Tuesday, 2 August 2016
War Infirmities and therapeutic marvels
Part V of ‘With Canadians from the Front’
By W. Lacey Amy
From The Canadian Magazine, January 1917.
In a study of the war it is uncertain which rouses the most wonder, the engines of destruction, the unprecedented physical effects on the soldiers, or the development of surgery and medicine. The remarkable advance of the destructive machine I have already treated in part, although each succeeding week proves that there is no limit to it. At the time of the penning of that part there were no “tanks”, although a few of us had some unproclaimed idea of their coming; and even they are but the beginning of war’s frightfulness.
The side of war less known to the public, because less dramatic, less pleasant to contemplate, less immediately material to the progress of victory, is the physical conditions induced by this novel struggle. In the old days of stand-up fighting, of mere guns and rifles, where some shadow of honour clung to both sides, there was small incentive to advanced surgical methods and practically none to new medical ideas. Soldiers fell pierced by a bullet or a sword or a lance, and the result differed immaterially from the accidents of daily life. Sickness was merely the sickness of civilian life and was treated as such.
But with the arrival of trench warfare everything altered, from the training of the soldier to his ailments and treatment. It is no longer a matter of passing out from a camp to a pre-arranged battlefield, like a great military tournament, with retirement at fall of darkness for rest and care of the wounded. There are no camps now, save rest-camps, where the soldiers are out of the struggle for a definite period. The fight is carried on without ceasing from exposed trenches that make camp life at the rear a rest indeed. And retirement is temporary defeat; rest is but the substitution of brigades or divisions whose period of relief has expired.
Whoever heard of “trench-shins” or “trench-feet” before this war? Or of shell-shock? And even nephritis and rheumatism and hernia, while illnesses of peace, have become much more the illnesses of the style of warfare in Flanders and France. “Trench-shins” may sound like a flippant name for an unimportant ailment, but to the sufferer it is temporarily as bad as a serious wound and less eager to respond to treatment. In reality it is a form of rheumatism that attacks the lower part of the leg in painful form, due to standing in mud and water. It is as incapacitating in time as a shrapnel wound. “Shell-shock” is more descriptive, but fails utterly in the indefiniteness of its application; for shell-shock may range from a mere mental surrender of the moment to staring madness or complete and everlasting paralysis.
Nephritis, an inflammation of the kidneys, has attacked many an otherwise strong soldier, and at the first of the war was not appreciated in all its seriousness by the doctors, largely because its inducement by such a condition was, of course, entirely new. But soon it entered into the list of diseases which received special consideration and yielded to modern therapeutics with gratifying readiness. Of course, in its favour stood the physical record of the sufferer, whose presence in the army denoted a constitution prepared for its eradication. That it was taken in time stands to the well-being of hundreds of Canadians whose previous health had unfitted them for describing their symptoms to the doctors.
Other kidney diseases have been induced by exposure in the trenches, being assisted by conditions of diet and bodily protection and care. But with the more careful study of results the soldier has been safe-guarded in a manner never thought possible at the beginning of the war.
The menace of rheumatism was more thoroughly understood from the first, and it has always received special treatment. “Frozen” feet are seldom frost-bitten, but a form of rheumatism caused by the continued cold and damp. The provision of trench mats, a raised slat walk along the bottom of the trench, has done much to keep feet dry—at least to give them a chance to dry. Never after that awful first winter have those fathomless depths of mud so inconvenienced and threatened the soldiers.
Although I have never heard hernia officially recognized as a war injury, I have come across too many cases not to see the connection. In modern warfare the manual labour forced on the soldier is infinitely greater than at any other stage of war’s history. Always there stands within easy range of rifle fire a great line of men who must be kept supplied. There are trenches to dig at fever pace and under all kinds of conditions. There are wire fences to erect, wounded to be retrieved under fire, strenuous night patrolling. And, while motor transport has been developed to completeness at the rear, everything near the front line is the work of human hands.
Take an ordinary night’s duties. A relieving column is going in. That in itself is a novelty of this war. And each man carries a load that would frighten him under peace conditions. In addition to his equipment of rifle, cartridges and pack, he probably staggers along under a roll of barb wire, or fence-posts, or extra supplies for those who remain at the front. And the conditions of approach to the front line are in themselves a strain. Perhaps for miles the incoming soldiers twist and turn and bump along through utter darkness in a trench not wide enough to give them ease of swing, and so crooked that a wall always seems to be facing them. Here and there are holes, probably filled with water, cave-ins, the chaos of recent shelling, dropped equipment and supplies. The physical strain is, of course, tremendous. And to evade the irritation of blind trench progress some who prefer to risk the open stagger into shell-holes or deep trenches whose first announcement is coincident with a few broken ribs or a bruised body. Walking unannounced into a six-foot trench in the dark is not a recreation to encourage.
The most interesting of the physical effects is shell-shock, both from the variety of its evidences and from its treatment. Essentially a thing of this war, its every mood and twist is a novelty which has called to its study the best medical minds in the country. While in every case shell-shock is a nervous affection, it is far more varied in its forms than anyone but those in daily touch with it would suspect. There are those who maintain that fifty per cent. of the soldiers, even including those in the trenches, suffer to some slight extent from it; and my own observation leads me to believe it. Its existence is noticeable in a petulance at unnecessary or sudden noise, and in the apparently unreconcilable effects of extreme sensitiveness to irritation and extreme indifference.
In its least serious recognized form it may go no further than a slight trembling under excitement, perhaps a profuse perspiration. Sufferers by the thousands have been temporarily relieved of trench life for nothing more than a startled shrinking at the sound of a gun. It has been found that it is much better to give the sufferer a chance to recover from the first slight symptoms than to leave it until months of careful treatment is required. A slightly more advanced stage in some is the perspiration that breaks out, the debilitating effects of which anyone can appreciate.
Of course, shell-shock is the result of the guns. In some cases it may come from the mere overwhelming roar itself, as anyone may have felt the mental irritation caused by the uproar in a stamping mill. But usually the physical condition of the soldier protects him until the shells begin to crowd him in quantities that leave him no time for recovering his poise. But the event of bombardment that claims its shell-shock victims by the score all along a much strafed line is being buried by the earth thrown up by an exploding shell. Very few cases of shell-shock have I encountered that were not induced by this terrifying experience or started on their way by it.
The story of shell-shock lends itself to dramatic effects, to startling narration of incident, for in it lies at times the weirdness of mental unbalance, of physical uncontrol, of ludicrous action, of mystifying and sudden recovery.
Where the effect is slight—it may not appear slight to the uninitiated—the sufferer usually treats it so lightly that the onlooker sees but the funny side of it. This is increased by the knowledge that shell-shock is ordinarily but temporary in its serious effects. For instance, seated at a card-table one evening with a French-Canadian soldier who looked fit for any trench, someone brushed a tiny ashtray into his lap. Instantly, trivial as the incident was, one hand began to shake so violently as to threaten the table itself. It was early in my acquaintance with shell-shock, and while I recognized it immediately I was much embarrassed for the sufferer. But embarrassment was uncalled for. For a second or two he watched his own right hand waving back and forward as if it belonged to someone else. Then he calmly seized it with his left and held it still, smiled down on it, and addressed it in the most pleasantly detached manner: “Hold on, there. Easy now, easy.” Twenty seconds later he was dealing.
The relieving feature of it is that the boys themselves treat it so lightly. A certain few make fun of it in others, and lay it to “funk”. But there is none of that in the vast majority of cases, V.C.’s suffering with others, colonels with privates; and many of them are as eager as their more fortunate comrades to return to the fight. While, of course, it is “nerves”, it is a form that comes so suddenly in its worst type as to be uncombattable. To me it is always distressing, and sometimes beyond description in its dire effects on the nervous system for the time being.
One of its worst forms is to deprive the sufferer temporarily of sight, or speech, or power of movement. That mental equipment has some influence on it seems evident from the fact that, at least in these forms, it is much more prevalent among Imperial than among Canadian troops. One Canadian soldier I know was paralyzed at first from head to foot. When I met him power had returned as far down as his legs, and he was most cheerful and hopeful. Slowly life crept downward, accompanied by pains like rheumatism, and soon he was walking.
The cures—that is the wonderful part of it. Being “nerves”, it sometimes demands treatment that might appeal to the outsider as cruel. There are in London special hospitals devoted to its cure. It was found that the treatment it demanded could not be administered in the ordinary hospital, nor could the disease be studied save by those whose attention was undiverted by the other injuries of war.
The essence of treating mere trembling is absolute mental rest, with sufficient physical exertion to keep the mind engaged without fatiguing body or mind. This, too, is the method for the final stage of recovery in all cases. By the experiences of one convalescent home situated in the midst of a large garden, work in the garden produced surprising results. The patients were set to raking or tending flowers or keeping a certain path in condition. On the results was founded a special hospital at Buxton. The work must be quiet, free from sudden noises and movements, and restful in every way.
The treatment for the various forms of paralysis is different. The very principle of it is surprise. Which should prove the diversity of shellshock. A man whose tongue refuses to express itself, whose eyes refuse to register, whose limbs refuse to perform their work, must be taken out of himself. The recoveries are usually amusing. A dumb man by mistake presses to his lips the lighted end of a cigarette—and cusses involuntarily. A friend tries to cheat him at cards—and in the blaze of the moment is told the particular kind of rogue he is. He falls into the water—and screams for help. One dreamed that he was entangled in the German wire and shouted his fear.
Blindness is more difficult because it cuts off the most active sense and makes counter-shock less startling. But it yields like speechlessness in the end. Paralysis forgets itself. One shell-shock patient rose from his invalid’s chair and leaped into the Thames to save a sinking girl. At a “revue” an actor fired a pistol, and a helpless paralytic jumped to his feet.
It is the knowledge of these recoveries that has developed a treatment, along lines hitherto unrecognized by therapeutics. In shell-shock hospitals mesmerism is a standard experiment that is frequently effective. The doctors bully unmercifully at times, until the exasperated dumb patient expresses his anger. More than one has found it impossible except by word of mouth to convey his repugnance at the doctor’s frank conviction that he is faking. A doctor comes to the chair of a paralytic and suddenly orders him to stand. In sheer surprise and alarm the patient may obey. Or the doctor seats himself quietly by the bedside of a speechless patient asleep and begins to talk. The patient awakes and replies before he remembers his affliction. Once a nurse so angered a patient by telling him that he was no gentleman that he exploded in a vivid recital of his impressions of her, although he had not spoken for weeks.
In another case speech returned to the soldier through embarrassment. The nurse accompanied him to a barber’s, excused herself while he was in the chair, and when settling time came the poor soldier found he had not a cent. He began to explain that he would return with the money.
Again, friends of the sufferer lay themselves out to cure him. An Australian was made to speak by his friends cutting the cord of a hammock in which he lay above a stream. As he clambered up the bank, boiling with rage, “Who the—did that?” he roared. Trick cigarettes and matches are given, to explode near the patient’s face. Bent pins are placed beneath them. Bad news is suddenly delivered. They are cuffed and booted and trodden upon and generally made miserable. And sooner or later some instinct within protests at further maltreatment and yields. The dumb or blind or paralyzed shellshocked soldier leads the life of a dog—for his own good.
For the ordinary cases, especially where the evidence of shell-shock is localized in a limb, massage is most beneficial, the subtle progress of the treatment from soothing gentleness to stiff kneading and rapping—always under medical advice—breaking down the barrier of nerves.
Perhaps the disease which the public and the soldier have most feared is spinal meningitis. Evidence seems to prove that the Canadians brought it to England early in the war, but its spread—in so far as it did spread—cannot be ascribed to the Canadians. The infection of an English nurse who died from it was traced to her association with a Canadian officer, who was found to be a germ carrier; but other cases have developed in France where there were no Canadians.
There has not been much loss of life from it, and its treatment has advanced to the point where there is little danger. I have talked with a number of Canadians who have completely recovered, although recovery is slow. It seems that the disease is being carefully watched, and when taken early is not necessarily dangerous. Three or four English physicians have made a special study of it.
At this time it is safe to say that at one stage of the war the most serious menace to the English arms was measles. The details of its prevalence during two or three months of the second year will probably never be known, but whole camps were in quarantine. No one but the authorities will ever know the anxiety that prevailed.
In the surgical department has been the most remarkable advance. It was quickly found that the greatest danger was not from the wounds themselves, but from a variety of sepsis that seemed to breed in the very soil of France. Wounds in themselves trivial developed seriously, and the word went forth that the utmost endeavour must be made to dress the slightest wounds as quickly as possible and to get the wounded man back to the hospitals without delay. There the main effort was towards frustrating septicaemia. Success has been marvellous. Even shrapnel wounds, the worst of all and the most likely to become infected, are looked upon with less anxiety.
The very method of disinfecting altered, and as this is writing it is still altering. That, of course, is the essence of wound treatment. The old application of peroxide of hydrogen, the standard the world over before the war, has been left somewhat in the limbo of the past. Iodine, in various forms, is the immediate hope; and it has justified itself. In hospital it changes again. A simple saline solution that anyone can make in a few minutes is the universal disinfectant and cleanser. Its curative properties have astounded the profession. It is a return to grandmother’s remedy, but slightly altered in preparation and strength.
Now a newer method is being experimented with by the celebrated America physician Dr. Carrol. His solution is simple but more or less arbitrary at this stage, and its application is a development of flushing that has prevailed for many months at the front. The result thus far is a wound healed in a fifth of the time formerly considered satisfactory.
There are, too, several discoveries that assist materially in the healing process. For instance, an English doctor has experimented successfully with the application of a celluloid covering to the wound beneath the dressing. The celluloid does not adhere, and in redressing the wound is never irritated and the patient is saved much suffering.
Much of the success of the hospitals depends upon the attitude of the wounded. Never have men gone through so much with such lightness of heart, such unfaltering courage. I will never forget a visit to one of the largest London hospitals where special attention was paid to face wounds. The doctor, showing me some of the worst cases—I would soon have had enough had it not been for the cheer of the sufferers—brought me to a bed where a Scots lad had received enough shrapnel in the face to have killed him at any other stage of the world’s medical development. I will not describe his face, as it had healed. Sufficient to say that one eye was gone, the other equally useless for any practical purpose.
“How the things to-day?” inquired the doctor, in that careless way which alone admits inquiry concerning health. In the broadest of Scots the poor, deformed face lifted itself towards the doctor’s and a patient smile twisted it. “Canny, doctor, canny.” Then with a surge of exultation, as if every ill had dropped from him: “I can see the light.”
“I can see the light!” How petty the indispositions of civilian life!
“What got you?” I asked a Toronto lad, the terrible condition of whose head was concealed by dressings that had been changed twice a day for a year. He grinned. “Don’t know. Must have been a sixteen-inch shell, direct hit, I think,” he laughed. His only worry was how the silver plate which he would be compelled to wear through life would act under the cold of Canada.
The work of the surgeons is beyond belief unless one is moving amidst it. Thousands of men will return to Canada capable of resuming their work, who would never have had a chance under the surgical knowledge of even the beginning of the war. And thousands whose lives would have been unbearable will suffer only slight inconvenience. The small proportion of deaths would have startled even the theorists of pre-war days. And so much of the recovery is practically painless that the wounded soldier is openly congratulated by his companions. It means “blighty” for him, and comparative comfort.
“You shouldn’t be here; you should be dead,” blurted out a doctor to a lad whose forehead, from temple to temple, a bullet had ploughed. And the fortunate fellow knew no inconvenience save the dressings.
Hospital is pretty nearly heaven to the soldier who has spent much time in the front lines in the winter season. I personally know many of them who, convalescing in the summertime from old wounds, purposely deceived the doctors so as to return to the trenches by early fall with the chance of getting back wounded to the hospitals for the winter. It is one of the best influences on his fighting that a soldier dreads the trenches more than the wounds that will send him to the rear. He may be killed—although the chances are unbelievably small—but if he is only wounded he is willing to take the chances.
The last stage of refitting the soldier for the fight of life is worth a book to itself. New limbs that act almost like the original, nerves and bones that are made once more to do their work, muscles that are renewed—the details are as wonderful as the rareness of amputation. And still medical science is in its infancy. That is one of the grandest results of the war, that the science of human conservation recognizes more than it ever did its incompleteness and is determined to seek the remedy.
War is indeed terrible, but much of its terror has been eliminated by the call of necessity. As the engine of destruction amplifies, the problem of conservation and physical salvation grows with it and goes even beyond it.
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- As an armed forces brat, we lived in Rockcliff (Ottawa), Namao (Edmonton), Southport (Portage La Prairie), Manitoba, and Dad retired to St. Margaret's Bay, NS.
Working with the Federal Govenment for 25 years, Canadian Hydrographic Service, mostly. Now married to Gail Kelly, with two grown children, Luke and Denyse. Retired to my woodlot at Stillwater Lake, NS, on the rainy days I study the life and work of A. Hyatt Verrill 1871-1954.