When it was all over, the story of the tank came under objective scrutiny. It had not been the machine that had won the war, but it had certainly helped. The question was widely asked, who had invented the tank? The public wanted to know and there was much speculation. For several days in October 1919 the Royal Commission on Awards to Inventors, which dealt with many different wartime inventions, considered the question of the tank. The hearings were conducted in a formal and judicial manner at Lincoln’s Inn before Mr Justice Sargant. The Treasury was concerned that so many claimants would come forward that it would be forced to pay out a small fortune in award money. Consequently, both the Attorney General and the Solicitor General, along with two leading counsels who represented the Crown, clearly tried to limit the damage to government funds.
Winston Churchill was the first to appear. He was not claiming an award himself, but was an expert witness who gave his own testimony on the path that led to the invention. Thirteen separate claimants came before the tribunal and presented their case. Mr Justice Sargant took a strong line, dismissing the cases of those public officials who in his view had merely been doing their job in supporting the work of the various committees that had advised on the different stages of development. In all, hundreds of thousands of words were recorded in evidence.15 Finally, and probably fairly, awards of £1000 were given to both Ernest Swinton and Tennyson d’Eyncourt; Tritton and Wilson shared £15,000 between them.
Once again, in the laboratory of war, individuals with good, fresh ideas and a new approach had won through against an often stubborn, obdurate military leadership. At Tank Corps headquarters the real significance of the Battle of Cambrai had been clear. It was written that Cambrai marked ‘a new epoch in warfare, the epoch of the mechanical engineer’.16 It was a victory for science, of sorts. The Inventions Commission did not take it upon itself to condemn the military authorities for their lack of enthusiasm in finding a machine to cross no man’s land. But their tardiness, at times amounting to obstruction, had cost tens of thousands of lives. If large numbers of tanks had been available earlier, the final victory might have come sooner. Basil Liddell Hart wrote that the real opponent of the tank was not the Germans but ‘the British General Staff. ‘The numbers manufactured,’ he wrote, ‘sufficed to bring victory; but they could not bring back the dead.’17
Part Four
Doctors and Surgeons
10
The Body
With all the high explosives, shells, gas and chemicals being thrown at frail human bodies along the Western Front, it is not surprising that the First World War would witness some of the highest casualty rates and most horrific wounds ever experienced in war. But with the help of outside consultants, the mobilisation of the nascent pharmaceutical industry and the rallying of the medical profession when some 11,000 doctors left their civilian practices and joined the army, the medical services responded with remarkable effect to the challenge of repairing bodies damaged or mutilated by the slaughter of an industrial war.
‘This is our Butcher’s Shop,’ said one medical officer to a visiting journalist in a Casualty Clearing Station at Corbie near Amiens. ‘Come and have a look at my cases. They’re the worst possible, stomach wounds, compound fractures and all that. We lop off limbs here all day long, and all night. You’ve no idea.’1 Amputation was certainly still one of the traditional options to which military surgeons resorted in a desperate attempt to prevent infection from spreading. That had been the case for centuries. But in the fifty preceding years, medical science had advanced in leaps and bounds and now offered a variety of cures and surgical responses to the huge volume of casualties generated by the war. Antiseptics were available, there was a greater awareness of the need for sanitation and a new understanding of the science of bacteriology.
Every army since the beginning of time has had to be able to deal with its wounded in battle. Soldiers’ morale is without doubt related to how they feel they will be treated if wounded. And by the early twentieth century, the morale of the citizens’ army that went to fight the Great War was closely tied up with the performance of its medical division. The availability of good medical services became a vital part of military efficiency. It was not only that good medicine would enable more men to return to the front quickly, but the provision of even the simplest bandage and dressing clearly gave men a huge psychological as well as physiological boost. It made them feel they had not been abandoned. As one RAMC corporal put it, ‘A clean white dressing … seems to reassure a wounded man strangely. It makes him feel that he is being taken care of.’2
R.H. Tawney, later one of the leading economic historians of his generation, wrote that the worst aspect of being wounded was being ‘cut off from others; he felt an overwhelming sense of reassurance when he finally received medical attention. ‘I knew he was one of the best men I had ever met,’ Tawney later wrote about the doctor who found him in no man’s land. ‘He listened like an angel when I told him a confused, nonsensical yarn about being hit in the back by the nose-cap of a shell. Then he said I’d been shot by a rifle bullet through the chest and abdomen, put a stiff bandage around me and gave me morphia... [and] in a grovelling kind of way, I worshipped him.’3
Most armies throughout history have suffered more casualties and deaths through disease and fever, like dysentery and typhus, than from battle itself. In the American Civil War there had been two deaths from disease for every one from battle wounds. Even in the Boer War this had only been reduced to 1.8 deaths from disease to one from wounds. However, in the First World War, the ratio was to be dramatically transformed. That war saw just one death from disease to every ten from battlefield injuries. It was the first conflict in which fewer men died from related diseases than from battle wounds. This massive reduction in deaths from disease, achieved by improved sanitation and health, was a great triumph in itself. Mortality levels from wounds dropped equally dramatically, from more than four out of every ten men wounded in the American Civil War to one out of ten in the Great War.4 The way in which the medical services approached the hideous wounds arising from a modern industrial war was to show how effective science could be at saving lives in war.
In the Crimean War of the 1850s, the care of those wounded in war had become an issue of great public concern. Mary Seacole and Florence Nightingale had shown up the inadequacy of medical support for the wounded and Nightingale had become something of a deity in Victorian Britain. The public began to demand that soldiers who risked their lives for the nation in battle should be cared for properly if injured. Traditionally, army officers had looked down on medics, who as non-combatants were not given the same status as the rest of the officer corps, but this began to change in 1898 with the formation of the Royal Army Medical Corps (RAMC).
In the Boer War at the end of the century, the army medical services scraped by, but the challenges of a European war would be on a different scale. From 1906, Haldane’s army reforms created a new system to establish a network of clearing hospitals behind the lines, fully equipped with the sort of operating theatres and other facilities found in civilian hospitals of the day. Haldane’s medical reforms were another aspect of his belief that science could help improve military efficiency. In 1907 a new RAMC college was established at Millbank and became part of London University’s Faculty of Medicine. The Director General of the Army Medical Services was the energetic and progressive Sir Alfred Keogh, who saw eye to eye with Haldane. He recruited many top London consultants into the Territorial reserve and helped to bring the military medical services much closer to those of the civilian population. Until his retirement from the RAMC in 1910 to become Rector of Imperial College, London, Keogh was to carry out substantial reforms in military medicine,
In line with Haldane’s other reforms, Keogh tried to supplement the small regular army medical service with support from the Territorial Force. Volunteers in the St John Ambulance Brigade and from the Officer Training Corps at universities provided the extra manpower. And a
new emphasis was laid on preventative health for soldiers, a manual on Military Hygiene and Sanitation for Soldiers in 1908 concluding that ‘disease prevention is synonymous with military efficiency.’5 Sir William Leishman, Professor of Pathology at the Royal Army Medical College, developed new forms of inoculation against typhoid fever. If typhoid had been as endemic as in previous wars it would have been a major scourge in the vast British Army, but Leishman’s innovations succeeded in keeping levels of the disease right down. It was later calculated that his inoculations had saved more than 130,000 lives and prevented about 900,000 soldiers from being invalided out of the army. As his obituary for the Royal Society noted, ‘For this achievement, Leishman must be accounted to have been one of our most successful generals in the Great War.’6
When it came to medical care, the emphasis fell on evacuating wounded men from the front to hospitals where proper care could be provided. Motorised ambulances were to be used to speed up the evacuation process. Much was done, meanwhile, to establish a system that could return wounded soldiers to the battlefield as soon as possible after they had been treated. This was ultimately the purpose of all army medical officers. And the War Office was acutely aware that the public would not stand for failures in the care and treatment of the wounded.
Despite all the pre-war preparations, in its typically bungling way the British Expeditionary Force that travelled to France in August 1914 did not take with it a single motorised ambulance. Although the army possessed such vehicles and there had been a debate about the need for them, the Director of Military Operations, Sir Henry Wilson, ruled that horse-drawn ambulances would be sufficient as it would take time to clear the bodies immediately after a battle. It had been estimated that the BEF might have to endure up to about 3000 casualties in its first engagement and Wilson believed horse-drawn ambulances would be adequate to evacuate this number of wounded. As a consequence, when the number of casualties in the BEF’s first battles at Mons and Le Cateau at the end of August was much higher than expected, it proved impossible to evacuate many of the wounded, who had to be left to die or to be captured in the retreat that followed. J.P. Lynch, a private in the RAMC, wrote in his diary of one small incident, ‘I was sorry to have to leave 14 men behind in the barn but there was nothing to do as we had no room for them.’7 The public in 1914 were unwilling to accept such poor treatment and when the story was reported there was an outcry. Kitchener appealed to the public for funds.
Many people in Britain and around the Empire responded by making generous donations. The citizens of Calcutta alone gave enough to equip an entire fleet of ambulances, while within a couple of months readers of The Times had donated the huge sum of £281,000 (about £28 million in 2014). By November this fund alone had paid for 93 motorised ambulances. By the end of the year there were 250 motorised ambulances with the British Army in France and Belgium and more were arriving daily, along with mountains of blankets, stoves and other supplies that people in Britain thought would be helpful. Accompanying the supplies were volunteers from the St John Ambulance Brigade and many privately funded groups of medical and nursing staff, all of whom tried to get as close to the battlefield as possible to provide their care. Their assistance was valuable, but the fact that so much medical care was provided by private charities made for tensions between the professional army medical men and the titled ladies who tended to run the charities. They were usually formidable women who were used to being listened to and treated with great respect, and who usually got their way.
Sir Arthur Sloggett, a career army medical officer, was the Director General of Army Medical Services at the outbreak of war. A classic army type, with a jaunty walk, a cheerful, outgoing manner and a fund of witty stories for every occasion, he had been wounded in a cavalry charge at the battle of Omdurman, had served in the Boer War and been director of medical services in India for three years. After the early failures and the complications that arose with the privately funded charity workers, Sloggett decided to locate himself permanently in France, while Sir Alfred Keogh was recalled from retirement to take over the director general’s role at the War Office. Despite their contrasting characters, Keogh and Sloggett got on well and between them now began to reorganise medical care for the British Army in a way better suited to a European war. Keogh ran the overall strategy from the War Office in London. This he was well equipped to do, with his established links to the academic world and his experience of the earlier army reforms. Sloggett managed the situation in France and Belgium and built up good relations with commanders in the field. He had a particularly good relationship with Haig, and at one New Year’s Eve dinner was ‘the life and soul of the party with his yarns, some of which were libellous and few of which would have passed muster in a drawing room’.8
The army turned for outside help to a group of consulting surgeons, asking them to provide advice on technical and specialist matters and to tap army practice into the latest developments in surgery. Sir Anthony Bowlby was the most eminent of the group. Having been a volunteer surgeon in South Africa in the Boer War, Bowlby knew the army well. Returning to London after the war he had become a senior surgeon at St Bartholomew’s Hospital, and in the army reforms had joined the local branch of the Territorial Force’s medical services. Bowlby came up with several ideas for improving the army’s medical care and argued forcibly for sensible modernisation of techniques and practices. He was particularly concerned that wounded men should be treated as quickly as possible, which in practice meant near to the front, writing that ‘public and professional opinion was united in expecting casualties to be treated as thoroughly as possible at the front.’9 With Keogh in the War Office, with Sloggett in France and with Bowlby’s expertise to draw upon, from 1915 the British Army began to plan for its medical services the system that would last the rest of the war.
The first general problem to appear was a major shortage of anaesthetics, and of other drugs such as antiseptics. Like other branches of the chemical industry, the British pharmaceutical industry before the war had been dependent upon imports, especially from Germany. John Anderson from the National Health Insurance Commission, the body responsible for the supply of drugs, turned to the Royal Society and asked its War Committee for advice. The Royal Society approached several universities asking for help in making drugs for the army and received thirty-two responses.10 The brightest young researchers in many universities had already joined up and gone to fight, but St Andrew’s University managed, under the supervision of Professor James Irvine, to carry out important work over the next year and found ways of synthesising a range of anaesthetics that were in desperately short supply. The same department later in the war, ironically, was to carry out important work on the manufacture of mustard gas.
There were of course many different types of wounds to be treated. Bullet wounds could be quite clean; a bullet entered a limb and exited on the other side without bringing any bacterial infection, unless it had first ricocheted off something. However, by far the largest number of wounds in the First World War were from shell fragments or shrapnel. These could bring far greater risks, not only from the damage caused when the shrapnel penetrated the body but also from infection. Because the soils of northern France were intensively cultivated and had been heavily manured for centuries, the bacteria picked up by an exploding shell could cause as much damage as the explosion itself. A typical fragment of a few square inches would be propelled from a shell that had exploded in the soil at high speed; when it hit a man it would first penetrate his outer clothing, which would often be covered with mud and trench filth. Carrying with it the bacteria it picked up, the shell fragment would then pass through his underwear, which might well have been unwashed for several days. It would penetrate his skin, severing veins, and might well cut a muscle or go through a main artery before hitting the bone, which would shatter sending smaller fragments in all directions. The fragment might then exit from the body, making an even larger hole on the way out and causing more tissue
damage. Obviously the nature of the injury depended upon where the shell fragment hit the body, but the problems of treating a single wound like this were often complex and varied.11
Tetanus was a major source of infection in wounds on the Western Front. Tetanus is a disease caught from bacteria found in the intestines of animals and which are present in heavily cultivated soil. Once the bacteria infects a wound it poisons the muscles through their nerve endings and causes contractions, usually of the head and neck, a condition often known as ‘lockjaw’. Before the era of antibiotics, the only way to treat tetanus was through the injection of a serum, and this was widely carried out on wounded men. Similar to tetanus but more severe was gas gangrene (which has nothing to do with gas warfare), an infection which could be combated by no known serum. It too came from bacteria in the soil, and when it became established in a wound the only option was to amputate. However, as understanding grew about the need to keep the wound clean, cases of gas gangrene infection dropped markedly, from 10 per cent of all wounds in 1914 to about 1 per cent by 1918.
In addition to these infections a wounded man might also be suffering from shock, perhaps delayed, and from blood loss. Blood transfusions were not generally performed in the early twentieth century as it was not known how to keep blood supplies for any length of time; any transfusion of blood took place directly from the artery of a comrade into the wounded man’s vein. As the war progressed, however, Australian and Canadian units began to use transfusion more frequently, and slowly methods improved for storing blood in refrigerated conditions, if only for a few days. The spread of blood transfusion techniques was one of the most important surgical advances in the war and helped greatly to improve the prospects of recovery for wounded men. But more than anything, a man’s recovery depended upon how quickly he could receive proper medical attention. The speed with which a wounded man could be given the right treatment meant the difference in most cases between life and death.
Secret Warriors Page 23
