Patients and the First World War

Patients and the first world war

One of the primary purposes of military medicine during the war was to preserve a precious resource. Patients were ‘repaired’ to be battle ready and a field surgeon or hospital was as much a part of the military complex as a sapper or gun emplacement. Patients were assessed for fitness to fight at every point during their care, with all but the most severely wounded in a loop that inexorably led back to the battlefront. Those undergoing treatment were aware of the situation they were in, one convalescing soldier described every patient such as himself in terms of being a:

‘…wheel in a complicated machine [and] all must work together otherwise disorder and chaos would inevitably result’ (Recollections of the Hospital Keighley and its Auxillaries, 1919, pp: 32–33).

If this seems harsh it should be remembered that the concept of an ordinary soldier as a valuable asset was a major driver in providing care. Just a century before, an injured combatant could expect little more than a place on a floor, minimal attention and most likely a painful death from disease or infection. Paradoxically, during the first world war, whilst injuries were inflicted on a hitherto unseen scale, medical services actually managed to deliver a higher chance of survival than ever before.

arraWounded waiting to be evacuated after the Battle of Arras in 1917 (image courtesy of the Imperial War Museum).

Patients during the First World War were treated differently according to rank and local conditions but there were established processes that most would have experienced in some form. The first was evacuation and ‘triage’, a term popularised during this period. Only the very seriously ill would get a ‘Blighty Ticket’ sending them back to hospitals like St George’s for care and convalescence.

blighty caseA postcard showing a wounded soldier being evacuated to ‘Blighty’ (image courtesy of WW1 postcards.com)

Established hospitals such as St George’s put beds aside for injured servicemen from the very outset of the war (St George’s Hospital Gazette, October 1914). Whilst wards followed the conventional layout of beds and treatment stations the buildings they were set up in varied widely. There were large ‘hut’ hospitals constructed especially to deal with the influx of wounded but a diverse range of buildings were also commandeered for use as ad hoc hospitals. However the treatment for all injured soldiers followed the medical mores of the time; bed rest, a ‘soft diet’, fresh air, and activities to promote good morale were all prioritised.

craigleath hospitalPatients at Craigleath hospital (image courtesy of WW1 postcards.com).

It might have been expected, even if some surroundings were basic, that everyone would be happy to be away from the battlefield but responses to the care offered were mixed. Many were relieved to have a bed and a bit of peace. However for others the confinement to a bed itself was sometimes resented. As one author noted in a hospital magazine:

‘The clothes [being] tucked in to such an extent that it is well-nigh impossible for [the patient] to move . The bed is no longer a bed, it is a nightmare’ (Ammonite, 1917, pp: 286–287).

Others were not happy with the general conditions they encountered. In 1917 one soldier, admitted for injuries caused by gas, described the Royal Naval Hospital as:

‘the closest combination of prison and workhouse I know’ [with] ‘infamous rules galore, scanty ill-cooked grub and general treatment rotten’ (Liddle Collection, 1917).

The military hospital was as full of distinctions, rules and constraints as any army base. Whilst patients were spared the shells and gas at the front, treatment itself could be painful and recovery was far from guaranteed. However those hospitalised had the shared experience of fighting at the front and an ‘esprit de corps’ did exist amongst patients. Much like the ‘Wipers Times’ (which was produced in Ypres by soldiers to entertain each other) hospital patients produced newspapers with a content that often satirised hospital life (Reznick, 2004).

The ordinary soldier was inclined to view his time in hospital with a grim, chippy, resignation and the therapies to encourage morale and recovery were often pilloried. One was the insistence on playing music, many soldiers enjoyed singing but sometimes the endless use of a gramophone grated. Another irritation was the attention of well-meaning upper class women making ignorant comments. When she was a volunteer nurse, the writer Enid Bagnold wrote exasperatedly of ‘the lady who comes in to tea and wants to be introduced to everyone as though it was a school treat’ (Bagnold, 1918, p.15).

cartoonwellcome“What will you do when leave hospital, my poor fellow?”

“Oh! I’ve got a splendid job in a brewery making ‘ops, and my friend here he’s going in for short’ and !”

Cartoon satirising well to do hospital visitors (image courtesy of Wellcome Images).

Soldiers recovering in Britain were required to wear a loose blue uniform, known as the ‘convalescent blues’. The reasons for this were partially practical. Uniforms from the front were worn, tatty, full of lice and had to be disinfected or replaced. A hospital uniform was the cheap utilitarian answer. However it also had a psychological role, that of reinforcing a sense of institutionalisation and discipline. Moreover there was also an undeniable propaganda purpose in forcing convalescents to wear the ‘blues’. It marked them out as heroic ‘Tommies’ whilst highlighting that they were being cared for by the government; reassuring for those whose family members remained at the front.

conbluesPainting of convalescent soldiers in their blue uniforms by Robinson (1920), (image courtesy of Wellcome Images).

The patients themselves had mixed feelings about them. To start with officers were exempted; they received an armband and an allowance to help them buy new clothes. Everyone else had to wear the outfit at all times and some found it undignified whilst others felt that it took away their individuality. Produced in one size only, they were often ill-fitting and some complained that the uniforms resembled pyjamas. There were advantages to wearing the uniform however, the attention could be positive and there was no risk of being presented with the dreaded white feather for cowardice. The injured soldier also gave the public at home the opportunity to be charitable and help the war effort. They would often be be given free entrance to theatres or gifts by grateful citizens.

A popular gift for someone wearing the convalescent blues was tobacco. It sometimes appeared that the army at the front ran on nicotine. Some frowned on this but the general consensus was that any small comfort was to be encouraged. In fact there were official charity drives to provide ‘Smokes for Soldiers’ and ‘Fag Day’ was the flag day for collecting funds in order to do so. Tobacco obtained with the fund could was also distributed to wounded and convalescing soldiers and sailors.

fagday

Poster promoting ‘Fag Day’  (image courtesy of the Imperial War Museum).

It might have been expected that the stress on cleanliness and hygiene would preclude smoking on wards and whilst there were sometimes limitations this does not appear to have been generally the case. Gifts of cigarettes and tobacco were regularly presented to the men at many London hospitals.

Alcohol was more problematic. At the front, despite some opposition, soldiers received a rum ration. The known tendency for it to dull reactions was considered to be outweighed by its ability to lift morale and comfort the troops. In clearing stations it was sometimes used as a disinfectant and pain suppressant. Those on leave in France and Belgium could also buy wine and spirits from the local population.

drinking postcardCartoon ridiculing the drinking prohibitions introduced during the war (image courtesy of WW1 postcards.com).

The situation on the Home Front was different. In fact it was women who caused the greatest consternation as they were drinking more than men. This was particularly worrying in the case of munitionettes and drivers but the government was also concerned about productivity and morality in more general terms. The result was that one of the most unusual laws in British history was passed in some areas in 1916. The so called ‘Treating laws’ forbid anyone to buy a drink for someone else, even a family member or spouse.

As a result there were no mass public drives to provide soldiers with gin or brandy or to encourage them to drink. However it was common for pub landlords to give drinks to serving and recuperating soldiers. Gifts of alcohol to convalescents in hospitals were not unusual. In the case of officers alcohol was freely available, a Canadian officer being treated at King Edward VII’s Hospital for Officers recalled that:

‘The butler used to come round the wards before meals and take one’s order for dinner. Liquor was available in any form by request’ (Reznick, 2004, p.64).

At the beginning of the war recruiting officers had been dismayed by the health of many volunteers, the results of poverty and poor nutrition amongst the general population. This, combined with the privations in the trenches might have been expected to ensure that food, at least, would be gratefully received. However patients complained about both the ingredients and the portion size of their meals. As one soldier drily observed in 1917:

‘Unless you are on a starvation diet, your food, consisting mainly of fish, soup and eggs, is fit for the gods – the gods being ethereal creatures and not standing much in the need of solid sustenance’ (In hospital,1917, p.80).

The First World War hospital was not simply about care and recovery.  A military hospital, in which an injured soldier could spend months recuperating, was often also a community. It emphasised the soldier’s continuing role in the war, his job was to recover and this was part of his service. The use of uniforms and team activities was designed to ensure the recovering serviceman remained institutionalised. Towards the end of the war, when Russia had undergone a revolution and soldiers were increasingly mutinous the British government was particularly worried about morale. Hospitals, with their concerts, music and cheery patriotism were part of the effort to prevent rebellion and foster comradery amongst an increasingly brutalised and weary fighting force.

amputeeAmputee being treated at Queen Mary’s Hospital, Roehampton (image courtesy of Imperial War Museum).

Nonetheless, the wounded, especially those from poor backgrounds received free treatment they would have been unused to prior to the conflict.  After the war many continued to benefit from medical care provided by charities and hospitals such as St George’s.

Bibliography.

Ammonite, ‘Beds and bed making’, (1917) Southern Cross: Magazine of the First Southern General Hospital, pp.286-287.
Bagnold, E. (1918) A Diary without Dates. London: William Heinemann.

Cayley Robinson, F. (1920) Acts of Mercy: The Doctor [paint on panel]. Available at: http://blog.wellcomelibrary.org/label/frederick-cayley-robinson/ (Accessed: 4 November 2014).

Imperial War Museum Collection. Available at: http://www.iwm.org.uk/collections-research (Accessed: 4 November 2014.
‘In hospital’ the magazine of the Fourth Northern General Hospital (1917).
Wallis, S. J.(1917) Letter from S.J Wallis to his brother George Wallis, 3 and 6 November. Leeds University Library, Liddle Collection.
Recollections of the Hospital Keighley and its Auxillaries. (1917) London: Wadsworth and Co.
Reznick, J. S. (2004) Healing the Nation. Manchester: Manchester University Press.

Wallis, S. J.(1917) Letter from S.J Wallis to his brother George Wallis, 3 and 6 November. Leeds University Library, Liddle Collection.

Wellcome Images. (2014) Available at: http://wellcomeimages.org/ (Accessed 11th November 2014).

WW1 Picture Postcards. (2014) Available at: http://www.worldwar1postcards.com/ (Accessed 11th November 2014)