Bill was bandaged up by the MO and sent on to a CCS at Corbie, where he slept for twenty-four hours. It was three months before he rejoined his battalion. He later admitted to suffering from shell shock, but this was combined with a sense of guilt that he had let his men down. When Bill wrote the battalion history fourteen years after the war, he summed up his memory of the event as follows: ‘On looking back I have never been particularly proud of my part in that night’s work and have always felt that by crawling out of the fight I let my Officers and men down badly. The more senior a soldier’s rank, from private upwards, the more he should live up to his responsibilities, but those of my old comrades who know what it is to be half shell-shocked will, I feel, be merciful in their judgement. It is the super men who carry on under such conditions and they deservedly win their VCs.’27
Major Frederick St John Steadman was serving as a medical officer a few miles to the north in a field ambulance unit with the 60th Division, running the wards in two wooden huts, intended for forty-eight patients but receiving about fifty men per day.28 So many shell shock patients had arrived at Steadman’s dressing station that he quickly began to recognise the symptoms. He wrote to his wife, ‘I have become fairly expert in diagnosing the degree of shell shock a man has, as I have seen so many cases now. I “spot” them at once by the nervous twitching of their faces or hands; some frown when they are talked to, as though to answer the simplest question is too much mental exertion. Some have a curious dazed look about their eyes, quite different from anything else I have seen. Some recover rapidly but others remain in the same state for days.’
The minor cases simply needed rest and were not classed in the official statistics as either wounded or sick. ‘I have had several men come in with shell shock, with their faces twitching, and hands and arms shaking constantly, who improve at once when they have been made clean and put into a comfortable bed, and had a good night’s rest.’ Other cases, which would have been listed in the statistics, were more severe and needed more elaborate treatment. ‘I have several very interesting but sad shell shock cases in my ward. One man has gone stone blind in one eye (right). Had he gone blind in both he would probably have recovered, but since only one eye has gone, it probably means detachment of the retina from haemorrhage, and I fear he will not recover the sight of that eye. Another man has lost his voice. He and a friend were in the trenches when two trench mortars burst on each of them. His friend has just disappeared. He himself is unhurt, but has lost his voice and his memory for certain things. He does not remember being brought here, for example, although he was conscious apparently all the time. Another man also lost his friend; he had actually been blown nearly 60 yards out of the trench to the top of another! He was, of course, killed instantly. This man’s friend is still in my ward, suffering from the shock.’29
If the ward was a distressing place during the daytime, it did not get any easier after dark. Steadman wrote, ‘All these shell shock cases dream dreadfully at night. They live through their experiences several times each night; sometimes I have to inject morphia to get them to sleep at all. They suffer very much in this way. So terrible are their dreams that they are afraid to go to sleep, worn out though they are. Poor fellows, I just loathe sending them back again [to the front]. I feel utterly wretched when I have to. Some are much too bad to go back, and these I send down the line to the CCS. When there is much noise at night by the guns, these men get into a rotten state. I have seen some cry and beg to be sent away from “those awful guns”. I send all these down the line and they will need many months of care, and absolute quiet, if they are ever to recover their nerve.’
On more than one occasion, Steadman had sent a man back to his unit, only for him to reappear at the dressing station a few days later. He described one such case: ‘His unit had foolishly given him sentry duty at night, on the first day he returned. Nothing could have been worse for him. He lost his nerve and his reason for a time, and was sent back to me; he was in a very bad state when I saw him again yesterday, so I sent him straight down the line to the CCS. I think they will send him further down, as I have written to ask them.’
Almost every medical account records the high incidence of psychiatric casualties that accompanied the Battle of the Somme. In August 1916, at the height of the battle, the 86th Machine Gun Company reported that about 80 per cent of the unit had been admitted to hospital ‘owing chiefly to the strain of the previous five weeks’.30 Leonard Stagg, a nursing orderly with a South Midland field ambulance unit, remembered that on the Somme ‘one was always seeing cases of shell shock.’31 Colonel Soltau told the War Office Committee of Enquiry after the war that there had been ‘one or two cases in the fighting line’ in 1915, ‘but nothing which really attracted attention’. He went on, ‘It was not until the Somme that it became an appreciable problem’ in the field ambulance unit he was commanding. ‘We were flooded,’ he said, ‘with cases in the later stages of the Somme.’32
Throughout July, the long lists of casualties continued to fill every major newspaper in Britain. The Pals battalions had been a great boost to the process of recruitment. But now whole districts where a battalion had been raised were plunged into collective grief. People in areas where a locally raised battalion had gone over the top and been decimated, like the Shankill district of West Belfast, Sheffield or Barnsley, Accrington or Tyneside, drew their curtains or blinds to mark the death of a family member, neighbour or friend. It looked as though whole streets had gone into mourning. No one could escape from the losses. They affected everyone at all levels of society. Before the battle was through, the Prime Minister and the Paymaster-General would each lose a son, and the Cabinet Secretary a younger brother. Dukes, earls, doctors, bankers and factory owners, as well as miners, munitions workers, typists and shopkeepers, experienced the loss of sons, brothers, husbands and fiancés. Barely a community in the nation remained untouched. And as people read the lists of dead and wounded, and looked at maps in newspapers and saw the tiny scale of the advances from one unknown small French village to another, they began to question if it was all worthwhile. It was natural that political pressure to reduce the rate of losses would grow.
By the end of the month some Cabinet members were already describing Haig as a ‘butcher’. Robertson, as CIGS, had to explain to the Cabinet’s War Committee what was happening on the Somme and found he was caught, as he put it, between ‘the God of War and the Mammon of Politics’.33 The professional army view was that in an industrialised war heavy losses had to be expected and decisive results would not come quickly. The politicians, however, wanted to see more tangible gains and less pain. In passing this political concern back to the commanders in the field, Robertson said they should look to avoid further manpower problems, what was officially described as ‘wastage’. At GHQ, Haig realised that he had to take heed of what was being said in Westminster. On 3 August he issued a communiqué to all senior commanders calling for ‘the utmost economy of men and material’ so that when the ‘wearing out’ battle had concluded, probably in the latter half of September, the ‘last reserves’ would still be available.34 The problem of ‘wastage’ had to become a subject of concern at every point. The number of men being evacuated to England with shell shock was clearly one of these areas of concern.
According to the Official Medical History, ‘the severe wastage of manpower which the psycho-neuroses were causing in France made the problem of dealing with them urgent towards the end of 1916.’35 On 21 August, MOs were told ‘that it is not considered desirable to evacuate to the base any cases of shell shock amongst officers and men unless there are definite lesions’, in other words unless there had been some sort of ‘commotional’ damage to the brain or nervous system. Two days later, the chief medical officer of Fourth Army demonstrated his anxiety by giving instructions that ‘the number of cases arriving at the Casualty Clearing Stations with a tally marked shell shock must be somehow decreased.’36
This was the moment that Charl
es Samuel Myers had long awaited. For some time, he had proposed the establishment of specialist centres to deal with psychological cases of war neurosis. Fearing that such centres would act like a magnet to shirkers and those with ‘insufficient stoutness of heart’ who wanted to escape the fighting, the army had opposed this for well over a year. The view had been that such centres ‘would open up a flood-gate for wastage from the army which no one would be able to control’.37 But now Sir Arthur Sloggett, Director General of the Army Medical Services in France, decided to listen. At the end of August, he appointed Myers ‘Consulting Psychologist’ to the army. It looked as though the British army had finally accepted the need for psychology.
Myers toured the front line, visited aid stations and met with generals and medical chiefs. Many patients who had been evacuated to Britain with shell shock took several months to recover once they were out of a military environment. So Myers presented a case that the successful treatment of shell shock, and the reduction of wastage from it, depended upon ‘promptness of action, a suitable environment and psychotherapeutic measures’ to be provided in France. Victims of shell shock should be evacuated to a special centre as quickly as possible to prevent ‘the contagiousness of the affection within a unit’. The centre should be away from the sound of the guns but not so far as to be out of a military environment; men would thus be able more easily to return to their unit. Appropriate psychotherapeutic treatment would restore the patient’s ‘memory, self-confidence and self control’ through a ‘judicious admixture of persuasion, suggestion, explanation and scolding’. The specialist MOs who would provide this ‘should possess enthusiasm, confidence, cheerfulness and tact’.38
In order to keep shell-shocked men in France and avoid evacuating them to Britain, Sloggett cautiously agreed in November 1916 to open four specialist treatment centres at converted CCSs.39 The principal figure at the first of these was Dr William Brown, a qualified psychologist who had been a student of Myers before the war. Brown had worked at the Maghull Military Hospital near Liverpool before coming out to France. He brought with him a strong sense that the emotional causes of war neuroses could be discovered, often through hypnosis, and treated. He was never popular with leading military figures but was tolerated because he seemed to have the ability to return paralysed men to their battalions.
However, if this was a sign that the army would be taking a softer line, it was only temporary. Myers’ star crashed almost as quickly as it had risen. Senior medical figures in the army had never been fully behind him and his new ideas. A few weeks after opening the first specialist centre, his job was split into two and he was given the junior role, keeping control only over the southern half of the front. Brought in over him was his old rival Dr Gordon Holmes, a hardliner on the treatment of shell shock. Holmes was appointed Consulting Neurologist to the Army. Myers complained bitterly but his protests were ignored.
At the beginning of 1917, Myers was sent on two months’ sick leave. He returned to France but not to the senior position. Myers put a brave face on it, writing that he had under ‘by no means favourable conditions … accomplished all that I was likely to perform in the direction of improving the treatment and disposal of shell shock cases in France’.40 But clearly he felt that his moment of influence had passed. Later in 1917, he returned to Britain for good, working until the end of the war with Sir Alfred Keogh in the War Office.
Holmes took a fundamentally different view from Myers and his ideas were far more in line with core army thinking. He believed that, before returning a man to his fighting unit, an army doctor should attempt to cure only the physical symptoms of war neurosis. He was not interested, as was Myers, in the underlying psychological causes. They might be related to a man’s emotional state before he joined the army and this was consequently not his concern. His no-nonsense approach put the principal emphasis on giving a man a few nights of good rest and regular meals and then telling him sternly ‘that there was nothing wrong and there was no need why the patient should not recover’. After a few days of physical exercises the man would then be sent back to his battalion. He told the War Office Enquiry after the war that it was far better to keep a man in areas under military control, on the grounds that ‘The further men got from the line the more difficult it was to get them back.’ He was still suspicious that men were trying it on; he told the enquiry that ‘during the Battle of the Somme a large number of men deserted from the line on the claim that they had “shell shock” and it was necessary to prevent that and keep them within the Army area where they were still under the discipline of the Army and could be reached by their battalion and sent back easily.’41 Holmes and his new tougher line would shape the attitude of the army medical authorities to shell shock for the rest of the war.
Throughout the relentless summer battles along the Somme, MOs on the Western Front were not allowed to forget the message sent out by the disgrace and removal of Lieutenant Kirkwood from the Lonsdales for being too lenient on shell shock. Several senior medical directors sent out notes to MOs, warning them to be aware of shirkers and not to confuse other conditions with shell shock. Typical of these was the message sent from the Medical Director of III Corps on 15 October to all MOs under his jurisdiction. It read: ‘Cases are very commonly sent to a M[edical] D[ressing] S[tation] during the heat of battle diagnosed hurriedly as Shell Shock (W). Frequently the W is omitted. During the patient’s stay in the MDS or Rest Station later it is possible to form a more deliberate opinion, and when as a result it is decided that the diagnosis of Shell Shock is incorrect it should be cancelled, and the new diagnosis substituted. The doctor in charge at Base should be informed of the change of diagnosis.’ This instruction was to be distributed to every MO in the corps. The officer who kept this document in his papers wrote that from the directive ‘there emerged, I fancied, a thinly veiled invitation to diagnose “S” in preference to “W” … When the diagnosis was questionable, as clearly it could be, how often I wonder did the official view err in the patient’s favour. I do not wonder, really.’42
The cases of genuine Shell Shock ‘W’ where a man had suffered ‘commotional’ damage to the brain from proximity to a shell explosion were always in a small minority, variously estimated at between 2.5 per cent and 10 per cent of all cases.43 The vast majority of cases were of ‘emotional’ damage to a man’s nervous system. Although medical opinion was still divided on the matter, Holmes’ view prevailed: sleep, relaxation and a rest from front-line duties could cure most of these men. He and others still argued that most war neuroses were the product of physical and mental exhaustion. This was Shell Shock ‘S’, or in some cases Neurasthenia. Cases of genuine psychological damage with the accompanying severe physical symptoms were also in need of treatment; sometimes these were listed as ‘W’ but on other occasions as ‘S’.
The term ‘shell shock’ was an increasingly unhelpful one that covered a variety of very different conditions. William Johnson, a neurologist with the army in France, told the War Office enquiry after the war, ‘“Shell shock” is a misnomer, and its introduction as an official term was deplorable. Soldiers developed the belief that a bursting shell produced mysterious changes in the nervous system which destroyed their self-control … So-called “shell shock” consisted of a motley of conditions. Its use was a loose proceeding which both obviated the need for accurate diagnosis and at the same time tended to obscure treatment and prognosis.’ He concluded that 5 per cent of cases were down to ‘commotional’ and 80 per cent to ‘emotional’ disturbance – the remaining 15 per cent were some sort of combination of the two.44
The numbers of shell shock cases peaked during the Battle of the Somme. This much at least was universally accepted by military and medical chiefs. At an address to a meeting of the British Medical Association in April 1919, Sir Frederick Mott said emphatically that ‘according to his experience the most serious cases of war neurosis occurred in 1915 and 1916.’45 The alarmingly high numbers in 1916 continued not only
to threaten the ‘wastage’ of troops when they were desperately needed but also to endanger morale. And as the Battle of the Somme ground on through the summer and into the autumn, it seemed that even the toughest, most battle-hardened units could not escape the horrors of shell shock.
8
Yard by Yard – From Pozières to the Ancre
Britain had not been alone in declaring war on Germany on 4 August 1914. Without consulting the governments of the Dominions, King George V made the declaration in Privy Council by royal prerogative on behalf of the Empire. When the governor-generals in each of the Dominions issued the royal proclamation, vast swathes of the globe suddenly found themselves at war with Germany. The Viceroy of India announced that all 250 million Indians were at war. The white Dominions, as they were then called – Canada, Australia, New Zealand and South Africa – all went to war as well. Not that the King or anyone else in London need have worried about objections. Such were the weighty bonds of empire that India and the Dominions unhesitatingly rallied behind the mother country, even if the cause was one about which they knew little.
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