CHAPTER VI.
THE MEDICAL SERVICES.
The magic-workers of the war—Fighting the Germans—Concerning the Victorian primness of conversation and the present popularity of "v.d." as a theme for small talk—The Army and "v.d."—The etiquette of hospitals and the ways of matrons—The war against Trench Feet—Mustard gas in 1918.
Probably more than half the men at G.H.Q. had been "crocked" at one time or another during the campaign, from wounds or one of those fevers of the battlefield born of mud and filth and fatigue. Some came to work on the Staff whilst still under medical treatment, and there was a local hospital at Montreuil which was a boon to those out-patients needing massage for their scars or quinine for their fevers.
Apart from the doctors of this hospital only the very big men of the medical services appeared ever at G.H.Q. It was a pleasure not easily won to persuade them to talk over their work. But when they did talk, what wonders they had to tell of!
A BY-WAY
Socrates in prison, when the fetters were taken off his legs, as he rubbed them to make the blood run freely again, speculated on how pleasure always followed pain, so that the two seemed to be linked together by some unbreakable bond. One would like to hear Socrates to-day, as his limb, injured in Flanders, was rubbed back to usefulness, talking to his masseur on the good that will follow the evil of the Great War as surely as if the two had been linked together and one was the consequence of the other. Matter for a fine homily there from the stubborn old hero with the divinely clear mind!
Those optimists who thought that a new heaven and a new earth would come at the end of the war, and that even all politicians would become sincere, alert, and vigorous in the public service, were perhaps not reasonable and may be disappointed in some measure; but no one can observe closely the phenomena of the war without being sure that from its sacrifices and lessons much good will come. The dreadful fire that had to be kindled to burn out the cancer of Germanism burned out evil too in the nations that were the instruments of vengeance. Peoples who went into war iron will come out steel ultimately; for the war, as well as being preservative, will prove regenerative.
There is no better proof of this than in the tale of our campaigns against the germs, those pitiless enemies who are always attacking human content and happiness. It was a wonderful part of the war, that defensive and offensive against Disease, with its trench systems which hold up foes whom we cannot destroy with our present weapons; its Intelligence Department, spying with a thousand microscopes into the designs and dispositions of the enemy; its clever diplomatic service, always raising up allies in our blood against germ invasion; its long illustrious roll of heroes who have given up life or health to hold positions against odds or to go out on forlorn hopes.
In this the benefits springing out from the Great War show splendid and palpable. In the process of beating the Germans we made such great advances in the war against the germs that we greet peace as a definitely healthier people, organised to save, in a generation or two, for service in this world, more than the total of all those who went to a Higher Service from the fields of France and Belgium.
Because the war has given a sounder national discipline, because it has cleared so many obstacles from the path of medical organisation, the world's death-rate, according to sound calculations, will in future years show a substantial decrease. The toll taken by the Germans will be more than made up by the lives saved from the germs. The British Medical Service, following in the path of the victorious British Army, and wielding an authority that it never knew before, carried on a war against disease in Europe, Asia, and Africa that is now saving thousands of lives, and will save millions in the ultimate result. Enteric, cholera, dysentery, scurvy, small-pox, beri-beri, malaria, phthisis were fought successfully. Even that national British disease, rheumatism, was pushed back from some of its trenches and compelled to surrender not a few of its ridges.
Fascinating as a fairy tale, absorbing as a good detective story, stimulating as the records of a stubborn battle, will be the record of British medical work in the Great War when it comes to be written. It will not be a story merely of drains and drugs and dressings, but also of kindly amulets and beneficent golden fishes; of wicked germs who chalk their throats to deceive with soft talk little red corpuscles; of fairy princes who destroy wicked enchantments with spells from tiny glass tubes. Those attentive gentlemen experimenting with neck ribbons smeared with potent charms have not come to their second childhood; they are on the track of the perfect cimicifuge which will keep lice off the body and, keeping off lice, will reduce the range of typhus and other diseases. A great tank of little live fish sent out to a malaria Front does not mean that we are relapsing into the old Chinese school of medicine (which prescribed a live mouse to be swallowed whole as a remedy for one complaint), but that these little fish love to eat the eggs of the anopheles mosquito, which spreads malaria. It lays its eggs in ponds; the fish eat the eggs; the eggs don't hatch; the mosquitoes don't come; and there is less malaria.
If your mind is more attracted by detective stories than by fairy tales, turn to a bacteriological laboratory and watch the tracking down of the Hidden Hand that is responsible for odious diseases; for example, that one known popularly as spotted fever, a very deadly disease of over-crowding. A cunning criminal is the spotted fever germ, and he has not yet been quite fully identified and convicted. A victim of spotted fever has in his throat and spinal fluid the causative germ; but this germ hides behind a smoke cloud of other germs and must be placed quite definitely before it can be destroyed. It was found that it is a germ shaped like a double bean, that it is to be distinguished from other germs of the same shape by the fact that its hide is impervious to a certain stain which those other germs will absorb. It was further found that this spotted fever germ would not increase and multiply at a warmth of 23 degrees C., whilst otherwise similar germs would. There certain knowledge stopped for a time. Other double-bean, non-staining, non-growing at 23 degrees C. germs existed, among whom the real criminal lived and hid. Finally, four bad brother germs were found and are now being dealt with, and the disease is no longer a serious menace.
The divine purpose for good that runs stubbornly through life and has made it impossible for the murderous German plans to thrive in spite of all our neglects and stupidities, crops up insistently in the story of the British medical campaign in this war. Thus, chlorine gas came into the field first as the poison gas of the Germans; it remained in the field on the British side chiefly as a means for purifying water.
One interesting result of the war which we noticed at G.H.Q. was the abandonment of the Early Victorian primness in conversation in England. Soldiers going home on leave noticed it from 1916 onwards; and on the balance of the evidence I do not think they were at all responsible for it. They would go away from Boulogne, after an extra careful bath and the putting on of a clean tunic, with a steady resolution to put away from their thoughts and their tongues all the coarseness of the camp; and find themselves at their first dinner party in England tackled by some young lady in her teens on the subject of lice; or by some matron not yet in the thirties on the subject of venereal disease at the Front. They would come back often with a distinct feeling of shame-shock, to welcome the comparative reticence of Mess conversation.
It was my duty once to see the representative of an organisation that wished to have lectures delivered to all the soldiers on the subject of "v.d." To my surprise the representative proved to be a lady—and a young and attractive lady at that. She plunged into her subject without the least trace of embarrassment. She wanted lectures, with pictures, in every recreation hut of the B.E.F., France, and was firm to brush away the objection that "the men might not like it," and scornful of the reservation that if the lectures were permitted they were not to be "parade lectures," i.e., the men were not to be compelled to attend.
Finally, discovering that though the lady wanted "pictures" she had not the pictures but expected the Army to supply them, I took refuge in a subterfuge. "Very sorry, very sorry indeed, but there is no Vote out of which we can get the pictures."
But the lady was insistent. She knew that there were cinematographs provided for the soldiers.
"Oh, but that is not my department. That is Amusements."
"Very well," she said firmly. "I'll see Amusements."
And she went away to convince some other Staff Officer that universal lectures on v.d., with pictures, would be an appreciated Amusement.
I do not know where the idea sprang from that v.d. was very common in the Army. So far as my observation went, and from what inquiries I made of medical officers, the opposite was the case. Among the officers with whom I came into touch during the campaign—many hundreds in the aggregate—I only heard of one case. Among the men of my battery before I was on the Staff I never heard of one case during 18 months of regimental life.
The Army's standard of health in this respect was better than that of the average of the civilian population. There were some tragic outbreaks—one in Cairo, another (of much less seriousness) with Amiens as its focus—but on an average the record was good.
British ideas did not favour the degrees of regulation and interference in this matter that other countries tolerate. But the soldier had some safeguards which the civilian had not. For instance it was the duty of the Assistant Provost Marshal of a Division, whenever a man reported sick from v.d., to go to the hospital, interview the patient and try to find out the fons et origo. If his mission were successful the person responsible was promptly expelled from the Army area.
One of the Dominion Corps adopted the method of advising prophylactic precautions (and supplying the means of prophylaxis). The British Army on a whole did not follow that course, though in the later stages of the campaign the means of prophylaxis were available if applied for.
But enough on that point. It was the surgical rather than the medical side of the R.A.M.C. that interested G.H.Q. So many had "taken a knock" and put in a spell at a hospital. Opinion was practically unanimous that "Hospital" was a place of real human sympathy as well as devoted skill, and that "sister" was the best pattern of womankind.
It is etiquette in the Army to call her always "Sister," though technically "sister" is an intermediate grade between "nurse" and "matron." Matron is a great dignitary. She has, in the language of the Bar, "taken silk," and when her silk gown rustles into the room it is etiquette for officers to stand up, provided they have legs and strength to stand up. Otherwise you "come to attention" by smiling as well as you can; a respectful, cheerful, but not an hilarious or free-and-easy smile. It should convey the message that you are having the time of your life in the best possible of hospitals under the best possible of matrons. The Sister whose patient you are will be very much hurt if you do not smile properly at Matron. "Sister" is of many different grades of skill, but of an almost unvarying grade of devotion, the highest.
A "strafer," in hospital language, is a Sister who by ten years or so of hard anxious work and self-denial has reached to the height of an office boy's wage and a professional skill which saves lives daily and cuts weeks off one's stay in hospital. You are always glad when she has gone away from your wound, but at the back of your gladness is the knowledge that you want her for next dressing. A good "strafer" goes over a wound with the enthusiasm of a thrush with a large family going over a lawn for worms. She examines, searches, squeezes, probes, looking out for shed pieces of bone, for "proud flesh," for odd corners where inflammatory matter might lurk. She is looking for mischief, and any mischief found is promptly "strafed." If it is bad she calls in the doctor; if it is minor she has her own little armoury of mischief-breakers, scissors, pincers, nitrate of silver, and the like.
Matrons are easily offended. At a certain hospital in France the King was half expected as a visitor. The Matron at once had a bad attack of decoration fever. As I was a lightly-wounded that time I assisted her policy of deceiving his Majesty into thinking that the hospital was always a fairy bower by going out and "finding" some flowers. Then Matron had clean quilts on all the beds, and the order went forth that these were to be kept creaseless and smooth. But one patient would persist in crooking up his knees. Matron argued with him. He disloyally pleaded that he was much more comfortable that way. Now, having got the flowers for the ward, I thought I had the right to give advice as a sort of accomplice, and I suggested mildly: "Better break his knees, Matron."
She was offended. Then the King did not come after all; and I think she was inclined to blame me for that.
But matrons are not altogether an evil; like the Staff and adjutants and brigade majors, they are at the worst necessary evils, at the best quite good sorts. But there is one matron-habit that should be dealt with sternly by regulation. If a very pretty nurse were posted to a hospital, Matron generally tried to assign her to the sick sisters' ward. Obviously that was bad strategy. The prettiness of their nurse would have no cheering effect on sick sisters, but to sick officers a pretty sister irresistibly suggests the wisdom of getting well quickly. Fortunately the supply of pretty sisters is too great to allow of their all being absorbed in wards for sick sisters.
A ROYAL VISIT, DECEMBER 1918
What reconciles one to Matron is the discovery sooner or later that, despite silk gown and awe-inspiring manner, she is at heart still "Sister," ready with skilful aid and encouraging sympathy in case of need. It is a nice etiquette that makes the title "Sister" general, for it is just sisterly affection which makes the atmosphere of a military hospital so cheering and recreating.
Distinctions of rank are abrogated in a military hospital to a large extent. The officer of general rank has a special quarter where he meets only other highnesses; but, for the rest, colonel and "pip-squeak" (the odious term which is vainly designed to lessen the self-importance of the second lieutenant) usually fraternise in a common cheerfulness. There are no rank badges on pyjamas. But one distinction has intruded—that between surgical cases and medical cases. The medical case must bear himself very humbly if he gets into a ward where there are surgical cases. Even that kindly authority "Sister" will in some unguarded moment, unless she is very, very careful, refer to him as "only a medical case."
One medical case, taught cunning by circumstances, discovered when he was being moved from one hospital to another that a special sort of headache he suffered from could be relieved by a large, impressive bandage. With this head adornment he successfully deceived us at —— Hospital. A rumour went around that he was a trepanned case, and as Rumour stalked from bed to bed the size of the silver plate in his skull grew and grew until it was almost the size of a dinner plate. His shameful secret was at length discovered; he was only a fever or a heart or something, and, whilst we were all sorry for him, he no longer disputed favour with our ward pet—a delightfully cheerful pip-squeak whose body was so be-stitched that we felt sure they had a sewing machine in the operating room for him.
It is etiquette in a military hospital to be very much interested in one's neighbour's wounds and to affect to hold lightly one's own. It is very bad form to hint that your lot is more severe than his lot.
"Oh, I am all right, thanks," (you say in answer to his first advances); "except for a bit of my liver and a few yards of lung blown away, I'm as fit as can be. But that looks an awful leg of yours."
"Not at all, not at all. It is almost certain now to stay on. But it must be horribly interesting to have a body wound."
And so the ghoulish chat goes on.
Quite half of G.H.Q. had hospital reminiscences to exchange; indeed a spell in hospital with a bad wound was often the clinching argument leading to "red tabs" if an officer were qualified for the distinction; and Medical Boards in England were quite willing to certify a man as fit for France if he was marked for a Staff Appointment even though his category was "light duty."
"Trench Feet" gave the Medical Services more trouble than any other single disease, and almost as much trouble as the shells of the enemy. In the winter of 1915 a pilgrim to Flanders (supposing him to have a military permit) might have observed in the rest camps behind the British lines companies of men with bare feet, and officers bending down anointing them. And he might have perhaps concluded that this was some religious ritual of humiliation, such as the theatrical washing of beggars' feet by the late Austrian Emperor once a year. But such a conclusion would have been wrong. The proceeding was religious certainly, in the highest sense, but in no way theatrical. It was "Trench Feet" treatment.
The disease known as "Trench Feet" was one of the most serious developments which the Army on the Western Front had to face when the Germans, beaten in the field, "dug in," and Trench War began. The struggle with the disease was a long and strenuous one, taxing to the utmost the resources of the British Army Medical Service.
The causes of the disease were not plain at the outset, and inquiry proved them to be various. Everybody knows that it is uncomfortable and, to a certain extent, unhealthy to stand for too long at a time. (The social legislation that shop employees must be allowed seats is an indication of this). The soldier in the trenches must often stand for long periods. That makes him to some extent liable to foot trouble. Again, tight boots and tight bandages round the legs are bad for the blood circulation, and can make foot trouble without any other cause. The soldier used to be rather careless as to whether his boots were of a proper fit, and he was apt to bind his puttees too tightly.
Here were the beginnings of "Trench Feet." To have the feet wet, to have the feet cold for long spells, will cause chilblains, i.e., local inflammations showing first as red itching lumps, afterwards if neglected, developing into open sores. Long periods of standing, and any constriction of the circulation from tight boots or tight puttees, help cold and damp to cause chilblains; and chilblains used to be almost invariably neglected by the soldier. Then came the final aggravating cause—the filth of the Flanders mud getting into the sores of the broken chilblains, and, behold, a typical case of Trench Feet.
In the early days cases were often of dreadful severity, sometimes leading to amputation. In one of my billets at Montreuil was a French soldier who had lost both his feet from this cause. Later, both treatment of the disease and, more important, the prevention of it, were so perfected that really bad cases were rare.
The story of the fight against "Trench Feet" is one of the many fine stories of the war. In the main it was, of course, a story of medical skill and devotion, but also it was a story of unstinted generosity on the part of the War Office, and of admirable and intelligent service on the part of regimental officers. The medical staff told me that it would have been impossible to carry on to success the campaign against "Trench Feet" if they had not been intelligently and perseveringly backed up by regimental officers, and if the War Office had not poured out very many thousands of pounds sterling for the furtherance of every approved preventive measure.
Preventive measures covered a wide field; precautions against tight boots and tight puttees; increased provisions of socks; increased bathing facilities; provision of waterproof rubber boots for men while in the trenches (these boots were of the high wader type); paving of the trenches with "duck-boards" which gave a dry standing; more frequent reliefs in wet trenches. These were material provisions. To second them there was an active propaganda in personal hygiene, and here the regimental officer and non-commissioned officer were enlisted to help the medical staff to make the men understand that the smallest sign of a chilblain was to be met with prompt treatment. A whale oil ointment was provided both as a prophylactic and as a curative for mild chilblains. When necessary this was reinforced by spirituous lotions. On officers was put the responsibility of seeing that their men's feet were kept clean and well anointed with oil, and that any breach of the skin tissue was promptly treated. So officers became chiropodists, and you might see enthusiastic company commanders assisting their men to wash and anoint their feet, to show them how it should be done.
The winter of 1917-1918 put to a severe test the precautions against "Trench Feet," for in almost every part of the Western Front the British had pushed the Germans back, and there was no longer the old organised trench system. Nevertheless the British hospital records show that the disease was held. It was still a trouble; but, thanks to the plentiful supply of comforts and preventatives, and to the scrupulous care demanded by regimental and medical officers, it was no longer a grave menace.
The fight against mustard gas in 1918 was another fine achievement of the Medical Services. But this subject of the medicine of the war calls for a volume to itself. Let me only add here that the successful medical results won in this war were largely due to the fact that—contrary to the system of other wars—the doctor had a real influence and power at G.H.Q. In his own department he was supreme. So were solved successfully the vast medical problems which the Great War presented. The greatest armies known to history grappled in a continuous and furious struggle, not for a day or a night or a week, but for months. The wounds caused by hand grenades and high explosive shells were often of terrible extent. The battlefield to a depth of five miles was under constant shell fire, and transport of the wounded for that distance was therefore always under fire, and roads were torn up almost as soon as made. Conditions of infection were extraordinarily favourable. Traffic regulation had to overcome the most serious obstacles, since railways, roads and tracks had to provide for the constant reinforcements, for the frequent passage to and fro of relieving Divisions, for food and water for men and horses, and also for ammunition unprecedented in quantity.