A Fine Brother: The Life of Captain Flora Sandes

by Louise Miller

  Worst affected by the spread of disease and the lack of food and shelter were the Austrian POWs. While there were individual cases of cruelty, the Serbs on the whole treated them reasonably well, employing as many as possible in a range of tasks for a minimal salary or better rations, while families could pay the government to have one as a servant.62 Many of those who were trained as doctors volunteered for service while others became efficient, hard-working and loyal orderlies in both Allied and Serbian-run hospitals. However, the Serbs simply could not absorb a further sixty thousand into their shattered economy. Many of those who were unable to find work were packed into crowded and filthy former stables, with insufficient food and little by way of sanitary arrangements.63 Sickness spread rapidly among them.

  More help was desperately needed amid the deteriorating situation. New Allied missions continued to arrive, including two more American Red Cross units who were assigned to Gevgelija in the south of the country. In December, Katherine MacPhail was one of five woman doctors to set out for Serbia as part of the First Serbian Unit of the Scottish Women’s Hospitals.

  Emily realized that conditions in Serbia were ripe for an epidemic. Before she returned home to New York, she wrote anxiously to the American Red Cross, pleading with them to send more help. Shocked at the worsening sanitary conditions, she illustrated her letter with an example of what she had seen happen to used dressings in Skopje on her way home. She was too discreet to name the British Red Cross as the culprits, who had far greater worries than what happened to their dressings and whose eighteen staff were working tirelessly in impossible conditions looking after fifteen hundred patients.64 “One of their buildings was on a steep hill and the orderly used to empty the dressing cans over the wall where they would blow about in all directions,” she wrote. “The Turks [the Muslim population]… used to pick these over, taking the cleanest ones to line their wadded waistcoats. I don’t want to be disgusting, but I do want to make you appreciate that this may be the beginning of an epidemic… If any help is coming it must come at once and must be of drastic measure.”65

  Chapter 4

  Typhus

  1915

  On 12th February 1915, Flora and Emily’s ship steamed through the mild green waters of the Aegean, past the towering heights of Mount Olympus, into Salonika’s vast harbour. Flora had rushed back to the Greek port after only five weeks at home, gladly leaving behind the damp and chill of an English winter. In the little time she had in England she had launched herself into raising funds for the Serbs. To her “utter astonishment”, she managed to collect £2,000 following an appeal for assistance published by the Daily Mail.1 Emily had done equally well. After a nine-day winter Atlantic crossing, she had spent a mere twelve days in New York. So impressed were the American Red Cross by the “courage and fine spirit” shown by “plucky little Miss Simmonds” that they also gave her £2,000.2 Flora and Emily used the funds to buy a remarkable one hundred and twenty tons of medical supplies, including absorbent wool, gauze, chloroform, Mead’s plaster, Phenosol and one X-ray apparatus “with latest attachments”.3 “I did not lose one single package, every one being numbered and the list checked off at Malta, Salonika, Nish and Valjevo,” wrote Flora proudly.4

  They were met in Salonika by a low hum of rumours about conditions in Serbia. Many people were dying of disease; it was foolhardy to go, it was said. Dismissing all such concerns, on 14th February the pair caught a morning train, bringing with them their supplies on five railway trucks.5 When they boarded, they were taken aback by the ominous smell of disinfectant, so strong that it made their eyes smart, from a formaldehyde-based solution used by the Greek railway authorities to douse the Serbia-bound carriages.6 A few hours later they caught their first glimpse of the tumbledown Serbian town of Gevgelija, just across the Greek border. As the train rumbled to its final stop, they could not help but notice hundreds upon hundreds of mounds of freshly turned earth in the cemeteries near the railway line.7

  Waiting on the platform in the pouring rain were members of the American Red Cross, who had been running a hospital in a building by the station. The arrival of the train was the one event each day they looked forward to. It was their only chance to meet other English speakers and swap news of the war, and as many as could be spared had scrambled to be there. As Flora and Emily stepped down onto the wet platform with their bags, the members of the mission rushed forward eagerly to invite them to tour their hospital while they waited for their connecting train north. On their short walk there, the Americans told them hurriedly about their work.

  The six doctors and twelve nurses had reached the town on 18th December 1914, and had agreed to take charge of a hospital in an old, rat-infested, former cigarette factory.8 The four-storey building had no heat, no running water and no sanitary or drainage facilities. On arrival they found the two thousand patients packed tightly together on filthy straw or on the bare floor while men with typhoid, typhus, dysentery and smallpox writhed and shivered among the wounded.9 By the time of Flora and Emily’s visit they had been at work for seven demoralizing weeks. With insufficient food, facilities and medical supplies, they were often forced to stand by helplessly as men with otherwise treatable conditions continued to die.

  One of the doctors, forty-year-old James Donnelly, offered to show Flora and Emily around the hospital. The sturdily built doctor, from Brooklyn, New York, had a passion for travel. He had worked in the Far East, Africa and Haiti before becoming one of the first American Red Cross volunteers for Serbia.10 Flora and Emily took to the “jolly young doctor” immediately. His pride and joy were two “very antediluvian boilers”, which, Emily commented wryly, “looked as if they had once upon a time belonged to a locomotive”.11 But they were left aghast by the damp, cold wards, full of sick, wounded and dying men and the news that three of the nurses and one doctor were seriously ill with typhus, a louse-borne disease which was killing nearly three quarters of those it infected.12 The reality of what they were letting themselves in for now suddenly struck home. If they stuck to their plan to work in a Serbian hospital, they knew that they would put their lives at risk.

  When they waved goodbye from the window of their train, they both breathed a sigh of relief. The town was a “Godforsaken little hole”, wrote Flora in her diary that evening, as she summed up her impressions of the day. Three days after their visit Dr Donnelly fell ill with typhus. On 22nd February he became delirious, seized an old musket from a Serbian sentry and shot himself in the forehead. He died almost instantly.13

  “Typhus raging throughout country. Mortality high. Cholera feared later,” Emily telegraphed the American Red Cross. She was appalled by what she had seen in Gevgelija and had wasted little time after arriving in Niš to find a post office from which to send her wire. She finished her message with a desperate plea. “Help urgently needed, especially doctors, nurses, with hospital isolation equipment and disinfectors for clothing. SIMMONDS.”14

  Emily’s warning to the Red Cross in 1914 had come to pass. In November and December, cases of typhus had begun to appear across Serbia, primarily in hospitals and POW camps. Initially there was little concern. Sporadic cases were nothing new and, in normal conditions, the disease could be controlled and cases isolated. But now conditions in Serbia were anything but normal. The country had been invaded twice. Although it had emerged victorious, it had been drained of resources and its soldiers and people were hungry and exhausted. It could not house or feed its own estimated half a million internal refugees, let alone seventy-five thousand POWs. Overcrowding increased the opportunities for transmission and a disease normally only endemic rapidly became epidemic.

  The first major outbreak had occurred in late December 1914 in the rail and roadway hub of Valjevo. The town of eight thousand people lay sixty miles south-west of Belgrade along the Kolubara River, surrounded by hills.15 Like most Serbian country towns it had a central marketplace and simple one-storey cottages that lined broad, roughly cobbled streets. In ordinary circumsta
nces it was bustling and prosperous.16 But by late 1914 the horrors of war were clear to see upon it. The town had been at the centre of much of the fighting in November and December. Thousands of grievously sick and wounded men, both Serbian and Austrian, crowded the filthy hospitals. Long dead horses lay decomposing in the streets whilst pigs and dogs were sometimes seen feeding on the human victims of the fighting who had been hastily and inadequately buried in its vicinity.17 The town was also crowded with five and a half thousand POWs who, weakened by hunger and crawling with lice, were packed together in the storehouses of the artillery barracks.

  The POWs became the epidemic’s earliest victims.18 A handful of men, initially, began to show symptoms similar to influenza. At first they were stricken with a severe headache, cough and chills. Within twenty-four hours they could hardly move, prostrated by soaring fever and excruciating muscle pain in their legs and back. Sticky white mucus began to accumulate in their mouths and throats, coating their tongues thickly. Four or five days later a pink rash spread from their chests across their bodies and rapidly developed into purplish-red, slightly elevated spots. Often its victims became delirious or writhed in agony from the wracking pains in their limbs; many suffered from diarrhoea and became incontinent. After about a week the high fever dropped away suddenly while its victims sweated profusely, only to rise and fall two or three times over subsequent days. Those who survived were often reduced to near skeletons. The disease raced like wildfire through the barracks among the lice-covered men who were forced to huddle together for warmth during the bitter nights. By the time of the first deaths, hundreds more of the men were showing the early symptoms of the disease.

  In December and January a handful of foreign medical workers reached Valjevo. The first to arrive, on 11th December, were members of a small Dutch mission, headed by Dr Arius van Tienhoven, who were returning to the hospital that they had been running before the invasion.19 Their previously well-managed wards were now overflowing with sick, dying and dead men. A sole Austrian POW doctor was attempting to do what he could for the four hundred patients, but many had not had their dressings changed for twenty days. The unit arrived to find the floors covered in excrement and running pus. “But that which made me literally tremble,” recalled Dr van Tienhoven, “was to find two dying men lying in the middle of a pile of bodies.”20

  Next to arrive were Albert Cooke and Barton Cookingham, two American doctors who had become restless while working in the overstaffed American Hospital in Neuilly, France.21 Cooke was a well-fed police doctor from Whitehall, New York. He looked older than his thirty-seven years, an impression lent by his brown, well-trimmed moustache, round, lined face and carefully side-parted hair. Twenty-five-year-old Cookingham, a young surgeon, was from Red Hook, New York. Pug-nosed, freckled, with unruly sandy hair, he towered over Cooke at nearly 6'2".

  The doctors arrived in Valjevo on New Year’s Day. Cooke took over the high school, which had been hastily converted into a hospital. Cookingham took over the military hospital, a former hotel. Between them they had four hundred half-starved, wounded men to care for. With few supplies, no drugs and little food, they found it a near hopeless task.22 “No matter how competent or clever an operator one may be his efforts are more or less in vain in this place,” wrote Cookingham desolately. “Our mortality has been high because there has been nothing for the poor beggars to eat post-operative… We have bought eggs and milk for them at times but our salary will not allow us to feed a whole hospital.”23 The doctors found what little respite they could in the companionship of the Dutch mission, who in turn greatly enjoyed the Americans’ company. “Cook [sic] was gaiety itself,” recollected Dr van Tienhoven. “He amused us all by his American songs and his Negro dances.”24

  During the second half of January, Cooke and Cookingham noticed the sinister signs of fever and spots appearing among the ranks of their wounded patients as the disease spread to their hospitals. They continued their work as black flags denoting death began to appear in the streets of the town, hung ominously above the windows of households. “The only way you can get an idea of the terrible conditions in the town is by reading accounts of some of the great plagues of the Middle Ages,” wrote Dr Cookingham later in a letter home.

  During the first few months they made some effort to give the victims a decent burial. That was when the deaths were running only fifty to seventy-five a day. Later, when deaths reached 150 a day and when a large part of the population was down with the fever, that was out of the question. They simply stacked the bodies together like logs and hauled them away. The dead wagon made its rounds as often as possible. Bodies were just tossed in and the grim callers passed on to the next house. When the wagon was full, it started for the outskirts of the town. I have seen it pass through the streets with a head or two hanging out behind and arms and legs extended over the sides. The bodies were dumped into a hole outside the city limits and the whole mess hastily covered with earth. Then the wagon and the overworked horse began the rounds again. The misery and the suffering in Valjevo are indescribable.25

  Despite the growing catastrophe the authorities continued to permit travel to and from the town. Trains continued to arrive and depart, laden with sick and lice-infested passengers. Soldiers on leave and refugees travelled freely on the crowded trains to all corners of Serbia, spreading the disease to villages across the length and breadth of the country.26

  On 6th February, in the midst of the epidemic, Dr Cookingham wrote to Whitney Warren, a New York architect who had helped fund their trip. “Right at the start I am going to take you by surprise and tell you that owing to an attack of ‘Typhus Recurrans’ I have not had an opportunity to write before,” he apologized.

  While writing this I am about two feet away from Cooke, who is on his back with the same malady, and, as he is very weak, he is in no condition to write, much as he wants to. I am at present in what they call the interval, which lasts a varying length of time. At the end of that period, the fever returns again and you have to go through the same thing over again. Twice usually ends it, but it leaves you very weak and thin. I have lost about fourty [sic] pounds already. Poor Cooke’s double chin is suffering very much. I am afraid it is lost for ever.27

  Flora and Emily found Niš even more depressing than they had remembered. They had planned to pass through the shabby, overcrowded town as quickly as possible, but first they needed to receive their assignment from Colonel Subotić, the Vice President of the Serbian Red Cross, and he was proving hard to find. While they waited impatiently for him to return to his offices, they dropped off their X-ray machine at the Second Reserve Hospital, which had been rushed into service in a large municipal building by the train station. It was also where their former colleagues from the Anglo-American Unit were at work.28 They pushed their way through the entrance, past crowds of “unkempt, unwashed individuals in ragged uniforms” and through “unspeakably stuffy” corridors lined with patients. On asking for the women they were directed to a ground-floor dressing room. They walked into a space that was fifty feet long and crowded with wounded men, with a long row of tables placed down the centre to which patients were carried in turn.29 There they found three of the five women at work.30 They looked exhausted. “Went to hospital and saw Miss O’Brien and ‘Scotland’, also the ‘Matron’ – Mrs Barlow,” scratched Flora briefly in her diary. “Had tea and chatted with the two former… the ‘touch of mauve’ and the ‘red-haired mouse’ also located there,” she added, unable to resist resurrecting her old, uncharitable nicknames.31

  Dr Abraham of the British Red Cross, more descriptive than Flora, visited the hospital shortly after they did. Two of the women, by then, had left for home. He found the other three “very worn and tired”. Little wonder, he remarked. “They had been working in the same awful atmosphere for months, each day, every day, with never an open window.” They also had six hundred cases of typhus. “We’re not supposed to know,” one of the women told him. “The government is afraid of a
panic if the truth were known, so they’re labelled influenza.”32

  Two of the remaining women were planning to leave for home by the time of his visit. Only Ada Barlow, an untrained nurse from Manchester who had experience in India and South Africa, was planning to stay.33 Dr Abraham asked her why. “I have nothing to go back for,” she replied. “There was nothing more to be said,” Dr Abraham recalled later. “It was the drab, grey tragedy of the unwanted woman. She was fat and plain, elderly and rather pasty. Personally I did not take to her. She was just a piece of flotsam on the tide of life, but she was an Englishwoman, and the thought of her made me feel wretched all day. I could hear her saying, ‘Remember I shall be all alone.’ It was horrible. I hated her for making me miserable.”34 Two days after Flora’s visit to the hospital, the British Red Cross asked her for a “character” for Mrs Barlow. Although Flora’s response was unlikely to have been positive, Barlow was grudgingly invited to join the British Red Cross Unit in Skopje.35

  “I’ll give you a month to live in that death trap,” predicted an American doctor whom Flora and Emily met in a café in Niš, when they told him that they were considering travelling to the heart of the epidemic at the request of Colonel Subotić. The colonel had taken one look at their supplies and paused, turning over in his mind where he should send them. “Would you be willing to go to Valjevo?” he had asked. “I don’t like the thought of sending you there but your supplies are badly needed, as are you.”36 Subotić’s request was the ultimate test of their nerve. “So we chewed it over together,” Flora wrote in her diary that night, “and finally left for Valjevo on the 8 p.m. train.”37