgar Jones and Nicola Fear, ‘Alcohol Use and Misuse within the Military: A Review’, International Review of Psychiatry 23, no. 2 (2011): 166. 30 Dunbar-Miller, ‘Alcohol and the Fighting Man’, 12. 31 Werth, Clavel Soldat, 30; Hubert Lidbetter and Norman Monk-Jones, eds, SSA 14: Section Sanitaire Anglaise Quatorze, 1915–1919: An Account of

NOTES

223

the Activities in Belgium and Northern France of a Section of the Friends’ Ambulance Unit (printed for private circulation only, J. Ellis Benson: Manchester, 1919), 111. 32 Jones and Fear, ‘Alcohol Use and Misuse within the Military’, 166–67; François Cochet, ‘1914–1918: L’Alcool aux Armées: Représentations et Essai de Typologie’, Guerres Mondiales et Conflits Contemporains 2, no. 222 (2006): 21. 33 ‘Russia’s Vow of Abstinence’, The Times, 21 October 1914. 34 Werth, Clavel Soldat, 31. 35 For the long-term impact of the First World War on the regulation of alcohol and other drugs see Virginia Berridge, ‘Drugs, Alcohol and the First World War’, Lancet 384, no. 9957 (22 November 2014): 1840–41. 36 MacDonald, Roses of No Man’s Land, 160. 37 John Greenaway, Drink and British Politics since 1830: A Study in PolicyMaking (London: Palgrave MacMillan, 2003), 99. 38 Dunbar-Miller, ‘Alcohol and the Fighting Man’, 14. 39 Sara Haslam, ‘A Literary Intervention: Writing Alcohol in British Literature, 1915–1930’, First World War Studies 4, no. 2 (2013): 222; ‘No Alcohol in his Household’, Daily Mail, 2 April 1915. 40 David Lloyd George, ‘An Appeal to Labour’, Times, 1 March 1915. 41 Correspondence: R. Simpson, ‘The Rum Ration’, British Medical Journal 1, no. 2824 (13 February 1915): 316. 42 MacDonald, Roses of No Man’s Land, 278; 269. 43 Carrington, Soldier from the Wars Returning, 93. 44 Haslam, ‘A Literary Intervention’, 221. 45 Victor Horsley, ‘On the Alleged Responsibility of the Medical Profession for the Re-Introduction of the Rum Ration into the British Army’, British Medical Journal 1, no. 2882 (30 January 1915): 203–6. 46 E.B. North, Trench Standing Orders, 1915–1916 cited in Bull, ed., An Officer’s Manual of the Western Front, 1914–1918, 83. 47 Horsley, ‘On the Alleged Responsibility of the Medical Profession for the ReIntroduction of the Rum Ration into the British Army’, 203. 48 Ibid., 204. 49 Correspondence: Simpson, ‘The Rum Ration’, 316–17. 50 Graves, Goodbye to All That, 2346. 51 Correspondence: J.W. Astley Cooper, ‘The Rum Ration’, British Medical Journal 1, no. 2823 (6 February 1915): 271. 52 Horsley, ‘On the Alleged Responsibility of the Medical Profession for the ReIntroduction of the Rum Ration into the British Army’, 203. 53 Correspondence: Charles Mercier, ‘The Rum Ration’, British Medical Journal 1, no. 2828 (13 March 1915): 489. 54 Correspondence: Rawdon Wood, ‘The Rum Ration’, British Medical Journal 1, no. 2828 (13 March 1915): 490. 55 ‘The Rum Ration in the Field’, The Times, 26 March 1915. 56 Charles Horton, Stretcher Bearer! Fighting for Life in the Trenches, ed. Dale Le Vack (London: Lion Hudson, 2013), 89. 57 House of Commons Hansard, Fifth Series, Volume 85, 2684W 23 August 1916.

224

NOTES

58 Holtzapffel, ‘Amateur Soldier’, Liddle Collection, General Aspects, Wounds 58, 84. 59 Carden-Coyne, The Politics of Wounds, 152. 60 Sarah Macnaughtan, My War Experiences in Two Continents (London: John Murray, 1919), 8–10; Reginald Pound, Gillies: Surgeon Extraordinary: A Biography (London: M. Joseph, 1964), 34. 61 Harry W. Paul, Bacchic Medicine: Wine and Alcohol Remedies from Napoleon to the French Paradox (Amsterdam: New York: Rodopi, 2001), 124–34. 62 Galtier-Boissière, Larousse Médicale Illustré de Guerre, 112. 63 E.M.M. Bernthal and D. Lamb, ‘From the Trenches to the Trenchard Lines: A Comparison of Military Nursing in 1914 to 2014’, Journal of the Royal Army Medical Corps 160, no. 2 Suppl. 1 (2014): 59. 64 Sarah Howard, Les Images de l’Alcool en France, 1915–1942 (Paris: CNRS, 2006), 41. 65 ‘The Supply of Wine to the French Soldier’, Lancet 1, no. 4874 (27 January 1917): 167. 66 Ibid., 167. 67 Cochet, ‘1914–1918: L’Alcool aux Armées’, 19. 68 George, ‘An Appeal to Labour’. 69 Ernest Taylor (undated), Unpublished Diary. Library of the Society of Friends, London, Temp MSS 23/3. 70 Review of The Drink Problem of Today, ed. T.N. Kelynack (London: Methuen & Co., 1916) in Journal of the Royal Army Medical Corps 30, no. 2 (February 1918): 230–31. 71 Westhorp, ed., The B.E.F. Times, 10 April 1917 in The Wipers Times, 186. 72 L’Alcool Tue! L’Alcool Rend Fou! Le Chef d’Escadrille en Boit!! 73 Barbusse, Under Fire, 40–41; Graves, Goodbye to All That, 2584. 74 Manning, Her Privates We, 79. 75 Haslam, ‘A Literary Intervention’, 231; ‘A Teetotal War’, The Times, 26 September 1914. 76 Ernest Raymond, Tell England: A Study in a Generation (London: Cassell, 1922), 309. 77 Louis Barthas, Les Carnets de Guerre de Louis Barthas, Tonnelier, 1914–1918 (Paris: La Découverte/Poche, 2013) (first published in 1978), 124. 78 Ford Madox Ford, Parades End (London: Wordsworth Classics, 2013) (first published in 1924–26), 512. 79 Graf, Prisoners All, 124; Dunn, The War the Infantry Knew, 21. 80 Nevinson, Paint and Prejudice, 101. 81 ‘Sir George Milne Speaks Out’, 85th Magazine VIII (November 1930) (printed for private circulation). WL RAMC/761 1/9-13. 82 Barbusse, Under Fire, 76–77. 83 Manning, Her Privates We, 59. 84 C.N. Roberts and T.C. Nicholson Roberts, ‘Diary of a World War One Surgeon’, Journal of the Royal Army Medical Corps 160, no. 2 (Suppl. 1) (2014), 124–26. 85 Dunbar-Miller, ‘Alcohol and the Fighting Man’, 14. 86 Comment on paper in the Military Surgeon (April 1917) by Surgeon R.G. Heiner of the US Navy in Lancet 1, no. 4893 (9 June 1917) 881–82.

NOTES 87

225

Rachel Duffett, The Stomach for Fighting: Food and the Soldiers of the Great War (Manchester: Manchester University Press, 2012), 79; Elliston (18 January 1918) National Army Museum, London, NAM 1994-02-194. 88 Holtzapffel, ‘Amateur Soldier’, Liddle Collection, General Aspects, Wounds 58, 85. 89 Robert Roberts, The Classic Slum: Salford Life in the First Quarter of the Century (London: Penguin, 1990), 120. 90 Duffett, The Stomach for Fighting, 215. 91 Vaughan, Some Desperate Glory, 62. 92 Raymond, Tell England, 191–93. 93 Ernst Thälmann (15 September 1918), Unpublished War Diary, Stiftung Archiv der Partei und Massenorganisationen der DDR, Federal Archives, Berlin, Nachlaß NL 4003/2. 94 Vaughan, Some Desperate Glory, 232. 95 Grimm, Schlump, 125–26. 96 Kaye (1 August 1915), Unpublished War Diary. WL RAMC/739/5. 97 Manning, Her Privates We, 3. 98 For an insightful account of men’s emotional lives and their caring responsibilities in the trenches see Michael Roper, The Secret Battle: Emotional Survival in the Great War (Manchester: Manchester University Press, 2009). 99 Graf, Prisoners All, 136. 100 Peppiette (13 April 1916), Unpublished War Diary. 101 Beach, ed., Diary of Corporal Vince Schürhoff, 230; Jünger, Storm of Steel, 102. 102 Graves, Goodbye to All That, 2446. 103 Vaughan, Some Desperate Glory, 218. 104 Westman, Surgeon with the Kaiser’s Army, 94. 105 Graves, Goodbye to All That, 3645. 106 Holger H. Herwig, The First World War: Germany and Austria-Hungary, 1914–1918 (London: Hodder, 1997), 300. 107 Manning, Her Privates We, 59; Barbusse, Under Fire, 32. 108 Garrison, Notes on the History of Military Medicine, 37. 109 Manning, Her Privates We, 41. 110 Siegfried Sassoon, ‘Stretcher Case’, in Michael Copp, Cambridge Poets of the Great War: An Anthology (Madison, NJ: Fairleigh Dickinson University Press; London: Associated University Presses, 2001) (first published in the Westminster Gazette, 28 September 1916), 149–50. For the extent to which men in the trenches relied on advice from their mothers see Roper, The Secret Battle, especially chapter 4, ‘Learning to Care’, 159–201. 111 Medical Press, 6 September 1916, xiii. 112 Ibid., xiii. 113 Advert for ‘Wincarnis’, The Times, 6 January 1900. 114 Advert for ‘Wincarnis’, The Times, 8 July, 1915. 115 Ibid. 116 Galtier-Boissière, Larousse Médicale Illustré de Guerre, 94; for more examples of advertisements see The Times, 14 October 1914; 18 October 1915. 117 Advert for ‘Oxo’, Daily Mail, 8 October 1914.

226

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118 ‘How Soldiers Banish Any Bad Foot Tortures’, The Times, 18 April 1917; Advert for ‘Vitafer: the All-British Tonic Food’, Daily Mail, 5 November 1917. 119 See, for example, the list of ‘welcome comforts’ for soldiers suggested by the Daily Mail, 2 October 1914. 120 Advert for ‘Harrison’s Nursery Pomade’, Daily Mail, 23 September 1916. 121 For images of ‘The Trenchman Belt’ and an associated advertisement see IWM, www.iwm.org.uk/collections/item/object/30081088 (accessed 29 March 2016). 122 The pre-war press regularly railed against the dangers of opium which was clearly being used both for medical and recreational use, see for example, ‘Victim of Drug Habit’, Daily Mail, 5 January 1912; ‘Death at an Opium Party’, Daily Mail, 15 March 1912. 123 Barbusse, Under Fire, 93. 124 WL Image L0063963, www.wellcomeimages.org (accessed 29 August 2016). 125 ‘Cocaine Snuffs’, The Sunday Times, 23 July 1916: 13. 126 ‘“Dope” Principals’, Daily Mail, 20 July 1916. 127 Arthur Woods, Dangerous Drugs: The World Fight against Illicit Traffic in Narcotics (Yale: Yale University Press, 1931), 12. 128 Ernest Jones, The Life and Work of Sigmund Freud (New York: Doubleday, 1963), 51. 129 ‘Dopey Soldiers’, Daily Mail, 12 May 1916. 130 ‘Cocaine Snuffs’. 131 Woods, Dangerous Drugs, 154. 132 Rosemary Elliot, Women and Smoking since 1890 (London: Routledge, 2008), 43. 133 G.J. Stoney Archer, ‘Cigarette Smoking and Nerves’, Journal of the Royal Army Medical Corps 30, no. 2 (February 1918): 233–34. 134 M.D., ‘Smoking in Hospital’, The Times, 4 October 1916. 135 Correspondence: ‘Reasonableness’, The Times, 6 October 1916. 136 Susanna Roughton, ‘Cigarette Smoking and “Nerves”’, Journal of the Royal Army Medical Corps 160, no. 2 Suppl. 1 (2014): 238–39. 137 Elliot, Women and Smoking, 47. 138 For concern about excessive tobacco consumption in the British army see medical correspondence and notes on the subject, for example, Alexander Morison, Correspondence: ‘The Soldier’s Heart and the Strained Heart’, British Medical Journal 1, no. 2874 (29 January 1916): 184; Robert Mitchell, Correspondence: ‘The Soldier’s Heart and the Strained Heart’. British Medical Journal 1, no. 2880 (11 March 1916): 396–97; ‘The War: Heart Disease among Soldiers’, British Medical Journal 2, no. 2896 (1 July 1916): 27. For a full discussion about the masculinity of tobacco and (later) cigarettes see Virginia Berridge, Demons: Our Changing Attitudes to Alcohol, Tobacco and Drugs (Oxford: Oxford University Press, 2013) especially chapter 7, ‘Internationalism and War’, 117–42. 139 ‘Nurse’s Praise of the Serbs: Heroes in Hospitals’, Daily Mail, 2 January 1915. 140 Hankey, A Student in Arms, 262. 141 W.D. Esplin, Memo (undated) The National Archives, Kew, London, PIN 15/2503 40B.

NOTES

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142 Emily Mayhew, Wounded: From Battlefield to Blighty (London: The Bodley Head, 2013), 1991, Kindle. 143 Blacker, ed., Have You Forgotten Yet? 270. 144 Ibid., 270. 145 Hankey, A Student in Arms, 228. 146 Herbert Wiesser cited in Witkop, ed., German Students’ War Letters, 106. 147 Muir, The Happy Hospital, 66–67. 148 Stefan Schimmer cited in Ulrich and Ziemann, eds, German Soldiers in the Great War, 38. 149 Nicoletta Gullace, ‘White Feathers and Wounded Men: Female Patriotism and the Memory of the Great War’, Journal of British Studies 36, no. 2 (April 1997): 178–206. 150 Hankey, A Student in Arms, 259. 151 Harold J. Reckitt and Margaret Storrs Turner, eds, V.R. 76: A French Military Hospital (London: William Heinemann, 1921), 84. 152 Reckitt and Turner, eds, V.R. 76, 85. 153 Mayhew, Wounded: From Battlefield to Blighty, 1976. 154 ‘Wounded Indians: A Visit to Brighton Pavilion’, The Times, 2 January 1915. 155 Gibbs, Realities of War, 291. 156 Hans Stegemann cited in Witkop, ed., German Students’ War Letters, 244; Dorothy Cator, In a French Military Hospital (London: Longmans Green and Co., 1915), 46. 157 Leo van Bergen, ‘Would It Not Be Better to Just Stop? Dutch Medical Aid in World War I and the Medical Anti-War Movement in the Interwar Years’, First World War Studies 2, no. 2 (2011): 171. 158 Hankey, A Student in Arms, 288; Latzko, Men in War, 238. 159 Muir, The Happy Hospital, 81. 160 Keegan, The Face of Battle, 270. 161 Watson, Enduring the Great War, 103. 162 Westman, Surgeon with the Kaiser’s Army, 80; Kaye (18 September 1916), Unpublished War Diary. WL RAMC/739/4. 163 Frederick Parkes Weber (undated), Personal Papers. WL PP/FPW/B163/6. 164 L.J. Stagg (British nursing orderly, RAMC) IWM Sound Archive 8764/7, reel 5. 165 Lord Moran (undated handwritten notes for Anatomy of Courage) WL PP/ CMW/I3/1. 166 Le Naour, Les Soldats de la Honte, 18. 167 Winter, Death’s Men, 228. 168 Parkes Weber (undated), Personal Papers. WL PP/FPW/B163/2. 169 Dunn, The War the Infantry Knew, 96. 170 Siegfried Sassoon, The Complete Memoirs of George Sherston (London: Faber and Faber, 1937), 523. 171 Beach, ed., Diary of Corporal Vince Schürhoff, 75–76. 172 Ibid., 176–78. 173 A. Sichell, ‘A New Test Type for the Detection of Malingerers in the Army’, Journal of the Royal Army Medical Corps 30, no. 2 (February 1918): 326–31. 174 Roger Cooter, ‘Malingering in Modernity’, in War, Medicine and Modernity, ed. Roger Cooter, Mark Harrison and Steve Sturdy (Stroud: Sutton, 1998), 127; ‘Tests for the Detection of Malingering among Soldiers’, Lancet 2, no. 4845 (8 July 1916): 80–81.

228

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175 For an extensive discussion on the culture and practices of malingering see Joanna Bourke, Dismembering the Male: Men’s Bodies, Britain and the Great War (Chicago: University of Chicago Press, 1996), especially chapter 2, ‘Malingering’, 76–123. 176 Ian Birchall, ‘From Slaughter to Mutiny’, in ‘Stop the First World War!’: Movements Opposed to the 1914–1918 War in Britain, France and Germany, Socialist History Society Occasional Publication, no. 37, ed. David Morgan (London: Socialist History Society, 2016), 35. 177 Bull, ed., An Officer’s Manual of the Western Front, 1914–1918, 150. 178 André Loez, ‘Between Acceptance and Refusal – Soldiers’ Attitudes towards War’, in International Encyclopedia of the First World War. http://dx.doi. org/10.15463/ie1418.10461 (accessed 29 March 2016). 179 Bowlby (28 April 1915), Unpublished War Diary. WL RAMC/ GC/181. 180 Kaye (15 September 1915), Unpublished War Diary. WL RAMC/739/5, 174; Westman, Surgeon with the Kaiser’s Army, 142. 181 Gehrhardt, The Men with Broken Faces, 81–82. 182 MacPhail, ‘The Cavendish Lecture’, 981; Westman, Surgeon with the Kaiser’s Army, 80. 183 Watson, Enduring the Great War, 39. 184 Hurst, Medical Diseases of the War, 231. 185 Newton, A Stretcher Bearer’s Diary (15 November 1917), 473. 186 Blacker, ed., Have You Forgotten Yet? 263. 187 Roberts and Nicholson Roberts, ‘Diary of a World War One Surgeon’, 124–26. 188 G. Roussy, J. Boisseau and M. d’Celsnitz, Traitement des Psychonévroses du Guerre (Paris: Masson et Cie, 1918), 115. 189 Read, Military Psychiatry in Peace and War, 100. 190 Kaye (17 September 1915), Unpublished War Diary. WL RAMC/739/5. 191 Dunham, The Long Carry, 102. 192 Benjamin Ziemann, War Experiences in Rural Germany, 1914–1923, trans. Alex Skinner (Oxford; New York: Berg, 2007), 100. 193 Parkes Weber (28 November 1916), Personal Papers. WL PP/FPW/B163/1. 194 Ford, Parades End, 387. 195 John Hutton, ed., A Doctor on the Western Front: The Diary of Henry Owens, 1914–1918 (Barnsley: Pen & Sword, 2013), 2007, Kindle. 196 The Lead-Swinger, Glossary. WL MS.8095. 197 Barbusse, Under Fire, 33. 198 Pte Wordsworth (January 1922), ‘My Personal Experience and Reminiscences of the Great War’, Reminiscences of 6 badly wounded soldiers collected by Lady Gough at Sidcup Hospital, Liddle Collection, General Aspects, Wounds, Item 34. 199 Barbusse, Under Fire, 33. 200 Newton, A Stretcher Bearer’s Diary (17 September 1916), 233; (21 September 1917), 668. 201 Reckitt and Turner, ed., V.R. 76, 82. 202 For an account of RAMC demands to ‘free beds’ see Carden-Coyne, The Politics of Wounds, 82. 203 Dearden, Medicine and Duty, 48–49. 204 Dunn, The War the Infantry Knew, 546. 205 Richard Schmieder cited in Witkop, ed., German Students’ War Letters, 209.

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206 Bagnold, Diary without Dates, 87. 207 Ibid., 109. 208 Vaughan, Some Desperate Glory, 198. 209 Sassoon, The Complete Memoirs of George Sherston, 608. 210 Vaughan, Some Desperate Glory, 151.

Chapter 5 1 Bagnold, Diary without Dates, 103. 2 A.J.P. Taylor, ‘War and Peace’, London Review of Books 2, no. 19 (2 October 1980): 3; For an analysis of how wars in the modern age have been justified in moral terms see David Welch and Jo Fox, eds, Justifying War: Propaganda, Politics and the Modern Age (London: Palgrave MacMillan, 2012). 3 Cited in John Hutchinson, Champions of Charity: War and the Rise of the Red Cross (Boulder, Colorado; Oxford: Westview Press, 1995), 19. 4 Jean Henri Dunant, Un Souvenir de Solferino (Genève: Joel Cherbuliez, 1862), 102–3. 5 Hutchinson, Champions of Charity, 31–43. 6 Gérard Chauvy, La Croix-Rouge dans la Guerre (Paris: Flammarion, 2000), 29–30. 7 ‘14–18 Mission Centenaire: La Croix Rouge Française’, http://centenaire. org/fr/tresors-darchives/fonds-publics/autres-etablissements/archives/la-croixrouge-francaise (accessed 29 March 2016). 8 Jean H. Quataert, Staging Philanthropy: Patriotic Women and the National Imagination in Dynastic Germany (Ann Arbor: University of Michigan Press, 2004), 177–216. 9 Blücher, An English Wife in Berlin, 107. 10 Quataert, Staging Philanthropy, 195. 11 Quataert, ‘Women’s Wartime under the Cross’, 453–84. 12 Geoffrey Best, Humanity in Warfare: The Modern History of the International Law of Armed Conflicts (London: Weidenfeld and Nicolson, 1980), 14. 13 Ibid., 141. 14 Leo Tolstoy, War and Peace, trans. Constance Garnett (London: The Reprint Society by arrangement with William Heinemann, 1960) (first published in 1865–1869), 738. This should not be taken as a summary of Tolstoy’s position because the author became committed to absolute Christian pacifism in the late nineteenth century and remained so until his death in 1910. 15 Dunant cited in Nick Lewer, Physicians and the Peace Movement (London: F. Cass, 1992), 11. 16 Dunn, ed., War the Infantry Knew, 57; Blücher, An English Wife in Berlin, 80; Nevinson, Paint and Prejudice, 98. 17 Nevinson, Paint and Prejudice, 98. 18 Ibid., 105. 19 Rémi, Hommes Sans Visage, 3. 20 Dion Clayton Calthrop, The Wounded French Soldier (London: St Catherine’s Press, 1916), 17. 21 Blücher, An English Wife in Berlin, 46.

230

NOTES

22 Westman, Surgeon with the Kaiser’s Army, 72; Bowlby (31 December 1914), Unpublished War Diary. WL RAMC/ GC/181. 23 N. Trotter, ‘The Martyred Nurse Cavell’, Daily Mail, October 20, 1915. 24 Blücher, An English Wife in Berlin, 314. 25 Roger Chickering, Imperial Germany and a World without War (Princeton: Princeton University Press, 1975), 8; Sandi E. Cooper, ‘Pacifism in France, 1891–1914: International Peace as a Human Right’, French Historical Studies 17, no. 2 (Autumn 1991): 362. 26 Sandi E. Cooper, Patriotic Pacifism: Waging War on War in Europe, 1815– 1914 (New York; Oxford: Oxford University Press, 1991), 6. 27 ‘Peace Conference in Glasgow’, The Times, 10 September 1901. 28 Actes et Manifestations Diverses de l’Association Médicale Internationale Pour Aider à la Suppression de la Guerre (Paris: Bouchy & Cie, 1910), 41. 29 Ibid., 27. 30 Latzko, Men in War, 182. 31 Cooper, Patriotic Pacifism, 116–39. 32 Essential links between peace and free trade appear fanciful in the twenty-first century yet it is important to remember that the European Union (formerly the European Economic Community) was initially created to foster trade links between European nations so as to prevent another world war. 33 Lewer, Physicians and the Peace Movement, 30. 34 Harold Josephson, ed., Biographical Dictionary of Modern Peace Leaders (London: Greenwood, 1984), 739–40. 35 Sidney Hook, The Hero in History (London: Secker and Warburg, 1945), 256. 36 Arthur Anderson Martin, Surgeon in Khaki (London: Edward Arnold, 1915), 9–10. 37 Cator, In a French Military Hospital, 25. 38 ‘Dug-Out’, ‘From Medic to Navvy-“ater”’, The Lead-Swinger (27 November 1915). WL MS.8095, 8. 39 ‘Castorius Iodinus’, The Lead-Swinger (6 November 1915). WL MS.8095, 10. 40 For an English translation of the Manifesto see www.amanifestforeurope.eu/ further-reading (accessed 29 March 2016). 41 C.F. Cabello, ‘The Great European Georg Friedrich Nicolai: Physician and Pacifist’, Revista Médica de Chile 141, no. 4 (April 2013): 535–39. 42 Antony David Skinner, ed., Gershom Scholem: A Life in Letters, 1914–1982 (Cambridge, MA: London: Harvard University Press, 2002), 16–17. 43 Julius Braunthal, ‘War Resistance in Austria and Germany’, in We Did Not Fight: 1914–1918: Experiences of War Resisters, ed. Julian Bell (London: Cobden-Sanderson, 1935), 63–94; in Cooper, ‘Pacifism in France, 1891–1914’, 384–86. 44 Ziemann, War Experiences in Rural Germany, 1914–1923, 86. 45 Marc Ferro, The Great War, 1914–1918 (London and New York: Ark, 1987), 14. 46 Ernest Taylor (date illegible, probably 1917) collection of personal newspaper cuttings in Unpublished Diary. LSF Temp MSS 23/3. 47 The Friends’ Ambulance Unit List of Members and Addresses (London: Chas Straker & Sons, 1919), 3. 48 Cited in Thomas C. Kennedy, British Quakerism, 1860–1920 (Oxford: Oxford University Press, 2001), 237–38.

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49 Farah Mendlesohn, Quaker Relief Work in the Spanish Civil War (London: Edwin Mellon, 2002), 181; Horace G. Alexander, The Growth of the Peace Testimony of the Society of Friends (London: Friends Peace Committee, 1956) (first published in 1939), 4. 50 Kennedy, British Quakerism, 313. 51 Martin Ceadel, Pacifism in Britain, 1914–1945: The Defining of a Faith (Oxford: Clarendon Press, 1980), 210–11. 52 Letters to the Editor, The Friend (21 August 1914), 626. After his marriage to FAU nurse Irene Noel, Baker became known as Philip Noel-Baker. 53 Letters to the Editor, The Friend (28 August 1914), 640. 54 Stapledon, ‘Experiences in the Friends’ Ambulance Unit’, 362. 55 Meaburn Tatham and James Edward Miles, eds, The Friends’ Ambulance Unit, 1914–1919 (London: Swarthmore Press, 1920), xi. 56 FAU First World War Personnel Card, LSF Temp MSS 881/PER. 57 Ibid. 58 Ibid. 59 Nevinson, Paint and Prejudice, 94–95. 60 Stapledon, ‘Experiences in the Friends’ Ambulance Unit’, 364. 61 Taylor (27 August 1914), Unpublished Diary. LSF Temp MSS 23/3. 62 Stapledon, ‘Experiences in the Friends’ Ambulance Unit’, 366. 63 Ibid., 364. 64 Ibid.; Tatham and Miles, eds, The Friends’ Ambulance Unit, 8. 65 Taylor (23 November 1918) collection of personal cuttings from the Yorkshire Gazette in Unpublished Diary. LSF Temp MSS 23/3. 66 Michael L. Gross, Bioethics and Armed Conflict: Moral Dilemmas of Medicine and War (Cambridge: Cambridge University Press, 2006), 287. 67 Minutes of the Friends Ambulance Committee and the Executive Committee (hereafter FAU Committee Minutes) November–December 1914. LSF MSS 881. 68 Corder Catchpool, On Two Fronts: Letters of a Conscientious Objector (London: George Allen and Unwin, 1919), 24. 69 Nevinson, Paint and Prejudice, 97. 70 Catchpool, On Two Fronts, 24. 71 Nevinson, Paint and Prejudice, 97. 72 Stapledon, ‘Experiences in the Friends’ Ambulance Unit’, 366. 73 Lidbetter and Monk-Jones, eds, SSA 14 (printed for private circulation only), 2. 74 Tatham and Miles, eds, The Friends’ Ambulance Unit, 93–95. 75 Ibid., 91. 76 A Train Errant. Being the Experiences of a Voluntary Unit in France and an Anthology from Their Magazine (Hertford: Simson & Co, 1919), 45. 77 Tatham and Miles, eds, The Friends’ Ambulance Unit, 133–34. 78 Ibid., 137–38. 79 Tatham and Miles, eds, The Friends’ Ambulance Unit, 138. 80 Rowntree, ‘A Nightmare’, LSF MSS 636, 2. 81 Ibid., 16–18. 82 Ibid., 19. 83 Ibid. 84 C.F. Dingle, ‘Reminiscences’ (no precise date given: probably June 1916). Library of the Society of Friends, London, Temp MSS 835 Box 7.

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85

Rachel E. Wilson, ‘Form of Declaration and Agreement’ (5 October 1917). LSF Temp MSS 1000/2. 86 FAU Committee Minutes (11 March 1915). LSF Temp MSS 881. 87 FAU Committee Minutes (10 June 1915). LSF Temp MSS 881 (complaints abridged by the committee). 88 FAU Committee Minutes (26 October 1916). LSF Temp MSS 881. 89 FAU Committee Minutes (7 June 1916). Library of the Society of Friends, London, Temp MSS 881. 90 Motivations for Conscientious Objection were complex and so some objectors were willing to join the RAMC whereas others considered it completely unacceptable. Cyril Pearce, Comrades in Conscience: The Story of an English Community’s Opposition to the Great War (London: Francis Boutle, 2001), 134–90. 91 Correspondence with members of the RAMC (no precise date given: June 1917). LSF Temp MSS 835 Box 7. 92 FAU Committee Minutes (28 June 1916). LSF Temp MSS 881. 93 FAU Committee Minutes (28 June 1916; 19 July 1916). LSF Temp MSS 881. 94 Tatham and Miles, eds, The Friends’ Ambulance Unit, 200; FAU Committee Minutes (17 May 1917). LSF Temp MSS 881. 95 Stapledon, ‘Experiences in the Friends’ Ambulance Unit’, 362. 96 Ibid., 363. 97 Ibid., 367. 98 Tatham and Miles, eds, The Friends’ Ambulance Unit, 132. 99 Rowntree, ‘A Nightmare’, LSF Temp MSS 636, 5. 100 Friends’ Ambulance Unit 3rd Anniversary (31 October 1917). LSF Temp MSS 999/13 (Paul Cadbury papers). © Religious Society of Friends (Quakers) in Britain. 101 Stapledon, ‘Experiences in the Friends’ Ambulance Unit’, 370. 102 Description of SSA 13 (April 1917) in Tatham and Miles, eds, The Friends’ Ambulance Unit, 104. 103 Stapledon, ‘Experiences in the Friends’ Ambulance Unit’, 369. 104 Nevinson, Paint and Prejudice, 100. 105 Tatham and Miles, eds, The Friends’ Ambulance Unit, 107–8. 106 Lidbetter and Monk-Jones, eds, SSA 14, 202. 107 Leo van Bergen, ‘“Would It Not Be Better Just to Stop?” Dutch Medical Aid in World War I and the Medical Anti-War Movement in the Interwar Years’, First World War Studies 2, no.2 (2011): 165–94.

Chapter 6 1 2

Historic Royal Palaces, Tower of London, www.hrp.org.uk/TowerOfLondon/ poppies (accessed 29 March 2016). Paul Owen, ‘What Would the Tower of London Poppy Exhibition Look Like If It Included the Global Dead of World War One?’ Guardian, 6 November 2014.

NOTES 3

233

Jay Winter, ‘Forms of Kinship and Remembrance in the Aftermath of the Great War’, in War and Remembrance in the Twentieth Century, ed. Jay Winter and Emmanuel Sivan (Cambridge: Cambridge University Press, 1999), 40–60. 4 John M. Barry, The Great Influenza: The Epic Story of the Deadliest Plague in History (New York: Viking, 2004); Anne Rasmussen, ‘The Spanish Flu’, in The First World War, ed. Winter, 334–57. For the effect of the influenza epidemic on British troops see Harrison, The Medical War, 141. 5 Taylor (no precise date given: probably late November 1918), collection of personal cuttings from the Yorkshire Gazette in Unpublished Diary. LSF Temp MSS 23/3. 6 Robert Wohl, Generation of 1914 (London: Weidenfeld and Nicolson, 1980); Adrian Gregory, The Last Great War: British Society and the First World War (Cambridge: Cambridge University Press, 2008). 7 Delaporte, Les Gueules Cassées, 24. 8 Ernst Friedrich, War against War! (Nottingham: Bertrand Russell Peace Foundation, 2014) (first published in 1924), 186–87. 9 Ibid., 201. 10 Gehrhardt, The Men with Broken Faces, 168–69. 11 Carol Poore, Disability in Twentieth-Century German Culture (Ann Arbor: University of Michigan Press, 2007), 3–5. 12 Deborah Cohen, The War Come Home: Disabled Veterans in Britain and Germany, 1914–1939 (Berkeley, Los Angeles, London: University of California Press, 2001), 150–51. 13 John Galsworthy, ‘The Gist of the Matter’, Reveille (formerly Recalled to Life) 1 August 1918, 14. 14 Blücher, An English Wife in Berlin, 305. 15 Pieter Verstraete, Martina Salvante and Julie Anderson, ‘Commemorating the Disabled Soldier: 1914–1940’, First World War Studies 6, no. 1 (2015): 1–7. For a long-term reflection on the history of disabled veterans see David A. Gerber, ed., Disabled Veterans in History (Ann Arbor: University of Michigan Press, 2012). 16 ‘Prematurely Aged Ex-Service Men’, Lancet 1, no. 5969 (22 January 1938): 215–16. 17 Professor Michael Roper (University of Essex) is currently researching a British Academy-funded project entitled ‘The Generation Between: Growing up in the Aftermath of War, 1918–1939’. A video lecture on this work, which is based on oral interviews, is available from the British Psychological Society. See www.youtube.com/watch?v=FBHNyNsAuI4&list=­ PLCkLQOAPOtT28X05RoZ8–31ojkigpkAl (accessed 29 March 2016). With many thanks to Michael Roper. 18 David Graeber, The Utopia of Rules: On Technology, Stupidity and the Secret Joys of Bureaucracy (London: Melville House, 2015). 19 For a discussion of the brutalization thesis see Benjamin Ziemann, Contested Commemorations: Republican War Veterans and Weimar Political Culture (Cambridge: Cambridge University Press, 2013), 266–79. 20 Susan Pedersen, Family, Dependence and the Origin of the Welfare State: Britain and France, 1914–1945 (Cambridge: Cambridge University Press, 1993); Whalen, Bitter Wounds, 135–39; Cohen, The War Come Home, 154.

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21 Lidbetter and Monk-Jones, eds, SSA 14, 172–73. 22 Cited in Leo van Bergen, ‘“Would It Not Be Better Just to Stop?” Dutch Medical Aid in World War I and the Medical Anti-War Movement in the Interwar Years’, First World War Studies 2, no. 2 (2011): 177. 23 Ibid., 182. 24 John Ryle Foreword to Horace Joules, ed., The Doctor’s View of War (London: George Allen and Unwin, 1938), 7. 25 Ibid., 8. 26 Joules, ed., The Doctor’s View of War, 120. 27 University of Bradford, ‘Archive of the Medical Association for the Prevention of War’, www.bradford.ac.uk/library/special-collections/collections/ archive-of-the-medical-association-for-the-prevention-of-war (accessed 29 March 2016). 28 Medact, ‘Peace and Security’, www.medact.org (accessed 29 March 2016). 29 Médecins Sans Frontières, www.msf.org/about-msf/msf-history (accessed 29 March 2016); Doctors of the World, www.doctorsoftheworld.org.uk/pages/ history (accessed 29 March 2016). 30 See, for example, the work of the ‘Invictus Games Foundation’, at https:// invictusgamesfoundation.org (accessed 29 August 2016). 31 Pte Murray (January 1922), ‘My Personal Experience and Reminiscences of the Great War’, Reminiscences of 6 badly wounded soldiers collected by Lady Gough at Sidcup Hospital, Liddle Collection, General Aspects, Wounds, Item 34.

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Linden, Stefanie, C. Edgar Jones and Andrew J. Lees, ‘Shell Shock at Queen Square: Lewis Yealland: 100 Years On’. Brain: A Journal of Neurology 136, no. 6 (2013): 1976–88. Love, Robert, Tom Brooking and Andrew Bamje. ‘Plastic Kiwis – New Zealanders and the Development of a Speciality’. Journal of Military and Veterans’ Health 17, no. 1 (October 2008): 11–18. May, Hans. ‘Erich Lexer: A Biographical Sketch’. Plastic & Reconstructive Surgery 29, no. 2 (February 1962): 141–52. Messelken, Daniel. ‘Physicians at War: Betraying a Pacifist Medical Ethos?’ Zurich Open Repository and Archive, University of Zurich (2013). http://dx.doi. org/10.5167/uzh-78221 Michl, Susanne. ‘Mapping the War: Gender, Health, and the Medical Profession in France and Germany, 1914–1918’. Medicine, Conflict and Survival 30, no. 4 (2014): 276–94. Nord, Philip. ‘The Welfare State in France, 1870–1914’. French Historical Studies 18, no. 3 (1994): 821–38. Ramasamy, Arul, W.G.P. Eardley, D.D. Edwards, J.C. Clasper and M.P.M. Stewart. ‘Surgical Advances during the First World War: The Birth of Modern Orthopaedics’. Journal of the Royal Army Medical Corps 162, no. 1 (February 2016): 12–17. Reid, Fiona and Christine Van Everbroeck. ‘Shell Shock and the Kloppe: War Neuroses amongst British and Belgian Troops during and after the First World War’. Medicine Conflict and Survival 30, no. 4 (December 2014): 252–75. Roberts, C.C. and T.C. Nicholson Roberts. ‘Diary of a World War One Surgeon’. Journal of the Royal Army Medical Corps 160 Suppl. 1 (2014), 124–26. Roudebush, Marc. ‘A Patient Fights Back: Neurology in the Court of Public Opinion’. Journal of Contemporary History 35, no. 1 (January 2000): 29–38. Taylor, A.J.P., ‘War and Peace’. London Review of Books 2, no. 19 (2 October 1980): 3–6. van Bergen, Leo. ‘“Would It Not Be Better to Just Stop?” Dutch Medical Aid in World War I and the Medical Anti-War Movement in the Interwar Years’. First World War Studies 2, no. 2 (2011): 165–94. van Bergen, Leo. ‘The Alleged Goodness of War for Medicine’. Unpublished paper distributed to the Medical History of the First World War Network (February 2016). Verstraete, Pieter, Martina Salvante and Julie Anderson. ‘Commemorating the Disabled Soldier: 1914–1940’. First World War Studies 6, no. 1 (2015): 1–7.

Primary sources Memoirs, personal recollections and literary sources Bagnold, Enid. Diary without Dates. London: Virago, 1978 (first published in 1918). Barbusse, Henri. Under Fire: The Story of a Squad. USA: Feather Trail Press, 2009 (first published in 1917). Barker, Pat. The Regeneration Trilogy. London: Viking, 1996.

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Barthas, Louis. Les Carnets de Guerre de Louis Barthas, Tonnelier, 1914–1918. Paris: La Découverte/Poche, 2013 (first published in 1978). Blücher, Evelyn. An English Wife in Berlin. New York: E.P. Dutton and Co., 1920. Blunden, Edmund. Undertones of War. London: Penguin, 2000 (first published in 1928). Kindle. Borden, Mary. The Forbidden Zone. London: Modern Voices, 2008 (first published in 1929). Braunthal, Julius. ‘War Resistance in Austria and Germany’. In We Did Not Fight: 1914–1918: Experiences of War Resisters, edited by Julian Bell, 63–94. London: Cobden-Sanderson, 1935. Buswell, Leslie. Ambulance No. 10. Boston; New York: Houghton Mifflin Company, 1916. Calthrop, Dion Clayton. The Wounded French Soldier. London: St Catherine’s Press, 1916. Catchpool, Corder. On Two Fronts: Letters of a Conscientious Objector. London: George Allen and Unwin, 1919. Carrington, Charles Edmonds. Soldiers from the War Returning. Barnsley: Pen & Sword, 2006 (first published in 1965). Cator, Dorothy. In a French Military Hospital. Longmans Green and Co.: London, 1915. Dearden, Harold. Medicine and Duty: A War Diary. London: William Heinemann Ltd., 1928. Deeping, Warwick. No Hero This. London: Cassell, 1936. Deglane, H., C.-R. Coppin and J. Camus, Le Grand Palais Pendant la Guerre (1914–1915–1916). Paris: Fournier, 1916. Dunant, Jean Henri. Un Souvenir de Solferino. Genève: Joel Cherbuliez, 1862. Dunn, J.C. The War the Infantry Knew, 1914–1919. London: Abacus, 1987 (first published in 1938). Ford, Ford Madox. Parades End. London: Wordsworth Classics, 2013 (first published in 1924–1926). Friedrich, Ernst. War against War! Nottingham: Bertrand Russell Peace Foundation, 2014 (first published in 1924). Gibbs, Philip. Realities of War. London: William Heinemann, 1920. Graf, Oskar Maria. Prisoners All. New York: A.A. Knopf, 1928. Graves, Robert. Goodbye to All That. London: Penguin Classics, 2000 (first published in 1929). Kindle. Grimm, Hans Herbert. Schlump: Tales and Adventures from the Life of the Anonymous Soldier Emil Schulz, Known as ‘Schlump’. Narrated by Himself. Translated by Jamie Bulloch. London: Vintage, 2013 (first published in 1928). Gross, Philip. ‘What Did You Do?’ In Deep Fields. Northumberland: Bloodaxe Books, 2011. Hankey, Donald. A Student in Arms. London: Andrew Melrose Ltd., 1916. Hillemand, Pierre. Journal d’un Médecin sur les Deux Guerres Mondiales. Paris: Fiacre 2013. Hugo, Victor. Les Misérables. London: Penguin Classics, 1982 (first published in 1862).

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Stapledon, William Olaf. ‘Experiences in the Friends’ Ambulance Unit’. In We Did Not Fight: 1914–1918: Experiences of War Resisters, edited by Julian Bell, 39–73. London: Cobden-Sanderson, 1935. Tatham, Meaburn and James Edward Miles, eds. The Friends’ Ambulance Unit, 1914–1919. London: Swarthmore Press, 1920. Tolstoy, Leo. War and Peace. Translated by Constance Garnett. London: The Reprint Society by arrangement with William Heinemann, 1960 (first published 1865–1869). A Train Errant. Being the Experiences of a Voluntary Unit in France and an Anthology from Their Magazine. Hertford: Simson & Co, 1919. Vaughan, Edwin Campion. Some Desperate Glory: The Diary of a Young Officer, 1917. Barnsley: Pen & Sword, 2010 (first published in 1981). Werth, Léon. Clavel Soldat. Paris: Viviane Hamy, 2006 (first published in 1919). Young, Louisa. My Dear, I Wanted to Tell You. London: Harpercollins, 2011. Zola, Emile. L’Assommoir (The Dram Shop). London: Penguin, 2000 (first published in 1877). Zweig, Arnold. The Case of Sergeant Grischa. Translated by Eric Sutton. London: Viking Press, 1928.

Edited collections of primary material Beach, James, ed. The Diary of Corporal Vince Schürhoff, 1914–1918. Stroud: The History Press for the Army Records Society, 2015. Blacker, John, ed. Have You Forgotten Yet?: The First World War Memoirs of CP Blacker, MC, GM. London: Leo Cooper, 2000. Bull, Stephen, ed. An Officer’s Manual of the Western Front, 1914–1918. London: Conway, 2008. Dunham, Frank. The Long Carry, edited by R.W. Haigh and P.W. Turner. Oxford: Pergamon Press, 1970. Horton, Charles. Stretcher Bearer! Fighting for Life in the Trenches, edited by Dale Le Vack. London: Lion Hudson, 2013. Hutton, John, ed. A Doctor on the Western Front: The Diary of Henry Owens, 1914–1918. Barnsley: Pen & Sword, 2013. Kindle. Roberts, C.C.N. and T.C. Nicholson-Roberts, eds. ‘Diary of a World War One Surgeon’, Journal of the Royal Army Medical Corps 160, Suppl. 1 (June 2014): 124–26. Robbins, Simon, ed. The First World War Letters of General Lord Horne. Stroud: History Press for the Army Records Society, 2009. Skinner, Anthony David, ed. Gershom Scholem: A Life in Letters, 1914–1982. Cambridge, MA: London: Harvard University Press, 2002. Ulrich, Bernd and Benjamin Ziemann, eds. German Soldiers in the Great War: Letters and Eyewitness Accounts. Translated by Christine Brocks. Yorkshire: Pen and Sword, 2010. Westhorp, Christopher, ed. The Wipers Times: The Famous First World War Trench Newspaper. London: Conway, 2013. Witkop, Philip, ed. German Students’ War Letters. Translated and arranged by A.F. Wedd. Philadelphia: First Pine Street Books, University of Pennsylvania Press, 2002 (first published in 1929).

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Military-medical texts: books Association Médicale Internationale Contre la Guerre. Actes et Manifestations Diverses de l’Association Médicale Internationale pour Aider à la Suppression de la Guerre. Paris: Bouchy and Cie, 1910. Fischer, H.C. and E.X. Dubois. Sexual Life during the World War. London: Francis Aldor, 1937. Freud, Sigmund. The Uncanny. Translated by David McLintock. London: Penguin, 2003 (first published in 1919). Friends Ambulance Unit. The Friends’ Ambulance Unit List of Members and Addresses. London: Chas Straker and Sons, 1919. Galtier-Boissière, Emile. Larousse Médicale Illustré de Guerre. Paris: Larousse, 1917. Garrison, Fielding H. Notes on the History of Military Medicine. Washington, DC: Association of Military Surgeons, 1922. Garton, Wilfrid. Electro-Therapeutics for Military Hospitals. London: H.K. Lewis and Co., 1917. Gillies, Harold Delf. Plastic Surgery of the Face Based on Selected Cases of War Injuries of the Face, Including Burns, with Original Illustrations. London: Frowde, 1920. Hurst, Arthur. Medical Diseases of the War. London: Arnold, 1918. Joules, Horace, ed. The Doctor’s View of War. London: George Allen and Unwin, 1938. Larrey, Dominique-Jean. Mémoires de Chirurgie Militaires et Campagnes. Paris: J. Smith, 1817. https://openlibrary.org/books/OL20580766M/M%C3%A9moires_ de_chirurgie_militaire_et_campagnes_de_D._J._Larrey_ ... MacCurdy, John. War Neuroses. Cambridge: Cambridge University Press, 1918. MacPherson, William Grant, ed. History of the Great War: Medical Services, General History, Vol. I. London: His Majesty’s Stationery Office, 1924. MacPherson, William Grant, Wilmot Parker Herringham, T.R. Elliott and A. Balfour, eds. History of the Great War: Medical Services, Diseases of the War, Vol. II. London: His Majesty’s Stationery Office, 1923. Melville, Charles Henderson. Military Hygiene and Sanitation. London: Arnold, 1912. Miller, Emanuel, ed. The Neuroses in War. London: MacMillan, 1940. Mitchell, T.J. and G.M. Smith. Medical History of the Great War, Medical Services. Casualties and Medical Statistics of the Great War. London: His Majesty’s Stationery Office, 1931. Moran, Lord. The Anatomy of Courage. London: Constable, 1946. Mott, Frederick W. War Neuroses and Shell Shock. London: H. Frowde; Hodder and Stoughton, 1919. Myers, Charles S. Shell Shock in France, 1914–1918 Based on a War Diary Kept by Charles Myers CBE FRS Temporary Lieut. Col, RAMC Sometime Consulting Psychologist to the British Armies in France. Cambridge: Cambridge University Press, 1940. Prinzing, Friedrich. Epidemics Resulting from Wars. Edited by Harald Westergaard. Oxford: Clarendon, 1916. Roussy, G., J. Boisseau and M. d’Celsnitz. Traitement des Psychonévroses du Guerre. Paris: Masson et Cie, 1918.

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Stanford Read, Charles Military Psychiatry in Peace and War. London: H.K. Lewis and Co, 1920. War Office. Report of the War Office Committee of Enquiry into ‘Shell Shock’. London: HMSO, 1922. Woods, Arthur. Dangerous Drugs: The World Fight against Illicit Traffic in Narcotics. Yale: Yale University Press, 1931. Yealland, Lewis R. Hysterical Disorders of Warfare. London: MacMillan, 1918.

Contemporary military-medical texts: journal articles Ash, Edwin L. ‘Massage and Medical Electricity in the After-Treatment of Convalescent Soldiers’. Lancet 1, no. 4874 (27 January 1917): 165–66. Astley Cooper, J.W. Correspondence: ‘The Rum Ration’. British Medical Journal 1, no. 2823 (6 February 1915): 270–71. Comment on paper in the Military Surgeon (April 1917) by Surgeon RG Heiner of the US Navy in Lancet 1, no. 4893 (9 June 1917): 881–82. Cooper, P.R. Correspondence: ‘Treatment of “Shell Shock”’. British Medical Journal 2, no. 2901 (5 August 1916): 201. Ewart, William and Charles Ewart. ‘The Trench Foot-Warmer’. Lancet 1, no. 4819 (8 January 1916): 103–4. Galsworthy, John. ‘The Gist of the Matter’. Reveille (formerly Recalled to Life) 1 (1 August 1918): 14. Garton, Wilfrid. ‘Shell Shock and Its Treatment by Cerebro-Spinal Galvanism’. British Medical Journal 2, no. 2913 (28 October 1916): 584–85. Horsley, Victor. ‘On the Alleged Responsibility of the Medical Profession for the Re-Introduction of the Rum Ration into the British Army’. British Medical Journal 1, no. 2882 (30 January 1915): 203–6. Hurst, Arthur. ‘The Pathology, Diagnosis and Treatment of Absolute Hysterical Deafness in Soldiers’. Lancet 2, no. 4910 (6 October 1917): 517–19. Hurst, Arthur. ‘Cinematograph Demonstration of War Neuroses’. Proceedings of the Royal Society of Medicine (Neurol. Section) 11 (1918): 40. Lumsden, Thomas. ‘The Treatment of War Neuroses’. Lancet 2, no. 4959 (14 September 1918): 370–71. MacPhail, Andrew. ‘The Cavendish Lecture’, Lancet 1, no. 4896 (30 June 1917): 979–84. Mercier, Charles. Correspondence: ‘The Rum Ration’. British Medical Journal 1, no. 2828 (13 March 1915): 489–90. Milligan, E.T.C. ‘A Method of Treatment of Shell Shock’. British Medical Journal 2, no. 2898 (15 July 1916): 73–74. Mitchell, Robert. Correspondence: ‘The Soldier’s Heart and the Strained Heart’. British Medical Journal 1, no. 2880 (11 March 1916): 396–97. Morison, Alexander. Correspondence: ‘The Soldier’s Heart and the Strained Heart’. British Medical Journal 1, no. 2874 (29 January 1916): 184. Mott, Frederick W. ‘Effects of High Explosives upon the Central Nervous System’. Lancet 1, no. 4824 (12 February 1916): 331.

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Mott, Frederick W. ‘The Lettsomian Lecture (I) on the Effects of High Explosives upon the Central Nervous System’. Lancet 1, no. 4824 (12 February 1916): 331–38. Mott, Frederick W. ‘The Lettsomian Lecture (II)’. Lancet 1, no. 4826 (26 February 1916): 441–49. Mott, Frederick W. ‘The Lettsomian Lecture (III)’. Lancet 1, no. 4829 (11 March 1916): 545–53. Mott, Frederick W. ‘The Chadwick Lecture: Mental Hygiene in Shell Shock during and after the War’. Journal of Mental Science, 63 (October 1917): 467–88. Mott, Frederick W. ‘War Neuroses’. British Medical Journal 1, no. 3041 (12 April 1919): 439–42. Myers, Charles Samuel. ‘A Contribution to the Study of Shell Shock: Being an Account of Three Cases of Loss of Memory, Vision, Smell and Taste, Admitted to Duchess of Westminster War Hospital, Le Touquet’. Lancet 1, no. 4772 (13 February 1915): 316–20. Myers, Charles Samuel. ‘Contributions to the Study of Shell Shock: Being an Account of Certain Cases Treated by Hypnosis’. Lancet 1, no. 4819 (8 January 1916): 65–69. Myers, Charles Samuel. ‘Contributions to the Study of Shell Shock: Being an Account of Certain Cases of Cutaneous Sensibility’. Lancet 1, no. 4829 (18 March 1916): 608–13. ‘“Nerve Shock” in War’. British Medical Journal 2, no. 2845 (10 July 1915): 64. Osler, William. ‘“An Address on Science and War” Delivered at the University of Leeds Medical School, 1 October 1915’. Lancet 2, no. 4806 (9 October 1915): 795–801. ‘Parliamentary Intelligence on the Treatment of Nerve-Shaken Soldiers’. Lancet 2, no. 4796 (31 July 1915): 261. ‘Prematurely Aged Ex-Service Men’. Lancet 1, no. 5969 (22 January 1938): 215–16. Review of Eder, M.D. War Shock: Psychoneuroses in War: Psychology and Treatment. London: William Heinemann, 1917, in Lancet 2, no. 4918 (1 December 1917): 828. Review of Kelynack, T.N., ed. The Drink Problem of Today. London: Methuen & Co., 1916, in Journal of the Royal Army Medical Corps 30, no. 2 (February 1918): 230–31. Roussy, Gustave. ‘Hysteria’. British Medical Journal 2, no. 2850 (14 August 1915): 270. Rows, Richard G. ‘Mental Conditions following Strain and Nerve Shock’. British Medical Journal 1, no. 2882 (25 March 1916): 442. Schuster, Arthur. ‘A Presidential Address on the Common Aims of Science and Humanity’. Lancet 2, no. 4802 (11 September 1915): 587–94. ‘Science and the National Service’. Lancet 2, no. 4854 (9 September 1916): 481. Sichell, A. ‘A New Test Type for the Detection of Malingerers in the Army’. Journal of the Royal Army Medical Corps 30, no. 2 (February 1918): 326–31.

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Simpson, R. Correspondence: ‘The Rum Ration’. British Medical Journal (13 February 1915): 316–17. Sieur, Célestin. ‘The Tribulations of the Medical Corps of the French Army from Its Origin to Our Own Time’. The Military Surgeon 64, no. 6 (June 1929): 844–49. Stoney Archer, G.J. ‘Cigarette Smoking and Nerves’, Journal of the Royal Army Medical Corps 30, no. 2 (February 1918): 233–34. ‘Tests for the Detection of Malingering among Soldiers’. Lancet 2, no. 4845 (8 July 1916): 80–81. ‘The Medical Service on the Somme’. British Medical Journal 2, no. 2907 (16 September 1916): 397–98. ‘The Supply of Wine to the French Soldier’. Lancet 1, no. 4874 (27 January 1917): 167. ‘The War’. British Medical Journal 2, no. 2814 (5 December 1914): 995. ‘The War: German Experiences: Neurasthenia among Soldiers’. British Medical Journal 1, no. 2882 (25 March 1916): 464–65. ‘The War: Heart Disease among Soldiers’. British Medical Journal 2, no. 2896 (1 July 1916): 27. ‘The War: Notes from German and Austrian Medical Journals: Disciplinary Treatment of Shell Shock’. British Medical Journal 2, no. 2921 (23 December 1916): 882. ‘The War. The French Army Medical Service: Recruitment, Organization and Work’. British Medical Journal 1, no. 2941 (12 May 1917): 627–28. Wood, Rawdon. Correspondence: ‘The Rum Ration’. British Medical Journal 1, no. 2828 (13 March 1915): 490.

Archives and collections The Wellcome Library (WL), London 85th Magazine VIII (November 1930) (Printed for private circulation). RAMC Muniments Collection, 761 1/9–13. Arthur Davy, Surgeon-Major F. The Breakdown of Young Soldiers under Training Explained (Woolwich: Cattermole, 1883). RAMC Muniments Collection, 31. Bowlby, Sir Anthony. Unpublished War Diary. RAMC Muniments Collection, GC/181. Glenny, Elliott T. and Henry W. Kaye. ‘Notes and Observations on Cases of Asphyxia caused by an Enemy Gas Attack’. RAMC Muniments Collection, 739/11/4. Kaye, Captain Henry Waynard. Unpublished War Diary. RAMC Muniments Collection, 739/4; 739/5; 739/7. The Lead-Swinger: The Bivouac Journal of the 1/3 West Riding Field Ambulance. Sheffield: J.W. Northend, 1916. MS.8095. Lee, Colonel Arthur. Correspondence. RAMC/466/3.

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Moran, Charles. (Charles McMoran Wilson, Later Lord Moran) Handwritten Notes for Book on Shell Shock, RAMC Muniments Collection. PP/CMW/ I3/1, 14. Parkes Weber, F. Personal Papers, Wellcome Library, PP/FPW/B163/6.

Imperial War Museum (IWM) London Dible, Captain J.H. First World War Account of Captain James Henry Dible, RAMC, 1914–1918. IWM, Con Shelf. West, B. Unpublished Diary, PP/MCR/335.

Sound Archive Oxley, H. 716/8. Stagg, L.J. 8764/7.

Library of the Society of Friends (LSF), London Correspondence with members of the RAMC, Temp MSS 835 Box 7. Dingle, C.F. ‘Reminiscences’. Temp MSS 835 Box 7. Friends Ambulance Unit First World War Personnel Cards. Temp MSS 881/PER. Letters to the Editor, The Friend (21 August 1914). Letters to the Editor, The Friend (28 August 1914). Minutes of the Friends Ambulance Committee and the Executive Committee, Temp MSS 881. Rowntree, Laurence. ‘“A Nightmare” by Laurie Rowntree 1916. Account of Service with the FAU (Dunkirk & York)’. Temp MSS 636. Taylor, Ernest. Unpublished Diary, Temp MSS 23. Wilson, Rachel E., Unpublished Diary and papers. LSF Temp MSS 1000/2.

National Archives, Kew, London Esplin, W.D. Memo (undated) The National Archives, Kew, PIN 15/2503 40B.

Liddle Collection, Brotherton Library, University of Leeds Evans, Reginald Josiah Thomas. General Aspects, Wounds, Item 232 Evans, RJJ GS 1816.

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Holtzapffel, Captain. ‘Amateur Soldier’. (unpublished and undated) G.A. Wounds 58, 86. Limerick, Dowager Duchess of (October 1976, tape transcripts). General Aspects, Wounds, Item 216, tape 405. ‘My Personal Experience and Reminiscences of the Great War’. Reminiscences of 6 badly wounded soldiers collected by Lady Gough at Sidcup Hospital, Liddle Collection, General Aspects, Wounds, Item 34. Ownsworth, L.J. (October 1976, tape transcripts). General Aspects, Wounds, Item 195, tape 370.

Gillies Archive, Frognal Centre for Medical Studies (property of Dr Andrew Bamje) Butt, E.R. (Gunner) Case notes 19515. Cullimore (Private). Case notes 9385. Howard, D. (Private). Case notes 206228. Whitehead letter 01-02-cover.

National Army Museum (NAM), London Lewis, T.M. Soldier’s Small Book (Army Form B50) (undated). NAM 1982-04-795 Elliston. NAM 1994-02-194.

Stiftung Archiv Der Partei Und Massenorganisation Der Ddr, Federal Archives, Berlin Ernst Thälmann, Unpublished War Diary, Nachlaß NL 4003/2.

Newspapers, magazines and reports Daily Mail. Guardian. Hansard. Medical Press. Reveille (formerly Recalled to Life). Sunday Times. The Times. Western Mail.

Films About Time. Richard Curtis, 2013. All Quiet on the Western Front. Lewis Milestone, 1930.

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Dr Zhivago. David Lean, 1957. J’Accuse. Abel Gance, 1919 La Grande Illusion. Jean Renoir, 1937. Oh! What a Lovely War. Richard Attenborough, 1969. Regeneration. Gillies MacKinnon, 1997.

Selected websites Military-medical history online https://arts.leeds.ac.uk/legaciesofwar/ (accessed 29 August 2016) details a whole range of First World War projects, including ‘War and Medicine’ and ‘Science and Technology’. http://centenaire.org/en/node/5640 (accessed 29 August 2016) provides a history of the French Red Cross during the First World War in English, French and German. It includes a wide range of photographs. www.chelsea-pensioners.co.uk/historyheritage (accessed 29 August 2016) provides a history of the Royal Hospital, Chelsea. www.croix-rouge.fr/La-Croix-Rouge/La-Croix-Rouge-francaise/Historique/ Premiere-guerre-mondiale (accessed 29 August 2016). A history of the French Red Cross during the First World War. www.gilliesarchives.org.uk (accessed 29 August 2016) provides information on facial injury and maxillo-facial surgery during the First World War. www.iwm.org.uk (accessed 29 August 2016) offers details of online and physical archives relating to the First World War on the home front and across the world. www.musee-armee.fr (accessed 29 August 2016) gives useful images and details of the history of the French army. www.nam.ac.uk (accessed 29 August 2016) provides details of online and physical archives relating to the British army. www.nato.int (accessed 29 August 2016) is the official NATO website containing details of its history. www.nhs.uk/Tools/Documents/Military%20history%20timeline%­20read-only.htm (accessed 29 August 2016) is the NHS military-medical timeline. www.sciencemuseum.org.uk/broughtto life is the website of (accessed 29 August 2016) The Science Museum’s History of Medicine. An excellent resource. www.smithsonianmag.com/videos/category/history/about-face (accessed 29 August 2016) has a video and photo gallery that shows images from Anna Coleman Ladd’s studio in Paris during the First World War. www.wellcomeimages.org (accessed 29 August 2016) holds an excellent collection of images relating to the history of medicine and war. www.youtube.com/watch?v=FBHNyNsAuI4&list=PLCkLQOAPOtT28X05R oZ8–31ojkigpkAl (accessed 29 August 2016) Professor Michael Roper, ‘The Generation Between: Growing up in the Aftermath of War, 1918–1939’. A video lecture available from the British Psychological Society.

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BIBLIOGRAPHY

First World War cartoons and other images www.britishpathe.com/video/blighty-again-wounded-coming-home (accessed 29 August 2016). Images of wounded soldiers returning to Britain by ship (preview copy). www.brucebairnsfather.org.uk/index.htm (accessed 29 August 2016) is the official Bruce Bairnsfather website containing an extensive collection of postcards featuring Bairnsfather’s ‘Old Bill’. www.cartoonww1.org/index.htm (accessed 29 August 2016). ‘Cartooning the First World War’ features all the wartime newspaper cartoons of Joseph Morewood Staniforth. www.worldwar1postcards.com (accessed 29 August 2016) shows picture postcards from the First World War.

Peace, pacifism and relief movements www.amanifestforeurope.eu/further-reading (accessed 29 August 2016). Einstein’s manifesto to Europeans (1914). www.bradford.ac.uk/library/special-collections/collections/archive-of-the-medicalassociation-for-the-prevention-of-war (accessed 29 August 2016) is the archive of the Medical Association for the Prevention of War. http://centenaire.org/fr/tresors-darchives/fonds-publics/autres-etablissements/ archives/la-croix-rouge-francaise provides a history of the French Red Cross during the First World War including some excellent images. www.doctorsoftheworld.org.uk/pages/history (accessed 29 August 2016) details the history of Doctors of the World and its current programme. https://www.icrc.org/en/who-we-are/movement (accessed 29 August 2016). The official website of the International Red Cross and Red Crescent Movement. www.medact.org (accessed 29 August 2016) is the official Medact website. www.msf.org/about-msf/msf-history (accessed 29 August 2016) provides the history of Médecins Sans Frontières and its current programme. www.opcw.org/chemical-weapons-convention/genesis-and-historical-development (accessed 29 August 2016) is the official website for the Organisation for the Prohibition of Chemical Weapons. www.ppu.org.uk (accessed 29 August 2016) is the official website of the Peace Pledge Union, established in 1934. www.quaker.org.uk/about-quakers/our-history/quakers-and-wwi (accessed 29 August 2016) gives a history of Quakers in the First World War, produced by the Religious Society of Friends.

Wounded service personnel in the twenty-first century www.combatstress.org.uk (accessed 29 August 2016) is the website of the Veterans’ Mental Health charity.

BIBLIOGRAPHY

255

https://invictusgamesfoundation.org (accessed 29 August 2016) is the official website of the Invictus Games Foundation, a charity which uses sport to rehabilitate wounded and sick service personnel. http://matthewgreenjournalism.com/category/blog/ (accessed 29 August 2016) is a useful site for those interested in current issues concerning PTSD.

INDEX Note: Locators with ‘f’ and ‘n’ denote figures and notes respectively ‘active treatment’ 97 Addison, Christopher 214 n.69, 217 n.107 Aide Civile Belge 175 alcohol 19, 131, 134–7, 158 beer 119, 121, 123–30, 132, 137, 185 medicinal value of 124 rum ration 121–31 rum 59, 118–19 whisky 121, 125–6, 129–31, 134 wine 14, 46, 86, 119–20, 123–32, 134, 137, 141, 184–5 All Quiet on the Western Front 14, 67 ambulance trains 172–4 transport by 68 transporting men in challenging climate 173–4 ‘ambulant hospitals’ 3 Angell, Norman 21 army disease 134 Army Medical Services (AMS) 33–7 Arnaud, Emile 157 Ash, Edwin 94 asphyxiating gas 73 Association des dames françaises (ADF) 152 Attwater, A. 205 n.1 Austro-Prussian War 152 Aux Ambulances 7 Babinski, Joseph 89 Bagnold, Enid 114–15, 149 Baker, Philip 164 balneotherapy 93 ‘baptism of fire’ 27 barber-surgeons 2–3 barbitone 135

Barbusse, Henri 46, 51, 81, 196 Barham, Peter 205 n.82 Barker, Pat 91 Barry, John M. 232 n.4 Barthas, Louis 114, 126–7, 145, 224 n.77 bathhouses of soldiers 50 battle losses 30 Baumer, Paul 67 Baxter, Lance Corporal 130 Beach, Jim 208 n.52, 213 n.36, 225 n.101, 227 n.171 Beard, George 85 Becker, Jean-Jacques 212 n.5 Beecham’s Pills 132 beer 119, 121, 123–30, 132, 137, 185 Before My Helpless 5–6 benzamine hydrochloride 135 benzamine lactate 135 Bismarckian welfare system 32 Blacker, Carlos 66, 138–9 Blanchard, Raphael 38 blighty wound 145–7 blood transfusions 7, 146 Blücher, Evelyn 152, 154 Blunden, Edmund 56, 77 Boer War 9, 14 bonne blessure 145 Borden, Mary 115 Boulogne 172 Bovril 133 Bowlby, Anthony 54–5, 74, 81 Boylston, Dora 76 Brancardiers 14, 184 British Military Service Acts of 1916 172 British National Society for Aid 153 British Red Cross Society (BRCS) 36–7, 153, 171–2, 177–8 Brittain, Vera 1 Buswell, Leslie 68

INDEX Caestre 175–6 Calthrop, Dion Clayton 155 Cambrai, Battle of 41 Cameron, David 5 Canal du Nord, Battle of 66 Carden-Coyne, Ana 5, 124 Carrington, Charles Edmund 46, 121 Catchpool, Thomas Corder 168–9 Cator, Dorothy 140, 159 Cavell, Edith 156 Central Control Board (CCB) 120 Chadwick, Eleanor 166 Chapple, William 123 Charley’s War 76 Chavasse, Paul 62 Cheape, Lady Griselda 123 chemical warfare 73 Chester, Robert 166 chloral hydrate 135 chlorine gas 74 ‘chloroform hypnosis’ 89 cigarettes 136 coca 135 cocaine 134–7 cockermouth 123 codeine 135 Cohen, Deborah 193 cold 53–4 Cooper, Astley 122 Cooter, Roger 5 Courbon 144 Crimean War 33, 45 Crimson Field, The 1 Croix-Rouge Française (CRF) 152 Cullimore, Private 109 Cummins, Paul 191 Dad’s Army 34 Daddy, what did YOU do in the Great War? propaganda 22–4 Dearden, Harold 44 death 18–22 Deeping, Warwick 36, 159 Delépine, Sheradin 55 deleterious gas 73 Derby Scheme 182 Deschamps, Baptiste 95 Deutsches Rotes Kreuz (DRK) 152 Devaux, Albert 84

257

diamorphine 135 Dible, J.H. 4, 37 Dingle, Charles Frederick 181 diseases 29–33, 45–6, 48–9 France 45 Germany 45 infantry 46 military losses 29–33 ‘Soldier’s Heart’ 45 United Kingdom 45–6 ‘Disorderly Action of the Heart’ 45 Dix, Otto 71 Doctor, The 72 doctor–patient relationship 89 Doctors of the World 198 Downton Abbey 1 drinks 118–19, 124–7 Dunant, Jean Henri 151 Dunham, Frank 60, 144 Dunkirk 168, 171, 175 Dunn, J.C. 154 ‘Dutch courage’ 119 ‘Effort Syndrome’ 45 Einstein, Albert 161 electrotherapy in Britain 93–5 in France 95–6 ‘galvanic therapy’ 93 in Germany 96–8 Elverdinghe 171 end of Great War 191–8 development of welfare states 195 emotional damage 194 fear of death 192 Peace Pledge Union 197 physical damage 194 post-war Europe 191–8 refugee crises 198 scale of death 191 Esplin, W.D. 138–9 Esser, Johannes 101 Etaples 172 European warfare, medical history of 2 Evans, Reginald 106–8, 110 Face of Battle: A Study of Agincourt, Waterloo and the Somme, The 5

258

INDEX

facial injury 71–111 facially-wounded men 99–101. See also plastic surgery, facial Farage, Nigel 126 Faragher, Private 115–16 fear 222 n.32 of death 192 of killed in explosion 27 female medical staff 14–17 as dominatrix and angel combination 17 Ferguson, Niall 118 First Anglo-Belgian Ambulance Unit 164 Ford, Ford Madox 145 Foreign Service Section 162–3 Anglo-Belgian Ambulance Unit 168 early days and the ‘Shambles’ 167–71 France, military medicine in 37–9 flying ambulances 37 gas attacks 76 Journées d’Hospitalisation (hospital days) 39 Franco-Prussian War (1870–1871) 8, 153 French convoys 170–1 French Red Cross 152 Friedrich, Ernst 192–3 Friends Ambulance Unit (FAU) 14, 162–7, 174, 177–88, 197 Friends Relief Services 197 Friends War Victims Relief Committee (FWVRC) 162 ‘galvanic therapy’ 93 Gance, Abel 72, 193 Garrison, Fielding H. 30 Garton, Wilfrid 94 gas attacks anti-gas curtains for 77 boracic acid in treatment of 79 chlorine gas 74 glycerine for 76 gongs for 76 Kampfgas 72–5 klaxons for 76 liquid paraffin in treatment of 79 mental and emotional consequences 79–81 mustard gas 74

pads soaked in hyposulphate of soda for 76 paroleine in treatment of 79 phosgene 74 prevention 76–8 sirens for 76 sodium bicarbonate for 76 treatments 78–9 Gassed 76 gaz de combat 72–5 Gehrhardt, Marjorie 100 George V, King 120 German Red Crosses 155 Germany, military medicine in 40–2 cultural base of 40–1 German Red Cross associations 40 Germany, Wilhelmine 33 Gesichts-Entstellten (Gesichtsentstellten) 99–101 Ghyllwoods Sanatorium 122 Gibbs, Philip 31, 140 Gillies, Harold 101–11. See also plastic surgery, facial Glenart Castle 163, 174 Glenny, Elliott 74 Glubb, John 138–9 Gorzel, Karl 59 Gott mit uns! 153 Graf, Oskar Maria 13, 93, 127, 130 Graves, Robert 56, 77, 131 Great Illusion, The 21 Grimm, Hans Herbert 48, 129 Gross, Philip 22 Grosz, George 71, 193 Group Scheme. see Derby Scheme Haber, Clara 73 Haber, Fritz 73 Haig, Douglas 55 Hall of Mirrors 192 Hankey, Donald 65, 138–9 hard drugs 134–7 Harrison, Mark 5 heliotherapy 90 Her Privates We 130 heroic wounds 138–40 Hillemand, Pierre 38 Holtzapffel, Captain 124, 128 Home Service Section 162

INDEX Hook, Sidney 159 Horne, Henry Sinclair 73 Horsley, Victor 122–3 Horton, Charles 123 hospital ships 174 Glenart Castle 174 Western Australia 174 Howard, Private D. 110 Hugo, Victor 3 Human Slaughterhouse, The 21 Humanity in Warfare: The Modern History of the International Law of Armed Conflicts 229 n.12 Hurst, Arthur 34, 36, 48, 92 Hynes, Samuel 114 hypnotism 89 hysteria in shell shocked men 87–8 iconic wounds 71–111 facial injury 71–111 gas injury 71–111 lachrymators 74 pulmonary lesions 74 sensory irritants 74 shell injury 71–111 shock injury 71–111 soft treatments and active therapies 90–3 Indian hemp 135 individual men, war, medicine and 10–17 anger of soldiers 13 anti-doctor sentiment 14 doctor–patient relationship 11 female medical staff 14–17 joking 12 massage 15f industrialization effect 31–3 Britain 32 France 32 Germany 32 infantry 46 Inglis, Elsie Maud 4 International Committee of the Red Cross (ICRC) 150–2 International Physicians for the Prevention of Nuclear War (IPPNW) 197

259

Jaurès, Jean 162 Joseph, Jacques 101 Joyce, James 22 Jünger, Ernst 31, 41, 43, 46, 66, 75, 129–30, 136 Kamarad 17, 18, 205 n.73 Kampfgas 72–5 Kaufmann, Fritz 96–7 Kaufmannisch (Kaufmann cure) 97 Kaye, Henry W. 8–9, 11, 18, 43, 50, 53–4, 59, 74, 130, 143–4, 195 Keegan, John 5 Keogh, Alfred 182 Khantzian, Edward 118 King George Hospital (KGH) 180 Kitchener, Lord 120 Krieg dem Kriege! (War against War!) 192 Kriegszitterer 81–2 L’Assommoir 119 La Grande Illusion 42, 126 La Motte, Ellen Newbold 14, 29, 106, 109, 195 La société française de secours aux blesses militaires (SSBM) 152 lachrymatory gas shells 78 Ladd, Anna Coleman 105 Laignel-Lavastine 144 Lamszus, Wilhelm 21 Lane, William Arbuthnot 103 Lanschot-Hubrecht, Jeanne van 196 Lapugnoy 172 Larousse Médical Illustré de Guerre 5 Larrey, Dominique Jean 37 Latzko, Andreas 42, 158 Lawley, Arthur 172 Léger, Fernand 114 Les Gueules Cassées 99–101 les obusites 81–2 lice problem in trenches 47–8 cresol-soap emulsion 49 Lysol 49 ‘trench fever’ 48 life in trenches 42–5 accidental deaths 44 fighting on the Western Front 43 men slipping in mud 44

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Lloyd George, David 121, 125 Logre, Ernest Benjamin 84 Longmore, Thomas 8 Lumley, Savile 188 Lumsden, Thomas 92 Lyons, Thomas James 134 MacCurdy, John 86, 88 Macnaughtan, Sarah 124 MacPhail, Andrew 35, 45, 143 MacPherson, William G. 79 Madhouse, The 21 malingering 141–2 Manning, Frederic 128, 130–1 Marne, Battle of the 57 Maze, Paul 28 McIntyre, John 1 Medical Action for Global Security (Medact) 197 Medical Association for the Prevention of War (MAPW) 197 medical neutrality 156 medical pacifism and war 149–89 hospital ships 174 International Red Cross 150–2 just war and the just conduct of war 149–50 testing autonomy 178–88 witnessing 175–7 medical role, in military terms 5 doctors, responsibility 5 Medical War: British Military Medicine in the First World War, The 5 medicinal value of alcohol 118–19, 124 medicine and military victories, link between 5 medicine from home 131–4 Beecham’s Pills 132 Bovril 133 Horlicks 132 lung tonic 132 Marmite 133 Ovaltine 132 Oxo 133 Sea-Sick Remedy 132 Vi-Casein 133 ‘Vitafer’ 133 Wincarnis Remedy 133–4 Médecins Sans Frontières (MSF) 198

Melville, Charles Henderson 12 Men in War 42 Mennel, Henry 164 Menschen ohne Gesicht 99–101 Mercier, Charles 123 militarization 157 military-medical services. See also France army medical services 33–7 lice problem 47–8 life in trenches 42–5 military losses 29–33 military reliance upon volunteers 36 personal journeys 65–8 sick and wounded, distinction 31 sickness 29–33 statistics 30 traditional battle cry 47 transport by ambulance 68 wounded journey 57–8 wounds 29–33 military losses 29–33 disease 29–33 sickness 29–33 statistics 30 wounds 29–33 military medical officer, role of 3 military reliance upon volunteers 36 military-mental breakdown 82 Miller, Emanuel 83 Milne, George 127 Mitchell, William 45, 134 modern medicine and modern warfare 4–6 Monk-Jones, Norman 196 moral pressure 119–21 Moran, Lord see Wilson, Charles McMoran Morestin, Hipployte 101 morphine 135 Mott, Frederick W. 80, 82, 90, 92 Moynier, Gustave 151 Muir, Ward 105, 160 Murray, Private 115–16, 198 mustard gas 74–6 Myers, Charles Samuel 83, 88 National Insurance Act 1911 32 national Red Cross societies 152–62

INDEX

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neurosis 85–6 Nevinson, Christopher R.W. 38, 72, 154, 168–9 Newman, George 182 Newton, Private 143 Nicolai, Georg Friedrich 161 Nightingale, Florence 4 Nockolds, Humphrey 179 Nonne, Max 83, 89 North, E.B. 122

power of science 29 psychofaradique treatment 96 pyrexia of unknown origin (PUO) 48–9

Oostvleteren 171 opium 21, 134–7 Oppenheim, Hermann 85 ordinary soldiers and pain 113–47 medicine from home 131–4 on being wounded 114–18 rum ration, reintroduction of 121–5 wartime regulations and moral pressure 119–21 Osler, William 28–9, 55, 81 Oxo 133

Raymond, Ernest 126 Read, Charles Stanford 144 Reckitt, Harold J. 145 Red Cross organizations 155 Regeneration trilogy 91 Regimental Aid Post 67 Relief of the Wounded 151 religious commitment 157 Religious Society of Friends see Quakers Remarque, Erich Maria 10, 50 remedies alcohol 19, 131 Sea-Sick Remedy 132 tobacco 19 tonics 132 Wincarnis Remedy 133–4 Rémi, Henriette 100, 106, 110, 195 Remy 172 Renoir, Jean 42 Rigby, Eleanor 100 Rivers, William H. 91 Rivière, Joseph 158–9 Roberts, C.N. 128 Roberts, Lord 120 Roberts, Robert 129 ‘rough treatment’ 97 Roussy, Gustave 89–90 Rowntree, Arnold 182 Rowntree, Lawrence (Laurie) 14, 52, 175 Rows, Richard G. 91 Royal Army Medical Corps (RAMC) 4, 33–4, 38, 40, 178–88 rum 59, 118–19 rum ration 121–31 Russo-Japanese War (1904–1905) 8, 33, 82 Ryle, John 197

pacifism/pacifists 21, 158 pain 115 Paré, Ambroise 3 Pasteur, Louis 35 Peace Pledge Union 197 Peace Testimony 163–7 Pelletier, Madeleine 159 People Act (1918) 189 Peppiette, Eric 11, 129 phosgene 74 Physicians’ Conference against War 196 Pierce, Hawkeye 1 pineapple gas 74 Piper, Tom 191 plastic surgery, facial 101–11 aesthetic dimension of 103 facially-wounded men in public sphere, managing 104 lifelike masks 105–6 wartime facial reconstruction 102 Politics of Wounds, The 5 Poperinghe 171, 175 post-war Europe 191–8 Potter, Henry 31 Pour la Paix du Monde 193

Quaker Peace Testimony 163 Quakers 157, 162–3 principles 183 Queen Alexandra Hospital (QAH) 153, 169 Queen Mary’s Red Cross hospital 153

262

INDEX

Sale, Lady 4 Sale, Robert Henry 4 Sandes, Flora 136 Sargent, John Singer 72, 76 Sassoon, Siegfried 136, 141, 147 Schipper, Adrie 140 Schmeider, Richard 146 Scholem, Gershom 161 Schultze, Otto 98 Schürhoff, Vince 77, 128, 142 science and pacifism, links between 158 Scott, Walter 156 Scottish Women’s Hospitals (SWH) 4 Scutts, Private 146 Sea-Sick Remedy 132 Second Working Men’s International Association 157 Sections Sanitaires Anglaises (SSA) 171 self-inflicted wounds 140–5 selfmedication 118 Service de Santé des Armées (SSA) 38 ‘Shambles’ 167–71 shared history 18–22 Sheahan, Henry 39 shell-shocked men 81–2 diagnoses and debates 84–6 Germany 85–6 hysteria in 87–8 initial responses to 82–4 symptoms and treatment 86–90 traumatic neurosis 85 sick and wounded in war 153 distinction 31 sickness 29–33 Sieur, Célestin 3, 11 Silverman, Aaron 152 Simpson, Robert 121–2 Sitzkrieg (static warfare) 57 Skat Players, The 71 Smith, D. 45 smoking 136 soft drugs 134–7 ‘soft’ therapy 93 Soldier’s Small Book 53 soldiers fear of killed in explosion 27 soldiers’ bathhouses 50 Sommer, Battle of the 5, 42–3, 52, 59, 101

Souques, Alexandre 92 South African War 33 spa therapy 93 Spanish ‘flu’ 192 Stahlhelm (steel helmets) 58 Stapledon, William Olaf 165, 167, 170–1, 185, 187 statistics on battle losses 30 Stegemann, Hans 140 stretcher bearers 1, 14, 17, 18, 22, 28, 59, 60, 63, 64–7, 69, 79, 152, 17–4, 198, 211 sulphonia 135 survival 18–22 Taylor, Ernest 166, 192 Tell England: A Study in a Generation 126 Testament of Youth 1 Thälmann, Ernst 12, 129 Thiepval Memorial 43 Thirty Years’ War (1618–1648) 3 Thomson, Thomas 165 Til, Jeanne 7 Times History and Encyclopaedia of the War 5 Tisdall, Claire 99 tobacco 19, 134–7, 141 damaging properties of 135 soothing qualities 135–6 Tolstoy, Leo 154 Tonks, Henry 103 torpillage 95–6 traumatic neurosis 85 treatments 78–9 blood transfusions, 7, 146 of gas attacks, boracic acid in 79 of gas attacks, liquid paraffin in 79 of gas attacks, paroleine in 79 psychofaradique treatment 96 rough treatment 97 shell-shocked men 86–90 soft treatments 90–3 trench foot 56–7 X-rays in 7, 64, 92, 107 trench foot 51–6 non-combatants suffering from 52 statistics 55 treatment of 56–7

INDEX trenches, disease and sickness in 45–6, 48–9 France 45 Germany 45 infantry 46 ‘Soldier’s Heart’ 45 United Kingdom 45–6 triage and hospital network 58–65 France 63 Germany 64–5 transportation of soldiers 61 Trochu (French general) 151 Trones Wood 116 Tuffier, Théodore 38 Überrumpelungsmethode (unexpected attack method) 97 Ulysses 22 Union des Blessés de la Face (UBF) 152, 193 van Bergen, Leo 5, 14 Vaughan, Edwin Campion 44, 46–7, 50–1, 129–31, 147 ‘Vermorel sprayers’ 77 Versailles Peace Treaty 192 Vi-Casein 133 Vimy Ridge, Battle at 35 Voluntary Aid Detachment (VAD) 35 voluntary enlistment 182 ‘voluntaryism’ principle 176 volunteers, military reliance upon 36 von Frundsberg, Georg 2 war/warfare as benefit for medicine, question of 1–24 Daddy, what did YOU do in the Great War? propaganda 22–4 experimentationrequired in chaos of war 9 French army medical services 20f internationalization of military medicine 8 medicine and 2

263

modern medicine and modern warfare 4–6 women in 3–4 wartime regulations and moral pressure 119–21 weapons, wounds from 28 Werth, Léon 13 Western Australia 163, 174, 182–3 Westman, Stephen 28, 90, 143, 155 Whalen, Robert W.44 whisky 121, 125–6, 129–31, 134 Whitehead, Wright 110 Wiesser, Herbert 139 Wilson, Charles McMoran 80, 82, 86 Wilson, John William 182 Wincarnis Remedy 133–4 wine 14, 46, 86, 119–20, 123–32, 134, 137, 141, 184–5 women warfare 4 Lady Florentina Sale 4 Wood, Francis Derwent 104–5 Wood, Rawdon 123 wounds 29–33. See also faciallywounded men; iconic wounds; ordinary soldiers and pain Blighty wound 145–7 controlling 137–8 from weapons 28 heroic wounds 138–40 idealizing 137 malingering 141–2 military losses 29–33 self-inflicted wounds 140–5 sick and wounded, distinction 31 wounded journies 57–8 X-rays in treatment 7, 64, 92, 107 Yarwood, Kathleen 53 Yealland, Lewis Ralph 94–5 yellow cross 74 Young, Louisa 109 Ypres, Battles of 74, 138, 171, 175 Zola, Emile 119 Zweig, Arnold 52