by Paul Ham
Men bore the loss of limbs with remarkable stoicism, as their letters attest. ‘[N]ow Mother,’ wrote Private C. J. Joss, ‘I have a piece of news for you that I’m afraid you won’t like … about three days ago my leg hemoerraged [sic] and the result has been that I have had to lose some of it. Please don’t be frightened …’26
New weapons, too, called on a new understanding of the horrors of war. The only treatment for mustard gas was to bathe the afflicted area in a soda solution and decontaminate the clothing. The gas clearing station received the first cases, about 1000 blinded and blistered men, on 22 July, of whom about twenty died, chiefly from bronchial troubles. ‘Fortunately vision does not appear to be often lost,’ observed an American medical officer, Dr Harvey Cushing.27
More deadly were chlorine and phosgene gas, the effects of which Edward Lynch witnessed after the battle of Polygon Wood:
I saw seven gassed men dying out behind a dressing station. They were in convulsions and black in the face and throat. Buckets of blood-specked foamy sort of jelly was [sic] coming from their mouths. The doctor and orderlies attending them wore gas masks. The poor gassed beggars kept grabbing at things and I saw one man grab at his own hand and smash his fingers out of joint. One man tore his mouth nearly back to his ear trying to pull the gas out of his throat. And as each man died, they threw buckets of mud over their head and shoulders. Been far kinder to have smothered them before they died not after.28
Not since the Somme had doctors encountered such extreme cases of ‘wound shock’ (often confused with the nervous complaint known as shell shock), in which a blast or projectile inflicted so powerful a shock to the body that it self-anaesthetised, shut down, and failed to exhibit any signs of recovery: ‘The local analgesia produced might permit of the removal of shattered limbs and of much manipulation without obvious pain …’ The pain, when it came, was often so intense as ‘to make men beg for death’; yet with effective ‘management’, such as complete immobilisation, ‘a smoke, hot tea, morphia’, the worst pain might be ‘surprisingly moderate’.29 ‘Wound shock’ came to mean the collapse of vital organs and bodily functions: the heart rate fell dramatically, the blood pressure sank, the whole system yielded. Only immediate, intensive care might reverse the process.
As old as warfare, yet barely understood, and not taken seriously in 1917, was the mental disorder then known as shell shock. None of the British, Dominion or German armies recognised shell shock as a serious medical condition, ‘though it undeniably existed’, remarked the Australian surgeon general Major General Sir Neville Howse VC. Commanders tended to dismiss shell-shocked men as ‘malingerers’, ‘windy’ and ‘neurotic’, whose condition, they believed, was a result of cowardice or a family predisposition to psychiatric illness, and not a nervous reaction to intense shellfire.30
Many sufferers were court-martialled for cowardice and punished; a few were shot. Traumatised soldiers whose self-discipline collapsed under the strain – abandoning their posts, falling asleep on sentry duty, drunkenness, going absent without leave – were severely dealt with: fined, sentenced to hard labour, or subjected to Field Punishment No. 1, ‘when the victim or culprit was spread-eagled on the wheel of an artillery wagon and strapped by the ankles and the wrists. He was in full sun and remained there for the requisite number of hours he had been sentenced to.’31 About 200 men per division probably experienced the wheel.
Death sentences were few, and rarely enacted. Only 94 British soldiers were shot, most for desertion, in the year to the end of September 1917 (and 95 in the next twelve months). Of the 3080 men sentenced to death by British courts martial between the start of the war and 31 March 1920, 346 cases went ahead. Haig was, however, an inveterate believer in capital punishment, in order to ‘make an example to prevent cowardice in the face of the enemy …’32
Self-inflicted wounds manifested the broken spirit of a soldier who no longer cared what his fellow men thought of him. There were surprisingly few cases – about 30 convictions per month (5.5 per cent of total convictions) in July, August and September 1917. Only the most acute terror overrode the shame of deliberately shooting yourself in the foot. A crop of self-inflicted wounds usually occurred in the lull of battle or in the anticipation of its resumption, when blowing off a finger seemed preferable to enduring another moment. ‘You could not help being sorry for these men, even though you despised them,’ wrote A. P. Herbert.33 When these ‘haggard, miserable wisps’ recovered from their wounds, they were given a dressing down, paraded in disgrace and dispatched to the front, often in the worst section of the line, where few survived.
Nobody seriously asked whether the unnatural strain of putting a man in a trench under an explosive storm might have caused his trauma. Dr William Rivers, of the Craiglockhart War Hospital in Edinburgh, immortalised in Pat Barker’s novels, under whose care fell Graves, Wilfred Owen and Siegfried Sassoon, believed that the soldier’s trauma resulted from his repressing the memory of his battle experiences; Rivers spent his days coaxing the patient to recall what had happened, however ghastly.
A medical officer at one casualty station, said to have ‘exceptional insight’, described shell-shocked men as ‘unfit simply through strain and war-weariness’.34 If so, it was a strange kind of fatigue that engendered such bizarre symptoms. Homer had described them in The Iliad; Hotspur suffered them in Shakespeare’s Henry IV, Part 1: in mild cases, nervous tension, flashbacks and terrible nightmares. The worst were reduced to laughing lunatics and shuddering wrecks who, at the sound of shells bursting, would go berserk or curl up into embryonic balls, the prelude to complete nervous breakdown. Two severely shell-shocked patients, recalled Rifleman J. E. Maxwell, in a ward within earshot of a bombardment, leapt up and ran amok ‘with their hands over their heads screaming and screaming and screaming’. The lights were out, due to the air raid, and ‘they were charging around banging into things’. The nurses managed to calm the men down and put them back to bed.35
Despite their dismissal of the condition, British and Dominion commanders at Third Ypres knew what to expect. The Somme had produced a ‘vast increase in the incidence of psychological casualties’.36 ‘[P]erhaps the most terrible thing of all,’ recalled Reverend Julian Bickersteth, a senior chaplain, ‘was the laughter and tears of the shell-shocked cases. I found that hard to stand. Every effort to quiet them failed.’37
Early in 1917, army doctors cited the ‘psychic factor’ as the chief cause of ‘delayed recovery’ in a large proportion of casualties of the Somme, according to the Australian official medical history.38 In short, they had been warned: regimental aid posts during Third Ypres were about to confront the same phenomenon, on a larger scale – due to the wretched conditions and more concentrated artillery.
During Third Ypres, the Royal Army Medical Corps reclassified cases of shell shock as ‘Not Yet Diagnosed Nervous’. Such cases were to be set aside for special examination at a dedicated clearing station, as decreed by a General Routine Order dated June 1917. At first, they were sent to a station near the front, ‘too noisy’ for ‘nervous’ men. A quieter station at Haringhe apparently achieved a remarkable success rate: just sixteen per cent of 5000 cases of shell shock required evacuation to specialist base hospitals.39 Most were sent back to the front. That did not mean they were ‘cured’; simply, that they’d been rested and persuaded to fight on. Doctors knew little of the long-term consequences and were discouraged from sending shell-shocked cases to comfortable hospitals at home, from where, the military feared, they would be reluctant to return to active duty.
No-one then knew the long-term complications of ‘nervousness’. Not until it was diagnosed as a genuine mental illness in 1980 would psychiatrists label a spectrum of war-related psychological conditions as post-traumatic stress disorders. In other words, the war, and chiefly heavy artillery, and not cowardice or a predisposition to mental illness had created these nervous wrecks. No military doctors were prepared to say that in 1917 (and even today, some military
officials vehemently deny the existence of PTSD). Perhaps it was no coincidence that, until 1917, shell-shocked cases were ineligible for a war pension: the government was afraid that special recognition of the disorder would ‘open up a floodgate of wastage’.40
Head wounds posed a terrific surgical challenge. The American neurosurgeon Dr Harvey Cushing, who served with the British Army in Flanders, recorded his experiences at the head wound clearing station at Proven in a diary of searing honesty. His work laid the basis for modern neurosurgery.
Consider a few days in the life of this extraordinary man.41 Never had he performed so many major brain operations with so little time. During the heavy rains in early August, Cushing’s station received 2000 ‘head cases’ a day, a rate he expected to rise ‘hugely’. Soon enough, his surgery was packed with ‘untouched cases, so caked in wet mud that it’s a task even to strip them to find out what they’ve got’.
Proven was one of the busiest of the fifteen clearing stations, treating about 30,000 casualties in the first weeks of the offensive, ten per cent of which were listed as ‘GSW (gun shot wound) Skull’. Often, Cushing operated ‘all day’. He ended one shift, he wrote, by extracting ‘a large piece of shell from a man’s badly infected ventricle with the magnet – then dinner, and now to bed’.
Next morning, ‘a large batch of wounded were unexpectedly brought in – mostly heads – men who have been lying out for four days in craters in the rain, without food. It is amazing what the human animal can endure. Some of them had maggots in their wounds.’ Again, he used a magnet to draw steel fragments out of damaged brains. On 5 August, he was engaged in ‘Urgent operations on more rotting men’. One had ‘a gross gas infection of the brain’. Another, brought in on the 15th, had the whole of his frontal lobe blown out, by a piece of shell almost an inch square. By this point, Cushing’s team were operating on eight serious neurological cases a day; they included ‘little East End Tommies’, big ‘Fritz’ prisoners and terrified Belgian civilians.
In early September, Cushing proposed that a special hospital be set aside for head wounds. The sheer volume warranted the reform, he argued. His team were more than fit to run it, having reduced the mortality rate of penetrating head wounds from 56 to 25 per cent. The British Surgeon-General Bruce Skinner answered that he would ‘look into it’. Nothing was done before Polygon Wood, during which Cushing experienced his busiest two days yet: twelve patients on 27–28 September, of which several had ‘multiples’, meaning that he operated on twenty major head wounds in 24 hours, ‘our record so far’.42 In peacetime, he would have been unlikely to do more than one such operation a day. Cushing was performing complex brain surgery; surgeons who performed so-called ‘knife, fork and spoon’ operations – amputations or flesh wounds – often exceeded 100 operations a day.43
Moments of black comedy punctuated Cushing’s routine: in late August, Skinner appeared in Cushing’s surgery, complaining of a bee sting. Was it a battle casualty? Cushing asked. Skinner ‘didn’t get it at all’.44
At night, Cushing operated by candlelight to avoid drawing the attention of German aircraft. Bombing hospitals was rare, but both sides did it. The density of the British barrage destroyed anything in its path, including German dressing stations. On at least one occasion, German aircraft deliberately targeted an Allied hospital: the 3rd Australian casualty clearance station near ‘a town that begins with the second last letter in the alphabet’ was shelled three times, Elsie Grant, a young nurse working there, wrote to a friend on 23 August (the cryptic clue to her whereabouts survived the censors): ‘this last time was too dreadful those brutal Germans deliberately shell our hospitals with all our poor boys [sic]’.
She and the other sisters were immediately moved to deep dug-outs. Not all the wounded could be evacuated in time, and four were killed during the bombardment. ‘I can’t tell you how cruel it was to leave those poor helpless patients,’ she wrote. Two dozen officers decided they were needed in the dugout to comfort the nurses, and arrived bearing food and a gramophone. Soon the party was singing ‘Pack Up Your Troubles in Your Old Kit Bag’. When they all emerged, the hospital ‘was a total wreck’.45
A kind of heaven awaited the recovering soldier in the little town of Poperinghe, nine miles west of Ypres, the British troops’ rest and rehabilitation centre. It was ‘one of the seven wonders of the world’ to men returning from the front, observed Edmund Blunden MC.46 Throughout 1917, troops pounded its mediaeval square and filled the local billets, pubs, cafes and brothels, swelling its population from 10,000 in peacetime to tens of thousands during the war.
In the heart of ‘Pop’, as the men dubbed it, was a church-run haven for the soldiers’ entertainment, called Talbot House, run by Chaplain Philip ‘Tubby’ Clayton, over whose rooms stood the sign, ‘All Rank Abandon Ye Who Enter Here’. Tubby meant what he said: his parties often entertained a general, lieutenants and privates.
Talbot House staged comedies and singing nights, and its restaurant served British classics (roasts with Yorkshire pud, etc.). The library, a ‘very large cupboard’, was packed with books that the soldiers borrowed by ‘pawning’ their army caps. Services were held in the chapel in the attic, where 800 soldiers were confirmed and at least 50 baptised during the war.47
The happiest and saddest place in Talbot House was Friendship’s Corner, the message board. Here, men who had been thought dead were brought back to life; and those who had been thought living were pronounced dead. The messages reunited thousands of troops over the years, with listings such as: ‘Gunner H. STOOKE would like to see his brother BILL’; or ‘Bdr [Bombardier] R. YEOMAN D/150 Howitzer Battery, RFA, would like to meet any old friends’; or ‘Pte [Private] W. STAPLEHURST would like to meet Pte E. STAPLEHURST.’48
Talbot House distributed the soldiers’ post and rations. When they arrived together, ‘the post won every time’, Tubby recalled. ‘Letters were of more value than many biscuits. Tins of bully beef were not infrequently thrown away, but old letters never …’49
Most days on leave, the men took a hot bath in the bathhouse, a former brewery situated in the village of Reninghelst. They stripped and plunged into the brewing tub, or took a hot shower under a series of pipes pierced with holes. They attempted to ‘delouse’ their clothes in a variety of ways, chiefly by boiling them, but ‘lice continued to live and thrive despite everything’, observed Captain Philip Gosse, of the 69th Field Ambulance.50
The men played soccer and cricket, drank and relaxed here, and fraternised with the locals. The appearance of normality among the townspeople was a source of comfort and reassurance. Corporal Alfred Leahy, who served at Third Ypres with the Royal Australian Engineers, was reassured to see ordinary people going about their business. ‘Harvesting is now in full swing over here and the fields are being mostly worked by women, girls and boys,’ he told his mother, on 2 September 1917. ‘Nearly every woman and girl are dressed in mourning for some dead relative or other who has fallen in the war. We all dread the approach of another winter but hope by the end of the year this great war will be terminated.’51
Even if the Channel was calm, the slightest rock of the troop ship jarred the seriously wounded, many of whom fell seasick. For them, the voyage home was ‘a nightmare of nauseating pain’.52 A buzz of voices, the honk of launches and the sound of automobiles on the wharves greeted their arrival at Southampton or Plymouth, where uniformed men with white armbands carried the stretcher cases off the ship and onto the hospital trains, bound for Charing Cross, London. These arm-banded men were conscientious objectors, whose religious beliefs had exempted them from combat. ‘They are perhaps doing their bit on home service,’ Ed Lynch recalled, ‘but nevertheless we somehow despise them.’53
A dream-like experience attended the soldiers’ return to Britain, in late 1917. A weary and divided nation awaited them. Anecdotally the home fires were still burning. The middle classes tended to carry a torch for the spirit of 1914. Children still dressed up in khaki; girl guides
volunteered to make socks and mittens for the troops; boy scouts acted as lookouts or ran errands for the army; and babies were still being named after towns in France and Flanders.
Long coal and food queues were ubiquitous: sullen-faced women and miserable children would wait for hours to buy coal, in short supply since the government introduced strict coal rationing in April 1917. As winter approached, angry crowds besieged the coal trolleymen and tried to gather extra fuel from the railway sidings. Queues for scarcities such as meat, sugar, tea, bacon and butter, the price of which soared in 1917, often turned violent. In Birmingham, they were ‘a pathetic and alarming spectacle’ of bedraggled despair, according to one witness.54 The queues lengthened alarmingly later that year, when thousands lined up in the hope of some butter or margarine. In response, from September 1917, the government introduced food rationing, along with a nationwide plan to boost tillage and cereal harvests.55
The British people, however, suffered none of the famine-like destitution of German civilians (see below). Potatoes were in plentiful supply, thanks to a good mid-year harvest, as were tinned fish and ‘war bread’, made out of wheat husks. People complained that the bread was inedible and fit only for pigs, but they ate it. Bread consumption was in fact higher than pre-war levels, because it was cheap, thanks to a government bread subsidy that kept the prices down, financed by taxes on the rich. Anyone caught wasting bread or giving crusts to pets was fined. One wealthy woman received a £20 fine for feeding her Pekingese a regular diet of rump steak.56