At three-thirty a.m. on 20th February, in the middle of an epidemic that was killing tens of thousands, Flora and Emily arrived in Valjevo. It had taken them a day and a half on the train to travel the sixty miles from Niš. Emily had made good use of the time. As the train wound slowly through the low hills, she wrote a letter to the Red Cross to follow up her wire. “[My telegram was] not in the least exaggerated,” she wrote, her head bent over her notepaper. “If this has not gotten through will you please act on this letter? It is not only for the Serbians we are appealing, but for us all – Americans, English, Russian, Austrian. This terrible scourge is not sparing any of us.” She was astute enough to tailor her letter to the American political climate. “What care we can give is given alike to Austrians and Serbs, and I feel in making this appeal that this fact should be emphasized, especially to America, where so many are interested in the German-speaking race.”38
Although Flora and Emily had braced themselves for conditions worse than anything they had ever experienced, they were horrified by what they encountered in Valjevo. “The town is in a fearful state, every place crammed with sick men lying in their clothes in filth and on dirty straw, no beds, nothing, 50 or 60 deaths a day, was much more,” Flora wrote in her diary on the day of their arrival.39 Five thousand lay sick. “Soldiers were lying in their dirty uniforms, straight as they came from the trenches, swarming with vermin, all over the floors of the hospitals, on the floors of the hotels, in the shops, out in the streets, lying on bare boards on a little filthy straw with no blankets in the depth of the rigorous Serbian winter,” she recalled later. “There was no one to nurse them, no nursing was being attempted, the only thing that was being done was to sort out the dead from the living in the mornings, and throw the dead into carts and take them out and bury them in shallow trenches, there was no one to make coffins for them and no time to make them.” It never crossed their minds to leave. They were needed, there was a job to be done, and that was that. And, as Flora reasoned, “a man can only die once anyhow”.40
Elsewhere in Serbia, other missions and medical workers were beginning to arrive in number, most notably from Russia, Switzerland, France and Greece. They joined the units who had started work the previous year – the Dutch mission under Dr van Tienhoven in Valjevo, the British Red Cross and Paget Units in Skopje and the American Red Cross in Belgrade and Gevgelija. Other British units too were starting work including the Anglo-Serbian Hospital, which was run by volunteers from the Royal Free Hospital in London and known as the “Berry Unit”. Individual “freelancers” also set up base across Serbia, including Mrs Hannah Hankin Hardy, a veteran of the Siege of Ladysmith, who opened and ran a hospital by herself in Kragujevac.41
Most noteworthy of all the units to arrive at this time, and the one that would have the most significant presence among the Serbs throughout the duration of the war, was the Scottish Women’s Hospitals. The women of the “First Serbian Unit”, including Dr Katherine MacPhail, were assigned to Kragujevac at the start of January. Also working in Kragujevac was thirty-six-year-old Dr Elizabeth Ross, from Tain in the Scottish Highlands. Known as “Tibbie” to her friends, Dr Ross had a delicate physique that stood in stark contrast to her steely determination to work as and where she wanted.42 On her arrival in January 1915 she agreed to take charge of the typhus wards in the First Reserve Hospital, the same hospital where the Anglo-American Unit had been based. “The air was quite indescribable; it was like entering a sewer,” wrote a visitor.
I have seen some of the worst slum dwellings one can find in Britain, but never anything to approach these wards in filth and squalor. Men lay crowded together on mattresses. We saw three shivering together on two mattresses. No one washes them; they lie there in the weakness of fever, becoming filthier and filthier. When a man dies the next comer is put straight onto the same dirty mattress, between the same loathsome sheets. The place is full of orderlies certainly, but they crouch apathetically in corners, waiting their own turn to die.43
On the day they reached Valjevo, Flora and Emily left their rooms in a private house to meet their new colleagues over lunch at the Fourth Reserve Hospital, known as the “Gymnasium Hospital”. They were ushered to the table by their new director, observing that above each seat was a “funeral card”. The cards, Flora recorded, had been printed in honour of “the one who sat there before and has just died of typhus”. Silently, they each took their place under one of them.44 During lunch, the tired staff mentioned to Flora and Emily that there were two American doctors, Cooke and Cookingham, lying sick with typhus in a hotel room in the town. The women left that afternoon to find them.
Flora and Emily walked through the ground floor of the doctors’ hotel, passing dozens of men huddled together unattended on thin straw, all suffering from typhus. They were directed up the stairs to the doctors’ room. As they pushed open the door, they saw only Dr Cookingham, lying alone on a mattress on the floor. Cooke was dead. “[We] found that one doctor had died… and had been taken away,” recalled Flora. “At the same time as they carried him out they brought in the coffin for his pal and laid it down beside his bed ready for him.”45
Cooke had died nine days previously. Although he was seriously ill himself, Dr Cookingham had remained at his bedside for three days and nights as his friend’s condition deteriorated. Cooke needed Cookingham’s constant attention. On the third night, exhausted and sick, the lanky young doctor fell into a deep sleep. When he awoke, he was horrified to find Cooke lying dead on the floor at his feet. In a bout of delirium he had climbed out of bed and his heart had given out.46
Cookingham could hardly believe his eyes when the women approached his bed. “He had given up till he saw us come in,” wrote Flora. For the next few days they kept a close watch over him as his health slowly stabilized. He was soon taken to an isolation hospital to which “anyone could go”, she noted drily.47 They also visited the Dutch mission shortly after arrival. They found many of the staff, including its chief, Dr van Tienhoven, suffering from typhus.48 A few days later, the mission pulled out of Serbia entirely.
Flora and Emily began work on 22nd February. Theirs was the largest hospital in Valjevo, an elegant former school in the centre of town whose many classrooms had been turned into crowded wards for officers, soldiers and POWs. Although it was supposed to be the surgical hospital, most of its patients were suffering from typhus. Several times a day the hospital orderlies made the grim rounds of the wards to sort the dead from the living. They stacked the bodies outside the door, until they could be taken away by ox carts.49 “Saw 3 dead men lying on stretchers, first thing we saw,” recorded Flora. The grounds also contained a muck heap. “It was full of amputated limbs and dirty dressings and smelt to high heaven,” she shuddered.50
The smell inside, of excrement and rotting flesh, hit them with an almost physical impact.51 The hospital was intended to take two hundred and fifty men. When Flora and Emily walked round the wards for the first time, they discovered more than eight hundred, of whom seven hundred and fifty were sick and seventy were wounded.52 Two men had been placed in each bed while the majority had to lie “agonizing” on some putrid straw, the only thing between them and the cold, hard floor.53 Few had blankets. They lay, uncovered, shivering in their soiled uniforms. Some were so covered with lice that it looked as though “moving grey patches were on [their] dusky skins”.54 Those in the grip of typhus writhed and shouted in delirium. The only doctor still on his feet was the Director. “The hero he was” had been working “day and night” looking after his patients, recollected Flora. He was beside himself with relief at their arrival.
“Took charge of dressing room and did dressings for the whole of Valjevo and countryside. Cleared and cleaned up the dressing room, put the fear of God into the orderlies, scrubbed and sterilized everything,” scribbled Flora in her diary on the day they started work. Three orderlies had been assigned to work alongside them. Two were Serbs, Ilia and Uroš.55 The third was a “Schwabe” – a dero
gatory but universally used Serbian term equivalent to “Hun”, which was applied to Austro-Hungarians. Flora, too, referred to them as “Schwabes”, although she observed from the start how hard they worked. Soon, as her esteem for these men grew, she stopped using the term entirely.
Austro-Hungarian POWs were at work in hospitals throughout Serbia. Many were Czech. None were forced to work; however, there was no shortage of volunteers. Most had recovered from typhus and were immune from catching it again. They also reasoned that their living conditions were no worse inside the hospital and, if they worked, their rations would be better. Others simply wanted to help. Throughout Serbia during the epidemic, Austrian POWs who were doctors in peacetime worked side by side with their Serbian counterparts. Some even ran hospitals.56
Across Serbia, the staff of the Allied-run hospitals were coping as best they could. In the days and months that followed some threw themselves into rounds of social activity by way of distraction, as one demoralizing day followed another in the wards or operating theatres. Others turned instead to the blackest of humour to get through their work. In the “British Eastern Auxiliary Hospital” run by the British Naval Mission in Belgrade, amputations became a sporting event among its surgeons. One of them, Dr William Sharpe from Brampton, Ontario, was a “rough-spoken and coarse-grained Canadian, addicted to somewhat brutal jokes”, one of the orderlies recalled. “I remember his telling us gleefully how he won his bet with a fellow surgeon as to which of them would most rapidly remove all twenty fingers and toes from a pair of frostbitten patients.”57 Even nurses were not immune to becoming blasé. Mildred Farwell, a journalist with the Chicago Daily Tribune, was struck when she met an English nurse struggling through her work, alone, in a military hospital. “You ought to see how nicely I take off toes,” the nurse told her, while making the motion of chopping. “One whack and they’re gone.”58
Most demoralizing of all was to watch their colleagues fall sick with typhus. The death rate among doctors and medical staff was enormous. Many were too fatigued from the impossible struggle to save the lives of their patients to pay sufficient attention to proper precautions against infected lice. Weakened by exhaustion, they succumbed quickly once infected. By the early spring there was hardly a unit that had not lost a member to the disease.59 The British missions were particularly badly hit. Two members of the British Red Cross Unit in Skopje died. The staff of the Scottish Women’s Hospital, based in Kragujevac, attended funerals on three consecutive Sundays. Two of the funerals were for members of the unit, Louisa Jordan and Margaret “Madge” Neill Fraser. The third was for Dr Elizabeth Ross, who died on 14th February, her thirty-seventh birthday. Since the early 1980s the town of Kragujevac has held a commemoration at her graveside on the anniversary of her death.
Although news had reached Britain about the deaths of previous volunteers, there was no shortage of replacements. In April 1915 the redoubtable Mabel Stobart, whom Flora had known from the FANY and Women’s Sick and Wounded Nursing Corps, arrived in Kragujevac with forty-five mainly female staff including Flora’s old friend, Nan MacGlade, to set up a hospital entirely under canvas.60 Units of the British Farmers also set out for Belgrade and Požarevac in northern Serbia, the Wounded Allies sent a small “fever” team to Kragujevac and the British Red Cross sent out a unit to Vrnjačka Banja in the east of the country. One more unit of the Scottish Women’s Hospitals also set sail for Serbia, bound for Valjevo.
Flora and Emily soon ditched their starched and formal British nurses’ uniforms for something more practical. Before she started work each day, Emily pulled a loose white ankle-length dress over her head and rolled the sleeves up to her elbows. She casually pulled an equally loose white hat over her dark, wavy hair. Flora threw on a grubby white medical coat over a white shirt and dark tie, which she wore with a hat similar to Emily’s. She usually had a cigarette trailing between her fingers.
The adversity of the conditions had not troubled them for long. “Getting used to Valjevo sights and smells,” Flora jotted in her diary only two days after arrival.61 Emily too coped admirably, grumbling only about “the lack of soap and not being able to have a good wash”.62 They spent most of their time in the dressing room, which was bare other than for a few tables, chairs and cases of supplies that had been placed on the wooden floorboards. A naked bulb was suspended from the high ceiling by an electric wire. Their window overlooked the section of the hospital grounds where the dead were first taken. “All the coffins were put in a row, and in front of each coffin was a stretcher with a dead man lying, fully dressed, with little wooden crosses at the foot of each with his name and regiment on it,” described Emily. “The priest came and chanted the service, and then they were put in coffins and left there for hours.”63
Within a couple of days they had everything running like clockwork. They expected their orderlies to work as hard as they did, and brooked no nonsense from them. “They seem to bear us no malice though we’ve done everything but beat them, and we all work quite cheerily doing dressings for dear life,” recorded Flora in her diary.64 But they could do little for certain of their patients. “We stripped [an unconscious patient],” recalled Emily, “and I thought he was wearing a red undershirt. When I looked closer it seemed to me the shirt was rippling. His breast was covered with a sheet of typhus lice… He [later] died.”65 They also struggled to treat those with frostbite and gangrene. “We have two ghastly cases of frostbite in today,” described Flora in a graphic letter to her sister Sophia. “One a man with the flesh rotted off his feet and literally nothing but the bones of his toes left. Another, an old man, with his hand coal black and very nearly off! It must be taken off entirely somehow soon…”66 This was the one dark cloud that hung over the horizon of their work: their “surgical” hospital had no surgeons. They faced watching their patients suffer needlessly and feared that those with gangrene might die for lack of treatment, whose lives could otherwise be saved by amputation. It made Flora and Emily almost sick to see it.
Still, they determined to do what they could for their patients. With so many requiring regular dressings it was essential for them to get through each one as quickly as possible. Flora soon devised a system. She knew that they would do anything for a cigarette. She also knew that she was about the only person in Valjevo with any – she had brought ten thousand with her. “Well I used to stick up a box of cigarettes in a conspicuous place, and tell each man if he was good and didn’t make a fuss I’d give him a cigarette when it was all over and they would go through almost anything, and then go off on their stretchers smiling and joking and smoking their cigarettes.” Her plan was almost too successful. “I found they were beginning to play me up, and were coming in two or three times in the same day to get their dressings done, they didn’t mind a little extra pain for the sake of the extra cigarette, and as we had not time for that, we had to make lists of them, and only do each man every second day.”67
While overseeing the work in the dressing room they managed to find the time to open an “amateur dispensary” with a medicine chest that had been sent to Flora by an English explorer. With no formal medical training, she began prescribing for patients, with indeterminate results. “Fortunately there was a book of words with it, so I don’t think I poisoned anybody,” she recalled.68 They also walked round the wards visiting their Serbian and POW patients whenever they had a spare moment. They had time only to hand out sweets and cigarettes, Flora’s universal panacea, but their presence made an enormous difference to the spirits of the men. Their work also lifted the morale of the other members of staff who, faced with fifty to sixty deaths per day, had almost given up. Soon their colleagues began to follow their example. They opened the windows, cleaned the wards, appropriated a bath to use in the hospital and, on Flora’s insistence, cleared away the muck heap in the yard.69
Within three days of beginning work, the thought of watching men die from gangrene had become too much for Emily, who had specialized as a surgical assistant durin
g her training. “Discussed how soon we should have to begin amputations,” wrote Flora tentatively in her diary, as they began to consider what had, until then, been unthinkable.70 The next day they blew the dust off an old sterilizer they discovered under a bed. Then, rounding up the few surgical knives they could find, they began operating. “It was a case of doing something for these men or seeing them die before our eyes without lifting our little finger to help them,” Flora later recalled. “So as there was nothing else for it we screwed up our courage and bit by bit we finally ended by doing the operations ourselves. We were very short of anaesthetics, what we had we kept for the worst cases. Besides which, we were so overwhelmed with work that the cases had to be got through without any unnecessary delay.”71
Emily started first, while Flora stood by with a camera to document the event. “So many of the men here have suppurative parotitis, as a complication of typhus I suppose,” wrote the young nurse to the head of the New York chapter of the American Red Cross. “I am sending you a snapshot Miss Sandes took of the very first operation I performed. This man is well now and has joined the firing line again. He hadn’t slept for nearly two weeks, and I took nearly half a pint of pus from both sides of his face.”72 Next she began amputating fingers and toes. The watershed for her came when she was faced with a soldier with a gangrenous foot. With no surgeon available, she cut it off herself. After the soldier survived, Emily operated and amputated as she felt necessary, while Flora began to follow her example.73 Lacking the necessary surgical instruments, she improvised. “Cut off a man’s toes with a pair of scissors this afternoon,” she cheerfully recorded in her diary.74 Despite their unorthodox approach to surgery, their treatments appeared to work. “The men had such faith in us because we were English that I really think we cured them more by faith than skill,” Flora acknowledged.75
A Fine Brother: The Life of Captain Flora Sandes Page 7