Crowds gathered at Charing Cross Station in July 1916 to watch the arrival of casualties from the Battle of the Somme, an event often seen as marking the end of any illusions of chivalry in war and in its horror ushering in the modern age of warfare. The moment was captured by the official war artist J. Hodgson Lobley in an oil painting ‘Outside Charing Cross Station, July 1916’, which epitomises Britain at this crucial moment during the First World War. The grandiose buildings of the station reflect the grandeur of the British Army in contrast to the pitiable state of the returning soldiers. Newspaper placards headline the war news and posters advertising continental holidays for a more peaceful time ironically make the point that instead of dispatching peaceful tourists abroad the same railways nowadays bring back the wounded and dying. The now redundant American Currency Exchange underlines this, for the exchange effectively has become one of wounded soldiers for fit, healthy young men. The crowds of besuited men and millinered women going about their affairs ostensibly as in peacetime and watching the scene cannot remain unaffected by the consequences of what they see.1 Civilian health was influenced by the war just as much as that of the injured troops. The mood of the Home Front might have been business as usual but the war had its effect all the same.
Almost from the outbreak of the war, military requirements took priority over the needs of women, children and men not in the armed forces. Winning the war was what mattered, whatever the sacrifice demanded. The care, nursing and rehabilitation of wounded soldiers now mattered more than the already patchy provision of medical services for everyone else. Whereas in Germany plans had been made for the conversion of public buildings and barracks blocks into hospitals in the event of war, Britain was caught unprepared when war came. The War Office had realised that the number of beds in the regular military hospitals would be inadequate and had made arrangements to take over some schools, asylums and voluntary hospitals but that only amounted to about 20,000 beds on mobilisation in August 1914. Fortunately, the public mood was generous and some 5,000 buildings were offered for use as hospitals, including Lambeth Palace, stately homes, schools and colleges.2 Not all premises offered were suitable nor was their offer always in the best interests of the donor. Louisa Gurney was Lady District Superintendent of the Jesmond Nursing Division of the St John’s Ambulance Brigade, as well as headmistress of the Newcastle Church High School for Girls, when she pressurised her governors into offering her school for use as a military hospital over which she could preside as matron. As this action would have meant the closure of the school, there was a sense of relief when the buildings were deemed unsuitable; the school governors were also able to curb Miss Gurney’s excessive enthusiasm for war service by refusing her permission to be absent for half a term to nurse at the Front, though they did allow her pupils to join her nursing division and be active members of Princess Mary’s Patriotic Union for Girls.3 George V and Queen Mary, by contrast, were criticised for not giving up Buckingham Palace and Sandringham for the wounded despite the patriotism of their fellow European monarchs in converting some of their palaces into hospitals and the generosity of most of the British nobility in offering their country houses for that purpose; H.A.L. Fisher, the former First Sea Lord commented that this failure on the part of ‘Futile and Fertile’, as he dubbed the royal couple, suggested that ‘Kings will be cheap soon’.4
The reliance on uncoordinated private generosity and voluntary effort was not without its drawbacks. At first the Red Cross, Order of St John and the Soldiers and Sailors Help Society each went their own way without reference to each other and even sent unauthorised medical teams to the Front where they were more of a nuisance than a help. One such team actually found itself left behind enemy lines during the retreat from Mons and its members were suspected by the German Army of being spies because they had no official accreditation as medical volunteers.5 The growth in private hospitals without regard to military necessity meant that ‘nurses are engaged who may never be required in the particular place allotted to them, while, worst of all, stores of surgical material are being hoarded up in scores of homes to such an extent that the market is being seriously depleted’.6 The advantage of using voluntary organizations, apart from them being well placed to raise additional money, was that it was cheap, and these groups soon set aside their rivalries to cooperate on a more rational basis. Very soon the influx of casualties from Flanders revealed the inadequacies of relying on voluntary effort even if it was the cheapest option.
Poor law infirmaries were requisitioned for military use with scant regard for the needs of their usual patients. There had long been a stigma attached to such hospitals, which had been intended for the treatment of paupers as part of the workhouse. Rather than have a mixture of civilian and military wards in such institutions, as in the voluntary hospitals run as independent charities for the deserving poor, the War Office took over entire workhouse hospitals and systematically removed all traces of their former use so that treatment of war heroes would not be associated with the evils of the Poor Law system. The Brighton Board of Guardians was given no prior warning that its workhouse was required as a hospital for wounded Indian troops or much time to make alternative arrangements for its inmates in November 1914.7 The Pavilion had already been requisitioned, its oriental architecture considered an appropriate environment for wounded Indians. It was not so easy to accommodate over 1,000 sick paupers dispossessed from the workhouse infirmary and there was an outcry from local residents ‘at this profanation of their stately neighbourhood’ when some of the former inmates were lodged in ‘well appointed hotels’.8 It was the local cottage hospital at Wimborne that was requisitioned with the result that respectable middle class patients were transferred to the local Poor Law infirmary and suffered the indignities of being classed with the destitute patients and denied access to their own private doctors.9 The Metropolitan Asylums Board not only gave up four of its infirmaries for use as military hospitals but also had to accommodate Belgian refugees in some of its asylums as well as organising larger war refugee camps at Alexandra Palace and the Earls Court Exhibition Centre despite the call-up of most of its male staff. All was at the expense of the patients for whom their hospitals were originally intended.10 It was little wonder that more thoughtful commentators thought that ‘it is very bad Imperial strategy to neglect the health of the large majority of the nation in order to serve the relatively small Fighting Force’.11
Yet the number of available beds for the civilian sick continued to decline. The voluntary hospitals had patriotically offered beds for the treatment of wounded soldiers in special military wards alongside their usual patients, at first free of charge but after the first few months of the war in return for War Office grants which helped to keep many of these hospitals in operation at a time when their income from annual subscriptions was declining due to wartime pressures and prices were rising. However, the beds reserved in the voluntary hospitals for military casualties were often underused and kept vacant during lulls in the fighting. The Board of Management of St Mary’s Hospital had placed 100 beds, a third of the total number in the hospital, at the disposal of the War Office on 10 September 1914 ‘in the event of accommodation in military hospitals proving inadequate’ but it was not until 16 November that these beds were occupied when the casualties from the fighting at Ypres and Armentières overwhelmed the military hospitals. Most of these first military admissions were suffering from wounds and frostbite and ‘the men as a whole looked rather worn by their hard experiences, but soon settled down.’12 Smoking, forbidden in the civilian wards, was allowed three times a day and wealthy benefactors took the blue-coated wounded soldiers for drives around the capital, a new experience for many of the men who had never previously visited London. Only after the Somme were the military wards filled to capacity, but throughout 1917 and 1918 there were long periods when large numbers of beds were again left unoccupied until another offensive brought in more casualties. The result was that fewer civilians could be treated than in peacetime. Meanwhile, civilian beds were being closed at the same time that military beds were lying empty because of financial pressures.13 The pattern was repeated throughout Britain and the other belligerent powers.
It was not only the number of hospital beds that was reduced as a result of the war. The initial rush to answer the call to arms denuded the civilian medical services of doctors and nurses they could ill-afford to lose and such shortages of trained staff became ever more acute as the war went on despite ‘the special importance of maintaining the public health at the present time’.14 By the end of the war over half of the general practitioners in Britain were serving in the armed forces and many trained nurses were tending wounded soldiers both at home and abroad. While doctors called up for military duties were afraid that they would lose their medical practices at home to their rival practitioners still at home, the doctors remaining in Britain complained of having ‘had to work even longer hours, endeavouring to cope with the increase of work entailed by the loss of colleagues’.15 Some patients were unable to find a doctor available to treat them at all.16 The situation was worst in the industrial towns where most of the doctors before the war had been under forty-one and were liable to be called up, resulting in severer shortages of doctors in such areas than in the country as a whole.17
Future generations of doctors were being lost too by the eagerness of medical students to serve their country as ordinary soldiers rather than wait until they had qualified and could use their medical and surgical skills to good wartime use. In this they were following the example of students in other disciplines, whose university careers were massively disrupted by the war. The difference, though, from a classics, history or English student was that a medical qualification could be directly useful in wartime and many people considered that the medical student must put first the competing demands of his ‘duty to himself, his family, his Hospital, his profession, his Empire and Humanity’.18 It was at first left to the individual student to decide what his conscience permitted, although students were needed to fill the places occupied by qualified doctors in peacetime by acting as clinical dressers and even as unqualified house officers on the wards of their teaching hospitals. One compromise was for a medical student to enlist as a surgeon probationer in the Royal Navy, which gave him a period of practical experience aboard a ship or in a naval hospital, considered the equivalent of the clinical clerkships and dresserships of a normal medical school course, though the range of experience was more limited than they would have experienced at home. The problem was exacerbated by the introduction of male conscription in 1915; only medical students in their final years of study and thus close to qualification were exempt from being called up but even so were expected to enrol in an officer training corps as preparation for future military duties.19
However, amidst a growing concern about an imminent shortage of qualified doctors, the War Office began to release conscripted medical students to return to their studies.20 The first to return to their medical schools were men invalided from the army, such as Thomas North who had entered the army as a private in November 1915 after only a month as a medical student, had been seriously wounded on the Somme in July 1916 and returned to his studies in May 1917 still only aged 20.21 However, many of the returning medical students, now keen to qualify as quickly as possible, feared that they might be accused of shirking. Some students at Guy’s Hospital were presented with white feathers after they had discarded their uniforms for civilian suits; in despair, they tried to re-enlist but were not permitted to do so.22 Opportunities were offered for suitable refugees from Allied but occupied nations to train as doctors. Djurdge Dimitrijevitch was invalided out of the Serbian Army early in the war and, on reaching England as a refugee, was funded by the Serbian Relief Fund to study first English and then physiology at Magdalen College, Oxford before completing his medical studies at a London teaching hospital.23 Similarly the German Army had released medical candidates to complete their studies, though some of them like Robert Otto Marcus who had studied medicine at Munich preferred to remain in the war because he ‘couldn’t stand the thought that other people were letting themselves be smashed up for my benefit, while I was enjoying myself going to afternoon concerts and promenading about’.24 For many of these tough young men who had been seasoned in combat as ordinary soldiers, it was difficult to readjust to life as students on their demobilization to train as doctors in civilian garb. One frustrated, black-browed returning student exploded during a physiology class, ‘Damn and blast you. Look, five days ago I was killing Germans. How the hell can you expect me to spend the afternoon tying little bits of cotton and wire to a dead frog?’.25
Until the return of the male students, the London medical schools in particular were coming under financial pressure from the loss of income from fees that went with the exodus of students. They needed to find a solution to these problems if they were to survive as medical schools and if enough new doctors were to qualify. In Germany, there was a wartime increase in the number of women studying medicine and Britain followed suit. Of the twelve medical schools of London, only the London School of Medicine for Women attached to the Royal Free Hospital admitted women medical students. Whereas by 1914, most other medical schools in the United Kingdom trained both sexes, the London schools remained resolutely single-sex and the male schools were bastions of a rough and ready masculine culture based on rugby, hard-drinking and hard-living. Now, many of the schools realized that they would have to admit women students if they were to survive.26 St Mary’s Hospital Medical School, Paddington, was one of the first to go down this route but not until other options had been exhausted. In 1915, its governing body preferred to admit an enemy alien, a non-naturalised, middle-aged German citizen, August Appelt, rather than sully its lecture theatres with a female student.27 Not until a year later, by which time ‘the raucous notes of the adolescent male are fast disappearing from within our walls’,28 did it embrace the inevitable and reach an agreement with the London School of Medicine for Women, which had been chafing under the limited clinical teaching capacity of its parent hospital for some time, to admit female students for the clinical part of the medical curriculum. As this was an experiment in co-education, the London School of Medicine for Women sent many of its best women students to St Mary’s in order to create a good impression, but, as ‘all the keen young men had escaped to the War and only the lame ducks, the persistent failures at exams and elderly men students were left’, the women ‘rather showed up everyone’s inefficiency’.29 Certainly, the women outshone their male fellows in the examination hall.30 Even though the women students were ‘no good at rugger, didn’t want to indulge in sport, even of the bedroom variety, and were a dead loss all round’,31 most of the other schools followed course and admitted women students but for the whole medical course and on the same terms as male students except for a hard core of medical schools which could afford to remain aloof as citadels of misogyny.32
Had it not been for women medical students and house officers, most of the London teaching hospitals would have found it difficult to survive their manpower crises of the war years. The University of London had a long tradition of granting degrees to women and wished to see the wartime expediency of co-education continued in its medical schools once the war was over.33 The Dean of Charing Cross Medical School admitted that it would be very difficult for a school ‘having once opened its doors to women to find any logical reason for closing them again’.34 It seemed as if the war had widened opportunities for women to become doctors and that the London medical schools had accepted the principle of co-education. It was merely a temporary advance. With the return of male medical students, the backlash began. Ex-servicemen were especially hostile towards women whom they saw as an emasculating force, undercutting them and usurping the career opportunities to which their sacrifice of their careers for the duration of the war had entitled them. At St Mary’s, a group of male students got up a petition against women students on the grounds that feminine influence was draining away the athletic virility of the medical school and that ‘the recent but, apparently habitual defeat of St Mary’s in the Rugger cup-tie, calls for serious consideration’, concluding with the strong stance that ‘the men do not want the women, they have no wish to be friends, or to co-operate with them in any way’.35 Within ten years of the end of the war, the position of women medical students in London was back to its state in 1914 with only the London School of Medicine for Women open to them. Only after the Second World War did the London schools again become co-educational.
Yet, women doctors had definitely proved themselves as the equal of their male counterparts in filling the vacancies caused by the war at home and in overseas service, despite entrenched misogynist opposition to them having any role at all. When Dr Elsie Inglis volunteered her services at the outbreak of hostilities, she was told to ‘go and sit quietly at home, dear lady’.36 Inglis was made of sterner metal and instead offered the services of the Scottish Women’s Hospitals, established by the Scottish Federation of the National Union of Women’s Suffrage Societies at her instigation, to her country’s allies. Units fully staffed by women doctors were sent to France, Serbia, Salonika, Corsica and Russia, but it was at the Abbaye de Royaumont that the Scottish Women’s Hospitals had the greatest success. This hospital, with its emphasis on scrupulous standards of hygiene, had lower amputation rates and the lowest mortality rate on the Western Front, in recognition of which the military authorities began to send the most severe cases there and the Pasteur Institute in Paris chose it as an experimental unit for an anti-gas gangrene serum.37 During the German advance on Aisne in the summer of 1918 it was the only hospital to remain in full working order with its operating theatres functioning round the clock to deal with the casualties flooding in. As the reputation of Royaumont spread among the men in the trenches, wounded men asked to be sent there and one patient on being discharged asked if he could be evacuated to ‘another Royaumont’.38 The Women’s Hospital Corps, backed by the Women’s Social and Political Union, organised a hospital at the Hotel Claridge in Paris, which had an equally impressive reputation and was invited by the War Office to establish a hospital staffed by women at Wimereux.39 Marie Curie, the discoverer of radium, toured the battlefields of France with a mobile X-ray unit in a converted ambulance, as well as organising 200 fixed radiological units in military hospitals and twenty mobile cars known as ‘les petites Curies’.40 In Russia women doctors were liable for front line service from the start of the war. In their service in the war zones, women doctors proved themselves the equal of men as indeed many of them, with a background in the suffrage movement, had set out to do.41 The Daily Telegraph admitted that ‘to the women doctors the war has brought triumph’.42 Perhaps even more important than their contribution to treating the wounded at the Front was the less dramatic but even more vital role played by women doctors in keeping medical services in existence on the Home Front, often to the surprise of male observers. When the jingoist journalists J.L. Garvin and John Bull visited Endell Street Military Hospital in London, which was staffed entirely by women, they asked ‘But who operates when seriously wounded casualties are brought in?’ only to be told ‘the women surgeons, naturally’.43
A more traditional role in healthcare for women was as nurses. The sentimentalised image of the nurse treating the wounded soldier became ubiquitous in all countries at war. She was depicted on the battlefield tending the wounded or looking pensive set against a background of war, with wounded soldiers in wheelchairs and as ‘the real angel of Mons’ and ‘L’ ange de nos blessés’ in the iconography of the war.44 Queen Elisabeth of the Belgians became known as ‘la reine-infirmiére’ for her devotion to the care of the wounded during her wartime exile from Belgium and was adopted in this role as a saintly national symbol, the image of the ‘Nurse Queen’ complementing that of her husband Albert I dubbed the ‘Soldier King’.45 The reality was much less glamorous. Even a seasoned sister in Queen Alexandra’s Imperial Military Nursing Service was shocked by the casualties she was faced with at Number 13 Stationary Hospital set up in converted sugar-sheds on the quay at Boulogne, where a soldier ‘caked with mud, in torn clothes … and blood stained bandages’ was classed as walking wounded ‘as long as he could crawl’.46 As a French military doctor, the writer Georges Duhamel was conscious of the contrast between the peacetime lives of many of these women and their wartime duties: ‘beautiful eyes, made for looking out for tennis balls or the nuance of a ribbon, now reflected, with a determined seriousness, the hideousness of the dressing room, of amputated limbs, of wounded heads’, yet these nurses offered a reminder of a better world to the men in the wards where ‘a scent of woman wafted that had not changed, which was always precious, childlike and heady’.47
There was a significant increase in the number of young women taking full nurse training during the war since nursing was seen as vital to the war effort: ‘at a time when women are being recruited for munitions, for agriculture, and for many other branches of national work, it is of the highest importance that no time should be wasted in securing those who will be needed for nursing work’.48 Hospitals were a popular option for those who wished to play their part in winning the war and women now occupied more roles than the traditional womanly role in nursing. The future thriller writer Agatha Christie worked in a wartime hospital pharmacy, which gave her a knowledge of poisons that was to prove invaluable for her successful writing career. In her first best-selling thriller, The Mysterious Affair at Styles, in which poisons play a major role, she allows her detective Hercule Poirot to comment on a wartime female pharmaceutical dispenser that ‘women are doing great work nowadays’.49 One woman who actually seized the opportunity offered by the war to realise her ambitions to become a nurse was the King’s niece Princess Arthur of Connaught, who willingly submitted to such indignities as being addressed as ‘nurse’ rather than by her royal title, being chased around the casualty department by drunks, being reprimanded by the matron for revealing too much when she bent over in the ward and catching fleas from her impoverished patients who also tried to offer a tip to a poor, overworked nurse. Despite her insistence on preparing her own trolleys and going about her work incognito in a probationer’s uniform, she was conspicuous at her nursing training school, St Mary’s Hospital, of which her husband and second cousin Prince Arthur was president, by wearing a military nursing headdress rather than the cap of the other nurses.50 However, she did qualify as a nurse, becoming the first member of the royal family to qualify as a state registered nurse when state registration was introduced after the war, and took on a more arduous role than the incessant hospital visiting and knitting for wounded soldiers of many other royal ladies from Queen Mary and Queen Alexandra downwards.51
Nevertheless, the greatest contribution came not from trained nurses but from the Voluntary Aid Detachments, the VADs, which had been established by the British Red Cross and St John’s Ambulance Association in 1910 to assist the professional military nursing service in the event of an emergency. Their employment was not at all greeted with joy by the nursing profession who complained throughout the war about the number of untrained nurses doing the work of trained nurses. As with the employment of unqualified men as housemen in hospitals, the use of untrained nurses was another example of the dilution of labour that was to arouse contemporary controversy among craftsmen in the trades union world.52 Vera Brittain, working as a volunteer nurse at the First London General Hospital in Camberwell, was well aware that the professional nursing staff were ‘still suspicious of the young semi-trained amateurs upon whose assistance they were beginning to realise with dismay they would be obliged to depend for the duration of the war’.53 She and other VADs worked from 7.30 a.m. to 8 p.m. with a weekly half day off, ‘which we gave up willingly whenever a convoy came in or the ward was filled with bad cases’.54 This they did throughout the sultry summer of 1916 when throughout ‘those busy and strenuous days’ the wards ‘sweltered beneath their roofs of corrugated iron; the prevailing odour of wounds and stinking streets lingered perpetually’.55 For women from genteel and sheltered backgrounds such experiences were eye opening and shocking.
Many VAD nurses had volunteered their services to serve their country, but if sent overseas might find themselves tending the enemy. For some nurses, especially in the early days of the war, this was difficult since they looked on the enemy soldiers as being ‘of the roughest and most objectionable type’; Hilda Speake, a nurse who had fallen into enemy hands when Brussels fell in 1914, was surprised, when called upon to nurse German wounded, that ‘the nurses were amply repaid by the smiles on the men’s faces when they saw the English nurses’.56 Vera Brittain’s family were more horrified than she was when she found herself nursing in a ward full of German prisoners at Étaples in the summer of 1917.57 Her attitude was professional and humanitarian in that ‘it is hardly possible to feel any antipathy to one’s patients in practice however much one may in theory; they are far too ill and utterly dependent on one for that’. Her attitude was shared by the British wounded in other wards that came to visit these severely wounded young men with gifts of cigarettes and fetched them drinks.58 Edith Cavell recognised that the duty of the nurse overrode nationalistic considerations too with her statement before her execution in 1915 that ‘I realise that patriotism is not enough. I must have no hatred or bitterness towards anyone’. Nurse Cavell’s execution by the Germans for helping Allied soldiers escape from German occupied territory was greeted with universal outrage simply because she was a nurse, though she had gone well beyond her nursing role in doing so and had used the cover of her school of nursing in Brussels to take on a less than neutral role in helping to return soldiers to combat.59 Nevertheless she died as a nurse and martyr to German brutality in the popular mind, rather than as simply the patriotic and brave heroine of the resistance that she undoubtedly was.
The men that Nurse Cavell had helped on their way back to fight were the lucky ones. For many wounded soldiers, there was little hope of return to action. Rehabilitation was their only hope if they were to lead productive lives once the war had ended. The novelist John Galsworthy waxed lyrical on the role that a proper rehabilitation scheme could play to ‘recreate and fortify’ the disabled serviceman ‘so that he fits again into the national life, becomes once more a workman with pride in his work, a stake in the country and the consciousness that, handicapped though he be, he runs the race level with his fellows, and is by that so much the better man than they’.60 The Joint War Committee of the Red Cross and Order of St John had been charged with this duty in 1914. One of its members, the exiled twenty-five-year-old King Manoel II of Portugal, was to make it a personal crusade to alleviate the plight of the disabled after he had first become involved with them when setting up a private officers’ hospital in Brighton at the beginning of the war. Not only was he the leading fundraiser for rehabilitation services but he was the motive spirit behind the creation of the Shepherd’s Bush Military Hospital in 1916 in premises requisitioned from the Hammersmith Workhouse Infirmary. Manoel had been impressed by the ‘curative workshops’ set up for the war disabled at the Anglo-Belgian Hospital in Rouen and the Canadian Hospital in Ramsgate and now tried to reproduce them in London. In the occupational therapy workshops at Shepherd’s Bush, the patients manufactured all the splints, surgical boots and other appliances used in the hospital and supplied the Ministry of Pensions with orthopaedic appliances.61 This self-sufficient and economical hospital was staffed by orthopaedic and physiotherapeutic specialists who were able to draw on their pre-war experience of dealing with crippled children when developing forms of physiotherapy for their military patients.
Elsewhere at Chailey Heritage Hospital in Sussex, disabled soldiers were matched with crippled boys to remind them of the value and hope of youth and their own promise as productive members of society.62 Robert Jones, Military Director of Orthopaedics, set up a further sixteen regional specialist orthopaedic centres and argued that disabled soldiers were ‘an essential part of the economic manpower of the nation, independent producers and wage-earners, not helpless dependents’.63 The aim was to restore the men’s self-respect as well as to fit them with new trades, such as tailoring, carpentry, engineering, cigarette-making, French polishing and sign writing, for a role in civilian life, but in the harsh post-war world disabled ex-servicemen found it much harder to make a living at a time of economic hardship.64
The plight of the wounded ex-serviceman was not one that would end with the war as many people realised very soon in the conflict, and charity, rather than the state, would bear the brunt of providing aid to them. The return home of blinded soldiers and sailors inspired the newspaper magnate Arthur Pearson, proprietor of the Daily Express and Evening Standard, to open a hostel where these men could be given the training that would enable them to lead productive, independent lives. Pearson, who had lost his own sight due to glaucoma, was President of the National Institute for the Blind. In 1915, St Dunstan’s was opened in Regent’s Park, London, as a training centre and workshops for Pearson’s ‘blind army’, many of whom had also lost limbs as well as their sight. By the end of the war over 1,500 men had been trained in the skills necessary for them to work as cobblers, joiners, poultry farmers, telephone switchboard operators and masseurs. This work was to be continued throughout the inter war years and in subsequent conflicts with new generations of ex-servicemen blinded in battle.65
Long-term care was also the idea behind the establishment of the Star and Garter Home at Richmond, Surrey, after Queen Mary suggested that the British Red Cross do something to provide a ‘permanent haven’ for the severely disabled young men returning from the Battle of the Somme in 1916. The Auctioneers and Estate Agents Institute purchased the Star and Garter Hotel on Richmond Hill and presented the deeds to the Queen as a home for ex-serviceman. The average age of the first sixty-five residents admitted in 1916 was twenty-two; some were able to return to their own families, for others the Star and Garter was to be their home for the rest of the lives. After 1924 they enjoyed an impressive new purpose-built home, erected with funding from the British Women’s Hospital Committee, which included workshops where residents could make and repair clocks and watches, toys rugs and even socks. Residents were taken on excursions by volunteers from the Lest We Forget and Not Forgotten associations, which also provided entertainments. With continuing royal patronage and a high public profile, the Star and Garter was never short of supporters.66
By contrast with the British emphasis on voluntary and charitable provision for the disabled ex-serviceman, Weimar Germany took the attitude that it was the responsibility of the state to provide not only pensions but also occupational therapy, retraining and free medical care for service-related medical problems. There were also quotas for the employment of disabled ex-servicemen in larger businesses and in state employment, which cushioned disabled veterans during the Great Depression. Yet, because the generosity of the public was not engaged as it was by charity in Britain, the disabled ex-servicemen of Germany felt more estranged from the state and society than their British counterparts.67
With all this emphasis on the medical needs of the armed forces, the health of the civilian population on the Home Front was neglected but could not be wholly ignored. There were fewer doctors and even fewer hospital beds available for the treatment of such weak and vulnerable social groups as the elderly poor and the mentally and physically handicapped, many of whom had been evicted from the institutions which had sheltered them in order that they could be used as military hospitals or convalescent facilities. Their well-being was not essential to the war effort and little attention was given to their problems. Charities for wounded soldiers, war widows, orphans and refugees caught the popular imagination with the result that less money was given for the aid of other needy social groups.68 The Royal Edinburgh Infirmary even appealed to the Mid and East Lothian Miners’ Association in 1916 to increase its subscription to the charity to mitigate the difficulties arising from the war, an appeal met with sympathy and money since the miners depended on the availability of hospital care if they were injured underground. At the same time the miners of Britain were subscribing towards a Red Cross ambulance convoy for France.69
Tuberculosis rates rose during the war, especially among young women. In Germany, 280,000 people died of consumption during the four years of conflict, representing one for every ten military casualties. In Britain mortality rates among young women from tuberculosis reverted to its 1890 rate.70 The Brompton Hospital for Consumption and Diseases of the Chest, where 700 consumptive servicemen were treated in 1917 alone, saw such a rise in the number of civilian outpatients with tuberculosis that each physician was limited to seeing no more than twelve new outpatients.71 The reasons for this rise were complex and reflected a number of factors coming together in wartime. Soldiers were crowded together in barracks and army camps, munitions workers lived in cramped, damp hostels and worked in poorly ventilated factories, and refugees spread diseases. A fourteen per cent increase in tuberculosis during the war in Paris was explained by the ‘considerable growth in the female workforce, the increased population in Parisian industrial centres and suburbs, from overcrowding’, with the munitions workers liable to develop the disease ‘through contagion or the reawakening of a youthful bacillus attack’.72 At the same time that wartime mobility and overcrowding had made the spread of tuberculosis more widespread, there were fewer facilities for its treatment. In France a national committee for the aid of tubercular soldiers was set up to deal with the problem of soldiers discharged with consumption and to prevent its spread among the civil population, but only a quarter of soldiers so discharged ever received treatment. Albert Calmette, with the support of the Rockefeller Foundation, pioneered a scheme in Lille for each soldier to be visited at home for treatment by a specialised health visitor but very few received this service.73 In Britain priority was given to soldiers in allocating the reduced number of beds available in sanatoria, rather than to industrial workers even though the treatment of the workers would have returned them to work of national importance quicker; one docker in the Port of London complained that he too had risked his health in serving the nation but had to wait for treatment while soldiers took priority.74
Food shortages and nutritional deficiencies also affected the health of the people at home, though the health of the people remained remarkably resilient and life expectancy may actually have increased during the war years. Full employment and higher real wages for many sections of the working classes meant that, despite wartime shortages, they were able to enjoy a better diet. Indeed shortages of meat and butter, coupled with a greater consumption of bread and potatoes, mean that the wealthy too were eating a more balanced diet. The reduction in the consumption of sugar meant improved dental hygiene for children. Medical officers of the Local Education Authorities reported that fewer schoolchildren were malnourished in 1918 than in 1913 and that there were fewer ‘necessitous children’ in receipt of free school meals.75 Yet the effect of more restricted wartime diets on the health of individuals was mixed rather than universally beneficial. In Germany, gout, that disease of good living, was said to have disappeared among the wealthy middle aged but there was an eightfold increase in rickets and hunger oedema among the poor. More cases of eclampsia were seen among pregnant women in Germany as a result of the starvation diet they faced as a consequence of the Allied blockade.76 In Russia, obesity, alcoholism, gout, gastritis, appendicitis and constipation were regarded as diseases of the past but there was an increase in enteritis, peptic ulcers and arteriosclerosis.77
Paradoxically, despite the reduction in the quantity and quality of medical services available on the Home Front, there is some evidence that average life expectancy rose during the war from forty-six to forty-nine for men and from fifty-three to sixty for women. The poor had had patchy access to medical services before the war so the absence of doctors had little real impact on them. There was a drop in the death rate for women in childbirth in Britain from 181 per million in 1914 to 125 in 1918, but this decline was probably a result of a fall in the birth rate caused mainly by the temporary break-up of families with husbands away at the war. Pregnant women may also have benefited from having their babies delivered by midwives who, unlike doctors, did not use forceps during labour and took fewer risks. At the same time, mortality among girls and young women rose during the war and the care of the elderly was neglected.78
Controls on alcohol consumption were seen as essential for the war effort to curb the absenteeism that was imperilling munitions production. David Lloyd George thundered that ‘drink is doing more damage in the war than all the German submarines put together’79 and declared that ‘We are fighting Germany, Austria and drink, and as far as I can see, the greatest of these deadly foes is drink’.80 Under the provisions of the Defence of the Realm Act, the Central Liquor Control Board took action to deal with the perceived problem. Opening hours of public houses were reduced in industrial areas, sales of alcohol were forbidden to anyone under 18, treating and credit in pubs were banned, and public houses near crucial munitions plants at Enfield Lock, Carlisle and Gretna Green and the naval bases at Inverness and Cromarty were nationalized.81 In an attempt to give an example to his country, George V took a pledge of abstinence from alcohol for the duration of the war in March 1915 until his medical advisers recommended that he take a ‘daily stimulant’ for the sake of his health after he was badly injured when falling from his horse during a visit to the Front in October 1915. It was a gesture that was widely ridiculed and rarely emulated.82
Alcohol continued to fuel courage at the Front, though as the war had gone on many men had had enough of soldiering. One ditty popular in the trenches expressed the determination not to have ‘a bayonet up my arse-hole, I don’t want my ballocks shot away’ coupled with the desire to remain in England ‘and fuck my bloody life away’.83 Yet had the soldier of the song had his wish, he might have exposed himself to the likelihood of being ‘rendered not only ineffective but in some cases killed’ through catching syphilis or gonorrhoea.84 Whereas the French and Germans, with a long tradition of the regulation of prostitution, set up maisons de tolerances where their men could have sex with prostitutes who were inspected periodically for disease, albeit with the same unsterilized speculum, the initial British approach was to print in the soldiers’ paybooks an exhortation from Lord Kitchener urging his men to stay chaste and shun wine.85 The American forces too warned their men that ‘a man who is thinking below the belt is not efficient’86 and that ‘they had to be 100% efficient to win the war’,87 but also took practical steps to ensure that if their doughboys should be seduced from the path of virtue by ‘booze, a pretty face, a shapely ankle’ they would ‘not take the European disease to America’ but would ‘go home clean’.88 Temperance campaigners ensured that the sale of alcohol in, or close to, the military training camps was forbidden, a move that contributed to the climate of opinion that would very soon endorse the Eighteenth Amendment to the United States Constitution enforcing prohibition, though only with the effect of driving minor vice underground where it could become a focus of still greater crime. The Commission on Training Camp Activities headed by the Princeton-educated lawyer Raymond B. Fosdick, bombarded the troops with vivid warnings about the dangers of venereal disease from women less clean than a German bullet.89 When the French prime minister Georges Clemenceau offered to help establish licensed brothels for his new American allies, Fosdick was warned by the Secretary of War, Newton D. Baker, ‘for God’s sake, Raymond, don’t show this to the President or he’ll stop the war’.90 Despite Woodrow Wilson’s high moral tone, American soldiers going on leave were issued, just like the German troops, with prophylactic kits, containing calomel ointment for syphilis, potassium permanganate solution or tablets for gonorrhoea and cotton wool for applying these to the penis as soon after sexual intercourse as possible. The British Army lagged behind in issuing what were known as ‘dreadnought packets’ for fear that by doing so they might be condoning vice. Soon, like other armies, they had set up ablution chambers, known as ‘Blue Lamp Depots’ on account of the blue lights they used to advertise their location at night, where a man who had had sex could have his penis irrigated with the chemical protargol and calomel ointment rubbed on his genitals in a procedure that was unpleasant, painful, undignified and not particularly effective. The issue of condoms would have done far more good.91
It was not only prostitutes who posed a threat, since any ‘bad and diseased woman can do more harm than any German fleet of aircraft that has yet passed over London’.92 The war had given greater freedom to young women and many of them wanted to enjoy themselves after a hard day’s work, mainly as munitions workers though even schoolteachers and flower girls were also out to have a good time with any available man.93 Such women were considered safer than prostitutes by men on leave – and cheaper since the costs of taking them on a date and buying them a present were much less than those of paying a professional for sex. Dominion troops were especially vulnerable to casual sex with such girls as they were too far from home to have any opportunity to relieve their sexual urges with their wives when on leave. Under pressure from the governments of Canada, Australia and New Zealand, Regulation 40D under the Defence of the Realm Act was introduced and laid down that ‘no woman who is suffering from venereal disease in a communicable form shall have sexual intercourse with any member of His Majesty’s forces, or solicit or invite any member of His Majesty’s forces to have sexual intercourse with her’ or would be liable to a fine of £100 or six months’ imprisonment.94 There was an immediate outcry against a measure that was specifically aimed at women, and women’s organisations pointed out that ‘men expect a certain standard of morality in their wives, and as wives we are entitled to expect the same from men’.95 The War Office and Home Office were defensive against such charges and pointed out that catching a venereal disease was considered to be a self-inflicted disease by the armed forces and that soldiers would be punished for contracting diseases under military law. What mattered was the necessity of protecting against something that caused as great ‘a wastage of manpower as German poison gas’; rather than making ‘vice safe for men’, the regulation was intended ‘to keep the realm safe by stamping out centres of infection which injure the fighting capacity of the nation’.96
Venereal disease had already been a major problem before the war and in 1916 a Royal Commission on Venereal Diseases had recommended a national scheme of free, confidential treatment in a series of local authority provided clinics and diagnostic laboratories.97 Venereal disease was declared a national emergency, which allowed the Local Government Board to compel the county and borough councils to implement the scheme and by the beginning of 1917 the first treatment centres were opened in London. At first there was a shortage of suitably skilled doctors but the Army Council agreed to release army medical officers to set up the new treatment centres where possible.98 This indicated the importance of the treatment of sexually transmissible infections in the thinking of the armed forces, but the setting up of this national treatment scheme had been conceived and realized as a civilian scheme and was not specifically a response to the pressures of wartime though the war had raised the stakes considerably and made firm action even more important.
It was not so much venereal disease as the lack of sex that caused problems in prisoner of war camps and in internment camps for male civilians of military age caught behind enemy lines on the outbreak of war. Soldiers in the trenches and the wounded in hospital often had little choice but to satisfy their need for women by playing with their ‘wanking warriors’ until they could go on leave and enjoy the real thing, but prisoners had no hope of sexual intercourse with a woman until the end of the war whenever that might be. Eric Higgins, incarcerated at Ruhleben Camp set up on a racecourse near Berlin where six men occupied the horsebox space formerly reserved for two horses, was obsessed with the effects of sexual deprivation on the young men with whom he was interned which led to what he called the ‘barbed wire disease’ or homosexuality. Young men itching to take part in the war and deprived of their usual activities were especially prone to depression and sought any available outlet to raise their spirits and compensate for their night starvation. He despaired that ‘against the consequences of unnatural sexual conditions there can, of course, be no ultimate remedy but the restoration of normal conditions’ but believed that the ‘establishment of such handicrafts as we were able to get into operation was the means of saving many young men from mental and moral destruction’. In fact, Ruhleben contained such a variety of internees that it was able to offer a variety of educational opportunities for its inmates such as lectures on the classics, Renaissance art and science as well as sports and music. Nevertheless, a German sexual specialist, Dr Magnus Hirschfeldt, was brought into Ruhleben to differentiate between the ‘cases of inborn psychopathy’ and men who were simply seeking any outlet for their frustrations and ‘thus prevent particularly among the young men yet imperfectly differentiated, an occasional and circumstantial vice becoming converted into a permanent inversion’.99 A similar pattern of homosexual relationships serving as a substitute for heterosexual intercourse was later observed in the male-only prisoner of war camps and in the sexually segregated civilian internment camps of the Far East during the Second World War, though in Hong Kong where men and women were interned in the same camp their captors had to insist that ‘sexual intercourse is prohibited except between husband and wife or close friends’ with the result that lovers found the cemeteries the most congenial place for close relationships to be consummated.100 Essentially what was needed back in First World War Ruhleben was an antidote to boredom rather than medical intervention, which was for truly medical needs supplied by interned doctors and German hospitals.
There were no such fears of idleness in the munitions factories at home where a greater danger to health came from poor, unsanitary working conditions. One of the most dangerous jobs in the munitions industry was the filling of shells with TNT101 powder, which could cause toxic jaundice; such workers were nicknamed ‘canaries’ on account of their faces going bright yellow as a result of the jaundice. At the Ministry of Munitions National Filling Factory at Chittening near Bristol, 1213 women munitions workers filling shells with mustard gas contracted a variety of illnesses including conjunctivitis, inflammation, congestion, nausea and vomiting, a reddening of the skin, blisters and persistent coughs as a result of contact with the toxic substances with which they were working. The Medical Research Committee recommended better ventilation and the wearing of facemasks and protective clothing by the women handling such chemicals but there was little more that could be done to safeguard the health of the workers. At Chittening a small surgery and hospital were opened at the plant for the treatment of the workers.102 Elsewhere, attempts were made to improve the conditions of the workers by the opening of washing facilities and works canteens offering such basic fare as sausages or mince and mashed potatoes, stewed fruit and milk puddings similar to the food offered by the National Kitchens set up to offer cheap, basic meals for the needy.103
The health of the next generation was of greater concern than that of the current generation of soldiers and war workers for the future of Britain. The Bishop of London drew attention to the fact that ‘while nine soldiers died every hour in 1915, twelve babies died every hour, so it was more dangerous to be a baby than a soldier’. A tenth of children died before their first birthday and a quarter of those who survived infancy died before they were five. Whooping cough, diphtheria and scarlet fever were childhood killers. Now, according to the Bishop, ‘the loss of life in this war has made every baby’s life doubly precious’.104 Great Ormond Street Children’s Hospital reminded the public that ‘at this critical time with ever lengthening casualty lists and a falling birth-rate, the lives and health of the next generation become of paramount importance as a national asset’105 although the needs of sick children were often overlooked however essential they may have been for ‘the future welfare of the British Empire’.106 Paddington Green Children’s Hospital emphasised that it was treating the children of serving troops and stressed that ‘medical and surgical care in infancy and during the early years should be, and must be, efficiently and liberally provided if the coming generation is to replace the terrible losses now being suffered on far-reaching battlefields, both on land and sea’.107
Such concerns were addressed with a national ‘Baby Week’ in July 1917 that aimed ‘to save every savable child’.108 There were calls for more health visitors and infant welfare centres.109 Comparisons were made with the situation in Germany where the prevention of infant mortality was ‘one of the greatest works standing to the credit of a scientific people’110 though this was disputed by some doctors.111 Indeed one German doctor, Stephen Westman, declared that the deplorable state of babies and small children, suffering from starvation in the Charité Hospital in Berlin, with ‘their big heads and sunken eyes, their faces like those of old people, their chests on which one could count every rib, their protruding bellies and rickety legs’, was ‘poor testimony to the humanity and culture of which the nations of Europe boasted so much’.112 Local authorities in Britain were encouraged to provide milk for expectant and nursing mothers and babies and the 1915 Care of Mothers and Young Children Act gave local authorities the power to set up further maternity and infant welfare facilities. The number of health visitors rose from 600 in 1914 to 1355 in 1918. Much of this wartime action, building on pre-war ideas and developments, was consolidated by the Maternity and Child Welfare Act in August 1918. This extension of state welfare provision in the field of child welfare was cemented by the establishment of a Ministry of Health in 1918 to take over some of the powers of the Local Government Board in this field, but the new ministry was of more symbolic than practical purpose since it possessed few new or real powers and was regarded with suspicion by general practitioners fearing it might be the first step to a salaried medical service. A report by Lord Dawson in 1921 anticipated the development of a rationalized, state system of health care under the aegis of the new Ministry of Health, based on district hospitals and primary health centres staffed by general practitioners, but the post-war economic slump ensured that no further action was taken.113 Nevertheless, the health of children had benefited from a war-inspired confluence of national interest and altruistic concern for the young.
Children’s Hospitals were not immune from the fall in charitable income suffered by most hospitals during the war though they fared better in terms of public support due to the public emphasis on child welfare, but shared the same problems of the shortage and escalating price of drugs. The growing internationalism of the pharmaceutical industry in the years leading up to the war had been disrupted by the outbreak of hostilities and had resulted in a shortage of some drugs produced by companies in enemy countries. This led to a search for substitutes for the medicines that could now no longer be imported. With the suspension of German patents and trademarks and the closure of British subsidiaries of German companies, companies such as Boots the Chemist and Howard’s of Ilford began to manufacture for themselves aspirin and other synthetic drugs formerly imported.114 Through its connection with the French company Poulenc Frères, which had been experimenting with arsenical compounds, May and Baker developed an alternative for salvarsan developed by Paul Ehrlich in 1909 for the treatment of syphilis.115 Meanwhile, with official government support, Burroughs Wellcome developed a generic substitute for the same drug under the brand name Kharsivan.116 Ehrlich was concerned not at the loss of patent income but by his fears that if other firms were producing the drug under less stringent conditions than he had stipulated for its German manufacture,117 any substandard batches being distributed might discredit his drug.118
The available medicines were of little use towards the end of the war when influenza ‘came like a thief in the night’, as Sir George Newman, chief medical officer to the Board of Education, described it, and swept through the world, hitting the young and robust the hardest, overshadowing the Armistice to some extent. In San Francisco the end of the war was surreally celebrated by crowds in facemasks. The pandemic struck in three waves, first appearing in March 1918 in the American Expeditionary Force camps in the United States before spreading to Africa and Asia. The second wave swept Africa, North America and Europe, starting off at Brest where the American troops disembarked, in the summer and had become a worldwide pandemic by November. Its third and final wave peaked from February to April 1919. Known as the ‘Spanish flu’, the disease struck rich and poor equally though young adults were most at risk. It was as lethal at home as at the Front. There was little that the medical authorities could do to prevent the spread of the disease, and the gargles, disinfectants and potions bought by the public had little effect. Timothy Leary of Tufts Medical College near Boston developed a vaccine that was distributed free to physicians in badly affected areas such as San Francisco, but to little practical effect. Schools closed, church congregations dwindled from fear of catching the disease and undertakers did not have enough coffins to bury the victims. A population weakened by four years of war was especially susceptible to the disease but it also affected neutral nations unaffected by the war just as severely.119 Perhaps the supreme irony was that men who had survived the rigour of combat and overcome severe wounds finally met their doom from influenza. One out of every sixty-seven American soldiers died of influenza or pneumonia in 1918.120 The surrealist poet Guillaume Apollinaire survived a head wound from a shell-burst and the ruination of his lungs by gas only to die of influenza on 9 November 1918, two days before the Armistice, crying out ‘Save me doctor! I want to live! I still have so much to say!’121 His words may speak for a generation for whom there was to be no business as usual after all they had endured and for whom their promise was to be cut short when medicine failed to save their lives.
1 IWM, ART 2759, J. Hodgson Lobley, ‘Outside Charing Cross Station, July 1916’, 1918. See also W. Muir, Observations of an Orderly at an English War Hospital 1915–1917 (2006), pp. 99–107 for more details on the unloading of patients from such trains.
2 Reports by the Joint War Committee and Joint War Finance Committee of the British Red Cross Society and the Order of St John of Jerusalem in England on Voluntary Aid Rendered to the Sick and Wounded at Home and Abroad, and to British Prisoners of War 1914–19 (1921), p. 211.
3 K. Brown, ‘History of the Newcastle upon Tyne Church High School 1885–1985’ in H.G. Scott and E.A. Wise (ed.), Centenary Book of the Newcastle upon Tyne Church High School 1885–1985 (1985), pp. 13, 30.
4 K. Rose, King George V (2000), p. 189.
5 B. Abel Smith, The Hospitals, 1800–1948 (1964), p. 255.
6 Lord Rothschild, Chairman, British Red Cross Society, Letter to The Times, 15 August 1915.
7 Brighton Herald and Hove Chronicle, 28 November 1914.
8 Ibid., 5 December 1914.
9 B. Abel Smith, The Hospitals, 1800–1948 (1964), pp. 263–4.
10 A. Powell, The Metropolitan Asylums Board and its Work, 1867–1930 (1930), pp. 84–92.
11 ‘Editorial’, St Mary’s Hospital Gazette, 20/10 (December 1914), p. 151.
12 K. Lees, ‘Wounded Soldiers at St Mary’s’, St Mary’s Hospital Gazette, 20/10 (December 1914), p.163.
13 K, Brown, ‘Another Day, Another War’, St Mary’s Gazette, 97/2 (April 1991), 35–7; ‘Tested Under Pressure: St Mary’s During the Great War’, St Mary’s Hospital Past and Present Nurses’ League Journal, 43 (2006), 14–20.
14 TNA, MH 10/80, Local Government Circular, 18 February 1916.
15 Letter signed ‘Scarified’, British Medical Journal, 1 (1917), 245.
16 The Times, 15 July 1918.
17 TNA, NATS 1/833, Report on Further Withdrawal of Doctors from Civil Medical Practice, March 1918.
18 ‘Editorial’, St Mary’s Hospital Gazette, 20/9 (November 1914), 131.
19 TNA, WO 293/3, Military Training for Medical Students, 10 December 1915.
20 TNA, NATS 1/711, Memorandum on the Shortage of Medical Students, August 1917.
21 St Mary’s Hospital Archives, MS/AD 28/725, T.S. North, October 1915–October 1922. North died in 1924, his health undermined by his brief but bloody war service.
22 I.R. Whitehead, Doctors in the Great War (1999), pp. 92–3.
23 St Mary’s Hospital Archives, MS/AD 28/942, D. Dimitrejevich, October 1920. Dimitrejevitch returned to Serbia and service as a doctor in the Yugoslav navy.
24 Robert Otto Marcus, 15 April 1915 in P. Witkop (ed.), German Students’ War Letters (2002), p. 80.
25 I. Mann, Ida and the Eye (1996), p. 62. The typescript of Mann’s autobiography gives a fuller account of her experiences as a woman medical student in a male world than the published version, St Mary’s Hospital Archives, DP 21.
26 C. Dyhouse, ‘Women Students and the London Medical Schools, 1914–39: the Anatomy of a Masculine Culture’, Gender and History 10/1 (1998), 110–132.
27 St Mary’s Hospital Archives, MS/AD 1/5, Medical School Committee, 2 February 1915.
28 ‘Notes’, St Mary’s Hospital Gazette, 22/7 (July1916), 88.
29 St Mary’s Hospital Archives, DP 21, typescript autobiography of Ida Mann, p. 126.
30 J.S. Garner, ‘The Great Experiment: the Admission of Women Students to St Mary’s Hospital Medical School, 1916–1925’, Medical History, 42 (1998), 77–8.
31 I. Mann, Ida and the Eye (1996), p, 40.
32 St George’s Hospital admitted 5 women only in 1915, Charing Cross Hospital Medical School followed in 1916, Westminster in 1917 and the London, King’s College and University College Hospitals all had women students by 1918. Only the older and more socially exclusive medical schools at St Bartholomew’s, St Thomas’s, Guy’s and the Middlesex Hospitals remained free of women medical students. See University of London, Report of the Special Committee to Consider the Medical Education of Women in London (1944).
33 University of London, Conference on Medical Education of Women in London (1917), p. 3
34 Ibid., p. 2.
35 St Mary’s Hospital Archives, MS/AD 46/1–4, petition requesting exclusion of women, 1 April 1924.
36 H. Bourdillon, Women as Healers (1988), p. 40.
37 E.S. McLaren, A History of the Scottish Women’s Hospitals (1919); SKIA, ‘A Hospital in France’, Blackwood’s Magazine, 204 (1918), 613–40. The lower death rate was ascribed to copious use of hot water and scrupulous cleanliness. In the early twenty-first century, such an approach to hospital infection has aroused renewed interest in the work at Royaumont as a result of concern about the rise of antibiotic resistant bacteria; HRH The Princess Royal is a great admirer of the achievement of Elsie Inglis and considers her methods of infection control might offer lessons to modern hospitals: conversation with author, April 2004. There is something in this argument. When soap and water are used to clean hospital wards, the same bacteria that were there return within 24 hours, but when antiseptics are used it is the more resilient and harmful bacteria that quickly return and fill the space vacated by the weaker germs that have succumbed to the antibiotics (conversation of author with Dr John Wain, June 2007).
38 Ibid., 633.
39 F. Murray, Women as Army Surgeons (1920), pp. 53–4; B. McLaren, Women of the War (1920), p. 2.
40 F. Thébaud, La Femme au Temps de la Guerre de 14 (1994), p. 92.
41 L. Leneman, ‘Medical Women at War, 1914–1918’, Medical History, 38 (1994), 160–77; In the Service of Life: the Story of Elsie Inglis and the Scottish Women’s Hospitals, (1994).
42 The Daily Telegraph, 8 October 1916.
43 O. Wilberforce, Octavia Wilberforce: the Autobiography of a Pioneer Woman Doctor (1989), p. 77.
44 Musée International de la Croix Rouge et du Croissant Rouge, Geneva, Inv. BBT-1997-16-64, French postcard ‘Le Brassard’; Inv. BBT-1997-16-69, German postcard ‘und ein nuer Frühling folgt dem Winter nad’; Inv. BBT-199-16-60, ‘The Real Angel of Mons’.
45 F. Thébaud, La Femme au Temps de la Guerre de 14 (1994), p. 82.
46 I. Hay, One Hundred Years of Army Nursing (1953), pp. 89–90.
47 G. Duhamel, Souvenirs de la Grande Guerre (1985), pp. 135–6.
48 TNA, WO 32/9342, Report of Committee on Supply of Nurses, 14 November 1916.
49 A. Christie, The Mysterious Affair at Styles (2001), p. 96.
50 Alexandra, A Nurse’s Story (1954); K. Brown, ‘“Contact with the Seamy Side of Life”: a Nurse’s Story’, St Mary’s Gazette, 96/3 (October1990), 38–9.
51 TNA, DT 13/65, General Nursing Council record for Princess Arthur of Connaught, 1922.
52 TNA, WO 32/9342, Report of Committee on Supply of Nurses, 14 November 1916.
53 V. Brittain, Testament of Youth (1979), p. 206.
54 Ibid., p. 209.
55 Ibid., p. 279.
56 H. Speake, ‘From a St Mary’s Nurse in Brussels’, St Mary’s Hospital Gazette, 21/5 (May 1915), 76–7.
57 Letter from Edward Brittain to Vera Brittain, 14 September 1917, A. Bishop and M. Bostridge (ed.), Letters from a Lost Generation (1999), p.374.
58 Letter from Vera Brittain to W.H.K. Bervon, 9 August 1917, A. Bishop and M. Bostridge (ed.), Letters from a Lost Generation (1999), p. 370.
59 TNA, FO 383/15, arrest and execution of Edith Cavell, 1915; M. de Croy, Le Martyre des Pays Envahis (1933); R. Ryder, Edith Cavell (1975), p. 228–9, 238.
60 Inter-Allied Conference on the Aftercare of Disabled Men, Reports (1918), pp. 14–15.
61 Reports by the Joint War Committee and Joint War Finance Committee of the British Red Cross Society and the Order of St John of Jerusalem in England on Voluntary Aid Rendered to the Sick and Wounded at Home and Abroad, and to British Prisoners of War 1914–19 (1921), pp. 733–4; Manoel II, ‘Scheme and Organization of Curative Workshops’ in R. Jones (ed.), Orthopaedic Surgery of Injuries (1921), 629–44; TNA, WO 32/5334, Orthopaedic work of King Manoel, 1920; A.H. Bizarro, El-Rei Dom Manoel II na Grande Guerra (1952).
62 S. Koven, ‘Remembering and Dismemberment: Crippled Wounded Soldiers and the Great War in Great Britain’, American Historical Review, 99/4 (1994), 1167–1202.
63 R. Jones, ‘The Problem of the Disabled’, American Journal of Orthopaedic Surgery, 16/5 (1918), 273.
64 R. Cooter, Surgery and Society in Peace and War (1993), pp. 113–21; J.S. Reznick, ‘Work Therapy and the Disabled British Soldier in the First World War: the Case of Shepherd’s Bush Military Hospital, London’ in D.A. Gerber (ed.), Disabled Veterans in History (2000), pp. 185–203.
65 St Dunstan’s Association for Blind Ex-Servicemen and Women, The Spirit of St Dunstan’s (2006), pp. 1–2.
66 N. Venus and P. Willis, The Home on the Hill (2006).
67 D. Cohen, ‘Will to Work: Disabled Veterans in Britain and Germany after the First World War’ in D.A. Gerber (ed.), Disabled Veterans in History (2000), pp. 295–321.
68 C. Rollet, ‘The Other War: Setbacks in Public Health’, in J. Winter and J.L. Robert (ed.), Capital Cities at War (1999), pp. 456–86.
69 I. MacDougall (ed.), Mid and East Lothian Miners’ Association Minutes, 1894–1918 (2003), pp.334–5. See also K. Brown, ‘The Lodges of the Durham Miners’ Association, 1869–1926, Northern History, 23 (1987), 138–52.
70 F.B. Smith, The Retreat of Tuberculosis, 1850–1950 (1988), p. 222.
71 P.J. Bishop, B.D.P. Lucas and B.G.B. Lucas, The Seven Ages of the Brompton (1991), p. 113.
72 H. Sellier, La Lutte Contre la Tuberculose dans la Région Parisienne (1928), p. 638.
73 G. Vitoux, ‘L’Oeuvre des Comités Départementaux d’ Assistance aux Soldats Réformés’, Revue d’Hygiène 1 (1918), 561–70.
74 The Lancet, 1 (1918), 646–7.
75 A. Marwick, The Deluge (1973), p. 199.
76 S. Westman, Surgeon with the Kaiser’s Army (1968), p. 139–40.
77 J.D.C. Bennett, ‘Medical Advances Consequent to the Great War, 1914–1918’, Journal of the Royal Society of Medicine, 83 (1990), 738–42; I. Loudon, ‘On Maternal and Infant Mortality 1900–1960’, Social History of Medicine, 4 (1991), 43–4.
78 J.M. Winter, The Great War and the British People (1985), pp. 105, 132–3, 138, 157; L. Bryder, ‘The First World War: Healthy or Hungry?’, History Workshop, 24 (1987), 141–55; B. Harris, ‘The Demographic Impact of the First World War: An Anthropometric Perspective’, Journal of the Society for the Social History of Medicine, 6 (1993), 343–66.
79 The Times, 1 March 1915.
80 Ibid., 30 March 1915.
81 Report of Central Control Board, Cd. 8243, 1916.
82 K. Rose, King George V (2000), p. 179. Lloyd George had suggested the King’s vow of abstinence, prompting Queen Mary to comment that ‘We have been carted’. The Prince of Wales was later to cast aspersions on the contents of his mother’s fruit cup and the nature of the business his father regularly retired to attend to after dinner.
83 ‘I don’t want to be a Soldier’ in M. Stephen (ed.), Never Such Innocence (1991), p. 97.
84 TNA, MH 55/530, deputation from Association of Municipal Councils to Lord Rhondda, statement of Sir Hamar Greenwood, 24 January 1917.
85 K. Brown, The Pox (2006), pp. 123–5.
86 National Archives, College Park, Maryland, Record Group 165, War Department and General Staff, box 433, syllabus accredited for use in official supplementary lectures on sex hygiene and venereal diseases, February 1918.
87 Ibid., box 426, letter from Hilton Railey to Raymond B. Fosdick, 17 September 1917.
88 Ibid., Record Group 120, American Expeditionary Forces, 1917–23, box 5259, ‘Something to Think about for Men Going on Leave’, 12 April 1919.
89 Ibid., Record Group 165, War Department and General Staff, box 433, syllabus accredited for use in official supplementary lectures on sex hygiene and venereal diseases, February 1918.
90 D.M. Kennedy, Over Here (1982), p. 187.
91 G. Walker, Venereal Disease in the American Expeditionary Forces (1922), pp. 10–19.
92 National Archives, College Park, Maryland, Record Group 165, War Department General and Special Staff, box 586, letter from J. Frank Chase to Raymond B. Fosdick, 13 October 1917.
93 TNA, MEPO 2/3434, Metropolitan Police figures obtained from a study of 2,312 social case sheets at Canadian hospital, Etchinghill, Lyminge, 25 August 1918.
94 TNA, HO 45/10893/359931, Order in Council, 22 March 1918.
95 Ibid., letter from Womens’ Cooperative Guild, 28 October 1918.
96 TNA, WO 32’4745, War Cabinet memorandum, 28 August 1918.
97 Final Report of the Commissioners, Royal Commission on Venereal Diseases, Cd. 8189, 1916.
98 The Lancet (1917), 236–7.
99 TNA, FO 383/524, Report by Eric Higgins on Ruheleben, 10 March 1919.
100 O. Lindsay and J.R. Harris, The Battle for Hong Kong (2005), pp. 218–9.
101 Trinitrotoluene.
102 TNA, WO 142/274, report on Ministry of Munitions National Filling Factory No. 23, 1918.
103 I.W.F. Beckett, Home Front 1914–1918 (2006), p. 124.
104 The Daily Telegraph, 1 July 1917.
105 Ibid., 7 May 1916.
106 Solicitors’ Journal and Weekly Reporter, 7 July 1917.
107 St Mary’s Hospital Archives, PG/AD 7/17, annual report of Paddington Green Children’s Hospital, 1917.
108 Westminster Gazette, 2 July 1917.
109 Letter from A.H.D. Acland, The Times, 7 April 1916.
110 Medical Correspondent, The Times, 5 April 1916.
111 Letter from W.A. Brend, The Times, 8 April 1916.
112 S. Westman, Surgeon with the Kaiser’s Army (1968), p. 139.
113 G.R. Searle, A New England? (2004), p. 817.
114 D. Jeffreys, Aspirin: The Story of a Wonder Drug (2004), pp. 97–122.
115 J. Slinn, ‘The Development of the Pharmaceutical Industry’ in S. Anderson (ed.), Making Medicines (2005), pp. 165–6.
116 P.A. Willcox, The Detective Physician (1970), pp. 83–4.
117 Paul Ehrlich Institut, PEI/S59, laboratory book testing toxicity of salvarsan, 1909–10, Hoechst tests, pp. 72–4.
118 K. Brown, The Pox (2006), p. 107.
119 S.M. Tomkins, ‘The failure of Expertise: Public Health Policy in Britain During the 1918–1919 Influenza Epidemic’, Social History of Medicine, 5 (1992), 435–54; E. Tognotti, ‘Scientific Triumphalism and Learning from the Facts: Bacteriology and the Spanish Flu Challenge of 1918’, Journal of the Society for the Social History of Medicine, 16 (2003), 97–110.
120 V.C. Vaughan and G.T. Palmer, ‘Communicable Disease in the United States Army During the Summer and Autumn of 1918’, Journal of Laboratory Clinical Medicine, 3 (1918), 587–623, 647–86.
121 T. Cross (ed.), The Lost Voices of World War I (1998), p. 204.