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Medical
aspects of the First World War
Article based on
the extended content
of
Before My Helpless Sight -
Suffering, Dying and Military Medicine on the Western
Front 1914 - 1918
by Leo van Bergen |
|
Content of the article Medical
aspects of the First World War
●
'To my knowledge 'Before my Helpless Sight' is the best
book on the wounds of war.'
Jay Winter. Yale University and Historial de la
Grande Guerre, Peronne
▬
Introduction
I: The photo book Krieg dem
Kriege!
-
II: Heroism
alone - III: War and the
individual -
IV: Who is the enemy?
V: The soldier as ‘Hero’ -
VI: Victims and perpetrators -
VII:
The dead of the Eastern Front and the civilian victims
VIII: Animal suffering
-
IX:
Atrocity propaganda
-
X: The war at sea and in the air
-
XI: The misery was universal
▬
Chapter 1 Battle
Introduction
I:
Changes on the eve of war - II: The
dominant military ideology - III:
The war - IV: Shared
affliction -
V: The Great War was too great
1914
I: The overture -
II: The invasion of Belgium -
III: Germans against the French -
IV: The British and their ‘great
retreat’ - V: Towards the stalemate -
VI: The First Battle of Ypres
1915
I: The spring offensives -
II: Battle of Loos
1916
I: Battle of Verdun -
II: The colonial troops -
III: Battle of the Somme
1917
I: Battle of the Chemin des Dames
- II: Battle of Messines -
III: Battle of Passchendaele (Third
Ypres)
1918
I: The German advance -
II: The Allied advance -
III: The armistice on 11 November 1918
1914-18: the
casualties
Counting the victims of war
▬
Chapter 2 Body
Conditions in
the trenches
I: Clothing - II:
The soldier’s burden - III: Hunger
and thirst - IV: Rain and mud and
cold
V: Vermin
- VI: Noise and stench -
VII: The trenches
Disease
I: Introduction -
II: Sickness in the trenches -
III: Heart problems, venereal disease and Spanish 'flu'
Wounds
I: Introduction -
II: Bullets and shells -
III: The chemical horror -
IV: The lucky wound
▬
Chapter 3 Mind
Introduction
A complete psychological breakdown
From health to neurosis
I: Morale
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II: Numbness - III: Inhumanity
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IV: Fear -
V: Self-mutilation and
suicide
Neurosis
I:
Introduction
-
II: Definition
of war neurosis
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III:
Numbers of war neurosis -
IV: Causes
of war neurosis
V: Symptoms
of war neurosis
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VI: The alleged hallmark: cowardice
▬
Chapter 4
Aid
Introduction: The
pain represented by figures -
From wounding to aid post -
From first aid to hospital -
The field hospital -
The base hospital - Too many
wounded, too little help -
Complication - Is survival a
blessing? -
Medical experiments -
Medical aid and military necessity
Military psychiatry -
I: War and madness -
II: Kaufmann and colleagues -
II: The Allies -
IV: Discipline versus analysis
-
In summary: the character of military
medicine
▬
Chapter 5 Death on the Western Front
Introduction
Killing
and being killed
Death outside of battle
I: ‘Ordinary’ losses -
II: Accidents and snipers -
III: Prisoners of war -
IV: Friendly fire -
V: Death by execution
Death in
battle
I: Bayonet and barbed wire -
II: The trench raid -
III: Artillery, the great destroyer -
IV: The offensive
Meetings with Death
I: Individuals -
II: The battlefield
Burial in wartime
I: Bodies in hospital -
II: Burial parties -
III: No peace, no rest -
IV: Too many dead
▬
Afterword
‘There is in our lives a wound
which will never heal. Nor should it.’
▬
Information
About
the author
-
Reviews Before My
Helpless Sight
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Before My Helpless Sight |
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Introduction
I: The photo book
Krieg dem Kriege!
On
Ernst Friedrich, his Krieg dem Kriege / War against
War and the (false) idea that showing gruesome war
pictures, the ‘truth of war’, would make an end to war.
“The photographs portray the dead and wounded of a
disastrous conflict that remains even now the archetype
of modern, total war. People responded by saying the
photographs were repulsive, but that only proved they
were good photographs; Friedrich had chosen them
precisely because they were repulsive, and in any case
the entire 1914-18 war had been repulsive. Many people,
including the historian Jay Winter, have argued that
since the photographs in Friedrich’s book were ‘almost
unbearable to look at’ they inevitably missed their
target to some degree. They were unlikely to convince
anyone of the horrors of war; at best they might
reinforce the views of those who no longer needed any
convincing. There is undoubtedly some truth in this, but
Krieg dem Kriege! prompts us to contemplate how
terrible the reality must have been if even its
portrayal was unbearable.”
II: Heroism alone
On the (as false) idea that war is about camaraderie,
heroism, altruism, and the attractiveness of war, even
on those who protest against it. “War fascinates. The
children of veterans of Passchendaele dreamed of heroic
roles in a battle their fathers told them had made any
kind of heroism impossible. Take Philip Toynbee, a
former peace activist who fought in the Second World
War. In Friends Apart, published in 1954, he
wrote: ‘Even in our Anti-War campaigns of the early
thirties we were half in love with the horrors which we
cried out against, and, as a boy, I can remember
murmuring the name ‘Passchendaele’ in an ecstasy of
excitement and regret.’”
III: War and the
individual
On the desastrous effect of modern warfare on the
individual; on individuality. “In
his novel The Middle Parts of Fortune (reissued
only many years later but quickly published in a
bowdlerized form as Her Privates We), British
soldier Frederic Manning observed that soldiers no
longer possessed anything, ‘not even their own bodies,
which had become mere implements of warfare’.”
IV: Who is the enemy?
On the anything but easy task to define exactly who in
the eyes of the 1914-1918 soldier in fact the enemy was.
“As time went on the average soldier began to wonder who
his real enemies were. The men facing him from beyond no
man’s land? The well-fed generals in their spacious
accommodation miles from the front? The politicians who
allowed the war to continue? The industrialists, lining
their pockets with the profits of war? Or civilians, who
seemed incapable of understanding what war actually
meant?”
V: The soldier as
‘Hero’
On the ritual that soldiers – especially dead soldiers –
are celebrated Heroes (with a capital H) even if they
died by a bomb shot ten miles from him. “With their
sceptical attitudes towards courage and honour, Brants,
Winter and Baggett are in fact following a line taken at
the time by an ordinary German soldier, Herbert Weißer,
who in March 1915, two months before his death, wrote
that the impression given in history lessons, in stories
told by parents and in books was thoroughly misleading.
Every soldier was given the honorary title ‘Hero’;
soldiers stopped being ordinary people, they were Heroes
who performed Heroic deeds, spilled Heroic blood, died
Heroic deaths and were buried in Heroes’ graves. … But,
asks Weißer, were heroic deeds really the hallmark of
warfare, were they truly its most prominent and
characteristic feature? ‘How much of a contribution is
made to these heroic deeds by momentary, instinctive
excitement, perhaps lust for blood and unjustified
hatred? ... There are also very quiet, unrecognised acts
of heroism. (Really so much more rare in times of
peace??). And there are alcoholism, aesthetic and
ethical brutalization, spiritual and physical laziness.
When do people ever write about those in their war
reporting?’”
VI: Victims and
perpetrators
On the unjustified idea that soldiers fighting in modern
wars are victims. They are at least perpetrators as
well. “The twentieth century was the first in which
soldiers could see themselves as victims rather than as
agents or perpetrators. This was a consequence of the
total helplessness of the individual in modern warfare.
In that sense they were indeed victims. But innocent,
unwitting victims or not, the soldiers were also, indeed
primarily, the active party. The shot precedes the
wound. Although men caught in gunfire and shelling are
central to this book, not dying but killing, sanctioned
killing, is the main feature of war.”
VII: The dead of the
Eastern Front and the civilian victims
On the non-Western front victims. “Although in the war
as a whole there were more deaths in the West than in
the East – leaving aside other theatres of conflict –
the Eastern Front was the most lethal in percentage
terms, certainly in the first year of fighting. Disease
in particular took a heavy toll in the East. Epidemics,
including malaria and typhoid (blamed, incidentally, on
working-class Polish Jews) wreaked far more havoc than
in the West. They were the main reason why deaths in the
Serbian army reached forty per cent and in the Romanian
army around thirty per cent. Prisoners of war were not
immune: 70,000 Austrian soldiers died in camps that
lacked sanitation of any kind.”
VIII: Animal
suffering in the First World War
On the impact of seeing and hearing animal suffering on
the soldiers’ psyche. “The pain caused to animals is not
the subject of this book, but it undoubtedly contributed
to the mental sufferings of soldiers. The sight of a
wounded horse, and perhaps even worse the sound
of a wounded horse, was harrowing in the extreme. Alan
Hanbury-Sparrow described the order received during the
retreat from Mons to give wounded horses the coup de
grâce as ‘perhaps the most senselessly savage order
ever issued by the staff’. Graves grew used to the sight
of human corpses, but he was shocked every time he saw a
dead horse or donkey.”
IX: Atrocity
propaganda
On the impact of atrocity propaganda on the harshness of
warfare. “It is important to add that there was not in
fact any ‘propaganda’ in the strict sense of the word.
No fabricated stories were distributed by the military
and political authorities with the aim of fuelling
hatred for the enemy and thereby strengthening the will
to fight. Propaganda consisted of stories that arose
among the ranks of soldiers and civilians, and were
sincerely believed by them. Perhaps such tales had a
greater and more subtle impact for this very reason, but
although neither distributed from above nor deliberately
invented, their effect was nevertheless to deepen the
gulf between the two sides, increasing the hatred and
making the fighting even more horrific. In other words,
the victims featured in propaganda were mythical, but
the victims of propaganda were all too real.”
X: The war at sea
and in the air
On the atypical forms of 1914-1918 warfare. “In the
post-war years the cult of the hero underwent a
transition. It no longer applied to every soldier, the
anonymous soldier, the unknown soldier, but to a few
famous characters whose names were known to all, like
Canada’s Billy Bishop and Germany’s Manfred von
Richthofen, the Red Baron. These were names that made
hearts beat faster and after the war men longed to
emulate them. The anachronistic nature of the desert war
and the futuristic nature of the air war, in which the
enemy was known by name and honoured in death by friend
and foe alike, meant that even after 1918 warfare was
still bathed in an aura of romanticism.”
XI: The misery was
universal
On the impartiality of suffering. “In this book I
describe a small part of the total, horrific experience
of soldiers who served on the front line between 1
August 1914 and 11 November 1918, voluntarily or not. I
see their sufferings as illustrative of the horrors
confronted by all those exposed to war. To paraphrase
Owen: my subject is war, and the horrors of war. All a
historian can do is describe.”
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Chapter
1 Battle
Introduction
I: Changes on the eve of war
On societal changes, military ideology and arms race. “By
1914 a company of 300 men could deploy firepower
equivalent to that of the entire 60,000 strong army
commanded by the Duke of Wellington at the Battle of
Waterloo. Wilhelm Lamszus, author of
Menschenschlachthaus. Visionen des Krieges (The
Human Slaughterhouse: Scenes from the War That Is Sure
to Come), published in 1912, realized after watching
a military exercise that a future war would bear no
resemblance to 1870-71. ‘It is as if death,’ he wrote,
‘had thrown his scythe onto the scrap-metal heap and
become a machine operator.’”
II: The dominant
military ideology
On the offensive mind-set of the military. “What the
enemy did was immaterial, the thinking went; it was his
location that mattered. The army must not cede an inch
of ground. The bayonet was of greater importance than
the machine-gun. Heavy artillery would only get in the
way. The last remnants of caution in the British
Field Service Regulations of 1905 were omitted from
the 1909 edition. A battle could be decided only by a
ruthless and uncompromising attack. Any officer who recognized the disadvantages of this
strategy and expressed his misgivings had little chance
of promotion.”
III: The war
On the paradox that the defence had the advantage but
the war could only be decided by the offence. “The war
of 1914-18 was neither the brief, bloody battle the
cavalry had anticipated nor the lengthy but literally
bloodless stalemate some had feared. It was the worst of
both worlds, an extremely bloody trench war that lasted
more than four years, drawing upon all the achievements
of preceding decades in social, technical and medical
fields, not for the benefit of humanity but in pursuit
of destruction.”
IV: Shared affliction
On
the impartiality of suffering. “Many officers regarded
urban populations as largely composed of leftwing
radicals or, even worse, enfeebled drunkards. For the
army staffs this presented one advantage: the blame for
any offensive that ended in bloody failure could be
placed on the men. There had been nothing wrong with
their plans for a great breakthrough, but those
responsible for executing them were not up to the task.”
V: The Great War was too great
On the simple fact that the costs in men and material
from the Great War was too much for any country
participating in it. “The huge death toll can be blamed
in part on the fact that none of the countries involved
was prepared for war on such a scale, nor could have
been.”
1914
I: The overture
On the weeks predating the war and the motives and
expectations of those who were about to engage in
battle. “Many
historians believe people welcomed the war with all the
enthusiasm described by the politicians, soldiers and
journalists of the day. The evidence suggests that the
story is more myth than reality. The monotony and
boredom said to characterize the lives of ordinary
citizens, from which the war promised escape, were to a
large extent figments of the imaginations of a small
intellectual elite.”
II:
The invasion of Belgium
On the opening days of the war in the West and on the
Belgian army. “Medical services were poorly organized.
Before the war it had been assumed that the intensity of
firepower would prevent any movement of the wounded
during a battle, so hardly any stretcher-bearers had
been trained. For the same reason no motorized vehicles
were provided as ambulances, only horses and carts –
after all, once a battle was over it would no longer be
necessary to move casualties particularly quickly. There
were thirty-three SSA trains (Service de Santé de
l’Armée), whose 300 carriages had room for 3,840
prostrate wounded and seats for another 3,600, but there
were insufficient Red Cross staff to man them.
Nevertheless the wounded were moved back behind the
lines train-loads at a time. They had to be transported
from railway stations to hospitals on open stretchers.
There were not enough army doctors to treat those who
made it that far.”
III: The Germans
against the French
On the first struggles between the German and the
French. “French reservists and volunteers, in their
traditional and highly visible red trousers, fell to
German gunfire in their tens of thousands, in the Vosges
Mountains and in Champagne, at Reims, St Quentin and
Chateau-Thierry, on the Aisne and the Marne. They
advanced in formation, without cover of any kind. Within
two weeks their losses had reached 300,000 and five
thousand officers were dead. At Roselies near Charleroi
on 22 August, the 74th Infantry Brigade lost
1,100 men. On that one day alone, 27,000 Frenchmen died
on various battlefields, making it the bloodiest day in
French history.”
IV: The British and their ‘great
retreat’
On the first battles, Mons, Elogues, Le Cateau, between
the Germans and the British Expeditionary Force and the
overwhelming fatigue during the retreat after Mons.
“Britain declared war on Germany as soon as the German
army crossed the Belgian border. Many British men
spontaneously reported for service with the British
Expeditionary Force (BEF). Their enthusiasm only
increased when the BEF suffered defeat at Mons. The
battle was costly for the Germans and in accordance with
an old British custom the defeat was celebrated as a
moral victory.”
V: Towards the stalemate
On the exhaustion of the Germans and the battle at the
Marne, leading to trench warfare. “Stephan
Westman, a doctor who was serving as a young conscript
with the 113th Infantry Regiment wrote: ‘We
slogged on, living, as it were, in a coma, often
sleeping whilst we marched, and when the column came to
a sudden halt we ran with our noses against the
billycans of the men in front of us.’”
VI:
The First Battle of Ypres
On the First Battle of Ypres fall 1914 and other battles
in the surroundings, making ‘Belgium’ a horror filled
word, and it would only get worse. “Corporal George
Matheson wrote from First Ypres, ‘We were complaining
about the Aisne being bad, but it was a king to the
fighting we have done since we came to Belgium. This is
pure murder, not war.’”
1915
I: The spring offensives
On the first battles of 1915, Neuve Chapelle, Fromelles,
Champagne, Notre Dame de Lorette, St Mihiel, Aubers
Ridge, Argonne, and the Hartmannswillerkopf in the
Vosgues Mountains, the blood and rain and mud and cold
that typified them, and on the Second Battle of Ypres
giving birth to poison-gas. “Towards
the end of the afternoon of 22 April, on the northern
side of the front near Langemarck, immediately after a
short but heavy barrage, the valves of thousands of
cylinders were unscrewed and 168 tons of yellow-green
chlorine gas drifted from German positions towards the
French in the northern sector, in clouds that gradually
turned into a bluish-white haze. French troops without
any protective equipment, many of them from the
colonies, panicked and left a gap in the front almost
eight kilometres wide.”
II: Battle of Loos
In the battle of Loos where the British heavily suffered
in spite of using gas themselves for the first time. “Thousands
of recruits to the new British volunteer army had their
first experience of battle here, and in many cases their
last. Within two hours, on the British side alone, more
soldiers died than were lost on all sides on D-Day, 6
June 1944.”
1916
I: Battle of Verdun
On the battle of Verdun, the ‘greatest’ (and longest,
and bloodiest) battle in history. “Paul Valéry had every
reason to describe the Battle of Verdun as a war within
a war. Henri Barbusse had every reason to write, with
Verdun in mind, that ‘two armies engaged in battle are
one great army committing suicide’. Jünger had every
reason to conclude that Verdun was not a battle but a
massacre, a bloody massacre on a few square kilometres
that brought no visible benefit or advantage to either
side. Many would argue it brought no invisible gains
either.”
II: The colonial troops
On the special problems of the colonial troops, wandered
of in the war that wasn’t theirs, fought in a way they
did not understand and rejected, although mostly they
were seen as the repulsive ones using inhuman ways of
warfare.
“One Indian soldier wrote home that he found himself not
in the midst of a war but at the ending of the world.
Nor could they understand why a wound did not exempt
them from any further fighting. A Sikh wrote to his
father in amazement that they were like baked grain
flung into the oven a second time, ‘and life does not
come out of it’.”
III: Battle of the
Somme
On the five months long British offensive at the river
Somme, most famous for its opening day, 1 July 1916,
leaving 20.000 British men dead on the ‘field of
honour’, the biggest toll ever of a single army in one
day on such a limited area. “The
army of volunteers, Kitchener’s men, was born during the
hard labours of Loos and buried less than a year later.
Siegfried Sassoon, whose platoon was not among the first
to advance, took a quick look at the battlefield after
he had finished shaving – a fleeting glance, since
merely looking put him in deadly danger. It was as if he
had seen ‘a sunlit picture of hell’.”
1917
I: Battle of the
Chemin des Dames
On the only attack in 1914-18, perhaps even in history,
unanimously condemned by military historians. “The
Germans were lying low in their extensive chalk tunnels
inside a hill, the Caverne du Dragon. After a
preparatory barrage they emerged from several tunnel
exits to inflict a bloodbath on the French troops
clambering up towards them. In heavy rain and sleet, the
French and Senegalese soldiers had to work their way up
through a hail of hand grenades and machine-gun
bullets.”
II:
Battle of Messines
On the intended explosion of several tunnels near Ypres,
7 June 1917, the biggest explosion in history apart from
Hiroshima and Nagasaki. “One
of the few Germans who lived to tell the tale wrote:
‘The ground trembled as in a natural earthquake, heavy
concrete shelters rocked, a hurricane of hot air from
the explosion swept back for many kilometres, dropping
fragments of wood, iron and earth, and gigantic black
clouds of smoke and dust spread over the country. … The
trenches were now the graves of our infantry.’”
III: Battle of Passchendaele (Third
Ypres)
On the battle that made ‘Passchendaele’ a metaphor for
the senselessness, the insanity of warfare. “Canadian
doctor Frederick W. Noyes experienced only the final two
weeks of the battle, but looking back he wrote: ‘One
long, weird, and terrible nightmare of
water-filled-trenches, zigzagging duck-walks, foul
slime-filled shell-holes, half-buried bodies and dead
men, horses and mules, cement pillboxes, twisted wire,
shrieking shells, flying humming metal, crashing aerial
bombs, stinking mud, water-logged and blood-soaked
trenches – a slough of Despond even Bunyan couldn’t
conceive of.’”
1918
I: The German
advance
On the last, desperate attempt of the German army to win
the war, before the America troops would be fully
deployed. ‘The price paid was huge. In four months the
German army lost around a million men, twice as many as
the British and French combined. After two months of
fighting, Zuckmayer wrote from Flanders to his friend
Kurt Grell: “What have I experienced (since our last
letter)? Offensives. ‘Kaiserschlacht’. Blood.
Cambrai. Blood. Gas shells. Kemmelberg. Blood. Horror. A
brief time in Lille. Schnapps. Whores. Booze.
Armentières: Blood. Killing. Blood. Three steps from
insanity.’”
II: The Allied advance
On the final turning of the tide, summer and fall 1918,
fro instance resulting in the ‘Black day’ for the German
army 8 August. “Douglas MacArthur, who would command
American forces in the Southwest Pacific more than
twenty years later, walked across the battlefield amid
the moans and screams of wounded men abandoned there. He
estimated he had seen 2,000 German corpses. A
machine-gun post was scattered with bodies, ‘the
lieutenant with shrapnel through his heart, the sergeant
with his belly blown into his back, the corporal with
his spine where his head should have been’. Yet we
should not be misled by sights and body-counts like
these. Roles had been reversed, but not completely. Now
it was the French, British, Australians, New Zealanders,
Canadians and Americans who were advancing, and
therefore it was the French, British, Australians, New
Zealanders, Canadians and Americans who died. The Battle
of the Marne, for example, cost the Germans 25,000 men,
the French around 100,000.”
III: The armistice
on 11 November 1918
On 11 November 1918, a day too good to be true and too
sad to be enjoyed. “The war that was supposed to be over
by Christmas 1914, and which many soldiers believed
would never stop, had finally ended. Many were not
convinced. The war over? They refused to believe it.
Most celebrations took place back home, among those who
knew that friends and family still out in France or
Belgium were safe and unhurt. In the trenches the most
noticeable effect was silence. No more roaring of guns,
no more whistling of bullets, little revelry either,
virtually no jubilation. The soldiers had been beaten
numb. Relief? Yes. Festivities? Although joy was
certainly one element of the numerous different moods
that overcame soldiers when they heard of the armistice,
many were incapable of responding with enthusiasm. Some
had no reason to feel joyful. The end had come too late
and they would either die or face life without arms or
legs. Graves later quoted a poem by Sassoon about the
armistice, including the words ‘everybody suddenly burst
out singing’, only to remark: ‘But “everybody” did not
include me.’”
1914-18: the
casualties
Counting the victims
of war
On the difficulty of counting the victims of war, for
instance because of the uncertainly who is to be
considered a victim, but nevertheless agreeing on the
conclusion that either number will be vast. “Take the
Battle of Verdun. Some sources speak of 100,000 dead and
500,000 wounded on either side. Historian Luc de Vos
gives figures of 160,000 dead and missing Frenchmen, and
220,000 French wounded, while Kurt Tucholsky, for
example, speaks of 400,000 dead on the French side
alone. One French officer had no hesitation in
announcing that there had been 1.5 million French
casualties. It is perhaps characteristic that Martin
Gilbert writes at one point in his The First World
War of more than a million French dead in the war as
a whole and elsewhere of almost 1.4 million. Of course
this is not a discrepancy, but it is telling that almost
400,000 dead seem simply to have been rounded down.”
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Chapter 2
Body
Conditions in the
trenches
I: Clothing
On the suffering coming from the inadequacy of clothing,
both in quantity as in quality. “In his book Krieg
(War), Arnold Vieth von Golssena, writing as
Ludwig Renn, described his one and only pair of
underpants as a rag. Only the legs were still in one
piece; they had no seat left, nor any buttons. In
desperation he sewed laces to the sides and tied them
round his waist. In Mud and Khaki, H.S. Clapham
describes how he walked around for six months with a
large hole in the seat of his trousers and was once
unable to change his underwear for a month.”
II: The soldier’s
burden
On the weight of the packs, making marched even more
exhausting and almost unbearable. “Henri Barbusse
described it as ‘monumental, crushing’, what with
flares, periscopes, wire-cutters, spare clothes (if he
had any), shaving kit, food, drinking water, tea,
cigarettes, matches, a Bible and perhaps other books,
family photographs and so on. A Swiss, Ulrich Braker,
serving in that famous German regiment whose name, the
Itzenplitz, conjures up images of Schweijk rather than
serious combat, opened his shirt after a march to feel
some fresh air on his chest and ‘steam rose up as if
from a boiling kettle’. One British soldier, a former
choirmaster, sighed that it was no fun having to carry
your house on your back.”
III: Hunger and
thirst
On the two greatest torments that can afflict a man and
which afflicted troops throughout their time in the
trenches: hunger and thirst. “If thirst was a torment in
dry periods, in times of particularly bad flooding it
was hell indeed. Soldiers suffered unquenchable thirst,
caused partly by their dry biscuits, while water
polluted by corpses lay everywhere they looked.
Estimates suggest that by early 1915, in the inundated
area around the Yser alone, tens of thousands of bodies
floated on the floodwaters or under the murky surface.
Men crawled out of their trenches and risked their lives
to fill their bottles with water from beneath the
greenish-brown slime that coated ponds and flooded
shell-holes, despite knowing they were certain to have
been polluted by gas or by the decomposing flesh of men
and horses. They knew the risks and accepted them.”
IV: Rain and mud
and cold
On the torment of bad weather when forced to stay
outside or even attacking in them, although on the whole
the weather was not particularly better or worse than in
other years; the impact increased enormously. In other
words: rain did not cause the Somme and Ypres mud, the
war did. “In January 1915, five days before his death,
German soldier Karl Aldag wrote from his Flanders
dugout: ‘Mud and water fill the trench, water from below
and rain from above. Day and night we lie low, moving
earth, shovelling water and pumping it. And all the time
that sense of futility, knowing it’s all completely
pointless! The water remains.’ Eugen Röcker wrote home
that in his shelter it was impossible for him to sleep
in his bunk, since it was floating around in deep
water.”
V: Vermin
On lice and mice, and rats and flies. “The only enemy
the rats encountered was an unnatural one: gas. A gas
attack would result in a huge death toll among rats, but
the positive effect was short-lived. As soon as the gas
had dissipated, more rats would start arriving from
neighbouring trenches. Alistair Horne writes that rats
seemed to be the only creatures who really profited from
the war, although, he adds cynically, there were few
other respects in which the life of a rat differed from
that of a soldier.”
VI: Noise and
stench
On the wall of sound of guns and flies and moaning
wounded (and the singing of birds) and the stomach
turning stench of gas and decaying corpses. “During a
bombardment the noise was loud enough to split the
eardrums and it quite commonly caused permanent hearing
loss, especially among gunners. The sound of one shell
bursting nearby is deafening, let alone thousands. Many
men said you did not so much hear the noise as feel it.
A Canadian soldier even wrote that it had assumed a
tangible form; for him the barrage had become a solid,
immovable ceiling of sound.”
VII: The trenches
On ‘life’ in the trenches. “It
will be clear from all this that life in and around the
trenches was filthy, foul, sickening, deafening,
dispiriting and extremely unhealthy. It was safer than
in no man’s land, but that was about all. Anyone who
peered over the breastwork out of curiosity, even for a
second, stood a fair chance of being shot by a sniper. A
man might be buried, alive or dead, in the foxhole where
he was hiding. In a trench there was a good chance of
being ripped apart by a bursting shell, indeed death in
the trenches was rarely quick or clean. Unless they were
caught by a sniper’s bullet, few of the men killed while
still in their trenches were hit in the head or heart by
a single shot. Shrapnel and shell splinters made for a
long, painful death.”
Disease
I: Introduction
On the huge amount of ‘non effective mandays’ caused by
disease and the definition it had. “Disease was not just
a serious problem on a human level, it was a substantial
military threat. Even though the mortality rate among
soldiers who contracted diseases was far lower (at
around one per cent) than that of the wounded (some
thirty per cent), sickness was and remained the main
cause of loss of manpower. It should be noted here that
the word ‘disease’ had a different meaning in the
trenches than in normal life. A large proportion of men
who took part in offensives may have had heavy colds or
'flu' but they were not regarded as sick. This made it
possible to claim that given the circumstances the
health of the troops was surprisingly good. If the definition of the word ‘ill’ had been the same in
1914-18 as it is today, there would have been
practically no healthy soldiers left to fight battles.”
II: Sickness in
the trenches
On illnesses tied up to the specific kind of warfare of
1914-1918 such as skin infections, myalgia, rheumatism,
trench fever, pyrexia, trench feet, frostbite, trench
mouth, pneumonia, diarrhoea, tuberculosis, bronchitis,
enteritis, typhus, typhoid, Weil’s disease, diphtheria,
dysentery, meningitis, tetanus and on the measures, such
as declaring some of them a military offence, taken
against them. “From 1916 onwards soldiers were simply
forbidden to develop trench foot. The duty officer was
obliged to ensure men took the prescribed precautions,
and if there were too many cases of trench foot in a
battalion, the officer in charge would be dismissed.
Anyone who contracted trench foot, at least if he were
an ordinary soldier or junior officer, would be
court-martialled. This was not as unreasonable as
it sounds. Like trench fever and trench mouth, trench
foot was one way out of a terrible mess, court martial
or no court martial. A very painful way, certainly.”
III: Heart
problems, venereal disease and Spanish ’flu
On illnesses not particularly tied up to war and
trenches, such as heart problems, Spanish influenza and
venereal diseases. “Twice as many suffered from venereal
disease as from any other complaint. Given that the
chances of infection in a single sexual act have been
estimated at no more than about three per cent, it is
clear that many soldiers in the vicinity of the trenches
and on short-term leave must have shared their beds with
prostitutes or local women. Leave in Paris was
particularly feared by army doctors. This does not alter
the fact that, generally speaking, precious little sex
is mentioned in war memoirs. The same applies to
personal experiences of killing. Individual
contributions to the beginning or ending of a life are
perhaps part of one and the same taboo. Many men saw
others go off to visit prostitutes, and many saw others
in the act of killing, but few admitted to taking part
in such activities themselves.”
Wounds
I: Introduction
On the estimations before the war of the numbers of
soldiers wounded, on the completely conflicting actual
numbers and on the nature and survival chances of the
wounds. “Wounds to the abdomen proved even more deadly
than wounds to the head. Of one British sample of a
thousand soldiers with stomach wounds, 510 died on the
battlefield, 460 on their way to hospital and twenty-two
following surgery. Only eight survived, or 0.8 per cent.
In this particular case the circumstances may have been
extreme – other studies conclude that the survival rate
was eight per cent – but clearly the survival chances
for men with abdominal wounds were small, even compared
to chest wounds which, despite proximity to the heart,
were survived by seventy-two per cent.”
II: Bullets and
shells
On the wounds caused by ‘conventional’ weaponry and the
essence of war. “The essence of warfare, as the First
World War makes graphically clear, can be described as
the handing over of one’s body to the state, giving the
government free rein to dispose of it as it sees fit,
even if that means it will be grotesquely mutilated by
bullets and shells, most but not all fired by the enemy.
Nevertheless, in theory bullet wounds were relatively
clean. If the bullet entered the body undamaged, there
was usually little bleeding, only a bluish hole with
smears of blood around it. Rotation of the bullet could
cause contusions, but even then heavy bleeding was rare,
since shock reduced blood pressure and severed blood
vessels sealed themselves off. […] However, if the
bullet did not go straight to its target but ricocheted,
as was very often the case, then the consequences could
be ghastly. The twisting bullet did not enter the flesh
point first but made a huge hole and could easily smash
a bone. Even in the first month of the war, the
British Medical Journal recorded bullet holes
measuring five by three inches as a result of
ricochets.”
III: The chemical
horror
On the flamethrower and poison gas. “In the days after
the first mustard gas attack, the Casualty Clearing
Station at Mendringhem alone received more than a
thousand gas casualties. Many were actually victims of
the very first attack. They had crawled into shell-holes
with yellow cross lying in the bottom where it had
failed to evaporate and did not notice as it soaked into
their clothes. After several days they emerged from
their hiding places. Their uniforms had burned through
in patches and their skin was covered in blisters.”
IV: The lucky wound
On the Blighty, the bonne blessure, the
Heimatschuss. “The lightly wounded stood a good
chance of being sent back up to the line before very
long. Those with serious wounds risked dying or being
disabled for life. But there was an intermediate
category: the Blighty, the Heimatschuss, the
bonne blessure. Such a wound was the best of all
ways to get out of the war. Being wounded meant there
was no need to feel any guilt. A Blighty was serious
enough to keep a man out for the duration, but not so
serious that he would go through life horribly maimed.
Soldiers had little respect for modern medicine, as we
shall see, but its ability to heal wounds that would
once have been fatal so that a man could set off home
and say goodbye to the front for ever was generally
welcomed.”
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Chapter 3
Mind
Introduction
A complete psychological breakdown
On the inevitable psychological trauma, mild, severe or
somewhere in between, in individuals fighting a highly
mechanized industrial war. “In
his evidence before the War Office Committee of Enquiry
into Shell Shock, J.F.C. Fuller said he had seen many
men who were in a perfectly healthy frame of mind when
they embarked for the continent whose first experience
of being under fire caused physical fear, which quickly
abated to be replaced by indifference. This mental state
might then develop along a path that led to extreme
nervousness and finally complete psychological
breakdown. In other words, healthy fear degenerated
first into indifference and later into obsessive fear,
and the chances of this happening were greater than in
previous wars because of new military technologies that
increasingly depersonalized war.”
From health to neurosis
I: Morale
On the decline of morale, starting already before but
accelerating after the soldiers had dug in. “The
constant awareness of death and destruction, the
apparent hopelessness of the fighting and the complete
lack of information all clearly impacted on morale.
Depression, lethargy and drunkenness steadily increased
and the number of cases of desertion and neurosis rose.”
II:
Numbness
On the change of individual personality as a consequence
of wartime conditions. “Vera Brittain’s fiancé, Roland
Leighton, expressed it by saying: ‘I feel like a
barbarian, a wild man of the woods, stiff, narrowed,
practical, an incipient martinet perhaps.’ Feelings that
were normal in civilian life, like empathy and grief,
soon vanished. The men’s joie de vivre and erotic
fantasies faded and sank ‘into the mire that covered
everything’, as Sophie de Schaepdrijver put it, writing
of the Belgian soldiers at the Yser front for whom the
impossibility of leave was a further demoralizing
factor.”
III: Inhumanity
On
the danger of developing a delight in killing and a
complete lack of respect for humans, the living as well
as the dead, in spite of the numerous tales of quite the
opposite. “In wartime people are ordered to do things
that are otherwise strictly forbidden. Everything that
is valued in peacetime, including human life, is
stripped of its value in times of war. Soldiers become
alienated from the civil society that produced them,
indeed it actively alienates them, until they become
strangers to their own world and even to themselves. The
fear, lack of sleep, appalling experiences, ubiquitous
violence and group pressures of wartime are a lethal
combination. They lead to what one historian of the
holocaust, Christopher Browning, has called ‘battlefield
frenzy’. […]. ‘Sometimes Tommy is not a pleasant
animal’, wrote Corporal W.H.L. Watson, an Oxford
undergraduate, after watching British infantrymen
fighting to wrench as many belongings as possible out of
the clothes of their German opponents in the early weeks
of the war. ‘One dead German had his pockets full of
chocolate. They scrambled over him, pulling him about,
until it was all divided.’”
IV: Fear
On
the source of all psychological and emotional problems,
fear: fear of bombardment, of gas, of mutilation, fear
of death, fear of fear itself, or of showing fear, and
fear of the war in general. “On 1 July 1916, Private
Surfleet watched men stumble back from the front line.
They were pale as death, with bloodstained hands and
uniforms and makeshift bandages. Each one had a look of
indescribable fear in his eyes. ‘I know, now, I hate
this warring business,’ he wrote.”
V: Self-mutilation and suicide
On the soldiers who not succeeded in suppressing their
fear, staving of le cafard, leading to the
physical way out of misery, self-mutilation, in spite of
the probability of court martial, or even suicide, and
the connection between this and military failure or
success. “There
is probably a connection between the number of suicides
and self-inflicted wounds and the degree of military
success the men were experiencing at the time. This
certainly seems a reasonable conclusion to draw from
reports in the early months of the war about British
soldiers who had killed themselves, or attempted to, and
from German suicide figures. While the suicide rate back
in Germany fell steadily, the rate among soldiers
increased in the final phase of the conflict. In August
1918 there were officially 3,500 cases; three months
later there were more than 5,100. Few would doubt that
the true figure was higher.”
Neurosis
I:
Introduction
On the subconscious way out of misery: neuroses such as
hysteria or neurasthenia, or, as they conveniently but
medically inadequate were called in general:
shell-shock. “The term ‘shell shock’ became synonymous
with war neurosis in general, despite the well-founded
medical criticism of it, in the context of the 1914-18
war. Terminology like NYD(N), DAH, hysteria and
neurasthenia were meaningless to soldiers and civilians
alike. Shell shock on the other hand, like
Granatshock, Granatfieber and so on,
contained references not only to war but to artillery
and trench warfare in particular. The term says
something about the 1914-18 war, just as for example
‘combat exhaustion’ says something about the Second
World War and ‘combat stress’ about the war in Vietnam.
Moreover, to a soldier the term was attractive in that
it placed the blame for a mental disorder outside the
man himself and even sounded a heroic note. It did not
of itself impose the stigma of being labelled either a
coward or mentally inferior, whether for reasons of
heredity or not.”
II: Definition of war neurosis
On the difficulty of an exact definition of war
neurosis, amongst others depending from cause or from a
psychological or neurological point of view. “Charles
Myers [who had introduced the term shell shock into the
medical world], like his old companion W.H.R. Rivers,
had been part of a small group of pre-war British
psychiatrists and psychologists who were more interested
in possible psychological causes of insanity than in its
presumed organic origins. Perhaps it was because of this
that Myers quickly realized neurosis was by no means
always caused by a bursting shell. Even an event that
seemed insignificant compared to the things soldiers had
to deal with every day could prove the final straw.”
III: Numbers of war neurosis
On the impossibility to know how many men suffered from
war neurosis and therefore on the enormous relativity of
all exact looking numbers mentioned. “In the absence of
reliable evidence, the compilers of Britain’s Medical
History of the War settled upon the figure of around
80,000 cases, or two per cent of British men mobilized,
a percentage that gave little cause for alarm. In fact
it was a misleading extrapolation, greatly
underestimating the scale of the problem. We may
nevertheless wonder, like John Ellis, at a situation in
which around 20,000 men per year on the British side
alone were officially driven temporarily or permanently
insane.”
IV: Causes
of
war neurosis
On the at the same time enormous simplicity and
difficulty of agreeing on the causes. “It does not take
long to sum up the causes. Apart from a handful of cases
of men who ought to have been declared unfit for duty
from the outset on psychiatric grounds, the main cause
was simply the war. Even if we examine the matter more
closely, the conclusion is briefly stated. There were
almost as many origins of shell shock as there were
patients. […] Otto Binswanger, a German professor of
psychiatry, wrote in an article published in 1922 that
he found it difficult to say anything meaningful about
war neurosis, not because few hard facts were available
but because he had too many facts and they were too
diverse.”
V: Symptoms
of
war neurosis
On
the symptoms of war neurosis, as divers as the causes,
having as well a close as very distant relation to each
other. “Babington writes of a man who screamed
incessantly: ‘He’s gone! He’s gone!’ After a while it
became clear that his brother had been killed as he
stood next to him in a trench. One of Rivers’ patients
at his war hospital for mental cases at Craiglockhart
had broken down after he bent to pick up what he thought
was a ball lying in the bottom of a trench. It was
indeed a ball. An eyeball. Insanity had robbed him of
his sight. […] None of this alters the fact that, as
already suggested, many men presented symptoms that
seemed to have little to do with the immediate causes of
their psychological wounds. Rifleman Arthur Russell, a
stretcher-bearer, had gone with a group of men who had
orders to dig a communication trench, in case any of
them should be wounded. It was a bitterly cold night.
Russell did not have to dig, so he suffered even more
from the cold than the others. At some point he took the
pick from one of his companions to allow him to rest for
a short time. As he worked he gradually became a bit
warmer. Then the point of the pick hit ‘something hard
and unyielding as a block of concrete’ and suddenly pins
and needles shot through his body like an electric
shock. He lost consciousness. There was not a scratch on
his body, but he was struck dumb and paralysed, able to
move only his eyes.”
VI:
The alleged hallmark: cowardice
On the often stated, but highly improbable – and
insulting – cause of neurosis: cowardice. “Although a
subconscious flight into insanity was far from usual,
there is no reason to conclude that neurosis was caused
by cowardice. Rarely were symptoms found to be less than
genuine, and faking was no simple matter. Nevertheless,
as Gibbs pointed out, in the early years of the war
especially, the neurotic was commonly considered a
deserter or a coward. After all, if he was suffering
from mental exhaustion as a result of the conditions of
war, then why was one soldier affected more than
another? Any man who was treated as mentally ill or
psychologically wounded rather than as a deserter had
his luck to thank more than anything else. […]
Lieutenant-Colonel Frank Maxwell of the 12th Middlesex
Regiment wrote in a letter to his wife dated 26 July
1916: ‘“Shell shock” is a complaint which, to my mind,
is too prevalent everywhere; and I have told my people
that my name for it is fright, or something worse, and I
am not going to have it. Of course, the average nerve
system of this class is much lower than ours, and sights
and sounds affect them much more. It means … that they
haven’t got our power of self-control, that’s all.’”
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Chapter 4
Aid
Introduction:
The pain
represented by figures
On
the improvement of medical care for soldiers since the
midst of the nineteenth century, not least because of
the introduction of conscription in many countries,
based on nationalist sentiments, which obliged the state
to pay more attention to military medicine, and on the
organization of medical care during the war But neither
improvement not organization could live up to the
demands of 1914-1918. “[During the war] around nine
million British sick and wounded were treated and 1,088
million doses of drugs administered. Doctors and
orderlies applied 1.5 million splints and 108 million
bandages, used 7,250 tons of cotton wool and fitted over
20,000 artificial eyes. The German military medical
service gave no less than 200 million inoculations, an
average of fifteen per soldier. Whenever an epidemic
threatened, whole regiments would line up to be
immunized or to receive booster injections. The German
army had 3,355 hospitals at its disposal, amounting to
almost 200,000 beds. A collection for medical aid to
soldiers raised 534 million marks, plus donated material
worth another 200 million. The American army had 443
medical officers in 1916 and another 146 in reserve. By
the end of the war their number had risen to almost
31,000 and the Army Nurse Corps had grown from 400 to
21,500. In addition there were more than 200,000 support
staff, both men and women. When the American
Expeditionary Force left for France, it estimated that
73,000 beds would be sufficient. This assessment was
quickly adjusted to 600,000 and by the end of the war a
total of 380,000 were available, 260,000 in France and
120,000 back in the US. Denis Winter comments: ‘If the
pain represented by these figures could be similarly
quantified, then it would be beyond any man to
comprehend such grief.’”
From wounding to aid post
On
the first step to salvation, getting from No Man’s Land
to the nearest aid post, a trip, although sometimes no
more than a mile, could take hours or even days, even
with the help of sometimes up to aught stretcher bearers
for each wounded, but often would not be made at all,
also because it was often forbidden for other soldiers
to help them and bring them back. “In late 1914 Louis
Barthas saw the following scene: ‘In the squad in front
of us a bullet had gone right through a man’s shoulder
and he bled profusely, eventually dying for lack of
first aid; but goodness knows where the
stretcher-bearers had got to and anyhow we couldn’t
delay our march, having been ordered not to stop to look
after anyone, not even to save our own brothers. We
passed in front, or rather stepped over, this first
wounded man, as he breathed his last.’”
From first aid to hospital
On
the initial care in the aid post, almost always little
more than a table and a supply of dressings in one of
the dugouts - dimly-lit places, sometimes even pitch
dark, damp, often with no fresh air and poorly heated in
cold weather giving room to swarms of flies, and never
out of the way of danger, explaining for a great deal
the bad name military medicine often had -, and the
laborious tour of getting from there to better equipped
hospitals further on (in the hope one would not get send
back, because they were also crowded. “Battalion doctor
Maurice Duwez (Max Deauville) described his job: ‘Our
aid post is located in a small café, in a street
perpendicular to the firing line. Straw has been hastily
laid on the blue tiles. The dressings, the brown bottles
with red labels, the nickel instruments from our opened
bags are piled high on the bar. Two men, wounded by
falling bricks, sit on the ground dazed, leaning back on
the wall, their bleeding heads bandaged with field
dressings. Ambulances come all the way to our post.
Stretcher-bearers are available to us. As I am talking
with two of them, one is suddenly hit in the leg by a
projectile. A snapping sound reverberates, as if someone
has broken a thin plank of wood, and the man falls to
the ground howling.’”
The
field hospital
On
the overcrowded and sometimes almost empty field
hospitals, giving under equipped doctors either too much
work to handle, or days or even weeks of utter boredom
and on the contact with nurses – the first women the
soldiers saw on their march home or back to the front.
“The hospital added one more complication to the life of
a soldier, already under enormous strain in such
constant close proximity to death. To the tension
between soldier and civilian, sick and healthy,
front-line service and safety, low and high rank, was
added the tension between the wounded and their nurses,
or between men and women, which was not made any easier
by the image of a nurse as someone who handed out pills
and asked: ‘How are we feeling today?’ Unrealistic
though this may have been – nurses rarely had time for
such personal attention – it was a pervasive image, and
the ‘hero’ saw himself as a sick child. […]
The Feldpuffordnung (field brothel regulations)
drawn up by German soldiers themselves, which Hans
Magnus Hirschfeld describes as the most grassroots
expression of front-line eroticism, stated that there
was no need to set up brothels in the vicinity of
hospitals where Red Cross nurses worked.
[…]
It was a reputation that could make a nurse like Jane De
Launoy extremely agitated, but which cannot be dismissed
as pure slander and delusion. Her own diary illustrates
this on several occasions. Nurses had of course been
drawn to the front by a desire to help the sick and
wounded, although they were rarely employed at aid posts
in the direct vicinity of the front line.
The
Frontschwester, the front-line nurse, celebrated in
books like Frontschwestern – Ein Deutsches Ehrenbuch
(Front-Line Nurses – A German Tribute), published in
1936, is largely a mythical figure. Riemann’s
Schwester der Vierten Armee, for instance, can be
read as an account of her sustained but ultimately
futile efforts to be allowed to work close to Ypres and
the Yser. Wanting to help the sick and wounded did not
preclude other, more human and down-to-earth motives,
such as a desire to take part in the war in the only
truly feminine way permitted, a longing to serve one’s
country and prove oneself a worthy citizen, an urge for
adventure, or a yearning for male company in women whose
menfolk had left for the war.
Suddenly they were seeing
men in ways they had seldom if ever seen them before.
Abruptly coming into contact with large numbers of naked
men undoubtedly aroused sexual excitement in completely
unprepared nurses, something that Enid Bagnold’s
A Diary Without Dates,
for example, makes unambiguously clear. Mary Borden’s
denial that this applied in her case only serves to
confirm the general picture. She wrote that the men she
nursed could hardly be called men any longer, ‘so why
should I be a woman?’ As a nurse she was interested in
the wounded as patients, not as men, but the fact that
she mentions sexual tension so explicitly suggests she
was an exception in this respect. […]
It was Vera Brittain who described this aspect of nursing work most
frankly. She had not seen a boy without his clothes
since she was three or four and had never laid eyes on a
naked man. Neither she nor her patients felt the
nervousness and shame that would normally have been
expected, and, apart from actually having shred a bed
with one of the wounded, in her four years as a war
nurse she had no choice but to carry out practically
every intimate act imaginable. There were not many
things for which she was grateful to the war, but she
was glad that it had liberated her from much of the
sexual reticence instilled by her Victorian upbringing.”
The
base hospital
On
the ambulance trains and ships taking the severely
wounded to base hospitals deep in the Fatherland, and on
the ghastly site all these wounded must have been (so
the ‘heroes’ were brought from the stations to the
hospitals by night to not upset the public and make them
doubt the war effort). “A British nurse described the
tumult that always surrounded a train about to depart.
She watched as thousands of wounded men ‘swarmed about a
long ambulance train standing in a field. They crowded
the carriages, leaned out of the windows with their
bandaged heads and arms, shouting at friends they saw in
the other crowds. … There were other wounded men from
whom no laughter came, nor any sound. They were carried
on to the train on stretchers, laid down awhile on the
wooden platforms, covered with blankets up to their
chins. … I saw one young Londoner so smashed about the
face that only his eyes were uncovered between layers of
bandages, and they were glazed with the first film of
death. Another had his jaw clean blown away, so the
doctor told me. … Outside a square brick building … the
‘bad’ cases were unloaded: men with chunks of steel in
their lungs and bowels were vomiting great gobs of
blood, men with arms and legs torn from their trunks,
men without noses, and their brains throbbing through
opened scalps, men without faces.’ […] Magnus Hirschfeld, who was to become a celebrated sexologist
between the wars, described a German base hospital in
his Sittengeschichte des Weltkrieges (The
Sexual History of the World War), one of the first
books to be thrown onto the Nazi pyres by German youth
in 1933, although the adolescents are said to have taken
a quick look at the photographs and drawings of
unclothed women first. He hit the nail on the head. ‘The
entire hospital ... with all its fabled romanticism and
its all too real distress was overshadowed by death. The
way out led in most cases, either directly or via a
detour to the trenches, to the heroes’ cemetery. The
great war factory known as a hospital normally gave
people back to life only after they had left parts of
their limbs or what little health they had behind its
walls.’”
Too
many wounded, too little help
On
the first reason why, the soldiers had little to expect
from medical world in spite of all its efforts: there
were simply too many sick and wounded to heal and to
look after. “Many died who would have lived had it been
possible to treat them in time. Gangrene and other
complications arose not only because of the filthy soil
that entered wounds but as a result of inadequate
medical aid, in many cases no aid at all. There were too
few doctors, nurses, hospitals, operating theatres,
drugs and instruments, and too many sick and wounded. At
certain times and places medical treatment was
practically impossible, no matter how much planning went
into the provision of medical services as time went on
and however well prepared the armies became for large
numbers of wounded. As we have seen, it was impossible
to treat every casualty after a major battle, despite
the willingness of doctors and nurses to work without a
break.”
Complication
On complications, the unavoidable consequence of medical
care in utterly filthy surroundings, carried out with
equipment not sterile and unsatisfactory, by doctors and
nurses often to tired to focus. “In his novella Die
Pfeiferstube (The Whistlers’ Room), Paul Alverdes tells
the story of Pointner, a farmer’s son from Bavaria whose
jaw and larynx had been crushed by a shell fragment. The
wound was serious, but he would have lived had blood
poisoning not set in. He was one of three Frontschweine
and one Tommy who were known as Pfeifers, whistlers,
because their wounds caused an audible whistling in
their throats as they breathed. ‘Slowly, almost
imperceptibly, the poison irrevocably affected his
blood. Often he could not get out of bed, was choosy
about the little he ate and had a fever. ... One early
morning when everyone was still lying in bed, the
whistlers heard him become restless. He shook his
bedside table fiercely; a glass fell to the floor and
smashed with a tinkling sound. They turned on the light
and saw Pointner sitting bolt upright in bed. ... Harry
leapt over to him in his nightshirt, barefoot, to give
him some support, but Pointner had already fallen slowly
backwards and was looking up at the ceiling and no
longer moving.’”
Is
survival a blessing?
On
wounds so ghastly that one wonders if the patient would
not have been better of dead. “Bagnold wrote of having
to nurse a man called Ryan at the hospital where she
worked in England. He lay on five or six pillows, tied
down with bandages that ran under his arms and were
secured to the bars of the bed. ‘He lay with his profile
to me – only he has no profile, as we know a man’s. Like
an ape, he has only his bumpy forehead and his
protruding lips – the nose, the left eye, gone.’ Then
there was a man without nostrils, struggling to breathe
through two rubber tubes. ‘It gave him a more horrible
look to his face than I have ever seen.’ Bagnold
believed the medical orderly was convinced he would not
survive and she asked herself whether the soldier in
question might actually prefer that to the prospect of
living.”
Medical experiments
On
the fact that war gives a lot of experimental materiel
for doctors to make a career in medical science, without
things like ethics bothering them. “In a chapter
entitled ‘A Surgical Triumph’, La Motte tells the story
of a barber’s son who was gravely wounded. After several
operations he was able to return to his father, who
fortunately was not short of money. He was alive, but
not fit and well – as his father Antoine, crippled by
polio as a child and therefore not eligible for military
service, had already begun to suspect in the long period
between hearing his son ‘had been wounded and his return
home. “He learned that his son was wounded, and then
followed many long weeks while the boy lay in hospital,
during which time many kind-hearted Red Cross ladies
wrote to Antoine, telling him to be of brave heart and
of good courage.
And Antoine … took quite large sums of
money out of the bank from time to time, and sent them
to the Red Cross ladies, to buy for his son whatever
might be necessary for his recovery. He heard … that
artificial legs were costly. Thus he steeled himself to
the fact that his son would be more hideously lame than
he himself. There was some further consultation about
artificial arms, rather vague, but Antoine was troubled.
Then he learned that a marvellous operation had been
performed upon the boy, known as plastic surgery, that
is to say, the rebuilding, out of other parts of the
body, of certain features of the face that are missing.
All this while he heard nothing directly from the lad
himself, and in every letter from the Red Cross ladies,
dictated to them, the boy begged that neither his father
nor his mother would make any attempt to visit him …
till he was ready.
Finally, the lad was ‘ready’. He had
been four or five months in hospital, and the best
surgeons of the country had done for him the best they
knew. They had not only saved his life, but, thanks to
his father’s money, he had been fitted out with certain
artificial aids to the human body which would go far
towards making life supportable. In fact, they expressed
themselves as extremely gratified with what they had
been able to do for the poor young man, nay, they were
even proud of him. He was a surgical triumph, and as
such they were returning him to Paris. … In a little
room back of the hairdressing shop, Antoine looked down
upon the surgical triumph. This triumph was his son. The
two were pretty well mixed up. A passion of love and a
passion of furious resentment filled the breast of the
little hairdresser. Two very expensive, very good
artificial legs lay on the sofa beside the boy. …
From
the same firm it would also be possible to obtain two
very nice artificial arms, light, easily adjustable,
well hinged. A hideous flabby heap, called a nose,
fashioned by unique skill out of the flesh of his
breast, replaced the little snub nose that Antoine
remembered. The mouth they had done little with. All the
front teeth were gone, but these could doubtless be
replaced, in time, by others. Across the lad’s forehead
was a black silk bandage, which could be removed later,
and in his pocket there was an address from which
artificial eyes might be purchased. … Antoine looked
down upon this wreck of his son that lay before him, and
the wreck, not appreciating that he was a surgical
triumph, kept sobbing, kept weeping out of his sightless
eyes, kept jerking his four stumps in supplication, kept
begging in agony: ‘Kill me Papa!’ However, Antoine
couldn’t do this, for he was civilized.’”
Medical aid and military necessity
On
the next reason that soldiers were not always helped as
one thinks they should have been: aid was first of all
given out of military necessity and not out of medical,
humanitarian necessity. “The enthusiasm with which many
doctors […] greeted the war brings us to the
relationship between military and medical aims. Even
more than by the desire of the sick and wounded to get
well, even more than by the urge to experiment, medical
treatment was driven by military necessity.
The medical
services were an integral part of their countries’ armed
forces and like all other army units they had to respond
to the demands of warfare. Georges Duhamel in
particular, with his book Civilisation and
especially the chapter ‘Discipline’, emphasized the
point that the primary task of medicine was to maintain
fighting strength rather than to care for individual
casualties. Hippocrates was not impartial: he served
Mars. […]
It was this attitude that made Oskar Maria
Graf explode with rage when a doctor assured him he was
only a man, just like him, and that he wanted nothing
other than to cure him. No, Graf exclaimed, the doctor
was not a man like him. ‘You’re the greatest criminal!
You only heal so that there’s someone left to kill! ...
The generals, the emperor, all those commanders-in-chief
act just as they’ve been taught to act, but you –
you’ve learned something different but you let yourself
be used for the most shameful ignominy. You bring
soldiers worn to death back to life so they can be
killed again, torn to pieces again! You’re a pimp,
you’re a whore!’ […]
It was because the medical services
had supported the war and thereby prolonged it that one
American nurse sent back her Croix de Guerre ten years
after the armistice. It was for this reason too that in
1926 German medical officer Karl Kassowitz said war was
a sickness all doctors had a duty to try to prevent.
Dutch nurse Jeanne van Lanschot Hubrecht, and twenty
years after the armistice British doctor John A. Ryle, a
Cambridge professor, asked themselves whether it would
not be a good idea to refuse to give any medical
assistance during a war or the preparations for war.
Would that not ultimately be more in accord with the
Hippocratic oath and medical ethics than a willingness
to provide medical aid?”
Military
psychiatry
I:
War and madness
On
the problem of defining madness in war when the war
itself is declared mad and on the task of military
psychiatrists if this means that men gone mad from
madness have to be made capable to face madness again.
“Saying
that the war was mad rather than the patients […] was a
notion particularly prevalent in the Dada movement but
it can be found elsewhere too, in Louis Ferdinand
Céline’s novel Voyage au Bout de la Nuit for
example.
Ernst Friedrich’s Anti-War Museum in Berlin grew out of
the conviction that in 1914 the whole world had shown
itself to be a madhouse. Friedrich decided to document
this ubiquitous mental illness in the hope that his
efforts might contribute to its reduction or even
disappearance.
Wilhelm Lamszus called the second volume
of one of his books, written before the war but
published only after it, Menschenschlachthaus.
Visionen vom Krieg: Das Irrenhaus (The
Human Slaughterhouse. Scenes from the war that is sure
to come: the madhouse), and the pacifist and future
Nobel Peace Prize winner Carl von Ossietzky wrote in the
foreword that ‘we have meanwhile experienced the
madhouse ourselves’.
Stefan Zweig spoke of enthusiasm
for the war as evidence of mass psychosis, insanity and
hate-hysteria, and Theodor Lessing remarked: ‘It is
certainly valid and legitimate to speak of the great
world war and the self-laceration of the white race in
the occident as a symptom of the madness of humanity.’
This same insight would lead to the publication in 1932
of a book by Emil Flusser, with an introduction by
Albert Einstein, entitled Krieg als Krankheit
(War as Illness), which concluded that doctors,
especially psychiatrists and psychologists, had a role
to play in combating the mental illness known as war.”
II:
Kaufmann and colleagues
On
the German military psychiatrists and their ideas and
methods, especially Fritz Kaufmann and his electric
disciplinary method. “Kaufmann’s main concern was to
spare the state as many pension payments as possible,
which meant that patients must be made to recover by
whatever means it took. The end result Kaufmann had in
mind was therefore not necessarily the restoration of a
man’s fitness for war service. If anything that was a
higher level of recovery. He was certainly in favour of
initial attempts to ‘cure’ men as close as possible to
the front – which was still regarded as having a
curative effect – and of keeping them as far away as
possible from their homeland, where they would be
embraced by their wives and families and have their
perception of themselves as ill reinforced. A return to
front-line service was therefore the primary aim, but
once a soldier had been taken further back behind the
lines to the point where Kaufmann would treat him,
efforts would have to be concentrated on making him fit
to re-enter society. He must recover sufficiently to be
able to support the war effort as a factory worker. It
was of course unfortunate that most patients preferred
this solution to a return to the front, but nothing
could be done about that.”
III: The Allies
On
the Allied psychiatrists such as W.H.R. Rivers, Lewis
Yealland or Joseph Babinski, often using means anything
but more humane than those of the Central power
psychiatrists, and those who did, such as Rivers, knew
as well that the outcome should be: back to the front.
“Discussion among French psychiatrists and neurologists
primarily concerned measures that might prevent
malingering. The policy was threefold: isolation,
surveillance and therapy. The psychosomatic sequence of
‘shock, emotion, suggestion, exaggeration, simulation
and progression’ had to be cut short. Céline wrote in
Voyage au Bout de la Nuit: ‘Professor
Bestombes, our medical major with the beautiful eyes,
had installed a complicated assortment of gleaming
electrical contraptions which periodically pumped us
full of shocks. He claimed they had a tonic effect. ...
“That, Bardamu, is how I mean to treat my patients,
electricity for the body, and for the mind massive doses
of patriotic ethics, injections as it were of
invigorating morality!”’”
IV:
Discipline versus analysis
On the already mentioned difference in method, but not
in outcome strived for, between the harsh disciplinary
methods and the more humane – officers’only – analytic
methods used by Rivers and others like him, and on the
measures taken against those who did not comply. “It
is certainly the case that psychiatrists, neurologists
and psychologists who showed ‘too much’ compassion for
the individual soldier were not making life any easier
for themselves. Lieutenant Kirkwood examined the 11th
Border Regiment 97th Infantry Battalion one
week after the start of the Battle of the Somme and
concluded that a large proportion of the men were not
fit for duty because they were suffering from shell
shock of one form or another. He was relieved of his
position. H.W. Hills acquired a reputation for being too
kind-hearted and received an order from higher up not to
send so many patients to the base hospitals. He had to
be reminded that, given the shortage of manpower, it was
not his task to heal his patients but to get them back
to the battlefield as quickly as possible.”
In summary: the character of military medicine
On
the system of military medicine being more important
than the individual doctors and nurses. “We should ask
how free doctors were to choose their own path. Once we
question whether, under the circumstances, the doctors
could have acted in fundamentally different ways than
they did, we begin to see how little choice they had.
Even had they wanted to, there was a limit to the degree
to which they could have treated their patients
sympathetically. During his service as a military
doctor, the famous psychologist Alfred Adler was all too
well aware of the consequences of declaring a soldier
healthy, in fact he was haunted by nightmares about
soldiers he had returned to the front. But he could not
have acted any differently. His function as a doctor in
wartime, in the service of the War Ministry, did not
allow him to act in any other way. Belgian doctor Armand
Colard came to the same conclusion. He regretted for the
rest of his life every occasion on which he had handed
over to the military court a soldier who was simulating
illness, but there had been no other option open to
him.”
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Before My Helpless Sight |
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Chapter 5 Death on the Western Front
Introduction
Killing and being killed
On
war and what it is about above all: killing and being
killed and on the way Death showed itself. “Death in the
trenches and on the battlefield was rarely a matter of
personal choice as to a certain degree it had been in
earlier wars, and still was in that anachronism of the
First World War, the desert battle. Technology had
defeated human will and courage. A man was rarely killed
because he faced a mentally and physically superior
opponent. Death did not come from close by but from far
away. A man did not look death in the eye; it was a
great unknown far beyond the horizon. You could hardly
ever choose death. It chose you. Death had become
impersonal, and hideous.”
Death
outside of battle
I: ‘Ordinary’ losses
On death in times when all was quiet on the Western
Front. “Whole companies were virtually wiped out in
periods when they were required merely to hold the line,
with no significant fighting at all. At Ypres alone on
such days the British might suffer 300 deaths. Augustin
Cochin, a French officer, spent five days in the
trenches at the Mort Homme in April 1916, of which ‘the
last two days soaked in icy mud, under terrible
bombardment, without any shelter other than the
narrowness of the trench.’ He had arrived there with 175
men; he left with thirty-four, ‘several half mad … not
replying any more when I spoke to them’.”
II: Accidents and
snipers
On death when feeling save, caused by snipers or
accidents. “The frequency of accidents was partly a
result of the unrelieved stress of life in the trenches,
stress rarely punctuated by the excitement of battle but
exacerbated by long periods of inactivity and boredom.
Men knew they had to be vigilant at all times, but no
one could remain alert for days, weeks, months on end.
The unremitting tension, along with the continual
handling of explosives that made the hazards seem
ordinary, led to carelessness in place of caution.
Graves writes of a man who threw a percussion bomb but
aimed too low. The bomb hit the edge of the breastwork
instead of going over it, blasted back and killed him. A
sergeant decided to demonstrate how dangerous a
percussion grenade could be, a demonstration that could
not have been more vivid. He rapped the edge of a table
with it, killing himself and the man standing next to
him instantly.
Twelve others were wounded, several seriously.”
III: Prisoners of war
On the deaths in prisoner of war camps and on the
question if, in spoite of thweae deaths, POW’s are
actually causalties of war. “Arthur Osburn, medical
officer with the 4th Dragoon Guards and
author of Unwilling Passenger gave the term
‘prisoner of war’ a different interpretation, as did
Louis Barthas, Andreas Latzko and others: not those who
had surrendered but those still on active service at the
front line were prisoners, Osburn said. They were
‘prisoners of the war’. In a conversation with Stefan
Zweig, Rainer Maria Rilke went even further. The war
itself was a prison. It kept everyone within its walls,
soldiers and civilians alike. Few will have given much
thought to these alternative meanings of the term, but
the fact remains that there were many, if always a
minority, to whom the idea of safety in a prisoner of
war camp seemed inviting. The notion of ‘voluntary
capture’ is a myth, and one that made many prisoners of
war furious, but it is a myth with some basis in truth.
Soldiers preferred to be prisoners of war than to fight
on in the face of almost certain death. Unless they were
convinced they would be mistreated or executed on the
spot, surrender represented an alternative to futile
combat.”
IV: Friendly fire
On the deaths killed by fire from own troops,
euphemistically called friendly fire. “Both Robert
Graves and Edmund Blunden regularly mention incidents of
friendly fire. Graves even describes one engagement in
which more British soldiers were killed by the British
army than by the Germans. The German 49th
Field Artillery Regiment was commonly referred to as the
48.5th because other regiments said that the
shells they fired more often than not fell short. Ernst
Jünger and his comrades once found themselves under fire
from German artillery whose range was set short. The
gunners did not stop firing despite being quickly
informed and before long the trench looked like a
butcher’s shop, with bloodstains everywhere, and pieces
of brain and flesh on which swarms of flies settled.
V: Death by execution
On the men shot at dawn, for the sake of example, a
practice especially popular amongst the French and
certainly relatively speaking even more the British
troops and on the questionable role medical officers
played. “Sidney Chaplin, who was a military policeman at
the time, sitting on horseback on a nearby hill, gave an
impression of how the British executed their soldiers.
‘I saw the man brought out to the post and the firing
squad march into position, turn right and take up stand.
I heard the report as they fired and saw the smoke from
their rifles. Then they turned and marched off. The
officer, with revolver in hand, inspected the body, then
turned away. The dead man was then taken away in a
blanket and buried in the small cemetery in the next
field. It was over. I came down, but it did not seem
real. The next one followed the same pattern, except the
Assistant Provost Marshal said, “Cowardice” – and the
man said, “Never!” They were shot by men from their own
units, in front of comrades forced to attend, only a few
hours after they had been told their sentences would not
be commuted. Twelve men were chosen, by drawing lots, to
form a firing squad. Each was given a rifle, some loaded
only with blanks so that any one of the twelve could
convince himself if he so wished that he had not been
responsible for the death of his brother in arms.”
Death in
battle
I: Bayonet and barbed
wire
On the deaths inflicted by an antagonism and a feature
of trench warfare. “We should bear in mind that the
bayonet often claimed its victims indirectly. One of the
reasons why bayoneting was such a prominent feature of
training, despite the lack of opportunities to use the
weapon as originally intended, was that it nourished the
spirit of attack. With bayonets fixed, troops were more
inclined to attack than to seek cover. Most soldiers
seem to have been aware of this. They were keen to fix
bayonets because doing so symbolized what they felt war
ought to be: a personal encounter with an opponent, from
which, after a fair fight, the stronger man emerged
victorious. […]There are innumerable stories of soldiers
caught in barbed-wire entanglements being shot to pieces
by machine-gun fire. Ypres, the Somme, Verdun:
everywhere men became ensnared in the many coils of
wire, ripping their flesh to shreds in hopeless attempts
to free themselves, efforts that often served only to
entangle them further. Gaps a few metres deep blasted
into the wire were no answer.
They
were a fatal trap.”
II: The trench raid
On the trench raid, the ideal way for soldiers to commit
suicide without ever being found out, since anyone who
volunteered to take part had a good chance of not coming
back. “Edmund Blunden states this repeatedly in his
book. ‘The word ‘raid’ may be defined as the one in the
whole vocabulary of the war which instantly caused a
sinking feeling in the stomach of ordinary mortals. … I
do not know what opinion prevailed among other
battalions, but I can say that our greatest distress at
this period was due to that short and dry word “raid”.’”
III: Artillery, the
great destroyer
On the main feature of World War I-warfare, not the
machine gun, not poison gas, but artillery, responsible
for about 90 percent of all the deaths. “Estimates of
the average number of shells and mortars the infantry
needed to fire to kill one man – not including those
aimed at earthworks and barbed wire rather than into the
trenches or at strongpoints and advancing troops – range
from several dozen to hundreds, even over a thousand. No
matter which figure is the more accurate, the fact that
the majority of the millions killed were victims of
artillery fire is a reminder of the enormous quantity of
explosives fired between August 1914 and November 1918.
A single shell did not usually kill a large number of
men, but collectively they did, mostly in a gruesome
manner, occasionally very cleanly indeed. Frank Richards
penetrated a machine-gun nest and found eighteen dead
Germans, all without a scratch. A shell had burst
directly above them and they had been killed by the
blast.”
IV: The offensive
On the most costly part of warfare in World War I: the
offensive, against an almost always superior defense. “Men
prayed, they pooled their money so it could be shared
out among the survivors, they exchanged addresses so
that relatives could if necessary be notified by one of
their own instead of by an official letter. Rum rations
were issued. Then came the order to prepare for the
attack. One foot was placed up against the side of the
trench, bayonets were fixed and rifles held at the
ready. Men waited for the signal to clamber up over the
parapet and run forward, or walk, or stumble. The
tension rose. Many carried what might be their last
letter home in their uniform pockets, so that it could
be sent posthumously if need be. The barrage became even
heavier. Everyone knew he would be exposing his entire
body to machine-gun fire. Sweat broke out. Hands shook.
It was almost impossible to keep one’s nerve. Men felt
sick, but often they had nothing in their stomachs to
bring up, partly because nerves had given them
diarrhoea. Their heartbeats seemed to keep pace with the
rattle of the machine-guns. They could feel their blood
race. No one knew how far he would get before being
hit.”
Meetings with Death
I: Individuals
On the way Death presented itself to and through
individuals, making men senseless towards the dead, but
occasionally taking care for a change of heart. “Death’s
work could be seen everywhere, and in some sense he
became visible himself; he sat next to you in the trench
and walked beside you on the battlefield. He lay next to
you in hospital. He was such an overwhelming presence
that the boundary between death and life faded.
Siegfried Sassoon saw the dead and living next to each
other in the trenches and could no longer tell which was
which, ‘for death was in all our hearts’. […] One day
Toller was standing in a trench, hacking at the earth
with a pick. ‘The steel point sticks, I yank and pull it
out with a jerk. Hanging from it is a slimy knot and
whichever way I look at it, I see human entrails. A dead
man is buried here. A – dead – man. What makes me pause?
Why do these words force me to stand still, why do they
press upon my brain like a vice, why do they close up my
throat and freeze my heart? Three words like any other
three. A dead man – ultimately I want to forget these
three words. What is it about these words? Why do they
overpower and overwhelm me? A – dead – man. And
suddenly, like darkness splitting itself from light, the
word splits from its meaning and I grasp the simple
truth of Man, which I had forgotten, which was buried
and covered over; the oneness, the unity, the uniting. A
dead man. Not: a dead Frenchman. Not: a dead German. A
dead man. All these dead are men, all these corpses have
breathed as I do, all these dead had a father, a mother,
wives whom they loved, a piece of land where they put
down roots, faces that told of their joys and
sufferings, eyes that saw the light and the sky.’”
II: The battlefield
On the field of battle after Death had used his scythe
without distinction, mowing soldiers down in vast
numbers leaving a landscape only Death himself could
enjoy. “The
aftermath of a battle was a desolate, deathly sight.
Hoffman described it as the most pitiful place on earth.
To Stanhope Walker, the landscape after a battle was an
‘absolute scene of destruction, miles and miles of
country battered beyond all possible recognition’,
demonstrating the enormity of contemporary warfare.
Blunden spoke of the Schwaben Redoubt as a web of
trenches in which ‘mud, and death, and life were much
the same thing’. Seeing dead men strewn all about him,
he concluded ‘the whole zone was a corpse’. Death had
done his work and could take a rest; he had wreaked
havoc on the field of honour and the field now belonged
to him, or perhaps more accurately, as Blunden
suggested, death and the battlefield had become one.”
Burial in wartime
I:
Bodies in hospital
On burial of corpses died in a hospital. “Chaplain John
Michael
Stanhope Walker had to bury 900 men in three months at
his own CCS alone. Little wonder that he regarded the
‘moribund ward’ as the most depressing place he knew.
‘Two large tents laced together packed with dying
officers and men, here they lie given up as hopeless, of
course they do not know it.’ Georges Duhamel would have
recognized the scene had he read Stanhope Walker’s
account. He wrote in similar terms about the hospital
outbuildings, often more than one, that were used as
mortuaries. The dead lay there ‘side by side, their feet
together, their hands crossed on their breasts, when
indeed they still possessed hands and feet’. Sometimes,
despite the heavy medical workload, there was time to
give a man a fairly decent funeral, although the
ceremony was never lengthy. ‘The burial-ground is near.
About a dozen of us follow the lantern, slipping in the
mud, and stumbling over the graves. Here we are at the
wall, and here is the long ditch, always open, which
every day is prolonged a little to the right, and filled
in a little to the left.’”
II: Burial parties
On perhaps the most gruesome of all jobs: burying the
dead who had lain in No Man’s Land for days or even
weeks. “After the war Ferdinand Bringolf committed his
memories of burial parties to paper under the title
Das Grauen (The Horror). Bringolf and several other
young German soldiers had to clear the market square at
Wytschaete near Ypres at midnight after the battle
fought there in November 1914. In despair he dug pit
after pit while his comrades dragged corpse after corpse
towards him. Always two of them, one dead and one
living, and Bringolf did not know ‘who felt colder. And
always the first spadeful of earth fell onto the
disfigured, once human face, always the second onto the
clenched hands, until gradually what had once been a
human being disappeared under lumps of earth – it was
November after all. They brought a young, handsome
captain with soft feminine hands as if made of wax, and
with a Henry IV beard on his interesting pale face –
what a shame that he’d lost the top half of his skull
somewhere!’”
III: No peace, no
rest
On the fact that also the dead once buried where not
allocated a final resting place, but washed free by the
pouring rains or dug up again by exploding shell.
“Lance-Corporal Ken Lovell lay in hospital troubled by
his promise to tell a man’s parents exactly how he had
died. He particularly dreaded them asking him where
their son was buried. ‘We’d buried him all right, a few
yards behind our position in the wood, with a rifle
plunged into the earth to mark the grave and his tin hat
on top of it. But by the next morning it had entirely
disappeared.’ German NCO Carl Heller remembered a
neatly maintained German cemetery. When he visited it
again at the end of the war ‘it was recognizable only by
a few splintered crosses and bleached bones sticking
half out of the ground here and there’.”
IV: Too many dead
On
the simple but awful truth that a decent burial, however
important out of a military as well as a humanitarian
point of view, was simply impossible because of the
enormous amount of dead. “If we are to believe Captain
De Lécluse, enemy dead were sometimes deliberately left
on the battlefield as a warning to their comrades. If
they were buried at all, then the bodies were thrown
into hastily dug mass graves with crude wooden crosses
on top. The survivors had their hands full bringing in
the wounded and could not make time for even a rapid,
provisional burial. The bodies that lay on the
battlefield for days, weeks, even months, were yet
another visible sign that the image of a romantic war so
many soldiers had in mind at the start of the conflict
bore no relation to the reality. Ernst Jünger admitted
he had never imagined ‘that in this war the dead would
be left month after month to the mercy of wind and
weather, as once the bodies on the gallows were’.”
Afterword
'There is in our lives a wound which
will never heal. Nor should it.'
On the remembrance and commemoration of all the grieve
the War had brought, including the most heart breaking
piece of art it has given us, the statue of the Grieving
Parents made by Käthe Kollwitz. “In
one graveyard […] post-war suffering, civilian
suffering, is starkly evident. In Germany after the war,
a small group of leftwing intellectuals fiercely opposed
the soldier cult, with its veneration of youth and
glorification of death. Toller and others set out to
‘deheroicize’ death. They campaigned against the idea
that death was something a man should long for on the
grounds that the death of an individual meant the
community would live, saying that sacrifice on the
‘altar of the fatherland’ was not heroic, it was
senseless. Käthe Kollwitz, whose eighteen-year-old son
Peter had been killed in the Battle of the Yser at the
beginning of the war, was receptive to their protest. In
those early months she had still been in thrall to the
glorification of youth and was therefore quite unlike
the anti-war militant she later became. Yet even before
her son was killed she had begun to have doubts that
verged on abhorrence. Her personal loss increased those
doubts: ‘There is in our lives a wound which will
never heal. Nor should it.’
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Leo van Bergen -
Before My Helpless Sight
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About
the author
Dr Leo van Bergen is a medical historian working at the
Vrije Universiteit Medical Centre in Amsterdam, The
Netherlands. His main focus is on the relationship between
war and medicine. Dr van Bergen is a member of the
editorial board of Medicine, Conflict and Survival. Prize:
Awarded the 'Dr. J.A. Verdoorn-award' for excellent
scientific work on the topic of medicine and war 2009. |
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Review: Before My
Helpless Sight
by Mark Harrison -
University of Oxford - in Medical History. 2010 July;
54(3): 411–412
Before my
helpless sight is “a book about soldiers as victims”
(p. 215) rather than a military or medical history in any
conventional sense. It tells us very little about generals
or other senior officers, and the work of the military
medical services is tangential to the main story, which is
about the soldier as patient and invalid. From an
historiographical point of view, this book has, therefore,
much in common with a genre of literature on the First
World War (primarily the Western Front) that focuses upon
the experience of soldiers. This has encompassed studies
of wartime literature and painting as well as the
day-to-day trials of soldiers in the trenches or during
battle, being typified by works such as Paul Fussell’s The
Great War and modern memory (London, 1975), John Ellis’s
Eye-deep in hell (London, 1976), and Stéphane
Audoin-Rouzeau’s Men at war, 1914–1918 (Providence, 1992).
From a specifically medical point of view, its
closest stable-mates are Joanna Bourke’s Dismembering the
male (Chicago, 1996) and some of the work on “shell shock”
which has dwelt on the soldier’s experience of the
condition and its treatment: for example, Peter Barham’s
Forgotten lunatics of the Great War (New Haven, 2004). It
shares with these histories great tenderness and sympathy
towards the plight of the men who fought the war and of
their civilian victims. As far as possible, it attempts to
see the horrors of the Western Front through their own
eyes. Readers may not be surprised by much of what they
read here but some of the material—especially the book’s
unusually graphic depictions of the casualties of
war—still has the capacity to shock.
The book is,
however, quite distinctive in the stance which the author
takes against war of any kind. The conflict on the Western
Front—the mud, the seemingly pointless assaults, and the
first use of weapons such as gas—often stands as the
epitome of senseless slaughter. Millions died for a cause
which most of us now fail to understand or have little
sympathy with. In this sense, our memory of the war of
1914–18 is very different to our memory of the war of
1939–45, which, despite its many victims, is often
remembered as a great patriotic war or at least a cause
worth fighting for. Van Bergen’s uncompromising pacifist
stance gives this book an edge which other books covering
similar subject matter lack. His theme is not so much the
horror of the Western Front but of war in general.
Before my
helpless sight focuses exclusively upon the Western
Front but it draws upon a wide range of literature in
English, French, Dutch, Flemish and German. In this sense,
it has few parallels among works which examine medicine
and medically related topics, and is an extremely useful
work of reference in consequence. Readers will gain an
overview of how the “disposal” of casualties differed in
the armies of the various combatant nations, even though
it is not the author’s main intention to analyse this from
a comparative perspective.
In view of the paucity of general
accounts of medicine in the First World War, the
advantages of the broad brush-stroke inevitably outweigh
its disadvantages in this case. But the author tends to
make generalizations on the basis of texts which are not
necessarily representative. A certain amount of distortion
and lack of nuance is the inevitable result, although van
Bergen generally tries to be even handed. For instance,
the author asserts (p. 286) that “the medical profession
was powerless” to do much for the enormous number of
casualties that passed through medical units on the
Western Front and that “no amount of organization could
resolve all the problems that inevitably arose” (p. 288).
This was, of course, true and the treatment provided was
often inadequate.
However, such statements ignore
that fact that medical arrangements did not break down, as
they did in previous conflicts such as the South African
and Crimean Wars, and that specialized centres of
treatment became increasingly adept at treating even
complex injuries. Death rates in front-line medical units
fell in the last two years of the war (despite the comment
made to the contrary on p. 327) and an impressive
percentage of men were returned to duty of some sort. Van
Bergen does not pay sufficient attention to how medical
arrangements evolved over the period of the campaign on
the Western Front and how they coped, for example, with
the resumption of more mobile warfare from the spring of
1918.
Another questionable assertion made
in the book is that practising medicine under wartime
conditions necessarily rendered doctors “numb” and
“insensitive” (p. 291); the reality was often a good deal
more complex and one would need to differentiate between
doctors working with regiments (where they were “part of
the family”, so to speak) and those at units some distance
from the front. It is also problematic to write of the
“motivation” of doctors (p. 361) for these and other
reasons.
Yet, these quibbles ought not to
detract from what is, by any standards, a major
achievement and a landmark in the medical historiography
of the Great War.
Review: Before My
Helpless Sight
Review by John E. Talbott,
University of California, Santa Barbara.
H-France Review
Vol. 11 (March 2011), No. 76 (read
more...)
Review: Before My
Helpless Sight
by
Victor
W. Sidel, MD - Distinguished
University Professor of Social Medicine
- Montefiore Medical Center and Albert Einstein
College of Medicine - Bronx, New
York
Leo van Bergens book, Before
My Helpless Sight, is an extraordinary achievement on at
least three levels. First, the book provides an
invaluable trove of information on the history of war
and on the history of medicine. Richly footnoted and
indexed, with an extensive bibliography, it will be an
important source of information for future historians
and analysts of the role of the healing arts in relation
to armed conflict.
Second, the book presents a moving description of the
Great War, supported by 20 remarkable illustrations.
Rarely has there appeared such a readable narrative on
the heroic and tragic ways in which a war was fought and
the dedicated yet at times inept ways in which medical
workers attempted to tend the dying and treat the
wounded.
Third, and most importantly, the book holds clear
lessons for our own times. The policy mistakes in the
planning and the execution of the war, the military
mistakes in strategy and tactics, and the medical
mistakes in triage and treatment during the Awar to end
all wars must be remembered or they will undoubtedly be
repeated in future wars. The descriptions of the
dysfunctional and shameful ways in which combatants were
sent into battle and of the suffering not only through
physical wounds but also through what was then called
shell shock and is now called post-traumatic stress
syndrome, are directly relevant to the discussions of
current wars in Iraq and Afghanistan.
This book is the most recent example of a long tradition
of work in the Netherlands on medicine and its
relationship to war, a field known as medical polemology.
One of the leaders of this field of study and action was
Dr. J.A. Verdoorn, whose pathbreaking book, Arts en
Oorlog (Medicine and War) awakened many military and
medical policy makers to the folly of modern warfare.
The establishment of the Dutch Medical Association for
Peace Research (NVMP), the affiliate of the
International Physicians for the Prevention of Nuclear
War in the Netherlands, has supported and strengthened
this work.
English language readers, including members of Medact
and readers of Medicine Conflict and Survival, will have
access to this invaluable book because of the clear and
evocative writing of the author and the excellent
translation into English by Liz Waters. This book is an
important contribution to an understanding of medical
consequences of war and a much-needed contribution to
the prevention of future wars.
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Leo van Bergen -
Before My Helpless Sight
Review
in the Journal of Military
History, Vol 74, No 1, January
2010 (read
more...)
Review: Before My
Helpless Sight
by Carol Acton, St Jerome’s, University of Waterloo,
Ontario, Canada
(Wilfred
Owen Association Journal 2009 Issue 2.)
Leo
Van Bergen in Before My Helpless Sight uses the
concept of witness in Wilfred Owen’s famous line along
with Owen’s desire to make public photographs of the dead
and maimed, to ser the approach and tone of his book,
first published in 1999 and now issued in translation with
revisions. Focusing on the combatant experience in the
context of more technical aspects of the war, Van Bergen
brings together a large range of sources to examine the
brutality of life for French, British and German soldiers
on the Western Front.
The
first chapter, ‘Battle’, sets the approach for the rest of
the book, weaving together the technical aspects of the
war and the individual experience of officers and men.
Subsequent chapters treat salient aspects of the trench
experience under the headings ‘Body’, ‘Mind’, ‘Aid’ and
‘Death’, with a long introduction outlining the war
experience overall and the main critical-historical and
primary s
ources Van Bergen draws on throughout the text.
His ironic point is made in the introduction where
he brings together what he sees as the two representative
technologies common to European culture that defined the
conduct of the war: ‘The machine-gun and the scalpel
exemplified the fact that all those developments that had
been such a boon to humanity in the preceding century
[...] could be used in pursuit of total destruction’(p.
33).
Van Bergen brings together a large range of
sources to create a very readable and useful discussion of
the war primarily from the perspective of the combatant.
As he notes in his introduction, rather than setting out
to do anything new, his work is ‘an attempt to bring
together [...] all the diffuse knowledge available in
primary and secondary literature on the subject of war’(p.
1). However, the strength of such an approach can also be
seen as its weakness. On the one hand, this tactic
is particularly successful in showing how similar the
individual experience of the French, German and British
soldier was, and, in an afterword, how that experience was
used in radically different ways by post war French,
British and German governments in their remembrances of
the war. It also gives the reader an enormously
comprehensive and detailed sense of the combatant
experience.
However, drawing on already available
sources means that there is no questioning of the way the
war has been portrayed over the past 20 or so years prior
to 1999 when the book was first published. Thus, for
example, although the chapter on ‘Aid’ provides a strong
and useful technical account of the treatment of
casualties and does include some direct quotations by
doctors and nurses, the lack of recourse to primary
archival material limits the perspective, since with a
very few exceptions, Van Bergen confines his quotations to
those used in other accounts.
This allows for a
certain negative slant towards medical personnel which
underplays the dedication to their work and concern for
the wounded combatant evident in multiple diaries, letters
and memoirs both by medical personnel and the soldiers in
their care, and overplays the sense of the system as
inconsiderate of the needs of the soldier.
Problematically, relying on established sources can mean
the repeat of the particular agenda of those sources,
which is not always offset by the range of material Van
Bergen draws on. In addition, there is some repetition in
in chapters so that the topics of illness and
psychological breakdown are discussed both in the chapters
on ‘Body’ and ‘Mind’ and in the chapter on ‘Aid’.
In
spite of the repetition and the problems inherent in
relying almost entirety on previous work that is a
consequence of this approach, the book is a very useful
detailed and thorough examination of the combatants
experience on the Western Front, particularly valuable as
a starting point for anyone looking for a desriptive
rather than analytical text.
The accumulation of
detail, both in statistics and specifics of the soldiers’
lives allows for a moving portrayal of of the combatant
lot. Thus, for example, with the recent 2009
commemorations of D-Day still in mind, Van Bergen’s
comments on the Batlle of Loos in the chapter ‘Battle’
reminds us of the massive casualties of the First
WorldWar: ‘[w]ithin the first two hours, on the British
side alone, more soldiers died than there were lost on all
sides on D-Day, 6 June 1944’ (p. 67). This book-offers the
immediate narrative of those casualties and the millions
of others like them.
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Leo van Bergen -
Before My Helpless Sight
Review:
Before My Helpless Sight
by Ian Whitehead University of Derby published in The
Social History of Medicine 12-11-2009 pp. 620-622
Leo van Bergen examines the journey of First World War
soldiers, from the moment of embarkation, through the
experience of sickness, wounding and medical aid to the
possibility of burial—whether alive or dead. The
physical and mental traumas of the battlefield are the
focus, conveying a profound sense of human suffering in
warfare, which van Bergen sees as ‘illustrative of the
horrors confronted by all those exposed to war’ (p. 29).
He hopes to free the dead and wounded from the confines
of cold casualty statistics, thus reminding us of their
centrality to any understanding of the war. Chapter one,
‘Battle’, highlights the impact of technological change
on the conduct of warfare. Science and industry
conspired to produce unprecedented slaughter on the
battlefields of the Western Front. For the troops, ‘two
weapons and one instrument came to typify the Great War:
the heavy guns deployed by the artillery, the
machine-guns carried by the infantry, and the surgeons’
scalpel' (pp. 32–3). Medical science provided a repair
service for the wounded, re-fitting them as cogs in the
machinery of battle.
Chapter two, ‘Body’, describes the challenges of
physical endurance posed by trench life. It details the
burdens of a soldier's daily existence and the common
diseases that afflicted the troops, examining attempts
to contain epidemics through the implementation of
preventive measures. It explores the impact of warfare
on a soldier's sex drive, highlighting the moral,
disciplinary and medical issues involved in controlling
sexual conduct and minimising the incidence of venereal
diseases. The harsh realities of life at the front
placed an immense strain on the mind and nerves of the
soldier, providing the subject of the third chapter,
‘Mind’. Shell-shock was a problematic term, both
medically and militarily, but it gained an unstoppable
currency as an umbrella term for describing the strains
of warfare on the human mind. Aside from its potential
to encourage misdiagnosis of war neuroses, much of the
opposition to shell-shock arose from fears that it made
mental collapse in battle a respectable war injury. Not
only might this have negative consequences for the
maintenance of discipline and morale, it threatened to
cost large sums in terms of war pensions. The position
was complicated by moral prejudices, in which many of
the men presenting with hysterical conditions were
looked upon as having failed the manly test of war.
Psychological casualties were regarded with suspicion,
received little sympathy and were subjected to painful
treatments, which were thought likely to overcome the
symptoms and revive the fighting spirit. Class
distinctions were apparent in the treatment of mental
illness. Officers were much more likely to be diagnosed
as neurasthenics, thus sparing the upper classes the
shame of moral failure and the brutalities of the
treatment room.
The wider difficulties of treating the sick and wounded
are set out in the fourth chapter, ‘Aid’, which looks at
how the military medical services responded to the
challenge of treating unexpected numbers of sick and
wounded. Modern medical knowledge enabled men with
grossly mutilated bodies to survive their injuries,
whilst nascent plastic surgery sought to rebuild men's
bodies. The recipients of these treatments were the
dubious beneficiaries of medical experimentation, and,
as van Bergen illustrates, many would rather have died
than live out the painful life of disability and
disfigurement, which was the legacy of medical
intervention.
Occasionally, van Bergen seems a little harsh in his
judgements of the medical profession, given the
pressures it faced, whilst his focus on suffering
inevitably distracts us from some of the positive
achievements of medicine on the Western Front. However,
he correctly highlights the extent to which medical
treatment was driven by military imperatives. Whether
and when a man received medical treatment depended on
his potential to be returned to military fitness. The
efficiency with which the medical services undertook
their role made them a crucial factor in sustaining the
long years of war, thus causing much debate about the
implications for medical ethics.
In the final chapter, ‘Death’, van Bergen examines
experiences of dying and killing. He highlights that not
only were the chances of dying higher than in earlier
conflicts, but the nature of modern warfare meant that
death could occur anywhere at any time. The random
nature of the killing ‘meant that the front was
synonymous with death’ (p. 411), despite the fact that
more men survived the battles than the number who were
killed. Death itself did not necessarily deliver peace
from the conflict; many of the men were buried in
shallow graves, which became exposed, either due to the
weather or the impact of explosions. Their decomposing
bodies were part of the devastated scenery of the
battlefield, witness to which created an inevitable gulf
between those who only read about the war, and those who
had experienced it at first hand. As van Bergen writes,
‘[t]he conditions of war are impossible for anyone who
has not experienced them first hand to comprehend’ (p.
473).
In his opening sentence, Van Bergen states that the book
‘is not the result of weeks or months spent in dark
bunkers and damp cellars, leafing through old documents
page by mildewed page’. Instead, he intends to
encapsulate, in one volume, knowledge of the casualties
and their medical treatment, from British, Dutch, French
and German publications. Certainly, by placing his prime
focus on the suffering of the individual casualties, he
provides a different approach to that found in many
other books on the war. Across the boundaries of the
belligerent nations, he shows the commonality of the
soldiers' experiences of combat, sickness, wounding and
death. The casualties emerge not as mere consequences of
battle, but as the essential agents of warfare. On the
other hand, van Bergen's approach does mean that readers
familiar with the history of the First World War in
general, or specifically of medicine and the war, will
find little that is new to them in the many pages of his
book. Moreover, given his aim of diffusing existing
knowledge, he tends to draw upon a disappointingly
narrow range of sources and opinions.
Nevertheless, the book serves as a powerful reminder of
the terrible human suffering endured, both during and
after the war, by those who bore the physical, mental
and emotional scars of the conflict. Van Bergen leaves
the reader with an overwhelming sense of the human
tragedy inflicted by industrialised warfare and mass
killing.
Review: Before My Helpless Sight
by
Christopher Albon (hhtp://conflicthealth.com)
Leo van Bergen’s book, Before
My Helpless Sight, is a history of suffering in World
War I, a description the author readily admits: “At the
roots of the book lies the question of what can happen
to a soldier between the moment he steps onto a train or
ship bound for the theatre of battle an the point at
which he is evacuated wounded, or whether dead or alive,
buried in the ground” (pg. 1). Needless to say, the book
is not a light read.
Read more.......
Review: Before My Helpless Sight
by
A.W. Purdue
(www.timeshighereducation.co.uk)
The First World War
gave war a bad name and, as the rather chilling title of
this book forewarns, Leo van Bergen is keen to tell us
why in grisly detail. No doubt a stroll around the
battlefields of Agincourt or Flodden immediately after
opposing armies clashed would have been grisly, but the
total war on the Western Front was characterised by its
industrial scale, the huge numbers involved and its
perseverance with no breaks for the seasons or the
harvests. The industrial image of the conflict is
brought home not just by the machinery of war, the
artillery, barbed wire, gas and the tank, but by van
Bergen's concept of hospitals for the wounded as repair
factories, putting men together again so that they could
go back into action.
Read more.......
WFA
East Coast Chapter - Books on medical care
...
I highly recommend this book to all
who are students of that war and the wars of
today because the real horrors of war
are not on the battlefield but in the aide
stations and hospitals then as now.
Read more.......
Before my
Helpless Sight - an excellent work
by Onne Eling (www.amazon.co.uk)
Drawing from sources in four
different languages the Dutch medical and military
historian Leo van Bergen has written an excellent work
on the wounds and diseases ravaging the World War I
soldier at both sides of the front, and the aid he did
or did not receive. He paints a rather grim picture of
medical care, more driven by military and political
arguments than humanitarian and closes with a chapter on
the encounters with Death and the (impossibility of)
burying following such encounters. Before my Helpless
Sight - a line from Owen's poem Dulce et Decorum but
also referring to Kollwitz's statue of the Grieving
Parents shown on the cover - is beautifully written,
beautifully composed and - of course - horrible in
content. It makes it a `must have' for all interested in
topics of war and medicine especially of course World
War I.
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Leo van Bergen -
Before My Helpless Sight
This book is definitely
worth the reading Reviewed
by Jolie Velasquez - St. Mihiel Trip Wire.The online
newsletter of the Great war Society, April 2011
More than one historian has voiced
the opinion that fiction is the best way to express the
true horrors of war. Perhaps they envy the resonance that
anti-war classics like Johnny Got His Gun has had compared
to the short attention that even the best historical
studies get from the public. Dr. van Bergen's work could
perhaps be the ultimate non-fiction war deterrent if
enough people could overcome their queasiness upon reading
the subtitle.
After a fairly
crisp chronological summary of the war and the technical
developments that led to new kinds of injuries, van Bergen
(a medical historian) divides the content into sections on
the physical consequences of combat, effects on the mental
health of those involved, the techniques used to treat the
afflicted, and then the problem of dealing with the
ultimate sacrifice made by the dead. Using a massive
amount of statistics and medical information, the author
gives the reader the entire scope of medical needs and
practices that took place at and behind the lines.
Remarkably, we learn that even though
great strides in medicine had taken place by 1914, such as
the initial survival rate for bullet wound casualties, the
fight against infection was little better than in
America's Civil War. Childhood illnesses, relatively minor
injuries, and nutritional deprivation were all exacerbated
by the environment of the trenches. (Not being able to
change one's socks could lead to gangrene.) And the
advances in artillery resulted in bodily injuries far
surpassing the damage expected from more personal forms of
combat and in numbers that outstripped any other kind of
casualty. Doctors were often forced to experiment with
unorthodox treatments to keep their patients alive.
Perhaps the best section is on the
treatment of mental disorders, which they called shell
shock. The general attitude of military doctors was often
dismissive and skeptical of non-physical injuries.
Affected soldiers were considered shirkers or worse,
facing punishment as often as treatment. The influx of
psychologists from civilian practice into the services
changed the tenor, but the discipline was so new that
effective methods were rare. The new doctors also fought
again the practice of "fixing" the soldiers so they could
be sent back into battle as soon as possible.
The exhaustive descriptions of even
simple physical discomforts would be numbing or dry after
time, but van Bergen intersperses his text with excerpts
from the diaries, memoirs and letters, of people on both
sides of No Man's Land. Soldiers, doctors, care-givers,
and civilians offer their poignant memories and make the
personal connection so necessary to complete the
experience. Van Bergen's pacing allows one to move
smoothly through almost 500 pages of text, some gruesome
illustrations, and casualty tables that can leave one
staggered. If one can take the subject, this book is
definitely worth the reading.
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Leo van Bergen -
Before My Helpless Sight |
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